bluuebunny/crossref_metadata_2025 huggingface dataset:
Global bridge damage detection using multi-sensor data based on optimized functional echo state networks
Authors: Dan Jingpei , Feng Wending , Huang Xia , Wang Yuming
Published: August 2020

While machine learning has been increasingly incorporated into structural damage detection, most existing methods still rely on hand-crafted damage features. For a given structure, the performance of detection is heavily impacted by the quality of features, and choosing the optimal features may be difficult and time-consuming. Various time series classification algorithms studied in machine learning are able to classify structural responses into damage conditions without feature engineering; however, most of them only deal with univariate time series classification and are either inapplicable or ineffective on multivariate (i.e. multi-dimensional) data, thus unable to fully utilize all sensors available on real bridges. To address these limitations, we propose a global bridge damage detection method based on multivariate time series classification with optimized functional echo state networks. In this method, data from multiple sensors are directly used as inputs without feature extraction. Training of the functional echo state network is simple and straightforward, and by leveraging the nonlinear mapping capacity and dynamic memory of functional echo state network, the separability of different classes, that is, classifying accuracy is enhanced compared to conventional classification algorithms. Furthermore, hyperparameters of the functional echo state network are automatically optimized with particle swarm optimization algorithm, which further improves the accuracy while saving the cost of manual tuning. Experimental results on two classical data sets show that functional echo state network achieves high and stable accuracy, which indicate that our method can detect global bridge structural damage efficiently by analyzing multiple sensor data, and is prospected to be applied in real bridge structural health monitoring systems.
Correlation of A-Kinase Interacting Protein 1 With Clinical Features, Treatment Response, and Survival Profiles in Patients With Multiple Myeloma
Authors: Wang Wei , Xie Yinghua , Han Xiyao , Liu Yihan , Li Pei
Published: August 2020

Objective:

The present study aimed to detect A-kinase interacting protein 1 expression and further explore the association of A-kinase interacting protein 1 with clinical features and prognosis in patients with multiple myeloma.

Methods:

Totally, 152 de novo symptomatic patients with multiple myeloma and 30 healthy donors were enrolled. Bone marrow mononuclear cells derived plasma cells were collected from patients with multiple myeloma before initial treatment and from healthy donors on the enrollment, respectively, and then A-kinase interacting protein 1 protein/messenger RNA expressions were detected by Western blot and reverse transcription quantitative polymerase chain reaction. Treatment response (complete response and overall response rate) was assessed, and survival profiles (progression-free survival and overall survival) were calculated in patients with multiple myeloma.

Results:

A-kinase interacting protein 1 protein/messenger RNA expressions were elevated in patients with multiple myeloma compared to healthy donors, and A-kinase interacting protein 1 (area under the curve: 0.809, 95% confidence interval: 0.726-0.891)/messenger RNA (area under the curve: 0.839, 95% confidence interval: 0.764-0.914) presented good value in differentiating patients with multiple myeloma from healthy donors. In patients with multiple myeloma, A-kinase interacting protein 1 /messenger RNA expressions negatively correlated with albumin while positively correlated with Beta-2-microglobulin, lactate dehydrogenase, International Staging System stage, and t (4;14). Meanwhile, there were 39 (25.7%) complete response patients, 113 (74.3%) noncomplete response patients, 112 (73.7%) overall response rate patients, and 40 (26.3%) nonoverall response rate patients. Complete response and overall response rates were decreased in patients with high A-kinase interacting protein 1 compared to patients with low A-kinase interacting protein 1. Additionally, progression-free survival and overall survival were reduced in patients with high A-kinase interacting protein 1 compared to patients with low A-kinase interacting protein 1.

Conclusion:

A-kinase interacting protein 1 exhibits the potency as a biomarker for multiple myeloma progression and prognosis, which implies the clinical application of A-kinase interacting protein 1 in multiple myeloma management.
Automatic Segmentation of the Gross Target Volume in Non-Small Cell Lung Cancer Using a Modified Version of ResNet
Authors: Zhang Fuli , Wang Qiusheng , Li Haipeng
Published: August 2020

Radiotherapy plays an important role in the treatment of non-small cell lung cancer. Accurate segmentation of the gross target volume is very important for successful radiotherapy delivery. Deep learning techniques can obtain fast and accurate segmentation, which is independent of experts’ experience and saves time compared with manual delineation. In this paper, we introduce a modified version of ResNet and apply it to segment the gross target volume in computed tomography images of patients with non-small cell lung cancer. Normalization was applied to reduce the differences among images and data augmentation techniques were employed to further enrich the data of the training set. Two different residual convolutional blocks were used to efficiently extract the deep features of the computed tomography images, and the features from all levels of the ResNet were merged into a single output. This simple design achieved a fusion of deep semantic features and shallow appearance features to generate dense pixel outputs. The test loss tended to be stable after 50 training epochs, and the segmentation took 21 ms per computed tomography image. The average evaluation metrics were: Dice similarity coefficient, 0.73; Jaccard similarity coefficient, 0.68; true positive rate, 0.71; and false positive rate, 0.0012. Those results were better than those of U-Net, which was used as a benchmark. The modified ResNet directly extracted multi-scale context features from original input images. Thus, the proposed automatic segmentation method can quickly segment the gross target volume in non-small cell lung cancer cases and be applied to improve consistency in contouring.
SKA3 Promotes Cell Growth in Breast Cancer by Inhibiting PLK-1 Protein Degradation
Authors: Ruan Li-wei , Li Peng-peng , Jin Lang-ping
Published: August 2020

