bluuebunny/crossref_metadata_2025 huggingface dataset:
Trajectory tracking control of hypersonic vehicle considering modeling uncertainty
Authors: Wang Yuxiao , Chao Tao , Wang Songyan , Yang Ming
Published: February 2019

The tightly coupled, highly nonlinear, and notoriously uncertain nature of hypersonic vehicle dynamics brings a great challenge to the control system design. In this paper, an integrated controller based on Differential flatness theory and L1 adaptive theory is designed, and a nonlinear disturbance observer is added to solve the problem of model uncertainty. Differential flatness is applied to the outer loop to linearize the nonlinear model, and L1 adaptive control is applied to the inner loop to stabilize the attitude. The combination realizes the complementarity of their shortcomings. It can not only retain the advantages of L1 adaptive controller, but also avoid wide range of state changes and makes it easy to design parameters satisfying global convergence. The computational order of differential flatness is also reduced and the design of nonlinear disturbance observer becomes feasible. Simulation results for the hypersonic vehicle are presented to demonstrate the effectiveness and robustness of the proposed control scheme.
Thrust control strategy based on the minimum combustor inlet Mach number to enhance the overall performance of a scramjet engine
Authors: Ji Zifei , Zhang Huiqiang , Wang Bing
Published: February 2019

A lower combustor inlet Mach number is desirable in order to design a compact, lightweight combustor and boost the overall performance of the scramjet engine. In this study, a thrust control strategy is proposed for a hydrogen-fueled scramjet taking into account the operating limitations, which is called the minimum combustor inlet Mach number rule since the combustor inlet Mach number is used as the control variable. By scheduling the fuel supply and modifying the intake geometry, the combustor inlet Mach number can be minimized while ensuring a certain thrust output within the operation constraints. In this manner, the scramjet engine can be operated with high specific thrust and low fuel consumption throughout the flight envelope. The thrust control strategy is further applied to a hydrogen-fueled scramjet in the hypersonic flight regime. Because the combustor inlet Mach number varies with flight conditions, the thrust strategy can be applied in practice by monitoring the following aerothermodynamic parameters in different flight regimes instead: (1) combustor outlet Mach number, (2) combustor inlet static temperature, and (3) combustor outlet static temperature. Furthermore, the effects of the thrust output on the division of flight regime are investigated, and the overall performance of the hydrogen-fueled scramjet engine obtained from applying the thrust control strategy is discussed in detail.
Property Damage and Exposure to Other People in Distress Differentially Predict Prosocial Behavior After a Natural Disaster
Authors: Vardy Tom , Atkinson Quentin D.
Published: February 2019

The persistent threat of natural disasters and their attendant resource shocks has likely shaped our prosocial drives throughout human evolution. However, it remains unclear how specific experiences during these events might impact cooperative decision making. We conducted two waves of four modified dictator-game experiments with the same individuals in Vanuatu ( N = 164), before and after Cyclone Pam in 2015. After the cyclone, participants were generally less likely to show prosocial motives toward both in-group and out-group members and more likely to show parochialism when sharing between groups. Experiencing greater property damage predicted a general decrease in prosocial allocations and preference for participants’ in-group. By contrast, exposure to other people in distress predicted increased prosocial allocations to both participants’ in-group and out-groups. Our results suggest that people adjust their prosocial behavior in response to natural disasters but that the nature and direction of the effect depend on the type and severity of their experiences.
Dynamic analysis of high-speed traction elevator and traction car–rope time-varying system
Authors: Zhang Qing , Yang Yu-hu , Hou Tao , Zhang Rui-jun
Published: February 2019

In this study, the compensating ropes and tension device on elevator vibration, as well as the car and hoisting ropes between the top of the car and traction wheel in a high-speed traction elevator lift system, were considered a system to analyze the effect of traction force. In addition, the vertical vibration of the system was used as the research object. The influence of hoisting ropes quality was measured, and a time-varying dynamic model with variable mass, damping, and stiffness for the car–hoisting rope system was constructed from the perspective of time-varying structural mechanics. Simultaneously, the ideal running state of the elevator, which is fitted by using the quintic polynomial, was utilized as input motion parameter. Then, a case study was conducted by using the fine integral method for the vertical vibration dynamic model of the car–hoisting rope system. Finally, the nonlinear vertical vibration response of the car–hoisting rope system during the operation of high-speed traction elevator was obtained. Results indicated that the influence of traction force, compensating ropes, and tension device on the vibration of the car–hoisting rope system when the elevator is in the upward process is greater than when the elevator is in the downward process. In addition, the low quality of the elevator car leads to the production of strong longitudinal vibration. The linear density of the hoisting ropes has a slight effect on the longitudinal vibration of elevator.
Protective effects of whey on rat liver damage induced by chronic alcohol intake
Authors: Radic I , Mijovic M , Tatalovic N , Mitic M , Lukic V , Joksimovic B , Petrovic Z , Ristic S , Velickovic S , Nestorovic V , Corac A , Miric M , Adzic M , Blagojevic DP , Popovic L , Hudomal SJ
Published: February 2019

