bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass properties identification and automatic mass balancing system for satellite attitude dynamics simulator
Authors: Sharifi Ghasem , Mirshams Mehran , Shahmohamadi Ousaloo Hamed
Published: December 2017

A Satellite Attitude Dynamics Simulator is a low-cost, ground-based system made to simulate the conditions of a weightless satellite in space. The identification of the mass characteristics is crucial for Satellite Attitude Dynamics Simulator application and so the center of mass place is necessary for balancing the platform and moment of inertia which is a significant factor in designing controllers and selecting actuators. The purposes of this paper are the mass properties identification and design, experimentation, and validation of an automatic mass balancing system, which is assembled on the Satellite Attitude Dynamics Simulator at the Space Research Laboratory. This paper presents a process of mass properties estimation for the Satellite Attitude Dynamics Simulator using classical Levenberg–Marquardt as an optimization method. By employing this technique lack of repeatability and difficulties in implementation will be eliminated. In order to verify this technique, a MATLAB® SIMULINK® model of the Satellite Attitude Dynamics Simulator is established. The gap between the center of mass and center of rotation is decreased by means of the automatic mass balancing system in order to remove gravity disturbance. The results of this identification process are compared to the recursive least square algorithm, which is commonly employed in identification of mass properties. The analytical and experimental results prove that the proposed characteristic estimation process using classical Levenberg–Marquardt algorithm is more effective and appropriate. Proper excitation of the platform will guarantee the accuracy of estimation and compensation of the center of gravity offset utilizing the balancing system.
A fault-tolerant control scheme within adaptive disturbance observer for hypersonic vehicle
Authors: Zhou Jun , Chang Jing , Guo Zongyi
Published: December 2017

The paper describes the design of a fault-tolerant control scheme for an uncertain model of a hypersonic reentry vehicle subject to actuator faults. In order to improve superior transient performances for state tracking, the proposed method relies on a back-stepping sliding mode controller combined with an adaptive disturbance observer and a reference vector generator. This structure allows for a faster response and reduces the overshoots compared to linear conventional disturbance observers based sliding mode controller. Robust stability and performance guarantees of the overall closed-loop system are obtained using Lyapunov theory. Finally, numerical simulations results illustrate the effectiveness of the proposed technique.
Neurosymptomatic cerebrospinal fluid escape in HIV-2: a case report
Authors: Kulkarni Vinay , Kulkarni Rahul , Parchure Ritu
Published: December 2017

Cerebrospinal fluid (CSF) escape phenomenon is widely studied and documented in HIV-1. However, hardly anything is known about progressive neurologic disease in otherwise well-controlled HIV-2 infection. We present a case of neurosymptomatic CSF escape in HIV-2 infection from India.
Acoustical comfort in building interior during musical production in town residential area of locality
Authors: Flimel Marián , Dupláková Darina
Published: December 2017

This article highlights the negative consequences of the provisional musical performance in the cities, particularly at the places that are not adjusted for this kind of performances. In the article, there is an appeal made to the need for a comprehensive solution in the form of noise studies and also an algorithm of solution is presented. It is important to achieve the permissible values of noise level in front of house facades for obtaining acoustical comfort in interior of buildings. This article presents the solution of the negative consequences of the provisional musical performance in the cities, particularly at the places that are not adjusted for this kind of performances. The solution for practice is the creation of algorithm for solving music performance in the cities.
Coxiella burnetii infection (Q fever) mimicking systemic lupus erythematosus: two cases
Authors: Durupt S , Puget M , Lega J C , Durieu I , Reynaud Q
Published: December 2017

Q fever has extremely polymorphic features, and has been reported to be associated with positivity of several autoimmune antibodies. We report two cases of atypical Q fever with a clinical presentation highly suggestive of an inflammatory systemic disease with positivity of autoimmune antibodies, mimicking systemic lupus erythematosus.
Microarray Expression Profile of lncRNAs and mRNAs in Rats with Traumatic Brain Injury after A2B5+ Cell Transplantation
Authors: Lyu Qiang , Zhang Zi-Bin , Fu Song-Jun , Xiong Liu-Lin , Liu Jing , Wang Ting-Hua
Published: December 2017

