bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon
Authors: Liu Joseph N. , Gowd Anirudh K. , Garcia Grant H. , Manderle Brandon J. , Beletsky Alexander , Nicholson Gregory P. , Forsythe Brian , Romeo Anthony A. , Verma Nikhil N.
Published: July 2019

Background:

The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury.

Hypothesis:

A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score.

Study Design:

Case series; Level of evidence, 4.

Methods:

A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores.

Results:

Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores ( P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1–repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5–repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031).

Conclusion:

Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.
Concussion in American Versus European Professional Soccer: A Decade-Long Comparative Analysis of Incidence, Return to Play, Performance, and Longevity
Authors: Ramkumar Prem N. , Navarro Sergio M. , Haeberle Heather S. , Luu Bryan C. , Jang Albert , Frangiamore Salvatore J. , Farrow Lutul D. , Schickendantz Mark S. , Williams Riley J.
Published: July 2019

Background:

The incidence and effect of sports-related concussions (SRCs) within the global sport of professional soccer is poorly described.

Purpose:

To comparatively examine the effects of SRC on athletes in Major League Soccer (MLS) and the English Premier League (EPL) in terms of incidence, return to play (RTP), performance, and career longevity.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Contracts, transactions, injury reports, and performance statistics from 2008 to 2017 were obtained and cross-referenced across 6 publicly available websites detailing MLS and EPL data, including official league publications. For each league, players who sustained a concussion were compared with the 2008-2017 uninjured player pool. RTP and games missed were analyzed and compared. Career length was analyzed with Kaplan-Meier survival curves. Player performance changes were evaluated before and after concussion.

Results:

Of the 1784 eligible MLS and 2001 eligible EPL players evaluated over the 10-year period, the incidence of publicly reported concussions per 1000 athlete-exposures was 20.22 and 18.68, respectively ( P = .53). The incidence of reported concussions steadily increased in both leagues. MLS players missed a mean 7.3 games after concussion (37.0 days missed); EPL players missed a mean 0.6 games after concussion (10.9 days missed) ( P < .0001, P < .0001). Statistical performance in terms of games started, assists, shots on goal, and total shots after concussion was significantly reduced at all nongoalie positions for players in the EPL; however, MLS nongoalie positions with concussion had no significant decreases in these categories. Goalies in both leagues had no significant change in performance or games started. The probability of playing a full season after concussion was not significantly decreased when compared with the uninjured pool in both leagues.

Conclusion:

This study established the SRC incidence among elite soccer players in 2 international professional leagues and identified major RTP and performance differences between EPL and MLS players. While career longevity was unaffected, the approach to managing concussion as in MLS may better promote player safety and preserve on-field performance.
Tidal peritoneal dialysis versus ultrafiltration in type 1 cardiorenal syndrome: A prospective randomized study
Authors: Al-Hwiesh Abdullah K , Abdul-Rahman Ibrahiem Saeed , Al-Audah Nadia , Al-Hwiesh Amani , Al-Harbi Mousa , Taha Abdulrahman , Al-Shahri Abdulla , Ghazal Sami , Amir Rawan , Al-Audah Nehad , Mansour Hany , El-Mansouri Mohammad , El-Salamony Tamer S , Nasr El-Din Mohammed A , Noor Abdulsalam , Al-Elq Zainab , Alzahir Zainab H , Alzawad Noor A
Published: July 2019

Background:

Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of peritoneal dialysis in patients with acute decompensated heart failure complicated by acute cardiorenal syndrome.

Methods:

We randomly assigned a total of 88 patients with type 1 acute cardiorenal syndrome to a strategy of ultrafiltration therapy (44 patients) or tidal peritoneal dialysis (44 patients). The primary endpoint was the change from baseline in the serum creatinine level and left ventricular function represented as ejection fraction, as assessed 72 and 120 h after random assignment. Patients were followed for 90 days after discharge from the hospital.

Results:

Ultrafiltration therapy was inferior to tidal peritoneal dialysis therapy with respect to the primary endpoint of the change in the serum creatinine levels at 72 and 120 h ( p = 0.041) and ejection fraction at 72 and 120 h after enrollment ( p = 0.044 and p = 0.032), owing to both an increase in the creatinine level in the ultrafiltration therapy group and a decrease in its level in the tidal peritoneal dialysis group. At 120 h, the mean change in the creatinine level was 1.4 ± 0.5 mg/dL in the ultrafiltration therapy group, as compared with 2.4 ± 1.3 mg/dL in the tidal peritoneal dialysis group ( p = 0.023). At 72 and 120 h, there was a significant difference in weight loss between patients in the ultrafiltration therapy group and those in the tidal peritoneal dialysis group ( p = 0.025). Net fluid loss was also greater in tidal peritoneal dialysis patients ( p = 0.018). Adverse events were more observed in the ultrafiltration therapy group ( p = 0.007). At 90 days post-discharge, tidal peritoneal dialysis patients had fewer rehospitalization for heart failure (14.3% vs 32.5%, p = 0.022).

