bluuebunny/crossref_metadata_2025 huggingface dataset:
Some comparisons between heterogeneous and homogeneous layers for nonlinear SH waves in terms of heterogeneous and nonlinear effects
Authors: Demirkuş Dilek
Published: August 2020

This paper aims to make some comparative studies between heterogeneous and homogeneous layers for nonlinear shear horizontal (SH) waves in terms of the heterogeneous and nonlinear effects. Therefore, with this aim, two layers are defined as follows: on the one hand, one layer consists of hyperelastic, isotropic, heterogeneous, and generalized neo-Hookean materials; on the other hand, another layer is made up of hyperelastic, isotropic, homogeneous, and generalized neo-Hookean materials. Moreover, it is assumed that upper boundaries are stress-free and lower boundaries are rigidly fixed. The method of multiple scales is used in both analyses, in addition to using the known solutions of the nonlinear Schrödinger (NLS) equation, called bright and dark solitary wave solutions; these comparisons are made, numerically, and then all results are given for the lowest branch of both dispersion relations, graphically. Moreover, these comparisons are observed both on a large scale and on a small scale, not only in terms of the bright and dark solitary wave solutions but also in terms of the heterogeneous and nonlinear effects.
LATENT//Missing: On Missing Values, Narrative Power, and Data Politics in Discourse of COVID-19
Authors: Petteway Ryan J.
Published: August 2020

April is National Minority Health Month in the United States. The first week of April is National Public Health Week. This year, both occasions passed as the COVID-19 pandemic unfolded and, in the process, rendered remarkably clear the magnitude of the United States’ collective shortcomings in advancing population health equity—particularly as related to dominant narratives of health and data politics. Drawing from critical theory, I use essay to contextualize present COVID-19 discourse and poetry to situate this discourse within a broader historical arc of the United States’ racist, classist, and homophobic proclivities in times of public health crises. I use the combination of essay/poem as creative praxis to analyze and reflect on our present moment in relation to public health pasts and to raise questions about public health research, education, and data futures—offering a critical commentary on the intersections of infectious diseases, structural inequality (e.g., racism), data politics, and public health violence.
Long-term follow-up of a case of posterior microphthalmos (PRSS56) with hyperautofluorescent retinal pigment epithelial deposits
Authors: Sen Piyali , Robson Anthony G , Webster Andrew R , Nicholson Luke , Sivaprasad Sobha , Hykin Philip G
Published: August 2020

Purpose:

To report a case of posterior microphthalomos (PM) related to PRSS56 gene mutation with long term follow up with multimodal imaging findings.

Methods:

Single retrospective case report.

Results:

A 43-year old male patient presented in 2009 with bilateral reduced vision. Clinical examination and multimodal imaging showed features consistent with posterior microphthalmos with prominent bilateral horizontal papillomacular retinal folds. Posterior pole hyperautofluorescent RPE deposits were present. Gradual worsening of visual acuity and rod and cone photoreceptor function more so on the left was demonstrated during the 8 years of follow up.

Conclusion:

Hyperautofluorescent RPE deposits may occur in patients with posterior microphthalmos and such patient’s may experience only gradual disease progression over long term follow up.
Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence
Authors: Sadigh Gelareh , Lava Neil , Switchenko Jeffrey , Duszak Richard , Krupinski Elizabeth A , Meltzer Carolyn , Hughes Danny , Carlos Ruth C
Published: August 2020

Background:

Multiple sclerosis (MS) results in considerable financial burdens due to expensive treatment and high rates of disability, which could both impact care non-adherence.

Objective:

To measure financial toxicity in MS patients, identify its predictors and association with care non-adherence.

Methods:

Adult MS patients visiting neurology clinic (June 2018 to February 2019) were consented to complete a survey. Financial toxicity was measured using Comprehensive Score for Financial Toxicity (COST) (range: 0–44, the lower the score, the worse the financial toxicity). Independent predictors of financial toxicity were identified using linear regression. Associations of COST score with patient outcomes were assessed.

Results:

The mean COST score in 243 recruited patients was 17.4 ± 10.2. In response to financial burdens, 66.7% and 34.7% reported life-style altering behaviors or care non-adherence, respectively. Higher financial self-efficacy was associated with less financial toxicity (coefficient, 1.33 (95% confidence interval (CI), 1.02–1.64); p < 0.001). At least one relapse in the last 3 months was associated with greater financial toxicity (coefficient, −3.34 (95% CI, −6.66 to −0.01); p = 0.049). Greater financial toxicity correlated with life-style-altering coping strategy use ( p < 0.001), care non-adherence ( p = 0.001), and worse health-related quality of life (HRQOL) ( p = 0.03).

