bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Safety Impacts of Access Management Alternatives with the Surrogate Safety Assessment Model
Authors: Kim Kyung Min , Saito Mitsuru , Schultz Grant G. , Eggett Dennis L.
Published: May 2018

In a traditional safety impact analysis, it is necessary to have crash data on existing roadway conditions and a few years must pass before accumulating additional crash data to evaluate the safety impact of an improvement. This is a time-consuming approach and there remains uncertainty in the crash data integrity. The surrogate safety assessment model (SSAM) was developed for resolving these issues. With SSAM, a conflict analysis is performed in a simulated environment. A planned improvement alternative is modeled and no physical installation of the alternative is needed. This study evaluated if SSAM can be used to assess the safety of a highway segment in terms of the number and type of conflicts and to compare the safety effects of multiple access management alternatives. An evaluation of the effect of converting a two-way left-turn lane (TWLTL) into a raised median on a section of an urban street was performed using SSAM working on VISSIM simulation’s trajectory files. The analysis showed that a raised median would be much safer than a TWLTL median for the same level of traffic volume, with approximately 32 to 50 percent reduction in the number of crossing conflicts. The analysis showed that about 34,000 to 38,000 veh/day would be the demand level where the median conversion is recommended for the four-lane study section. The study concluded that the combination of a simulation software program with SSAM could be a viable surrogate analysis approach for evaluating and comparing the safety effects of multiple access management alternatives.
The Challenge of Advanced Driver Assistance Systems Assessment: A Scale for the Assessment of the Human–Machine Interface of Advanced Driver Assistance Technology
Authors: Biondi Francesco N. , Getty Douglas , McCarty Madeleine M. , Goethe Rachel M. , Cooper Joel M. , Strayer David L.
Published: May 2018

Despite driver assistance systems being engineered to enhance safety, recent studies show the potential for some of these systems and deficient human–machine interfaces to cause unintended consequences on safety. The NHTSA, the Alliance of Automotive Manufacturers, and the European Commission have all released best practices and human factors guidelines for the development and assessment of function-aspecific interfaces. However, given their broad scope, none of these documents provides a rating and benchmarking tool for assessing design aspects pertinent to a wide spectrum of assistance systems, ranging from rearview cameras to lane keeping assist systems. In this article we detail the development of a scale for assessing the human–machine interfaces of 10 different assistance systems. The scale contains 59 items, developed through multiple iterations, in which a total of 94 distinct assistance systems available on vehicles of different makes and models underwent evaluation. For each system included, we provide a description of its characteristics, a list of items for assessment, and relevant references. Widely accepted industry (ISO, SAE) standards, design guidelines, and assessment methodologies were considered for the development of this scale. The adoption of this scale required at least two evaluators to rate each system against specific assessment items using the following 4-point scale: No Concern (3 points), Minor Concerns (2 points), Serious Concerns (1 point), Not Applicable (0 points). Final ratings resulting from this evaluation will aid evaluators in the benchmarking process, and in determining what specific design aspects of the systems assessed merit further attention.
Management of Traumatic Hip Fracture in the Palliative Care Unit
Authors: Whitehead Katherine , Spaner Donna
Published: May 2018

We report on the case of an elderly patient in a palliative care unit who fell and sustained a hip fracture. Hip fractures are potentially terminal events for elderly patients with other life-limiting conditions. The case highlights the need for more evidence to determine the best approach to care for hip fractures in patients who are in the final weeks or months of life.
Building the Case: Changing Consumer Perceptions of the Value of Expanded Community Pharmacist Services
Authors: Steckowych Kathryn , Smith Marie , Spiggle Susan , Stevens Andrew , Li Hao
Published: May 2018

Background:

The role of the community pharmacist has traditionally been a medication dispenser; however, community pharmacists’ responsibilities must expand to include more direct patient care services in order to transform primary care practice.

Objectives:

Use case-based scenarios to (1) determine factors that contribute to positive and negative consumer perceptions of expanded community pharmacist patient care roles, (2) identify facilitators and barriers that contribute to consumer perceptions of the value of expanded community pharmacist patient care services, and (3) develop a successful approach and strategies for increasing consumer advocacy for the value of expanded community pharmacist patient care services.

Methods:

Two consumer focus groups used scenario-based guided discussions and Likert scale questionnaires to elicit consumer reactions, facilitators, and barriers to expanded community pharmacist services.

Results:

Convenience, timeliness, and accessibility were common positive reactions across all 3 scenarios. Team approach to care and trust were viewed as major facilitators. Participant concerns included uncertainty about pharmacist training and qualifications, privacy, pharmacists’ limited bandwidth to accept new tasks, and potential increased patient costs. Common barriers to service uptake included a lack of insurance payment and physician preference to provide the services.

