bluuebunny/crossref_metadata_2025 huggingface dataset:
A tribological analysis on stuffing box-piston rod system of low-speed marine diesel engines
Authors: Li Rui , Meng Xianghui , Xie Youbai
Published: August 2018

The stuffing box-piston rod system is widely used in the low-speed marine diesel engines to scrape oil and ensure sealing. Its friction power loss and wear rate are great, but the studies about the system are very limited. In this study, based on the special structure and working conditions of the stuffing box, the analytical model for the tribological properties of the stuffing box-piston rod system is developed considering the oil starvation and relative ring location effects. The minimum oil film thickness, friction, oil transportation, and asperity contact are calculated for the stuffing box. The analysis results show that compared with the fully flooded lubrication, the minimum oil film thicknesses of the rings reduce significantly in the middle of the strokes under the starved lubrication condition, but the friction losses of the rings are influenced by the comprehensive effects of the oil film thickness reduction and lubricating area reduction under the starved lubrication condition, which is related to the specific profiles of the rings. In addition, compared with the engine piston ring pack, the relative ring location effect is more obvious in the stuffing box ring pack because there are more rings and the ring intervals are larger. The relative ring location effect makes the minimum oil film thicknesses, friction forces, and asperity contacts of the rings have oscillations after bottom dead center and top dead center.
Adult education for a change: Advocacy, learning festivals, migration, and the pursuit of equity and social justice
Authors: Tuckett Alan
Published: August 2018

This paper explores the characteristics of learning festivals and Adult Learners’ Weeks and their use as tools of advocacy in seeking policy change on behalf of under-represented groups, and it considers their impact on public policy affecting adult learners. In addition, it reflects on the role of the week in celebrating a culture of adult learning. The paper includes analysis of the relationship between the development of festivals and policy change affecting adult learners through Adult Learners’ Weeks in the United Kingdom after 1992, exploring, in particular, the role of the Week in affecting policy, participation, and inter-communal understanding arising from increased migration. The paper explores the spread of learning festivals and the sequence of Presidency conferences in the European Union in the years leading up to the Lisbon Memorandum in 2000; the role of festivals in the aftermath of war in the Balkans; and the role of the World Social Forum as an antidote to neo-liberal orthodoxies in international policy discussions. It also considers the success and failure of learning weeks as a tool of advocacy and policy change.
The game-theoretic model and experimental investigation of cyber wargaming
Authors: Colbert Edward JM , Kott Alexander , Knachel Lawrence P
Published: August 2018

We demonstrate that game-theoretic calculations serve as a useful tool for assisting cyber wargaming teams in identifying effective strategies. We note a significant similarity between formulating cyber wargaming strategies and the methodology known in the military practice as Course of Action (COA) generation. For scenarios in which the attacker must penetrate multiple layers in a defense-in-depth security configuration, an accounting of attacker and defender costs and penetration probabilities provides cost–utility payoff matrices and penetration probability matrices. These can be used as decision tools by both the defender and attacker. Inspection of the matrices allows players to deduce preferred strategies (COAs) based on game-theoretical equilibrium solutions. The matrices also help in analyzing the anticipated effects of potential human-based choices of wargame strategies and counter-strategies. We describe a mathematical game-theoretic formalism and offer detailed analysis of a cyber-physical table-top wargame executed at the US Army Research Laboratory. Our analysis shows how game-theoretical calculations can indeed provide a useful tool for effective decision-making during cyber wargames.
Compliant balloon angioplasty for the treatment of internal carotid artery dissection
Authors: Bricout Nicolas , Nouri Nasreddine , Henon Hilde , Estrade Laurent , Boustia Fakhreddine , Leclerc Xavier
Published: August 2018

This report describes the innovative management of a severe haemodynamic stroke related to an occlusive extracranial internal carotid artery dissection. Intravenous thrombolysis combined with endovascular treatment were undertaken on the basis of a total mismatch profile (National Institutes of Health stroke scale (NIHSS) score of 27 and infarct volume on diffusion-weighted imaging of 0 mL). Balloon angioplasty using a long and compliant balloon microcatheter allowed complete recovery of the intracranial blood flow. The patient showed dramatic clinical improvement (day 1, NIHSS 5) and favourable functional outcome (day 90, modified Rankin scale score 2). Day 90 follow-up brain magnetic resonance imaging revealed no ischaemic change and magnetic resonance angiography assessed the patency of the internal carotid artery.
Early warning system in business, finance, and economics
Authors: Klopotan Igor , Zoroja Jovana , Meško Maja
Published: August 2018

