bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial
Authors: Abou-Chebl Alex , Yeatts Sharon D. , Yan Bernard , Cockroft Kevin , Goyal Mayank , Jovin Tudor , Khatri Pooja , Meyers Phillip , Spilker Judith , Sugg Rebecca , Wartenberg Katja E. , Tomsick Tom , Broderick Joe , Hill Michael D.
Published: July 2015

Background and Purpose—

General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.

Methods—

The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.

Results—

Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA;
P
<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52–0.90;
P
=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65–4.91;
P
=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30–0.81;
P
=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18–7.10;
P
<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (
P
=0.32) or symptomatic intracerebral hemorrhage (
P
=0.37).

Conclusions—

GA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00359424.
Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age
Authors: Arntz Renate M. , Rutten-Jacobs Loes C.A. , Maaijwee Noortje A.M. , Schoonderwaldt Hennie C. , Dorresteijn Lucille D.A. , van Dijk Ewoud J. , de Leeuw Frank-Erik
Published: July 2015

Background and Purpose—

Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality.

Methods—

We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, aged 18 to 50 years. Survival analysis and Cox proportional hazard analysis were used to estimate cumulative mortality and hazard ratios for patients with and without epilepsy.

Results—

After mean follow-up of 12.5 years (SD 8.6), 76 (12.0%) developed poststroke epilepsy. Case fatality was 27.4% for patients with poststroke epilepsy and 2.1% for those without. Poststroke epilepsy was associated with 30-day mortality (hazard ratio, 4.8; 95% confidence interval, 1.7–14.0) and long-term mortality (hazard ratio, 1.8; 95% confidence interval, 1.2–2.9).

Conclusions—

Epilepsy is a common problem after a young stroke and is associated with an increased short-term and long-term mortality.
Detecting cardiac events – state-of-the-art
Authors: Collinson Paul
Published: July 2015

Cardiac biomarker measurement currently addresses two key questions in patient management: the differential diagnosis of chest pain and the differential diagnosis of the patient with breathlessness. There are currently three major themes in the strategies for the differential diagnosis of chest pain. The first is to undertake troponin measurement in patients selected to be at lower risk, hence to have a low prior probability of disease. The second is the introduction of high-sensitivity cardiac troponin (hs cTn) assays into routine clinical use with measurement at 0 and 3 h from admission. Two other approaches that utilize the diagnostic characteristics of these assays have also been suggested. The first is to use the limit of detection or limit of blank of the assay as the diagnostic discriminant. The second approach is to use the low imprecision of the assay within the reference interval and combine a discriminant value with an absolute rate of change (delta value). The third is the use of additional biomarkers to allow early discharge from the emergency department. The concept is to measure high-sensitivity cardiac troponin plus the extra marker on admission. The role of measurement of B-type natriuretic peptide or its N-terminal prohormone, N-terminal pro-B-type natriuretic peptide, has been accepted and incorporated into guidelines for chronic heart failure for some time. More recently, guidelines for acute heart failure can also recommend a single measurement of B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide in people presenting with new suspected acute heart failure.
On the future of foreign policy think tanks in Canada
Authors: Woo Yuen Pau
Published: July 2015

Will foreign policy think tanks face the same fate as so many “old media” organizations? The average Canadian has better access to global news and analysis today through a handheld device than the expert analyst of 30 years ago working from published sources at a foreign policy think tank. Furthermore, the increasingly blurred boundaries between domestic and international issues have made the distinction between foreign policy and domestic policy less clear. Canadian foreign policy think tanks have to respond to these challenges, as well as to the broader problem of parochialism in Canadian society.
Politics of fiscal consolidation in Europe: a comparative analysis
Authors: Kickert Walter J.M. , Randma-Liiv Tiina , Savi Riin
Published: July 2015

The aim of the article is to comparatively describe and explain consolidation measures and political decision-making processes in 14 European countries. The consolidation measures followed a similar pattern. Hiring and pay freeze occurred almost everywhere, whereas more radical cutback measures were introduced only in a limited number of countries. Cutback decision-making was not a one-off event, but consisted of a series of stages, beginning with temporary and small measures and gradually evolving into more serious cutbacks, sometimes arriving at targeted cuts and political priority-setting. The political decision-making was moderate and gradual rather than drastic and swift. Exceptions to this general pattern were the Baltic states as well as those European countries which received financial assistance on the condition of swift and severe cutbacks. Economic factors and supra-national influences primarily explained the size of consolidation measures, whereas domestic political factors turned out to have limited explanatory power.