In 2012, alcohol liver disease resulted in 3.3 million—5.9% of global deaths. This study introduced whey protection capacity against chronic alcohol-induced liver injury. Rats were orally administered to 12% ethanol solution in water (ad libitum, average 8.14 g of ethanol/kg body weight (b.w.)/day) alone or combined with whey ( per os, 2 g/kg b.w./day). After 6-week treatment, chronic ethanol consumption induced significant histopathological liver changes: congestion, central vein dilation, hepatic portal vein branch dilation, Kupffer cells hyperplasia, fatty liver changes, and hepatocytes focal necrosis. Ethanol significantly increased liver catalase activity and glutathione reductase protein expression without significant effects on antioxidative enzymes: glutathione peroxidase (GPx), copper–zinc-containing superoxide dismutase (CuZnSOD) and manganese-containing superoxide dismutase (MnSOD). Co-treatment with whey significantly attenuated pathohistological changes induced by ethanol ingestion and increased GSH-Px and nuclear factor kappa B (NF-κB) protein expression. Our results showed positive effects of whey on liver chronically exposed to ethanol, which seem to be associated with NF-κB-GPx signaling.
Beneficial role of vanillin, a polyphenolic flavoring agent, on maneb-induced oxidative stress, DNA damage, and liver histological changes in Swiss albino mice
Authors: Sefi M , Elwej A , Chaâbane M , Bejaoui S , Marrekchi R , Jamoussi K , Gouiaa N , Boudawara-Sellemi T , El Cafsi M , Zeghal N , Soudani N
Published: February 2019

Vanillin, a widely used flavoring agent, has antimutagenic and antioxidant properties. The current study was performed to evaluate its beneficial role against hepatotoxicity induced by maneb, a dithiocarbamate fungicide. Mice were divided into four groups of six each: group 1, serving as negative controls which received by intraperitoneal way only distilled water, a solvent of maneb; group 2, received daily, by intraperitoneal way, maneb (30 mg kg−1 body weight (BW)); group 3, received maneb at the same dose of group 2 and 50 mg kg−1 BW of vanillin by intraperitoneal way; and group 4, serving as positive controls, received daily only vanillin. After 10 days of treatment, mice of all groups were killed. Our results showed that vanillin significantly reduced the elevated hepatic levels of malondialdehyde, hydrogen peroxide, and advanced oxidation protein product and attenuated DNA fragmentation induced by maneb. In addition, vanillin modulated the alterations of antioxidant status: enzymatic (superoxide dismutase, catalase, and glutathione peroxidase) and nonenzymatic (reduced glutathione, nonprotein thiol, and vitamin C) antioxidants in the liver of maneb-treated mice. This natural compound was also able to ameliorate plasma biochemical parameters (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, total bilirubin, and total protein). The protective effect of vanillin was further evident through the histopathological changes produced by maneb in the liver tissue. Thus, we concluded that vanillin might be beneficial against maneb-induced hepatic damage in mice.
Epigenetics and Hot Spots of Crime: Rethinking the Relationship Between Genetics and Criminal Behavior
Authors: Leshem Rotem , Weisburd David
Published: February 2019

There is a growing recognition of the importance of micro-geographic areas in the generation of crime problems. While many studies show that crime is heavily concentrated at crime hot spots, scholars have only begun to examine how living in such places affects human development. We point to an unexplored component of the relationship between living in a hot spot, and crime and violence. We argue that crime hot spots function as violent and stressful environments and thus have long-term, possibly intergenerational, impacts on brain development. It is proposed that living in such places may be associated with DNA methylation profiles related to aggressive behavior. In this context, the study of the epigenetic influences of crime hot spots has tremendous potential for advancing our understanding of crime and violence, as well as generating new approaches for crime prevention.
Effect of carbon nanotube waviness on smart damping of geometrically nonlinear vibrations of fuzzy-fiber reinforced composite plates
Authors: Datta Priyankar , Ray Manas Chandra
Published: February 2019

In this article, we present a finite element model for the three-dimensional analysis of smart constrained layer damping of geometrically nonlinear vibrations of laminated fuzzy-fiber reinforced composite plates. The three-dimensional fractional derivative constitutive relation is implemented for the viscoelastic layer. The constraining layer of the smart constrained layer damping treatment is composed of the vertically/obliquely reinforced 1–3 piezoelectric composites. The von Kármán–type nonlinear strain–displacement relations are used to incorporate the geometric nonlinearity in the model. The main aim of this article is to numerically investigate the effect of carbon nanotube waviness on the nonlinear smart damping. Several thin laminated substrate fuzzy-fiber reinforced composite plates with straight carbon nanotubes and wavy carbon nanotubes with different waviness in different planes are considered with various boundary conditions and stacking sequences to numerically compute their effect on smart damping. The performance of the obliquely reinforced 1–3 piezoelectric composites is discussed and the efficacy of the present smart finite element model in terms of active control authority is also presented.
An experimental study of mechanical behavior of brittle rock-like specimens with multi-non-persistent joints under uniaxial compression and damage analysis
Authors: Yang Wendong , Li Guizhi , Ranjith PG , Fang Lindong
Published: February 2019

