bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis
Authors: Nichay Nataliya R. , Gorbatykh Yuriy N. , Kornilov Igor A. , Soynov Ilya A. , Kulyabin Yuriy Y. , Gorbatykh Artem V. , Ivantsov Sergey M. , Bogachev-Prokophiev Alexander V. , Karaskov Alexander M.
Published: September 2017

Background:

Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA.

Methods:

Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed.

Results:

Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression.

Conclusions:

Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.
Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery
Authors: Chandrasekaran Sivashankar , Gui Chengcheng , Walsh John P. , Lodhia Parth , Suarez-Ahedo Carlos , Domb Benjamin G.
Published: September 2017

Background:

Improvements in pain, function, and patient satisfaction are used to evaluate the outcomes of hip arthroscopic surgery.

Purpose:

To identify correlations between the visual analog scale (VAS) score for pain and patient satisfaction with 4 commonly used patient-reported outcome (PRO) scores to determine to what extent changes in these 2 parameters are reflected in each of the PRO scores.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Patients undergoing hip arthroscopic surgery between February 2008 and February 2013 were assessed prospectively before surgery, at 3 months, and annually thereafter with the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–sports-specific subscale (HOS-SSS), and Hip Outcome Score–activities of daily living (HOS-ADL). Patients were also assessed using a 10-point VAS for pain and queried for satisfaction at the same time points (“0” indicated no pain, and “10” indicated complete satisfaction with surgery). The VAS score and patient satisfaction were correlated with changes in the 4 PRO scores.

Results:

During the study period, 1417 patients underwent hip arthroscopic surgery, of whom 1137 patients had 2-year postoperative PRO scores after primary surgery. There was a significant improvement in all PRO scores at 2-year follow-up. The mean improvements in mHHS, NAHS, HOS-ADL, and HOS-SSS scores were 16.7, 21.6, 19.7, and 22.7 points, respectively. The mean improvement in the VAS score was 2.9 points. Mean patient satisfaction at 2-year follow-up was 7.74 (of 10). There was a statistically significant correlation between the VAS and patient satisfaction scores and changes in each of the 4 PRO scores. The strength of the correlation was moderate.

Conclusion:

This study demonstrated a moderate correlation between the VAS and patient satisfaction outcomes and changes in 4 commonly used PRO scores in hip arthroscopic surgery (mHHS, HOS-ADL, HOS-SSS, and NAHS). In addition to several PRO instruments, a VAS for pain and patient satisfaction may add to the overall assessment of the efficacy of hip arthroscopic surgery.
Spirituality and Hope in Africa: A Study in Five Countries
Authors: Balcomb Anthony , Chirongoma Sophie , Dah Ini Dorcas , Daniel Woldegiorgis Seblewengel , Deouyo Paul , Gaisie Rudolf K. , Howell Allison M.
Published: September 2017

This article documents a research project in five African countries related to African spirituality and hope. The methodology of the research was based on the need to recognize that spirituality could not be separated from the everyday experience of ordinary people and that the people should be given maximum opportunity to express their experiences and beliefs without outside interference. Over seven thousand pieces of data were gathered concerning a wide range of issues that informants raised as being important. Five of these are discussed: marriage, divination, the sacred environment, work and business, and religious tolerance.
Sub-national government and pathways to sustainable energy
Authors: Cowell Richard , Ellis Geraint , Sherry-Brennan Fionnguala , Strachan Peter A , Toke David
Published: September 2017

In an effort to understand how to promote more sustainable forms of energy provision, researchers have begun addressing the scale of political and governance processes, yet the effects of sub-national government remain neglected. At the same time, analysts of political devolution, decentralisation and independence have rarely given attention to the energy sector. Papers in this special issue seek to better understand the relationship between sub-national government and pathways to sustainable energy: examining how city-regional and devolved governments have shaped agendas for building retrofit; elucidating the importance of decentralised governance in knitting together electricity, heat and transport energy markets; mapping the complex, fuzzy spatial organisation of legal powers to direct energy policy across multi-level polities; and analysing conflicts over the allocation of energy infrastructure consenting powers between national and devolved governments. The papers highlight the interdependencies of action in different governmental arenas, and reinforce arguments for greater central-to-local reflexivity in governance styles. Analysing the interface between sub-national government and energy transition also raises new questions about the meaning of ‘sovereignty’, the fragmentary nature of democratic control over energy systems, and the effects of boundaries.
Dalit Participation in Total Sanitation Campaign with Special Reference to Satara District in Maharashtra
Authors: Jamdade Pravin , Jungari Suresh , Thakur Mahesh
Published: September 2017