Breast cancer (Bca) remains the most common form of malignancy affecting females in China, leading to significant reductions in the mental and physical health of those with this condition. While spindle and kinetochore associated complex subunit 3 (SKA3) is known to be linked with cervical cancer progression, whether it is similarly associated with Bca progression remains unknown. Using shRNA, we specifically knocked down the expression of SKA3 in Bca cell lines and then assessed the resultant changes in cell proliferation using CCK-8 and colony formation assays. In addition, we used western blotting to quantify the expression levels of relevant proteins in these cells, and we assessed the interaction between SKA3 and polo-like kinase-1 (PLK-1) via co-immunoprecipitation.In this study, we observed elevated SKA3 expression in Bca tissues and cell lines. When we knocked down SKA3 expression in Bca cells, we were able to determine that it functions in an oncogenic manner so as to promote the growth and proliferation of these cells in vitro. From a mechanistic perspective, we were able to show that in Bca cells SKA functions at least in part via interacting with PLK-1 and preventing its degradation. In summary, we found that SKA3 is able to regulate PLK-1 degradation in Bca cells, thus controlling their growth and proliferation. These results highlight SKA3 as a potentially viable target for anti-cancer drug development aimed at combatting Bca.
Bend the Tool, Not the Wrist: An Ergonomic Investigation of Medical Suturing Needle Holder Design and Medical Engineering Solution
Authors: Abdelall Esraa S. , Stone Richard T. , Rajana Nedved Leela , Fales Colten
Published: August 2020

The study aimed to assess a new needle holder grip and head design on medical suturing quality and experience. Generally, suturing remained fundamentally unchanged since its invention, possessing high variability, discomfort, and can be moderately predictable. In this study, 2 grip designs (traditional holder grip and a new slightly curved crescent-shaped grip) and 2 head types (smooth vs knurled) were investigated resulting in 4 groups. Thirty-two medical interns were recruited to participate in this study. Their performances were assessed across time, symmetry, wrist posture, discomfort, and perceived difficulty. Findings revealed that the new grip led to a lesser time, better wrist posture, less discomfort, and difficulty than the traditional grip. More, the new grip with smooth head holder led to more symmetrical and shorter knots than knurled and conventional grip one. Findings are of interest for medical personnel, where it is recommended to use a smooth head and new grip needle holder while suturing for better suturing performance, wrist posture, and hand comfort.
The Effect of Male Sexual Abstinence Periods on the Clinical Outcomes of Fresh Embryo Transfer Cycles Following Assisted Reproductive Technology: A Meta-Analysis
Authors: Li Jinhong , Shi Qingquan , Li Xiaohong , Guo Junliang , Zhang Long , Quan Yi , Ma Ming , Yang Yihong
Published: August 2020

A sexual abstinence period (SAP) lasting for 2–7 days is recommended before undertaking semen analyses. However, there is no consensus regarding the length of the SAP for couples using assisted reproductive technology (ART). Therefore, a meta-analysis was performed to compare the effect of short SAPs (less than 4 days) and long SAPs (4–7 days) on the clinical outcomes of fresh embryo transfer cycles after ART. A total of four studies were included in the meta-analysis. Although the fertilization rate in short SAP couples was higher than that in long SAP couples, a pooled analysis demonstrated that it was not statistically significant ( p = .09). The implantation rate was, however, significantly higher in short SAP couples ( p = .0001). The pooled analysis revealed that the pregnancy rate was significantly higher in short SAP couples than that in long SAP couples. The overall odds ratio (OR) for the pregnancy rate was 1.44 ( p = .0006). No significant difference in miscarriage rates between the short and long SAP couples was found ( p = .88). The meta-analysis indicates that a shorter abstinence period could result in higher implantation and pregnancy rates for patients undertaking ART treatments.
Flow diverter stents with hydrophilic polymer coating for the treatment of acutely ruptured aneurysms using single antiplatelet therapy: Preliminary experience
Authors: Guzzardi Giuseppe , Galbiati Andrea , Stanca Carmelo , Del Sette Bruno , Paladini Andrea , Cossandi Christian , Carriero Alessandro
Published: August 2020

Background

The use of flow diverter stent (FDS) has limitations in cases of subarachnoid haemorrhage caused by ruptured aneurysm, due to the need for double antiplatelet therapy and the delay in the aneurysm occluding. The p48 MW and the p64 MW (Phenox) are available with Hydrophilic Polymer Coating (HPC), that reduces the risk of thrombus formation. Purpose of this study is to evaluate the safety and efficacy of p48 and p64 MW HPC with single antiplatelet therapy for the acute treatment of ruptured aneurysm.