The mechanical behavior of jointed rock masses significantly affects the stability of rock engineering applications. In this paper, the peak strength, Young's modulus and failure patterns of brittle rock-like specimens with multi-non-persistent joints under uniaxial compression are investigated. The joint geometry is defined by four factors: joint angle, spacing, joint length, and rock bridge length. The experiment results show that the joint angle has the greatest influence on the peak strength and Young's modulus of specimens, followed by joint length. A damage mechanical theory is adopted which deals with some sets of joints distributed in rock masses. Based on the geometrical distribution of joints, a macro damage model which considers the influence of the normal vector and area density of joints is used to describe the joints. The peak strength and Young's modulus of jointed specimens predicted by the damage mechanics method reflect the trend of the experimental results, which proves the influence of initial geometric damage of joints on the peak strength and Young's modulus of jointed specimens. The initial geometric damage of joints is mainly induced by the joint area density. Finally, from the micro damage aspect, to analyze the damage evolution and strain softening process of jointed rock masses, a modified numerical model (damage strainsofting model) on the basis of secondary development in fast Lagrangian analysis of Continua is proposed to simulate the fracture development of jointed rock masses. The peak strengths, Young's modulus and failure modes of rock specimens with non-persistent joints under uniaxial compressions are simulated and compared with the results obtained from the lab experiments indicating that the model is capable to replicate the physical processes.
Deriving the bodily grounding of living beings with molecular autopoiesis
Authors: Agmon Eran
Published: February 2019

“Are living beings extended autopoietic systems? An embodied reply,” makes the case for grounding the autopoietic definition of living beings to the discrete bodies of organisms rather than to autopoietic systems that extend beyond the organisms into their environments. They attempt this grounding by amending a clause to the original formulation of autopoiesis that identifies living beings with their bodies, and then they explicitly define “bodies”. This commentary makes the case that bodily grounding can be derived from molecular autopoiesis by taking the molecular domain seriously, and no new amendment is required.
A little more social enaction than that: comment on Arango (2019)
Authors: McGann Marek
Published: February 2019

In his article “From Sensorimotor Dependencies to Perceptual Practices”, Alejandro Arango presents a case for socialising enactive perception. While noting the importance of understanding perception as embodied, he argues that addressing just the issues of embodiment is not enough, that the socially situated and conditioned character of bodies, and the practices involved in perception, must be given full account. In surveying the current state of enactive theories of perception Arango dismisses what he terms “autopoietic” enactivism as only “hand waving” on the manner in which social aspects of life affect or transform bodily perception and action. In this commentary I argue that Arango has overlooked an important body of research by researchers in the “life-mind” or “sense-making” domain of enactive thinking. This literature addresses the dynamics of sociality in perception and action, and while greater integration between the descriptions of embodied action and social engagement is needed, significant progress has been made on this matter in recent publications.
Career Indecision Profile–Short: Reliability and Validity Among Employees and Measurement Invariance Across Students and Employees
Authors: Xu Hui
Published: February 2019

While the Career Indecision Profile–Short (CIP-Short) has demonstrated sound reliability and validity as a brief measure of career indecision in students, its psychometric performance in employees remains unclear. To facilitate research and practice on career indecision within the employee population, the present study examined the internal consistency reliability, structural validity, and convergent validity of the CIP-Short in employees. Additionally, the present study examined the measurement invariance of the CIP-Short across students and employees. Based on a sample of students ( n = 330) and a sample of employees ( n = 436), the results revealed that (1) the CIP-Short demonstrated good internal consistency reliability in employees, (2) the CIP-Short validly measured the four-factor structure of career indecision in employees, (3) the CIP-Short was positively associated with career decision ambiguity aversion and negatively associated with career adaptability in employees, and (4) the CIP-Short demonstrated measurement invariance on configural, metric, and scalar levels across students and employees. The theoretical and practical implications of this study are discussed, along with limitations and suggestions for future research.
Trading Places: Microlevel Predictors of Women Who Commit Intimate Partner Homicide
Authors: Szalewski Alec , Huff-Corzine Lin , Reckdenwald Amy
Published: February 2019

Intimate partner homicide (IPH) research has established the importance of the offender’s gender regarding motivations, situations, and structures present in the offense. However, little is known about female IPH perpetrators’ microlevel characteristics, despite research indicating female IPH offense numbers are closer to males’ than in other homicide types. To fill this gap, the current exploratory study assesses the likelihood of female-perpetrated IPH by the couples demographics, weapon type, relationship status, and regional location of the homicide. Using data from the Supplementary Homicide Reports (SHR), results show microlevel gender-specific differences. Female, compared to male, IPH perpetrators more often kill in intraracial, compared to interracial relationships, and are more likely to kill in dating rather than marital relationships.
Clinical features of cats diagnosed with coccidioidomycosis in Arizona, 2004–2018
Authors: Arbona Nichole , Butkiewicz Christine D , Keyes Minta , Shubitz Lisa F
Published: February 2019

Objectives

The goal of this study was to describe the clinical presentation, diagnosis and treatment of coccidioidomycosis in cats residing in a region endemic for Coccidioides species.