Points for practitioners

The comparative analysis of fiscal consolidation in 14 European countries showed that the consolidation measures followed a similar pattern. Hiring and pay freeze occurred almost everywhere, whereas more radical cutback measures were introduced only in the later stages of fiscal consolidation. At the beginning of the crisis, the severity and duration of the crisis were denied and the necessity for serious cutbacks was recognized only later. Exceptions to this general pattern were the Baltic States as well as those European countries which were bailed out on condition of swift and severe cutbacks. The article argues that the political will and capacity of governments to take drastic and targeted measures based on political priority-setting is still a serious need.
Fiscal consolidation in federal Belgium
Authors: Troupin Steve , Steen Trui , Stroobants Jesse
Published: July 2015

This article analyses fiscal consolidation policy in federal Belgium in the period 2009–14, until the initial 2014 budget. It relies on documentary analysis and interviews to examine the intensity, content and decision-making process of this policy. Explanations for this particular fiscal consolidation policy are looked for in the macro-economic context, the political-administrative system, and external influences. We find generally modest budget cutbacks punctuated by an exceptionally significant budget exercise. This pattern is best explained by the tensions within the Belgian political-administration, generating policy continuity, and by external pressure, that allowed policymakers to overcome these tensions.

Points for practitioners

Beyond providing insight into the specifics of fiscal consolidation in federal Belgium, this article allows a better understanding of why governments engage in fiscal consolidation the way they do. Emphasizing that fiscal consolidation is an essentially political process influenced by national and international factors, our analysis helps practitioners to understand how national and international arguments can be mobilized in national political contexts to trigger policy changes.
Contextualized measures of public service motivation: the case of Spain
Authors: Ballart Xavier , Riba Clara
Published: July 2015

Since the initial ‘public service motivation’ concept and measures were developed, various studies have raised concerns with regard to cultural differences. According to previous research trying to supplement the four original dimensions of the original construct with a fifth dimension, this study follows this same strategy, taking into account three aspects of the Napoleonic administrative tradition. The analysis captures one new dimension with political loyalty values, which slightly improves the measurement of public service motivation in that specific context.

Points for practitioners

Previous research has showed that ‘public service motivation’ has consequences in terms of individual and collective behaviour and, thus, it may contribute to improve organizations. Public service motivation has been related to performance, organizational commitment and job satisfaction, among other attitudes and behaviours. It has also been used by public administrations in job selection processes.
Avoid or Fight Back? Cultural Differences in Responses to Conflict and the Role of Collectivism, Honor, and Enemy Perception
Authors: Günsoy Ceren , Cross Susan E. , Uskul Ayse K. , Adams Glenn , Gercek-Swing Berna
Published: July 2015

We investigated how responses to interpersonal conflict differed across Ghana, Turkey, and the northern United States. Due to low levels of interpersonal embeddedness, people from individualistic cultures (northern United States) have more freedom to prioritize individual goals and to choose competitive and confrontational responses to conflict compared with people from collectivistic cultures (Turkey, Ghana). Consistent with this idea, we found that northern American participants were less willing to avoid instigators but more willing to retaliate against them compared with other cultural groups. Moreover, in honor cultures like Turkey, there is strong concern for other people’s opinions, and insults are more threatening to personal and family reputation compared with non-honor cultures. Therefore, Turkish participants were less willing to engage in submissive behaviors such as yielding to the instigator. Finally, in Ghana, relationships are more obligatory and enemies are more prominent compared with other cultures. Consistent with our predictions, Ghanaian participants were less willing than Turkish or northern American participants to choose retaliation but more willing to yield to the instigator. Differences in response styles were consistent with dominant cultural values and the cultural nature of interpersonal relationships.
Integrating engineering design and analysis using a parameter constraint graph approach
Authors: He Bin , Hou Shuangchao , Song Wei
Published: July 2015

With the present gap between engineering design and analysis, designers are often hindered in their efforts to explore design alternatives and ensure product robustness. This paper is devoted to parameter constraint graph approach-based dynamic information association and integration between the design model and analysis model. After the description of the gap between design and analysis is analyzed, the modeling and representation method of the product parameter constraints model are proposed. With the help of a product virtual prototyping element model, it can be simplified to a product parameter constraint graph to support an integrated model for multidisciplinary virtual prototyping of complex products. An integrated design and analysis method based on the parameter constraint graph approach is proposed based on the parameterized design method for analysis. The decoupling method of parameter constraints for multidisciplinary virtual prototyping is also discussed in detail in five steps. The integrated design and analysis of an automatic pipe racking robot in an offshore platform are given as an example, which demonstrates that the methodology is obviously helpful in improving the associability of design–analysis models.
Social function after solid organ transplantation: An integrative review
Authors: Cavallini Josefin , Forsberg Anna , Lennerling Annette
Published: July 2015