Conclusion:

MS patients with lower financial self-efficacy and prior relapse history are at higher risk for financial toxicity, with associated care non-adherence and lower HRQOL.
Progressive multifocal leukoencephalopathy in dimethyl fumarate-treated multiple sclerosis patients
Authors: Jordan Allison LM , Yang Jennifer , Fisher Caitlyn J , Racke Michael K , Mao-Draayer Yang
Published: August 2020

Dimethyl fumarate (DMF), a fumaric acid with antioxidant and immunomodulatory properties, is among the most commonly used oral therapies for relapsing multiple sclerosis (MS). Progressive multifocal leukoencephalopathy (PML) has been associated with several disease-modifying therapies (DMTs), including DMF in treating MS. We present detailed clinical characteristics of nine PML cases and show that the PML incidence in DMF-treated patients is 0.02 per 1000 patients. In addition to persistent severe lymphopenia, older age appears to be a potential risk for PML. However, younger patients without lymphopenia were also observed to develop PML. DMF-associated PML has occurred in patients with absolute lymphocyte counts (ALCs) above the guideline threshold, suggesting that changes in specific subsets might be more important than total ALC. Furthermore, since DMF has been found to decrease immune cell migration by decreasing the expression of adhesive molecules, the cerebrospinal fluid (CSF) immune profile may also be useful for assessing PML risk in DMF-treated patients. This review provides an up-to-date assessment of PML cases occurring in DMF-treated patients and discusses other potential considerations in light of our current understanding of DMF’s mechanism of action on the immune system in the periphery and in the central nervous system (CNS).
Connections among physical activity, motivation, and depressive symptoms in adolescent girls
Authors: Cecchini Jose A , Fernandez-Rio Javier , Mendez-Gimenez Antonio , Sanchez-Martinez Beatriz
Published: August 2020

Adolescence can be a difficult period of life characterised, among many other things, by a significant increase in depressive symptoms among girls. Recent studies have suggested that sedentary habits and self-determined motivation can be associated with depressive symptoms. The main goal of the present study was to examine the associations between physical activity levels, sedentary behaviours, and self-determined motivation and depressive symptoms in girls during adolescence. A total of 714 adolescent girls (16.53 ± 1.01 years) agreed to participate in the study. They completed a questionnaire including the scale of depressive symptoms, the International Physical Activity Questionnaire, and the Situational Motivation Scale. Participants’ smoking habits and body mass index were also assessed. Results showed that those adolescents who performed physical activity of moderate (odds ratio (OR): 0.55; 95% confidence interval (CI): 0.31, 0.99) or high intensity level (OR: 0.22; 95% CI: 0.10, 0.21) had a significantly lower probability of suffering from depressive symptoms. Accordingly, the most sedentary group had a higher probability of suffering from depressive symptoms (OR: 4.90; 95% CI: 2.00, 11.54). Vigorous self-determined motivation was also a significant predictor of the lowest levels of depressive symptoms. In conclusion, results seemed to indicate that educators should promote the most self-determined types of motivation and physical activity habits in their students if they want to help prevent depressive symptoms.
Will the relevance of review language and destination attractions be helpful? A data-driven approach
Authors: Hlee Sunyoung , Lee Hyunae , Koo Chulmo , Chung Namho
Published: August 2020

Because tourism destinations are difficult to assess in certain standard aspects, the factors that contribute to the helpfulness of reviews remain largely unknown. Moreover, the helpfulness of online reviews has not been explored in terms of the interaction between language style (high- vs. low-cognitive) and attraction type (hedonic vs. utilitarian). Hence, this study examines the impact of language style on the helpfulness of an online review of an attraction, depending on the type of attraction and the meaning of the destination. This study’s data included 8,032 reviews of four attractions (2 hedonic x 2 utilitarian), drawn from TripAdvisor in two different meanings of destinations. Specifically, our findings indicate that when a reviewer posts a utilitarian attraction of the destination, high-cognitive language is perceived to be more helpful. First, we discuss the theoretical contribution of our study using cognitive fit theory, and then provide the study’s managerial implications.
Concept of knowledge boxes – a tool for professional development for learning and support assistants
Authors: Lederer Julia , Breyer Caroline , Gasteiger-Klicpera Barbara
Published: August 2020

By supporting children with disabilities, learning and support assistants have become an essential component of inclusive education in regular schools. Assistants in European countries have various levels of vocational training, but they do not consider themselves to be adequately qualified for what are often highly demanding duties. In an attempt to raise standards, five web-based knowledge boxes have been developed within the Erasmus+ project, ‘Improving Assistance in Inclusive Educational Settings II’. The knowledge boxes are available open access through a learning platform and focus on different aspects of inclusion and disabilities. Learning and support assistants, as well as children from five different European countries, participated in the creation of this tool for professional development. In addition, the knowledge boxes are to be evaluated by assistants, parents, teachers and students in order to assess the impact of the knowledge boxes on the competencies in inclusive education of assistants.
Strengthening and Characterization of Existing Reinforced Concrete Beams for Flexure by Effective Utilization of External Steel Elements
Authors: Gul Akhtar , Alam Bashir , Ahmed Wisal , Wahab Nauman , Shahzada Khan , Irfan Badrashi Yasir , Wali Khan Sajjad , Khan Muhammad Nasir Ayaz
Published: August 2020

