bluuebunny/crossref_metadata_2025 huggingface dataset:
Gas face seal status estimation based on acoustic emission monitoring and support vector machine regression
Authors: Yin Yuan , Liu Xiangfeng , Huang Weifeng , Liu Ying , Hu Songtao
Published: May 2020

The difficulty of knowing the real-time status of gas face seals is the main cause of common problems, including sudden failure, ineffective diagnosis, and unpredictability of service life. This study analyzed the acoustic emission signals generated from experiments, uncovering their features in terms of the frequency distribution, periodic fluctuations, and the behaviors during different operation phases. A new vectorization procedure was designed according to the knowledge of informative acoustic emission features. Based on the vectorization procedure, a support vector machine regression method was applied to develop models predicting the eccentric load on the stator of the seal. Cross-validation was conducted to evaluate the regression performance and search for a proper kernel scale. This study found the informative features of acoustic emissions at different timescales and during different seal operation phases, and particularly the great informative potential of certain segments of the starting and stopping phases. The vectorization and support vector machine regression were shown to be effective in estimating the loads in experiments with cross-validation. Thus, a method for estimating the status of gas face seals based on acoustic emission monitoring was established.
Quantitative Analysis of 7 Compounds in Diospyros lotus Leaf Extract and Its Biological Effects on Neuroprotection and Antineuroinflammation
Authors: Kim Yu Jin , Lim Hye-Sun , Kim Joo-Hwan , Na MinKyun , Jeong Soo-Jin
Published: May 2020

Diospyros lotus L. (Ebenaceae) is a deciduous plant that was traditionally used to treat various diseases such as sedation, constipation, and hypertension. However, its effects on Alzheimer’s diseases (AD) have not been reported. We investigated the potent biological effects of D. lotus on AD and performed quantitative analysis of 7 standard compounds in D. lotus leaves. First, two parts leaf and branch of D. lotus were compared to examine the effects on amyloid-β (Aβ) aggregation and oxidative stress. Ethanol extract of D. lotus leaves (EDLL) had higher activities on the Aβ disaggregation and antioxidation compared with ethanol extract of D. lotus branches (EDLB). Second, we have focused on the biological activities of EDLL for neurocellular analyses. In HT22 neuronal cells, EDLL reversed hydrogen peroxide (H2O2)-damaged cell death. In BV-2 microglia, EDLL suppressed lipopolysaccharide-stimulated productions of nitric oxide (NO) and prostaglandin E2. Third, we performed quantitative analyses of 7 standard compounds in D. lotus using high-performance liquid chromatography. Among 7 compounds, myricitrin (44.189 mg/g) was the most abundant compound in EDLL. Myricetin presented the marked inhibitory effect on Aβ aggregation, indicating its potential as a bioactive compound to control Aβ aggregation. Overall, this study suggests that EDLL may be a promising therapeutic agent for AD via Aβ disaggregation, and inhibition of neuronal cell damage and inflammation.
Indigenous Preferences for Inpatient Rooms in Australian Hospitals: A Mixed-Methods Study in Cross-Cultural Design
Authors: Nash Daphne , O’Rourke Timothy , Memmott Paul , Haynes Michele
Published: May 2020

Aim:

This mixed-method study aimed to establish preliminary evidence for spatial and design features that can improve the experience and participation of Indigenous inpatients in healthcare.

Background:

Disadvantaged across a range of health measures, a disproportionately high number of Indigenous people leave hospital without receiving appropriate medical care. Australian government policies to improve cultural safety of Indigenous patients have largely ignored physical settings and their potential to improve health outcomes. Despite increasing evidence on the potential of design to reduce patient stress, there is minimal research on cross-cultural design in health facilities, including for Indigenous Australians.

Methods:

A cross-sectional, area-based survey elicited design preferences of four healthcare settings from Indigenous participants ( n = 602). On the screen-based survey, participants selected from paired images that indicated their preferences for room layout and features of inpatient rooms. Semistructured in-depth interviews ( n = 55) explored meanings behind preferences.

Results:

Participants showed majority preferences for the two-bed patient room, for a balcony rather than a window only, Indigenous art, and view of a park over an urban environment. Analysis of qualitative data shifted the focus from Ulrich’s three supportive design components to cultural recognition, the desire for company of family members, and connection to life outdoors.