Conclusion:

Consumer unfamiliarity with non-traditional community pharmacist services is likely an influencer of consumers’ hesitancy to utilize such services; therefore, an opportunity exists to engage consumers and advocacy organizations in supporting expanded community pharmacist roles. This study can inform consumers, advocates, community pharmacists, primary care providers, and community-based organizations on methods to shape consumer perceptions on the value of community pharmacist expanded services.
New definitions of deformation index for the measurement of bus survival space in crash
Authors: Abdul Hamid I , Li QM
Published: May 2018

Vehicle crashworthiness can be described as the capability of the vehicle to protect the occupant during a crash. The space containing the occupants should remain intact and should not allow any potential intrusion or crushing to injure the occupants. For rollover crash test of a bus, this safety space is well defined in a standard, that is, the United Nations Regulation No. 66 (UN R66), where it gives pass/fail criteria. However, the standard does not measure and quantify the bus structural deformation. The measurement of such deformation has been systematically quantified by the angular deformation index ( DIα), in which the deformation of bus structure can be generalized for comparative study giving more descriptive assessment of the bus structure deformation level. DIα is suitable for rollover test that is done strictly in a controlled environment, where the deformation is typically not severe. In real crashes, impact load varies widely and can cause severe structural damages, especially among the aged buses with poor structural strength, which are still broadly used in less developed countries. If the deformed bus structures penetrate deeply into the residual space, DIα index becomes irrelevant because the angular values in the equation give exponential results. It is therefore suggested that a new deformation index, termed as the area deformation index ( DIA), is used for real rollover crashes involving severe damages to the bus structure. This is to quantify the damages in two dimensions once the structures penetrate into the residual space, up to where the structure is totally collapsed. By having this new index, a suitable structural deformation severity rating for the bus with respect to real rollover crashes can be proposed. This severity rating can be correlated to the injury severity (e.g. number and level) of the bus occupants, and can be used to evaluate some specific parameters influencing crashworthiness performance (e.g. aging effects). Case studies are discussed to show the practicality of the proposed DIA concept. Volume deformation index ( DIV) is also proposed to quantify the deformation in three dimensions.
Potential use of fly ash and bagasse ash as secondary abrasives in phenolic composites for eco-friendly brake pads applications
Authors: Choosri Saowapa , Sombatsompop Narongrit , Wimolmala Ekachai , Thongsang Sirinthorn
Published: May 2018

Brake pad is the essential component of disk brake in automotive applications that is made of phenolic-based composites. The alumina and silica are often used as primary abrasives in brake pads. In this study, we investigated the hardness, compressive, friction and wear properties under room temperature and elevated temperatures (100°C and 150°C) of phenolic-based composites containing the natural ashes of fly ash and bagasse ash as secondary abrasives, which ranged from 0 to 12 wt%, for replacing primary abrasives. The results suggested that 4 wt% secondary abrasives was recommended for optimization of the overall properties of the composites. It was found that all composites exhibited the abrasive wear behavior evidenced by wear debris between the counterfaces acting as third-body abrasives. The phenolic-based composites at 100°C and 150°C had higher coefficient of friction and lower wear resistance than those at room temperature. The incorporation of bagasse ash resulted in more compression for a given load than that of fly ash. In summary, the fly ash and bagasse ash, which were natural ashes, showed a potential use as secondary abrasives in the phenolic-based composites for eco-friendly brake pads.
Enacting and capturing embodied knowledge in the practices of enthusiast car restorers: Emerging themes
Authors: Lloyd Annemaree , Olsson Michael
Published: May 2018

This paper reports on emerging themes drawn from a larger ongoing qualitative study of car restorers which explores themes of embodiment, embodied knowledge and ways of knowing. The themes described in this current article indicate that car restoration is bounded within a discourse of loyalty to the particular type of practice and its projects (restoration), its material object (the car) and to narratives of expertise, maintenance and preservation. The study’s findings also demonstrate that enthusiast car restorers, along with other serious leisure communities, have become the unacknowledged custodians of a large body of hands-on knowledge which would otherwise be in danger of being lost in an increasingly post-industrial world.
Information discernment, mis-information and pro-active scepticism
Authors: Walton Geoff , Pickard Alison Jane , Dodd Lara
Published: May 2018

A participatory action research approach was employed to investigate school students’ information discernment capabilities. Placing school student participants at the centre of the research process enabled them to define the problem in their own words and begin to find solutions to the issue of how to choose good quality information. Findings confirmed the results of many studies - that school students adopt a cognitive default position of trust and are relatively unquestioning when using information sources for their work (in this case the Extended Project Qualification or EPQ). Results also showed that with an appropriate embedded learning and teaching intervention, which includes aspects of information and digital literacy, school students adopt a cognitive questioning state, which leads to pro-active scepticism, enhancing their information discernment and in turn enables them to make better information choices. This has implications not only for school teachers and librarians but for educational policy makers also.
The Route by Which Intranasally Delivered Stem Cells Enter the Central Nervous System
Authors: Galeano Carlos , Qiu Zhifang , Mishra Anuja , Farnsworth Steven L. , Hemmi Jacob J. , Moreira Alvaro , Edenhoffer Peter , Hornsby Peter J.
Published: May 2018

