bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 249: Understanding the Patient Experience of Pain and Discomfort During Cardiac Catheterization
Authors: Mall Anna E , Girton T. A , Yardley Kevin , Rossman Paige , Ohman E M , Jones W. S , Granger Bradi B
Published: April 2019

Background:
Patient centeredness is an essential component of high-quality care, yet little is published regarding the patient experience during procedures performed in the cardiac catheterization lab. Available literature focuses on the safe delivery of sedation, but does not address patient-reported satisfaction, comfort, or procedural experience. Further delineation of how procedural factors impact the patient experience is needed.

Methods and Results:
We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients receiving nurse-administered, physician-prescribed procedural sedation (benzodiazepine and/or opioids) between April-June, 2017. Data were abstracted from the procedural database, EHR and Press Ganey© surveys. Patients (n=375) had a mean age of 63, were male 60% (226/375), White 73% (271/375), and overweight / obese (mean BMI = 29). Procedural sedation was given in 93% (348/375) of cases. Press Ganey© results showed good satisfaction with pain control (>75
th
percentile) and staff concern for comfort in all patients. There was no significant difference in pre- and post-procedural patient reported pain scores. The median patient received 1.63 doses of midazolam with either 1.48 doses of fentanyl or 1.33 doses of hydromorphone. Median time interval between administration of initial sedative dose and local anesthetic was 6.2 minutes. Patients with longer intervals had less frequent dosing (p<0.001) and less total procedural sedation (p<0.001). Adjusting for demographic and procedural characteristics, trainee involvement (p=0.001), older age (p=0.002) and longer time intervals (p=<0.001) between dosing and local anesthetic were associated with decreased frequency and total dose.

Conclusions:
Extended duration of sedation intervals was associated with lower overall sedation administration with similar patient satisfaction. Optimizing processes for administering peri-procedural sedation may allow for less total medication without impacting patient experience.
Abstract 250: Does Driving Time to the Transcatheter Aortic Valve Replacement Site Impacts on Long-Term Mortality Following a Successful Procedure? Insights from the STS/ACC TVT Registry
Authors: Marquis-Gravel Guillaume , Stebbins Amanda , Kosinski Andrzej , Cox Morgan , Harrison J. Kevin , Hughes J. Chad , Thourani Vinod , Vemulapalli Sreekanth
Published: April 2019

Background:
The expansion of transcatheter aortic valve replacement (TAVR) centers in the United States has been controlled through the institution of center and provider volume requirements, but little is known about the impact of potential increased patient travel time resulting from this policy. We sought to assess the association between driving time and 1-year outcomes following TAVR.

Methods:
Patients ≥65 years registered in the TVT Registry who underwent a successful transfemoral TAVR implantation from June 2015 to June 2017, and were linked to Centers for Medicare and Medicaid Services data, were eligible. Driving time to the TAVR site was determined using Google Maps. The zip codes of patients’ homes were used to determine rural status, according to the Federal Office of Rural Health Policy data files. Multivariable Cox proportional hazards modelling was performed to assess the relationship between driving time and all-cause death (primary endpoint) prespecified secondary endpoints (all-cause hospitalization, heart failure hospitalization, stroke, and any bleeding). The presence of residual confounding was assessed with falsification analysis.

Results:
Among 31,098 patients, median driving time to the TAVR site was 0.58 hours (interquartile range [IQR]: 0.33-1.18). Median age was 83.0 years old (IQR: 78.0-88.0), and 47% were females. Mean STS score was 7.31±5.56%, and 7,422 patients (23.9%) lived in a rural area. Patients living in rural areas were younger than those who were not (median age: 82.0 and 84.0 years, respectively; p<0.0001). Cumulative incidence of all-cause mortality by quartiles, and unadjusted and adjusted hazard ratios for 1-year outcomes, are presented in Table 1. Driving time was not significantly associated with falsification endpoints, suggesting that there was no residual confounding in the adjusted model.

Conclusion:
Following successful transfemoral TAVR, longer driving times from the patients’ residence to the TAVR site are associated with statistically significant, yet non-clinically meaningful, lower adjusted hazards of one-year all-cause mortality. Longer driving distance resulting from control of expansion of TAVR centers in the United States to respect institutional and operators volume requirements do not negatively impact long-term clinical outcomes.
Abstract 256: Optimal Medical Therapy Does Not Prevent Readmission in GWG-HF Patients with Ventricular Conduction Abnormalities
Authors: Oglat Hamza , Torosoff Mikhail
Published: April 2019

Background:
Conduction system abnormalities in heart failure (HF) patients have been associated with worse prognosis and higher mortality. Cardiac resynchronization has been successful in reducing readmission in patients with LBBB, but not other in ventricular conduction abnormalities. Effects of co-morbidities on readmission rates in HF patients with conduction abnormalities on and optimal, guideline directed medical therapy (OGDMT) were not well investigated.