Conclusions:

Social and cultural factors were highly significant to patients for sense of control, family support, and positive distraction. In response, inpatient room size and type, views, access to outdoors and Indigenous art need to be considered in hospital design for Indigenous patients and families.
Risk Factors Influencing the Incidence of Ankle Sprain Among Elite Football and Basketball Players: A Prospective Study
Authors: Pourgharib Shahi Mohammad Hosein , Selk Ghaffari Maryam , Mansournia Mohammad Ali , Halabchi Farzin
Published: May 2020

Introduction. The objective of the present study was to investigate whether certain intrinsic factors (foot hyperpronation, generalized joint laxity) and clinical tests (anterior drawer and talar tilt tests, single-leg balance test and star excursion balance test, ankle and first metatarsophalangeal range of motion) could predict the incidence of lateral ankle sprains among elite football and basketball players during a full year. Method. In a prospective cohort study, 106 elite basketball and football players were recruited. During the preseason period, players underwent baseline measurements. Team physicians in following year reported occurrence of new ankle sprains. Results. Ankle sprain was more frequent among basketball players ( P = .01). The history of recurrent ( P = .001) and acute ankle sprain ( P = .01) and each 5-year increase in age ( P = .039) were predictive factors for ankle sprain. No evidence for relationship between other risk factors and occurrence of ankle sprain were achieved. Conclusion. In our study, the history of recurrent and acute ankle sprain was the strongest predictor for ankle injuries. Considering the limitations of this study, it seems mandatory to conduct more prospective studies with a larger sample size and longer follow-up period.

Levels of Evidence: Level II: Prognostic
Study on myelin injury of AD mice treated with Shenzhiling oral liquid in the PI3K/Akt–mTOR pathway
Authors: Wang Yahan , Chen Fang , Wang Pengwen , Mana Lulu , Sheng Ning , Huang Shuaiyang
Published: May 2020

Shenzhiling oral liquid (SZL) is a Traditional Chinese Medicine (TCM) compound to be approved by the China Food and Drug Administration (CFDA) (Z20120010) for the treatment of mild-to-moderate Alzheimer’s disease (AD). However, its mechanism in early AD is not clear. We studied its mechanism in protecting myelin. Three-month-old APPswe/PS1dE9double transgenic mice were used as AD model and wild-type C57BL/6 mice were used as control. After 3-month intervention, the Morris water maze was used to detect behavioural changes. Myelin mTOR pathway (PI3K, p-PI3K, Akt, p-Akt, mTOR, p-mTOR), myelin basic protein (MBP) and postsynaptic density protein 95 (PSD95) were detected by immunohistochemistry and western blot and reverse transcriptase polymerase chain reaction (RT-PCR). After 3 months of SZL treatment, compared with the model group (M), SZL medium-dose (SM) and SZL low-dose groups (SL) exhibited increased staying and crossing results in Morris water maze ( P < 0.05). Compared with M, PI3K-positive cells in SM and SL groups were increased ( P < 0.01), p-PI3K expression increased in the Donepezil group (D), SZL high-dose group (SH) and SM ( P < 0.05); number of Akt-positive cells and Akt expression in D, SM and SL were increased ( P < 0.01, P < 0.05); number of p-Akt- and mTOR-positive cells and mTOR expression in all drug-treated groups were significantly increased ( P < 0.01); p-Akt and p-mTOR expression increased in all drug-treated groups ( P < 0.05, P < 0.01); MBP expression in D and SH increased ( P < 0.05), while in SM and SL it increased more significantly ( P < 0.01); and PSD95 expression in D, SM and SL was increased ( P < 0.05). RT-PCR results showed that compared with M, PI3K mRNA and Akt mRNA expression in all drug-treated groups increased, but there was no statistical difference ( P > 0.05), mTOR mRNA expression in all the drug-treated groups increased significantly ( P < 0.01) and MBP mRNA and PSD95 mRNA expression in D and SH increased ( P < 0.05). SZL oral liquid could play a role in myelin protection in early AD.
Teaching Training and Surgical Education in Minimally Invasive Surgery (MIS) of the Spine: What Are the Best Teaching and Learning Strategies for MIS? Do We Have Any Experience and Data?
Authors: Falavigna Asdrubal , Guiroy Alfredo , Taboada Néstor
Published: May 2020

Study Design:

Literature review and transversal study.

Objective:

Advances in new technologies give the surgeons confidence to manage complex spine conditions with a lower morbidity rate. This has changed the expectations of patients and medical payers and foreshadows the shift now underway: the use of minimally invasive techniques. The ethical considerations of learning directly on patients require a change in the education and training programs.

Methods:

The education paradigm has changed, and surgical training on minimally invasive surgery of the spine (MISS) techniques should follow a “curriculum.” The assessment of skill proficiency while learning the MISS techniques must be measurable to objectively show the performance gained over time and the changes that should be performed during training. Different strategies include “ex vivo” and “in vivo” training.

Results:

We have worked on a curriculum in which the participants can perceive the growth in their knowledge through the different educational opportunities. There are 3 levels: basic, advanced, and masters.

Conclusions:

We developed an educational curriculum for MISS rationale and techniques, that showed to be effective and interesting in our region.
Robotic Spine Surgery: Current State in Minimally Invasive Surgery
Authors: Vo Chau D. , Jiang Bowen , Azad Tej D. , Crawford Neil R. , Bydon Ali , Theodore Nicholas
Published: May 2020

Study Design:

Narrative review.