The way organ transplant recipients depend on social interactions to develop and experience social health and well-being is similar to that of the general population. A transplant may result in a close to full recovery of health status, but the physical and social problems can persist in some patients. The focus on improving the recipients’ social participation has therefore become an important issue. The purpose of this integrative literature review was study social function after solid organ transplantation, that is, kidney, liver, lung or heart. An integrative review was performed on studies that matched the selection criteria and published in peer-reviewed journals from January 2000 to December 2014. The information from the text was extracted and patterns of social function were categorized into different subgroups that were further looked at, and five categories emerged: 1) work, 2) education, 3) daily activities and leisure, 4) social adaption and 5) barriers. The key aspects of social functioning involve five vital domains, that is, work, education, daily activities and leisure, social adaption and barriers. Returning to work appears to be the most important for the recipients independently of the transplanted organ.
Instruction in Letter-Sound Correspondences for Children With Autism and Limited Speech
Authors: Benedek-Wood Elizabeth , McNaughton David , Light Janice
Published: July 2015

This study used a multiple probe across participants’ research design to evaluate the effects of instruction on the acquisition of letter-sound correspondences (LSCs) by three young children with autism spectrum disorder and limited speech. All three children (ages 3–5 years) reached criterion for identifying the LSCs targeted during instruction, and a Nonoverlap of All Pairs (NAP) analysis showed evidence of medium to strong treatment effects. All three children also provided evidence of maintenance and generalization of LSC skills to other tasks. Implications for instruction and future research directions are discussed.
A Decision Analysis of Percutaneous Left Atrial Appendage Occlusion Relative to Novel and Traditional Oral Anticoagulation for Stroke Prevention in Patients with New-Onset Atrial Fibrillation
Authors: Micieli Andrew , Wijeysundera Harindra C. , Qiu Feng , Atzema Clare L. , Singh Sheldon M.
Published: July 2015

Background. Percutaneous left atrial appendage occlusion (LAAO) is a nonpharmacologic approach for stroke prevention in nonvalvular atrial fibrillation (NVAF). No direct comparisons to novel oral anticoagulants (OACs) exists, limiting decision making on the optimal strategy for stroke prevention in NVAF patients. Addressing this gap in knowledge is timely given the recent debate by the US Food and Drug Administration regarding the effectiveness of LAAO. Objective. To assess the cost-effectiveness of LAAO and novel OACs relative to warfarin in patients with new-onset NVAF without contraindications to OAC. Design. A cost-utility analysis using a patient-level Markov micro-simulation decision analytic model was undertaken to determine the lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of LAAO and all novel OACs relative to warfarin. Effectiveness and utility data were obtained from the published literature and cost from the Ontario Drug Benefits Formulary and Case Costing Initiative. Results. Warfarin had the lowest discounted QALY (5.13 QALYs), followed by dabigatran (5.18 QALYs), rivaroxaban and LAAO (5.21 QALYs), and apixaban (5.25 QALYs). The average discounted lifetime costs were $15 776 for warfarin, $18 280 for rivaroxaban, $19 156 for apixaban, $20 794 for dabigatran, and $21 789 for LAAO. Apixaban dominated dabigatran and LAAO and demonstrated extended dominance over rivaroxaban. The ICER for apixaban relative to warfarin was $28 167/QALY. Apixaban was preferred in 40.2% of simulations at a willingness-to-pay threshold of $50 000/QALY. Limitations. Assumptions regarding clinical and methodological differences between published studies of each therapy were minimized. Conclusions. Apixaban is the most cost-effective therapy for stroke prevention in patients with new-onset NVAF without contraindications to OAC. Uncertainty around this conclusion exists, highlighting the need for further research.
Pathogenesis of Bolivian Hemorrhagic Fever in Guinea Pigs
Authors: Bell T. M. , Bunton T. E. , Shaia C. I. , Raymond J. W. , Honnold S. P. , Donnelly G. C. , Shamblin J. D. , Wilkinson E. R. , Cashman K. A.
Published: July 2015

Machupo virus, the cause of Bolivian hemorrhagic fever, is a highly lethal viral hemorrhagic fever with no Food and Drug Administration–approved vaccines or therapeutics. This study evaluated the guinea pig as a model using the Machupo virus–Chicava strain administered via aerosol challenge. Guinea pigs ( Cavia porcellus) were serially sampled to evaluate the temporal progression of infection, gross and histologic lesions, and sequential changes in serum chemistry and hematology. The incubation period was 5 to 12 days, and complete blood counts revealed leukopenia with lymphopenia and thrombocytopenia. Gross pathologic findings included congestion and hemorrhage of the gastrointestinal mucosa and serosa, noncollapsing lungs with fluid exudation, enlarged lymph nodes, and progressive pallor and friability of the liver. Histologic lesions consisted of foci of degeneration and cell death in the haired skin, liver, pancreas, adrenal glands, lymph nodes, tongue, esophagus, salivary glands, renal pelvis, small intestine, and large intestine. Lymphohistiocytic interstitial pneumonia was also present. Inflammation within the central nervous system, interpreted as nonsuppurative encephalitis, was histologically apparent approximately 16 days postexposure and was generally progressive. Macrophages in the tracheobronchial lymph node, on day 5 postexposure, were the first cells to demonstrate visible viral antigen. Viral antigen was detected throughout the lymphoid system by day 9 postexposure, followed by prominent spread within epithelial tissues and then brain. This study provides insight into the course of Machupo virus infection and supports the utility of guinea pigs as an additional animal model for vaccine and therapeutic development.
Confirmatory Factor Analysis of the Antisocial Process Screening Device
Authors: Pechorro Pedro , Hidalgo Victoria , Nunes Cristina , Jiménez Lucía
Published: July 2015