Methods:
The study cohort included 2583 consecutive heart failure patients with sinus, non-paced rhythm (41.4% females, 65.2 ± 14.9 years old, EF 42.2% ± 14.1%) on modern medical therapy enrolled in Get With The Guidelines (GWTG) Registry at a single academic medical center. LBBB was noted in 7.6%, IVCD in 4.1%, and RBBB in 8.21%. Common comorbidities included HTN in 68.8%, CAD in 42.2%, DM in 38%, hyperlipidemia in 51.5%, and chronic lung disease in 24.5%.

Results:
The HF readmissions were significantly more common in patients with conduction abnormalities (21.2 vs. 15.4%, p=0.0016). Readmission rates were similar in patients with LBBB (20.9%), RBBB (21.2%) or nonspecific IVCD (21.5%). Patients with RBBB were older (70.5±14.8 vs. 63.9±14.7, p<0.01) Caucasian (81.1 vs. 71.5%, p<0.01) male (68.4 vs. 58.3%, p<0.01) with histories of CAD (51.4 vs. 40.2%, p<0.01), CVA/TIA (14.2 vs. 9.9%, p=0.04), hyperlipidemia (60.4 vs. 51.0%, p<0.01) and COPD or asthma (30.19%, p=0.04) despite fewer of them with history of smoking in last 12 months (21.2 vs. 31.5%, p=0.013). There was no difference between patients with RBBB and the rest of the cohort in utilization of ACE inhibitors, ARBs, or Hydralazine/Nitrates (77.1 vs. 82%, p=0.111), beta-adrenergic blockers (90.5 vs. 89.5%, p=0.625), or aldosterone receptor antagonists (19.6 vs. 19.5%, p=0.981).

Conclusion:
Ventricular conduction abnormalities are associated with increased risk of readmission in HF patients despite OGDMT. RBBB may serve as a surrogate marker for increased non-cardiac co-morbidity, where aggressive treatment of associated illness burden may translate in reduced readmission rates.
Abstract 258: Impact of Post-Traumatic Stress Disorder on Clinical Outcomes in Veterans with Coronary Artery Disease
Authors: Parikh Puja , Romeiser Jamie , Jannello Pam , Shroyer A, Laurie
Published: April 2019

Background:
While post-traumatic stress disorder (PTSD) has been associated with increased risk of coronary artery disease (CAD), the association between PTSD and outcomes in Veterans with CAD remains unclear.

Methods:
The study population included 168 Veterans with CAD who were seen in Cardiology Clinic in January 2015. Demographics, clinical history, medications, lab and echocardiographic testing, and outcomes were recorded and compared in Veterans with PTSD versus those without. The primary outcome of interest was major adverse cardiovascular events (MACE) at 1 year, which was a composite of all-cause mortality, cardiovascular hospitalization, and emergency room presentation for chest pain and/or dyspnea.

Results:
Of the 168 Veterans with CAD, 26 (15%) had PTSD while 142 (85%) did not. No differences in age, cardiac risk factors, or comorbidities were noted in Veterans with and without PTSD. Veterans with PTSD were more likely to have served in the Vietnam War and had higher prevalence of agent orange exposure. They also had higher rates of depressive disorders (50% vs 26%, p=0.01) and were more often prescribed a selective serotonin receptor inhibitor (42% vs 15%, p=0.0002) and benzodiazepine (35% vs 9%, p=0.012). Veterans with PTSD were more often prescribed long-acting nitroglycerin (39% vs 14%, p=0.003) and had a trend toward higher rates of ranolazine (8% vs 0.7%, p=0.06). They were also had higher LDL cholesterol (84 vs 71, p=0.04), and a trend towards higher total cholesterol (157 vs 141, p=0.09) and lower serum creatinine (1.0 vs 1.2, p=0.08). Echocardiographic characteristics were similar in both groups. Rates of MACE were signficantly lower in Veterans with PTSD (12% vs 32%, p=0.03), primarily driven by lower rates of cardiovascular hospitalization (4% vs 21%, p=0.05). In multivariable logistic regression, PTSD was not associated with 1-year MACE rates (OR 0.32, 95%CI 0.09-1.21).

Conclusions:
In Veterans with CAD, presence of PTSD was not independently associated with MACE at 1 year. Further research on PTSD and its relation to CAD outcomes in the Veteran population however is warranted.
Abstract 285: Do Providers Prescribe Statins to Patients Diagnosed with Carotid Artery Stenosis in Adherence with the AHA/ASA Stroke Prevention Guidelines?
Authors: Sunder Vikas , Farber Jason , McCarey Melissa , Whellan David
Published: April 2019

Background:
Patients with carotid artery stenosis (CAS)≥ 50% have an annual stroke risk of 1-2% and an annual cardiac-related mortality approaching 3% .The 2014 AHA/ASA stroke prevention guidelines provide a class I recommendation that patients diagnosed with CAS be prescribed a statin as part of optimal medical management. Recent data shows that approximately 70% of patients with CAS≥ 50% report not receiving a statin prescription. The aim of this study was to examine whether patients with CAS ≥ 50% are prescribed statins at 6 months after diagnosis by duplex ultrasound.