Development cannot be achieved without the participation of people from all segments of society. It is a process that requires collective action for social transformation or social change in the socio-economic and political lives of the people. The Total Sanitation Campaign (TSC) is one of the major programmes in India to promote sanitation and hygiene. The article is an attempt made to understanding the Dalit population’s participation in the total sanitation programme. The field visits in six villages reveal that illiterate 20 per cent respondents did not participate in the decision-making process. Gram panchayat has not given equal opportunity for participation to Dalit women in the planning process of the campaign activities. Educated people are more likely to get the opportunity for participation in planning and implementation of the scheme. Villages, even gram panchayats, have not conducted any awareness campaign to disseminate the information of the Campaign among Dalit and rural masses.
From Source to Building Fragility: Post-Event Assessment of the 2013 M7.1 Bohol, Philippines, Earthquake
Authors: Naguit Muriel , Cummins Phil , Edwards Mark , Ghasemi Hadi , Bautista Bartolome , Ryu Hyeuk , Haynes Marcus
Published: September 2017

We use ground-motion simulations of the 2013 Bohol, Philippines, earthquake along with a new post-disaster exposure/damage database to constrain building fragility and vulnerability. The large number of damaged buildings (>70,000) and the wide spread of seismic intensities caused by this earthquake make it an ideal candidate for such a study. An extensive survey was conducted leading to a robust description of over 25,000 damaged and undamaged structures. Ground-motion fields were simulated using ground-motion prediction equations and stochastic modeling, and the estimated and observed values were compared. The finite source model used in the simulation was based on the analysis of aftershocks and SAR data. The ground motions were associated with the empirical database to derive fragility and vulnerability models. Results indicate that the pattern of damage is best captured in the stochastic simulation. Constraints were placed on seismic building fragility and vulnerability models, which can promote more effective implementation of construction regulations and practices.
Time-Variant Modal Parameters and Response Behavior of a Base-Isolated Building Tested on a Shake Table
Authors: Astroza Rodrigo , Gutiérrez Gonzalo , Repenning Christian , Hernández Francisco
Published: September 2017

This paper presents the identification of the instantaneous modal properties and the experimental response of a full-scale, five-story base-isolated RC building tested on a shake table. A suite of earthquake motions of various intensities was applied to the building to progressively increase the seismic demand. The deterministic-stochastic subspace identification method is employed to estimate the variations of the modal properties of the building by employing a short-time windowing approach. The changes of the modal parameters during the seismic motions are tracked and analyzed. Observed and measured responses of the structure are analyzed and correlated with the variation of the identified modal parameters. The nonlinear behavior of the isolators generates the variation of the identified natural frequencies and equivalent damping ratios of the building, which change in agreement with the input motion intensity. A high correlation between the effective stiffness of the isolators and the instantaneous frequency of the first mode is found. The effective damping ratio of the isolation system and the instantaneous damping ratio of the fundamental mode of the building are highly correlated.
Numerical and Empirical Simulation of Linear Elastic Seismic Response of a Building: The Case of Nice Prefecture
Authors: Lorenzo Guillermo Wenceslao Fernández , d'Avila Maria Paola Santisi , Deschamps Anne , Bertrand Etienne , Mercerat E. Diego , Foundotos Laetitia , Courboulex Françoise
Published: September 2017

The structural motion of a tall reinforced concrete (RC) building on alluvial soil in Nice (France) is continuously recorded using accelerometers. The structural behavior of the building is studied using operational modal analysis (OMA) to identify its dynamic properties, a finite element (FE) model to reproduce the building response, and empirical Green's functions (EGFs) to generate the structural response to ground motions stronger than those registered in the analyzed seismic area. These different approaches are applied for the analysis of seismic response of the instrumented building and results are consistent. The FE model is calibrated by comparing natural frequencies and mode shapes with those obtained using OMA. Numerically-simulated time histories are qualitatively and quantitatively compared with recordings showing good agreement. Based on regional earthquakes, linear seismic response of the building is simulated for a stronger scenario earthquake using EGF. This approach allows for structural deformation analysis of existing buildings without the need of structural plans and mechanical parameter calibration in the case where the seismic response is within linear elastic regime.
Observations of Landslides Caused by the April 2015 Gorkha, Nepal, Earthquake Based on Land, UAV, and Satellite Reconnaissance
Authors: Zekkos Dimitrios , Clark Marin , Whitworth Michael , Greenwood William , West A. Joshua , Roback Kevin , Li Gen , Chamlagain Deepak , Manousakis John , Quackenbush Paul , Medwedeff William , Lynch Jerome
Published: September 2017

Thousands of landslides occurred during the April 2015 Gorkha earthquake in Nepal. Previous work using satellite imagery mapped nearly 25,000 coseismic landslides. In this study, the satellite-based mapping was analyzed in three areas where field deployment was also conducted—the Budhi Gandaki, Trishuli, and Indrawati river valleys—to better characterize the landslides. Unmanned aerial vehicles (UAVs) were deployed to map the three-dimensional (3-D) geometry of failed slopes using photogrammetry, as well as to characterize rock structure and strength. The majority of landslides were rock slides along the ridges and the steeper portions of the basins primarily involving the weathered rock zone. Additional landslides included rock falls and soil failures. Satellite imagery analysis indicated that landsliding was concentrated north of the physiographic transition, in steep areas, and in close proximity to the major rivers. The Trishuli area experienced the lowest landslide density in terms of number of landslides compared to the Budhi Gandaki and Indrawati areas, although all three areas had similar density in terms of total landslide area and other landslide statistics.
Clinical Use of Precision Oncology Decision Support
Authors: Johnson Amber , Khotskaya Yekaterina B. , Brusco Lauren , Zeng Jia , Holla Vijaykumar , Bailey Ann M. , Litzenburger Beate C. , Sánchez Nora S. , Abu Shufean Md , Piha-Paul Sarina , Subbiah Vivek , Hong David , Routbort Mark , Broaddus Russell , Shaw Kenna R. Mills , Mills Gordon B. , Mendelsohn John , Meric-Bernstam Funda
Published: September 2017