The main aim of the present study was to examine the factor structure, internal consistency, and some additional psychometric properties of the Antisocial Process Screening Device–Self-Report (APSD-SR) among a large forensic sample of incarcerated male juvenile offenders ( N = 438). The results, based on this forensic sample, support the use of the APSD-SR in terms of its factor structure, and internal consistency despite the fact an item had to be removed from the callous-unemotional (CU) dimension. Statistically significant positive associations were found with measures of psychopathic traits, CU traits, narcissism, and aggression, as well as negative associations with a measure of empathy. Findings provide support for the use of the APSD-SR among the incarcerated male juvenile offender population.
Cartilage Restoration of the Knee
Authors: Mundi Raman , Bedi Asheesh , Chow Linda , Crouch Sarah , Simunovic Nicole , Sibilsky Enselman Elizabeth , Ayeni Olufemi R.
Published: July 2015

Background:

Focal cartilage defects of the knee are a substantial cause of pain and disability in active patients. There has been an emergence of randomized controlled trials evaluating surgical techniques to manage such injuries, including marrow stimulation (MS), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OAT).

Purpose:

A meta-analysis was conducted to determine if any single technique provides superior clinical results at intermediate follow-up.

Study Design:

Systematic review and meta-analysis of randomized controlled trials.

Methods:

The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched and supplemented with manual searches of PubMed and reference lists. Eligible studies consisted exclusively of randomized controlled trials comparing MS, ACI, or OAT techniques in patients with focal cartilage defects of the knee. The primary outcome of interest was function (Lysholm score, International Knee Documentation Committee score, Knee Osteoarthritis Outcome Score) and pain at 24 months postoperatively. A meta-analysis using standardized mean differences was performed to provide a pooled estimate of effect comparing treatments.

Results:

A total of 12 eligible randomized trials with a cumulative sample size of 765 patients (62% males) and a mean (±SD) lesion size of 3.9 ± 1.3 cm2 were included in this review. There were 5 trials comparing ACI with MS, 3 comparing ACI with OAT, and 3 evaluating different generations of ACI. In a pooled analysis comparing ACI with MS, there was no difference in outcomes at 24-month follow-up for function (standardized mean difference, 0.47 [95% CI, –0.19 to 1.13]; P = .16) or pain (standardized mean difference, –0.13 [95% CI, –0.39 to 0.13]; P = .33). The comparisons of ACI to OAT or between different generations of ACI were not amenable to pooled analysis. Overall, 5 of the 6 trials concluded that there was no significant difference in functional outcomes between ACI and OAT or between generations of ACI.

Conclusion:

There is no significant difference between MS, ACI, and OAT in improving function and pain at intermediate-term follow-up. Further randomized trials with long-term outcomes are warranted.
Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-In Single-Bundle Anterior Cruciate Ligament Reconstruction
Authors: Osti Michael , Krawinkel Alessa , Ostermann Michael , Hoffelner Thomas , Benedetto Karl Peter
Published: July 2015

Background:

Anatomic graft tunnel placement is recommended in anterior cruciate ligament (ACL) reconstruction to restore knee joint stability and function. Transtibial (TT), anteromedial portal (AMP), and outside-in (OI) retrograde drilling surgical techniques have been described for tibial and femoral bone tunnel preparation.

Purpose/Hypothesis:

The purpose of this study was to evaluate the bone tunnel parameters and compare the ability of 3 different surgical techniques to achieve placement of the ACL femoral and tibial bone tunnels at the center of the native ACL femoral and tibial attachment sites. The hypothesis was that tunnel placement using an AMP or OI technique would result in optimized tunnel parameters and more closely reconstruct the center of the native ACL femoral attachment site.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The study population consisted of 100 patients undergoing anatomic single-bundle ACL reconstruction using multiple-stranded hamstring tendon grafts. In group 1 (n = 36), the femoral tunnel was drilled using a TT surgical technique; in group 2 (n = 32), the femoral tunnel was drilled through an AMP; and in group 3 (n = 32), the femoral tunnel was created by use of an OI technique with retrograde drilling. Computed tomography (CT) scans were obtained postoperatively, and characteristics of femoral and tibial tunnel apertures were correlated to femoral and tibial measurement grid systems. The position of the resulting tibial and femoral bone tunnels for each group was compared with the center of the native ACL attachment sites.