Different economic crises such as banking, financial, and currency lead to high economic costs and have negative impact to whole society. Development of early warning systems could help in prevention of economic and business crisis, while they present a systematic forecast of unwanted events. Early warning systems are used primary for detecting crises before damage has been made and for reducing false alarms of possible crisis. The aim of our article is to provide bibliometric analysis of early warning system, their development and usage in different environment especially in economic and finance sector. It investigates the role of early warning systems for prediction and recognition of negative events, especially in the area of business, finances, and economy. Moreover, this article contributes to the existing literature by providing systematic analysis of development and usage of early warning systems to predict critical and problematic events for economic and social development.
The Utility and Scope of Forensic Histopathology
Authors: Parai Jacqueline L. , Milroy Christopher M.
Published: August 2018

Forensic histopathology is the use of histology to aid in the identification of disease and injuries in forensic pathology practice. The value of routine microscopy has been challenged in various studies and discussions have taken place in forensic journals about how useful microscopic diagnosis is in medicolegal autopsies. This paper reviews the literature on the value of histological examination in forensic practice and discusses routine histochemical stains that can be used in postmortem examinations to aid in the diagnosis and add value by confirming or refuting macroscopic findings.
Forensic Aspects of Perinatal Deaths
Authors: Cohen Marta C. , Scheimberg Irene
Published: August 2018

From a forensic pathologist’s perspective, there are several aspects of the perinatal postmortem that are particularly important. If a fetus is found abandoned, the pathologist needs to ascertain the fetal age, the appropriateness of growth, if the baby was born alive or dead, and the possible causes of death. In cases of litigation for perinatal deaths occurring in hospitals, access to the obstetric and neonatal notes (if the baby is born alive and dies a few hours or days later) is fundamental to reach a correct interpretation and conclusion. The most important points to consider in cases of intrapartum death are the roles of asphyxia and trauma in the causation of the baby’s death. Timing of the fetal death in relation to delivery may also be an important point in these cases. Finally, intrapartum lesions should always be considered in the differential diagnosis of possible child abuse in babies aged two months or less.
Pathological Assessment of Chronic Traumatic Encephalopathy
Authors: Van Ommeren Randy , Hazrati Lili-Naz
Published: August 2018

Chronic traumatic encephalopathy (CTE) has become a topic of considerable interest in recent years, with wide-ranging implications for athletes, military members, and other groups exposed to frequent concussive or subconcussive head trauma. The condition has been subject to intensive neuropathological characterization by various groups, with assessment methodologies and staging criteria proposed. Clinical characterization of symptoms has also been performed, but has not yet been definitively formalized. While efforts are underway to develop in vivo markers of tauopathies including CTE, these remain experimental at this time, necessitating postmortem analysis for definitive diagnosis. The putative link between development of cognitive and behavioral dysfunction and neuropathological findings of CTE may prompt requests for postmortem assessment in the forensic setting. Here, we review current concepts in CTE research, describe histopathological findings in CTE, and describe methodologies for pathological assessment of CTE which may be useful to the forensic pathologist.
Histologic Examination of the Heart in the Forensic Autopsy
Authors: Duncanson Emily R. , Mackey-Bojack Shannon M.
Published: August 2018

Histologic examination of the myocardium, valves, and cardiac blood vessels is often as important as the gross examination. The diagnostic features and categories of heart disease are many and varied, possibly more than any other organ. We present a review of the histologic features of forensically important heart disease.
Brief Review on Metabolic Bone Disease
Authors: el Demellawy Dina , Davila Jorge , Shaw Ashley , Nasr Youssef
Published: August 2018

Metabolic bone disease (MBD) is a broad term that describes a clinically heterogeneous group of diseases that are only united by a common denominator of an aberrant bone chemical milieu leading to a defective skeleton and bone abnormalities. From a forensic pathologist’s perspective, MBDs create a challenging diagnostic dilemma in differentiating them from child abuse, particularly when the victim is an infant. Through this brief narrative review on MBD, bone pathophysiology and two relatively challenging pediatric MBDs will be discussed.
Manner of Death Certification After Significant Emotional Stress
Authors: Lesnikova Iana , Leone Lisa , Gilliland MGF
Published: August 2018

Not commonly seen, the risk of sudden death after significant emotional stress has been reported since antiquity and incorporated into folk wisdom, reflected by phrases such as “scared to death” and “broken heart.” A typical “victim” suffers from significant and often life-threatening natural diseases, making determination of the manner of death complicated, and at times controversial. The present study is designed to assess inter-rater variability and nonuniformity and controversy seen in manner of death certification in certain cases of death with significant stress involved in the circumstances of death.

Members of the National Association of Medical Examiner (NAME) were surveyed to assess differences in manner of death certification for eight sudden unexpected death scenarios in middle-aged men and women with underlying cardiac disease after significant stressful events including: being chased down a lonely road followed by a verbal confrontation, a roll-over motor vehicle collision (MVC) without injuries, a fall from a wheelchair in a MVC, an alleged armed robbery, an involuntary commitment, an arrest by police, sexual intercourse, and a severe panic attack with breathing problems. In all cases, the autopsy examination revealed hypertensive and arteriosclerotic cardiovascular disease. In all cases, natural diseases were identified as significant contributing condtions, including emphysema in six cases and diabetes mellitus in three.

