bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of dynamic characteristics of thin cylindrical sandwich panels with magnetorheological core
Authors: Mikhasev Gennadi I , Eremeyev Victor A , Wilde Krzysztof , Maevskaya Svetlana S
Published: September 2019

Based on the equivalent single-layer linear theory for laminated shells, free and forced vibrations of thin cylindrical sandwich panels with magnetorheological core are studied. Five variants of available magnetorheological elastomers differing in their composition and physical properties are considered for smart viscoelastic core. Coupled differential equations in terms of displacements based on the generalized kinematic hypotheses of Timoshenko accounting for transverse shears with coefficients depending on the complex shear modulus for a smart core are used to govern vibrations of cylindrical panels. Assuming conditions of simple support for straight and curvilinear edges, solutions in the explicit form describing natural modes as well as an equation with respect to the required complex eigenfrequencies are found. To predict the shell response to an external harmonic force, the general solution of non-homogeneous governing equations is derived in the form of series in natural modes. To estimate damping capability of magnetorheological elastomers under consideration, the principle tunable parameters, the lowest natural frequencies and associated logarithmic decrements are calculated for the same panels with different magnetorheological elastomers under the action of a magnetic field of different intensities. Finally, the amplitude–frequency plots for magnetorheological elastomer-based panels of different opening angles with and without magnetic field are presented.
Safety Outcomes of Atorvastatin 80 mg Versus Atorvastatin 40 mg in a Veteran Population
Authors: Jacobs Devon , Wassell Katelyn , Guidry Tommie Jo , Sullivan Joshua
Published: September 2019

Background: High-intensity atorvastatin dosing may lead to a greater incidence of adverse events, subsequently leading to discontinuation and suboptimal risk reduction for major adverse cardiovascular events. No previous studies exist investigating the safety of high-intensity atorvastatin therapy among a veteran population. Objective: To evaluate the safety profile of high-intensity atorvastatin in the veteran population. Methods: This was a retrospective observational study conducted on patients newly prescribed atorvastatin 80 or 40 mg daily at the Memphis Veterans Affairs Medical Center. The primary outcome was incidence of adverse drug events. Secondary outcomes include incidence of high-intensity atorvastatin discontinuation and change of lipid panel values. Results: A total of 205 veterans were analyzed among atorvastatin 80 mg daily (n = 103) and atorvastatin 40 mg daily (n = 102) groups. Of 40 adverse events reported, 23 events occurred with atorvastatin 80 mg and 17 events with atorvastatin 40 mg ( P = 0.31). Myalgia (11% vs 7%; P = 0.33) and weakness (12% vs 9%; P = 0.51) were commonly reported events among both cohorts. Rates of discontinuation of high-intensity atorvastatin therapy were similar between cohorts (26% vs 15%; P = 0.45). No statistically significant differences in lipid profile reductions were found. Conclusion and Relevance: Atorvastatin 80 mg daily was well tolerated with similar incidence of discontinuation and reduction of lipid panel values compared with atorvastatin 40 mg daily in a veteran population. This study provides a direct comparison of safety outcomes for high-intensity atorvastatin doses among veterans to highlight the importance of clinician-patient discussion on statin-related adverse effects compared with desired efficacy when considering initiation of therapy.
Active vibration control for the time-varying systems with a new adaptive algorithm
Authors: Zheng Hongbo , Qin Hui , Ren Mingke , Zhang Zhiyi
Published: September 2019

This paper proposes a new adaptive algorithm for the active vibration control of time-varying systems in the presence of broadband or narrowband disturbances. The new algorithm combines the conventional filtered-x least mean square algorithm with the recursive prediction error (RPE) algorithm after the gradient modification of the RPE algorithm. The modified RPE algorithm is used to estimate the model of the control path online. The well-known filtered-x least mean square (FxLMS) algorithm is effective for the uncertain or time-varying systems, and adopts an auxiliary white noise approach to estimate the model of the control path online. However, the auxiliary excitation will degrade the control performance to some extent. In the new algorithm, the auxiliary excitation is eliminated at the expense of a larger computational burden. The influence of the estimated finite impulse response series on the convergence is also discussed. A propulsion shafting model with the time-varying dynamics is established by frequency response function synthesis. Numerical simulation for the established model is presented to demonstrate the superior performance of the proposed algorithm as compared with the FxLMS algorithm.
Gastroschisis Is Associated With Placental Delayed Villous Maturation
Authors: Ruschkowski Brittany , Lafreniere Anthea , Demellawy Dina El , Grynspan David
Published: September 2019