Results:

There were statistically significant differences ( P < .05) for the ACL femoral tunnel between the 3 groups with respect to intercondylar height, total tunnel length, graft fixation length, tunnel axis, and tunnel entry angle. Statistically significant differences ( P < .05) were found for the ACL tibial tunnel with respect to anteroposterior tunnel position and sagittal tunnel axis between the TT and both the OI and AMP techniques. The OI surgical technique produced more oblique and anatomically correct femoral tunnel apertures and longer femoral tunnel lengths compared with the AMP technique. Both AMP and OI techniques resulted in a more precise replication of intercondylar tunnel depth and height. There was no statistically significant difference for graft fixation length between the AMP and OI techniques.

Conclusion:

The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques.
A Soldier’s Matrix: A Group Analytic View of Societies in War
Authors: Friedman Robi
Published: July 2015

In this article 1 I will discuss the question of violence in (large) groups and the relationship between the mass and the individual selves. This will be done through the concept of the ‘soldier’s matrix’ 2 . I refer to a matrix dominating a whole society, which participates in organized aggression and suffers its emotional consequences. Everybody in the matrix becomes a soldier, and the identity or the ‘Habitus’ (Elias, 1989) of the society is influenced by soldiership. This applies not only to Iraq and Afghanistan, and to the dark days in Germany, but also to two, three or more decades after the Second World War, and for most other societies in war. The advantage as well as the disadvantage of using the term soldier’s matrix in Germany is the fact that for the new generation, the attitude towards the army has undergone a great change. For many people, soldiers represent almost a taboo or a kind of sickness. Finally I would like to contribute to the understanding of pathological relationships, with particular reference to relation disorders, which are connected to violence.
Factors Affecting the Choice and Desire to Exclusively Breastfeed in Jamaica
Authors: Harrison Abigail , Fletcher-Groves Shani , Gordon-Strachan Georgiana , Thame Minerva
Published: July 2015

Background:

Exclusive breastfeeding rates (EBRs) may be influenced by sociodemographic and sociocultural factors, including maternal age, socioeconomic status, education, and breastfeeding knowledge. The EBR in Jamaica has been low and declining, leaving a need for better determination of the specific local contributory factors.

Objectives:

This study aimed to better elucidate the factors that influence mothers exclusively breastfeeding, including antenatal intentions to breastfeed, mothers’ knowledge of the benefits of breastfeeding, and mothers’ infant feeding practices in general, inclusive of breastfeeding, formula feeding, and complementary feeding.

Methods:

A cross-sectional survey was conducted using a 52-item interviewer-administered questionnaire with mothers attending their 6-week postnatal clinic visit. Sociodemographic data were collected on all participants as well as data regarding participants’ breastfeeding knowledge, attitudes, and practices. Statistical analyses were done using χ2 tests, t tests, and risk analyses.

Results:

Two hundred participants were interviewed; the mean ± SD age of participants was 26.2 ± 6.46 years (range, 15-46 years). The EBR in this study sample was 32%. Sociodemographic factors, including maternal age and socioeconomic status, as well as antenatal and postnatal breastfeeding sessions, did not significantly affect the likelihood of exclusively breastfeeding at 6 weeks postpartum. The only factor significantly associated with the EBR was mothers’ belief that exclusively breastfeeding was able to ensure infant satiety.

Conclusion:

Antenatal and postnatal breastfeeding sessions should place more emphasis on dispelling maternal myths and misperceptions regarding signs of satiety and hunger in infants and reinforcing the knowledge that breast milk alone is sufficient for the first 6 months of life.
A new mathematical model of friction for pneumatic cylinders
Authors: Tran XB , Dao HT , Tran KD
Published: July 2015

This paper focuses on investigating friction behaviors in pre-sliding state and developing a new mathematical model of friction for pneumatic cylinders. Using pneumatic cylinders with different sizes, an experimental setup is made to measure friction force–displacement characteristics in pre-sliding state under various conditions of applied force and pressures in the cylinder chambers. A new mathematical model of friction is proposed by incorporating a hysteresis function into the new modified LuGre model. The friction behaviors of the pneumatic cylinders in pre-sliding state are clarified and the usefulness of the proposed mathematical model is verified through various experimental results.
Characteristics of the internal flow and the near-field spray of a single-hole injector and a multi-hole injector for diesel engines
Authors: Dong Pengbo , Inaba Takuya , Nishida Keiya , Shimo Daisuke
Published: July 2015