Intranasal administration is a promising route of delivery of stem cells to the central nervous system (CNS). Reports on this mode of stem cell delivery have not yet focused on the route across the cribriform plate by which cells move from the nasal cavity into the CNS. In the current experiments, human mesenchymal stem cells (MSCs) were isolated from Wharton’s jelly of umbilical cords and were labeled with extremely bright quantum dots (QDs) in order to track the cells efficiently. At 2 h after intranasal delivery in immunodeficient mice, the labeled cells were found under the olfactory epithelium, crossing the cribriform plate adjacent to the fila olfactoria, and associated with the meninges of the olfactory bulb. At all times, the cells were separate from actual nerve tracts; this location is consistent with them being in the subarachnoid space (SAS) and its extensions through the cribriform plate into the nasal mucosa. In their location under the olfactory epithelium, they appear to be within an expansion of a potential space adjacent to the turbinate bone periosteum. Therefore, intranasally administered stem cells appear to cross the olfactory epithelium, enter a space adjacent to the periosteum of the turbinate bones, and then enter the SAS via its extensions adjacent to the fila olfactoria as they cross the cribriform plate. These observations should enhance understanding of the mode by which stem cells can reach the CNS from the nasal cavity and may guide future experiments on making intranasal delivery of stem cells efficient and reproducible.
Local, Controlled Release In Vivo of Vascular Endothelial Growth Factor Within a Subcutaneous Scaffolded Islet Implant Reduces Early Islet Necrosis and Improves Performance of the Graft
Authors: Gebe John A. , Preisinger Anton , Gooden Michel D. , D’Amico Leonard A. , Vernon Robert B.
Published: May 2018

Islet transplantation remains the only alternative to daily insulin therapy for control of type 1 diabetes (T1D) in humans. To avoid the drawbacks of intrahepatic islet transplantation, we are developing a scaffolded islet implant to transplant islets into nonhepatic sites. The implant test bed, sized for mice, consists of a limited (2-mm) thickness, large-pore polymeric sponge scaffold perforated with peripheral cavities that contain islets suspended in a collagen hydrogel. A central cavity in the scaffold holds a 2-mm diameter alginate sphere for controlled release of the angiogenic cytokine vascular endothelial growth factor ( VEGF). Host microvessels readily penetrate the scaffold and collagen gel to vascularize the islets. Here, we evaluate the performance of the implant in a subcutaneous (SC) graft site. Implants incorporating 500 syngeneic islets reversed streptozotocin-induced diabetes in mice approximately 30 d after SC placement. Controlled release of a modest quantity (20 ng) of VEGF within the implant significantly reduced the time to normoglycemia compared to control implants lacking VEGF. Investigation of underlying causes for this effect revealed that inclusion of 20 ng of VEGF in the implants significantly reduced central necrosis of islets 24 h after grafting and increased implant vascularization (measured 12 d after grafting). Collectively, our results demonstrate (1) that the scaffolded islet implant design can reverse diabetes in SC sites in the absence of prevascularization of the graft site and (2) that relatively low quantities of VEGF, delivered by controlled release within the implant, can be a useful approach to limit islet stress after grafting.
Report from Paris. The German Military Attaché in France, Detlof von Winterfeldt, and his views of the French Army, 1909–1914
Authors: Grawe Lukas
Published: May 2018

Although historiography often attributes the German military leadership a high responsibility for the outbreak of the First World War, the action of the German military attaché in Paris, Detlof von Winterfeldt, has so far been ignored. This article shows how Winterfeldt assessed the strengths and weaknesses of the French army and describes how his reporting influenced the General Staff’s evaluations in Berlin. It examines the concrete effects of his reporting on German military policies and military planning before 1914 to ascertain whether the General Staff relied on Winterfeldt’s reports and if so, what difference they made.
LGI1 antibody encephalitis and psychosis
Authors: Wang Dahai , Hao Qinjian , He Lan , Wang Qiang
Published: May 2018

Objective:

To describe a case of leucine-rich, glioma inactivated 1 antibody-encephalitis presenting with psychosis.

Methods:

Case report.

Results:

A young man with leucine-rich, glioma inactivated 1-antibody encephalitis initially presented with acute psychotic symptoms, short-term memory loss and faciobrachial dystonic seizures. Magnetic resonance imaging revealed hippocampal lesions. Electroencephalography revealed frontotemporal slowing of background activity.

Conclusion:

Increased awareness of leucine-rich, glioma inactivated 1-antibody encephalitis may promote early recognition and treatment.
The language we use – the effect of writing mental health care plans in the first person
Authors: Wyder Marianne , Kisely Steve , Meurk Carla , Dietrich Josie , Fawcett Teresa , Siskind Dan , Robinson Gail , Crompton David
Published: May 2018

Objective:

This study describes the impact of Motivational Aftercare Planning (MAP) – an intervention to increase consumer/clinician collaboration on the content of mental health recovery plans. The intervention focussed on enhancing existing discharge processes in psychiatric inpatient wards and supporting nursing staff in using motivational interviewing techniques to facilitate the completion of these plans.