Gastroschisis is a congenital abnormality characterized by visceral herniation through an abdominal wall defect. While the cause of gastroschisis is unknown, it has been linked to risk factors including young maternal age, smoking, and alcohol use during pregnancy. To date, the only established placental correlate is amniocyte vacuolization. Based on our clinical experience, we hypothesized that delayed villous maturation (DVM) is also associated with gastroschisis. We conducted a retrospective slide review of 23 placentas of neonates with gastroschisis. Additionally, we selected 2 control groups of placentas: 1 with a previous diagnosis of DVM and 1 with normal villous morphology. All placentas were randomized and reviewed by 2 perinatal pathologists, who were blinded to the group; DVM and amniocyte vacuolization were assessed. Gastroschisis was associated with increased placental DVM in 65.2% of cases (vs 13.6% of controls; P = .0007) and increased amniocyte vacuolization in 52.2% of cases (vs 9.1% of controls; P = .003) compared to the control group. Based on the normal and DVM groups, kappa agreement between current slide review and initial pathology diagnosis was 0.419, indicating moderate agreement. Our study shows that gastroschisis is associated with placental DVM. This association may be due to (1) a common upstream factor contributing to both gastroschisis and DVM or (2) DVM may be a consequence of the altered placental and amniotic environment in the context of gastroschisis.
Iris and ciliary body cysts and phakic intraocular lenses
Authors: Gharaibeh AM , Liehneova I , Mojzis P , Ziak P , Alió Jorge L
Published: September 2019

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.
Cutaneous Myiasis Around Gastrostomy (PEG) Tube Insertion Site: The Second Case Report
Authors: Bani Hani Mohammed N , Al Manasra Abdel Rahman , Daradkah Hamzeh , Bani Hani Farah , Bani Hani Zeina
Published: September 2019

Background:

Myiasis refers to the infestation of live human with 2-winged larvae (maggots). Cutaneous myiasis is the most commonly encountered clinical form. It is divided into 3 main forms: furuncular, creeping (migratory), and wound (traumatic) myiasis.

Case report:

In this article, we report an extremely rare case of myiasis around percutaneous endoscopic gastrostomy (PEG) tube in a 71-year-old female patient. She had the tube placed for feeding purposes, 8 months prior to her presentation. Family noticed alive worms emerging from skin at the gastrostomy tube insertion site. Patient was treated conservatively with daily dressing with no debridement or use of systemic agents.

Conclusions:

PEG tube cutaneous myiasis is an extremely rare disease. Conservative management with petroleum-based and sterilizing agents is shown to be efficient to clear the disease in a short period of time.
Perforated Small Intestine: A Case of a Delayed Presentation of an Intra-Abdominal Injury in a Pediatric Patient With a Seatbelt Sign
Authors: Taylor Gregory M , Zygowiec Jonathan P , Wallace Laurie C , Zelenka-Joshowitz Dawn C , Chudler Angel F
Published: September 2019

With the use of seatbelts comes a unique injury profile that has been called “the seatbelt syndrome.” The classically described “seatbelt sign” has become a pattern of injury, describing potential underlying damage. As a clinician, clues to the underlying damage follow a thorough physical examination including the removal of all clothing to locate abrasions and bruises to the skin that potentially follow a seatbelt pattern. Delayed presentation of an intra-abdominal injury in the setting of a seatbelt sign has been well documented; however, the question is how long to observe these patients. We present the case of a 17-year-old woman involved in a motor vehicle collision who presented to the emergency department (ED) hemodynamically stable with a lower abdominal wall seatbelt sign. Her initial imaging revealed only an abdominal wall contusion. She was admitted for observation. Approximately 12 h later she started developing abdominal pain, and by 14 h abdominal distention, with repeat imaging showing free fluid and free air. She was taken to the operating room for an exploratory laparotomy and was ultimately discharged back home on day 7.
Individual differences in L2 frequency effects in different script bilinguals
Authors: Mor Billy , Prior Anat
Published: September 2019

Aims:

High frequency words are read more quickly and accurately than low frequency words, a phenomenon called the frequency effect. In the current study, we examine several possible predictors for explaining individual differences between bilinguals in their sensitivity to frequency in the second language: specific second language exposure and vocabulary; general language abilities (therefore also evident in native language performance); and general cognitive ability (non-linguistic sensitivity to regularities).

Approach:

We used an individual differences approach with unbalanced Hebrew–English bilinguals, two typologically different languages that do not share a writing system, which allows a clear discrimination between native language and second language exposure and vocabulary.