The geometric structure of a diesel fuel injector plays a significant role in the injected spray behaviours. Furthermore, the characteristics of diesel fuel spray are well known to have a crucial impact on the combustion process and the resulting engine performance. A single-hole diesel injector is usually applied in fundamental internal flow, spray and combustion research. On the contrary, under most realistic operating conditions, an axisymmetric multi-hole injector is used to couple with the combustion chamber. In the present paper, a detailed experimental investigation of the diesel fuel spray emerging from a single-hole nozzle and a multi-hole nozzle and a computational study of the internal flow inside these two kinds of configuration are reported. Globally, the analysis mainly focused on the different injection processes (the injection rate) and the spray structures of the single-hole nozzle and the multi-hole nozzle, keeping the same sac configuration, the same nozzle hole diameter of 0.1 mm and the same hole length of 0.8 mm for an injection quantity of 2 mm3 per hole. High-speed images of the spray development were freeze captured by Mie scattering at 10,000 frames/s under the conditions where the rail pressure varies from 80 to 180 MPa, the ambient pressure is 1.5 MPa, the room temperature T = 298 K and there is an air environment. Image-processing algorithms were used to determine the fuel spray characteristics. The experimental results revealed that the spray of a multi-hole nozzle with 10 holes had a longer injection duration, a lower injection rate, a shorter spray tip penetration, a wider spray angle and a wider spray cone angle than those of a single-hole nozzle. The spray behaviours of the multi-hole nozzle were more sensitive to variation in the pressure than those of the single-hole nozzle. Moreover, aiming to correlate the observed spray properties to the internal flow phenomenon, computational fluid dynamics simulations were also carried out under the baseline conditions. The more complicated internal flow inside the multi-hole nozzle provided added insight into the different spray characteristics for these two nozzles.
Through-flow calculation with a cooling model for cooled turbines
Authors: Li Hai-bo , Gu Chunwei , Song Yin
Published: July 2015

Conjugate heat transfer is a key feature of modern gas turbine, as cooling technology is widely applied to improve the turbine inlet temperature for high efficiency. Impact of conjugate heat transfer on heat loads and thermodynamic efficiency is a key issue in gas turbine design. This paper proposes a through-flow method for the design of cooled turbines, taking into account the influence of the complicated interaction between the flow field and heat transfer in cooled turbines. The energy and continuity equations are rederived theoretically by considering the historical influence of cooling with the method that deals with viscous losses. A cooling model is introduced to the through-flow method to predict the coolant requirement. This paper applies the method in the design of a high-pressure turbine with convective cooling. With the prescribed blade temperature limitation and the knowledge of the flow variables of the mainstream at the turbine inlet, such as the total pressure, total temperature, and mass flow rate, the convergence of the calculation is then obtained and the properties of the flow field, velocity triangles, and coolant requirement are well predicted. Three-dimensional conjugate heat transfer analysis is performed for the validation of the through-flow method. By comparing these two calculations, it is shown that the through-flow method is a useful tool for flow analysis and coolant requirement prediction in the design of cooled turbines.
Holocene shorelines and lake evolution in Juyanze Basin, southern Mongolian Plateau, revealed by luminescence dating
Authors: Jin Ming , Li Guoqiang , Li Fangliang , Duan Yanwu , Wen Lijuan , Wei Haitao , Yang Liping , Fan Yuxin , Chen Fahu
Published: July 2015

Holocene environment change in the Gobi Desert of Mongolia and northwestern China is of global significance as it is one of the key dust source areas of the world. The Juyanze Basin, located in the central Gobi Desert of southern Mongolian Plateau, is one of the three terminal basins of the Heihe River that flows north from the Qilian Mountain. A series of geomorphic shorelines at different elevations around the basin indicate that large lake levels fluctuated during the past. In this study, we measured the exact elevation of shorelines in the Juyanze Basin using Digital Global Positioning System and found seven shorelines at ~37, ~36, ~34, ~30, ~28, ~24, and ~22 m above modern basin floor (a.m.b.f.). Optically stimulated luminescence dating was employed to date the deposition of beach sand and gravel sequences at these shorelines. Results indicate a paleolake developed in the basin at ~5 ka when lake levels reached ~26 m a.m.b.f.. The lake level then gradually increased to ~29 m a.m.b.f. at ~3.3 ka and reached its highest Holocene level of~37 m a.m.b.f. at ~2.7 ka. The lake environment during 1.1–0.8 ka was characterized by frequent lake-level fluctuations at ~30 m a.m.b.f. The lake disappeared from both East and West Juyanze Basin after ~0.6 ka. This sequence is out-of-phase with other regional Holocene lake records which indicate Holocene high stands occurred during the early to middle Holocene. We suggest that out-of-phase lake high stands at ~5–1 ka in the Juyanze Basin are related to geomorphological shifts of the Heihe River channels across its fan/delta, feeding the three sub-basins of the Ejina at different times. Using paleolake shorelines in this region to reconstruct the climate changes needs to be very careful.
Decadal-resolution record of winter monsoon intensity over the last two millennia from planktic foraminiferal assemblages in the northeastern Arabian Sea
Authors: Munz Philipp M , Siccha Michael , Lückge Andreas , Böll Anna , Kucera Michal , Schulz Hartmut
Published: July 2015