Traumatic brain injury (TBI) may cause neurological damage, but an effective therapy and the associated mechanisms of action have not yet been elucidated. A TBI model was established using the modified Feeney method. A2B5+ cells, an oligodendroglial progenitor, were acquired from induced pluripotent stem cells (iPSCs) by mouse embryonic fibroblasts and were transplanted into the injured site. The neurological severity score (NSS) was recorded on 3 d, 7 d, 11 d, 15 d, and 19 d. Seven days after transplantation, oligodendrocytes 2 (Olig2) and myelin basic protein (MBP) were detected by immunohistochemistry (IHC) and Western blot (WB), and long noncoding RNAs (lncRNAs) and messenger RNAs (mRNAs) were screened by microarray technology. Moreover, we took an intersection of the differentially expressed lncRNAs or mRNAs and scanned 10 kb upstream and downstream of the common lncRNAs. Meanwhile, Gene Ontology (GO) and pathway analysis on mRNAs was performed in the A2B5+ iPSC group. A2B5+ iPSCs survived and migrated around the injury site and differentiated into oligodendrocytes. Meanwhile, the increase in Olig2 and MBP were higher in A2B5+ cell-engrafted rats than that in TBI rats. However, the NSSs in the A2B5+ iPSC group were lower than that in the TBI group. Between the TBI and sham groups, 270 lncRNAs and 1,052 mRNAs were differently expressed ( P < 0.05, fold change (FC) > 2), while between the A2B5+ iPSC and TBI groups, 83 lncRNAs and 360 mRNAs were differently expressed ( P < 0.05, FC > 2). Meanwhile, 37 lncRNAs and 195 mRNAs were simultaneously changed in the 2 parts. Using bioinformatic analysis, we found the crucial lncRNA and mRNA were ENSRNOT00000052577 and Kif2c in the TBI brain with cell transplantation. This study demonstrated that A2B5+ iPSC grafts effectively improved neurological function, and the mechanism of action was associated with lncRNA and mRNA expression. Therefore, A2B5+ iPSC transplantation could be considered as a new method for the treatment of TBI, and ENSRNOT00000052577 and Kif2c may be new molecular targets or markers for functional improvement.
Performances of the Online Self for Networked Audiences: An Introduction to the Special Issue
Authors: Mishra Smeeta , Ismail Amani
Published: December 2017

Social media affordances enable us to construct multi-faceted online identities and personal brands that we use to engage and interact with audiences—defined and ambiguous, intended and unintended. There is a need to examine such online identities and associated micro-celebrity practices by users who appeal to multiple audiences through the strategic use of online spaces. In this special issue, we explore performances of our digital selves and the role played by active and interactive audiences in meaning-making within complex socio-political contexts while simultaneously attempting to understand varied positions of media refusal and enactments of digital media resistance.
Student Satisfaction in an Undergraduate International Business EMI Program: A Case in Southern Taiwan
Authors: Chu Hsiang-Ning Rebecca , Lee Wing Shing , OBrien Peter William
Published: December 2017

This study assessed both local and international students’ satisfaction on dimensions that may foster or disadvantage their learning experience in a recently established English-medium instruction (EMI) undergraduate international business program in Southern Taiwan. The study recruited 278 students (171 local and 97 international), and assessed their satisfaction with program management, interaction with peers within the program, and cultural diversity in the university. The results indicated that both local and international students were satisfied with local students’ openness to foreign cultures, students’ ability to communicate in English during class, content of courses, and the level of internationalization of the college. All participants, however, were significantly dissatisfied with the depth and frequency of social interaction outside classrooms, and with the facilities and management offered by the university. Findings of this study may have managerial and instructional implications for staff and faculty of English-medium programs in identifying potential issues and improving student retention.
Validity of a Novel Touch Screen Tablet-Based Assessment for Mild Cognitive Impairment and Probable AD in Older Adults
Authors: Huang Yo-Ping , Singh Avichandra , Chen Sheng , Sun Fang-Ju , Huang Chiu-Ron , Liu Shen-Ing
Published: December 2017

This study aimed to develop a psychometrically valid touch screen tablet-based cognitive test battery to identify early cognitive impairment due to dementia in older adults. The battery includes eight tests with 13 subscores, evaluating visual attention, auditory attention, information processing speed, visual memory, motor control, and visuospatial perception. Among the participants, 43 had been diagnosed with mild cognitive impairment (MCI) and 36 with probable Alzheimer’s disease (AD); 41 had no cognitive impairment. The average time to administer the tablet-based tests was 10 minutes. Significant correlations with the Mini-Mental State Examination were found in 9 out of 13 subscores. Patients with probable AD scored significantly lower than controls in 8 out of 13 subscores, whereas those with MCI scored significantly lower in 4 out of 13 subscores. Confirmatory factor analysis using Promax rotation showed that four factors caused lower subscores in the MCI group compared with the controls: information processing speed, memory, visuospatial perception, and motor control. All four factors significantly discriminated the controls from the MCI and probable AD groups, and in the expected direction. The touch screen tablet-based cognitive test battery is psychometrically valid for evaluating cognition in older adults.
Critical Arts–Based Research: A Performance of Provocation
Authors: Bagley Carl , Castro-Salazar Ricardo
Published: December 2017

The article from a critical race theory standpoint draws on data from life history interviews with undocumented Mexican-Americans, and live performance work with Mexican-American artists, to reflect on the methodological issues raised by qualitative research addressing the ways in which critical arts–based research affects research participants as artists, subjects, and audience. To date, arts-based research literature has tended to concentrate on theoretically framing a performance piece within a specific genre (and its acclaimed advantages) and subsequently describing in detail the nature of a performance, an approach which at times means the impact of a performance is accepted uncritically, if not taken for granted. Our intent in this article is to draw on postperformance interviews and correspondence with artists, subjects, and audience members to critically reflect on participant impact, an impact which in this article we are calling a performance of provocation.
Theoretical Study of Aerosols Loading and Retention Over Bolgatanga, Ghana
Authors: E Emetere Moses , SE Sanni , SA Akinwumi
Published: December 2017