Data and analysis:

To examine frequency effects, 69 Hebrew–English bilingual adults completed lexical decision tasks in native language and second language. In addition, participants completed vocabulary tests in both languages, reported language use and proficiency, and performed a statistical learning task. Data were analyzed using linear mixed-effects models.

Findings:

The results demonstrated that only vocabulary knowledge in the second language was a significant predictor of frequency effects in the second language. In addition, neither sensitivity to frequency in the native language nor statistical learning ability (a measure of general sensitivity to regularities) predicted sensitivity to frequency in the second language.

Originality:

Using an individual differences approach with bilinguals of two typologically different languages that do not share a writing system allows us to distinguish between native language and second language proficiency, and therefore identify the unique contribution of predictive factors from each of the languages to efficient visual word recognition in second language.

Implications:

The current findings support the lexical entrenchment hypothesis and highlight the importance of testing a variety of bilingual populations.
Stress monitoring and impact bearing capacity of circular concrete-filled steel tubular short columns under axial impact loads
Authors: Li Zhao , Gao Jingwei , Xu Jindong , Du Guofeng
Published: September 2019

Compared with the traditional reinforced concrete columns, the concrete-filled steel tubular columns with a better restraint effect of steel tube on core concrete showed higher bearing capacity and ductility under static loads. However, except static loads, concrete-filled steel tubular columns are commonly exposed to the extreme dynamic loads including earthquake, explosion, and impact. The study on dynamic behavior of concrete-filled steel tubular columns is extremely significant to ensure their safety against such dynamic loads. In this article, a polyvinylidene fluoride piezoelectric smart sensor was proposed to monitor the axial impact bearing capacity of specimen based on stress monitoring under impact loads. The concrete-filled steel tubular columns with smart sensor embedded were tested, which considered the effects of both hammer impact heights and steel tube thickness on the axial impact bearing capacity. The impact bearing capacity calculated based on the monitoring results of polyvinylidene fluoride sensor is in good agreement with the measured values, which verifies the feasibility of this method. Moreover, it is found that the failure mode of concrete-filled steel tubular short columns is the local tearing failure or local buckling. In addition, non-linear finite element models were also established to study the effect of different parameters on the axial bearing capacity. The simplified formula for calculating the axial impact bearing capacity of concrete-filled steel tubular short columns was proposed based on the large amount verified model. Through the comparison between the calculation value and the test value, the formula is found to well reflect the axial impact bearing capacity of concrete-filled steel tubular short columns, which provides a reference for similar research.
Analysis of wind attack angle increments in wind tunnel tests for the aerodynamic coefficients of iced hangers
Authors: Guo Pan , Li Shengli , Wang Dongwei
Published: September 2019

Wind attack angle increments are important inputs for the accurate and efficient wind tunnel test in analyzing the aerodynamic coefficients and Den Hartog galloping coefficients of iced cable structures. This research aims to investigate the interference of wind attack angle increments on the aerodynamic coefficients and Den Hartog galloping stability of iced hangers based on the aerodynamic coefficient theory and Den Hartog galloping theory, and by adopting the method of wind tunnel test. The analysis shows that considerable calculation error will be caused when directly using the conventional method during the processing and analysis of Den Hartog galloping for iced cable structures. The curve fitting of the aerodynamic coefficients of iced hangers in which their characteristics are better presented, for example, smooth-going characteristic, antisymmetric characteristics for lift coefficients, and symmetric characteristics for drag coefficients, can satisfy the accuracy requirement of the derivation of lift coefficients and can then be used to examine the Den Hartog galloping coefficients of iced hangers accurately. In cases where the wind attack angle increments are more than 3°, the wind attack angle that corresponds to the minimum value of the Den Hartog coefficients shows an offset. Meanwhile, distortions occur when determining the range of wind attack angles of Den Hartog galloping, and thus quantitative analysis cannot be conducted. These cases are only applicable to a preliminary study. The precision of the Den Hartog coefficients, which is solved in cases where the wind attack angle increments are not more than 3°, can meet the requirements for the Den Hartog galloping analysis. Results of this study can provide a reference for research on the galloping of iced hangers using the wind tunnel test.
Being professional in New Zealand early childhood education: A genealogy
Authors: Stuart Margaret
Published: September 2019

An academic, Peter Dinniss, discussed the then emerging issue of professionalism in the early childhood education sector in 1974. “There has been much debate over the term ['professional'] together with discussion as to whether teaching is a profession” (1974: 11).