Purpose

Precision oncology is hindered by the lack of decision support for determining the functional and therapeutic significance of genomic alterations in tumors and relevant clinically available options. To bridge this knowledge gap, we established a Precision Oncology Decision Support team that provides annotations at the alteration level and subsequently determined whether clinical decision making was influenced.

Methods

Genomic alterations were annotated to determine actionability on the basis of a variant’s known or potential functional and/or therapeutic significance. The medical records of a subset of patients annotated in 2015 were manually reviewed to assess trial enrollment. A Web-based survey was implemented to capture the reasons genotype-matched therapies were not pursued.

Results

The Precision Oncology Decision Support team processed 1,669 requests for annotation of 4,084 alterations (2,254 unique) across 49 tumor types for 1,197 patients. A total of 2,444 annotations for 669 patients included an actionable variant call: 32.5% actionable, 9.4% potentially actionable, 29.7% unknown, and 28.4% nonactionable. Sixty-six percent of patients had at least one actionable/potentially actionable alteration, and 20.6% of patients (110 of 535) annotated enrolled in a genotype-matched trial. Trial enrollment was significantly higher for patients with actionable/potentially actionable alterations (92 of 333; 27.6%) than for those with unknown (16 of 136; 11.8%) and nonactionable (2 of 66; 3%) alterations ( P < .001). Actionable alterations in PTEN, PIK3CA, and ERBB2 most frequently led to enrollment in genotype-matched trials. Clinicians cited a variety of reasons that patients with actionable alterations did not enroll in trials.

Conclusion

Over half of alterations annotated were of unknown significance or nonactionable. Physicians were more likely to enroll a patient in a genotype-matched trial when an annotation supported actionability. Future studies are needed to demonstrate the impact of decision support on trial enrollment and oncologic outcomes.
Reduced Frequency of Biological and Increased Frequency of Adopted Children in Males With 21-Hydroxylase Deficiency: A Swedish Population-Based National Cohort Study
Authors: Falhammar Henrik , Frisén Louise , Norrby Christina , Almqvist Catarina , Hirschberg Angelica Linden , Nordenskjöld Agneta , Nordenström Anna
Published: September 2017

Context

Fertility in males with 21-hydroxylase deficiency (21OHD) is unclear.

Objective

Study fertility outcome in males with congenital adrenal hyperplasia.

Design, Setting, and Participants

Males ≥15 years old with 21OHD (n = 221) were compared with controls matched for sex and year and place of birth (n = 22,024). Data were derived by linking national population-based registers. Subgroup analyses were performed regarding phenotype [salt-wasting (SW), simple virilizing (SV), and nonclassic (NC)] and CYP21A2 genotype (null, I2 splice, I172N, and P30L) and stratified by the introduction of neonatal screening.

Main Outcome Measures

Number of biological and adopted children.

Results

Males with 21OHD were less likely to be fathers of biological children [odds ratio (OR), 0.5; 95% confidence interval (CI), 0.4 to 0.7; after adjusting for socioeconomic characteristics: OR, 0.4; 95% CI, 0.2 to 0.5]. This was true for SW, SV, I2 splice, and I172N, but not for NC, null, and P30L groups (all adjusted). Among patients born before the neonatal screening introduction, fewer were fathers (adjusted OR, 0.3; 95% CI, 0.2 to 0.5), but this normalized in those born afterward. Adoption was more common in the 21OHD males (OR, 2.9; 95% CI, 1.0 to 7.9) and the SV and I172N subgroups. Age at becoming a father, marriage, region of residence, and education were similar, but fewer patients had high incomes. NC and I172N groups had, however, higher academic degrees and NC patients were more often married, whereas SW and I2 splice patients were more often divorced.

Conclusions

21OHD was associated with a reduced frequency of biological children and an increased frequency of adopted children, suggesting impaired fertility, although some subgroups had normal fertility.
Wrist Pain in Gymnasts: A Review of Common Overuse Wrist Pathology in the Gymnastics Athlete
Authors: Benjamin Holly J. , Engel Sean C. , Chudzik Debra
Published: September 2017