Methods

We retrospectively evaluated all patients treated for acutely ruptured aneurysms with a p48 MW HPC or p64 MW HPC from October 2019 to April 2020 using single antiplatelet therapy. For each patient, we considered demographic and aneurysm-related data, clinical presentation, size and location of the implanted flow diverter stent, intra- and post-procedural complications, aneurysm occlusion.

Results

Seven patients were included. The ruptured aneurysms were four saccular, two blister-like and one dissecting, six in the anterior and one in posterior circulation. No intraprocedural stent thrombosis and rebleeding was observed. In two cases the aneurysm is completely excluded, in one patient it was found only neck perfusion, in three cases there were mild reduction of the sac and in one case there was a persistent perfusion. No patients needed retreatment in this series.

Conclusion

In our experience, FDS HPC appears a potential treatment option in selected cases. Our study is limited by small population and short-term follow-up. We report our preliminary data, but further investigations are necessary.
Parameter identification of Bouc-Wen model for Magnetorheological (MR) fluid Damper by a Novel Genetic Algorithm
Authors: Negash Birhan Abebaw , You Wonhee , Lee Jinho , Lee Kwansup
Published: August 2020

In this research, novel genetic algorithm (nGA) is proposed for Bouc-Wen modle parameters esstimation for magnetorheological (MR) fluid dampers. The optimization efficiency is improved by modifying the crossover and mutation steps of a GA. In the crossover stage, the probability of reproducing offspring from the same parent (same mother and father chromosome) is done to be zero, which may happen in the standard GA, and the probability of a chromosome to be selected for mating is based on error rank weighting of the chromosomes. Additional fitness evaluation of chromosomes will take place in between the crossover and mutation steps to save the best chromosome found so far, which is not implemented in the standard genetic algorithm (GA). The model is validated by comparing its simulation output force ( Fsim) with experimentally generated MR damper force ( Fexp). The mean absolute error, standard deviation and number of generations for convergence are taken as a criterias for performance evaluation. With these ctriterias, the proposed novel GA outperform better than the other researches. The accuracy is improved by 46.67% compared to standard GA. The proposed novel GA for Bouc-Wen model parameter identification can be used for any MR damper control system with better accuracy.
Development of collision avoidance system for multiple autonomous mobile robots
Authors: Hou Yew Cheong , Mohamed Sahari Khairul Salleh , Weng Leong Yeng , Foo Hong Kah , Abd Rahman Nur Aira , Atikah Nurul Anis , Homod Raad Z
Published: August 2020

This article presents a collision avoidance system for multiple robots based on the current autonomous car collision avoidance system. The purpose of the system is to improve the current autonomous car collision avoidance system by including data input of other vehicles’ velocity and positioning via vehicle-to-vehicle communication into the current autonomous car collision avoidance system. There are two TurtleBots used in experimental testing. TurtleBot is used as the robot agent while Google Lightweight Communication and Marshalling is used for inter-robot communication. Additionally, Gazebo software is used to run the simulation. There are two types of collision avoidance system algorithm (collision avoidance system without inter-robot communication and collision avoidance system with inter-robot communication) that are developed and tested in two main road crash scenarios, rear end collision scenario and junction crossing intersection collision scenario. Both algorithms are tested and run both in simulation and experiment setup, each with 10 repetitions for Lead TurtleBot sudden stop, Lead TurtleBot decelerate, Lead TurtleBot slower speed, and straight crossing path conditions. Simulation and experimental results data for each algorithm are recorded and tabulated. A comprehensive comparison of performance between the proposed algorithms is analyzed. The results showed that the proposed system is able to prevent collision between vehicles with an acceptable success rate.
Broadcast control of multi-robot systems with norm-limited update vector
Authors: Mohamad Nor Mohamad Hafizulazwan , Ismail Zool Hilmi , Ahmad Mohd Ashraf
Published: August 2020

This article addresses a problem in standard broadcast control framework which leads to an unstable solution in a certain motion-coordination task. First, the unstable phenomenon in a certain motion-coordination task is illustrated using standard broadcast control framework. This issue calls for modification to the standard broadcast control framework by limiting the norm of the update vector of robots’ positions into a constant value. Then, we demonstrate that the modified broadcast controller achieves the convergence with the probability of 1. Finally, we illustrate in numerical simulations that the modified broadcast controller can effectively solve the instability issue and also may improve the convergence time as compared to the standard broadcast controller.
The DURATIONS randomised trial design: Estimation targets, analysis methods and operating characteristics
Authors: Quartagno Matteo , Carpenter James R , Walker A Sarah , Clements Michelle , Parmar Mahesh KB
Published: August 2020

Background:

Designing trials to reduce treatment duration is important in several therapeutic areas, including tuberculosis and bacterial infections. We recently proposed a new randomised trial design to overcome some of the limitations of standard two-arm non-inferiority trials. This DURATIONS design involves randomising patients to a number of duration arms and modelling the so-called ‘duration-response curve’. This article investigates the operating characteristics (type-1 and type-2 errors) of different statistical methods of drawing inference from the estimated curve.