Strengthening of structural members is a common practice around the world that may arise due to deterioration of concrete with age or upgradation of design code. This paper aims to elucidate a technique used for strengthening of the reinforced concrete beam for flexural capacity by using externally welded steel angles and steel bars. For this motive, three beams were strengthened with external steel angles and three with external steel bars. The external strengthening steel elements were attached at the bottom of the beam with shear reinforcement. Control samples without external steel angles and steel bars for comparison purposes were also prepared. All reinforced concrete beams were first constructed using a concrete ratio of 1:2:4, and then external steel elements were added to existing flexural reinforcement by using a fillet weld with tee joints having thickness and length of 5/16" (7.9 mm) and 6" (152.4 mm), respectively. Fourth point loading criteria were used to investigate the flexural capacity of beams in positive bending. All beams were designed strong enough in shear, to resist the ultimate loads without shear failure. Test results indicated that beams strengthened with this technique have an average increase of 238% with steel angles and 106% with steel bars, in load-carrying capacity than control samples. Strengthened beams showed a uniform crack pattern. Moreover, the concrete cover made a good bond with existing concrete and was strong enough to withstand ultimate loads. Conclusively, the steel angles and steel bars can be used as an external strengthening material, to enhance the flexural capacity of reinforced concrete beams.
Numerical simulation of the metal inert gas welding process that considers grain heterogeneity
Authors: Li Chang , Chen Zhengwei , Gao Hexin , Zhang Dacheng , Han Xing
Published: August 2020

It is of great significance to reveal the microevolution mechanism of welded structures during thermo-mechanical coupling to improve the welding quality. In this paper, a random microcrystalline structure model for welds is established by the Voronoi tessellation method. According to the nanoindentation results, heterogeneous grains are produced. A welding workpiece model with statistical significance is established. On this basis, the Python script and the birth and death element method are used to realize the transient growth of a weld, and a thermo-mechanical coupling model for the SUS301L-HT stainless steel metal inert gas welding process is established. The temperature field and thermal stress field are calculated. The calculation shows that the thermal stresses along the growth direction of the weld area are in the form of a “trapezoid,” and the stresses at both ends are small. The stress in the vertical direction of the weld has a single peak, and the peak appears in the center of the weld. The stress distribution of the model that considers heterogeneous grains is obviously inhomogeneous compared with that of the traditional model. The thermal stress distribution in the weldment is obviously inhomogeneous due to the heterogeneous grains, the stresses at the boundaries of the adjacent grains in the weldment change abruptly. It is found that the greater the difference in the mechanical properties between grains is, the more obvious the change.
Domination and enforcement: The contingent and non-ideal relation between state and freedom
Authors: Guillery Daniel
Published: August 2020

It is common to think that state enforcement is a restriction on freedom that is morally permitted or justified because of the unfortunate circumstances in which we find ourselves. Human frailty and material scarcity combine to make the compromise of freedom involved in exclusive state enforcement power necessary for other freedoms or other goods. In the words of James Madison, ‘if men were angels, no government would be necessary’ ( 1990 : 267). But there is an opposing tradition, according to which the very idea of freedom in society entails the necessity of state enforcement. However morally good human beings are, or whatever material conditions they find themselves in, on this view, the ideal of freedom we ought to be concerned to realise is such that it cannot be attained without state enforcement. It follows a priori from an important ideal of freedom that a state with exclusive enforcement power is necessary for individual liberty in society. In this paper, I argue against what I take to be the strongest argument of the a priori kind, which begins from the neo-republican ideal of freedom as non-domination, and thereby in (partial) defence of the alternative, Madisonian, view. Insofar as it is true that some sort of problematic domination will inevitably be present in a stateless society, I argue, the introduction of a state can do nothing to eliminate it. For the state to improve on even an ideal stateless society, it would need to give individuals control over the interference of potential dominators of a sort that could not be achieved in the ideal stateless society.
Peripheral Arterial Disease Located in the Feet of Patients With Diabetes and Foot Ulceration Demands a New Approach to the Assessment of Ischemia
Authors: Manu Chris Adusei , Freedman Ben , Rashid Hisham , Winkley Kristy , Edmonds Michael E.
Published: August 2020

Peripheral arterial disease (PAD) is common below the knee in diabetes but arteries in the foot are controversially said to be spared of occlusive disease. This is relevant to the convenient site of vascular assessment that is recommended in guidelines. Should assessment be distal at toe/forefoot to detect foot disease or only proximal to detect disease at ankle level? The objective was to determine frequency of PAD at foot and ankle level. This was a cross-sectional observational study, evaluating arterial disease proximally by palpation of pedal pulses and Ankle Brachial Index (ABI), and distally by Toe Brachial Index (TBI), and forefoot transcutaneous oxygen tension (tcpO2), in consecutive patients presenting with foot ulceration. We assessed 301 limbs in 154 patients: 59% of limbs were ulcerated. PAD in the foot was detected in 70% and 74% of limbs by TBI and forefoot tcpO2, respectively, but PAD at ankle level only in 51% and 34% by pulse palpation and ABI, respectively. In limbs with “normal” ABI, PAD was present in the foot in 70% as indicated by low TBI, and in 73% by low tcpO2, with 70% to 64% having associated ulceration, respectively. When compared with arterial waveforms, as a measure of PAD, TBI gave an excellent AUC (area under the curve of the receiver operating characteristic curve) of 0.81 (95% confidence interval: 0.73-0.89), but ABI gave a poor AUC of 0.65 (95% confidence interval: 0.55-0.76). In conclusion, arterial disease is important in the foot and can be detected by TBI, which should be performed even when ABI is normal. Guidelines that recommend TBI only if ABI is artificially raised need updating.
The Yield of Ambulatory EEG-Video Monitoring
Authors: Primiani Christopher T. , Rivera-Cruz Angélica , Trudeau Pat , Sullivan Lucy , MacIver Stephanie , Benbadis Selim R.
Published: August 2020