The aerosols loading and retention over West Africa have grave effect on life-forms through the impact on health, farming, rainfall pattern, cloud formation, and regional climate. Bolgatanga can be found on the latitude and longitude of 10.78°N and 0.85°W, respectively. This research is focused on an investigative consideration of the negative effect of atmospheric aerosols over Bolgatanga in Ghana through a conceptual model using analytical and descriptive statistical methods with MATLAB curve-fitting tool. The model was verified using aerosol optical depth data set from satellite imagery—multi-angle imaging specto-reflectometer (MISR)—obtained over a period of 13 years. The highest percentage increase of aerosol retention was 64.27% over the research site. The model was used to estimate the atmospheric constants as 0.67, tuning constants as 0.24, and phase difference as [Formula: see text]. The physical interpretation of the results was analyzed systematically.
Improvements in Regional Left Ventricular Function Following Late Percutaneous Coronary Intervention for Anterior Myocardial Infarction
Authors: Adhyapak Srilakshmi M , Menon Prahlad G , Varghese Kiron , Mehra Abhinav , Lohitashwa SB , Fantini Fabio
Published: December 2017

Background:

Late revascularization following a myocardial infarction has questionable clinical benefit.

Methods:

We studied 13 patients with anterior wall myocardial infarction who underwent percutaneous coronary intervention within 2 weeks of the primary event, by quantitative analysis of 2-dimensional echocardiographic images. Endocardial segmentations of the left ventricular (LV) endocardium from the 4-chamber views were studied over time to establish cumulative wall displacements (CWDs) throughout the cardiac cycle.

Results:

Left ventricular end-systolic volume decreased to 42 ± 8 mL/body surface area ( P = .034) and LV ejection fraction improved to 52% ± 7% ( P = .04). Analysis of LV endocardial CWD demonstrated significant improvements in mid-systolic to late-systolic phases in the apical LV segments, from 3.5 ± 0.32 to 5.89 ± 0.43 mm ( P = .019). Improvements in CWD were also observed in the late-diastolic phase of the cardiac cycle, from 1.50 ± 0.42 to 1.76 ± 0.52 mm ( P = .04).

Conclusions:

In our pilot patient cohort, following late establishment of infarct-related artery patency following an anterior wall myocardial infarction, regional improvements were noted in the LV apical segments during systole and late diastole.
Telemonitoring in patients with heart failure: Is there a long-term effect?
Authors: Gingele Arno J , Brunner-la Rocca Hanspeter , Ramaekers Bram , Gorgels Anton , De Weerd Gerjan , Kragten Johannes , van Empel Vanessa , Brandenburg Vincent , Vrijhoef Hubertus , Cleuren Ger , Knackstedt Christian , Boyne Josiane JJ
Published: December 2017

Introduction

Evidence suggests that telemonitoring decreases mortality and heart failure (HF)-related hospital admission in patients with HF. However, most studies follow their patients for only several months. Little is known about the long-term effects of telemonitoring after a period of application.

Methods

In 2007, the TEHAF study was initiated to compare tailored telemonitoring with usual care with respect to time until first HF-related hospital admission. In total, 301 patients completed the study after a follow-up period of one year. No differences could be found in time to first HF-related admission between intervention and control groups. Here, we performed a retrospective analysis in order to investigate potential long-term effects of telemonitoring. The primary endpoint was time to first HF-related hospital admission. Secondary endpoints were, amongst others, all-cause mortality, hospital admission due to HF and days alive and out of hospital (DAOOH). Electronic files of all included patients were reviewed between October 2007 and September 2015.

Result

Mean follow-up duration was 1652 days (standard deviation: 1055 days). No significant difference in time to first HF-related hospital admission (log-rank test, p = 0.15), all-cause mortality (log-rank test, p = 0.43), or DAOOH (two-sample t-test, p = 0.87) could be found. However, patients that underwent telemonitoring had significantly fewer HF-related hospital admissions (incident rate ratio 0.54, 95% confidence interval 0.31–0.88).

Discussion

Telemonitoring did not significantly influence the long-term outcome in our study. Therefore, extending the follow-up period of telemonitoring studies in HF patients is probably not beneficial.
Experiences of social support among persons seeking HIV testing
Authors: Moodley Athena , Kagee Ashraf
Published: December 2017

We interviewed 15 HIV test seekers to understand how social support acted either as a facilitator or barrier to HIV testing. Participants were recruited at community outreach testing sites in South Africa and participated in qualitative interviews which were then analysed using thematic analysis. We identified three main themes, namely, the social phenomenon of perceived risk as a facilitator to HIV testing, social support as a way of managing distress and the public health service as a supportive environment, which all played a role in test-seeking among participants. The results are integrated with the current debates on HIV testing in South Africa.
Infusing fundamental cause theory with features of Pierre Bourdieu’s theory of symbolic power
Authors: Veenstra Gerry
Published: December 2017