Injury rates among gymnasts are among the highest of any sport at the high school and collegiate level per athletic exposure. The wrist has increased injury risk due to repetitive physical stresses predisposing it to acute injury, overuse, and degenerative damage. This article will review the most common overuse wrist injuries seen in gymnasts. Prompt evaluation and management is necessary to avoid the negative sequelae that can often accompany these injuries. Little is known about effective sport-specific injury prevention strategies, but general guidelines for overuse injury prevention including limiting excessive loading of the wrist, maintaining wrist joint flexibility, an emphasis on proper technique, and incorporating wrist and general core strengthening seem beneficial. General return to play principles are similar for all gymnast-related wrist injuries, including resolution of pain, restoration of normal wrist joint function, completion of a progressive rehabilitation program, and use of proper technique.
Competitive Diving Principles and Injuries
Authors: Jones Nathaniel S.
Published: September 2017

Competitive diving is a sport that has evolved over time to become an admired present-day aquatic sport, especially in the Olympic setting. Despite its popularity, sparse research has been written as it applies to our understanding of competitive diving injuries. This article attempts to discuss common principles of competitive diving as they relate to the sport, especially as it relates to the extreme physical forces encountered by the diver and also the repetitive nature of diving. Next, these principles will be applied in the context of musculoskeletal and medical diving specific injuries.
Care of Water Polo Players
Authors: Stromberg Jennifer D.
Published: September 2017

Water polo is a team sport that combines swimming with overhead throwing and wrestling. This places water polo players at risk for a unique group of illnesses and injuries. In addition to the medical problems and injuries seen in competitive swimmers, water polo players are at risk for a variety of traumatic injuries, including concussions, eye injuries, tympanic membrane perforation, fractures, dislocations, and lacerations. Repetitive overhead throwing also places these athletes at risk for related injuries, such as shoulder problems, including rotator cuff strain and impingement, and elbow problems, such as ulnar collateral ligament injuries, posteromedial impingement, and osteochondritis dissecans of the radial capitellum. This article serves as an overview of these illnesses and injuries, as well as how the aquatic environment affects pathogenesis, treatment, and return to play.
Patterns and Appropriateness of Thrombophilia Testing in an Academic Medical Center
Authors: Cox Nicholas , Johnson Stacy A. , Vazquez Sara , Fleming Ryan P. , Rondina Matthew T. , Kaplan David , Chauv Stephanie , Fontaine Gabriel V. , Stevens Scott M. , Woller Scott , Witt Daniel M.
Published: September 2017

BACKGROUND

Clinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event.

OBJECTIVE

To determine appropriateness of thrombophilia testing in a teaching hospital.

DESIGN

Retrospective cohort study.

SETTING

One academic medical center in Utah.

PARTICIPANTS

All patients who received thrombophilia testing between July 1, 2014, and December 31, 2014.

MAIN MEASUREMENTS

Proportion of thrombophilia tests occurring in situations associated with minimal clinical utility, defined as tests meeting at least 1 of the following criteria: discharged before results available; test type not recommended; testing in situations associated with decreased accuracy; duplicate testing; and testing following a provoked thrombotic event.

RESULTS

Overall, 163 patients received a total of 1451 thrombophilia tests for stroke (50% of tests; 35% of patients), venous thromboembolism (21% of tests; 21% of patients), and pregnancy‐related conditions (15% of tests; 25% of patients). Of the 39 different test types performed, the most common were cardiolipin IgG and IgM antibodies (9% each), lupus anticoagulant (9%), and β2‐glycoprotein 1 IgG and IgM antibodies (8% each). In total, 911 tests (63%) were performed in situations associated with minimal clinical utility, with 126 patients (77%) receiving at least one such test. Only 2 patients (1%) had clear documentation of being offered genetic consultation.

CONCLUSIONS

Thrombophilia testing in this single‐center study was often associated with minimal clinical utility. Strategies to improve testing practices (eg, hematology specialty consult prior to inpatient testing, improved order panels) might help minimize inappropriate testing and promote value‐driven care.
The Weekend Effect in Hospitalized Patients: A Meta‐Analysis
Authors: Pauls Lynn A. , Johnson‐Paben Rebecca , McGready John , Murphy Jamie D. , Pronovost Peter J. , Wu Christopher L.
Published: September 2017

BACKGROUND

The presence of a “weekend effect” (increased mortality rate during Saturday and/or Sunday admissions) for hospitalized inpatients is uncertain.

PURPOSE

We performed a systematic review to examine the presence of a weekend effect on hospital inpatient mortality.

DATA SOURCES

PubMed, EMBASE, SCOPUS, and Cochrane databases (January 1966–April 2013) were utilized for our search.

STUDY SELECTION

We examined the mortality rate for hospital inpatients admitted during the weekend compared with those admitted during the workweek. To be included, the study had to provide discrete mortality data around the weekends (including holidays) versus weekdays, include patients who were admitted as inpatients over the weekend, and be published in English.

DATA EXTRACTION

The primary outcome was all‐cause weekend versus weekday mortality with subgroup analysis by personnel staffing levels, rates and times to procedures rates and delays, or illness severity.

DATA SYNTHESIS

A total of 97 studies (N = 51,114,109 patients) were examined. Patients admitted on the weekends had a significantly higher overall mortality (relative risk, 1.19; 95% confidence interval, 1.14‐1.23). With regard to the subgroup analyses, patients admitted on the weekends consistently had higher mortality than those admitted during the week, regardless of the levels of weekend/weekday differences in staffing, procedure rates and delays, and illness severity.