Methods:

We conducted a qualitative thematic content analysis of the recovery plans completed throughout the study ( n = 110). Chi-squared tests were then used to compare the occurrence of themes and content identified in recovery plans pre and post the intervention ( n = 55).

Results:

The thematic content of the recovery plans shifted in focus following the intervention, with a change from third to first person language. Those completed prior to the intervention generally mentioned: decreasing symptoms of mental illness; acceptance of the illness; achieving clinical stability; risk management and treatment compliance. The recovery plans completed after the intervention focussed on: general wellness; participate in meaningful activities; community life; social roles and connections with others.

Conclusions:

This study demonstrated that a simple time-limited, facilitated intervention resulted in a change of thematic content in recovery plans. The use of these plans and its effect on care planning will need further evaluation.
Teaching Journalism Ethics Through “The Newsroom”: An Enhanced Learning Experience
Authors: Peterlin Laveda J. , Peters Jonathan
Published: May 2018

As documented in multiple fields, students taking ethics courses can benefit from alternative pedagogical approaches using television shows for learning. This article explores the journalistic ethics conflicts depicted in the first season of the HBO show “The Newsroom.” These conflicts, brought to life through vivid and realistic storytelling, enable students to experience how ethical decisions affect a newsroom and the audience it serves. This is a form of screen narrative ethnography (SNE) that provides journalism instructors additional classroom resources and that creates an innovative, rich learning experience for students.
On the Origin of Beliefs about the Sexual Orientation and Gender-role Development of Children Raised by Gay-male and Heterosexual Parents: An Italian Study
Authors: Carnaghi Andrea , Anderson Joel , Bianchi Mauro
Published: May 2018

In three studies, heterosexual participants were presented with descriptions of heterosexual and gay-male parents. Importantly, the level of gender-role conformity of the gay-male parents was experimentally manipulated, resulting in their level of gender-role conformity ranging from high to low. Compared to the son of a heterosexual couple, the son of all gay-male couples had a lower expected likelihood of developing as heterosexual. This result was independent of the level of gender-role conformity of the gay-male couples (study 1–3). The beliefs about the gender-role development of the son, in terms of anticipated masculinity (study 1), gender stereotyping (study 2), and affective adjustment (study 3), mapped onto the level of gender-role conformity of the parents, regardless of their sexual orientation. Also, heterosexual parents were consistently judged more positively than gay-male parents, independently of their level of gender-role conformity (study 1–3). Results were discussed within the theoretical framework of stereotypes about gay-male parenting.
Cementless total hip arthroplasty in young patients under the age of 30: a minimum 10-year follow-up
Authors: Shin Eun Ho , Moon Kyoung Ho
Published: May 2018

Purpose:

The purpose of this study was to evaluate the clinical and radiologic outcomes of young patients (under the age of 30) who received a total hip arthroplasty (THA) and in whom patients had been followed for more than 10 years.

Materials and methods:

This retrospective study was conducted for 51 hips (44 patients) that had undergone THA. The mean age for the index operation was 25.71 years, and the mean follow-up period was 13.7 years. Clinical outcomes were evaluated by Harris hip score (HHS), activity level, and complications. Radiographic evaluations were assessed according to osteolysis, loosening, and polyethylene wear.

Results:

The average HHS improved from 67.47 pre-operatively to 97.42 at the final follow-up ( p < 0.001). The activity level changed from 1.92 pre-operatively to 1.33 at the final follow-up ( p < 0.001). Ten cases had undergone revision arthroplasty within the follow-up period, and the overall survival rate was 80.4% at the final follow-up with revision for any reason as the end point. Polyethylene liners were used in all revision cases ( p = 0.003). Patients with modular stem had a higher failure rate than patients with a fully porous coated stem ( p < 0.001). Furthermore, a small diameter head size was associated with a higher risk of revision surgery ( p = 0.003). Complications such as dislocations were found in three hips.

Conclusion:

Cementless THA yields encouraging clinical and radiological results in young and active patients under the age of 30. However, the bearing surface, type of stem, and head size influenced component durability and revision rate.
Striving for liminality: Eating disorders and social suffering
Authors: Eli Karin
Published: May 2018

In this article, I argue that eating disorders constitute a form of social suffering, in which sufferers embody liminality as a response to, and a reflection of, oppressive sociality, structural violence, and institutional constraints. Based on the illness narratives of people with anorexia nervosa, bulimia nervosa, and their subclinical variants in Israel, the analysis draws the experiential, the social, and the structural into critical focus. These narratives, which delineate lived experiences of self-starving, bingeing, and purging, and the attendant viscerality of hunger, fullness, and emptiness, reveal how participants developed an embodied drawing inward and away, being at once within and without society for extended periods of time, through eating disordered practices. This liminal positioning, I argue, was a mode through which participants cultivated alternative (if temporary) personal spaces, negotiated identities, and anesthetized pain: processes many deemed essential to survival. Embedding the participants’ narratives of eating disordered experiences within familial, societal, and political-economic forces that shaped their individual lives, I examine the participants’ striving for liminality as at once intimately embodied and structurally mapped. The analysis suggests that policy initiatives for eating disorder prevention must address the social suffering that eating disorders manifest: suffering caused by structures and institutions that reinforce social inequality, violence, and injustice.
Dimming strategies for open office lighting: User experience and acceptance
Authors: Chraibi S , Creemers P , Rosenkötter C , van Loenen EJ , Aries MBC , Rosemann ALP
Published: May 2018