Methods:
We reviewed carotid duplex ultrasound studies performed at Thomas Jefferson University for various indications from 2/2017 to 3/2018 and identified studies reporting either unilateral or bilateral CAS≥ 50%. We obtained the patient identification and medication list at the time of the ultrasound. We then queried the electronic medical record for the patient active medication list at 6 months after the ultrasound.

Results:
Carotid ultrasounds of 411 patients were reviewed. 105 patients were found to have CAS ≥ 50%. 87% (91 of 105) of these patients had hypertension and 80% (84 of 105) had hyperlipidemia. 24% (25 of 105) of these patients had a history of stroke. 79% (83 of 105) had a statin prescription prior to ultrasound diagnosis. Of the patients without a statin prescription, 31% (7 of 22) were prescribed a statin by 6 months after ultrasound diagnosis. 81% (85 of 105) of patients with CAS ≥ 50% had an active statin prescription at 6 months after ultrasound diagnosis. 53% (45 of 85) of prescriptions at 6 months were for high-intensity statins. Vascular surgery, primary care, and cardiology were the most common prescriber specialties with 34% (20 of 75) of prescriptions ordered by providers from other medical specialities.

Conclusion(s):
In a single institution sample, the majority of patients with unilateral or bilateral carotid artery stenosis ≥ 50% are prescribed statins prior to diagnosis by duplex ultrasound and at 6 months after diagnosis by duplex ultrasound. The intensity of the statin prescribed, as well as the medical specialty of the prescriber, vary.
Abstract 34: Implementation of a Novel Fast-Track Extubation Protocol after Routine and Complex Adult Cardiovascular Operations
Authors: Ellis Myra F , Pena Heather , Farrell Debra , Cadavero Allen , Kester Kelly , Kettle Mollie , Parker Carrie , Robinson Emily , Rudolph Alexandra , Suplee Emily , Thomas Tonda , Granger Bradi B , Ghadimi Kamrouz
Published: April 2019

Background:
The Society of Thoracic Surgeons (STS) defines early extubation after cardiac operations as endotracheal extubation and separation from mechanical ventilation in less than 6 hours of surgery, which is associated with improved postoperative outcomes.

Objectives:
1. To improve rates of early extubation in post-operative cardiac surgery patients. 2. To evaluate implementation of a multidisciplinary fast-track extubation (FTE) protocol on the duration of mechanical ventilation after adult cardiac surgery as compared to historical unmatched-controls.

Methods:
After IRB approval, prospective data were collected on 101 consecutive patients identified by the operating surgeon as appropriate for early extubation based on standard protocols (Control Cohort). Our multidisciplinary stakeholder group evaluated barriers to early extubation and developed a sustainable FTE protocol. Post-implementation data was collected for 3 months (FTE Cohort). A structural framework to alter culture and behavior was utilized for long-term adoption of our protocol.

Results:
The study included 312 patients (Control Cohort N=101 / FTE Cohort N=211). Patient and procedural demographics were similar between the groups. Extubation occurred within 6 hours in 48% (N=48) in the control cohort versus 73% (N=153) in the FTE cohort (p <0.001) (Figure 1). Following implementation of the FTE protocol, patients with more complex surgeries, not meeting original inclusion criteria, were also safely extubated using the protocol.

Conclusion:
Our FTE protocol safely improved the rate of early extubation after routine and complex cardiac surgery. A behavioral change framework was instrumental in establishing and maintaining staff engagement.
The Rise of the “Underground” Catholic Church in Early Reform-Era China
Authors: Mariani Paul
Published: April 2019

This essay aims to present a detailed account of the restoration of the Catholic Church in Shanghai during 1979–1981 and then to explain how the arrests and suppression of Catholic leaders in late 1981 solidified the division between the official and underground Catholic churches. Two of the major factors that lead to the reemergence of the Shanghai Catholic underground community were the release and rehabilitation of veteran priests and other Catholic leaders and the dissemination of a 1978 Vatican decree that gave great latitude to the church, which was functioning in “difficult circumstances.” The essay ends with a discussion of current prospects of the Catholic Church in China.
Two new species of Hemiphyllodactylus (Reptilia: Gekkonidae) from Laos
Authors: ELIADES SAMUEL J. , PHIMMACHAK SOMPHOUTHONE , SIVONGXAY NIANE , SILER CAMERON D. , STUART BRYAN L.
Published: April 2019

Two new species of the gekkonid lizard genus Hemiphyllodactylus are described based on specimens collected from Champasak Province in southern Laos and Houaphanh Province in northern Laos. Phylogenetic analyses recover H. indosobrinus sp. nov. from Champasak Province as the sister lineage to the Thai endemic H. flaviventris. Hemiphyllodactylus indosobrinus sp. nov. can be diagnosed by having 15 supralabial scales, eight chin scales, 4‑5‑5‑4 subdigital lamellae on Fingers II–V, 4‑5‑5‑5 subdigital lamellae on Toes II–V, and 18 continuous precloacofemoral pores. Phylogenetic analyses recover H. serpispecus sp. nov. from Houaphanh Province to be most closely related to the Vietnamese endemic H. banaensis. Hemiphyllodactylus serpispecus sp. nov. differs from congeners by having seven chin scales; 3‑4‑4‑4 subdigital lamellae on Fingers II–V; 3‑4‑4‑5 subdigital lamellae on Toes II–V; and 11 continuous precloacofemoral pores. The recognition of these two new species doubles the number of Hemiphyllodactylus known from Laos.
North Atlantic Rossby Wave Breaking during the Hurricane Season: Association with Tropical and Extratropical Variability
Authors: Zhang Gan , Wang Zhuo
Published: April 2019