Methods

A retrospective review of records was performed at both primary and tertiary care veterinary practices in Tucson and Phoenix, Arizona, USA. Data collected included signalment, clinical signs, physical examination findings, diagnostic test results, treatment and outcome.

Results

Fifty-one feline cases were identified from six veterinary hospitals. Cats presented with clinical signs and laboratory abnormalities similar to what has been seen in dogs, including respiratory illness (n = 20/51), neutrophilia (n = 24/31), monocytosis (n = 17/31) and hyperglobulinemia (n = 16/30). However, cats at diagnosis were typically significantly ill, with 31/51 having disseminated infection, most commonly to the skin (n = 22). Additionally, 43/44 cats that had serum antibody tests performed were positive, and median titer at diagnosis was 1:32 (range 1:4 to ⩾1:256). Serum antibody titers were significantly reduced ( P ⩽0.001) in cats that responded to treatment compared with cats that did not clinically improve. Forty of 46 cats that were treated with oral fluconazole responded and did not require additional therapy. Fourteen cats developed recurrent disease and all but one had antifungal therapy successfully reinstituted.

Conclusions and relevance

Coccidioidomycosis is a disease of concern for cats residing in the regions endemic for Coccidioides species. Disease is most often disseminated at the time of diagnosis, possibly due to delays in presentation for care and recognition of the infection. Suspicion of disease, serum chemistries, blood cell counts, presence of antibody and imaging aid in the diagnosis of coccidioidomycosis in cats. Serum antibody reduction during treatment frequently correlated with an adequate response to medication. Consideration of coccidioidomycosis as a cause of illness will lead to earlier diagnosis and potentially better treatment outcomes in cats.
Outcomes of radiocephalic fistula created by nephrologists
Authors: Prasad Narayan , Thammishetti Venkatesh , Bhadauria DS , Kaul Anupama , Sharma RK , Srivastava Aneesh , Gupta Amit
Published: February 2019

Introduction:

Arteriovenous fistula is considered as gold standard access for maintenance hemodialysis. Due to increasing burden of end-stage renal disease requiring dialysis, it is important for nephrologists to complement creation of arteriovenous fistula to meet the demand.

Methods:

This retrospective study was designed to assess the outcomes of arteriovenous fistula made by nephrologists at a tertiary care center from North India. The study included all radiocephalic arteriovenous fistula performed by nephrologists between November 2015 and January 2017. All arteriovenous fistulas were performed in patients whose duplex ultrasonography revealed both arterial and venous diameter of at least 2 mm. Data were collected with regard to age, gender, dialysis status, basic diseases, co-morbidities, and mineral bone disease parameters. The predictors of the primary and secondary patency rates were analyzed.

Results:

Five hundred patients (age 39.3 ± 14.4 years; 82.4% males; 21.6% diabetics) were included. In total, 83 (16.6%) patients had primary failure and 31 (7%) patients had secondary failure. Diabetes was associated with poor primary and secondary patency rates. Mean survival among the patients without primary failure was 11 months. The primary patency rates at 3, 6, 12, 18, and 21 months were 82%, 78%, 73%, 70%, and 70%, respectively.

Conclusion:

To conclude, the outcomes of radiocephalic arteriovenous fistulas created by nephrologists are at par with historic outcomes.
Palliative care and public health: an asymmetrical relationship?
Authors: Whitelaw Sandy , Clark David
Published: February 2019

Interest in the potential for public health and palliative care to work together is now widely established. Based on a mapping review of existing literature, we describe for the first time the ways in which public health has entered palliative care policy and practice and how this has been specifically articulated. We then go on to pursue analytical and critical lines of enquiry that are largely absent from the existing literature. We do this in three ways: (i) by considering why the link between public health and palliative care has become so ubiquitous within palliative care policy; (ii) by establishing how this has been constructed; and (iii) by exploring public health as a ‘reference discipline’ from which its ‘secondary deployment’ can become embedded inside another disciplinary field. From this, we develop a range of critical perspectives on the relationship between public health and palliative care by scrutinising its claims of utility and effectiveness and questioning the strength of the interdisciplinary interaction between the two disciplines. We see their relationship in a ‘cross disciplinary’ context which is still largely symbolic and tactical in nature. We conclude by considering the significance of these insights for policy and practice, with two possible scenarios. If the use of public health is essentially figurative and its resources are not unique, the particular and exclusive use of the term becomes insignificant. Progressive and effective policy and practice is possible, independent of any explicit public health label. If however public health is considered to have intrinsic and definable worth, we suggest that this currently asymmetrical association needs to be significantly developed with much higher levels of theoretical, practical and critical engagement between the two disciplines. Such work would result in more reflective and robust policy and practice.
Current State of the Literature on Psychological and Social Sequelae of Sports-Related Concussion in School-Aged Children and Adolescents
Authors: Wilmoth Kristin , Tan Alexander , Hague Cole , Tarkenton Tahnae , Silver Cheryl H , Didehbani Nyaz , Rossetti Heidi C , Batjer Hunt , Bell Kathleen R , Cullum C Munro
Published: February 2019