Objectives:

Robotic systems in spinal surgery may offer potential benefits for both patients and surgeons. In this article, the authors explore the future prospects and current limitations of robotic systems in minimally invasive spine surgery.

Methods:

We describe recent developments in robotic spine surgery and minimally invasive spine surgery. Institutional review board approval was not needed.

Results:

Although robotic application in spine surgery has been gradual, the past decade has seen the arrival of several novel robotic systems for spinal procedures, suggesting the evolution of technology capable of augmenting surgical ability.

Conclusion:

Spine surgery is well positioned to benefit from robotic assistance and automation. Paired with enhanced navigation technologies, robotic systems have tremendous potential to supplement the skills of spine surgeons, improving patient safety and outcomes while limiting complications and costs.
The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review
Authors: Liounakos Jason I. , Wang Michael Y.
Published: May 2020

Study Design:

Review.

Objectives:

To review the current state of endoscopic spine surgery with regard to discectomy, interbody fusion, and combination with Enhanced Recovery After Surgery programs in order to evaluate its relevance to the future of spine care.

Methods:

A review of the literature and expert opinion is used to accomplish the objectives.

Results:

The greatest strength of endoscopic spine surgery lies in its adherence to the basic tenets of minimally invasive surgery and its innate compatibility with Enhanced Recovery After Surgery programs, which aim to improve outcomes and reduce health care costs. The greatest challenge faced is the unique surgical skill set and significant learning curve.

Conclusions:

Endoscopic spine surgery strives to achieve the core goals of minimally invasive surgery, while reducing cost and enhancing quality. In a healthcare market that is becoming increasingly burdened by cost and regulatory constraints, the utilization of endoscopy may become more widespread in the coming years.
Development of a Curriculum for Minimally Invasive Spine Surgery (MISS)
Authors: Schmidt Franziska A. , Wong Taylor , Kirnaz Sertac , Taboada Néstor , Assaker Richard , Hofstetter Christoph , Kim Jin-Sung , Parajón Avelino , Taylor Paul , Assous Muhammed , Härtl Roger
Published: May 2020

The purpose of this review is to describe how a curriculum for minimally invasive spine surgery (MISS) was developed and implemented. The authors discuss the curriculum roadmap, its target audience, and the educational process for teaching general skills and specific procedures in MISS. Initiated by AOSpine, a panel of experts within spinal surgery from multiple centers formed the minimally invasive spine surgery task force. Together, task force members redefined the standards and milestones of the MISS education and training. Therefore, we conclude that the MISS task force created a structured curriculum which will have a positive influence on daily practice for surgeons and patients worldwide.
Persistent Infection Versus Type 2 Immunological Reaction in Lepromatous Leprosy
Authors: Tanabe Melinda B. , Group Ashley Rae , Rincon Liliana , Stryjewska Barbara M. , Sarria Juan C.
Published: May 2020

The distinction between persistent infection and immunologic reactions in leprosy is often difficult but critically important since their management is different. We present the case of a 51-year-old Vietnamese female who presented in 2015 with areas of erythema and skin infiltration on face and chest, as well as edema on her hands and feet. Skin biopsy was consistent with lepromatous leprosy. She was treated with rifampin, clarithromycin, and levofloxacin for 2 years. Her lower extremity edema was attributed to type 2 immunological reaction for which she was started on prednisone and methotrexate, but she was lost to follow-up for 19 months. She presented with new skin lesions and pain on her extremities. New biopsies revealed an intense neutrophilic infiltrate in the dermis and acid-fast bacilli focally within cutaneous nerve twigs. As compared with the initial biopsy, the inflammatory infiltrates were diminished and the bacilli had a degenerating appearance. These findings were consistent with type 2 immunological reaction. The patient was treated with thalidomide with improvement in the appearance of the skin lesions. A follow-up biopsy showed lack of neutrophilic infiltrates and decreased number of bacilli. This case illustrates the importance of differentiating between persistent infection and immunologic reactions in leprosy. Clinicians should be aware of these complications. A high index of suspicion and accurate interpretation of skin biopsy results are essential for appropriate diagnosis.
Exports of Spanish manufacturing firms and financial constraints
Authors: Máñez Juan A. , Vicente-Chirivella Óscar
Published: May 2020

We investigate the role of financial constraints on firms’ exporting behavior, including firms’ export decision, export intensity, firms starting to export decision, and exports persistence. Our financial constraints variable is a synthetic variable that summarizes information on different dimensions such as total assets, profitability, liquidity, solvency, repaying ability, and (new in this type of analyses) the cost of external financing. Using data on Spanish manufacturing for the period 1992–2014, we find evidence supporting that financial health is relevant to explain small and medium-sized enterprises (SMEs) exporting decisions and starting to export decisions but not those of large firms. Financial health does not seem to affect large firms’ export intensity and the results of the impact of financial health on SMEs export intensity are not conclusive. Nevertheless, financial health is a determinant of export persistence of large firms and SMEs.