Methods:

Our first estimation target is the shortest duration non-inferior to the control (maximum) duration within a specific risk difference margin. We compare different methods of estimating this quantity, including using model confidence bands, the delta method and bootstrap. We then explore the generalisability of results to estimation targets which focus on absolute event rates, risk ratio and gradient of the curve.

Results:

We show through simulations that, in most scenarios and for most of the estimation targets, using the bootstrap to estimate variability around the target duration leads to good results for DURATIONS design-appropriate quantities analogous to power and type-1 error. Using model confidence bands is not recommended, while the delta method leads to inflated type-1 error in some scenarios, particularly when the optimal duration is very close to one of the randomised durations.

Conclusions:

Using the bootstrap to estimate the optimal duration in a DURATIONS design has good operating characteristics in a wide range of scenarios and can be used with confidence by researchers wishing to design a DURATIONS trial to reduce treatment duration. Uncertainty around several different targets can be estimated with this bootstrap approach.
The relationship between principal leadership and teacher collaboration: Investigating the mediating effect of teachers’ collective efficacy
Authors: Meyer André , Richter Dirk , Hartung-Beck Viola
Published: August 2020

Empirical research considers teacher collaboration to be an important predictor of outcome variables at the student, teacher, and school level. Principals are responsible for shaping teachers’ work environments, and in doing so, they can strengthen and support teacher collaboration. Drawing on social interdependence theory, we hypothesized that teachers’ collective efficacy has a mediating effect on the relationship between principal leadership and teacher collaboration. We collected data from 630 teachers in 29 primary and secondary schools in Germany and found, based on structural equation modeling, that principal leadership had a significant indirect effect on teacher collaboration, mediated by teachers’ collective efficacy. We discuss the implications of these results for supporting school improvement.
Assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges during a pandemic: An Intensive Care Society clinical guideline
Authors: Montgomery J , Stokes-Lampard HJ , Griffiths MD , Gardiner D , Harvey D , Suntharalingam G
Published: August 2020

This national professional society guidance lays out operational and ethical principles for decision-making during a pandemic, in the immediate context of COVID-19 in the early 2020 surge iteration but with potential ongoing relevance. It identifies the different phases of a pandemic and the implications for capacity and mutual aid within a national healthcare system, and introduces a revised CRITCON-PANDEMIC framework for shared operational responsibilities and clinical decision-making. Usual legal and ethical frameworks should continue to apply while capacity and mutual aid are available (CRITCON-PANDEMIC levels 0-3); clinicians should focus on current clinical needs and should not treat patients differently because of anticipated future pressures. In conditions of resource limitation (CRITCON-PANDEMIC 4), a structured and equitable approach is necessary and an objective Decision Support Aid is proposed. In producing this guidance, we emphasise that all patients must be treated with respect and without discrimination, because everyone is of equal value. The guidance has been put together with input from patient and public groups and aims to provide standards that are fair to everyone. We acknowledge that COVID-19 is a new disease with a partial and evolving knowledge base, and aim to provide an objective clinical decision-making framework based on the best available information. It is recognised that a factual assessment of likely benefit may take into account age, frailty and comorbidities, but the guidance emphasises that every assessment must be individualised on a balanced, case by case, basis and may inform clinical judgement but not replace it. The effects of a comorbidity on someone's ability to benefit from critical care should be individually assessed. Measures of frailty should be used with care, and should not disadvantage those with stable disability.
First-line treatments for advanced renal-cell carcinoma with immune checkpoint inhibitors: systematic review, network meta-analysis and cost-effectiveness analysis
Authors: Su Yingjie , Fu Jie , Du Jiangyang , Wu Bin
Published: August 2020

Background:

Immune checkpoint inhibitors (ICIs) are effective for advanced renal-cell carcinoma (aRCC) but can increase costs. This study compares the efficacy, safety and cost-effectiveness of ICIs for newly diagnosed aRCC patients in the first-line setting.

Methods:

Trials evaluating ICI regimens as first-line treatment for newly diagnosed aRCC were searched and included. A network meta-analysis (NMA) was conducted, and a cost-effectiveness analysis was performed from the US payer’s perspective. The key outcomes were overall survival (OS) and progression-free survival (PFS) in the NMA, and quality-adjusted life years (QALYs), costs and the incremental cost-effectiveness ratio (ICER) in the cost-effectiveness analysis.

Results:

Four randomized controlled trials (RCTs) involving 3758 patients receiving first-line ICIs treatment were analyzed. The NMA showed that pembrolizumab plus axitinib was ranked higher than the other three ICI regimens and sunitinib in the overall population. Nivolumab plus ipilimumab and pembrolizumab plus axitinib achieved more health benefits than the other ICI regimens and sunitinib in programmed death ligand 1 (PD-L1)-positive and negative tumors, respectively. Among the four ICI regimens, only the ICERs of nivolumab plus ipilimumab over sunitinib were lower than the willingness-to-pay threshold ($150,000/QALY) in the overall and PD-L1-positive populations, and none of four ICI regimens were lower than $150,000/QALY in PD-L1-negative populations.