Considerably less attention has been paid to psychological and social sequelae of concussion in youth athletes compared with neurocognitive outcomes. This narrative review consolidates the literature on postconcussive emotional and psychosocial functioning in school-aged children and adolescents, highlighting athlete-specific findings. MEDLINE and PsycINFO databases were queried for pediatric concussion studies examining psychological and/or social outcomes, and 604 studies met search criteria (11 of those specific to sport). Results were organized into domains: emotional and social dysfunction, behavioral problems, academic difficulties, sleep disturbance, headache, and quality of life. The small body of literature regarding psychological and social issues following pediatric concussion suggests behavioral disturbances at least temporarily disrupt daily life. Extrapolation from samples of athletes and nonathletes indicates postconcussive anxiety and depressive symptoms appear, although levels may be subclinical. Social and academic findings were less clear. Future well-controlled and adequately powered research will be essential to anticipate concussed athletes’ psychosocial needs.
Remaking identities and stereotypes: How film remakes transform and reinforce nationality, disability, and gender
Authors: Cuelenaere Eduard , Willems Gertjan , Joye Stijn
Published: February 2019

When films are being remade, they undergo several transformations, including changes related to (the representation of) national, disability, and gender identities. By drawing on the case of the Flemish film Hasta La Vista and its Dutch remake Adios Amigos, this article critically investigates the (dis)similarities on these levels through the prism of the film remake. Both films are popular road trip movies dealing with the adventure of three friends with disabilities who overcome boundaries in multiple ways not only by figuratively (and almost literally) escaping their parents and their disabilities but also through traveling, exploring sexuality, and eventually by dying. Although the films deal with almost exactly the same themes, their interpretation and contextualization differ considerably. Our findings show that as a consequence of the localizing processes embedded in film remakes, subtexts which were ‘originally’ ingrained in the source text were ignored or even withheld in the newer version. As the involved filmmakers built on particular stereotypical visions and myths about these specific cultures and national identities, often with the purpose of recreating a socio-cultural context, such narrowed perceptions were occasionally subverted but also reconsolidated. Finally, we argue that, through the remake process, some ableist and patronizing representations of, respectively, disability and gender identities were subverted, while others were kept or even reinforced. Our results show that such transformations point toward specific socio-culturally defined disability and gender identities but also toward a shared and almost universally shaped disability and gender culture.
Data ambiguity and clinical decision making: A qualitative case study of the use of predictive information technologies in a personalized cancer clinical trial
Authors: Even Chorev Nadav
Published: February 2019

Personalized medicine aims to tailor the treatment to the specific characteristics of the individual patient. In the process, physicians engage with multiple sources of data and information to decide on a personalized treatment. This article draws on a qualitative case study of a clinical trial testing a method for matching treatments for advanced cancer patients. Specialists in the trial used data and information processed by a specifically developed drug-efficacy predictive algorithm and other information artifacts to make personalized clinical decisions. While using high-resolution data in the trial was expected to provide a more accurate basis for action, sociomaterial engagements of oncologists with data and its representation by artifacts paradoxically hindered personalized clinical decisions. I contend that the engagement between human discretion, ambiguous data, and malleable artifacts in this non-standardized trial produced moments of contradiction within entanglement. Sociomaterial approaches should acknowledge such conflicts in further analyses of medical practice transitions.
Making person-centred assessments
Authors: Symonds Jon , Miles Caroline , Steel Mike , Porter Sue , Williams Val
Published: February 2019

The social care assessment is a ‘key interaction’ between a person and the local authority with ‘critical’ importance for determining a person’s needs for care and support. In order to achieve this, the guidance requires that assessments must be ‘person-centred throughout’. The concept of person-centred practice is now routinely invoked, but there remains little empirical evidence on how it gets put into practice.

Findings

This paper draws on interview data from 30 practitioners about their experiences of conducting social care assessments in England. While there was widespread support for the principles of a person-centred approach, tensions emerged for practitioners in three ways: the way in which ‘chat’ was used to build a relationship or conduct the assessment, whether to conduct the assessment via a conversation or by following the sections on the agency form and the extent to which the assessor should involve and negotiate the contributions of family members.

Applications

We argue that each of these dilemmas represents an occasion when a commitment to person-centred practice is negotiated between professionals and service users and sometimes compromised as a result. We consider the possibilities for and constraints on achieving person-centred assessments in a post-Care Act environment and discuss the implications for social work practice and research.
The use of triangulation in qualitative studies employing elite interviews
Authors: Natow Rebecca S.
Published: February 2019