Sensor-triggered control strategies can limit the energy consumption of lighting by considering the presence of users in the office and dimming lighting down when it is not needed. In multi-user offices, the application of occupancy-based dimming at room level limits the energy saving potential. However, zone- or desk-based dimming may affect the comfort of co-workers due to its dynamics. This paper reports the assessment by 17 participants (30–50 years of age) of occupancy-based dimming in a mock-up office, using different dimming speeds. Participants consisted of co-workers experiencing changes triggered by others, and actors triggering these light changes. While the participants performed an office-based task, the luminaire above the actors’ desk was dimmed from approximately 550 lx to 350 lx (average horizontal illuminance), and vice versa. The participants evaluated the dimming conditions regarding their noticeability and acceptability. The study showed that the noticeability of light changes due to dimming, increases when fading times become shorter. Dimming with a fading time of at least two seconds was experienced as acceptable by more than 70% of the participants. The results of this experiment provide insights to system behaviour that does not compromise user experience while addressing energy efficient use of electric lighting.
Towards an enhanced view of doctoral writing environments: Learning alliances to reconceptualise practice
Authors: Johnson E Marcia
Published: May 2018

As doctoral enrolments have soared in many countries around the world, considerable attention has been devoted to how an increasingly diverse candidature can succeed in thesis writing. Along with supervisory guidance during the student’s research project, various publications have emerged to help students with thesis writing requirements. However, neither necessarily helps students become expert writers as supervisors tend to focus on content discussions, and self-help books attend to the more surface or mechanical features of writing. Along the way to a finished thesis, students can become mired in uncertainty about what they are discovering – intellectually stuck – and then lose confidence in their ability to express themselves within an academically accepted writing style. Indecision hampers student progress as they struggle with appropriate ways to reveal the insights they are gaining during research. Yet, generic, group-oriented, doctoral writing programmes can provide a powerful means for students to appreciate key features of the doctoral writing genre and overcome intellectual hurdles. This paper explores how an understanding of threshold concepts and the use of cultural, social and linguistic tools can mediate students’ emerging knowledge of how to become proficient and successful thesis writers.
Sinomenine Induces G1-Phase Cell Cycle Arrest and Apoptosis in Malignant Glioma Cells Via Downregulation of Sirtuin 1 and Induction of p53 Acetylation
Authors: He Xiaoyan , Maimaiti Mayinur , Jiao Yan , Meng Xuegang , Li Hongyan
Published: May 2018

Sinomenine, a bioactive alkaloid isolated from the traditional Chinese herb Sinomenium acutum, possesses antiinflammatory, antinociceptive, antifibrotic, and antitumorigenic properties. In this work, we sought to explore the biological effects of sinomenine on glioma cells. It was found that sinomenine caused a concentration-dependent inhibition of viability in both U87 and U251 glioma cells. Sinomenine at 16 μmol/L caused 55% to 60% reduction in the proliferation of U87 and U251 cells. Moreover, sinomenine treatment induced a G0/G1 cell cycle arrest and apoptosis. Mechanistically, sinomenine promoted p53 expression and acetylation and reduced the expression of sirtuin 1. Ectopic expression of sirtuin 1 significantly prevented sinomenine-induced p53 acetylation and growth suppression in glioma cells. Moreover, sinomenine inhibited the growth of U87 xenograft tumors in vivo and raised the p53 protein expression. Collectively, sinomenine shows antiproliferative effects against glioma cells which is mediated through downregulation of sirtuin 1 and induction of p53 activity.
The kinematics modeling and parameter optimization of six-wheel lunar exploration robot
Authors: Guodong Zhai , Peiyuan Gao , Lili Meng
Published: May 2018

This article proposes a six-wheel lunar exploration robot which will move on the lunar surface. It is known that lunar surface is mostly rugged. When the six-wheel lunar exploration robot moves on the rugged surface, its centroid position will change, which has an impact on the vehicle obstacle performance and anti-overturning performance, and so on. Therefore, it is very important to analyze the centroid domain of the robot. In order to get the relation between centroid domain and position as well as the posture equation during the motion process, the kinematics model of the robot is built based on the coordinate transforming relations. So the calculation formula of centroid domain and body posture equation at any movement position are obtained. The mathematical model of detection robot is analyzed by entity analysis. So the centroid vector model of radial angle change curve and the changing rule of both sides of the rocker arm angle and centroid vector mode are given. MATLAB [version 6.0] is used to optimize the parameters of the robot and ADAMS is used to simulate the process when the robot moving on the rugged lunar surface. The results show that the centroid domain is a flat area. Based on the calculations and simulations, the vertical displacement and the pitch angle of the robot are decreased with different degrees after the optimization of the rocker arm suspension and the integrated moving stable performance of the lunar exploration robot is obviously enhanced.
Strategies of traversing obstacles and the simulation for a forestry chassis
Authors: Zhu Yue , Kan Jiangming , Li Wenbin , Kang Feng
Published: May 2018