The theory of fundamental causes is one of the more influential attempts to provide a theoretical infrastructure for the strong associations between indicators of socioeconomic status (education, income, occupation) and health. It maintains that people of higher socioeconomic status have greater access to flexible resources such as money, knowledge, prestige, power, and beneficial social connections that they can use to reduce their risks of morbidity and mortality and minimize the consequences of disease once it occurs. However, several key aspects of the theory remain underspecified, compromising its ability to provide truly compelling explanations for socioeconomic health inequalities. In particular, socioeconomic status is an assembly of indicators that do not necessarily cohere in a straightforward way, the flexible resources that disproportionately accrue to higher status people are not clearly defined, and the distinction between socioeconomic status and resources is ambiguous. I attempt to address these definitional issues by infusing fundamental cause theory with features of a well-known theory of socioeconomic stratification in the sociological literature—Pierre Bourdieu’s theory of symbolic power.
Associations between snus use, body mass index and general health in a cross-sectional population-based sample of women.
Authors: Lund Ingeborg , Kvaavik Elisabeth , Nygård Mari , Hansen Bo T.
Published: December 2017

Background: In Norway, snus use among women has increased substantially over the last decade, particularly in younger age groups. Snus use is associated with increased morbidity among men, but few studies have addressed health consequences of snus use among women. Aim: To investigate the associations between body mass index (BMI) and female snus use, and between self-rated general health and female snus use. Methods: A nationally representative net sample of 13,756 women in Norway, aged 18–45 years, participated in a survey on lifestyle and health. Ordinal logistic regression was applied to address associations between snus use and BMI/general health, adjusting for age and lifestyle factors. Results: Compared to never users of snus, daily snus users had a lower likelihood of high BMI (OR: 0.83, 95% CI: 0.68–1.00), a higher likelihood of low BMI (OR: 1.63, 95% CI: 1.14–2.33), and a higher likelihood of poor/fair health (OR: 1.43, 95% CI: 1.08–1.90). Former and occasional snus users did not differ from never users in terms of BMI or general health in multiply adjusted models. Daily smokers had the highest likelihood of reporting poor/fair health (OR: 2.18, 95% CI: 1.8–2.63) relative to never smokers. Conclusions: Daily female snus use was associated with a lower likelihood of being overweight, and a higher likelihood of being underweight. Moreover, daily snus use was associated with a higher likelihood of worse general health. Former and occasional female snus use was not associated with BMI or general health.
A discipline at the crossroads? Using a gender-inspired paradigm to reposition the sociology of work and employment
Authors: Huppatz Kate , Ross-Smith Anne
Published: December 2017

The future of work and employment sociology has been a subject of concern for a number of authors in recent years. Halford and Strangleman, among others, have suggested that work and employment sociology is on the decline, in that it has been disconnected from wider sociology and co-opted by management and business schools. In this article we unpack the debate and look at how it relates to gender and work scholarship. In doing so, we propose that the decline thesis might be overstated. While gender and work sociology has been implicated in the demise of labour process theory, it has also embraced change and strengthened and diversified work and employment sociology. Nevertheless, in this article, we treat the perceived threat as an opportunity to rethink work and employment sociology. We propose a four-themed, interdisciplinary, gender-inspired research paradigm.
Pharmaceutical care services to people living with dementia in care homes: A qualitative study of community pharmacists' perceptions
Authors: Navti Beryl , Apampa Bugewa
Published: December 2017

There is a paucity of information on the perceptions of community pharmacists about the nature and effectiveness of pharmaceutical care services they provide to people living with dementia in care homes. This paper explores pharmacists’ perceptions of the nature and effectiveness of pharmacy services provided, and their experiences when providing these services. Community pharmacists delivering services to care homes with dementia in Thurrock, Essex and in Medway, Kent, England were invited to participate in the study involving face-to-face interviews. Analysis of semi-structured interviews with 15 community pharmacists revealed that the main pharmaceutical service provided by the pharmacists was prescription processing, normally involving the clinical review and supply of medication into monitored dosage systems (dosette boxes) and delivery to the homes. This was coupled with advice to care homes on the appropriate storage and administration of drugs and appliances supplied, which was in line with the NHS Community Pharmacy Contractual Framework Enhanced Service for care homes. A majority of the community pharmacists interviewed acknowledged that the services they were currently commissioned to provide did not meet the pharmaceutical care needs of dementia patients in care homes, including the monitoring of the appropriateness, safety and effectiveness of drug therapy.
Perioperative Outcomes From the Prospective Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry
Authors: Krajcer Zvonimir , Ramaiah Venkatesh G. , Henao Esteban A. , Metzger D. Chris , Nelson Wayne K. , Moursi Mohammed M. , Rajasinghe Hiranya A. , Al-Dallow Raed , Miller Larry E.
Published: December 2017

