bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of keratin extraction from wool by chemical methods for bio-polymer application
Authors: Shavandi Amin , Bekhit Alaa El-Din A , Carne Alan , Bekhit Adnan
Published: September 2016

This study investigated some physicochemical properties of keratin extracted from Merino wool using five chemical extraction methods: alkali hydrolysis, sulfitolysis, reduction, oxidation, and extraction using ionic liquid. The ionic liquid method produced the highest protein yield (95%), followed by sulfitolysis method (89%), while the highest extraction yield was obtained with the reduction method (54%). The lowest yield was obtained with the oxidation method (6%). The oxidation extract contained higher molecular weight (>40 kDa) protein components, whereas the alkali hydrolysis extract contained protein material of <10 kDa. The sulfitolysis, reduction, and ionic liquid extracts contained various protein components between 3.5 and 60 kDa. Keratin obtained from various extraction methods had different yield, morphology, and physicochemical properties. None of the samples were toxic to L929 fibroblast cells up to a concentration of 2.5 mg/mL. Apart from the alkali hydrolysis extract, all other keratin extracts (reduction, sulfitolysis, ionic liquid, and oxidation) showed Fourier transform infrared adsorption peaks attributed to the sulfitolysis–oxidation stretching vibrations of cysteine-S-sulfonated residues, with the oxidation extract showing the highest content of cysteine-S-sulfonated residues. This study indicates that the properties of the keratin extract obtained vary depending on the extraction method used, which has implications for use in structural biomaterial applications.
The Importance of Ground Critical Care Transport
Authors: Wilcox Susan R. , Ries Michael , Bouthiller Ted A. , Berry E. Dean , Dowdy Travis L. , DeGrace Sharon
Published: September 2016

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.
To Detain or Not to Detain? Using Propensity Scores to Examine the Relationship Between Pretrial Detention and Conviction
Authors: Lee Jacqueline G.
Published: September 2016

Recent work has found that individuals who are detained prior to their sentencing are more likely to be convicted, be sentenced to prison as opposed to jail or probation, and to receive longer sentences if convicted. Is this effect due to detention, or is it merely a result of the same underlying criminal propensity being considered separately at each stage of the sentencing process? This study uses propensity score methods to create more comparable comparisons between detained and released criminal defendants. The results of this study indicate that detention itself has an independent effect on the likelihood of conviction. Even after matching with available covariates, individuals who are detained are more likely to be convicted than those who are released prior to their trial.
Numerical comparisons of rotordynamic characteristics for three types of labyrinth gas seals with inlet preswirl
Authors: Li Zhigang , Li Jun , Feng Zhenping
Published: September 2016

Numerical results of frequency-dependent rotordynamic force coefficients and leakage flow rates are presented and compared with three types of labyrinth gas seals, which include a tooth-on-stator (TOS) labyrinth seal, a tooth-on-rotor (TOR) labyrinth seal, and an interlocking-tooth (INT) labyrinth seal. These three labyrinth seals represent the typical labyrinth seal designs used in rotating machinery as shaft seals to limit leakage and ensure a robust rotordynamic design. The three labyrinth seals have the identical rotor diameter, sealing clearance, tooth number, and profile. Using a proposed transient computational fluid dynamics (CFD) method based on the multi-frequency elliptical orbit whirling model, transient CFD solutions were conducted at rotational speed of 7000 r/min, inlet pressure of 6.9 bar, ambient out pressure, and three inlet preswirl ratios up to 1.0. The accuracy and availability of the present transient CFD method were demonstrated with the experiment data of frequency-dependent rotordynamic coefficients of the TOS labyrinth seal with different rotational speeds and inlet preswirl ratios. The rotordynamic coefficients were generally well-predicted by the present numerical method, with direct stiffness and direct damping modestly under predicted (∼67% and ∼34%, respectively). Numerical results compared leakage flow rates and rotordynamic coefficients for three labyrinth seals, while paying special attention to the cross-coupling stiffness, effective damping, crossover frequency, and swirl velocity development along the flow direction in seal. The INT and TOS labyrinth seals consistently leaks less than the TOR labyrinth seal across all preswirl ratios, respectively, by factors of 27% and 5%. The TOS labyrinth seal is relatively most stable, followed by the INT labyrinth seal and then the TOR labyrinth seal. The stability of labyrinth seals can be improved by reducing the swirl velocity at the seal entrance (installing anti-swirl devices) and in the seal cavity (applying “textured” or “pocket” stator surfaces).
Repulsive torque control of a robot-assisted surgery system using a magnetorheological haptic master
Authors: Song Byung-Keun , Oh Jong-Seok , Kim Pyunghwa , Kim Soomin , Choi Seung-Bok
Published: September 2016