As to the complicated terrain in forest, forestry chassis with an articulated body with three degrees of freedom and installed luffing wheel-legs (FC-3DOF&LW) is a novel chassis that can surmount obstacles. In addition, the rear frame of FC-3DOF&LW is regarded as the platform to carry equipment. Small inclination angle for rear frame contributes to stability and ride comfort. This article describes the strategy of traversing obstacles and simulation for FC-3DOF&LW that drives in forest terrain. First, key structures of FC-3DOF&LW are briefly introduced, which include articulated structure with three degrees of freedom and luffing wheel-leg. Based on the sketch of luffing wheel-leg, the movement range of luffing wheel-leg is obtained by hydraulic cylinder operation. Second, the strategy of crossing obstacles that are simplified three models of terrain is presented, and the simulation for surmounting obstacles is constructed in multibody dynamics software. The simulation results demonstrate that the inclination angle of rear frame is 18° when slope is 30°. A maximum 12° decrease of inclination angle for rear frame can be acquired when luffing wheel-legs are applied. For traversing obstacles with both sides, the maximum inclination angle of rear frame is about 1.2° and is only 3° for traversing obstacles with single side.
Singing for Lung Health: service evaluation of the British Lung Foundation programme
Authors: Lewis A , Cave P , Hopkinson NS
Published: May 2018

Aims:

Singing for Lung Health (SLH) is a novel intervention for individuals with respiratory disease. Qualitative results suggest benefits to physical, mental and emotional health. Limited data also suggest objective improvements in measures of quality of life with SLH are achievable. It is not known how effective the SLH groups supported by the British Lung Foundation (BLF) in the UK are. The objective was to understand the clinical impact SLH has on individuals with respiratory disease.

Methods:

The BLF conducted a questionnaire survey of singers with respiratory disease from new SLH groups set up in 2016–2017. Questionnaires were administered prior to participants’ first session and after 12 weeks of singing. Health-related quality of life, patient activation, anxiety and breathlessness outcomes were included. Healthcare resource utilisation including general practitioner (GP) visits, hospitalisations and frequency of inhaler use were recorded.

Results:

A total of 228 singers participated from 26 SLH groups in the UK. Participants were 70.7 (10.1) years old, 156 (68.4%) were female and 114 (47.5%) had chronic obstructive pulmonary disease (COPD). In all, 113 (49.5%) participants provided 12-week data. There were significant improvements in COPD Assessment Test (CAT) score (Mean = –1.4, CI: (−0.25 to −2.48) (  p = .017)). Furthermore, 45% of singers reported reduced GP visits (  p ≤ .001) and 18% reported reduced hospital admissions (  p = .01). However, there were no significant improvements in general quality of life, anxiety, patient activation, breathlessness or inhaler use. Baseline characteristics were not significantly different between people who completed the 12-week evaluation and those who did not.

Conclusions:

This service evaluation found that participants in SLH groups report improvement in respiratory health-related quality of life and a reduction in healthcare utilisation. SLH has potential economic and health benefits. Therefore, to confirm these findings, these endpoints should be evaluated further in large-scale randomised controlled trials (RCTs).
The impact of meridian balance method electro-acupuncture treatment on chronic pelvic pain in women: a three-armed randomised controlled feasibility study using a mixed-methods approach
Authors: Chong Ooi Thye , Critchley Hilary OD , Williams Linda J , Haraldsdottir Erna , Horne Andrew W , Fallon Marie
Published: May 2018

Introduction:

Chronic pelvic pain (CPP) is estimated to affect 6%–27% of women worldwide. In the United Kingdom, over 1 million women suffer from CPP and it has been highlighted as a key area of unmet need. Standard treatments are associated with unacceptable side effects. The meridian balance method electro-acupuncture (BMEA), and traditional Chinese medicine health consultation (TCM HC) (BMEA + TCM HC = BMEA treatment) may be an effective adjunct to standard treatment.

Aim:

The aim of our study was to evaluate the feasibility of a future trial, to determine the effectiveness of the BMEA treatment for CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to assess the effectiveness of the BMEA treatment and acceptability of the study’s methodology.

Methods:

Women with CPP were randomised into BMEA treatment (group 1), TCM HC alone (group 2) (each intervention administered twice weekly for 4 weeks) or National Health Service standard care (NHS SC, group 3). Primary outcomes were assessed by the proportion of eligible participants randomised, and the proportion of randomised participants who returned follow-up questionnaires. Interventions were assessed by validated pain/physical/emotional functioning questionnaires at baseline (0), 4, 8 and 12 weeks. Focus groups and semi-structured telephone interviews were embedded in the study.