Conclusions:

The NMA and cost-effectiveness analysis revealed that nivolumab plus ipilimumab is the most favorable first-line treatment for PD-L1-positive aRCC compared with other ICI regimens and sunitinib. Pembrolizumab plus axitinib is likely to be an alternative for PD-L1-negative aRCC due to its more favorable health advantages.
Eccrine Porocarcinoma: Avoiding Diagnostic Delay
Authors: Jarocki Christine , Kozlow Jeffery , Harms Paul W. , Schmidt Brian M.
Published: August 2020

Skin cancer is the most common cancer within the United States. Reports estimate that 1 in 5 Americans will develop some form of skin cancer. Eccrine porocarcinoma is a rare type of skin cancer of sweat gland origin. Eccrine porocarcinoma is most commonly found on the lower extremities. Clinically it may appear similar to benign skin lesions and it has significant metastatic potential. The authors present a case report with 22 months’ follow-up. It describes a multiyear delay in diagnosis involving 3 specialties, including primary care, dermatology, and wound physical therapy. Information is given on techniques when high-risk cutaneous cancers are suspected or encountered. A multispecialty treatment plan is discussed.

Levels of Evidence: Level V
Mandibular Reconstruction With Block Iliac Crest: An Institutional Experience
Authors: Camarini Camila , Spagnol Guilherme , Pinotti Manuela Monteiro , do Canto Alan Motta , Maciel Fernando Alves , de Freitas Ronaldo Rodrigues
Published: August 2020

Study Design:

Mandibular reconstruction is a challenge. Several reconstructive techniques are available, and the individualization of choice for each patient leads to better results and quality of life for the individual.

Objective:

The aim of this study is to evaluate the characteristics and complications of cases submitted to mandibular reconstruction with autogenous bone graft block of the iliac crest.

Methods:

Records of 45 patients undergoing mandibular reconstruction with autogenous bone graft block of the iliac crest were analyzed from January 2000 to December 2014. The data collected included age, gender, etiology and graft size, surgical approach, complications, comorbidities, and habits and addictions. Analysis of variance, chi-square test, and Fisher exact test were used for analysis of the variables with a significance level of P < .05.

Results:

The success rate of the 45 charts analyzed was 75.6%. No statistical differences were found between age and presence of complications, between defect size and presence or absence of complications, and between type of surgical approach and presence or absence of complications.

Conclusion:

According to our study, medical history may influence postoperative complications and require attention, though further studies should be performed to further elucidate the relationship between diseases and postoperative complications.
What Surgeons Want: Access to Online Surgical Education and Peer-to-Peer Counseling—A Qualitative Study
Authors: Häberle Astrid D. , Nath Riya , Facente Shelley N. , Albers Autumn E. , Girod Sabine
Published: August 2020

Study Design:

Mixed methods study including quantitative data analysis and qualitative analysis of semi-structured interviews.

Objectives:

Utilizing information and communication technology can facilitate professional communication within health care on a global scale. This study aimed to identify the educational and peer-to-peer communication needs of craniomaxillofacial (CMF) surgeons across the globe, determine preferred modes of communication, and assess technological and other barriers to online education and peer-to-peer communication.

Methods:

We performed semi-structured videoconference interviews of 92 CMF surgeons from around the globe, with the largest number in the Asia/Pacific region, the Middle East, and Latin America. We triangulated quantitative summaries with qualitative themes to improve validity and enable a more comprehensive understanding of participant perspectives.

Results:

The interviews revealed 3 main areas of technology use: new surgical technology, technology that enables information exchange, and communication technology. When asked about technology and communication platforms used in the course of their work, 33 participants (36%) mentioned PubMed or other journal-related sites; 25% recalled using YouTube as a resource; 23% described conducting internet searches using Google or other search engines; 21% used WhatsApp groups; and 11% used closed Facebook groups.

Conclusion:

CMF surgeons embraced communication technologies that allowed them to quickly obtain knowledge especially on new surgical technology, discuss cases on demand, and maintain strong communication with their global peers.
Formation of student’s hypertext competence using hypertext technologies
Authors: Bourina Helena V , Dunaeva Larisa A
Published: August 2020

The formation of hypertext competence emerges from a combination of methods, tools and technologies that provide communication between hypertext network devices with the aim of transmitting information. The information transmitted may be diverse depending on its type and content and is intended to be used collectively through network information and communication resources, where the network language and culture differ from traditional speech practices. The difference here lies at the macro level, i.e. at the level of texts, and at the micro level, the level of lexeme transformation, at the level of meaning and form, different from the norms existing in the language system of the community. Moreover, the level of fact acquisition and, as a result, memorization increase when the information is structured, taking into account common features, which are relevant for students. Objectivity, integrity and network identity pay an important role there. The formation of hypertext competence is carried out in the course of environment-oriented training, which means that a foreign language is acquired in natural situational conditions.
An SF-MDA of the Textual and the Logical Cohesive Devices in a Postgraduate Accounting Course
Authors: Alyousef Hesham Suleiman
Published: August 2020