Introduction

The availability of ambulatory EEG-video monitoring gives an alternative to traditional inpatient EEG-video, but its yield and diagnostic value are not well known. This study evaluates the yield of ambulatory EEG-video for the diagnosis of epilepsy.

Methods

We retrospectively reviewed the ambulatory EEG-video monitoring data from 200 consecutive and unselected patients aged 12 years and older performed by a single company (RSC Diagnostic Services) between January 2018 and May 2018. Studies were processed by two senior certified long-term monitoring EEG technologists and interpreted by neurologists.

Results

Of the 200 patients, 130 (65%) were women, mean age was 45 years. Mean duration of studies were 76.6 hours (range 23-175 hours). There were 110 studies (55%) with events recorded and 101 (92%) were captured on video. Epileptic events accounted for 17.8% (18/101) of the events captured and 9% (18/200) of our total cohort. Nonepileptic diagnosis accounted for 38% of the total number of patients in study (76/200).

Conclusion

Ambulatory EEG-video monitoring may be a useful alternative to inpatient epilepsy monitoring unit, particularly with high clinical suspicion for nonepileptic events.
Unethical not to Investigate Radiotherapy for COVID-19
Authors: Cuttler Jerry M. , Bevelacqua Joseph J. , Mortazavi S. M. J.
Published: August 2020

The primum non nocere letter by Boon et al. urged caution and careful examination of the evidence and logistics of low-dose radiotherapy in COVID-19 patients. This is exactly what was requested in March and what has occurred since late April 2020 when the first phase I/II clinical trial was approved at the Winship Cancer Institute, Emory University Hospital. The preprint of day-7 interim results by the investigators concluded, “In a small pilot trial of 5 oxygen-dependent patients with COVID-19 pneumonia, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy, and radiographic infiltrates without acute toxicity or worsening the cytokine storm. Low-dose whole-lung radiation appears to be safe, shows early promise of efficacy, and warrants larger prospective trials.” Preliminary results from another clinical trial gave similar results. In conclusion, the authors believe it would be unethical not to investigate radiotherapy as a potential remedy against COVID-19 induced pneumonia
Research development of soft manipulator: A review
Authors: Zongxing Lu , Wanxin Li , Liping Zhang
Published: August 2020

The development of robotic interaction is becoming an increasing topic. The excellent grasp ability of low safety and fragile objects will greatly solve the complex labour of people. Rigid actuation have made significant progress for manufacturing and automation assembly, but it lacks of excellent interaction ability for humans and unstructured environments. Soft manipulator is the basic part of man-machine safety cooperation, which can make up for the deficiency. This paper describes the current research status of soft manipulator, driving methods, structures of soft manipulator and principles. Then, we specially show the joint fluid-elastic pneumatic drive, which enables control bending of different joints of the fingers. A detailed classification and principle description of intelligent materials is made for the flexible hands application. In addition, the principle of two new driving modes: biological driving and gas-liquid driving are presented. The performance of different driving modes is compared in detail, and the advantages and disadvantages of different pneumatic driving modes are listed. Finally, we make some prediction for the application prospect of soft manipulator in the future. The practical application and key problems of soft manipulator are summarised endly.
Endografts with mini-cuff-augmented fenestrations for endovascular repair of thoracoabdominal aortic and common iliac artery aneurysms
Authors: Joseph George , Kota Albert , Thomson Viji Samuel , Perla Harsha Teja , Keshava Shyamkumar N
Published: August 2020

Objective

To report a technique of creating mini-cuff-augmented fenestrations in endografts for use in endovascular aneurysm repair.

Methods

Circular fenestrations are made in Dacron thoracic (Valiant Captivia, Medtronic) or tapered iliac limb (Endurant, Medtronic) endografts using thermal cautery and the edges are strengthened with radio-opaque wire sutured on with 6–0 polypropylene. Straight thin-wall expanded polytetrafluoroethylene vascular graft of the same diameter as the fenestration is affixed to its edge with nonlocking 5–0 polypropylene suture, everted, trimmed, balloon-dilated to its nominal diameter and prevented from invaginating by relaxed external stay sutures. Mini-cuff-augmented fenestrations are often pre-cannulated with looped or externalized nitinol guidewires to facilitate catheter crossing. Successful use of mini-cuff-augmented fenestrations is illustrated in a symptomatic patient with Crawford extent-3 thoracoabdominal aortic and bilateral common iliac artery aneurysm undergoing endovascular repair. Seven mini-cuff-augmented fenestrations were created to preserve flow into five visceral arteries (celiac, superior mesenteric, left and dual right renal; all arising from the aneurysm) and both internal iliac arteries (arising at the aneurysm edge).