In this work, a repulsive torque control of a robot-assisted surgery system using a 4-degree-of-freedom haptic master which is operated using the properties of magnetorheological fluid is undertaken. The proposed haptic master can generate a repulsive torque along 4-degree-of-freedom motion and provide command signals to the slave robot. This is possible due to controllability of the torque by applying the magnetic field (or current) to magnetorheological fluid domain of the clutch system. For the realization of the master-slave robot-assisted minimally invasive surgery system, an encoder is integrated with the haptic master, and the motion command of the haptic master is realized by the surgical slave robot in the robot-assisted minimally invasive surgery architecture. The haptic master–slave system is then established by incorporating the slave robot with the master device, in which the repulsive torque and position commands are transferred to each other. In order to demonstrate superior performance of the proposed haptic master in terms of torque-tracking controllability between the master and surgical positions, a sliding mode controller is designed and experimentally implemented. It is validated via tracking experiment that superior torque-tracking control performance can be achieved by commanding dynamic motions of the haptic master featured by the inherent characteristics of magnetorheological fluid.
Enhanced ionic polymer–metal composite actuator with pore size–controlled porous Nafion membrane using silica sol–gel process
Authors: Jung Sun Yong , Ko Seong Young , Park Jong-Oh , Park Sukho
Published: September 2016

We fabricated a pore size–controlled porous Nafion membrane using a silica sol–gel process and hydrofluoric acid etching and we developed an enhanced ionic polymer–metal composite actuator using the porous Nafion membrane through the electroless plating and ion exchange procedure. As the pore size of the proposed porous Nafion membrane decreased, the porosity, the water uptake, and the ion exchange capacity increased. Compared with conventional Nafion-based ionic polymer–metal composite actuator, the proposed ionic polymer–metal composite actuator using the porous Nafion membrane with the smallest pore size showed the increased electrical conductivity and displacements of about 122% at the alternating current input (1 V, 0.5 Hz, and 1 Hz) and of about 128% at the direct current input (1 V), as well as an increased blocking force of about 138% at direct current input. The ionic polymer–metal composite actuator that was fabricated by the porous Nafion membrane with the smaller pore size showed better actuation performances.
The Technical Communicator as (Post-Postmodern) Discourse Worker
Authors: Wilson Greg , Wolford Rachel
Published: September 2016

This article reexamines Henry’s 2006 proposal for training technical communicators as “discourse workers,” as a solution within a certain postmodern problematic, in which changing economic conditions in the late 1990s and early 2000s made workers vulnerable to exploitation, outsourcing, and layoffs. Henry used postmodern and critical theory to describe discourse as a medium of leverage for enabling workers to define new workplace agencies. Even though Henry’s discourse worker is an appealing concept buttressed by solid theory, it did not become a widely implemented model for pedagogy or workplace practice. To reexamine Henry’s concept, the authors exchange late 20th-century postmodern theory for the more recent articulation of “post-postmodern” theory proposed by Nealon and explore the implications of swapping out the postmodern puzzle piece for a post-postmodern puzzle piece in Henry’s formulation of the discourse worker.
Comparison of All-Inside Arthroscopic and Open Techniques for the Modified Broström Procedure for Ankle Instability
Authors: Yeo Eui Dong , Lee Kyung-Tai , Sung Il-hoon , Lee Sun Geun , Lee Young Koo
Published: September 2016

Background:

No reported study has compared clinical and radiologic outcomes between an all-inside arthroscopic modified Broström operation (MBO) and an open MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs.

Methods:

From August 2012 to July 2014, 48 patients were included. They were divided into 2 groups: all-inside arthroscopic MBO (25 patients) and open MBO (23 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. MBO was performed in 87 patients. Of these, 50 patients met the inclusion criteria. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Patients were randomized into 2 groups, all-inside arthroscopic MBO and open MBO, using a permuted block randomization method. Clinical outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum of 12 months postoperatively using the Karlsson score, the AOFAS ankle-hindfoot score, and pain VAS scores. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle.

Results:

After randomization, 25 ankles were allocated to the all-inside arthroscopic MBO group and 25 to the open MBO group. Two ankles in the open MBO group were excluded from the analysis because they were lost to follow-up. Thus, evaluations were performed for 25 ankles in the all-inside arthroscopic MBO group and 23 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups ( P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05).