The use of cohesive devices in academic discourse not only improves the quality of writing but also enhances our learning experiences. This study aims to explain how the multimodal accounting discourse is constructed by postgraduate business students through the cohesive ties. Halliday and Hasan’s and Halliday’s cohesion analysis schemes were employed in the systemic functional multimodal discourse analysis (SF-MDA) of the cohesive devices in the multimodal accounting texts. The schemes are based on systemic functional linguistics (SFL) which suits the context of this study as it considers language as a social semiotic resource for making meaning. Its linguistic tools are capable of explaining the way we construct and make meanings. The SF-MDA findings showed the first and most frequently occurring cohesive device type in the orthographic texts was lexical cohesion, in particular repetition of the same lexical items, followed by reference and conjunctions. Lexical cohesive devices were higher in the tables than in the orthographic texts. Conjunctions were only employed in the orthographic texts to signal extension and enhancement relationships. One of the key features that characterize financial statements is the abundance of implicit hierarchically networked lexical ties that bind the separate lexical strings, thereby organizing the discourse of financial statements. The results contribute to our understanding of the complex multimodal meaning-making processes in accounting discourse.
Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India
Authors: Bhosale Sunil , Prabhakar Akil , Srivastava Sudhir , Raj Aditya , Purohit Shaligram , Marathe Nandan
Published: August 2020

Study Design:

Retrospective observational analysis.

Objectives:

Spinal tuberculosis accounts for about 50% of cases among extra pulmonary osteoarticular tuberculosis. Resistance to drugs in spinal tuberculosis patients is on a rise and there is inadequate literature concentrating on the precise pattern of resistance in Indian subcontinent which harbors 24% of global prevalence. The aim was to study the pattern of drug resistance in spinal tuberculosis among first- and second-line drugs. Drug resistance is common in spinal tuberculosis and we intended to find the prevalence of various drug resistance patterns.

Methods:

Patients with spinal tuberculosis visiting a tertiary center were assessed. Samples were taken from the affected vertebrae and sent for BACTEC mycobacterium growth indicator tube (MGIT) 960 culture. Patients with a positive growth in MGIT were included in the study. All previously treated patients (relapse, treatment after failure, treatment after loss to follow-up and other previously treated patients) were excluded.

Results:

A total of 150 patients with a positive growth in MGIT report were included in the study, of whom 43 patients had some kind of drug resistance. Seven were multidrug resistant (MDR), 9 had preextensive drug resistance (pre-XDR), and 4 had extensive drug resistance (XDR). Seventeen patients had mono-drug resistance, which was most frequently for isoniazid. Resistance among second-line drugs was common in the fluoroquinolone group.

Conclusion:

Drug resistance in spinal tuberculosis was found to be 28.6%. Of these, MDR was in 16.2%, pre-XDR in 20.9%, and XDR in 9.3% patients.
Implant Distribution Versus Implant Density in Lenke Type 1 Adolescent Idiopathic Scoliosis: Does the Position of the Screw Matter?
Authors: Dial Brian L. , Esposito Valentine R. , Catanzano Anthony A. , Fitch Robert D. , Lark Robert K.
Published: August 2020

Study Design:

Retrospective study.

Objective:

Previous studies have demonstrated that increased implant density (ID) results in improved coronal deformity correction. However, low-density constructs with strategically placed fixation points may achieve similar coronal correction. The purpose of this study was to identify key zones along the spinal fusion where high ID statistically correlated to improved coronal deformity correction. Our hypothesis was that high ID within the periapical zone would not be associated with increased percent Cobb correction.

Methods:

We identified patients with Lenke type 1 curves with a minimum 2-year follow up. The instrumented vertebral levels were divided into 4 zones: (1) cephalad zone, (2) caudal zone, (3) apical zone, and (4) periapical zone. High and low percent Cobb correction groups were compared, high percent Cobb group was defined as percent correction >67%. Total ID, total concave ID, total convex ID, and ID within each zone of the curve were compared between the groups. A multivariable analysis was performed to identify independent predictors for coronal correction. Subsequently increased and decreased thoracic kyphosis (TK) groups were compared, increased TK was defined as post-operative TK being larger than preoperative TK and decreased TK was defined as post-operative TK being less than preoperative TK.

Results:

The cohort included 68 patients. The high percent Cobb group compared with the low percent Cobb group had significantly greater ID for the entire construct, the total concave side, the total convex side, the apical convex zone, the periapical zone, and the cephalad concave zone. The high percent Cobb group had greater pedicle screw density for the total construct, total convex side, and total concave side. In the multivariate model ID and pedicle screw density remained significant for percent Cobb correction. Ability to achieve coronal balance was not statistically correlated to ID ( P = .78).