JEL CLASSIFICATION: F14; G32; L60; C35
Prediction of Wind Erosion over a Heritage Site: A Case Study of Yongling Mausoleum, China
Authors: Wang Xiaoyu , Meng Jinzhu , Zhu Tianwei , Zhang Jingyu
Published: May 2020

To protect heritage buildings better, a method exploiting computational fluid dynamics (CFD) was developed for the analysis of wind erosion at a heritage site. Over a two-year period, we collected measurements of hourly weather data at Xinbin County to obtain statistics of wind speeds and directions for the Yongling Mausoleum. Subsequent results from CFD simulations show that before greening, with wind speeds reaching 10 m/s, certain structures (southwest-facing corners, doors and windows on open sides, places where swirling winds develop, and eaves of sloping roofs) of four heritage buildings were eroded more severely. With appropriate greening, plants may exert their unique ecological presence to better protect heritage buildings and their historical environments. After greening, the severity of damage to these vulnerable structures by wind was reduced. With wind speeds reaching 10 m/s, the average pressure on the structures of each building was 0.41–27.85 Pa, representing a reduction of 2.4%–75.6% from pressures before greening. We also constructed a 1:500-scale model to verify in experiments the correctness of CFD simulation qualitatively. The CFD simulations were found to provide an effective method to investigate and predict wind erosion of the heritage site.
Negotiating Contestations for Community-Oriented Heritage Management: A Case Study of Loushang in China
Authors: Zhao Xiaomei
Published: May 2020

Rural heritage is a living heritage of significant importance; it requires community-oriented management for cultural continuity and local development. Different social relations exist at rural heritage sites, which lead to external contestation among stakeholders and internal contestation within the community. It is essential to identify the impact caused by such contestations and determine an appropriate way to negotiate solutions. This paper examines the case of Loushang in Guizhou Province, identifying the contestations by examining the social relations through questionnaires and semi-structured interviews. Negotiation requires an appropriate person or social group to act as intermediary: they engage the stakeholders and induce them to collaborate; they also empower the community in heritage management. The case of Loushang indicates the tools that are necessary to facilitate community-oriented management for rural heritage; it bridges theoretical research and heritage practice.
Complete chloroplast genomes of four Physalis species (Solanaceae): lights into genome structure, comparative analysis, and phylogenetic relationships
Authors: Feng Shangguo , Zheng Kaixin , Jiao Kaili , Cai Yuchen , Chen Chuanlan , Mao Yanyan , Wang Lingyan , Zhan Xiaori , Ying Qicai , Wang Huizhong
Published: May 2020

Background

PhysalisL. is a genus of herbaceous plants of the family Solanaceae, which has important medicinal, edible, and ornamental values. The morphological characteristics ofPhysalisspecies are similar, and it is difficult to rapidly and accurately distinguish them based only on morphological characteristics. At present, the species classification and phylogeny ofPhysalisare still controversial. In this study, the complete chloroplast (cp) genomes of fourPhysalisspecies (Physalis angulata,P. alkekengivar.franchetii,P. minimaandP. pubescens) were sequenced, and the first comprehensive cp genome analysis ofPhysaliswas performed, which included the previously published cp genome sequence ofPhysalis peruviana.

Results

ThePhysaliscp genomes exhibited typical quadripartite and circular structures, and were relatively conserved in their structure and gene synteny. However, thePhysaliscp genomes showed obvious variations at four regional boundaries, especially those of the inverted repeat and the large single-copy regions. The cp genomes’ lengths ranged from 156,578 bp to 157,007 bp. A total of 114 different genes, 80 protein-coding genes, 30 tRNA genes, and 4 rRNA genes, were observed in four new sequencedPhysaliscp genomes. Differences in repeat sequences and simple sequence repeats were detected among thePhysaliscp genomes. Phylogenetic relationships among 36 species of 11 genera of Solanaceae based on their cp genomes placedPhysalisin the middle and upper part of the phylogenetic tree, with a monophyletic evolution having a 100% bootstrap value.

Conclusion

Our results enrich the data on the cp genomes of the genusPhysalis. The availability of these cp genomes will provide abundant information for further species identification, increase the taxonomic and phylogenetic resolution ofPhysalis, and assist in the investigation and utilization ofPhysalisplants.
Molecular delimitation of European leafy liverworts of the genus Calypogeia based on plastid super-barcodes
Authors: Ślipiko Monika , Myszczyński Kamil , Buczkowska Katarzyna , Bączkiewicz Alina , Szczecińska Monika , Sawicki Jakub
Published: May 2020

Background

Molecular research revealed that some of the EuropeanCalypogeiaspecies described on the basis of morphological criteria are genetically heterogeneous and, in fact, are species complexes. DNA barcoding is already commonly used for correct identification of difficult to determine species, to disclose cryptic species, or detecting new taxa. Among liverworts, some DNA fragments, recommend as universal plant DNA barcodes, cause problems in amplification. Super-barcoding based on genomic data, makes new opportunities in a species identification.