Results

Effective sealing was achieved immediately at all mini-cuff-augmented fenestrations. At 6-month follow-up there were no endoleaks, all fenestration stents were patent and undistorted, and the aneurysm sac size had decreased.

Conclusion

Mini-cuff-augmented fenestrations accomplish effective fenestration sealing, despite being in aneurysmal zones, while preserving the advantages of fenestrations over cuffed branches.
Pharmacists’ perspectives on the value of reason for use information
Authors: Whaley Colin , Bancsi Ashley , Burns Catherine , Grindrod Kelly
Published: August 2020

Background:

The indication for a particular medication, or its reason for use (RFU), is important information for prescribers, pharmacists and patients but is not often communicated in writing from prescribers to pharmacists. Adding RFU to a prescription and a medication label would ensure that pharmacists are confident that they are providing high-quality, accurate patient care. This study aims to describe the perspectives of pharmacists on how receiving RFU from prescribers would affect their practice and how pharmacists putting this information on prescriptions would affect patients.

Methods:

Semi-structured qualitative interviews were conducted with 20 pharmacists in Southwestern Ontario. Thematic analysis was used to analyze the interview transcripts, leading to 4 major themes.

Results:

Pharmacists expressed that RFU should be formatted to ensure that it is of clinical utility via the use of written text and noted that either medical or lay (also known as plain) language would be appropriate for use. Pharmacists indicated that patient privacy should be considered when writing RFU on labels and that patient preference with respect to the addition of RFU should dictate its inclusion on a medication label. Pharmacist access to RFU was universally acknowledged to improve patient safety by providing pharmacists with more information to determine whether the given medication was indicated.

Conclusions:

This study provides further information about the impact that having access to RFU would have on pharmacy practice and can be used to advocate for the inclusion of RFU information with prescriptions to improve patient outcomes. Can Pharm J (Ott) 2020;153:xx-xx.
Autonomous navigation control based on improved adaptive filtering for agricultural robot
Authors: Jia Weikuan , Tian Yuyu , Duan Huichuan , Luo Rong , Lian Jian , Ruan Chengzhi , Zhao Dean , Li Chengjiang
Published: August 2020

Under the complex agricultural operation environment, reliable navigation system is the basic guarantee to realize the agricultural robot automated operation. This study focuses on improving navigation accuracy and control accuracy and conducts related research on autonomous navigation control of agricultural robots. This article discusses the advantages of using strict convergence criteria and combining Sage–Husa adaptive filtering with strong tracking Kalman filtering and then proposes an improved adaptive Kalman filter algorithm. The new algorithm can effectively suppress the filter divergence, improve the dynamic performance of the filter, and ensure its better filtering accuracy and strong adaptive ability to improve navigation accuracy of GPS. Further variable structure switching method is used to prevent proportional integral differential (PID) controller integral saturation phenomenon, which effectively solves the controller over-saturation problem. And combining this method with an improved adaptive filtering algorithm not only can effectively inhibit control interference but also achieve the anti-saturation effect, thereby enhancing the stability and accuracy of the control system. Finally, the simulation and experiment of the new method show that the proposed method greatly improves the ability of the filter to suppress divergence and control precision.
Improved neural network-based adaptive tracking control for manipulators with uncertain dynamics
Authors: Wang Dong-hui , Zhang Shi-jie
Published: August 2020

In this article, a robust adaptive tracking controller is developed for robot manipulators with uncertain dynamics using radial basis function neural network. The design of tracking control systems for robot manipulators is a highly challenging task due to external disturbance and the uncertainties in their dynamics. The improved radial basis function neural network is chosen to approximate the uncertain dynamics of robot manipulators and learn the upper bound of the uncertainty. The adaptive law based on the Lyapunov stability theory is used to solve the uniform final bounded problem of the radial basis function neural network weights, which guarantees the stability and the consistent bounded tracking error of the closed-loop system. Finally, the simulation results are provided to demonstrate the practicability and effectiveness of the proposed method.
Customers’ response to the offer of substitute brands of medicines for the prescribed ones – An exploratory study of consumer behavior in North India
Authors: Kumar Yogesh , Khandelwal Utkal , Saxena Ankit
Published: August 2020