Eighty-six responses were collected. The results show wide inter-rater variability, ranging from very good to poor (Kappa ranges from 0.16 to 0.94). One hundred fifty-five comments were collected. Most of the comments addressed more than one topic and were followed by discussions, open questions, and responders’ experiences with previous cases and legal proceedings.

Our data show that cases of sudden death after significant stress have almost complete agreement in four cases and very high inter-rater variability in the other four. We propose that a detailed analysis of each case and an algorithmic approach could improve the predictability of the outcomes of death investigations for the legal system and for families.
The Elephant in the Room
Authors: Wilcoxon Rebecca M. , Middleton Owen L. , Meyers Sarah E. , Kloss Julie , Love Sara A.
Published: August 2018

Over a three-month period in early 2017, the Hennepin County Medical Examiner’s Office investigated nine apparent opioid toxicity deaths that occurred in three separate urban, suburban, and rural counties in our jurisdiction. All decedents were known substance abusers and had reportedly recently used heroin; most were found with drug paraphernalia. Complete autopsies variably showed classic stigmata of opioid overdose with no significant injury or natural disease to explain death. Initial toxicology screens failed to identify heroin or other narcotic substances. Several cases were presumptively positive for fentanyl by immunoassay, yet failed to confirm positive for fentanyl. Following American Board of Forensic Toxicology reporting standards, these cases were reported as negative for fentanyl by the laboratory. Due to the discrepant scene and toxicology findings suggestive of an opioid toxicity death, further discussion between the medical examiners and toxicologists prompted additional testing at a referral laboratory. This resulted in quantifiable blood carfentanil in all cases (mean 0.26 ng/mL, range 0.12 – 0.64 ng/mL). Cointoxicants included ethanol (n=2), methamphetamine (n=3), benzodiazepines (n=3), and cocaine (n=1). No case had definitive evidence of acute heroin intoxication, but two cases had low concentrations of morphine present (0.03 and 0.06 ng/mL), and two others had 6-monoacetyl morphine in the urine without morphine in the blood, suggesting recent use. All deaths were certified as accidental acute or mixed carfentanil toxicity. These cases present additional information about carfentanil-related deaths and highlight the importance of collaboration between forensic pathologists and toxicologists.
Genetic Diversity and Structure From Antillean Manatee (Trichechus manatus manatus) in the Southern Gulf of México: Comparison Between Connected and Isolated Populations
Authors: Gómez-Carrasco Guadalupe , Lesher-Gordillo Julia María , Olivera-Gómez León David , Bonde Robert K , Arriaga-Weiss Stefan , Hernández-Martínez Raymundo , Castañón-Nájera Guillermo , Jiménez-Domínguez Darwin , Romo-López Armando , Delgado-Estrella Alberto
Published: August 2018

Antillean manatees ( Trichechus manatus manatus), a subspecies of the West Indian manatee, is listed as endangered species in the Red List of Threatened Species of the International Union for Conservation of Nature. The aims of this research were to survey on the possible regional genetic structure in the southern Gulf of Mexico and to compare genetic status of a landlocked population in Laguna de las Ilusiones (IL) with individuals from localities with no barriers to displacement and breed (open population [OP]). We analyzed 45 manatee skin samples collected from different locations in Tabasco ( n = 38, including 19 from IL), Veracruz ( n = 3), Campeche ( n = 2), and Chiapas ( n = 2). The genomic DNA was isolated and PCR amplifications were performed for each sample using 28 microsatellite loci, previously designed for West Indian manatees and described as polymorphic for this species. Two clusters ( k = 2) were identified by STRUCTURE. The analysis of both a priori populations (IL and OP) indicate that the global values of FST and RST ( FST=0.049, RST=0.077) were significant. The HE for IL was 0.38 ± 0.03 and for OP was 0.49 ± 0.01. The average number of alleles NA for IL was 2.21 ± 0.09 and for OP was 2.32 ± 0.09. The overall inbreeding coefficient was FIS=−0.013 for analyzed populations. Genetic diversity was low. The IL population had slightly lower genetic diversity compared with OP, which could be explained by isolation of that small group, so conservation plans for IL should be considered as priority.
Researching the home using architectural and social science methods
Authors: Lewis Camilla , May Vanessa , Hicks Stephen , Costa Santos Sandra , Bertolino Nadia
Published: August 2018