Conclusions:

There was no difference in the clinical or radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 1 year after surgery. An all-inside arthroscopic MBO should be considered carefully in patients who have lateral ankle instability.

Level of Evidence:

Level I, randomized controlled trial.
Moving Beyond Blind Men and Elephants: Providing Total Estimated Annual Costs Improves Health Insurance Decision Making
Authors: Barnes Andrew J. , Hanoch Yaniv , Rice Thomas , Long Sharon K.
Published: September 2016

Health insurance is among the most important financial and health-related decisions that people make. Choosing a health insurance plan that offers sufficient risk protection is difficult, in part because total expected health care costs are not transparent. This study examines the effect of providing total costs estimates on health insurance decisions using a series of hypothetical choice experiments given to 7,648 individuals responding to the fall 2015 Health Reform Monitoring Survey. Participants were given two health scenarios presented in random order asking which of three insurance plans would best meet their needs. Half received total estimated costs, which increased the probability of choosing a cost-minimizing plan by 3.0 to 10.6 percentage points, depending on the scenario ( p < .01). With many consumers choosing or failing to switch out of plans that offer insufficient coverage, incorporating insights on consumer decision making with personalized information to estimate costs can improve the quality of health insurance choices.
The Way We Weren’t
Authors: Harris Anne
Published: September 2016

This autoethnographic performance uses the lyrics, mode, and performative stylistic of Barbra Streisand’s famous song as a provocation for exploring the ways in which young adoptees sometimes idealize an imaginary love that is not limited to parent–child but rather floats out like a lyrical overture into the broader landscape of “misty watercolor memories” of a wish for the way things might have been. When Barbra asks Can it be that it was all so simple then?, the adoptee answers no, and lives the need in families that What’s too painful to remember, we simply choose to forget. Adoptee consciousness, like Braidotti’s nomad, abandons any “nostalgia for fixity” and in so doing is able to cultivate an “intense desire to go on trespassing, transgressing” for survival and “thrival.” In this way, Streisand’s song represents a critical moment of letting go within my own developing nomadic queer and adoptee consciousness—a letting go of an idealized “way we were” and a redirection toward a future-looking nomadic subject. Through this queer lens, Barbra’s nostalgic lyrics might be considered a “queer retrosexuality” for a time, place, and kind of love and belonging that has never existed and is increasingly culturally crippling.
Economic Freedom and the Affordable Care Act
Authors: Callison Kevin , Sicilian Paul
Published: September 2016

A greater level of government involvement in the financing of health care is generally viewed unfavorably by organizations monitoring economic freedom. However, increased government provision of health insurance could be associated with improved economic freedom through enhanced labor market mobility. For example, job-lock alleviation accompanying a public insurance expansion could lead to increased innovation or a higher likelihood of self-employment. In this article, we use the Affordable Care Act (ACA)’s recent Medicaid expansions to examine the effect of an increase in public health insurance provision on labor market outcomes by gender and race/ethnicity. Our results lend support to the notion that state Medicaid expansions are associated with improved labor market autonomy for white men and white women; however, we find mixed results for black and Hispanic men and women. Notably, our findings cast doubt on earlier claims that the ACA would lead to large reductions in labor force participation and employment.
Ultrasonographic, endoscopic and histological appearances of the caecum in cats presenting with chronic clinical signs of caecocolic disease
Authors: Hahn Harriet , Pey Pascaline , Baril Aurélie , Charpentier Julie , Desquilbet Loic , Le Poder Sophie , Château-Joubert Sophie , Laloy Eve , Freiche Valerie
Published: September 2016

Objectives

This study aimed to describe the ultrasonographic, endoscopic and histological characteristics of the caecum and ileocaecocolic junction in cats suffering from chronic clinical signs compatible with caecocolic disease.

Methods

Cats presenting with clinical signs suggestive of a caecocolic disease were prospectively recruited. All cats underwent an ultrasonographic examination of the caecum, ileum, colon, ileocolic lymph nodes and local mesenteric fat, in addition to comprehensive abdominal ultrasonography. This was followed by a colonoscopy with a macroscopic assessment of the caecocolic mucosa; caecocolic tissue samples were systematically collected for histologic analysis.