Results

On the basis of 22 individuals, representing 10Calypogeiaspecies, plastid genome was tested as a super-barcode. It is not effective in 100%, nonetheless its success of species discrimination (95.45%) is still conspicuous. It is not excluded that the above outcome may have been upset by cryptic speciation inC. suecica, as our results indicate. Having the sequences of entire plastomes of EuropeanCalypogeiaspecies, we also discovered that thendhBandndhHgenes and thetrnT-trnLspacer identify species in 100%.

Conclusions

This study shows that even if a super-barcoding is not effective in 100%, this method does not close the door to a traditional single- or multi-locus barcoding. Moreover, it avoids many complication resulting from the need to amplify selected DNA fragments. It seems that a good solution for species discrimination is a development of so-called “specific barcodes” for a given taxonomic group, based on plastome data.
Infraclavicular nerve block reduces postoperative pain after distal radial fracture fixation: a randomized controlled trial
Authors: Wong Stanley S. , Chan Wing S. , Fang Christian , Chan Chi W. , Lau Tak W. , Leung Frankie , Cheung Chi W.
Published: May 2020

Background

It is unclear whether regional anesthesia with infraclavicular nerve block or general anesthesia provides better postoperative analgesia after distal radial fracture fixation, especially when combined with regular postoperative analgesic medications. The aim of this study was to compare the postoperative analgesic effects of regional versus general anesthesia.

Methods

In this prospective, observer blinded, randomized controlled trial, 52 patients undergoing distal radial fracture fixation received either general anesthesia (n = 26) or regional anesthesia (infraclavicular nerve block, n = 26). Numerical rating scale pain scores, analgesic consumption, patient satisfaction, adverse effects, upper limb functional scores (Patient-Rated Wrist Evaluation, QuickDASH), health related quality of life (SF12v2), and psychological status were evaluated after surgery.

Result

Regional anesthesia was associated with significantly lower pain scores both at rest and with movement on arrival to the post-anesthetic care unit; and at 1, 2, 24 and 48 h after surgery (p ≤ 0.001 at rest and with movement). Morphine consumption in the post-anesthetic care unit was significantly lower in the regional anesthesia group (p<0.001). There were no differences in oral analgesic consumption. Regional anesthesia was associated with lower incidences of nausea (p = 0.004), and vomiting (p = 0.050). Patient satisfaction was higher in the regional anesthesia group (p = 0.003). There were no long-term differences in pain scores and other patient outcomes.

Conclusion

Regional anesthesia with ultrasound guided infraclavicular nerve block was associated with better acute pain relief after distal radial fracture fixation, and may be preferred over general anesthesia.

Trial registration

Before subject enrollment, the study was registered at ClinicalTrials.gov (NCT03048214) on 9th February 2017.
End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit
Authors: Bobillo-Perez Sara , Segura Susana , Girona-Alarcon Monica , Felipe Aida , Balaguer Monica , Hernandez-Platero Lluisa , Sole-Ribalta Anna , Guitart Carmina , Jordan Iolanda , Cambra Francisco Jose
Published: May 2020

Background

The purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit.

Methods

A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records.

Results

One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1,p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%,p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn.

Conclusions

The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.
Efficacy of tubing technique with biomaterials compared to direct coaptation technique after peripheral neurotmesis in nerve healing and return to functionality in young adult rats: a systematic review protocol
Authors: Brito Ana Camila Nobre de Lacerda , Santos Sara Emanuely Veríssimo , Martins Wilayane Alves , Queiroz Paulo César da Silva , Sougey Wenddy Wyllie Damascena , Alves Paula Ketilly Nascimento , Ribeiro Kalline Lourenço , de Oliveira Maria Danielly Lima , de Moraes Sílvia Regina Arruda
Published: May 2020

Background

Peripheral nerves are constant targets of traumatic injury which may result in neurotmesis and which invariably requires surgical treatment. In view of this, tissue engineering studies developed biomaterials which were first tested in animal models and used as a guide for nerve stumps in the procedure in order to speed up the healing process. Therefore, the aim of this study is to evaluate the efficacy of biomaterials used in tubing technique on healing and histological and functional recovery after peripheral nerve neurotmesis in rats.

Methods

We will search PubMed/MEDLINE, Embase, Web of Science, LILACS, and CENTRAL (from inception onwards). Grey literature will be identified through searching dissertation databases, guidelines, policy documents, and reports. We will include randomized and non-randomized trials conducted in young adult rats with peripheral neurometsis undergoing surgical repair through tubing technique with biomaterials. Primary outcomes will be histomorphometry, immunohistochemistry of the nerve tissue, and sciatic functional index. Secondary outcome will be nerve macroscopic evaluation. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis.