This study explores the connection of Rossby wave breaking (RWB) with tropical and extratropical variability during the Atlantic hurricane season. The exploration emphasizes subtropical anticyclonic RWB events over the western North Atlantic, which strongly affect tropical cyclone (TC) activity. The first part of the study investigates the link between RWB and tropical sea surface temperature (SST) variability. Tropical SST variability affects tropical precipitation and modulates the large-scale atmospheric circulation over the subtropical Atlantic, which influences the behaviors of Rossby waves and the frequency of RWB occurrence. Meanwhile, RWB regulates surface heat fluxes and helps to sustain SST anomalies in the western North Atlantic. The second part of the study explores the connections between RWB and extratropical atmosphere variability by leveraging weather regime analysis. The weather regimes over the North Atlantic are closely associated with RWB over the eastern North Atlantic and western Europe, but show weak associations with RWB over the western North Atlantic. Instead, RWB over the western basin is closely related to the weather regimes in the North Pacific–North America sector. The finding helps clarify why the correlation between the Atlantic TC activity and the summertime North Atlantic Oscillation is tenuous. The relations between the extratropical weather regimes and tropical climate modes are also discussed. The findings suggest that both tropical and extratropical variability are important for understanding variations of RWB events and their impacts on Atlantic TC activity.
Northwest Pacific Anticyclonic Anomalies during Post–El Niño Summers Determined by the Pace of El Niño Decay
Authors: Jiang Wenping , Huang Gang , Huang Ping , Wu Renguang , Hu Kaiming , Chen Wei
Published: April 2019

This study investigates the characteristics and maintaining mechanisms of the anomalous northwest Pacific anticyclone (NWPAC) following different El Niño decaying paces. In fast decaying El Niño summers, the positive SST anomalies in the tropical central-eastern Pacific (TCEP) have transformed to negative, and positive SST anomalies appear around the Maritime Continent (MC), whereas in slow decaying El Niño summers, positive SST anomalies are present in the TCEP and in the tropical Indian Ocean (TIO). During fast decaying El Niño summers, the cold Rossby wave in response to the negative TCEP SST anomalies has a primary contribution to maintaining the NWPAC anomalies. The warm Kelvin wave response and enhanced Hadley circulation anomalies forced by the positive MC SST anomalies also facilitate developing the NWPAC anomalies. During slow decaying El Niño summers, the warm Kelvin wave anchored over the TIO plays a crucial role in sustaining the NWPAC anomalies, while the warm Rossby wave triggered by the positive TCEP SST anomalies weakens the western part of the NWPAC anomalies. The southwesterly anomalies of the NWPAC anomalies during fast decaying El Niño summers can reach to higher latitudes than those during slow decaying El Niño summers. Correspondingly, positive rainfall anomalies appear in northern China and the Yangtze River basin in fast decaying El Niño summers but are only distributed in the Yangtze River basin in slow decaying El Niño summers. This study implies that the El Niño decaying pace is a key factor in East Asian summer climate.
Masseter Deoxygenation in Adults at Risk for Temporomandibular Disorders
Authors: Shah N. , Melo L. , Reid W.D. , Cioffi I.
Published: April 2019

Patients with muscular temporomandibular disorder (TMD) present with abnormal oxygenation of the jaw muscles. Nonetheless, the deoxygenation pattern of jaw muscles of healthy subjects with frequent wake-time tooth-clenching episodes, who are at greater risk for TMD, has never been investigated. This case-control study compared the deoxygenation of the masseter during standardized tasks between TMD-free individuals with frequent self-reports of wake-time clenching and those with infrequent self-reports. University students ( N = 255) filled out the Oral Behavior Checklist. Fourteen females with high versus low scores—high parafunctional (HP) group ( n = 7, ≥80th percentile of score distribution) versus low parafunctional (LP) group ( n = 7, ≤20th percentile)—completed 2 sessions during which they clenched at their maximum voluntary contraction (MVC) for 2 min and at 10% to 20% MVC for 20 min. Tissue oxygen saturation (StO2) and changes in oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin of the masseter were measured via near-infrared spectroscopy and analyzed with a generalized mixed effect model. A significant interaction effect (task × study group) was found on all outcome measures, indicating that the deoxygenation pattern of the HP group differed from the LP group (all P < 0.001). MVC of the masseter induced an almost 5-times-greater reduction of StO2 in the HP group as compared with the LP group ( P = 0.023). However, the relative increase in StO2 at rest after the MVC was similar between groups ( P > 0.05). At the end of the prolonged MVC task (10% to 20%), the blood flow (change in total hemoglobin) was almost 6 times higher in the LP group as compared with baseline. On the contrary, it increased minimally in the HP group (all P < 0.001). Healthy individuals at risk for TMD have abnormalities in masseter deoxygenation. Future prospective studies are needed to test whether this contributes to the onset of muscular TMD.
Refining the Analysis of Mechanism–Outcome Relationships for Anxiety Treatment: A Preliminary Investigation Using Mixed Models
Authors: Kuckertz Jennie M. , Najmi Sadia , Baer Kylie , Amir Nader
Published: April 2019