Results

Eighteen cats were included. Eleven of 18 cats had ultrasonographic abnormalities adjacent to the ileocaecocolic junction (lymphadenopathy, local steatitis) and 13/18 cats had abnormalities directly related to the junction (wall thickening, loss of wall layering). Seventeen of 18 cats had at least one ultrasonographic abnormality. Endoscopically, hyperaemia, oedema, discoloration and/or erosions were found in all cats. Each cat was classified as having mild or moderate-to-severe lesions according to endoscopic results; no classification could be established statistically for ultrasonographic results. The accentuation of the dimpled pattern tended to be inversely related to the severity of endoscopic lesion scoring. Histologically, a large proportion of cats showed typhlitis (13/16), one had lymphoma and two were normal. All cats with typhlitis also had colitis. There was only slight agreement between endoscopic and histological caecal results regarding the severity of lesions. Loss of caecal wall layering on ultrasound was found in 7/18 cats and, surprisingly, did not appear as a reliable predictor of the severity of inflammation or of malignancy; neither did local steatitis nor lymph node size.

Conclusions and relevance

Ultrasonography and endoscopy should not be used as the sole methods to investigate the ileocaecocolic region in cats with clinical signs suggestive of caecocolic disease. The presence of chronic clinical signs should routinely prompt histological biopsy.
Decreased soluble IFN-β receptor (sIFNAR2) in multiple sclerosis patients: A potential serum diagnostic biomarker
Authors: Órpez-Zafra Teresa , Pavía Jose , Hurtado-Guerrero Isaac , Pinto-Medel Maria J , Rodriguez Bada Jose Luis , Urbaneja Patricia , Suardíaz Margarita , Villar Luisa M , Comabella Manuel , Montalban Xavier , Alvarez-Cermeño Jose C , Leyva Laura , Fernández Óscar , Oliver-Martos Begoña
Published: September 2016

Background:

The soluble isoform of the interferon-β (IFN-β) receptor (sIFNAR2) could modulate the activity of both endogenous and systemically administered IFN-β. Previously, we described lower serum sIFNAR2 levels in untreated multiple sclerosis (MS) than in healthy controls (HCs).

Objective:

To assess sIFNAR2 levels in a new cohort of MS patients and HCs, as well as in patients with clinically isolated syndrome (CIS) and with other inflammatory neurological disorders (OIND) and to assess its ability as a diagnostic biomarker.

Methods:

The cross-sectional study included 148 MS (84 treatment naive and 64 treated), 87 CIS, 42 OIND, and 96 HCs. Longitudinal study included 94 MS pretreatment and after 1 year of therapy with IFN-β, glatiramer acetate (GA), or natalizumab. sIFNAR2 serum levels were measured by a quantitative ELISA developed and validated in our laboratory.

Results:

Naive MS and CIS patients showed significantly lower sIFNAR2 levels than HCs and OIND patients. The sensitivity and specificity to discriminate between MS and OIND, for a sIFNAR2 cutoff value of 122.02 ng/mL, were 70.1%, and 79.4%, respectively. sIFNAR2 increased significantly in IFN-β-treated patients during the first year of therapy in contrast to GA- and natalizumab-treated patients who showed non-significant changes.

Conclusion:

The results suggest that sIFNAR2 could be a potential diagnostic biomarker for MS.
Optimistic bias in young adults for cancer, cardiovascular and respiratory diseases: A pilot study on smokers and drinkers
Authors: Masiero Marianna , Riva Silvia , Oliveri Serena , Fioretti Chiara , Pravettoni Gabriella
Published: September 2016

Optimistic bias defines the tendency for human beings to underrate risk when it pertains to themselves compared with their view of risk pertaining to other people in the same conditions. The aim of this work is to investigate the optimistic bias in risk perception and health-related behaviours for three specific conditions in a young adult sample: cancer, respiratory disorders and cardiovascular diseases. Young adults showed an optimistic bias related to cancer, and to cardiovascular diseases. Our findings suggest that optimistic bias is linked to specific behavioural patterns, largely widespread in young adults, such as tobacco cigarette smoking and alcohol consumption.
A simplified model for estimating axial impact forces resulting from debris with non-uniform nonstructural mass
Authors: Piran Aghl Payam , Naito Clay J , Riggs H Ronald
Published: September 2016