Results:

A total of 30 women (51% of those referred) were randomised over 8 months. Retention rates were 80% (95% confidence interval (CI): 74–96), 53% (95% CI: 36–70) and 87% (95% CI: 63–90), in groups 1, 2, and 3, respectively. Qualitative data suggested a favourable trial experience in groups 1 and 3.

Discussion:

Group 2 retention rate was problematic and has implications for our next trial.

Conclusion:

Our study suggests that a future trial to determine the effectiveness of BMEA treatment for women with CPP is feasible but with modifications to the study design.
Atypical teratoid rhabdoid tumor in a 65-year-old man presenting with disseminated leptomeningeal disease: A case report and review of the literature
Authors: Babi Marc-Alain , Fecci Peter , Luedke Matthew , Pineda Olinda , O’Keefe Yasmin Ali
Published: May 2018

Central nervous system atypical teratoid rhabdoid tumors are very rare aggressive tumor of childhood, primarily occurring at age of less than 3 years old. The prognosis of these tumors is very poor, with a reported median survival of 6–12 months in most cases. Treatment typically consists of aggressive chemotherapy and radiotherapy. We present the case of a 65-year-old man who presented with progressive encephalopathy and change in personality over 3 months period. The patient had further accelerated decline over 3 weeks. The diagnosis of atypical teratoid rhabdoid tumor initially remained elusive despite very extensive workup, but was eventually confirmed via open brain biopsy. To the best of our knowledge, this is the oldest reported case of atypical teratoid rhabdoid tumor in the literature. We further extend the spectrum of this rare disease.
Intra- and extracapsular synovial chondromatosis of the temporomandibular joint: Rare case and review of the literature
Authors: Holtmann Henrik , Böttinger Thomas , Kübler Norbert R , Singh Daman D , Sproll Christoph K , Sander Karoline , Langie Renan , Schrader Felix , Lommen Julian
Published: May 2018

Synovial chondromatosis is a benign disease which most commonly appears in large joints and only rarely affects the temporomandibular joint. The diagnosis is quite difficult due to the fact that a large swelling in the preauricular area and the radiographic findings may be misdiagnosed as other benign or malignant diseases. We report an unusual case of intra- and extracapsular chondromatosis of 25 osteochondral loose bodies in the right temporomandibular joint.
Chest Pain, Atherosclerotic Cardiovascular Disease Risk, and Cardiology Referral in Primary Care
Authors: Buch Vishaal , Ralph Hayley , Salas Joanne , Hauptman Paul J. , Davis Dawn , Scherrer Jeffrey F.
Published: May 2018

Background: The atherosclerotic cardiovascular disease (ASCVD) 10-year risk estimate is recommended by cardiologists for determining risk of a cardiac event. However, the majority of patients presenting to primary care with chest pain have noncardiac etiologies. Therefore, we determined if high versus low ASCVD risk was associated with primary care physicians’ referral to cardiology in patients with and without chest pain. Methods: Deidentified electronic health record (EHR) data was obtained from 5795 patients treated in academic primary care clinics from 2008 to 2015. Referral to cardiology was defined by an EHR code, chest pain was defined by ICD-9-CM code (786.5) and ASCVD was modeled as high versus low risk. Separate logistic regression models were computed to estimate the association between chest pain and referral to cardiology, ASCVD risk and referral, and both chest pain and ASCVD risk and referral with adjustment for potential confounding factors. Results: More patients with (n = 95, 7.8%) versus without (n = 75, 2.0%) chest pain were referred to cardiology ( P < .0001). Separate unadjusted models revealed chest pain and high versus low ASCVD risk were significantly associated with referral (odds ratio [OR] = 4.20; 95% confidence interval [CI] 3.07-5.73 and OR = 1.41; 95% CI 1.04-1.91, respectively). After adjusting for ASCVD risk and confounders, chest pain but not high ASCVD risk remained significantly associated with referral (OR = 1.75; 95% CI 1.24-2.47 and OR = 1.15; 95% CI 0.72-1.82, respectively). Conclusions: In primary care patients presenting with chest pain, ASCVD risk scores are not associated with referral to cardiology. Overall, less than 8% of patients with chest pain were referred. While there is no evidence to indicate excessive referral to cardiology, we posit that implementing ASCVD risk tools in decision aids could contribute to referring those most in need of cardiology care.
Modern Buddhisms and Democracy: Diverse Encounters in India and Sri Lanka
Authors: Uyangoda Jayadeva
Published: May 2018

The article explores the ways in which Buddhism had reinvented itself in a modernist idiom to deal with social and political conditions in India and Sri Lanka. This is done primarily by looking into the work of Anagarika Dharmapala, Iyothee Thass and B.R. Ambedkar. In general, the article is an attempt to place in context how political conditions of specific times and expectations of democracy play an active role in refashioning a religious ideology into an engaging political force.
Development as Urban Imaginary: Post-colonial Planning and Heteroglossic Cities of India
Authors: Tripathy Jyotirmaya
Published: May 2018