Patients/customers are offered a substitute brand of medicine generally when the prescribed brand is not available at retail store. However, the customers respond in various ways to such an offer. There are many factors that affect the acceptance/rejection of the substitute brand by the customers. This study’s objective is to categorize consumers’ responses to the offer for substitute brand of medicine in place of the prescribed one in north India. Another objective of the study is to identify common characteristics of customers falling in different response categories. Researchers conducted in-depth interviews with chemists/retailers and customers. The common responses of the customers to the offer of substitute drugs were- straightway acceptance, acceptance of substitute brand after the assurance of substitute being chemically equivalent by the pharmacist and rejection of the substitute. Education, age, trust on pharmacist and perceived seriousness of illness were the main factors affecting the acceptance of substitution.
Electroencephalogram patterns in critical care: A primer for acute care doctors
Authors: Anderson Dustin , Jirsch Jeffrey D , Wheatley Matt B , Brindley Peter G
Published: August 2020

Electroencephalograms are commonly ordered by acute care doctors but not always understood. Other reviews have covered when and how to perform electroencephalograms. This primer has a different, unique, and complementary goal. We review basic electroencephalogram interpretation and terminology for nonexperts. Our goal is to encourage common understanding, facilitate inter specialty collaboration, dispel common misunderstandings, and inform the current and future use of this precious resource. This primer is categorically not to replace the expert neurologist or technician. Quite the contrary, it should help explain how nuanced electroencephalogram can be, and why indiscriminate electroencephalogram is inappropriate. Some might argue not to teach nonexperts lest they overestimate their abilities or reach. We humbly submit that it is even more inappropriate to not know the basics of a test that is ordered frequently and resource intensive. We cover the characteristics of the “normal” electroencephalogram, electroencephalogram slowing, periodic epileptiform discharges (and its subtypes), burst suppression, and electrographic seizures (and its subtypes). Alongside characteristic electroencephalogram findings, we provide clinical pearls. These should further explain what the reporter is communicating and whether additional testing is beneficial. Along with teaching the basics and whetting the appetite of the general clinician, this resource could increase mutual understanding and mutual appreciation between those who order electroencephalograms and those who interpret them. While there is more to electroencephalogram than can be delivered via a single concise primer, it offers a multidisciplinary starting point for those interested in the present and future of this commonly ordered test.
Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees
Authors: Goodwin Laura , Samuel Katie , Schofield Behnaz , Voss Sarah , Brett Stephen J , Couper Keith , Gould Doug , Harrison David , Lall Ranjit , Nolan Jerry P , Perkins Gavin D , Soar Jasmeet , Thomas Matthew , Benger Jonathan ,   in collaboration with the Research and Audit Federation of Trainees (RAFT) network
Published: August 2020

Background

The optimal airway management strategy for in-hospital cardiac arrest is unknown.

Methods

An online survey and telephone interviews with anaesthetic and intensive care trainee doctors identified by the United Kingdom Research and Audit Federation of Trainees. Questions explored in-hospital cardiac arrest frequency, grade and specialty of those attending, proportion of patients receiving advanced airway management, airway strategies immediately available, and views on a randomised trial of airway management strategies during in-hospital cardiac arrest.

Results

Completed surveys were received from 128 hospital sites (76% response rate). Adult in-hospital cardiac arrests were attended by anaesthesia staff at 40 sites (31%), intensive care staff at 37 sites (29%) and a combination of specialties at 51 sites (40%). The majority (123/128, 96%) of respondents reported immediate access to both tracheal intubation and supraglottic airways. A bag-mask technique was used ‘very frequently’ or ‘frequently’ during in-hospital cardiac arrest by 111/128 (87%) of respondents, followed by supraglottic airways (101/128, 79%) and tracheal intubation (69/128, 54%). The majority (60/100, 60%) of respondents estimated that ≤30% of in-hospital cardiac arrest patients undergo tracheal intubation, while 34 (34%) estimated this to be between 31% and 70%. Most respondents (102/128, 80%) would be ‘likely’ or ‘very likely’ to recruit future patients to a trial of alternative airway management strategies during in-hospital cardiac arrest. Interview data identified several barriers and facilitators to conducting research on airway management in in-hospital cardiac arrest.

Conclusions

There is variation in airway management strategies for adult in-hospital cardiac arrest across the UK. Most respondents would be willing to take part in a randomised trial of airway management during in-hospital cardiac arrest.
Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study
Authors: Bagga Rahul , Cay Peter , Ricketts David , Roper Tom , Phadnis Joideep
Published: August 2020

Aim

The aim of this study was to assess the accuracy of quotations of the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study in the published literature.

Methods

A literature search was performed from March 2015 to November 2019 to identify all papers that reference ProFHER since its publication. Full text articles were reviewed by two independent reviewers using a validated framework of assessing quotation errors. A kappa co-efficient was calculated to assess interobserver reliability of the reviewers.

Results

There were 260 individual ProFHER quoted references within the 138 included articles. We identified 35/260 quotation errors (13%). Of these, 10/35 (29%) were major quotation errors and 25/35 (71%) minor quotation errors. There was substantial interobserver agreement when errors were classified. Of the 10 major errors, six quotations were not substantiated by the results of ProFHER and three were unrelated to ProFHER. One paper contained a quotation error that contradicted the results of ProFHER. Of the 25 minor errors, 19 oversimplified or generalised the conclusions of ProFHER and six contained numerical or grammatical errors.