Discussion

This systematic review of animal studies will identify, evaluate, and synthetize the evidence on the the efficacy of tubing technique with biomaterials compared to direct coaptation technique after peripheral neurotmesis in nerve healing and return to functionality.

Systematic review registration

PROSPERO CRD42018106042.
Exploring the development of an innovation metric — from hypothesis to initial use
Authors: Radziszewski Peter
Published: May 2020

Purpose

The challenge to improving innovation in an organisation is limited by the metrics used to measure it. Dimensions related to where an organisation is on an innovation spectrum, how fast is that organisation innovating and what is holding it back are key elements that could be used to adequately measure innovation. The objective of this work is to explore the development of an innovation metric based on a pipe flow analogy that has the potential to provide insights into these key elements describing innovation.

Methodology

This work follows three steps: establishing a hypothesis, testing the hypothesis and applying the hypothesis. The proposed hypothesis suggests that an innovation metric, Ri, can be developed based on a pipe flow analogy. This hypothesis is tested qualitatively and quantitatively. The quantitative assessment is accomplished by populating the innovation metric, Ri, with data mainly from the World Bank, comparing the results with established innovation and competitiveness metrics and examining if the metric confirms the trends suggested by the qualitative assessment. Using an illustrative case drawn from the quantitative assessment, the resulting innovation metric is used to indicate possible avenues for innovation performance improvement. Statistical analysis is limited to describing the goodness of fit of different trend line relationships.

Results

A qualitative assessment indicates that the innovation metric (Ri) behaves as illustrated in the literature. The quantitative assessment confirms the qualitative assessment results. The illustrative case demonstrates how the innovation metric can be used to potentially orient innovation performance improvement. The paper closes with a discussion addressing issues and limitations of the metric.

Research limitations/implications

The validity of this innovation metric is limited by the variables defining it and the quality of the data input. Consequently, the variables used are limited to the analogous versions of fluid mechanics variables used to describe fluid flow in a pipe. The variables used require both hard and soft data which was obtained from the data sources cited as related to nations. On the other hand, the subsequent challenge is related to applying this model to ever smaller organisations especially with respect to gathering soft data related to trust and ease of communication.

Practical implications

Keeping in mind the limitations mentioned, the innovation metric, as it stands, can be used to describe an organisation’s innovation performance, the speed of innovation and resistance to innovation with the data available from the sites indicated. As a result, the model also can be used to see how an organisation’s innovation performance evolves over time as well as indicate possible avenues to improve innovation performance.

Originality/value

This is the first application of the fluid mechanics analogy to describe innovation performance. Its main value is related to contributing to the global conversation on innovation.
Four-strand hamstring graft is stiffer than a tripled semitendinosus graft in anterior cruciate ligament reconstruction: a cadaveric study
Authors: Hagemans Frans J. A. , van Overvest Karlijn L. J. , Zijl Jacco A. C. , Meuffels Duncan E.
Published: May 2020

Purpose

The aim of this study was to compare the biomechanics of a four-strand hamstring graft with a tripled semitendinosus graft, with and without adjustable extra-cortical button fixation, in a cadaveric model.

Methods

Four groups of 10 cadaveric hamstrings were tested: In group A, a tripled semitendinosus graft fixated with two adjustable extra-cortical buttons; in Group B, a four-strand semitendinosus and gracilis graft fixated with an adjustable extra-cortical button and a clamp; in group C, a tripled semitendinosus graft fixated to a steel hook and a clamp; in group D, a four-strand semitendinosus and gracilis graft fixated to a steel hook and a clamp. Each group was submitted to a cyclic loading test (1000 cycles between 50 and 250 Newton at a frequency of 0.5 hertz) and a load-to-failure test. Primary outcomes were ultimate failure load and stiffness. Secondary outcomes were graft elongation and graft diameter.

Results

There was no difference in ultimate failure load among groups. Group B achieved a median stiffness of 171 N/mm (interquartile range [IQR] 139–204) which was significantly higher than Group A (median 103 N/mm (74–119), p < 0.01). Group B showed more cyclic elongation (4.1 mm (3.4–5.7)) compared to group D (2.3 mm (1.9–3.0)), and also lower stiffness was noted (171 N/mm (139–204) vs 265 N/mm (227–305)). There was no difference in graft diameter among groups.