The Indian monsoon system is an important climate feature of the northern Indian Ocean. Small variations of the wind and precipitation patterns have fundamental influence on the societal, agricultural, and economic development of India and its neighboring countries. To understand current trends, sensitivity to forcing, or natural variation, records beyond the instrumental period are needed. However, high-resolution archives of past winter monsoon variability are scarce. One potential archive of such records are marine sediments deposited on the continental slope in the NE Arabian Sea, an area where present-day conditions are dominated by the winter monsoon. In this region, winter monsoon conditions lead to distinctive changes in surface water properties, affecting marine plankton communities that are deposited in the sediment. Using planktic foraminifera as a sensitive and well-preserved plankton group, we first characterize the response of their species distribution on environmental gradients from a dataset of surface sediment samples in the tropical and sub-tropical Indian Ocean. Transfer functions for quantitative paleoenvironmental reconstructions were applied to a decadal-scale record of assemblage counts from the Pakistan Margin spanning the last 2000 years. The reconstructed temperature record reveals an intensification of winter monsoon intensity near the year 100 CE. Prior to this transition, winter temperatures were >1.5°C warmer than today. Conditions similar to the present seem to have established after 450 CE, interrupted by a singular event near 950 CE with warmer temperatures and accordingly weak winter monsoon. Frequency analysis revealed significant 75-, 40-, and 37-year cycles, which are known from decadal- to centennial-scale resolution records of Indian summer monsoon variability and interpreted as solar irradiance forcing. Our first independent record of Indian winter monsoon activity confirms that winter and summer monsoons were modulated on the same frequency bands and thus indicates that both monsoon systems are likely controlled by the same driving force.
Single- and repeat-dose toxicity of IDX14184, a nucleotide prodrug with antiviral activity for hepatitis C viral infection, in mice, rats, and monkeys
Authors: Luo S , Rush R , Standring D
Published: July 2015

The single- and repeat-dose toxicity profile of IDX14184, a novel guanosine nucleotide prodrug with antiviral activity against hepatitis C viral infection, was characterized following once daily oral administration for durations up to 13, 26, and 32 weeks in mouse, rat, and cynomolgus monkey, respectively. The heart, liver, kidney, skeletal muscles, and lower gastrointestinal tract (cecum, colon, and/or rectum) were identified as the primary toxicity targets in these nonclinical species. The mouse was relatively insensitive to IDX14184-induced cardiac toxicity and hepatotoxicity. The rat was very sensitive to IDX14184-induced skeletal muscle, liver, heart, and lower gastrointestinal tract toxicity but relatively insensitive to kidney toxicity. The monkey is a good animal species to detect IDX14184-induced toxicity in the cardiac and skeletal muscles, and in the liver and kidney, but not lower gastrointestinal tract toxicity. The toxicity profile of IDX14184 was most appropriately characterized in rats and monkeys. The conduct of a series of cardiac size and function assessments during a non-rodent toxicology study using echocardiography proved great utility in this work. IDX14184 clinical development was eventually terminated due to suboptimal efficacy and regulatory concerns on potential heart and kidney injury in patients, as seen with a different guanosine nucleotide prodrug, BMS-986094.
Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis
Authors: Yang J , Liang D , Zhang H , Liu Z , Le W , Zhou M , Hu W , Zeng C , Liu Z
Published: July 2015

In the present study, we observed the renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis (LN) and evaluated the risk factors associated with poor renal prognosis. The 5 -, 10 -, 15 - and 20-year renal survival rates were 93.1%, 87.9%, 81.0% and 68.3%, respectively. Gender, LN duration, mean arterial pressure (MAP), proteinuria, serum creatinine, haemoglobin and pathological classification at the time of biopsy were independent risk factors for end-stage renal disease (ESRD). The long-term renal outcomes of patients with class II LN were unfavorable as opposed to those with class V. Additionally, the time-average proteinuria (TA-Pro) and the time-average mean arterial pressure (TA-MAP) during the follow-up were important risk factors for ESRD, with better predictive values than the baseline proteinuria and MAP. The results underscore the need for proteinuria and blood pressure control during follow-up in patients with LN; proteinuria levels should be controlled at least to < 1.0 g/24 h, and optimally to < 0.5 g/24 h; MAP should not exceed 96.5 mmHg. More attention should be paid to class II LN and emphasis should be placed on recurrence prevention of class II LN.
A Criminological Reading of the Concept of Vulnerability
Authors: de Pérez Julie Lima
Published: July 2015

The United Nations Trafficking Protocol establishes the ‘abuse of a position of vulnerability’ as one of the means used to traffic persons. This term, however, was not properly defined, leaving it open for multiple interpretations, many of which do not focus on the well-being of the supposedly vulnerable victims. Through a case study of how (potential) Brazilian victims of trafficking are dealt with in Brazil and (to a lesser extent) outside the country, this article focuses on how ‘vulnerability’ is often interpreted as a synonym of strain that leads to deviant behaviour. In this way, the concept is co-opted to enable the punishment or restraint of certain people (particularly women from developing countries) who are considered to be unsuitable to migrate.
Marriage equality is a mental health issue
Authors: Kealy-Bateman Warren , Pryor Lisa
Published: July 2015

Objective:

We aim to review marriage equality in New Zealand and Australia and critically evaluate the health impact of such a legal change.