Although efficacious treatments exist for anxiety disorders, issues remain regarding how best to conceptualize and measure purported change processes in clinical research. In the current study, we examined the relationship between treatment-specific (exposure therapy, attention bias modification [ABM]) as well as more general change processes with symptoms within a transdiagnostic sample using mixed models. Results indicated that slope of self-efficacy across treatment and between-session habituation across identical exposures was associated with slope of symptom change. Although slope of anxiety ratings within session was not associated with slope of symptom change, it did interact with other candidate exposure processes to predict symptoms. Purported ABM change processes were not associated with outcome. Our use of mixed models exemplifies an emerging trend in this research aimed at minimizing loss of data through aggregation, and our results highlight the utility of integrating treatment-specific as well as more general change processes in mechanistic research.
Second-Generation Contextual Mobility: Neighborhood Attainment from Birth to Young Adulthood in the United States
Authors: Tran Van C.
Published: April 2019

This article examines trajectories of neighborhood mobility for the post-1965 second generation in the United States. It advances the concept of second-generation contextual mobility, defined as the change in neighborhood context over the life course among the second generation. This analysis uses unique geocoded longitudinal data over three decades to documents patterns of second-generation neighborhood attainment. Compared to US blacks, the second generation has achieved significant contextual mobility both over time and across generations. Specifically, the second generation in this New York sample lived in better neighborhoods in young adulthood compared to birth neighborhood where their parents once lived. Most groups moved away from the most disadvantaged areas, with the exception of Dominicans. While the second generation has yet to achieve neighborhood parity with US whites, they have already surpassed US blacks in neighborhood attainment. Second-generation contextual mobility is thus an important, but missing, piece in established accounts of neighborhood mobility in the United States.
Development, concurrent validity and internal consistency of a simulator tool for assessing continued car driving after a brain injury/disease
Authors: Samuelsson Kersti , Tropp Maria , Lundqvist Anna , Wressle Ewa
Published: April 2019

Introduction

Beyond relevant cognitive tests, a simulated driving activity could be useful to observe performance and behaviour in a standardized ‘driving-like’ situation and provide information on attention, reaction time and information processing speed when evaluating the ability to continue driving after a brain injury or disease. The aim was to develop and evaluate concurrent validity and internal consistency of a computerized simulated driving task tool.

Methods

Results from a new tool (CyberSiM, including three subtests and four result variables) were compared with results from the Trail Making Test, Useful Field of View test and Nordic Stroke Driver Screening Assessment. There were 126 healthy adults included in the study.

Results

The correlation analysis showed significant correlations ( p<0.001) for CyberSiM reaction time and all cognitive tests except for Useful Field of View 1. The CyberSiM showed good internal consistency, with Cronbach’s alpha=0.85.

Conclusion

The analysis of concurrent validity showed conformity to most cognitive tests. CyberSiM might be a useful complement to cognitive testing with the opportunity to observe some behaviours ‘in a driving-like activity’. Further studies on clinical groups are needed to confirm its usefulness.
Deep Learning System for Travel Speed Predictions on Multiple Arterial Road Segments
Authors: Nguyen Hoang , Bentley Christopher , Kieu Le Minh , Fu Yushuai , Cai Chen
Published: April 2019

Accurate travel speed prediction is a critical tool for incidence response management. The complex dynamics of transport systems render model-based prediction extremely challenging. However, the large amounts of available vehicle speed data contain the complex interdependencies of the target travel speed; the data itself can be used to generate accurate predictions using deep learning methods. In this work, a deep learning methodology involving feature generation, model development, and model deployment is presented. The authors demonstrate the high performance of deep learning methods (relative to more traditional benchmarks) in predicting travel speeds from 5–30 min in advance, for a challenging arterial road network. In this study, different deep learning architectures that exploit both spatial and temporal information for several time frames are compared and analyzed. Finally, the authors demonstrate the integration of their deep learning method into a visualization system that can be directly applied for vehicle speed prediction in real time. The model-selection analysis and data-to-visualization framework in this manuscript provide a step towards decision support for incident management; for practical implementation, the predictive power of deep learning models under incident conditions should continue to be investigated and improved.
Potential Energy Implications of Connected and Automated Vehicles: Exploring Key Leverage Points through Scenario Screening and Analysis
Authors: Bush Brian , Vimmerstedt Laura , Gonder Jeff
Published: April 2019