On the cusp of the 21st century, the Education Council (now renamed Teaching Council) of New Zealand consulted with teachers on their register about a professional code. This article follows the emergence of the professionalism discourse.

I examine traces of the ‘strategies, tactics and procedures’ in a genealogy of the managerial technicist process of education. My interest lies in emergent ‘responsibilization’ of teachers over the period. I examine the power/knowledge of the ‘profession’ in Aotearoa, New Zealand, as teachers invent and govern themselves. I ask if the Council’s discourse of professionalism through registration of individuals can be re-envisioned through the collective and democratic practices evident in parent-led services.
Becoming Unburdened: Writing and Revealing the Debt of Heteronormativity
Authors: Stern Danielle M.
Published: September 2019

In this essay, I use embodied, autoethnography to transform my fiscal self and disentangle my queer body from my heteronormative body. I position autoethnography and auto/archeology as a privileged orientation/method that must be viewed, practiced, and critiqued as such, even for those of us with some circumscription of marginal identities. I write my “radically specific” narrative not only to improve my own relationship, but also to contribute to feminist, queer bodies of knowing and relating that disrupt heteronormative, middle-class, White domesticity. My goal is to inspire others to simultaneously shed the stigma of financial burdens and challenge heteronormative privilege.
Structurally conserved binding motifs of transcriptional regulators to notch nuclear effector CSL
Authors: Hall Daniel P , Kovall Rhett A
Published: September 2019

This mini review discusses the protein complexes comprised of the universal Notch signaling transcription factor, CSL (CBF1/Su(H)/Lag-1), and its activating or repressing transcriptional coregulation partners. Many of these complex structures have been solved crystallographically as well as undergoing extensive binding studies with wild-type and mutant variants. Notch signaling is critically important in a large variety of basic biological processes: cell proliferation, differentiation, cell cycle control to name a few. Aberrant Notch thus remains a coveted target for pharmaceutical intervention. To that end, we provide a molecular-level summary of the similarities and differences in the Notch coregulator complexes that ultimately govern these processes. We highlight a conserved binding motif that multiple superficially unrelated proteins have adopted to become involved in Notch target gene regulation. As CSL-interacting small molecules begin to be characterized, this review will provide insight to potential binding sites and differential complex disruption.

Impact statement

Proper Notch signaling regulation is informed by many distinct protein complexes involving a single nuclear effector. A decade of research into these protein complexes yields multiple crystal structures and a wealth of binding data to guide drug development for Notch-related diseases – cancer, cardiovascular, development disorders.
A Bibliometric Survey of Publications in Vascular Ultrasound
Authors: Wooster Douglas L. , Angelson Mary E. , Williams David M.
Published: September 2019

Access to a body of published research is important to the development of research and to inform quality patient care. Measures of such activities are determined by bibliometric analysis of publication databases. This project aims to identify the scope of such publications in vascular ultrasound and its implications for the ultrasound professionals. Major databases were surveyed to identify the range of publications in “vascular ultrasound” from 2016 to 2018. The topics, sources, and relevance of the publications were noted along with recognized impact factors and other parameters. A list of target journals was created in radiology, ultrasound, and clinical vascular spheres. These journals were assessed for bibliometric parameters, total number of articles, and articles specific to vascular ultrasound. Web of Science was used over a 3-year period to identify 4136 articles (1421, 1384, and 1326 in each of 2016, 2017, and 2018, respectively). This search returned 414 pages; of these, 2-page analysis revealed 15% were relevant to vascular ultrasound practice. Of the 21 “highly cited” articles, one was related to carotid ultrasound and one was aortic practice guidelines. Of the 31 targeted journals (radiology, 5; ultrasound, 16; vascular surgery, 7; vascular medicine, 3), 3873 articles were published; 123 (3.2%) were relevant to vascular ultrasound. The maximum vascular ultrasound content in any one journal was 8%. The activities were guidelines, 11; cases, 7; and mixed other, 105. The topics were carotid, 30; arterial, 17; aorta, 7; venous, 16; education, 12; and other, 41. The impact factor was 0.36 to 16.8 (median = 2.1). None of the targeted journals nor the major databases have much content in vascular ultrasound. The choice of journal for publication should be determined by potential audience rather than the journal itself. As a tool for an environment scan of trends in vascular ultrasound, no journal serves well.
Privacy-based medical data protection against internal security threats in heterogeneous Internet of Medical Things
Authors: Habib Muhammad Asif , Faisal C M Nadeem , Sarwar Shahzad , Latif Muhammad Ahsan , Aadil Farhan , Ahmad Mudassar , Ashraf Rehan , Maqsood Muazzam
Published: September 2019