Method:

We undertook a review of the literature using the search terms “marriage equality”, “same sex marriage” and “gay marriage” in combination with “health”, “wellbeing”, “psych*”, “mental illness” and “distress”. This search included medical literature, legal literature and mass media.

Results:

This review indicates that Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people disproportionately face negative health stressors and negative health events compared with the general population and this is related to the stress of being a stigmatised minority group. The evidence strongly supports the proposition that marriage equality is related to improved health outcomes. A diverse range of professional health groups advocate for the legislative progression to marriage equality. The authors found no evidence that marriage equality harms opposite-sex marriage.

Conclusion:

Marriage equality is still lacking in Australia and as a positive correlate of health should be strongly supported.
What happens to episode duration and cycle length over the course of bipolar disorder?
Authors: Subramanian Karthick , Kattimani Shivanand , Rajkumar Ravi P , Bharadwaj Balaji , Sarkar Siddharth
Published: July 2015

Objectives:

Published scientific literature on cycle acceleration over the course of bipolar disorder has been equivocal. The present analysis aimed to find whether episode duration and cycle lengths become shorter over the course of bipolar disorder with predominantly manic polarity.

Methods:

The present study comprised 150 patients diagnosed with bipolar I disorder using SCID-I for DSM-IV TR. The course of illness was charted according to the NIMH Life Chart Methodology – Clinician Retrospective Chart (NIMH – LCM CRC). Spearman correlation was used to assess the relationship of episode duration and cycle length with the number of episodes.

Results:

The mean age of the sample was 37.8 years and the average duration of illness was 13.4 years. Unipolar mania comprised 52.7% of the sample. The episode duration and the cycle length decreased with increasing number of episodes ( r=−0.245, p<0.001 & r=−0.299, p<0.001 respectively).

Conclusion:

The present study suggests that over the course of bipolar I disorder, cycle length and episode duration become shorter.
Exploring Patients’ Experiences of Eating Disorder Treatment Services From a Motivational Perspective
Authors: Sheridan Grace , McArdle Siobhain
Published: July 2015

This study employed qualitative methods to explore eating disorder (ED) patients’ perspectives on their treatment experiences to gain insight into those factors that influenced their motivational trajectory. Semistructured interviews were conducted with a purposive female sample of current ( N = 11) and discharged ( N = 3) ED service users, aged 18 to 31 years ( M = 23.21, SD = 4.19). An interpretive thematic analytic approach, comprising both inductive and deductive methods of analysis, was employed to identify key themes in the data. Self-determination theory (SDT) provided a conceptual lens for analyzing data. Participants highlighted that factors such as physical design and nature of the treatment environment, relational aspects of care, and therapeutic methods all played a role in treatment engagement. The findings highlight ways in which current ED services might more effectively meet the needs of service users and support the utility of applying SDT to the study of motivational dynamics in the treatment of EDs.
Provider Difficulties With Spiritual and Forgiveness Communication at the End of Life
Authors: Wittenberg Elaine , Ferrell Betty , Goldsmith Joy , Buller Haley
Published: July 2015

Background:

Due to an absence of communication training, provider responses to patient/family spiritual distress are highly variable. Assessing spiritual and forgiveness concerns are important to ensuring quality holistic care.

Methods:

Cross-sectional survey data were collected from providers attending 1 of 2 continuing education courses. The survey measured the frequency and initiation of communication about spirituality and forgiveness with patients/families, the perceived difficulty in communication across topics, and preparation and resources for these discussions.

Results:

Most participants (n = 124) were nurses followed by social workers with over half of providers having 10 years or more of clinical experience. Participants reported the highest level of difficulty in spiritual communication when talking with family after the death of a patient, followed by conducting a spiritual history with a patient. Facilitating forgiveness communication between parent and adult child, followed by facilitating forgiveness between partners was most difficult for all participants. Social workers reported much lower difficulty than nurses on all items of spiritual and forgiveness communication.

Conclusion:

The majority of participants indicated they were involved in spiritual and forgiveness communication. The most difficult communication included talking with family after death and facilitating forgiveness between patients and families. These findings support the importance of spiritual communication in clinical practice, and the need for clinician training in communicating about spirituality and forgiveness with patients and families.