Connected and automated vehicle (CAV) technologies could transform the transportation system over the coming decades, but face vehicle and systems engineering challenges, as well as technological, economic, demographic, and regulatory issues. The authors have developed a system dynamics model for generating, analyzing, and screening self-consistent CAV adoption scenarios. Results can support selection of scenarios for subsequent computationally intensive study using higher-resolution models. The potential for and barriers to large-scale adoption of CAVs have been analyzed using preliminary quantitative data and qualitative understandings of system relationships among stakeholders across the breadth of these issues. Although they are based on preliminary data, the results map possibilities for achieving different levels of CAV adoption and system-wide fuel use and demonstrate the interplay of behavioral parameters such as how consumers value their time versus financial parameters such as operating cost. By identifying the range of possibilities, estimating the associated energy and transportation service outcomes, and facilitating screening of scenarios for more detailed analysis, this work could inform transportation planners, researchers, and regulators.
Enhancement of fuel characteristics of rice husk via torrefaction process
Authors: Aslam Umair , Ramzan Naveed , Aslam Zaheer , Iqbal Tanveer , Sharif Shahzad , Hasan Syed Waheed ul , Malik Abdullah
Published: April 2019

Torrefaction, is a pretreatment process in the conversion of various biomass feedstocks into an efficient solid fuel. In the present research, rice husk was torrefied at 200°C, 250°C, and 300°C for 10, 30, 90, and 150 minutes under a non-oxidative environment. The energy yield and mass yield of torrefied solid residues ranged from 51.3% to 96.8%, and 49.1% to 95.1%, respectively, under torrefaction conditions. Increasing the residence time and temperature of thermal treatment causes a rise in carbon content from 32.45% to 48.5%, and raises the calorific value from 16.48 MJ/kg to 19.82 MJ/kg. The torrefaction process also reduced the swelling tendency of the biomass in water from its initial value of 308% to 92% only. Various other characterizations including Fourier transform infrared radiation, thermogravimetric analysis (TGA) and scanning electron microscopy were performed to analyze the structural and textural aspects of torrefied biomass. The TGA and derivative thermogravimetric analysis curves indicated that torrefaction affected the hemicellulose fraction of biomass significantly. The surface morphology of thermolyzed samples revealed the rupture of the surface induced by the torrefaction process. Overall, the torrefaction process has not only improved the fuel characteristics of the rice husk but also enhanced its hydrophobicity.
Factors affecting access and use of preventive and weight management care: A public health lens
Authors: Aboueid Stephanie , Meyer Samantha B.
Published: April 2019

Obesity is an important risk factor for various chronic diseases. While people with obesity use the health system more and incur higher costs, they may forego using preventive care services (e.g., gynecological cancer screenings) due to issues of service use and service access. The aim of this paper was to use a public health lens to elucidate system level factors that affect healthcare access and utilization for preventive and weight management care by patients with obesity. Some elucidated factors include lack of access to a Primary Care Provider (PCP) and multidisciplinary healthcare settings, gender of the PCP, duration of medical visits and health professionals' attitudes about obesity. We highlight potential strategies for leaders to use when improving access and use of health services by patients with obesity in Canada and the need for future empirical studies in this research area.
Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation
Authors: Wang Ann A , Tapia Christopher , Bhanji Yasin , Campbell Christopher , Larsen Daniel , Gross Derick , Ganatra Seema , Qodsi Melad , Tellez Claudia , Jain Shikha
Published: April 2019

Introduction

Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics.

Methods

This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed.

Results

Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned.

Conclusion

Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.
Risk factors for femoral stem breakage: an analysis of the AOANJRR results
Authors: Rickman Mark S , Lewis Peter L , Chou Daud TS , Donnelly William , Graves Stephen E , Lorimer Michelle
Published: April 2019

Introduction:

Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design.

Methods:

We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs.

Results:

Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem.

Discussion:

To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.
Mid-term follow-up after all-size acetabular revision and proposal for a stability classification system
Authors: Walter Sebastian G , Thomas Tom S , Kenndoff Daniel , Thomas Wolfram
Published: April 2019

Background:

There is a trend for using jumbo cups/oblong devices for acetabular reconstruction as alternative to biological solutions. We report about a spectrum of reconstruction methods and their mid-term results.

Methods:

Inclusion of 214 consecutive patients undergoing total hip arthroplasty revision surgery. Patients were examined using the Harris Hip Score (HHS). Based on the intraoperative acetabular defect situation, cases were classified into 1 of 5 possible categories of a stability classification for acetabular replacement (SCAR).

Results:

Mean HHS improved from 42 preoperatively (range 12–62) to 77 (range 54–90; p < 0.05) 6 months after operation. There were significant differences of the pre-and postoperative HHS between SCAR subgroups ( p < 0.05). Inter-observer reliability of the SCAR was high (kappa 0.94 (95% CI, 0.90–0.98)). Re-revision was performed in 15 cases (7%).