Purpose: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. Methods: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge. The primary endpoint was major adverse events (MAE) through 30 days. The target performance goal for the MAE endpoint was 10.4%. Results: Vascular access, stent-graft delivery, and stent-graft deployment success were 100%. A total of 216 (86%) patients completed all elements of the fast-track EVAR protocol. Completion of individual elements was 98% for general anesthesia avoidance, 97% for bilateral percutaneous access, 96% for ICU avoidance, and 92% for next-day discharge. Perioperative outcomes included mean procedure time of 88 minutes, median blood loss of 50 mL, early oral nutrition (median 6 hours), early mobilization (median 8 hours), and short hospitalization (median 26 hours). Fast-track EVAR completers had shorter procedure time (p<0.001), less blood loss (p=0.04), faster return to oral nutrition (p<0.001) and ambulation (p<0.01), and shorter hospital stay (p<0.001). With 241 (96%) of the 250 patients returning for the 30-day follow-up, the MAE incidence was 0.4% (90% CI 0.1% to 1.8%), significantly less than the 10.4% performance goal (p<0.001). No aneurysm rupture, conversion to surgery, or aneurysm-related secondary procedure was reported. There were no type III endoleaks and 1 (0.4%) type I endoleak. Iliac limb occlusion was identified in 2 (0.8%) patients. The 30-day hospital readmission rate was 1.6% overall. Conclusion: A fast-track EVAR protocol was feasible in well-selected patients and resulted in efficient perioperative resource utilization with excellent safety and effectiveness.
Temporal Changes in Intraluminal Thrombus Volume Within Abdominal Aortic Aneurysms: Implications for Planning Endovascular Aneurysm Sealing
Authors: Paraskevas Kosmas I. , Torella Francesco , Swaelens Charles , England Andrew , Chan Tze Y. , Shaikh Usman , McWilliams Richard G. , Fisher Robert K.
Published: December 2017

Purpose: To explore whether or not there are temporal changes in the abdominal aortic aneurysm (AAA) and intraluminal thrombus (ILT) volumes between planning and implantation of the endovascular aneurysm sealing (EVAS) device and how these changes influence lumen volume. Methods: A retrospective review was conducted of 51 AAA patients (mean age 76±7.1 years; 36 men) in whom 2 serial preoperative computed tomography angiograms (CTAs) had been performed within 1 to 18 months before fenestrated endovascular repair. The 2 preoperative CTAs were analyzed to identify changes in total sac, ILT, and lumen volumes. Results: Over a median 7.0 months (interquartile range 4, 10), 46 (90%) of 51 AAAs increased in volume between the 2 CTAs. ILT volume increased in 44 aneurysms. In contrast, lumen volume increased in 31 and decreased in 20 AAAs. There was a strong correlation between changes in AAA volume and ILT volume (rs=0.859, p<0.001), which remained significant after adjustment for initial volumes (rs=0.815; p<0.001). There was no correlation between the time interval separating the 2 CTAs and changes in AAA volume (rs=0.115; p=0.421), changes in ILT volume (rs=0.084; p=0.599), or changes in lumen volume (rs=0.060; p=0.676). The AAA growth rate (defined as the change in AAA size/days between CTAs) showed a weak correlation with ILT volume (rs=0.272, p=0.054), which disappeared after adjustment for initial AAA size (rs=−0.002, p=0.991). Between the 2 CTAs, 12 aneurysms crossed the new <1.4 Nellix maximum aorta/lumen diameter ratio. Conclusion: As AAAs grow, the increase in aortic volume is largely occupied by additional ILT formation, with minimal change in lumen volume. These changes may alter the suitability of the aneurysm for the Nellix device and could have implications for EVAS planning and device deployment.
Nutritional Supplementation for Diabetic Foot Ulcers: The Big Challenge
Authors: Vas Prashant R. J. , Edmonds Michael E. , Papanas Nikolaos
Published: December 2017

Diabetic foot ulcers remain difficult to heal and nutritional supplementation may be an important complementary therapeutic measure. However, we need to clarify many issues before such supplementation is more widely used. Indeed, improvements are needed in the following areas: evaluation of nutritional inadequacy, completion of randomized controlled trials, understanding of patient and ulcer characteristics that favor response to nutritional supplementation, optimal duration of supplementation therapy, and evaluation of patient adherence. The challenge is now to acquire more knowledge in the aforementioned areas.
Keystone-Designed Perforator Island Flaps for the Coverage of Traumatic Pretibial Defects in Patients With Comorbidities
Authors: Yoon Chi Sun , Kim Sang Il , Kim Hoon , Kim Kyu Nam
Published: December 2017

Reconstruction of pretibial skin and soft-tissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Here, we present a retrospective review of our experience with pretibial reconstruction using the keystone-designed perforator island flap (KDPIF) in patients with comorbidities. All defects resulted from nononcological causes. We describe the expanding versatility of KDPIF reconstruction for pretibial defects and suggest a simple algorithmic approach. The medical records of 9 patients who underwent reconstruction with a KDPIF to cover a pretibial defect between May 2016 and June 2017 were reviewed. Clinical and operative data were collected. All 9 KDPIFs fully survived. The defect size varied from 3 × 2 cm2 to 8 × 6 cm2. The flap size varied from 5 × 3 to 20 × 10 cm2. The mean operative time was 90.4 minutes (range = 37-127 minutes). No postoperative complications occurred. The cosmetic results were favorable, and all patients were satisfied with the final outcomes. Thus, the KDPIF is a good reconstruction modality with few complications and provides an alternative to free flaps for pretibial defect reconstruction in patients with comorbidities.
A survey of attitudes, beliefs and practice regarding alcohol use and screening in pregnancy: an opportunity for support and education?
Authors: Howlett Helen , Gray William K , Dismore Lorelle , Mackenzie Shonag , Langley Kate , Davidson Catriona , Rankin Judith
Published: December 2017