Conclusions

The results of this study indicate that higher stiffness can be achieved using four-strand hamstring tendon grafts compared to tripled semitendinosus grafts when using femoral extra-cortical buttons, despite comparable graft diameters. Thereby, the use of adjustable extra-cortical fixation devices may result in more cyclic elongation and lower stiffness of the graft.
High precision control model of large-sized gantry-type linear motor slider
Authors: Ojiro Tetsuya , Tachibana Toshiyuki , Honda Hideki , Watanabe So , Hamamatsu Hiroshi , Tsuruta Kazuhiro
Published: May 2020

Large-sized gantry-type linear motor sliders are widely used in industry (e.g. in liquid crystal panel production equipment). An appropriate control model is important for deriving control methods to improve control performance. Although various control models of large-sized gantry-type linear motor sliders have been developed in previous studies, no results are yet reported regarding control models which precisely reproduce characteristics of a large-sized gantry-type linear motor slider. In general, a method to derive a transfer function by using frequency responses can be employed to obtain an accurate control model, however, large sized gantry-type linear motor sliders have unique characteristics, namely “distortion” and “coupling”, thus the transfer function derived using only the frequency response cannot reproduce the experimental results with high accuracy. In this paper we report on a method to obtain a highly precise control model of a large sized gantry-type linear motor slider.
Understanding the Anemic Global Response to COVID-19
Authors: Busby Joshua W.
Published: May 2020

The COVID-19 outbreak is the most serious test of the international system since the 2008 global financial crisis. Rather than cooperate to contain and respond to a common threat, the world's leading powers—the United States and China—have increasingly blamed each other through wildly speculative theories about the origins of the virus. The World Health Organization sought to coordinate a global response, but it has been hamstrung and has come under attack. Given past cooperation between major powers to mobilize and eradicate smallpox and previous US leadership to fight HIV/AIDS and the 2014 West African Ebola crisis, the limited cooperation and lack of leadership are puzzling. What explains the anemic global response to date? This article draws from structural international relations theory to suggest a partial but somewhat dissatisfying answer. International organizations are inherently weak and now face opposition by major powers. The international system simultaneously incentivizes states to cooperate and address common threats, but it also encourages countries to take care of themselves, potentially at the expense of others. Which of these motives dominates cannot be explained by structural theory, thus requiring us to look to other factors such as the attributes of states and leaders themselves.
Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements
Authors: Soni Aparna , Gian Cong , Simon Kosali , Sommers Benjamin D.
Published: May 2020

Context: Twenty states are pursuing community engagement requirements (“work requirements”) in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries.

Methods: The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551).

Findings: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population—particularly women, older adults, and those with less education—would not currently satisfy a 20-hour-per-week requirement.

Conclusions: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.
The Elephant in the Room: The Impact of Labor Obligations on Credit Markets
Authors: Favilukis Jack , Lin Xiaoji , Zhao Xiaofei
Published: May 2020

We show that labor market frictions are first-order for understanding credit markets. Wage growth and labor share forecast aggregate credit spreads and debt growth as well as or better than alternative predictors. They also predict credit risk and debt growth in a cross section of international firms. Finally, high labor share firms choose lower financial leverage. A model with labor market frictions and risky long-term debt can explain these findings, and produce large credit spreads despite realistically low default probabilities. This is because precommitted payments to labor make other committed payments (i.e., interest) riskier. (JEL D33, E23, E24, E25, E44, F23, G32)
An investigation into dose optimisation for imaging root canal anatomy using cone beam CT
Authors: McGuigan Margarete B , Theodorakou Christie , Duncan Henry F , Davies Jonathan , Sengupta Anita , Horner Keith
Published: May 2020

Objectives:

To identify a dose as low as diagnostically acceptable and a threshold level of image quality for cone beam CT (CBCT) imaging root canals, using maxillary first molar (M1M) second mesiobuccal (MB2) canals of varying complexity for two CBCT scanners.

Methods:

Dose–area product (DAP) and contrast-to-noise ratio (CNR) were measured for two scanners at a range of exposure parameters. Subjective-image-quality assessment at the same exposures was performed for three M1Ms of varying MB2 complexity, positioned in an anthropomorphic phantom. Nine raters (three endodontists, three dental radiologists and three junior staff) assessed canal visibility, using a 5-point confidence scale rating.

Results:

Identification of simple-moderate MB2 canal complexity was achieved at a range of protocols, with DAP values of ≥209.3 and ≥203.2 mGy cm² and CNRs of 3 and 7.6 for Promax®3D and Accuitomo-F170® respectively. For complex canal anatomy, target subjective image quality was not achieved, even at the highest DAP values for both scanners. Junior staff classified significantly more images as undiagnostic compared with senior staff (p = 0.043).