CONCLUSIONS

Hospital inpatients admitted during weekends may have a higher mortality rate compared with inpatients admitted during the weekdays.
National Trends (2007‐2013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome
Authors: Chatterjee Kshitij , Goyal Abhinav , Chada Aditya , Kakkera Krishna Siva Sai , Corwin Howard L
Published: September 2017

BACKGROUND

Clostridium difficile is the most common infectious cause of healthcare‐associated diarrhea and is associated with worse outcomes and higher cost. Patients with septic shock (SS) are at increased risk of acquiring C. difficile infections (CDIs) during hospitalization, but little data are available on CDI complicating SS.

OBJECTIVE

Prevalence of CDI in SS between 2007‐2013 and impact of CDI on outcomes in SS.

DESIGN

We used the National Inpatient Sample to identify hospitalizations (2007‐2013) of adults with SS and CDI and the Nationwide Readmissions Database 2013 to calculate 30‐day readmissions.

MAIN MEASUREMENTS

Outcomes were prevalence of CDI in SS, effect on mortality, length of stay (LOS), and 30‐day readmission.

RESULTS

There were 2,031,739 hospitalizations with SS (2007‐2013). CDI was present in 8.2% of SS. The in‐hospital mortality of SS with and without CDI were comparable (37.1% vs 37.0%; P = 0.48). Median LOS was longer for SS with CDI (13 days vs 9 days; P < 0.001). LOS >75th percentile (>17 days) was 36.9% in SS with CDI vs 22.7% without CDI (P < 0.001). Similarly, LOS > 90th percentile (> 29 days) was 17.5% vs 9.1%, P < 0.001. Odds of LOS >75% and >90% in SS were greater with CDI (odds ratio [OR] 2.11; 95% confidence interval [CI], 2.06‐2.15; P < 0.001 and OR 2.25; 95% CI, 2.22‐2.28; P < 0.001, respectively). Hospital readmission of SS with CDI was increased, adjusted OR 1.26 (95% CI, 1.22‐1.31; P < 0.001).

CONCLUSIONS

CDI complicating SS is common and is associated with increased hospital LOS and 30‐day hospital readmission. This represents a population in which a focus on prevention and treatment may improve clinical outcomes.
Blood Products Provided to Patients Receiving Futile Critical Care
Authors: Neville Thanh H. , Ziman Alyssa , Wenger Neil S.
Published: September 2017

The number of hospitalized patients receiving treatment perceived to be futile is not insignificant. Blood products are valuable resources that are donated to help others in need. We aimed to quantify the amount of blood transfused into patients who were receiving treatment that the critical care physician treating them perceived to be futile. During a 3‐month period, critical care physicians in 5 adult intensive care units completed a daily questionnaire to identify patients perceived as receiving futile treatment. Of 1136 critically ill patients, physicians assessed 123 patients (11%) as receiving futile treatment. Fifty‐nine (48%) of the 123 patients received blood products after they were assessed to be receiving futile treatment: 242 units of packed red blood cells (PRBCs) (7.6% of all PRBC units transfused into critical care patients during the 3‐month study period); 161 (9.9%) units of plasma, 137 (12.1%) units of platelets, and 21 (10.5%) units of cryoprecipitate. Explicit guidelines on the use of blood products should be developed to ensure that the use of this precious resource achieves meaningful goals.
Creating and Capturing Value in Repeated Exchange Relationships: The Second Paradox of Embeddedness
Authors: Elfenbein Daniel W. , Zenger Todd
Published: September 2017

Prior empirical studies suggest repeated exchange develops increasing value in buyer–supplier relationships. A first order implication of this finding is that buyers will concentrate exchange among a relatively small number of suppliers to generate maximum value in relationships. However, buyers are equally concerned with value capture. By distributing rather than concentrating exchange, buyers may position themselves to capture more of the value created, leaving buyers potentially conflicted concerning the choice. We label this dynamic the second paradox of embeddedness, distinguishing it from Uzzi’s [Uzzi B (1997) Social structure and competition in inter-firmnetworks: The paradox of embeddedness. Admin. Sci. Quart. 42(1):35–67.] paradox driven by technological uncertainty. By examining the procurement activities of a large, diversified manufacturing company, we then test for supplier and buyer behavior consistent with the conditions that give rise to the second paradox and behaviors that result from it.
Why it pays to invest in staff training
Authors: Brownlie Tom
Published: September 2017

With an estimated 12% vacancy rate in GP posts, fewer nurses from Europe coming to the UK and many leaving due to Brexit, staff training should be of greater focus for practice managers than ever, says Tom Brownlie
Making volunteering economically valuable: the relationship between valuation devices and volunteering
Authors: Larsson Ola Segnestam , Andersen Rebecka
Published: September 2017