Conclusion

The current study demonstrated substantial inaccuracies in quotations of the Proximal Fracture of the Humerus Evaluation by Randomization study. Vigilance is recommended when quoting the literature and reviewing submitted papers in order to prevent the perpetuation of misquoted data.
Acquisition of human capital for organizational sustainability: A BASS-SIR forecasting approach
Authors: Dankyi Alex Boadi , Yusheng Kong , Ankomah-Asare Evans Takyi , Dankyi Joyce Kwakyewaa , Addo Antoinette Asabea
Published: August 2020

We investigated the probabilities of acquisition of requisite human capital by new entrants in the institutional network. Graph theories applied in complex social networks using multi-attribute decision models were employed for our study. We coupled the dynamical and complexities of social network analysis with BASS-SIR epidemiological model to ascertain sustainability in the light of internal and external forces in the human capital acquisition. The results show that a new entrant’s ability to acquire human capital within the network increases rapidly and reaches a steady state by the third month. The fractional analysis indicated that a combined effect of internal and external injection of knowledge into the network sees entrants acquiring the required knowledge and work world skills in a relatively shorter time. Finally, the discrete and continuous analyses revealed that relatively even and continuous patterns of information flow reduce the time of reaching a steady state in the industry. We recommend a strong policy on continuous and even rates of training, a high rate of information flow such as internal and external training with the emphasis on internal training systems to gain competitive advantage.
Patients with Type 1 Diabetes Treated with Insulin Pumps Need Widely Heterogeneous Basal Rate Profiles Ranging from Negligible to Pronounced Diurnal Variability
Authors: Lindmeyer Anna M. , Meier Juris J. , Nauck Michael A.
Published: August 2020

Background:

Pump-treated patients with type 1 diabetes have widely differing basal insulin infusion profiles. We analyzed consequences of such heterogeneity for glycemic control under fasting conditions.

Methods:

Data from 339 adult patients with type 1 diabetes on insulin pump therapy undergoing a 24-hour fast (basal rate test) were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations as well as their proportions within, below, or above arbitrarily defined target ranges were assessed for specific periods of the day (eg, 1-7 hours, “dawn” period, 16-19 hours, “dusk” period, reference period 20-1 hours/10-14 hours), by tertiles of a predefined “dawn” index (mean basal insulin infusion rate during the “dawn” divided by the reference periods).

Results:

The “dawn” index varied interindividually from 0.7 to 4.4. Basal insulin infusion profiles exhibited substantial differences ( P = .011), especially overnight. Despite higher insulin infusion rates at 4 and 6.45 hours, patients with the most pronounced “dawn” phenomenon exhibited higher plasma glucose concentrations at those time points ( P < .012). Patients with a marked “dawn” phenomenon exhibited a lower probability for low (<4.4 mmol/L) and a higher probability of high values (>7.2 mmol/L) during the dawn period (all P values <.01).

Conclusions:

We observe substantial interindividual heterogeneity in the “dawn” phenomenon. However, widely different empirically derived basal insulin infusion profiles appear appropriate for individual patients, as indicated by similar plasma glucose concentrations, mainly in the target range, during a 24-hour fasting period.
“Regulatory capture” and “extractive hegemony”: the relevance of Nicos Poulantzas’ theory of the state to contemporary environmental politics in Canada
Authors: Bernauer Warren
Published: August 2020

This paper considers the relevance of Nicos Poulantzas’ theory of the state to debates about hydrocarbon extraction and environmental assessment in Canada. I begin with a brief summary of Poulanztas’ work, followed by an overview of the politics of hydrocarbon extraction in Canada. Next, I examine recent public policy debates about the assessment and regulation of energy extraction in Canada. These debates, which focus on the concept of “regulatory capture,” fall victim to many of the problems Poulantzas identifies with instrumentalist approaches to the state. Critical accounts of regulatory capture have helped expose the fact that oil companies exercise an incredible degree of control over the Canadian state. However, it offers limited guidance for long-term strategies to confront extractive capital. In the section on “Environmental assessment and extractive hegemony,” I draw on Poulantzas to examine recent academic debates about the role of environmental assessment in the reproduction of extractive capitalism in Canada. Scholars have shown a more nuanced understanding of the power dynamics at play in the assessment and regulation of energy projects in Canada. Nevertheless, engagement with Poulantzas’ work can help deepen and expand these critiques, especially his emphasis on the role of state-organized material concessions in producing consent to capitalism.
Emetophobia: A case of nausea leading to dehydration in an adolescent female
Authors: Kannappan Anju , Middleman Amy B
Published: August 2020