Conclusions:

Increased ID for the entire construct, the entire convex side, the entire concave side, and within each spinal zone was associated with improved percent Cobb correction. The ability to achieve coronal balance was not statistically influence by ID. The results of this study support that increasing ID along the entire length of the construct improves percent Cobb correction.
“Law of Temporary Diminishing Distraction Gains”: The Phenomenon of Temporary Diminished Distraction Lengths With Magnetically Controlled Growing Rods That Is Reverted With Rod Exchange
Authors: Cheung Jason Pui Yin , Bow Cora , Cheung Kenneth M. C.
Published: August 2020

Study Design:

Prospective study.

Objectives:

To study the increasing divergence between targeted and achieved distractions observed with magnetically controlled growing rod (MCGR)lengthening, and the relationship of this reduced rate of achieved lengthening with remaining rod length.

Methods:

Patients with early onset scoliosis (EOS) who underwent MCGRs with minimum 2-year follow-up were consecutively enrolled. Targeted and achieved lengths were compared. Correlation between percentage of lengthening achieved from targeted length was identified with the timing of rod exchanges.

Results:

A total of 20 patients fulfilled the inclusion criteria. The mean age at index surgery was 9.5 years and mean postoperative follow-up was 68 ± 28 months. Of these, 8 patients had at least one rod exchange that occurred at 23 ± 4 months. A decrease in rate of achieved lengthening was observed when compared with targeted distractions. The achieved lengthening drops from 86% of targeted length at the first distraction to only 58.8% at the 21st distraction episode for the first set of rods. After rod exchange, the average achieved lengthening went back up to 81.3% of the targeted length but subsequently had a gradual reduction to 35% at the 19th distraction episode.

Conclusions:

We propose a “law of temporary diminishing distraction gains” that MCGR users should be aware of when monitoring rod lengthening. Diminishing distraction length gains is observed as the rod is lengthened and is a phenomenon independent of patient factors. It is only temporary as the rates of achieved lengthening returns to baseline after rod exchange.
Investigating Commercial Incentives for Innovation: An Application in Traditional Medicine
Authors: Saha Debdatta , Vasuprada T. M.
Published: August 2020

Innovation in traditional medicine is not easily compatible with standard measures, such as patents and clinical trials. Especially, in the current context of COVID-19, there is a renewed interest in alternative cures from traditional medicine. While the ‘historical capital’ associated with traditional medicine systems like Ayurveda creates a ready market for medicinal formulations, possibilities of innovation remain uncaptured. Within the space of traditional medicines, Ayurveda has, in recent years, resulted in a plethora of medicines: both proprietary formulations as well as ‘pill-ized’ versions of standard classical herbs. We conduct a detailed investigation of this issue using a two-pronged strategy. First is a qualitative investigation through a primary survey of Ayurveda practitioners based in Delhi and Kerala in 2018, using the snowball sampling technique, to understand what innovation should mean for Ayurvedic pharmacopeia. Second is our quantitative analysis using the hedonic method, which checks for commercial incentives reflected in retail prices of Ayurvedic formulations, which incorporate varying degrees of innovation. We find the existence of commercial profit-making incentives, and that innovation in Ayurveda is synonymous with improvements in utility for patients by making medicines more palatable and travel friendly. We conduct robustness checks by contrasting the results from our parametric specification with a non-parametric chi-square automatic interaction detector (CHAID) analysis. However, we do not find scientific evidence supporting the discovery and efficacy of these medicines. Public investments in efficacy standards that strengthen the linkages between research and commercial drug discovery are necessary to infuse innovation in the large pharmacopoeia of traditional medicine systems like Ayurveda.

JEL Classifications: D40, L790, I110, O31
Comment on Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective
Authors: Amutah-Onukagha Ndidiamaka , Mahadevan Meena , Opara Ijeoma , Rodriguez Monica , Baxter Aminah , Trusdell Megan , Kelly Jessica
Published: August 2020

The aim of Project THANKS (Turning HIV/AIDS into Knowledge for Sisters) was to provide resources for African American women living with a dual diagnosis of HIV and associated comorbidities such as a chronic illness, and substance use disorder. HIV self-management is viewed within a larger context that addresses HIV and comorbidities concurrently. Project THANKS is an evidence-based, culturally competent curriculum that provides African American women with the necessary knowledge and tools to manage their complications associated with having multiple chronic diseases. The intervention was piloted in 2015 and later conducted in 2018 in 3 community-based health centers in New Jersey. Future interventions of Project THANKS will address the social support, mental health, and health literacy needs expressed by participants as well as incorporating a licensed social worker to further improve their physical and mental health outcomes.
“Looking for Deviations”: Nurses’ Observations of Older Patients With COPD in Home Nursing Care
Authors: Øfsti Ruth , Devik Siri Andreassen , Enmarker Ingela , Olsen Rose Mari
Published: August 2020