This article contributes to previous research on determining the economic value of volunteering by analysing the relationship between the valuation devices being proposed and volunteering and its properties. Is the relationship best characterised as direct, mediated or imposed? The empirical material for the article consists of volunteering economic valuation devices, as presented in previous research, which are analysed with a framework derived from the theoretical field of valuation. In addition to introducing the analytical framework and its application to the field of volunteering, the article discusses the absence of direct relationships while underscoring the dominance of the mediated relationship. It also argues that the imposed relationship highlights a hitherto less-discussed analytical dimension in the research debate on valuing volunteering. In conclusion, the relevance of the findings are discussed and ideas for a future research agenda presented.
La «Letanía de Nuestro Señor Don Quijote»
Authors: Rovira Soler José Carlos
Published: September 2017

En 1905 escribe Rubén Darío la «Letanía de nuestro señor don Quijote» que se integra en Cantos de vida y esperanza. Se trata de una de las conmemoraciones cervantinas más importantes del año del centenario de la publicación de la primera parte del Quijote, por las resonancias culturales y sociales que se identifican en ese texto que es la culminación de una larga trayectoria cervantina del poeta. Comentar el poema en sus referencias culturales y en su oposición a aspectos de la conmemoración popular y sobre todo de confrontación con la celebración académica es el objetivo de la lectura que proponemos.
On the Cauchy problem of a degenerate parabolic-hyperbolic PDE with Lévy noise
Authors: Biswas Imran H. , Majee Ananta K. , Vallet Guy
Published: September 2017

In this article, we deal with the stochastic perturbation of degenerate parabolic partial differential equations (PDEs). The particular emphasis is on analyzing the effects of a multiplicative Lévy noise on such problems and on establishing a well-posedness theory by developing a suitable weak entropy solution framework. The proof of the existence of a solution is based on the vanishing viscosity technique. The uniqueness of the solution is settled by interpreting Kruzhkov’s doubling technique in the presence of a noise.
The Crown of the Divine Child in the Meroitic Kingdom. A Typological Study
Authors: Spindler Eric
Published: September 2017

The crown of the divine child was one of the headdresses that transferred from Egypt to the Meroitic Kingdom. It was integrated in the Egyptian decoration program in the early Ptolemaic time. The first king of Meroe to use this crown in the decoration of the Lion Temple in Musawwarat es-Sufra was Arnekhamani (235-218 BCE). It also appeared later in the sanctuaries of his successors Arkamani II (218-200 BCE) and Adikhalamani (ca. 200-190 BCE) in Dakka and Debod. The Egyptians presented it as the headdress of child gods or the king. In the Kingdom of Meroe the crown was more like a tool to depict the fully legitimised king before he faced the main deity of the sanctuary. To show this the Meroitic artists changed its iconography in such a way that the primarily Egyptian focus on the aspects of youth and rebirth withdrew into the background so that the elements of cosmic, royal and divine legitimacy became the centre of attention. Even if the usage and parts of the iconography were different, the overall meaning remained the same. It was a headdress that combined all elements of the cosmos as well as of royal and divine power.
The Argument against the Friends of the Forms Revisited: Sophist 248a4–249d5
Authors: Wiitala Michael
Published: September 2017

There are only two places in which Plato explicitly offers a critique of the sort of theory of forms presented in thePhaedoandRepublic: at the beginning of theParmenidesand in the argument against the Friends of the Forms in theSophist. An accurate account of the argument against the Friends, therefore, is crucial to a proper understanding of Plato’s metaphysics. How the argument against the Friends ought to be construed and what it aims to accomplish, however, are matters of considerable controversy. My aim in this article is twofold. First, I show that the two readings of the argument against the Friends that dominate the contemporary literature – the “Cambridge Change” reading and the “Becoming-is-Being” reading – lack sufficient textual support. Second, I offer an alternative reading of the argument against the Friends that better explains both the text of 248a4–249d5 and the role the argument plays within the Stranger’s wider project of demonstrating that non-being is. My thesis is that the Stranger’s argument against the Friends seeks to demonstrate that the forms must be both at rest and moved, where “moved” (kineisthai) has the sense of “affected.” To participate in a form is to be affected by that form. I argue that since, according to the Stranger, every form participates in some other forms (see 251d5–253a2), every form is “moved” in the sense that it is affected by the forms in which it participates. Likewise, I argue that every form is at rest in the sense that its unique nature remains unaffected by the other forms in which it participates.
Universal Basic Income and Helicopter Money
Authors: Mencinger Jože
Published: September 2017

A unique opportunity for testing whether universal basic income (UBI) on the European level is a realistic option could be provided by its monetary financing as an alternative to “traditional” fiscal financing. Fiscal financing of UBI would namely request a much larger European “federal” budget financed by a specific European tax or by participation of the “federation” on some of the existing tax bases, and by agreed upon allotment of the accumulated “federal” fiscal revenues. Though ensuing redistribution of GDP would be relatively modest, the European UBI without an alternative to the tax revenues requirements remains illusionary. Helicopter money (HM) replacing quantitative easing (QE) might provide such an alternative. Modalities of its implementation differ and the idea raises questions of its compliance with the legal regime of the ECB and opens many other topics such as the effectiveness of “QE for the people” and its long-run consequences.
A Numerical Study of Non-hydrostatic Shallow Flows in Open Channels
Authors: Zerihun Yebegaeshet T.
Published: September 2017