Conclusion:

The SCAR classification is a practicable tool for intraoperative decision-making as it provides standardised treatment recommendations.
Instagram: Friend or foe? The application’s association with psychological well-being
Authors: Mackson Samantha B , Brochu Paula M , Schneider Barry A
Published: April 2019

The current study examined the association between the social media application Instagram and its users’ psychological well-being. Participants, both Instagram users and non-users, were surveyed online on measures of depression, anxiety, loneliness, self-esteem, body image, and social comparison. Participants who reported having an Instagram account were also asked about their time spent on Instagram and Instagram anxiety. To understand the association between Instagram and psychological well-being, the study’s first aim was to compare participants who had an Instagram account with those who did not have one. Results revealed that participants with the application reported lower levels of anxiety, depression, and loneliness, and higher levels of self-esteem, than participants who did not have an account. Furthermore, loneliness and self-esteem mediated the association between having an Instagram account and depression and anxiety. The second aim of the study was to examine what factors are associated with Instagram users’ reports of anxiety and depression, focusing specifically on participants who reported having an Instagram account. Results revealed that anxiety and depression were predicted by Instagram anxiety and social comparison, respectively. Overall, these results show that Instagram is associated with psychological well-being. However, when Instagram users experience Instagram anxiety or engage in social comparison, it is associated with poorer psychological outcomes. This research provides an insight into the psychological impact that Instagram can have on its users.
Implementation of Active Learning Approach to Teach Biorisk Management and Dual-Use Research of Concern in Egypt
Authors: Elhadidy Mohamed , El-Tholoth Mohamed , Brocard Anne-Sophie
Published: April 2019

Introduction:

Frequent reports of laboratory- and hospital-acquired infection in Egypt suggested a deficiency in handling hazardous samples and microorganisms among different researchers and professionals. The most common cause of laboratory incidents and potential exposure is often identified as a lack of biosafety training.

Methods:

In this study, we designed and implemented an effective laboratory biorisk management (BRM) training. Two workshops were delivered to 42 faculty members working in laboratories handling biological material in Egypt. The workshop modules were based on the global biorisk management curriculum developed by Sandia National Laboratories, with some modifications. The content was delivered to actively engaging participants in the learning process that included group work, case studies and scenarios, short presentations, demonstrations, hands-on activities, and questions and answers that created analytical thinking situations. These workshops introduced the concept of biorisk management, which combines risk assessment, risk mitigation, and performance systems and dual-use research of concern.

Results:

Results of pre-tests/post-tests revealed significant ( P < .001) improvement in knowledge acquisition among participants. Course evaluation surveys indicate that most participants felt that these teaching methods met their needs and that their personal laboratory practices would change as a result of the training course.

Conclusion:

We conclude that using varied hands-on strategies in teaching biorisk management provided the participants with the skills, tools, and confidence to guide their laboratory staff and colleagues on sustainable biorisk management to reduce the risks associated with infectious disease research in a laboratory setting.
Adoption and adherence to chronic obstructive pulmonary disease GOLD guidelines in a primary care setting
Authors: Surani Salim , Aiyer Akshar , Eikermann Stephen , Murphy Timothy , Anand Pranav , Varon Joseph , Vanderheiden David , Khan Alamgir , Guzman Antonio
Published: April 2019

Objectives:

Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and management of chronic obstructive pulmonary disease at a primary care level. The aim of the study was to examine primary care physician management of chronic obstructive pulmonary disease in two community clinics.

Methods:

After approval from the Institutional Review Board, a retrospective chart review was done among all patients with the diagnosis of chronic obstructive pulmonary disease in two community clinics. Baseline demographics, utilization of spirometry, exacerbation history and home oxygen use were also obtained.

Results:

Chart reviews of 101 patients were completed (52 male and 49 female) in two outpatient primary care provider offices (Office A: 66 patients and Office B: 35 patients). None of the patients had validated measures of dyspnoea such as CAT or mMRC scores. Only 21% (22/101) of the patients had formal pulmonary function test testing done, and of those who had pulmonary function tests, 31.5% of patients were incorrectly diagnosed and mislabelled as chronic obstructive pulmonary disease. Pharmacotherapy for chronic obstructive pulmonary disease was not in alignment with GOLD guidelines, with only 42% of patients on an inhaler regimen that included a long-acting muscarinic antagonist.

Conclusion:

There is suboptimal use of pulmonary function test in a primary care setting for diagnosis of chronic obstructive pulmonary disease and substantial errors in diagnosis. There is virtually no use routinely of validated symptom scales for diagnosis of chronic obstructive pulmonary disease. There is substantial variance in pharmacotherapy, and regimens routinely do not follow GOLD guidelines.
A patient with neurofibromatosis type 1 presenting with bilateral frontal lobe infarctions following anterior communicating artery aneurysm rupture
Authors: Herath HMMTB , Yogendranathan Nilukshana , Kulatunga Aruna
Published: April 2019