The impact forces resulting from the debris strikes during tsunami and flood events can lead to extreme damage to the structures located in inundation zones. It is important to estimate reliably such impact demands in order to design structures safely. This study is aimed to develop a simplified one-dimensional model to predict the impact force and duration for axial impact of the debris with non-uniformly distributed nonstructural mass. The focus herein is on in-air impact. An experimental study is carried out on a 6.1-m rectangular steel tube with different configurations of rigidly attached nonstructural mass under elastic response. A nonlinear dynamic finite element model of a steel tube with nonstructural mass is also developed and validated by comparing with the experimental data. Parametric studies are carried out to investigate the effect of nonlinearity on impact demands. The results reveal that the peak impact force is sensitive to the location of the nonstructural mass. It is also observed that the peak impact force is not affected by the magnitude of nonstructural mass during inelastic response. The experimental and simulation results are also used to assess the applicability of the simplified design-oriented one-dimensional model. It is found that the debris impact demands are well represented by the proposed one-dimensional model.
Allocation of Resources to Communication of Research Result Summaries
Authors: Richards Julie E. , Bane Emmi , Fullerton Stephanie M. , Ludman Evette J. , Jarvik Gail
Published: September 2016

Researchers and policymakers recommend communicating summary research results to biobank participants when feasible. To date, however, there have been few explorations of participant preferences for dedicating resources to this activity. Fifteen semi-structured interviews were conducted with participants of a genetic medicine biobank. Participants were interviewed by phone about their motivation for participation, and opinions about the allocation of resources to communicating summary results. De-identified transcripts were used for a directed content analysis. Most biobank participation was altruistic. All participants were not only interested in receiving summary results but also expressed a clear preference for allocating limited funds to conducting additional genetic research. The results suggest that participants have a nuanced view about the allocation of biobank resources to returning summary results, and asking their opinion is a valuable exercise. Researchers may benefit from transparency about research goals and involving biobank participants in decisions about return of summary results.
Short Sleep Duration and Screen-Based Activities
Authors: Alqaderi Hend , Goodson J. Max , Subramanian S. V. , Tavares Mary
Published: September 2016

Objective. The aim of this study was to identify lifestyle habits that contribute to night sleep reduction in the Kuwaiti population. Methods. Children were 10 to 12 years old and were approximately equally distributed among 138 elementary schools representing the 6 governorates of Kuwait. In the first phase of the study, data were collected from 8317 children. The same data were collected 2 years later from 6316 of the children from the first phase of the study. Calibrated examiners conducted sleep evaluation, lifestyle habits interviews, and body weight measurements. A multilevel random intercept and slope model was conducted to determine the effect of screen-based activities on the daily night sleep hours at 3 levels: within schools, among children, and over time. The primary dependent variable was the number of daily sleep hours. Independent variables assessed were lifestyle habits including screen-based activity variables including TV and video game use. Results. Screen-based activities were significant factors that reduced daily sleep hours (P < .05). There were statistically significant variations between schools and children over time. Conclusion. Longitudinal analysis of Kuwaiti children revealed that TV and video game use were major risk behaviors contributing to decreased sleep duration with strong clustering effect of the observations within schools across time.
Calculation of the effective bearing contact radius for precision tightening of bolted joints
Authors: Gong Hao , Liu Jianhua , Ding Xiaoyu
Published: September 2016

Torque control is usually the only method for tightening bolts in some precision assembly applications. However, the scatter of the torque–tension relationship may significantly decrease the accuracy of the preload, which conflicts with the high requirement for mechanical accuracy in such precision assemblies. An important, but often ignored, factor affecting the accuracy of the torque–tension relationship is the effective bearing contact radius. In this article, a three-dimensional finite element model of a typical bolted joint was developed to obtain the actual bearing pressure distribution, based on which the effective bearing contact radius can be further calculated. Then, a parametrical study was conducted to systematically investigate the effects of various geometrical, material, and frictional factors on the effective bearing contact radius. Based on the numerical results, a comprehensive and quantitative evaluation of the relative accuracy of each traditional method of calculating the effective bearing contact radius was made. In particular, it was found that the effective bearing contact radius, calculated based on the assumption of uniform bearing pressure distribution, was always relatively accurate regardless of the geometrical, material, and frictional conditions considered. This study will be helpful in increasing the accuracy of preload, thus ensuring mechanical accuracy and quality for precision assemblies.
A randomized study of multimedia informational aids for research on medical practices: Implications for informed consent
Authors: Kraft Stephanie A , Constantine Melissa , Magnus David , Porter Kathryn M , Lee Sandra Soo-Jin , Green Michael , Kass Nancy E , Wilfond Benjamin S , Cho Mildred K
Published: September 2016

Background/Aims:

Participant understanding is a key element of informed consent for enrollment in research. However, participants often do not understand the nature, risks, benefits, or design of the studies in which they take part. Research on medical practices, which studies standard interventions rather than new treatments, has the potential to be especially confusing to participants because it is embedded within usual clinical care. Our objective in this randomized study was to compare the ability of a range of multimedia informational aids to improve participant understanding in the context of research on medical practices.