Elite interviews provide valuable information from perspectives of power and privilege. However, the information elites provide may be biased or inaccurate, and researchers must be knowledgeable about the elites they interview. Therefore, the use of triangulation in studies using elite interviews is crucial. This article analyzes more than 120 peer-reviewed articles that reported the findings of elite interview research to understand the researchers’ use of triangulation. This analysis found that triangulation was common in studies that involved elite interviews, particularly by combining interviews with document review. This analysis also found that the purpose and value of triangulation in these studies varied based on the researchers’ interpretive frameworks.
Interactive 3D Reconstruction of Pulmonary Anatomy for Preoperative Planning, Virtual Simulation, and Intraoperative Guiding in Video-Assisted Thoracoscopic Lung Surgery
Authors: Sardari Nia Peyman , Olsthoorn Jules R. , Heuts Samuel , Maessen Jos G.
Published: February 2019

Objectives

Routine imaging modalities combined with state-of-the-art reconstruction software can substantially improve preoperative planning and simplify complex procedure by enhancing the surgeon’s knowledge of the patient’s specific anatomy. The aim of the current study was to demonstrate the feasibility of interactive three-dimensional (3D) computed tomography (CT) reconstructions for preoperative planning and intraoperative guiding in video-assisted thoracoscopic lung surgery (VATS) with 3D vision.

Methods

Twenty-five consecutive patients referred for an anatomic pulmonary resection by a single surgeon were included. Data were collected prospectively. All patients underwent a CT angiography in the diagnostic pathway prior to referral. 3D reconstruction of the pulmonary anatomy was obtained from CT scans with dedicated software. An interactive PDF file of the 3D reconstruction with virtual resection was created, in which all the pulmonary structures could be individually selected. Furthermore, the reconstructions were used for intraoperative guiding on double monitor during VATS with 3D vision.

Results

In total, 26 procedures were performed for 5 benign and 21 malignant conditions. Lobectomy and segmentectomy were performed in 20 (76.9 %) and 6 (23.1%) cases, respectively. In all patients, preoperative 3D reconstruction of pulmonary vessels corresponded with the intraoperative findings. Reconstructions revealed anatomic variations in 4 (15.4%) patients. No conversion to thoracotomy or in-hospital mortality occurred.

Conclusions

Preoperative planning with interactive 3D CT reconstruction is a useful method to enhance the surgeon’s knowledge of the patient’s specific anatomy and to reveal anatomic variations. Intraoperative 3D guiding in VATS with 3D vision is feasible and could contribute to the safety and accuracy of anatomic resection.
Implantation of Acellular Nerve Allograft Using Nerve Connectors
Authors: Isaacs Jonathan , Mallu Satya , Patel Gaurangkumar , Kite Amy , Shah Sagar , Graham Gordon P.
Published: February 2019

Background: Nerve connectors are short nerve conduits used to approximate nerve ends. Acellular nerve allografts are viable alternatives when direct repair is not possible but do not produce exudate essential for fibrin clot formation. We hypothesize that acellular nerve allograft implanted using nerve connectors must have end-to-end contact with the in situ nerve stumps to support nerve regeneration. Methods: Sixty Sprague Dawley rats underwent a 14-mm unilateral tibial nerve injury and subsequent repair using various combinations of acellular nerve grafts and nerve connectors. Proximal repairs for all groups utilized direct contact with the nerve stump within connector. Variations in distal repair methods (allograft length, nerve gap, and connector length) defined our 4 groups—group A: 14 mm allograft, no distal gap, and distal connector; group B: 11.5 mm allograft, 2.5 mm distal gap, and distal connector; group C: 9 mm allograft, 5 mm distal gap, and distal connector; group D: 14 mm allograft, no distal gap, and no distal connector. At 3 months post-repair, function and histomorphology were assessed. Results: Developed muscle force was significantly lower in group C (0.073 ± 0.077 N) compared with the other 3 groups (group A = 0.529 ± 0.312 N, group B = 0.461 ± 0.462 N, and group D = 0.409 ± 0.327 N). Axon counts were significantly lower in group C (2121 ± 389) compared with group A (6401 ± 855), group B (4710 ± 755), and group D (4450 ± 126). There was no statistically significant difference in G-ratios (myelination) between groups ( P > .05). Conclusion: Nerve regeneration was significantly impaired as the gap distance between the distal end of the allograft and the distal nerve stump increased to 5 mm.
Caregiver-guided pain coping skills training for patients with advanced cancer: Background, design, and challenges for the CaringPals study
Authors: Porter Laura S , Samsa Gregory , Steel Jennifer L , Hanson Laura C , LeBlanc Thomas W , Bull Janet , Fischer Stacy , Keefe Francis J
Published: February 2019

Background/Aims

Pain is a major concern of patients with advanced cancer and their caregivers. There is strong evidence that pain coping skills training interventions based on cognitive-behavioral principles can reduce pain severity and pain interference. However, few such interventions have been tested for patients with advanced cancer and their family caregivers. This study aims to test the efficacy of a caregiver-guided pain coping skills training protocol on patient and caregiver outcomes.