Providing antenatal and postnatal support for women who drink alcohol in pregnancy is only possible if those at risk can be identified. However, screening will only be helpful if women feel comfortable with the method used. We conducted a survey of pregnant women and their partners to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. Pregnant women and their partners attending antenatal clinics in North-East England were asked to complete a short survey regarding their alcohol consumption in pregnancy, their beliefs about safe levels of alcohol in pregnancy and whether they would be happy to have their blood or their baby’s meconium analysed for alcohol biomarkers. The data were summarised using descriptive statistics and thematic analysis. A total of 171 pregnant women and 41 partners participated. Of the pregnant women, 153 (89.5%) felt women should abstain from alcohol consumption, although only 70 (40.9%) reported not drinking in pregnancy. Of 96 women who reported drinking in pregnancy and reported when they stopped, all but six (6.3%) stopped drinking when they found out they were pregnant. Of women and partners who recorded an answer, 177 (87.2%) said they would consent to blood biomarker analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear.
A zero-failure accelerated degradation test under ramp–soak–stress loading
Authors: Wanti Srivastava Preeti , Manisha
Published: December 2017

This article deals with the design of optimal ramp–soak–stress accelerated degradation test using Wiener process for modeling degradation paths. In an accelerated degradation test, failure occurs when the performance characteristic crosses the critical value the first time. Accelerated degradation test is incorporated in zero-failure reliability demonstration test to facilitate reduction in the test duration resulting in reduction in the test cost of high-reliability items. The parameters in model are estimated using method of maximum likelihood. The optimum plan consists in finding out optimum number of ramp–soak–stress cycles, optimum number of specimens, optimum stress change point(s), and optimum stress rates by minimizing asymptotic variance of estimate of [Formula: see text] quantile of the lifetime distribution at use condition subject to the constraint that total testing or experimental cost does not exceed a prespecified budget. An example is given to illustrate the proposed model, and sensitivity analysis is also carried out.
Stability of a micro-tidal inlet using semi-numerical approach
Authors: Senthilkumar R , Murali K , Sundar V
Published: December 2017

Tidal inlets get disconnected depending on the seasons due to the formation of sand bars near its mouth are termed as “seasonally open tidal inlets.” These inlets are usually small of width of about 100 m and occur in micro-tide (tidal range not exceeding 1 m). Since the east coast of India experiences a net littoral drift of up to about 0.8 Mm3/annum, which is one of the largest in magnitudes that needs to be considered in the analysis of modeling of the sand bar formation and the associated phenomena. Kondurpalem inlet situated along the South east coast of India is considered as a case study. A frequency domain wave model (STeady-state spectral WAVE) has been used to compute the nearshore wave climate. The wave-induced currents have been obtained, and the longshore sediment transport rate is obtained through empirical relations. The tidal prism is found from measured depth and tidal velocity by solving shallow water equations. The stability of the inlet is investigated by applying the criteria developed by Bruun (1986). The effect of a pair of training walls on maintaining the stability of the mouth is reassessed over the periods.
Observations of turbulent kinetic energy dissipation at the Labrador Sea surface layer
Authors: Gremes-Cordero Silvia
Published: December 2017

We present an analysis of turbulent kinetic energy dissipation rates in the upper ocean using in situ measurements collected by a coherent Doppler sonar in the Labrador Sea during summer 2004. The sonar recorded horizontal velocity fluctuations of the upper 2 m with an uncommonly small spatial resolution of 0.8 cm, allowing direct calculations of wavenumber spectra and the application of Kolmogorov theory to obtain turbulent kinetic energy dissipation rates for the first time in this area. The project presented a unique opportunity for the study of air–sea exchange during a phytoplankton bloom, being the first time a specialized air–sea interaction spar buoy was deployed during such particular event. An additional uniqueness of this experiment resulted from being the first turbulent kinetic energy dissipation rate observations obtained at higher latitudes, coincidentally in a well-known region of dense water formation, with a fundamental role in both global circulation and forecasting studies of global climate change. Focusing on the relationship between turbulent kinetic energy dissipation rates and wave phase in the upper 2 m, we estimated O[Formula: see text] turbulent kinetic energy dissipation rates, consistent with previous estimates obtained through similar devices and methods. A T-test between dissipation rates calculated at the crest and at the trough of waves showed no dependency of turbulent kinetic energy dissipation rates on the wave phase at 2 m depth, coinciding with many of the earlier findings available. a comparison with previous research showing conflicting results with our values is also discussed here linking them to the relative roles of experimental design variations, diverse dynamical frames, and particular environmental conditions.
Decreased Rates of Inpatient Hypoglycemia Following Implementation of an Automated Tool in the Electronic Medical Record for Identifying Root Causes
Authors: Sinha Gregory Naina , Seley Jane Jeffrie , Ukena Jenny , Shah Sona , Fred Matthew R. , Dargar Savira Kochhar , Mauer Elizabeth , Kim Robert J.
Published: December 2017

Objective:

The objective was to identify root causes of hypoglycemia on medicine inpatient units using an automated tool. Data collected will guide educational interventions aimed at improving patient care and safety by decreasing rates of hypoglycemia.