Methods:

We administered a web-based survey to members of a proprietary online panel sample selected to match national US demographics. Respondents were randomized to one of five arms: four content-equivalent informational aids (animated videos, slideshows with voice-over, comics, and text) and one no-intervention control. We measured knowledge of research on medical practices using a summary knowledge score from 10 questions based on the content of the informational aids. We used analysis of variance and paired t-tests to compare knowledge scores between arms.

Results:

There were 1500 completed surveys (300 in each arm). Mean knowledge scores were highest for the slideshows with voice-over (65.7%), followed by the animated videos (62.7%), comics (60.7%), text (57.2%), and control (50.3%). Differences between arms were statistically significant except between the slideshows with voice-over and animated videos and between the animated videos and comics. Informational aids that included an audio component (animated videos and slideshows with voice-over) had higher knowledge scores than those without an audio component (64.2% vs 59.0%, p < .0001). There was no difference between informational aids with a character-driven story component (animated videos and comics) and those without.

Conclusion:

Our results show that simple multimedia aids that use a dual-channel approach, such as voice-over with visual reinforcement, can improve participant knowledge more effectively than text alone. However, the relatively low knowledge scores suggest that targeted informational aids may be needed to teach some particularly challenging concepts. Nonetheless, our results demonstrate the potential to improve informed consent for research on medical practices using multimedia aids that include simplified language and visual metaphors.
An Adaptive Nonlinear Basal-Bolus Calculator for Patients With Type 1 Diabetes
Authors: Boiroux Dimitri , Aradóttir Tinna Björk , Nørgaard Kirsten , Poulsen Niels Kjølstad , Madsen Henrik , Jørgensen John Bagterp
Published: September 2016

Background:

Bolus calculators help patients with type 1 diabetes to mitigate the effect of meals on their blood glucose by administering a large amount of insulin at mealtime. Intraindividual changes in patients physiology and nonlinearity in insulin-glucose dynamics pose a challenge to the accuracy of such calculators.

Method:

We propose a method based on a continuous-discrete unscented Kalman filter to continuously track the postprandial glucose dynamics and the insulin sensitivity. We augment the Medtronic Virtual Patient (MVP) model to simulate noise-corrupted data from a continuous glucose monitor (CGM). The basal rate is determined by calculating the steady state of the model and is adjusted once a day before breakfast. The bolus size is determined by optimizing the postprandial glucose values based on an estimate of the insulin sensitivity and states, as well as the announced meal size. Following meal announcements, the meal compartment and the meal time constant are estimated, otherwise insulin sensitivity is estimated.

Results:

We compare the performance of a conventional linear bolus calculator with the proposed bolus calculator. The proposed basal-bolus calculator significantly improves the time spent in glucose target ( P < .01) compared to the conventional bolus calculator.

Conclusion:

An adaptive nonlinear basal-bolus calculator can efficiently compensate for physiological changes. Further clinical studies will be needed to validate the results.
Distraction First Metatarsophalangeal Arthrodesis With Tricortical Calcaneus Autograft
Authors: McAlister Jeffrey E. , Hyer Christopher F. , Black Trevor E.
Published: September 2016

First metatarsophalangeal joint arthritis can stem from a biomechanical imbalance as in hallux abducto valgus, metabolic arthritidies such as rheumatoid or gout, and even in posttraumatic cases. Advanced arthritis in the foot and ankle can often become debilitating. Surgical intervention is often necessary. Revision of failed first metatarsophalangeal joint arthroplasty is often in the setting of bony erosion and lysis, cystic changes, and loss of bone stock. In this article, we describe first metatarsophalangeal distraction arthrodesis technique using tricortical calcaneus autograft with the aim of simplifying donor site graft harvesting and decreasing donor site morbidity while attaining successful osseous union.

Levels of Evidence: Level V
Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters
Authors: Kurashige Toshinori , Suzuki Seiichi
Published: September 2016

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch.