Data and information security is considered to be an important and challenging task for any field of life. But it becomes more critical especially when it deals with the medical field due to life and health hazards. The ratio of internal security threats to external threats always remains high. A huge number of efforts and technical expertise are required in the case of attacking the system from the external environment. But it requires fewer efforts if a system is attacked internally by the stakeholders of the system. This article presents an access control model that secures the medical data of patients against internal cybersecurity threats. It allows only the legitimate users, that is, authorized patients and doctors to communicate despite the fact of physical boundaries. The proposed model implements authorization in combination with permissions and roles instead of roles only for medical staff. It removes the discrepancies in the existing access control models. The proposed model ensures communication among doctors and patients in a secure, private, and efficient manner. The model is demonstrated by using mathematical modeling along with implementation examples. The proposed model outperformed in comparison with state-of-the-art access control models.
Analysis of factors affecting the speed of probabilistic target search using unmanned aerial vehicles
Authors: Ha Il-Kyu , Cho You-Ze
Published: September 2019

When searching for targets using unmanned aerial vehicles, speed is important for many applications such as the discovery of patients in a medical emergency. The speed of operation of actual unmanned aerial vehicles is strongly related to the performance of the camera sensor used for target recognition, search altitude, and the search algorithm employed by the unmanned aerial vehicle. In this study, the major factors affecting the speed of a probabilistic unmanned aerial vehicle target search are analyzed. In particular, simulations are performed to analyze the influence of the search altitude, sensor false alarm rate, and sensor missed detection rate on the required travel distance and the time required for a search. Furthermore, the search performance of an unmanned aerial vehicle is analyzed by varying the search altitude with fixed false alarm and missed detection probabilities. The simulation results show that the search performance is significantly affected by changes in the false alarm and missed detection probabilities of the sensor, and it confirms that the effect of the missed detection probability is greater than that of the false alarm probability. The second simulation proves that the altitude of an unmanned aerial vehicle is a very important factor for the speed of a target search. In particular, the result shows that, for a real data set, the search distance and time at 10 and 5 m are about 2.8 times and 14.3 times larger, respectively, than those at 20 m.
A convenient two-step synthesis of Coenzyme Q1
Authors: Lu Bin , Qiu Yong-Fu , Qi Shi , Wang Jin
Published: September 2019

A convenient method for the preparation of Coenzyme Q1 from cheap and readily available 3,4,5-trimethoxytoluene is developed. Coenzyme Q1 is synthesized in a moderate yield by a two-step procedure involving the key reaction of an allyl bromide with Coenzyme Q0 through a redox chain reaction. The reaction is efficient and can be used for the synthesis of other Coenzyme Q compounds.
Research on fractal image compression hybrid algorithm based on convolutional neural network and gene expression programming
Authors: Li Wenjing , Pan Qiuxia , Liang Shiaofang , Jiao Jiang Yin
Published: September 2019

Regarding the problems of insufficient image segmentation intelligence, low compression rate, slow speed for global searching to find the optimal fractal image compression encoding, and bad decoding effect, this article proposes the fractal image compression hybrid algorithm based on convolutional neural network and gene expression programming. Firstly, according to the accurate and fast image classification of deep convolutional neural network and the fast search and matching encoding advantages of gene expression programming, it realizes theoretically the action mechanism of fractal image compression hybrid encoding by combining the convolutional neural network and the gene expression programming; then, it uses the deep convolutional neural network to train and classify the image, and uses the adaptive quadtree segmentation method to segment the classified image, thus generating the domain block and range block classification set. According to the action mechanism of gene expression programming in fractal image compression encoding, it then quickly obtains the optimal solution of fractal image compression encoding by searching and encoding the sub-blocks of range block classification set and the classification set corresponding to the domain. Finally, in the CPU/GPU environment, it conducts the comparative experiment with basic fractal image compression algorithm and fractal image compression algorithm based on convolutional neural network. The experimental results show that this proposed algorithm outperforms similar algorithms in terms of image segmentation speed and accuracy as well as fractal compression encoding speed and compression ratio. Therefore, this algorithm is a fractal image compression algorithm with intelligent segmentation, fast encoding and high compression ratio.
Chemical Studies of Cremanthodium (Asteraceae) Species; Sesquiterpenoids and Related Compounds
Authors: Tori Motoo , Saito Yoshinori , Gong Xun , Kuroda Chiaki
Published: September 2019