Nurses working in home care play a significant role in observing and identifying changes in the health status of patient with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore and describe nurses’ observations of older patients with COPD when providing home nursing care. In this qualitative explorative study, data were collected through observations of 17 home care visits using the think-aloud technique, followed up with individual interviews with the nurses. Qualitative content analysis was used to analyze the data. The findings showed that the nurses’ observations (focus, methods, and interpretation) were characterized by their search for deviations from what they judged to be the patient’s habitual state. The nurses did not use any tool or guidelines, nor did they follow a standard procedure. Instead, when observing and interpreting, they performed a complex process guided by their experience and knowledge of the patient, and the patient’s individual and contextual circumstances. This knowledge contributes to warranted reflection on nurses’ practice in this context to secure COPD patients’ safety and quality of life.
The Case for Writing Critical Thinking Reports as a Teaching Strategy on Today’s Hospital Wards
Authors: Manian Farrin A
Published: August 2020

I review some of the challenges in teaching medical students and housestaff on today’s hospital medicine wards, including increasingly limited time for dedicated teaching. Tapping into the extensive literature of “writing to learn” or “writing-across-the curriculum” in non-medical educational settings ranging from elementary school to college classes, I urge consideration of writing concise critical thinking reports (CTRs) by medical students and housestaff in response to questions raised during patient rounds as a means of enhancing their ward-based learning experience. Several potential reasons for writing CTRs are offered: (1) Nurtures curiosity; (2) Demands self-directed search for and encoding of new knowledge; (3) Emphasizes metacognition and conceptualization crucial to meaningful learning; (4) Provides opportunity for learners to teach and share newly-assimilated material with a broader web-based audience; (5) Encourages the concept of narrow but more in-depth learning related to a specific clinically relevant subject matter; (6) Nudges learners toward clear and succinct writing as an important general skill to develop in their everyday professional activities, including electronic medical record documentation; and (7) Reduces work-related burnout. Barriers to writing CTRs, including lack of general appreciation for explanatory writing as a potential teaching strategy in medical education and allowing sufficient time for medical students and housestaff to engage in this activity among other competing demands, are discussed. Writing CTRs is a potentially powerful pedagogical tool in ward-based learning that deserves consideration and formal evaluation by properly designed studies.
Breathing in the polyrhythmic city: A spatiotemporal, rhythmanalytic account of urban air pollution and its inequalities
Authors: Walker Gordon , Booker Douglas , J Young Paul
Published: August 2020

Inspired by Lefebvre’s meditation on the rhythms seen from his apartment in Paris, we develop a novel rhythmanalytic account of urban air pollution, its breathing-in and impact in vulnerable bodies. We conceptualise urban air pollution as entwined in its making and consequence with the diverse rhythms of technologies, social practices and socio-temporal structures, environmental and atmospheric processes, bodily movements in space and time, and rhythmically constituted corporeality. Through this interdisciplinary account we position urban air pollution as integral to the ‘beat’ of the city, both a product of and constituent part of its evolving spatiotemporal form. We build on this foundation to develop a polyrhythmic conceptualisation of how certain places and lives are more dominated by pollution than others. Unequal patternings are made through the structuring effects of rhythmic repetition and by fatal intersections between the rhythms of polluted air and unequal capacities to avoid harmful breathing in and to resist the arrhythmic corporeal consequences that can follow. Understanding inequalities as manifest not within a static landscape of spatial relations, but in sets of unequally unfolding and structured polyrhythmic relations has implications for revealing patterns of inequality and for extending evidence-making more deeply into how rhythms intersect. Which and whose rhythms are to be intervened in are also considered as key ethical and political questions. We draw out implications for activism and community action, and identify the potential for bringing rhythmanalysis into productive engagement with broader environmental justice concerns, including in relation to recent COVID-19 experiences.
Effect of Lateral Sliding Calcaneus Osteotomy on Tarsal Tunnel Pressure
Authors: Halm Sebastian , Fairhurst Paul G. , Tschanz Stefan , Wieland Fluri A. M. , Djonov Valentin , Krause Fabian
Published: August 2020

Background:

Lateral sliding calcaneus osteotomies are common procedures to correct hindfoot varus deformities. Shifting the calcaneal tuberosity laterally (lateralization) can lead to tarsal tunnel pressure increase and tibial nerve palsy. The purpose of this cadaveric biomechanical study was to investigate the correlation of lateralization and pressure increase underneath the flexor retinaculum.

Methods:

The pressure in the tarsal tunnel of 12 Thiel-fixated human cadaveric lower legs was measured in different foot positions and varying degrees of calcaneal lateralization.

Results:

The mean pressure increased from plantarflexion (PF) to neutral position (NP) and from NP to hindfoot dorsiflexion (DF), and with increasing amounts of lateralization of the calcaneal tuberosity. The mean baseline pressure in PF was 1.5, in NP 2.2, and in DF 6.5 mmHg and increased to 8.1 in PF, 18.4 in NP, and 33.1 mmHg with 12 mm of lateralization. The release of the flexor retinaculum significantly lowered the pressure.

Conclusion:

Increasing pressures were found in the tarsal tunnel with increasing lateralization of the tuberosity and with both dorsiflexion and plantarflexion of the ankle.

Clinical Relevance:

A pre-emptive release of the flexor retinaculum for a lateralization of the calcaneal tuberosity of more than 8 mm should be considered, especially if specific patient risk factors are present. No tibial nerve palsy should be expected with 4 mm of lateralization.