Methods:

A survey was conducted among RNs to identify risk factors for hypoglycemia. Survey data were used to create a hypoglycemia root cause survey tool in the EMR. RNs were prompted to utilize the tool when blood glucose (BG) < 70 mg/dL. Once the most common modifiable cause of hypoglycemia was identified, an educational intervention for safe and effective use of insulin was launched. This strategy was designed to empower the care team to reduce the insulin dose when appropriate to prevent future hypoglycemic episodes.

Results:

BG data were compared from March and April in 2016 and 2017. Rates of hypoglycemia (BG < 70 mg/dL) decreased from 2.3% to 1.5%; BG values in target range (70-180 mg/dL) increased from 59.4% to 65.7%; hyperglycemia (BG > 180 mg/dL) decreased from 38.3% to 32.8% (all P values < .001). The number of patients with recurrent hypoglycemia (3 or more episodes) decreased from 5.7% to 2.2% ( P = .044).

Conclusions:

The two most frequent modifiable causes of hypoglycemia (insulin and nutrition) were identified by an RN survey and confirmed by chart review. A targeted educational intervention addressing safe and effective insulin dosing resulted in a significant decrease in both hypoglycemia and recurrent hypoglycemia. This was associated with an improvement in overall glycemic control. Ongoing clinician education regarding insulin and nutrition accompanied by discussions between RNs and prescribers to address hypoglycemic events in real-time could continue to lower the rate of occurrence.
There’s a New Alphabet in Town: ESSA and Its Implications for Students, Schools, and School Nurses
Authors: Blackborow Mary , Clark Elizabeth , Combe Laurie , Morgitan Judith , Tupe Anna
Published: December 2017

The 2015 passage of the Every Student Succeeds Act (ESSA) provides state education agencies with more local control over educational planning, requires development of state accountability plans, and provides opportunities for advocacy surrounding school nursing-sensitive indicators of student success. Federal Title I, II, and IV funds are available for state and local education agency utilization in meeting educational needs of impoverished students and for development of high-quality instructional and support personnel. As Specialized Instructional Support Personnel, school nurses can utilize ESSA Title funding to positively impact chronic absenteeism, school climate, and school nurse staffing. ESSA can be a resource for funding school health services and professional education. This article will assist school nurses in better understanding ESSA and how funding is allocated to states and local education agencies.
Current best practice in the management of Turner syndrome
Authors: Shankar Roopa Kanakatti , Backeljauw Philippe F.
Published: December 2017

Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population.
Lipopolysaccharide acutely suppresses right‐ventricular strain in rats with pulmonary artery hypertension
Authors: Zhang Junjie , Cao Yanan , Gao Xiaowei , Zhu Maoen , Zhang Zhong , Yang Yue , Guo Qulian , Peng Yonggang , Wang E.
Published: December 2017

Worsening right ventricular (RV) dysfunction in the presence of pulmonary artery hypertension (PAH) increases morbidity and mortality in this patient population. Transthoracic echocardiography (TTE) is a non‐invasive modality to evaluate RV function over time. Using a monocrotaline‐induced PAH rat model, we evaluated the effect of acute inflammation on RV function. In this study, both PAH and control rats were injected with Escherichia coli lipopolysaccharide (LPS) to induce an acute inflammatory state. We evaluated survival curves, TTE parameters, and inflammatory markers to better understand the mechanism and impact of acute inflammation on RV function in the presence of PAH. The survival curve of the PAH rats dropped sharply within 9 h after LPS treatment. Several echocardiographic parameters including left ventricular (LV) stroke volume, RV tricuspid annular plane systolic excursion, RV longitudinal peak systolic strain, and strain rate decreased significantly in PAH rats before LPS injection and 2 h after LPS injection. The expression of phospholamban (PLB) and tumor necrosis factor‐α (TNF‐α) significantly increased and the expression of SERCA2a significantly decreased in PAH rats after LPS administration. LPS suppressed the RV longitudinal peak systolic strain and strain rate and cardiac function deteriorated in PAH rats. These effects may be associated with the signal pathway activity of SERCA2a/PLB.
Multicenter mortality and morbidity associated with pulmonary hypertension in the pediatric intensive care unit
Authors: Balkin Emily Morell , Steurer Martina A. , Delagnes Elise A. , Zinter Matt S. , Rajagopal Satish , Keller Roberta L. , Fineman Jeffrey R.
Published: December 2017