Chemical constituents of Cremanthodium angustifolium, C. brunneopilosum, C. campanulatum, C. daochengense, C. discoideum, C. ellisii, C. helianthus, C. lineare, C. nobile, C. potaninii, C. principis, C. pulchrum, C. rhodocephalum, C. stenactinium, C. pleurocaule, and C. stenoglossum were reviewed. They produced mainly sesquiterpenoids–bicyclic and/or tricyclic eremophilanes, bisabolanes, bakkanes–and related compounds. Cremanthodium was shown to be close to Ligularia in chemical constituents.
Analysis of Mogrosides in Siraitia grosvenorii Fruits at Different Stages of Maturity
Authors: Wang Bin , Yang Zhou , Xin Zhenqiang , Ma Gil , Qian Yong , Xie Tianpei , Prakash Indra
Published: September 2019

Monk fruit extract has been approved as a natural sweetener by many countries. Its major sweet components, mogrosides, display different sweet intensities and profiles. Therefore, it is important to understand the change of mogroside contents in Siraitia grosvenorii at different maturity stages. In this study, monk fruit cultivars were collected from 4 locations in GuangXi, GuiZhou, and HuNan, at different times. Mogroside IIe, mogroside III, mogroside IIIe, mogroside IV, mogroside V, isomogroside V, and siamenoside I in each sample were quantified using high performance liquid chromatography coupled to triple quadrupole mass spectrometer (LC-MS-MS). As a result, mogroside IIe was the major component at the early maturity stage. It is converted to mogroside III from 15 to 45 days, then continued the glycosylation rapidly to yield mogroside V which kept predominant after 60 days. Highly glycosylated mogrosides, such as mogroside V and siamenoside I, which provide a better taste profile, accumulated and stabilized from 75 to 90 days. It is recommended to harvest the fruit after 75 days of pollination.
Hospital outcomes and cumulative burden from complications in type 2 diabetic sepsis patients: a cohort study using administrative and hospital-based databases
Authors: Hsieh Ming-Shun , Hu Sung-Yuan , How Chorng-Kuang , Seak Chen-June , Hsieh Vivian Chia-Rong , Lin Jin-Wei , Chen Pau-Chung
Published: September 2019

Background:

The association between type 2 diabetes and hospital outcomes of sepsis remains controversial when severity of diabetes is not taken into consideration. We examined this association using nationwide and hospital-based databases.

Methods:

The first part of this study was mainly conducted using a nationwide database, which included 1.6 million type 2 diabetic patients. The diabetic complication burden was evaluated using the adapted Diabetes Complications Severity Index score (aDCSI score). In the second part, we used laboratory data from a distinct hospital-based database to make comparisons using regression analyses.

Results:

The nationwide study included 19,719 type 2 diabetic sepsis patients and an equal number of nondiabetic sepsis patients. The diabetic sepsis patients had an increased odds ratio (OR) of 1.14 (95% confidence interval 1.1–1.19) for hospital mortality. The OR for mortality increased as the complication burden increased [aDCSI scores of 0, 1, 2, 3, 4, and ⩾5 with ORs of 0.91, 0.87, 1.14, 1.25, 1.56, and 1.77 for mortality, respectively (all p < 0.001)]. The hospital-based database included 1054 diabetic sepsis patients. Initial blood glucose levels did not differ significantly between the surviving and deceased diabetic sepsis patients: 273.9 ± 180.3 versus 266.1 ± 200.2 mg/dl ( p = 0.095). Moreover, the surviving diabetic sepsis patients did not have lower glycated hemoglobin (HbA1c; %) values than the deceased patients: 8.4 ± 2.6 versus 8.0 ± 2.5 ( p = 0.078).

Conclusions:

For type 2 diabetic sepsis patients, the diabetes-related complication burden was the major determinant of hospital mortality rather than diabetes per se, HbA1c level, or initial blood glucose level.
Treatment of pulmonary thromboembolism with edoxaban in a cancer patient with borderline fulfillment of the dose reduction criteria
Authors: Takama Takuro , Fukue Mitsunori , Kanaya Koji , Taniuchi Masato
Published: September 2019