Neurofibromatosis is a neurocutaneous genetic condition with dysplasia of the mesodermal and ectodermal tissues. Vascular abnormalities are well recognized in neurofibromatosis and cerebral aneurysms are rarely reported in literature. Here, we present a 20-year-old Sri Lankan female presented with headache, altered personality, disinhibited behaviour, and urinary incontinence. On imaging, she was found to have infarctions of both frontal lobes and evidence of a ruptured anterior communicating artery aneurysm with a small subarachnoid haemorrhage. Another small middle cerebral artery aneurysm was also seen in the angiogram. She was managed conservatively and gradually recovered. Because aneurysms in neurofibromatosis are usually asymptomatic and as rupture of such an aneurysm is rare, regular vascular screening is not recommended to all patients with neurofibromatosis. This is the first case report in literature in which a patient with neurofibromatosis presented with infarctions of both frontal lobes due to rupture of an anterior communicating artery aneurysm.
Intratumoral platelet aggregate formation in a murine preclinical glioma model depends on podoplanin expression on tumor cells
Authors: Costa Barbara , Eisemann Tanja , Strelau Jens , Spaan Ingrid , Korshunov Andrey , Liu Hai-Kun , Bugert Peter , Angel Peter , Peterziel Heike
Published: April 2019

Binding of the sialomucin-like transmembrane glycoprotein podoplanin (PDPN) to the platelet receptor C-type lectin-like receptor 2 induces platelet activation and aggregation. In human high-grade gliomas, PDPN is highly expressed both in tumor cells and in tumor-associated astrocytes. In glioma patients, high expression of PDPN is associated with worse prognosis and has been shown to correlate with intratumoral platelet aggregation and an increased risk of venous thromboembolism (VTE). To functionally assess the role of PDPN in platelet aggregation in vivo, we established a syngeneic orthotopic murine glioma model in C57/Bl6 mice, based on transplantation of p53- and Pten-deficient neural stem cells. This model is characterized by the presence of intratumoral platelet aggregates and by the upregulation of PDPN both in glioma cells and in astrocytes, reflecting the characteristics of human gliomas. Deletion of PDPN either in tumor cells or in astrocytes resulted in glioma formation with similar penetrance and grade compared with control mice. Importantly, only the lack of PDPN in tumor cells, but not in astrocytes, caused a significant reduction in intratumoral platelet aggregates, whereas in vitro, both cell types have similar platelet aggregation-inducing capacities. Our results demonstrate a causative link between PDPN and platelet aggregation in gliomas and pinpoint the tumor cells as the major players in PDPN-induced platelet aggregation. Our data indicate that blocking PDPN specifically on tumor cells could represent a novel strategy to prevent platelet aggregation and thereby reduce the risk of VTE in glioma patients.
Randomized trial comparing standard vs sequential high-dose chemotherapy for inducing early CR in adult AML
Authors: Bassan Renato , Intermesoli Tamara , Masciulli Arianna , Pavoni Chiara , Boschini Cristina , Gianfaldoni Giacomo , Marmont Filippo , Cavattoni Irene , Mattei Daniele , Terruzzi Elisabetta , De Paoli Lorella , Cattaneo Chiara , Borlenghi Erika , Ciceri Fabio , Bernardi Massimo , Scattolin Anna M. , Todisco Elisabetta , Campiotti Leonardo , Corradini Paolo , Cortelezzi Agostino , Ferrero Dario , Zanghì Pamela , Oldani Elena , Spinelli Orietta , Audisio Ernesta , Cortelazzo Sergio , Bosi Alberto , Falini Brunangelo , Pogliani Enrico M. , Rambaldi Alessandro
Published: April 2019

Here we evaluated whether sequential high-dose chemotherapy (sHD) increased the early complete remission (CR) rate in acute myelogenous leukemia (AML) compared with standard-intensity idarubicin-cytarabine-etoposide (ICE) chemotherapy. This study enrolled 574 patients (age, 16-73 years; median, 52 years) who were randomly assigned to ICE (n = 286 evaluable) or sHD (2 weekly 3-day blocks with cytarabine 2 g/m2 twice a day for 2 days plus idarubicin; n = 286 evaluable). Responsive patients were risk-stratified for a second randomization. Standard-risk patients received autograft or repetitive blood stem cell-supported high-dose courses. High-risk patients (and standard-risk patients not mobilizing stem cells) underwent allotransplantation. CR rates after 2 induction courses were comparable between ICE (80.8%) and sHD (83.6%; P = .38). sHD yielded a higher single-induction CR rate (69.2% vs 81.5%; P = .0007) with lower resistance risk (P < .0001), comparable mortality (P = .39), and improved 5-year overall survival (39% vs 49%; P = .045) and relapse-free survival (36% vs 48%; P = .028), despite greater hematotoxicity delaying or reducing consolidation blocks. sHD improved the early CR rate in high-risk AML (odds ratio, 0.48; 95% confidence interval [CI], 0.31-0.74; P = .0008) and in patients aged 60 years and less with de novo AML (odds ratio, 0.46; 95% CI, 0.27-0.78; P = .003), and also improved overall/relapse-free survival in the latter group (hazard ratio, 0.70; 95% CI, 0.52-0.94; P = .01), in standard-risk AML, and postallograft (hazard ratio, 0.61; 95% CI, 0.39-0.96; P = .03). sHD was feasible, effectively achieved rapid CR, and improved outcomes in AML subsets. This study is registered at www.clinicaltrials.gov as #NCT00495287.