This article explores the possibilities of using innovative, interdisciplinary methods for understanding home-making. Drawing on a study of Claremont Court (1959–1962), a post-war social housing scheme designed by Sir Basil Spence in Edinburgh, we discuss the methodological potentials of combining architectural and social science methods to study the home. Claremont Court was built in the post-war era as part of Scotland’s social housing drive. It was designed following the principles of ‘cross-class’ living in order to foster a sense of community. In subsequent years, inhabitants of the court have adapted their dwellings in numerous ways and the population of the court has changed dramatically. But, while meanings of home and understandings of the division between public and private have been reconfigured, the spatial layouts of the dwellings continue to shape residents’ sense of home. To explore how residents make home at Claremont Court, we use ‘facet methodology’, which opens up new ways of thinking about the research process through a ‘playful’ approach to epistemology. In doing so, we develop an innovative approach which combines architectural methods (including survey drawings and visual mappings of both dwellings and communal areas) with social science methods (including ‘traditional’ interviews and walk-along interviews). To conclude, we discuss the possibility of widening the scope of qualitative research by bringing architectural and social science methods into dialogue through visual methods, in order to attend to spatial and material aspects of the home. We argue that our novel cross-disciplinary approach broadens understandings of home, by bringing attention to the unspoken dimensions of physical space, embodied elements of home and what people said about their homes, all of which are central to home-making.
Understanding the Writing Demands of Crowdfunding Campaigns With the Genre-Mapping Report
Authors: Pope Adam R.
Published: August 2018

This article lays out an approach for introducing students to the writing demands of crowdfunding platforms using a genre-driven research report. Using genre theory and genre ecologies, students leverage primary research to map the genre norms and writing demands within a specific area of a crowdfunding platform, generating a data set to help them either formulate their own campaign or critically engage with the crowdfunding genre.
A robust approach for determining borehole shape from six-arm caliper logs
Authors: Yang Zhentao , Fang Xinding , Huang L.
Published: August 2018

We have developed a robust and reliable method for determining borehole shape from six-arm caliper logs. Four- and six-arm calipers are the common caliper tools used in open-hole logging. They provide information about wellbore geometry that is important in petrophysical and geomechanical analyses. The analysis procedure for four-arm caliper logs is well-established, but the analysis for six-arm caliper logs can be troublesome in complex hole environments containing breakouts or keyseats when the tool is off center. The challenge with the six-arm caliper is how to remove the effect of tool decentralization, which cannot be handled properly by using conventional correction methods, which are developed based on the assumption of circular or elliptical boreholes. To resolve this issue, we have developed a new approach for tool decentralization correction. The new method is based on an assumption that the true borehole center should be the center of a circle that fits the caliper pad positions in the least-squares sense subjected to the restriction that the circle is confined within the six pads. We first compare the new method with the conventional chord method and ellipse-fitting method through numerical modeling. We numerically investigate the general performance of these three methods by using a Monte Carlo approach to generate a large number of simulations that mimic caliper logging run in boreholes with a variety of different wellbore geometry. We then study the applicability of the new method in field data analysis by applying it to a field logging data set acquired in a well that contains the breakout and the keyseat. The modeling and field-data results indicate that the new method can yield more reliable estimates of the virgin borehole center than the other two methods and thus can give clearer delineation of the borehole shape.
Testing geologic assumptions and scenarios in carbonate exploration: Insights from integrated stratigraphic, diagenetic, and seismic forward modeling
Authors: Lanteaume Cyprien , Fournier François , Pellerin Matthieu , Borgomano Jean
Published: August 2018

Carbonates are considered complex, heterogeneous at all scales, and unfortunately often poorly seismically imaged. We propose a methodology based on forward-modeling approaches to test the validity of common exploration assumptions (e.g., chronostratigraphic value of seismic reflectors) and of geologic interpretations (e.g., stratigraphic correlations and depositional and diagenetic architecture) that are determined from a limited amount of data. The proposed workflow includes four main steps: (1) identification and quantification of the primary controls on carbonate deposition and the prediction of the carbonate stratigraphic architecture (through stratigraphic forward modeling); (2) identification of diagenetic processes and prediction of the spatial distribution of diagenetic products (diagenetic forward modeling); (3) quantification of the impact of diagenesis on acoustic and reservoir properties; and (4) computation of synthetic seismic models based on various scenarios of stratigraphic and diagenetic architectures and comparison with actual seismic. The likelihood of a given scenario is tested by quantifying the misfit between the modeled versus the real seismic. This workflow illustrates the relevance of forward-modeling approaches for building realistic models that can be shared by the various disciplines of carbonate exploration (sedimentology, stratigraphy, diagenesis, seismic, geomodeling, and reservoir).
Incentive-Based Game for Allaying Preoperative Anxiety in Children: A Prospective, Randomized Trial
Authors: Chaurasia Bijay , Jain Divya , Mehta Swati , Gandhi Komal , Mathew Preethy J.
Published: August 2018

BACKGROUND:

Induction of anesthesia can be distressing both for children and their parents. Nonpharmacological behavioral interventions can reduce the anxiety of children without significant adverse effects as seen with sedative medications. We hypothesized that the use of incentive-based game therapy in conjunction with parental involvement would be a simple and cost-effective intervention in reducing the preoperative anxiety in children.