The flow field of many practical open channel flow problems, e.g. flow over natural bed forms or hydraulic structures, is characterised by curved streamlines that result in a non-hydrostatic pressure distribution. The essential vertical details of such a flow field need to be accounted for, so as to be able to treat the complex transition between hydrostatic and non-hydrostatic flow regimes. Apparently, the shallow-water equations, which assume a mild longitudinal slope and negligible vertical acceleration, are inappropriate to analyse these types of problems. Besides, most of the current Boussinesq-type models do not consider the effects of turbulence. A novel approach, stemming from the vertical integration of the Reynolds-averaged Navier-Stokes equations, is applied herein to develop a non-hydrostatic model which includes terms accounting for the effective stresses arising from the turbulent characteristics of the flow. The feasibility of the proposed model is examined by simulating flow situations that involve non-hydrostatic pressure and/or nonuniform velocity distributions. The computational results for free-surface and bed pressure profiles exhibit good correlations with experimental data, demonstrating that the present model is capable of simulating the salient features of free-surface flows over sharply-curved overflow structures and rigid-bed dunes.
Lignin-based carbon fibers for renewable and multifunctional lithium-ion battery electrodes
Authors: Nowak Andrzej P. , Hagberg Johan , Leijonmarck Simon , Schweinebarth Hannah , Baker Darren , Uhlin Anders , Tomani Per , Lindbergh Göran
Published: September 2017

Lignin-based carbon fibers (LCFs) from the renewable resource softwood kraft lignin were synthesized via oxidative thermostabilization of pure melt-spun lignin and carbonization at different temperatures from 1000°C to 1700°C. The resulting LCFs were characterized by tensile testing, scanning electron microscopy (SEM), X-ray diffraction (XRD) and confocal Raman spectroscopy. The microstructure is mainly amorphous carbon with some nanocrystalline domains. The strength and stiffness are inversely proportional to the carbonization temperature, while the LCFs carbonized at 1000°C exhibit a strength of 628 MPa and a stiffness of 37 GPa. Furthermore, the application potential of LCFs was evaluated as negative electrodes in a lithium-ion battery (LIB) by electrochemical cycling at different current rates in a half-cell setup. The capacity drops with the carbonization temperature and the LCFs carbonized at 1000°C have a capacity of 335 mAh g−1. All LCFs showed good cycling stability. Because of the mechanical integrity and conductivity of the LCFs, there is no need to apply current collectors, conductive additives or binders. The advantage is an increased gravimetric energy density compared to graphite, which is the most common negative electrode material. LCFs show a promising multifunctional behavior, including good mechanical integrity, conductivity and an ability to intercalate lithium for LIBs.
Accessibility of hydroxyl groups in anhydride modified wood as measured by deuterium exchange and saponification
Authors: Beck Greeley , Strohbusch Sarah , Larnøy Erik , Militz Holger , Hill Callum
Published: September 2017

Acetylated wood (WAc) shows improved properties largely due to the reduced amount of water in its cell wall, but the exact mechanism of water reduction remains unclear. Acetylation reduces hydroxyl (OH) content by acetyl (Ac) substitution but may also limit water access to unmodified OH groups by steric hindrance. In the present work, the accessibility of OH groups in acetylated or propionylated Radiata pine (Pinus radiata D. Don) wood (WAc and WPr) was investigated by deuterium exchange, saponification in sodium hydroxide followed by high-performance liquid chromatography (HPLC) analysis and weight percentage gain determination of the modified samples. Acetylation reduced OH accessibility (OHA) to a greater extent than would be predicted, if OH substitution were the only responsible mechanism for accessibility reduction. The combination of deuterium exchange and saponification results provides strong evidence that steric hindrance plays a key role in reduction of water accessibility to unmodified OH groups in WAc. The supramolecular architecture of WPr samples seems to be modified by the propionylation reaction, which leads to increased OHA at low levels of substitution. This suggests that molecular restructuring within the cell wall exposes new OH groups after propionylation. At higher levels of substitution, however, the WPr exhibited less OHA than expected indicating steric hindrance from the propionyl groups.
A case-control association study of 12 candidate genes and attempted suicide in French adolescents
Authors: Mirkovic Bojan , Cohen David , Laurent Claudine , Lasfar Malaika , Marguet Christophe , Gerardin Prsicille
Published: September 2017

Background

Suicide is the second leading cause of death for 10–19-year-olds. Evidence has shown that attempted suicide is a complex interplay of genes and environmental factors. In the adult population, possible associations between genetic polymorphisms and suicidal behaviors have been investigated for several genes, most often with inconsistent findings and poor replicability of significant associations. This study aimed to identify gene variants conferring risk for adolescent suicide attempt.