Methods

A total of 214 patients age ≥18 with Stage III–Stage IV cancer and moderate to severe pain, along with their family caregivers, are being identified and randomized with a 1:1 allocation to the caregiver-guided pain coping skills training intervention or enhanced treatment-as-usual. Dyads in both conditions receive educational resources on pain management, and the caregiver-guided pain coping skills training intervention includes three weekly 60-min sessions conducted with the patient–caregiver dyad via videoconference. Measures of caregiver outcomes (self-efficacy for helping the patient manage pain, caregiver strain, caregiving satisfaction, psychological distress) and patient outcomes (self-efficacy for pain management, pain intensity and interference, psychological distress) are collected at baseline and post-intervention. Caregiver outcomes are also collected 3 and 6 months following the patient’s death. The study is enrolling patients from four tertiary care academic medical centers and one free-standing hospice and palliative care organization. The primary outcome is caregiver self-efficacy for helping the patient manage pain.

Results

This article describes challenges in the design and implementation of the CaringPals trial. Key issues for trial design include the identification and recruitment of patients with advanced cancer and pain, and the follow-up and collection of data from caregivers following the patient’s death.

Conclusion

The CaringPals trial addresses a gap in research in pain coping skills training interventions by addressing the unique needs of patients with advanced cancer and their caregivers. Findings from this study may lead to advances in the clinical care of patients with advanced cancer and pain, as well as a better understanding of the effects of training family caregivers to help patients cope with pain.
Exploring the roots of clinical trial methodology in medieval Islamic medicine
Authors: Zarvandi Mahdi , Sadeghi Ramin
Published: February 2019

There is a dominant opinion in the Western sources of history of medicine that the roots of modern clinical trials and methodology of experimental medicine first started in the Renaissance. However, this opinion has been disputed with the thorough study of the rich medical literature of the medieval Islamic era. In the current review, the roots of clinical trial methodology have been traced back to the medieval Islamic tradition and the contribution of Islamic scholars in this field is discussed. The importance of experimental versus theoretical reasoning, the need for a control group, a statistical approach to interpreting trial results, appreciation of uncertainty in medical practice, and the difference between human and animal trials all can be traced back to the rich medieval Islamic medical literature.
Child abuse
Authors: Babakhanlou Rodrick , Beattie Tom
Published: February 2019

Child abuse is a global public health concern. Not only is it appalling that children should suffer unnecessarily, but also children who have been abused are at increased risk of recurrent abuse and may proceed to be abusers in later life. Early and prompt recognition of signs and features of abuse is crucial to alleviate the presenting condition and to prevent future harms. The aim of this article is to present the current advice and recommendations for the recognition and management of child abuse from a primary care perspective.
Improving the physical health of people with severe mental illness
Authors: Silverwood Victoria , Chew-Graham Carolyn , Shiers David
Published: February 2019

People with severe mental illness are three times more likely to die prematurely than the general population. Three-quarters of deaths arise from physical illnesses, the biggest cause being cardiovascular disease (CVD), far commoner than suicide. Psychotic illness, adverse treatment effects, lifestyle and socio-economic disadvantage combine to markedly increase risks for CVD and diabetes, often ignored by inadequate or discriminatory healthcare. We argue for more proactive approaches to address cardiometabolic risks. CVD risk has been reduced in the general population over the last 30 years, but not for those with severe mental illness. Reducing this health inequality should be core business for primary care and is overdue. This article will focus on physical conditions arising as a consequence of experiencing severe mental illness, rather than those that may be a primary organic cause of psychosis.
Combined targeted therapy and immunotherapy in melanoma: a review of the impact on the tumor microenvironment and outcomes of early clinical trials
Authors: Pelster Meredith S. , Amaria Rodabe N.
Published: February 2019

The development of BRAF and MEK inhibitors (BRAFis and MEKis) and immune checkpoint inhibitors have changed the management of advanced stage melanoma and improved the outcomes of patients with this malignancy. However, both therapeutic approaches have limitations, including a limited duration of benefit in subsets of BRAF-mutant melanoma patients treated with targeted therapy and a lower overall response rate without a clear predictive biomarker in patients treated with checkpoint inhibitors. Preclinical and translational data have shown that BRAFis and MEKis alter the tumor microenvironment to make it more amenable to immunotherapy and have provided the scientific rationale for combing BRAFis and MEKis with immunotherapy. In this review, the initial studies demonstrating the impact of BRAFis and MEKis on the expression of melanoma differentiation antigens, T-cell infiltration, and the balance of immune stimulatory and immune suppressive cells and cytokines are addressed. Preclinical work on the combination of targeted therapy with BRAFis and MEKis with immunotherapy are reviewed, highlighting improved tumor responses in mouse models of BRAF-mutated melanoma treated with combinatorial strategies. Lastly, data from early clinical trials of combined targeted therapy and immunotherapy are discussed, focusing on response rates and toxicities.
Sociocultural Importance of Dogs (Canis lupus familiaris) in Maya Subsistence Hunting: Revelations From Their Participation in the Traditional Group Hunting (Batida) in Yucatan
Authors: Plata Elías , Montiel Salvador , Fraga Julia , Evia Carlos
Published: February 2019