METHODS:

Eighty children between the age group of 4 and 8 years scheduled to undergo surgery were randomly assigned to a control group (n = 40) and intervention group (n = 40). Children in the intervention group participated in an incentive-based game in the preoperative room. Anesthesia was induced with parental presence in both the groups. The modified Yale Preoperative Anxiety Scale (mYPAS) score to measure the anxiety of the children during induction was taken as the primary outcome. Induction Compliance Checklist score and parental satisfaction were assessed as secondary outcomes.

RESULTS:

The mYPAS score of children in the intervention group was significantly less than the control group during anesthesia induction. The mean difference (95% confidence interval [CI]) of the mYPAS at induction between the 2 groups was 20 (95% CI, 16–24; P < .001). Fourteen (35%) children in the intervention group and 2 (5%) children in control group displayed no anxiety (mYPAS score <30) (difference of −30%; 95% CI, −11% to −49%; P < .001). Children in the intervention group were more compliant with mask induction and had a significantly less Induction Compliance Checklist score compared to the control (P < .001). Thirty (75%) parents in the intervention group were satisfied at the end of surgery compared to 6 (15%) in the control group (difference of −60%; 95% CI, −39% to −73%; P < .001).

CONCLUSIONS:

The use of incentive-based game therapy reduces the anxiety scores during induction of anesthesia and improves the compliance to facemask induction in children undergoing surgery. It can form a simple, cost-effective, and easy-to-administer technique that can be easily applied in low-income settings.
Reversal of Deep Pipecuronium-Induced Neuromuscular Block With Moderate Versus Standard Dose of Sugammadex: A Randomized, Double-Blind, Noninferiority Trial
Authors: Tassonyi Edömér , Asztalos László , Szabó-Maák Zoltán , Nemes Réka , Pongrácz Adrienn , Lengyel Szabolcs , Fülesdi Béla
Published: August 2018

BACKGROUND:

Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium.

METHODS:

This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-of-four (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point.

RESULTS:

Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ± 1.03 minutes (95% confidence interval [CI], 1.33–2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ± 0.63 minutes (mean ± standard deviation) (95% CI, 1.17–1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, −0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur.

CONCLUSIONS:

The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective.
Observation of Complement Protein Gene Expression Before and After Surgery in Opioid-Consuming and Opioid-Naive Patients
Authors: Johnson Ken B. , Light Alan R. , Odell Daniel W. , Stuart Ami R. , Radtke Jacob , Light Kathleen C.
Published: August 2018

Opioids may influence inflammation. We compared genes associated with pain and inflammation in patients who consumed opioids (3–120 mg of oral morphine equivalents per day) with those who did not for differential expression. White blood cells were assayed in 20 patients presenting for total lower extremity joint replacement. We focused on messenger ribonucleic acid expression of complement proteins. We report that the expression of a complement inhibitor, complement 4 binding protein A, was reduced, and the expression of a complement activator, complement factor D, was increased in opioid-consuming patients. We conclude that opioid consumption may influence expression of complement activators and inhibitors.
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial
Authors: Abdelaal Ahmed Mahmoud Ahmed , Mansour Amr Zaki , Yassin Hany Mahmoud , Hussein Hazem Abdelwahab , Kamal Ahmed Moustafa , Elayashy Mohamed , Elemady Mohamed Farid , Elkady Hany W. , Mahmoud Hatem Elmoutaz , Cusack Barbara , Hosny Hisham , Abdelhaq Mohamed
Published: August 2018

BACKGROUND:

Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study.

METHODS:

This randomized, controlled, double-blind study compared neostigmine and atropine (n = 41) versus a saline placebo (n = 44) for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. The primary outcome was a visual analog scale score of ≤3 at 6, 12, 24, 36, 48, and 72 hours after intervention. Secondary outcomes were the need for an epidural blood patch, neck stiffness, nausea, and vomiting. Patients received either neostigmine 20 μg/kg and atropine 10 μg/kg or an equal volume of saline.

RESULTS:

Visual analog scale scores were significantly better (P< .001) with neostigmine/atropine than with saline treatment at all time intervals after intervention. No patients in the neostigmine/atropine group needed epidural blood patch compared with 7 (15.9%) in the placebo group (P< .001). Patients required no >2 doses of neostigmine/atropine. There were no between-group differences in neck stiffness, nausea, or vomiting. Complications including abdominal cramps, muscle twitches, and urinary bladder hyperactivity occurred only in the neostigmine/atropine group (P< .001).

CONCLUSIONS:

Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood–brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.
Preoperative Salivary Cortisol am/pm Ratio Predicts Early Postoperative Cognitive Dysfunction After Noncardiac Surgery in Elderly Patients
Authors: Han Yuan , Han Liu , Dong Meng-Meng , Sun Qing-Chun , Zhang Zhen-Feng , Ding Ke , Zhang Yao-Dong , Mannan Abdul , Xu Yi-Fan , Ou-Yang Chang-Li , Li Zhi-Yong , Gao Can , Cao Jun-Li
Published: August 2018

BACKGROUND:

The diagnosis of postoperative cognitive dysfunction (POCD) requires complicated neuropsychological testing and is often delayed. Possible biomarkers for early detection or prediction are essential for the prevention and treatment of POCD. Preoperative screening of salivary cortisol levels may help to identify patients at elevated risk for POCD.