Levels of Evidence: Therapeutic, Level IV: Case series
Global Multimodal News Frames on Climate Change
Authors: Wessler Hartmut , Wozniak Antal , Hofer Lutz , Lück Julia
Published: September 2016

This paper presents the first fully integrated analysis of multimodal news frames. A standardized content analysis of text and images in newspaper articles from Brazil, Germany, India, South Africa, and the United States covering the United Nations (UN) Climate Change Conferences 2010–2013 was conducted using a subset of photo-illustrated articles ( n = 432) as well as the entire conference coverage ( n = 1,311). In the photo-illustrated articles, four overarching multimodal frames were identified: global warming victims, civil society demands, political negotiations, and sustainable energy frames. The distribution of these global frames across the five countries is relatively similar, and a comparison of frames emerging from the national subsets also reveals a strong element of cross-national frame convergence. This is explained by the news production context at global staged political events, which features uniform media access rules and similar information supplies, as well as strong interaction between journalists from different countries and between journalists and other actors. Event-related frame convergence across vastly different contexts is interpreted as one mechanism by which truly transnational media debate can be facilitated that can potentially serve to legitimize global political decisions. In conclusion, perspectives for future qualitative and quantitative multimodal framing research are discussed.
An Excel Spreadsheet Model for States and Districts to Assess the Cost-Benefit of School Nursing Services
Authors: Wang Li Yan , O’Brien Mary Jane , Maughan Erin D.
Published: September 2016

This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by full-time school nurses. Prior to applying the model, states or districts need to collect data using two forms: “Daily Nurse Data Collection Form” and the “Teacher Survey.” The former is used to record daily nursing activities, including number of student health encounters, number of medications administered, number of student early dismissals, and number of medical procedures performed. The latter is used to obtain estimates for the time teachers spend addressing student health issues. Once inputs are entered in the model, outputs are automatically calculated, including program costs, total benefits, net benefits, and benefit-cost ratio. The spreadsheet model, data collection tools, and instructions are available at the NASN website ( http://www.nasn.org/The/CostBenefitAnalysis ).
Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults
Authors: Assari Shervin
Published: September 2016

Objectives:

Despite the well-established association between self-rated health and mortality, research findings have been inconsistent regarding how men and women differ on this link. Using a national sample in the United States, this study compared American male and female older adults for the predictive role of baseline self-rated health on the short-term risk of mortality.

Methods:

This longitudinal study followed 1500 older adults (573 men (38.2%) and 927 women (61.8%)) aged 66 years or older for 3 years from 2001 to 2004. The main predictor of interest was self-rated health, which was measured using a single item in 2001. The outcome was the risk of all-cause mortality during the 3-year follow-up period. Demographic factors (race and age), socio-economic factors (education and marital status), and health behaviors (smoking and drinking) were covariates. Gender was the focal moderator. We ran logistic regression models in the pooled sample and also stratified by gender, with self-rated health treated as either nominal variables, poor compared to other levels (i.e. fair, good, or excellent) or excellent compared to other levels (i.e. good, fair, or poor), or an ordinal variable.

Results:

In the pooled sample, baseline self-rated health predicted mortality risk, regardless of how the variable was treated. We found a significant interaction between gender and poor self-rated health, indicating a stronger effect of poor self-rated health on mortality risk for men compared to women. Gender did not interact with excellent self-rated health on mortality.

Conclusion:

Perceived poor self-rated health better reflects risk of mortality over a short period of time for older men compared to older women. Clinicians may need to take poor self-rated health of older men very seriously. Future research should test whether the differential predictive validity of self-rated health based on gender is due to a different meaning of poor self-rated health for older men and women and whether poor self-rated health reflects different health statuses based on gender.
Biblical Canons in Church Traditions and Translations
Authors: Loba Mkole Jean-Claude
Published: September 2016

This issue of The Bible Translator is devoted to the subject of the biblical canon, offering papers presented at UBS Global Bible Translation meetings. The introduction to the issue highlights the following points: the purpose of the papers, church perspectives on biblical canons, the contents of the papers, and the findings and suggestions drawn from the authors’ conclusions.
Use of Tolvaptan in a Patient With Palliated Congenital Heart Disease
Authors: Chakravarti Sujata , Busovsky-McNeal Melissa
Published: September 2016

Heart failure is a common problem in the ever growing population of patients with palliated congenital heart disease. It is frequently complicated by hyponatremia that has been associated with increased morbidity and mortality. Tolvaptan is a vasopressin receptor antagonist that has been effective in improving hyponatremia and congestive symptoms in adults with chronic heart failure. We describe the short-term use of tolvaptan to treat hyponatremic hypervolemia in an adolescent patient with chronic heart failure in the setting of palliated congenital heart disease prior to definitive surgical intervention. In this case, the patient had improvement in hyponatremia and a decrease in body weight, without any adverse effects.
Hereditary risk factors for thrombophilia and probability of venous thromboembolism during pregnancy and the puerperium
Authors: Gerhardt Andrea , Scharf Rüdiger E. , Greer Ian A. , Zotz Rainer B.
Published: September 2016