Venous thromboembolism is the most common cause of death in cancer patients with venous thrombosis. Treatment of venous thrombosis is important in cancer patients, as it can have a major impact on prognosis. We report a case of advanced gastric cancer that was discovered owing to pulmonary thromboembolism and describe the treatment for both conditions. Dose reduction criteria of edoxaban are established. Appropriate dose was based on body weight and creatinine clearance; patients with creatinine clearance values slightly exceeding or below 50 are considered to be on the borderline of the dose reduction criteria. This case had borderline value (body weight: 63 kg, creatinine clearance: 46 mL/min). We observed no response after initiating treatment with 30 mg edoxaban; however, pulmonary thrombus disappeared after increasing the dose to 60 mg edoxaban. When selecting an anticoagulation drug in borderline patients with cancer-associated thrombosis, dose increase should be considered if hemorrhage risk is assessed.
The effectiveness of a social media intervention for reducing portion sizes in young adults and adolescents
Authors: Sharps Maxine A , Hetherington Marion M , Blundell-Birtill Pam , Rolls Barbara J , Evans Charlotte EL
Published: September 2019

Objective

Adolescents and young adults select larger portions of energy-dense food than recommended. The majority of young people have a social media profile, and peer influence on social media may moderate the size of portions selected.

Methods

Two pilot interventions examined whether exposure to images of peers’ portions of high-energy-dense (HED) snacks and sugar-sweetened beverages (SSBs) on social media (Instagram) would influence reported desired portions selected on a survey. Confederate peers posted ‘their’ portions of HED snacks and SSBs on Instagram. At baseline and intervention end participants completed surveys that assessed desired portion sizes.

Results

In intervention 1, undergraduate students ( n = 20, mean age=19.0 years, SD=0.65) participated in a two-week intervention in a within-subjects design. Participants reported smaller desired portions of HED snacks and SSBs following the intervention, and smaller desired portions of HED snacks for their peers. In intervention 2, adolescents ( n = 44, mean age = 14.4 years, SD = 1.06) participated in a four-week intervention ( n = 23) or control condition ( n = 21) in a between-subjects design. Intervention 2 did not influence adolescents to reduce their reported desired portion sizes of HED snacks or SSBs relative to control.

Conclusions

These preliminary studies demonstrated that social media is a feasible way to communicate with young people. However, while the intervention influenced young adults’ reported desired portions and social norms regarding their peers’ portions, no significant impact on desired reported portion sizes was found for HED snacks and SSBs in adolescents. Desired portion sizes of some foods and beverages may be resistant to change via a social media intervention in this age group.
Coal-Mine Canaries in Clinical Psychology: Getting Better at Identifying Early Signals of Treatment Nonresponse
Authors: Hong Natalie , Cornacchio Danielle , Pettit Jeremy W. , Comer Jonathan S.
Published: September 2019

Sequential, multiple-assignment, randomized trials (SMARTs) have emerged as a preferred design strategy with which to inform dynamic mental-health treatment decisions and adaptive interventions, yet their potential to improve patient outcomes is only as strong as the extent to which selected tailoring variables (i.e., interim response factors that dictate whether treatment shifts course) do indeed predict ultimate response. To date, tailoring variable selection has rarely drawn on adequately powered findings or conceptual links to interim target mechanisms underlying treatment response. Building on early work in this area, we detail a strategy that leverages randomized controlled trial data to simultaneously compare candidate tailoring variables at candidate decision points and their relationships with treatment response. Findings from such efforts can improve the conceptual clarity and efficiency of SMARTs, laying a foundation for modern clinical trials to ask, “Are treatment-related change mechanisms being affected and, if not, what is the most appropriate next treatment strategy?”
A 3-Year Review of an Outpatient Burn Sedation Program in a Tertiary Burn Care Centre: Is It Safe and Does It Work?
Authors: Chan Rayleigh , Van Slyke Aaron C. , Bucevska Marija , Verchere Cynthia
Published: September 2019

Introduction:

The burn treatment room at our tertiary-care centre is run by a multidisciplinary team, providing care to primarily burn patients who require moderate to deep sedation to undergo dressing changes in a monitored setting outside the operating room. There is little literature on the safety, efficacy, and logistics of treating outpatient pediatric burn patients in this manner. This study reviews the safety of deep sedation in the burn treatment room.

Methods:

A retrospective chart review of patients with burns treated in the burn treatment room from 2013 to 2015 was conducted. Patient demographics, diagnosis, procedure details, sedation, and adverse events were recorded. Data were analyzed descriptively.

Results:

Sevety-four patients with burns had a total of 308 visits in the burn treatment room for burn bath and/or dressing changes. Scald burns were the most common mechanism of injury (n = 56). Most burns were superficial and mid-dermal (54%), initially estimated at 5% to 10% TBSA (50%). Of the 308 visits, 304 required sedation. Adverse events were recorded in 11 (3.6%) of 304 sedated procedures. None of these events were critical: 7 patients required intravenous conversion due to inadequate oral sedation, 2 experienced brief apnea episodes but recovered spontaneously, and 2 had delayed discharge of more than 2 hours due to residual sedation.