METHODS:

One hundred twenty patients >60 years of age and undergoing major noncardiac surgery underwent neuropsychological testing 1 day before and 1 week after surgery. Saliva samples were collected in the morning and the evening 1 day before surgery. POCD was defined as a Z-score of ≤−1.96 on at least 2 different tests. The primary outcome was the presence of POCD. The primary objective of this study was to assess the relationship between the ratio of am (morning) to pm (evening) salivary cortisol levels and the presence of POCD. The secondary objective was to assess the relationship between POCD and salivary cortisol absolute values in the morning or in the evening.

RESULTS:

POCD was observed in 17.02% (16 of 94; 95% confidence interval [CI], 9.28%–24.76%) of patients 1 week after the operation. A higher preoperative am/pm salivary cortisol ratio predicted early POCD onset (odds ratio [OR], 1.56; 95% CI, 1.20–2.02; P = .001), even after adjusting for the Mini-Mental Sate Examination score (odds ratio, 1.55; 95% CI, 1.19–2.02; P = .001). The area under the receiver operating characteristic curve for the salivary cortisol am/pm ratio in individuals with POCD was 0.72 (95% CI, 0.56–0.88; P = .006). The optimal cutoff value was 5.69, with a sensitivity of 50% and specificity of 91%.

CONCLUSIONS:

The preoperative salivary cortisol am/pm ratio was significantly associated with the presence of early POCD. This biomarker may have potential utility for screening patients for an increased risk and also for further elucidating the etiology of POCD.
Navigating Goals of Care While Confronting an Urgent, Difficult Intubation: A Case Report
Authors: Choi Christine , Pagel Paul S. , Estimé Stephen R.
Published: August 2018

Urgent airway management is challenging because time constraints limit thorough evaluation and planning before endotracheal intubation. In this report, we describe a case in which an airway history review revealed extraordinarily complex airway anatomy that led to a decision not to attempt intubation in a man with end-stage chronic obstructive pulmonary disease. We emphasize the utility of reviewing history and imaging before attempted urgent intubation. We discuss the importance of a multidisciplinary approach that includes the patient, their family, and consultants when high-risk intubation is contemplated. The ethical role of the anesthesiologist is also discussed.
Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report
Authors: Martin Charlotte , Au Duong Jonathan , Tissot Bernard , Minville Vincent , Ferré Fabrice
Published: August 2018

Venous complications in Behcet disease (BD) affect nearly 40% of patients. We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. Methotrexate was withheld 15 days before surgery and restarted on postoperative day 2. Immunosuppressive therapy, such as methotrexate, appears to be the most effective prophylactic treatment for venous thrombosis in patients with BD, whereas prophylaxis with low-molecular-weight heparin may be ineffective, as was the situation in our patient. Therefore, continuation of methotrexate perioperatively should be considered in patients with BD. Systematically performing preoperative deep vein thrombosis screening should be also considered. The patient also had diabetes mellitus treated with metformin and sitagliptin preoperatively.
Plasticity of differentiated cells in wound repair and tumorigenesis, part II: skin and intestine
Authors: Burclaff Joseph , Mills Jason C.
Published: August 2018

Recent studies have identified and begun to characterize the roles of regenerative cellular plasticity in many organs. In Part I of our two-part Review, we discussed how cells reprogram following injury to the stomach and pancreas. We introduced the concept of a conserved cellular program, much like those governing division and death, which may allow mature cells to become regenerative. This program, paligenosis, is likely necessary to help organs repair the numerous injuries they face over the lifetime of an organism; however, we also postulated that rounds of paligenosis and redifferentiation may allow long-lived cells to accumulate and store oncogenic mutations, and could thereby contribute to tumorigenesis. We have termed the model wherein differentiated cells can store mutations and then unmask them upon cell cycle re-entry the ‘cyclical hit’ model of tumorigenesis. In the present Review (Part II), we discuss these concepts, and cell plasticity as a whole, in the skin and intestine. Although differentiation and repair are arguably more thoroughly studied in skin and intestine than in stomach and pancreas, it is less clear how mature skin and intestinal cells contribute to tumorigenesis. Moreover, we conclude our Review by discussing plasticity in all four organs, and look for conserved mechanisms and concepts that might help advance our knowledge of tumor formation and advance the development of therapies for treating or preventing cancers that might be shared across multiple organs.
Comparing the impacts of macronutrients on life-history traits in larval and adult Drosophila melanogaster: the use of nutritional geometry and chemically defined diets
Authors: Jang Taehwan , Lee Kwang Pum
Published: August 2018