Key Points

Women with severe thrombophilia have a high absolute risk of pregnancy-associated VTE independent of a positive family history of VTE. These women should be considered for routine antenatal thromboprophylaxis regardless of family history of VTE.
A hybrid computational strategy to address WGS variant analysis in >5000 samples
Authors: Huang Zhuoyi , Rustagi Navin , Veeraraghavan Narayanan , Carroll Andrew , Gibbs Richard , Boerwinkle Eric , Venkata Manjunath Gorentla , Yu Fuli
Published: September 2016

Background

The decreasing costs of sequencing are driving the need for cost effective and real time variant calling of whole genome sequencing data. The scale of these projects are far beyond the capacity of typical computing resources available with most research labs. Other infrastructures like the cloud AWS environment and supercomputers also have limitations due to which large scale joint variant calling becomes infeasible, and infrastructure specific variant calling strategies either fail to scale up to large datasets or abandon joint calling strategies.

Results

We present a high throughput framework including multiple variant callers for single nucleotide variant (SNV) calling, which leverages hybrid computing infrastructure consisting of cloud AWS, supercomputers and local high performance computing infrastructures. We present a novel binning approach for large scale joint variant calling and imputation which can scale up to over 10,000 samples while producing SNV callsets with high sensitivity and specificity. As a proof of principle, we present results of analysis on Cohorts for Heart And Aging Research in Genomic Epidemiology (CHARGE) WGS freeze 3 dataset in which joint calling, imputation and phasing of over 5300 whole genome samples was produced in under 6 weeks using four state-of-the-art callers. The callers used were SNPTools, GATK-HaplotypeCaller, GATK-UnifiedGenotyper and GotCloud. We used Amazon AWS, a 4000-core in-house cluster at Baylor College of Medicine, IBM power PC Blue BioU at Rice and Rhea at Oak Ridge National Laboratory (ORNL) for the computation. AWS was used for joint calling of 180 TB of BAM files, and ORNL and Rice supercomputers were used for the imputation and phasing step. All other steps were carried out on the local compute cluster. The entire operation used 5.2 million core hours and only transferred a total of 6 TB of data across the platforms.

Conclusions

Even with increasing sizes of whole genome datasets, ensemble joint calling of SNVs for low coverage data can be accomplished in a scalable, cost effective and fast manner by using heterogeneous computing platforms without compromising on the quality of variants.
Shared Goal Setting in Team-Based Geriatric Oncology
Authors: Magnuson Allison , Wallace James , Canin Beverly , Chow Selina , Dale William , Mohile Supriya G. , Hamel Lauren M.
Published: September 2016

We present the case of a 92-year-old man, MH, who was given a diagnosis of colorectal cancer. His primary care physician, surgeon, geriatric oncologist, and family members all played important roles in his care. MH’s case is an example of a lack of explicit shared goal setting by the health care providers with the patient and family members and how that impeded care planning and health. This case demonstrates the importance of explicitly discussing and establishing shared goals in team-based cancer care delivery early on and throughout the care process, especially for older adults. Each individual member’s goals should be understood as they fit within the overarching shared team goals. We emphasize that shared goal setting and alignment of individual goals is a dynamic process that must occur several times at critical decision points throughout a patient’s care continuum. Providers and researchers can use this illustrative case to consider their own work and contemplate how shared goal setting can improve patient-centered care and health outcomes in various team-based care settings. Shared goal setting among team members has been demonstrated to improve outcomes in other contexts. However, we stress, that little investigation into the impact of shared goal setting on team-based cancer care delivery has been conducted. We list immediate research goals within team-based cancer care delivery that can provide a foundation for the understanding of the process and outcomes of shared goal setting.
Facilitating Teamwork in Adolescent and Young Adult Oncology
Authors: Johnson Rebecca H. , Macpherson Catherine Fiona , Smith Ashley W. , Block Rebecca G. , Keyton Joann
Published: September 2016

A case of a young adult patient in the days immediately after a cancer diagnosis illustrates the critical importance of three interrelated core coordinating mechanisms—closed-loop communication, shared mental models, and mutual trust—of teamwork in an adolescent and young adult multidisciplinary oncology team. The case illustrates both the opportunities to increase team member coordination and the problems that can occur when coordination breaks down. A model for teamwork is presented, which highlights the relationships among these coordinating mechanisms and demonstrates how balance among them works to optimize team function and patient care. Implications for clinical practice and research suggested by the case are presented.