Conclusion:

The burn treatment room is a safe and effective setting for treating pediatric burn patients, bypassing what might historically require operating suite inpatient management.
Distal Clavicle Fracture Repair: Clinical Outcomes of a Surgical Technique Utilizing a Combination of Cortical Button Fixation and Coracoclavicular Ligament Reconstruction
Authors: Yagnik Gautam P. , Jordan Charles J. , Narvel Raed R. , Hassan Robert J. , Porter David A.
Published: September 2019

Background:

When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described.

Purpose:

To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction.

Study Design:

Case series; Level of evidence, 4.

Methods:

We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores.

Results:

Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure.

Conclusion:

We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.
Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data
Authors: Song Yujie , Li Hongyun , Sun Chao , Zhang Jian , Gui Jianchao , Guo Qinwei , Song Weidong , Duan Xiaojun , Wang Xiaoqin , Wang Xuesong , Shi Zhongming ,   Chinese Society of Sports Medicine, Hua Yinghui , Tang Kanglai , Chen Shiyi
Published: September 2019

Background:

The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered.

Purpose:

To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI.

Study Design:

A consensus statement of the Chinese Society of Sports Medicine.

Methods:

A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized.

Results:

A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded.

Conclusion:

This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.
Adsorption of crystal violet dye by a zeolite-montmorillonite nano-adsorbent: modelling, kinetic and equilibrium studies
Authors: Sarabadan Malihe , Bashiri Hadis , Mousavi Seyed Mahdi
Published: September 2019

A zeolite-montmorillonite (zeolite-Mt) nano-adsorbent was prepared by calcination at 600°C. The synthesized nano-adsorbent was tested for removal of a toxic and cationic dye (crystal violet) from water, and it was characterized by various techniques. The effects of variables such as pH, temperature, adsorbent dosage and initial dye concentration on the removal efficiency of the dye were investigated by response surface methodology (RSM). Experimental conditions were optimized by RSM to achieve the maximum dye removal efficiency. Optimum conditions for maximum removal of dye were obtained at pH 9, temperature of 25°C, adsorbent dosage of 2 g L−1 and initial dye concentration of 40 mg L−1. Under these conditions, the maximum removal efficiency obtained was 99.9%. Various isotherms were applied to study adsorption equilibrium, and of these, the Freundlich isotherm provided the best fit. In addition, the fractal-like integrated kinetic Langmuir model was the most appropriate among several kinetic models. The thermodynamic parameters were also determined. The zeolite-Mt prepared under optimum conditions displayed a greater adsorption capacity than activated carbon (manufactured by Merck) and than various other adsorbents.
Evaluating the potential impact of bird predation on the SW Atlantic fiddler crab Leptuca uruguayensis
Authors: Ribeiro Pablo D. , Navarro Diego D. , Jaureguy Luciano M. , Daleo Pedro , Iribarne Oscar O.
Published: September 2019

The southernmost permanent population of the fiddler crab Leptuca uruguayensis occurs along the Samborombón Bay (36°22′S, 56°45′W, Argentina), an important feeding site for many bird species, including ruddy turnstones (Arenaria interpres), whimbrels (Numenius phaeopus), grey plovers (Pluvialis squatarola), american golden plovers (Pluvialis dominica) and gull-billed terns (Gelochelidon nilotica). Although all these birds are known to prey on many fiddler crab species worldwide, there is no estimation of their joint predation impacts, probably due to the difficulty in conducting experiments on an appropriate spatial scale. In these situations, computer simulation methods are useful tools. By using Monte Carlo methods and field data, we modeled the decrease of a fiddler crab population due to bird predation. The model found that under current bird occurrences and crab densities, birds do not consume more than 0.03% of the studied fiddler crab populations. Birds only consume more than 10% of the population if crab density is below 0.02 crabs m2, or if bird occurrences are at least 3 orders of magnitude higher than currently observed. Both situations are unlikely, as mean crab density is 140 crabs m2, and bird density is never so high. Furthermore, by monitoring three different fiddler crab patches, we found that bird predation cannot account for temporal density changes, suggesting that other population processes are more important than bird predation. In conclusion, even though fiddler crabs may exhibit strong predator-avoidance behavior, direct lethal effects of bird predation are currently small.