Protein and carbohydrate are the two major macronutrients that exert profound influences over fitness in many organisms, including Drosophila melanogaster. Our understanding of how these macronutrients shape the components of fitness in D. melanogaster has been greatly enhanced by the use of nutritional geometry, but most nutritional geometric analyses on this species have been conducted using semi-synthetic diets that are not chemically well-defined. Here we combined the use of nutritional geometry and chemically defined diets to compare the patterns of larval and adult life-history traits expressed across 34 diets systematically varying in protein:carbohydrate (P:C) ratio and in protein plus carbohydrate (P+C) concentration. The shape of the response surfaces constructed for all larval and adult traits differed significantly from one another, with the nutritional optima being identified at P:C 1:4 for lifespan (P+C 120 g l−1), 1:2 for egg-to-adult viability (120 g l−1), 1:1 for female body mass at adult eclosion (240 g l−1) and lifetime fecundity (360 g l−1), 2:1 for larval developmental rate (60 g l−1), and 8:1 for egg production rate (120 g l−1). Such divergence in nutritional optima among life-history traits indicates that D. melanogaster confined to a single diet cannot maximize the expression of these traits simultaneously and thus may face a life-history trade-off. Our data provide the most comprehensive and nutritionally explicit analysis of the impacts of macronutrients on life-history traits in D. melanogaster and support the emerging notion that the fundamental trade-offs among life-history traits are mediated by macronutrients.
Simultaneous Intracellular Detection of Plasmonic and Non-Plasmonic Nanoparticles Using Dark-Field Hyperspectral Microscopy
Authors: Akhatova Farida , Danilushkina Anna , Kuku Gamze , Saricam Melike , Culha Mustafa , Fakhrullin Rawil
Published: August 2018

Herein we report the detection and differentiation of plasmonic and non-plasmonic nanoparticles simultaneously administered to A549 lung epithelium cells using dark-field microscopy and hyperspectral imaging. Reflectance spectra-based hyperspectral mapping and image analysis allows for the effective quasi-quantitative identification of nanomaterials in cultured human cells.
In Search of Labor Demand
Authors: Beaudry Paul , Green David A. , Sand Ben M.
Published: August 2018

We propose and estimate a novel specification of labor demand which encompasses search frictions and the role of entrepreneurs in new firm creation. Using city-industry variation over four decades, we estimate the wage elasticity of employment demand to be close to −1 at the industry-city level and −0.3 at the city level. We argue that the difference between these estimates reflects the congestion externalities predicted by the search literature. Our estimates also indicate that entrepreneurship should be treated as a scarce factor in the determination of labor demand. We use our estimates to evaluate the impact of large changes in the minimum wage on employment. (JEL J23, J31, J38, L26, M13, R23)
Incidental Bequests and the Choice to Self-Insure Late-Life Risks
Authors: Lockwood Lee M.
Published: August 2018

Despite facing significant uncertainty about their lifespans and health care costs, most retirees do not buy annuities or long-term care insurance. In this paper, I find that retirees’ saving and insurance choices are highly inconsistent with standard life-cycle models in which people care only about their own consumption but match well models in which bequests are luxury goods. Bequest motives tend to reduce the value of insurance by reducing the opportunity cost of precautionary saving. The results suggest that bequest motives significantly increase saving and significantly decrease purchases of long-term care insurance and annuities. (JEL D14, D15, D64, G22, H55, J26)
Asset Bubbles and Credit Constraints
Authors: Miao Jianjun , Wang Pengfei
Published: August 2018

We provide a theory of rational stock price bubbles in production economies with infinitely-lived agents. Firms meet stochastic investment opportunities and face endogenous credit constraints. They are not fully committed to repaying debt. Credit constraints are derived from incentive constraints in optimal contracts which ensure default never occurs in equilibrium. Stock price bubbles can emerge through a positive feedback loop mechanism and cannot be ruled out by transversality conditions. These bubbles command a liquidity premium and raise investment by raising the debt limit. Their collapse leads to a recession and a stock market crash. (JEL D25, E22, E32, E44, G12, G14)
Media Bias in China
Authors: Qin Bei , Strömberg David , Wu Yanhui
Published: August 2018

This paper examines whether and how market competition affected the political bias of government-owned newspapers in China from 1981 to 2011. We measure media bias based on coverage of government mouthpiece content ( propaganda) relative to commercial content. We first find that a reform that forced newspaper exits (reduced competition) affected media bias by increasing product specialization, with some papers focusing on propaganda and others on commercial content. Second, lower-level governments produce less-biased content and launch commercial newspapers earlier, eroding higher-level governments’ political goals. Third, bottom-up competition intensifies the politico-economic trade-off, leading to product proliferation and less audience exposure to propaganda. (JEL D72, L31, L82, O14, O17, P26, P31)
Probing Plasmodium falciparum sexual commitment at the single-cell level
Authors: Brancucci Nicolas M.B. , De Niz Mariana , Straub Timothy J. , Ravel Deepali , Sollelis Lauriane , Birren Bruce W. , Voss Till S. , Neafsey Daniel E. , Marti Matthias
Published: August 2018

Background: Malaria parasites go through major transitions during their complex life cycle, yet the underlying differentiation pathways remain obscure. Here we apply single cell transcriptomics to unravel the program inducing sexual differentiation in Plasmodium falciparum. Parasites have to make this essential life-cycle decision in preparation for human-to-mosquito transmission.