Methods

We selected the genes and variants after an analysis of the literature and a selection of the most significant associations identified. We performed analysis on 22 single nucleotide polymorphisms (SNPs) in 12 genes (COMT, CRHR1, FKBP5, SLC6A4, HTR1B, HTR2A, TPH1, TPH2, BDNF, NTRK2, NOS1 and IL28RA) for association with suicide attempt, hopelessness and impulsivity in an independent sample, composed of 98 adolescent suicide attempters who required hospitalization based on emergency assessments, and 150 healthy volunteers. Quality controls, deviations from the Hardy-Weinberg disequilibrium and statistical tests of association (case/control) were calculated using PLINK. Asymptotic p-values were corrected with the Benjamini-Hochberg method. The level of significance was set to 0.05.

Results

We identified four polymorphisms of interest, rs10868235 (NTRK2), rs1659400 (NTRK2), rs2682826 (NOS1) and rs7305115 (TPH2), with significant associations for suicide attempts or for the quantitative hopelessness or impulsivity phenotypes. However, none of the associations withstand statistical correction tests.

Conclusion

Our results do not support the role of the 22 SNPs selected in suicide attempt or hopelessness and impulsivity in adolescent population. However, the relatively small sample size and the probable effect of gene-gene interaction or gene-environment interaction on suicidal behavior could not be ruled out.
Design techniques for low-voltage analog integrated circuits
Authors: Rakús Matej , Stopjaková Viera , Arbet Daniel
Published: September 2017

In this paper, a review and analysis of different design techniques for (ultra) low-voltage integrated circuits (IC) are performed. This analysis shows that the most suitable design methods for low-voltage analog IC design in a standard CMOS process include techniques using bulk-driven MOS transistors, dynamic threshold MOS transistors and MOS transistors operating in weak or moderate inversion regions. The main advantage of such techniques is that there is no need for any modification of standard CMOS structure or process. Basic circuit building blocks like differential amplifiers or current mirrors designed using these approaches are able to operate with the power supply voltage of 600 mV (or even lower), which is the key feature towards integrated systems for modern portable applications.
Theoretical concept and FEM simulations of improved shielding for round horizontal yokes for rotational power loss measurement
Authors: Zurek Stan
Published: September 2017

The paper introduces a theoretical concept of a shielding for horizontal yokes for measurements of rotational power loss and other rotational and two-dimensional properties. Apart from horizontal parts, the shielding relies on vertical pieces distributed uniformly around the sample circumference, symmetrically on both sides. The simulations in 2D and 3D FEM show significant improvement in reduction of H perpendicular to the sample surface (Hz). The gradient of the tangential H is reduced so that the extrapolation of values towards the surface might be no longer required. There is also an added benefit that the required magnetomotive force is significantly lower (20-70%) for achieving the same B in the sample, as compared to the previously used simple horizontal shields.
Reducing usage of the computational resources by event driven approach to model predictive control
Authors: Misik Stefan , Bradac Zdenek , Cela Arben
Published: September 2017

This paper deals with a real-time and optimal control of dynamic systems while also considers the constraints which these systems might be subject to. Main objective of this work is to propose a simple modification of the existing Model Predictive Control approach to better suit needs of computational resource-constrained real-time systems. An example using model of a mechanical system is presented and the performance of the proposed method is evaluated in a simulated environment.
RNA-Seq Mouse Brain Regions Expression Data Analysis: Focus on ApoE Functional Network
Authors: Babenko Vladimir N. , Smagin Dmitry A. , Kudryavtseva Natalia N.
Published: September 2017

ApoE expression status was proved to be a highly specific marker of energy metabolism rate in the brain. Along with its neighbor, Translocase of Outer Mitochondrial Membrane 40 kDa (TOMM40) which is involved in mitochondrial metabolism, the corresponding genomic region constitutes the neuroenergetic hotspot. Using RNA-Seq data from a murine model of chronic stress a significant positive expression coordination of seven neighboring genes in ApoE locus in five brain regions was observed. ApoE maintains one of the highest absolute expression values genome-wide, implying that ApoE can be the driver of the neighboring gene expression alteration observed under stressful loads. Notably, we revealed the highly statistically significant increase of ApoE expression in the hypothalamus of chronically aggressive (FDR < 0.007) and defeated (FDR < 0.001) mice compared to the control. Correlation analysis revealed a close association of ApoE and proopiomelanocortin (Pomc) gene expression profiles implying the putative neuroendocrine stress response background of ApoE expression elevation therein.
Arguing Against Corporate Claims Visually and Multimodally: The Genre of Subvertisements
Authors: Tseronis Assimakis , Forceville Charles
Published: September 2017

In this paper, we describe the conditions under which the manipulation of the verbal and the visual elements or of the visual elements alone in the genre of subvertisements can be considered as an act of objecting or rebutting in an implicit argumentative discussion. We thus consider the cognitive and pragmatic aspects of communication while paying serious attention to the interaction of semiotic modes in order to analyse a number of images produced by anti-consumerist groups such as Adbusters. We identify four different ways in which image-text relations or the visuals alone can cue an incongruity between the message of the original ad and the message of the subvertisement in such a way that the latter functions as an objection or rebuttal of the claim advanced by the original advertisement.