Contemporary India’s tryst with development continues to revolve around cities, and the latter remain the locus of India’s development narrative. But instead of seeing the city as already constituted or as a backdrop for economic activities, the present article proposes to implicate the city as a producer and product of social relations as well as a site of resistance and conformity. While doing so, it moves away from conventional modernist paradigms of imagining the city as the highest rung of development geography or the Marxist/subaltern studies formula of reading the city as a space of unredeemable inequality leading to the insurgency of the marginalised. What is proposed here is that the idea of city is emergent which expresses itself neither through its official representations nor through the radicalism of dissent but through multiple unstructured articulations of everyday life as well as the contingency of power and resistance. This is corroborated by drawing upon the experience of Thyagaraya Nagar (T. Nagar) which provides a representative Indian urban experience and where social and political relations spill out of institutional planning templates.
Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies
Authors: Wang Li , Hong Brian Y. , Kennedy Sean A. , Chang Yaping , Hong Chris J. , Craigie Samantha , Kwon Henry Y. , Romerosa Beatriz , Couban Rachel J. , Reid Susan , Khan James S. , McGillion Michael , Blinder Victoria , Busse Jason W.
Published: May 2018

Purpose

Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery.

Methods

We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study.

Results

Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection.

Conclusion

Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.
Outcomes by EGFR, KRAS, and ALK Genotype After Combined Modality Therapy for Locally Advanced Non–Small-Cell Lung Cancer
Authors: Mak Raymond H. , Hermann Gretchen , Aerts Hugo J. , Baldini Elizabeth H. , Chen Aileen B. , Kozono David , Rabin Michael S. , Swanson Scott J. , Chen Yu-Hui , Catalano Paul , Johnson Bruce E. , Jänne Pasi A.
Published: May 2018

Purpose

In 699 patients with locally advanced non–small-cell lung cancer (NSCLC) treated with radiation therapy as part of combined modality therapy, we compared outcomes among genotyped and ungenotyped patients and by tumor genotype status ( EGFR, KRAS, and ALK).

Patients and Methods

Genotyping was performed in 250 patients: EGFR+ (19%), KRAS+ (32%), ALK+ (9%), and wild type (WT−/−/−; 40%). Outcomes were analyzed using the Kaplan-Meier method and Cox regression.

Results

With a median follow-up of 48.2 months among genotyped patients, median overall survival (OS) was significantly longer for EGFR+ and ALK+ compared with KRAS+ and WT−/−/− (55.8 months v not reached v 28.0 v 33.2 months; P = .02). There was no difference in progression-free survival (median, 15.3 v 13.7 v 13.0 v 14.5 months; P = .47) or in freedom from distant metastases by genotype (3-year estimates: 42% v 49% v 27% v 25%; P = .25). There was higher freedom from locoregional recurrence (LRR) for EGFR+ tumors and lower freedom from LRR in ALK+ tumors, compared with KRAS+ and WT−/−/− tumors (3-year: 77% v 38% v 49% v 46%). In multivariable analysis, ALK+ remained associated with increased OS (HR, 0.32; 95% CI, 0.12 to 0.87; P = .03), and EGFR+ was associated with decreased LRR (HR, 0.47; 95% CI, 0.24 to 0.92; P = .03). Analysis of post-recurrence survival demonstrated that EGFR+/ ALK+ patients treated with appropriate tyrosine kinase inhibitors had higher OS compared with other groups.

Conclusion

In this series of locally advanced NSCLC treated with combined modality therapy, EGFR+ and ALK+ were associated with higher OS, whereas LRR was lower in EGFR+ patients, and the risk of distant metastases was high in all subgroups. The outcomes and patterns of failure in genotypic subgroups of NSCLC from this study can inform the design of future trials integrating targeted therapies.
After Defeat: Conservative Postenactment Opposition to the ACA in Historical-Institutional Perspective
Authors: Patashnik Eric M. , Oberlander Jonathan
Published: May 2018

Since the enactment of the Affordable Care Act (ACA) in 2010, conservatives have sought to undermine the law's entrenchment. While they have failed in their ambitious quest to repeal the ACA, opponents have succeeded in overturning one major provision (the individual mandate penalty), narrowing the law's reach, complicating its implementation, and fomenting doubts about its political sustainability. This essay places the postenactment battle over the ACA in historical-institutional perspective by juxtaposing the strategic choices that conservatives have made to limit the role of the federal government in the core social welfare areas of pensions and health since the New Deal. Our central argument is that conservatives' varying strategies of postenactment opposition, resistance, and accommodation for Social Security, Medicare, Medicaid, and the ACA have been shaped by shifts in conservative ideology, changes in control of institutional resources, and the nature of policy feedback. Attention to these contextual factors helps explain why ACA opponents viewed the law as a threat despite its moderate policy design, why opposition did not subside after the law's enactment, and how conservatives managed to keep the conflict going across multiple election cycles.