Conclusions:

In this first study to address optimisation of CBCT imaging of root canal anatomy, a similar threshold dose for both scanners was identified for M1Ms with simple-moderate MB2 canal complexity. Increasing dose to enhance visualisation of more complex canal anatomy was ineffective. Selection of standard protocols (while avoiding lower kV/mA protocols) instead of high-resolution scans was a practical means of reducing patient dose. CNR is not a transferable measure of image quality.
A combinatorially regulated RNA splicing signature predicts breast cancer EMT states and patient survival
Authors: Qiu Yushan , Lyu Jingyi , Dunlap Mikayla , Harvey Samuel E. , Cheng Chonghui
Published: May 2020

During breast cancer metastasis, the developmental process epithelial–mesenchymal transition (EMT) is abnormally activated. Transcriptional regulatory networks controlling EMT are well-studied; however, alternative RNA splicing also plays a critical regulatory role during this process. A comprehensive understanding of alternative splicing (AS) and the RNA binding proteins (RBPs) that regulate it during EMT and their impact on breast cancer remains largely unknown. In this study, we annotated AS in the breast cancer TCGA data set and identified an AS signature that is capable of distinguishing epithelial and mesenchymal states of the tumors. This AS signature contains 25 AS events, among which nine showed increased exon inclusion and 16 showed exon skipping during EMT. This AS signature accurately assigns the EMT status of cells in the CCLE data set and robustly predicts patient survival. We further developed an effective computational method using bipartite networks to identify RBP-AS networks during EMT. This network analysis revealed the complexity of RBP regulation and nominated previously unknown RBPs that regulate EMT-associated AS events. This study highlights the importance of global AS regulation during EMT in cancer progression and paves the way for further investigation into RNA regulation in EMT and metastasis.
Typing and classification of non-tuberculous mycobacteria isolates
Authors: Clarke Thomas , Brinkac Lauren , Manoranjan Joanna , García-Basteiro Alberto , Grewal Harleen , Kiyimba Anthony , Lopez Elisa , Macaden Ragini , Respeito Durval , Ssengooba Willy , Tameris Michele , Sutton Granger
Published: May 2020

Background: There are a large and growing number of non-tuberculous mycobacteria (NTM) species that have been isolated, identified, and described in the literature, yet there are many clinical isolates which are not assignable to known species even when the genome has been sequenced. Additionally, a recent manuscript has proposed the reclassification  of the Mycobacterium genus into five distinct genera.

Methods: We describe using a community standard fast  average nucleotide identity (ANI) approximation method, MASH, for classifying NTM genomes by comparison to a resource of type strain genomes and proxy genomes. We evaluate the genus reclassification proposal in light of our ANI, MLST, and pan-genome work.

Results: We describe here a sequencing study of hundreds of clinical NTM isolates. To aid in characterizing these isolates we defined a multi-locus sequence typing (MLST) schema for NTMs which can differentiate strains at the species and subspecies level using eight ribosomal protein genes. We determined and deposited the allele profiles for 2,802 NTM and Mycobacterium tuberculosis complex strains in PubMLST.

Conclusions: The MLST schema and our pan-genome analysis of Mycobacteria can help inform the design of marker-gene diagnostics. The ANI comparisons likewise can assist in the classification of unknown genomes, even from previously unknown species.
Limitations to current methods to estimate cause of death: a validation study of a verbal autopsy model
Authors: Menéndez Clara , Quintó Llorenç , Castillo Paola , Carrilho Carla , Ismail Mamudo R. , Lorenzoni Cesaltina , Fernandes Fabiola , Hurtado Juan Carlos , Rakislova Natalia , Munguambe Khátia , Maixenchs Maria , Macete Eusebio , Mandomando Inacio , Martínez Miguel J , Bassat Quique , Alonso Pedro L , Ordi Jaume
Published: May 2020

Background: Accurate information on causes of death (CoD) is essential to estimate burden of disease, track global progress, prioritize cost-effective interventions, and inform policies to reduce mortality. In low-income settings, where a significant proportion of deaths take place at home or in poorly-resourced peripheral health facilities, data on CoD often relies on verbal autopsies (VAs). Validations of VAs have been performed against clinical diagnosis, but never before against an acceptable gold standard: the complete diagnostic autopsy (CDA).

Methods: We have validated a computer-coded verbal autopsy method –the InterVA- using individual and population metrics to determine CoD against the CDA, in 316 deceased patients of different age groups who died in a tertiary-level hospital in Maputo, Mozambique between 2013 and 2015.  

Results: We found a low agreement of the model across all age groups at the individual (kappa statistic ranging from -0.030 to 0.232, lowest in stillbirths and highest in adults) and population levels (chance-corrected cause-specific mortality fraction accuracy ranging from -1.00 to 0.62, lowest in stillbirths, highest in children). The sensitivity in identifying infectious diseases was low (0% for tuberculosis, diarrhea, and disseminated infections, 32% for HIV-related infections, 33% for malaria and 36% for pneumonia). Of maternal deaths, 26 were assigned to eclampsia but only four patients actually died of eclampsia.

Conclusions: These findings do not lead to building confidence in current estimates of CoD. They also call to the need to implement autopsy methods where they may be feasible, and to improve the quality and performance of current VA techniques.