Emetophobia is defined as the specific fear of vomiting and avoidance behaviors related to vomiting situations; the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, specifies this condition as a Specific Phobia: Other type: Vomiting (SPOV). Our case report describes an adolescent presenting with medical complications, specifically notable dehydration, due to new onset Specific Phobia: Other type: Vomiting after experiencing a bout of viral gastroenteritis. In this patient’s case, her severe anxiety served as the root cause for a significant decrease in her quality of life for a year and was not identified by healthcare providers until after an extensive medical workup had taken place. Treatment involved alleviating her dehydration with slow introduction of foods with high water content into her diet and addressing her anxiety with hydroxyzine as a short-term intervention and a selective serotonin reuptake inhibitor for long-term management. This treatment plan allowed for our patient’s symptoms to resolve over the course of a few months and she was able to return to her usual activities of daily living. With discussing emetophobia, this case highlights a topic that is not largely discussed in the literature surrounding adolescent health.
The effects of COVID-19 on training within urology: Lessons learned in virtual learning, human factors, non-technical skills and reflective practice
Authors: Fonseka T , Ellis R , Salem H , Brennan PA , Terry T
Published: August 2020

The COVID-19 pandemic has changed training and recruitment in urology in unprecedented ways. As efforts are made to ensure trainees can continue to progress, lessons can be learned to improve training and urological practice even after the acute phase of the pandemic is over. Novel methods of education through virtual learning have burgeoned amidst the social distancing the pandemic has brought. The importance of training in human factors and non-technical skills has also been brought to the fore while operating under the constraints of personal protective equipment and working in new teams and unfamiliar environments. This paper critically appraises the available evidence of how urological training has been affected by COVID-19 and the lessons we have learned and continue to learn going forward.

Level of Evidence:

Not Applicable.
Disseminated Coccidioidomycosis Following Insufficient Treatment at Initial Presentation: Case Report
Authors: Dev Ameesh , Janysek Dawn , Gnecco James , Haghayeghi Kamyar
Published: August 2020

A 35-year-old male presented to our university hospital with night sweats, fevers, ulcerated skin lesions to the lower mouth and posterior neck, shortness of breath, and an enlarging cervical lymph node. The patient was evaluated 2 months prior for respiratory symptoms, cervical lymphadenopathy, and skin lesions resulting in a diagnosis of primary pulmonary coccidioidomycosis and was treated with a 4-week course of fluconazole. On presentation to our hospital, initial laboratory test results revealed leukocytosis, increased liver enzymes, elevated inflammatory markers, and hypercalcemia. Computed tomography scan of the chest revealed lung nodules in a miliary pattern and prominent mediastinal lymphadenopathy. Magnetic resonance imaging revealed multiple vertebral and iliac bone lesions, as well as bilateral psoas muscle lesions. Serum ELISA (enzyme linked immunosorbent assay) detected elevated serological markers against coccidioides, and sputum culture revealed coccidioides arthroconidia, confirming the presence of an acute coccidioides infection. Biopsy of the right iliac crest and cervical lymph node revealed spherules resembling coccidioides, escalating the diagnosis to disseminated coccidioidomycosis. The patient’s hospital course was complicated by septic shock, acute respiratory distress syndrome requiring several days of mechanical ventilation, and acute kidney injury. He was ultimately treated with several weeks of voriconazole and liposomal amphotericin-B. He made a full recovery and was discharged on an extended course of oral voriconazole. Our case highlights the importance of recognition and appropriate treatment duration of disseminated coccidioidomycosis at initial presentation. Failure to do so may lead to increased morbidity and mortality.
The Binaural Interaction Component of the Auditory Brainstem Response Under Precedence Effect Conditions
Authors: Dean Kelly , Grose John H.
Published: August 2020

The purpose of this study was to measure the binaural interaction component (BIC) derived from click-evoked auditory brainstem responses (ABRs) using stimuli configured to elicit the Precedence Effect. The hypothesis was that the contribution of binaural processing to echo suppression can be evidenced by a diminished or absent BIC associated with the echo. Ten normal-hearing young adults provided ABRs generated by sequences of click pairs. Results showed that BICs elicited by diotic clicks in isolation were obliterated when those diotic clicks were preceded by a click pair having an interaural time difference of 400 µs and where the interclick interval was 8.4 ms. The presence of the leading click pair increased the latency of the ABR generated by the lagging diotic click pair but did not decrease its amplitude. The results were interpreted as indicating a contribution of binaural processing at the level of the brainstem to echo suppression, at least for the conditions tested here.
Criminal Threats Undermining Indo-Pacific Maritime Security: Can International Law Build Resilience?
Authors: Lindley Jade
Published: August 2020

Maritime security in the Indo-Pacific region is strategically important to not only the surrounding states, but also those with an interest in its good governance, to support safe passage and natural resources extraction. Criminal threats, such as maritime piracy and illegal fishing, enabled by corruption and the potential for terrorism, undermine regional maritime security and therefore, there is incentive for states to respond cooperatively to secure the region. Drawing on broken windows crime theory, implicitly supporting the continuation of criminal threats within the region may enables exiting crimes to proliferate. With varying legal and political frameworks and interests across the Indo-Pacific region, achieving cooperation and harmonisation in response to regional maritime-based criminal threats can be challenging. As such, to respond to criminal threats that undermine maritime security, this article argues that from a criminological perspective, aligning states through existing international law enables cooperative regional responses. Indeed, given the prevalence of corruption within the region enabling serious criminal threats, harmonising through existing counter-corruption architecture may be a suitable platform to build from.