Historically, dogs have played a prominent role in subsistence hunting. In the contemporary Mayab, the group hunting or batidaprovides multiple sociocultural benefits for those who practice it, in addition to wild meat. Here, we analyze the social perception of dogs used in batidaas part of the cosmovision of Maya peasant-hunters in a rural community of Campeche, Mexico. We conducted semistructured interviews with 36 local batidahunters who owned a total of 51 dogs. Batidadogs provide different benefits (meat and social prestige for Maya peasant-hunters) depending on their roles as maestros(leader dogs) or secretarios(support dogs) and the type of prey captured. Hunting dogs go beyond their utilitarian value as a hunting technology and play an important role in the sociocultural dynamic of the batida, one of the main wildlife practices mediating the relationships between peasant communities and their natural surroundings in the Yucatan Peninsula.
Helicobacter pylori eradication in patients with type 2 diabetes mellitus: Multicenter prospective observational study
Authors: Nam Seung-Joo , Park Sung Chul , Lee Sang Hoon , Choi Dong Wook , Lee Sung Joon , Bang Chang Seok , Baik Gwang Ho , Park Jong Kyu
Published: February 2019

Objective:

To compare Helicobacter pylori ( H. pylori) eradication rate of type 2 diabetic patients with non-diabetic subjects.

Methods:

In this multicenter prospective observational study, H. pylori-infected subjects were enrolled from three university-affiliated hospitals. Eradication regimen was triple therapy with standard dose of proton pump inhibitors (b.i.d), amoxicillin (1.0 g b.i.d), and clarithromycin (500 mg b.i.d) for 7 days. Urea breath test was performed 4 weeks after treatment. Various clinical and laboratory data were collected for identification of factors associated with successful eradication.

Results:

Totally, 144 subjects were enrolled and 119 (85 non-diabetic and 34 diabetic patients) were finally analyzed. Eradication rate was 75.6% and there was no difference between diabetic patients and non-diabetic subjects (73.5% vs 76.5%, p value: 0.814). Adverse drug reactions were reported in 44.5% of patients. In multivariate analysis for predicting H. pylori eradication in diabetic patients, HbA1c (⩾7.5%) was a significant factor affecting eradication rate (adjusted odds ratio: 0.100, 95% confidence interval: 0.011–0.909, p value: 0.041).

Conclusion:

Diabetes itself is not a major factor affecting H. pylori eradication. However, poor glucose control may harmfully affect H. pylori eradication.
Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy
Authors: Abdullahi Idle Salwa , Hamoda Haitham
Published: February 2019

Objective

This study correlates the transvaginal ultrasound findings with histopathology results in women who present with unscheduled bleeding on hormone replacement therapy.

Study design

Retrospective analysis of 469 consecutive cases with unscheduled bleeding on hormone replacement therapy (203 patients on sequential hormone replacement therapy (seq-HRT) and 266 patients on continuous combined hormone replacement therapy (con-HRT)).

Main outcome measures

Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy.

Results

Normal appearance of the endometrium on pelvic ultrasound was seen in 62% patients on seq-HRT and 43% of women on con-HRT. These women required no further assessment and were discharged. Histological assessment showed normal endometrial tissue in 22% of women on seq-HRT and 22% of con-HRT group. Benign endometrial polyps were noted in 8% of women on seq-HRT versus 18% of women on con-HRT. Hyperplasia without atypia was noted in 0.5% of woman on seq-HRT versus 0.4% of women on con-HRT while atypical hyperplasia/endometrial cancer was noted in 2% of women on seq-HRT versus 1% of women on con-HRT.

Conclusion

Women who present with unscheduled bleeding on hormone replacement therapy both on sequential and continuous combined regimens can be reassured that the risk of pathology is low.
Time–motion analysis examining of the impact of Medic Bleep, an instant messaging platform, versus the traditional pager: a prospective pilot study
Authors: Menon Rahul , Rivett Christopher
Published: February 2019

Objectives

Efficient and accurate communication between healthcare professionals (HCPs) serves as the backbone to safe and efficient care delivery. Traditional pager-based interpersonal communication may contribute to inefficient communication practices and lapses in medical care.

Methods

This study aimed to examine the impact of Medic Bleep, a National Health Service (NHS) information governance-compliant instant messaging application, in an NHS Hospital Trust. We examined Medic Bleep’s impact on participant time and workflow using time–motion methodology. Cohorts of doctors and nurses using both Medic Bleep and the traditional pager were compared. Secondary endpoints of our study were to assess whether efficient communications could lead to better resource utilisation, patient safety as well as better quality of work life for the end user.

Results

Assimilation of Medic Bleep corresponded to a reduction in mean task-duration that was statistically significant ( p < 0.05) for To Take Out (TTO) and Patient Review categories. Nurses saved an average of 21 minutes per shift ( p < 0.05), whereas doctors saved an average of 48 minutes ( p < 0.05) per shift. Qualitative analysis suggested that HCPs benefited from better work prioritisation, collaboration and reduced medical errors enabled by an auditable communication workflow.

Conclusion

Medic Bleep reduced time spent on the tasks requiring interpersonal communication. Efficiencies were seen in Discharge Patient Flow, Patient Review and TTO categories. This improved HCP availability and response times to the benefit of patients. End users revealed that Medic Bleep had a positive effect on quality of work life.