Methods: By combining transcriptional profiling with quantitative imaging and genetics, we defined a transcriptional signature in sexually committed cells.

Results: We found this transcriptional signature to be distinct from general changes in parasite metabolism that can be observed in response to commitment-inducing conditions.

Conclusions: This proof-of-concept study provides a template to capture transcriptional diversity in parasite populations containing complex mixtures of different life-cycle stages and developmental programs, with important implications for our understanding of parasite biology and the ongoing malaria elimination campaign.
Entomological determinants of malaria transmission in Kayin state, Eastern Myanmar: A 24-month longitudinal study in four villages
Authors: Chaumeau Victor , Fustec Bénédicte , Nay Hsel Saw , Montazeau Céline , Naw Nyo Saw , Metaane Selma , Sawasdichai Sunisa , Kittiphanakun Prapan , Phatharakokordbun Phabele , Kwansomboon Nittipha , Andolina Chiara , Cerqueira Dominique , Chareonviriyaphap Theeraphap , Nosten François H. , Corbel Vincent
Published: August 2018

Background: The Thailand-Myanmar borderland is an area endemic for malaria where transmission is low, seasonal and unstable. The epidemiology has been described but there is relatively few data on the entomological determinants of malaria transmission.

Methods: As part of a pilot study on Targeted Malaria Elimination, entomological investigations were conducted during 24 months in four villages located in Kayin state, Myanmar. Anopheles mosquitoes were identified by morphology, and molecular assays were used in order to discriminate between closely related sibling species of malaria vectors. Plasmodium infection rate was determined using quantitative real-time PCR.

Results: The biodiversity of Anopheles entomo-fauna was very high and multiple species were identified as malaria vectors. The intensity of human-vector contact (mean human-biting rate= 369 bites/person/month) compensates for the low infection rate in naturally infected populations of malaria vectors (mean sporozoite index= 0.4 and 1.7 /1,000 mosquitoes for P. falciparum and P. vivax respectively), yielding intermediary level of transmission intensity (mean entomological inoculation rate= 0.13 and 0.64 infective bites/person/month for P. falciparum and P. vivax, respectively). We estimated that 65% of the potential infective bites are not prevented by mosquito bed nets because of outdoor and early biters.

Conclusion: This study provided a unique opportunity to describe the entomology of malaria in low transmission settings of Southeast Asia. Our data are important in the context of malaria elimination in the Greater Mekong Subregion.
Registro de plantas hospedeiras de Gargaphia lunulata (Mayr) (Hemiptera: Tingidae) em área rural no estado do Tocantins
Authors: Ferreira Cleidiane de Andrade , Coelho Luci Boa Nova , Santos Rodrigo Souza
Published: August 2018

Resumo. A partir de coletas realizadas em área rural no município de Paraíso do Tocantins, TO, foram obtidos exemplares do percevejo-de-renda Gargaphia lunulata (Mayr). Os insetos estavam ocasionando danos em cultivos comerciais de feijão (Phaseolus vulgaris L.) (Fabales: Fabaceae), quiabo [Abelmoschus esculentus (L.) Moench] (Malvales: Malvaceae), maracujá (Passiflora edulis Sims) (Malpighiales: Passifloraceae) e também em plantas daninhas conhecidas como flor-do-guarujá (Turnera ulmifolia L.) (Malpighiales: Turneraceae) e fedegoso [Senna alata (L.) Roxb.] (Fabales: Fabaceae). A ocorrência de G. lunulata em feijão, quiabo, flor-do-guarujá e fedegoso é registrada pela primeira vez no Estado, sendo os percevejos-de-renda encontrados com maior densidade populacional em flor-do-guarujá, maracujá e feijão.Record of host plants of Gargaphia lunulata (Mayr) (Hemiptera: Tingidae) in rural area in the state of Tocantins, BrazilAbstract. From the samples made in rural areas in the municipality of Paraíso do Tocantins, Tocantins state, Brazil, specimens of the lace bug Gargaphia lunulata (Mayr) were obtained. The insects were causing damage to commercial of bean (Fabales: Fabaceae), okra [Abelmoschus esculentus (L.) Moench] (Malvales: Malvaceae), passion fruit (Passiflora edulis Sims) (Malpighiales: Passifloraceae) (Turnera ulmifolia L.) (Malpighiales:Turneraceae) and fedegoso [Senna alata (L.) Roxb.] (Fabales: Fabaceae). The occurrence of G. lunulata in cowpea, okra, “guarujá flower” and “fedegoso” is recorded for the first time in the state, with the lace bugs found with higher population density in “guarujá” flower, passion fruit and bean.