Despite advances in the diagnosis and management of pediatric pulmonary hypertension (PH), children with PH represent a growing inpatient population with significant morbidity and mortality. To date, no studies have described the clinical characteristics of children with PH in the pediatric intensive care unit (PICU). A retrospective multicenter cohort study of 153 centers in the Virtual PICU Systems database who submitted data between 1 January 2009 and 31 December 2015 was performed. A total of 14,880/670,098 admissions (2.2%) with a diagnosis of PH were identified. Of these, 2190 (14.7%) had primary PH and 12,690 (85.3%) had secondary PH. Mortality for PH admissions was 6.8% compared to 2.3% in those admitted without PH (odds ratio = 3.1; 95% confidence interval = 2.9–3.4). Compared to patients admitted to the PICU without PH, those with PH were younger, had longer length of stay, higher illness severity scores, were more likely to receive invasive mechanical ventilation, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, and more likely to have co‐diagnoses of sepsis, heart failure, and respiratory failure. In a multivariate model, factors significantly associated with mortality for children with PH included age < 6 months or > 16 years, invasive mechanical ventilation, and co‐diagnoses of heart failure, sepsis, hemoptysis, disseminated intravascular coagulation, stroke, and multi‐organ dysfunction syndrome. Despite therapeutic advances, the disease burden and mortality of children with PH remains significant. Further investigation of the risk factors associated with clinical deterioration and mortality in this population could improve the ability to prognosticate and inform clinical decision‐making.
Occult catheter rupture causing episodic symptoms in a patient treated with epoprostenol
Authors: LeVarge Barbara L. , Law Anica C. , Murphy Blanche
Published: December 2017

Infection, thrombosis, and catheter dislodgment are well‐recognized potential complications of chronic intravenous prostanoid therapy for pulmonary arterial hypertension. As long‐term outcomes of pulmonary hypertension patients improve, novel adverse events are likely to arise. We describe the sudden development of unexplained hypotension and lightheadedness in a patient receiving intravenous epoprostenol for several years, ultimately determined to be due to an unusual catheter complication, not previously described in this population.
Hemophagocytic syndrome masquerading as septic shock: An approach to such dilemma
Authors: Hindi Zakaria , Khaled Abdallah A , Abushahin Ashraf
Published: December 2017

Introduction:

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis is a rare condition characterized by excessive inflammation that is thought to be caused by the absence of normal downregulation of activated macrophages and lymphocytes. The treatment of hemophagocytic lymphohistiocytosis can depend on whether it is primary or secondary. In secondary hemophagocytic lymphohistiocytosis, the treatment can be directed according to the cause. In general, protocol HLH-94 (which consists of dexamethasone and etoposide in induction and maintenance) has been widely used as it has good outcomes. Hemophagocytic lymphohistiocytosis and septic shock largely overlap which can lead to refractory septic shock and death if not treated. Unfortunately, there is no clear approach for such dilemma. Thereby, we would like to present our case as it has a valuable approach to hemophagocytic lymphohistiocytosis in the setting of sepsis.

Case description:

A 60-year-old female, with history of hypertension, came with fever, productive cough, and dyspnea; she was admitted for acute exacerbation of chronic obstructive pulmonary disease and was transferred to intensive care unit for septic shock. The patient progressed to refractory septic shock with no focus of infection. After further investigations, detailed history raised the suspicion of hemophagocytic lymphohistiocytosis; a bone marrow biopsy was collected and confirmed the diagnosis. The patient was on methylprednisolone while waiting for other investigation results and improved markedly. After ruling out secondary causes of hemophagocytic lymphohistiocytosis, she was switched to protocol-94 and continued to improve.

Conclusion:

It should be emphasized that septic shock, with or without focus of infection, overlaps with hemophagocytic lymphohistiocytosis and can consequently lead to refractory septic shock and death. Thus, our aim of this case is to encourage further investigations, specifically for hemophagocytic lymphohistiocytosis in the setting of septic shock of unknown origin, to decrease mortality rate. More importantly, early initiation of immunosuppression therapy may be a crucial step before switching to hemophagocytic lymphohistiocytosis–specific treatment.
Parotid gland cholesteatoma in a 23-year-old male: Case report
Authors: Piersiala Krzysztof , Klimza Hanna , Jackowska Joanna , Wierzbicka Małgorzata
Published: December 2017

Cholesteatoma is a pathological tissue that may extend into all parts of temporal bone and rarely, as this study highlights, beyond its structures. Nevertheless, the spread outside the mastoid tip into the soft tissues of the neck or parotid space is very rare. The case of 23-year-old male with right parotid mass is presented. The patient had history (2006, 2009, and 2012) of three tympanoplastics for recurrent right ear cholesteatoma. The parotid tumor was revealed incidentally in magnetic resonance imaging in January 2016, but the imaging was inconclusive. After 6 months, the patient developed right-sided facial nerve palsy. The second look of the right ear was performed with simultaneous parotid surgery. The ear was healed and free of cholesteatoma, but the parotid mass resembled the cholesteatoma confirmed later on by histological examination. The tumor extended from stylomastoid foramen. This case was unusual as the disease had extended beyond the ear with the bony parts of the mastoid being preserved. To our knowledge, this is the first case report to describe a parotid gland cholesteatoma not being an extension of a cholesteatoma present in the tympanic cavity and entering the parotid gland via stylomastoid foramen.