Conclusion:

Tidal peritoneal dialysis is a safe and effective means for removing toxins and large quantities of excess fluid from patients with intractable heart failure. In patients with cardiorenal syndrome type 1, the use of tidal peritoneal dialysis was superior to ultrafiltration therapy for the preservation of renal function, improvement of cardiac function, and net fluid loss. Ultrafiltration therapy was associated with a higher rate of adverse events.
Hispanic Millennial Ideology: Surprisingly, No Liberal “Monolith” Among College Students
Authors: Greene William , Kim Mi-son
Published: July 2019

The goal of this study is to analyze the ideological positions of Hispanic college students in the U.S. Rio Grande Valley (RGV). Building on Feldman and Johnston’s work, where they argue that a unidimensional model of political ideology provides an incomplete basis for study, we employ two dimensions to account for domestic policy preference. The core of the study is a taxonomic analysis of a survey of RGV college students taking government courses, where we find that the political beliefs of Hispanic millennials trend significantly more conservative and, especially, libertarian than expected. Possible implications for the future include a realignment of Hispanics with the Republican Party, a shift in a more libertarian direction within the Democratic Party itself, or an increase in younger Hispanics’ proclivity for independence from the two major parties. Our findings conform to Feldman and Johnston’s argument that the economic and social dimensions of political ideology are separate and distinct, making it essential that researchers analyze both dimensions in order to have an accurate and comprehensive understanding of individuals’ political ideology. In addition, using recent American National Election Studies (ANES) data sets, we compare how our samples are different from the general U.S. population, employing a principal component analysis (PCA).
Hybrid metal/thermoplastic composites for FDM-type additive manufacturing
Authors: Chávez Francisco Andrade , Quiñonez Paulina A , Roberson David A
Published: July 2019

Hybrid material systems, where two materials with similar melting temperatures are combined to form a new compound, represent a possible avenue to expand the materials palette available for 3-D printing platforms such as fused deposition modeling (FDM™). In general, the morphology of filler materials in thermoplastic composites is unchanged before and after combining with a polymer matrix. However, the processing of hybrid material systems in FDM™-type processing allows for the possibility of manipulating the morphology of the filler material. The work presented here demonstrates the development of three different hybrid (polymer–metal) blends for 3-D printing platforms based on FDM™ technology. Tin-bismuth (SnBi) alloy powder was combined with three thermoplastic materials: (1) acrylonitrile butadiene styrene (ABS), (2) polylactic acid, and (3) a polymer blend composed of ABS and styrene ethylene butylene styrene containing a maleic anhydride graft (SEBS-g-MA). A notable feature observed through the use of scanning electron microscopy (SEM) was the drawing of the spherical SnBi particles into wires, leading to an in situ reinforcement. The efficacy of a silane functionalization process was also noted, though the material processing temperatures were well above the melting temperature of the SnBi particles.
Investigations on 3D printed thermosetting and ceramic-reinforced recycled thermoplastic-based functional prototypes
Authors: Singh Rupinder , Kumar Ranvijay , Singh Inderpreet
Published: July 2019

The 3D printing of thermoplastic polymers (both virgin and reinforced with metal/ceramic particles) has been widely explored in recent past with fused deposition modelling (FDM) process. But hitherto very little has been reported on 3D printing of thermoplastics polymers with reinforcement of thermosetting polymers and ceramic particles. This article is an extension of work reported on thermo-mechanical investigations on waste thermosetting polymer bakelite and ceramic (silicon carbide and aluminium oxide) as reinforcement in recycled acrylonitrile butadiene styrene (ABS) thermoplastic matrix for sustainability. The study reports the experimental investigations on mechanical (tensile), morphological, surface hardness and thermal stability analysis of 3D printed functional prototype as tensile specimen (as per ASTM D 638). In the present case study, it has been ascertained that composition/proportion of thermoplastic matrix has a significant role in controlling the mechanical properties, whereas other input process parameters of FDM are insignificant. The results of the study suggest that thermosetting and ceramic-reinforced ABS thermoplastic-based 3D printed parts have mechanical properties at par with unreinforced ABS.
Survival forests under test: Impact of the proportional hazards assumption on prognostic and predictive forests for amyotrophic lateral sclerosis survival
Authors: Korepanova Natalia , Seibold Heidi , Steffen Verena , Hothorn Torsten
Published: July 2019

We investigate the effect of the proportional hazards assumption on prognostic and predictive models of the survival time of patients suffering from amyotrophic lateral sclerosis. We theoretically compare the underlying model formulations of several variants of survival forests and implementations thereof, including random forests for survival, conditional inference forests, Ranger, and survival forests with L1 splitting, with two novel variants, namely distributional and transformation survival forests. Theoretical considerations explain the low power of log-rank-based splitting in detecting patterns in non-proportional hazards situations in survival trees and corresponding forests. This limitation can potentially be overcome by the alternative split procedures suggested herein. We empirically investigated this effect using simulation experiments and a re-analysis of the Pooled Resource Open-Access ALS Clinical Trials database of amyotrophic lateral sclerosis survival, giving special emphasis to both prognostic and predictive models.
New Approach meets new economy: Enforcing EU product safety in e-commerce
Authors: Ullrich Carsten
Published: July 2019

This article reviews recent regulatory initiatives in the area of EU product safety legislation and market surveillance from the angle of e-commerce through online marketplaces. With the arrival of the internet, the sale of non-compliant and illegal consumer products has proliferated. E-commerce and globalized supply chains are challenging a regulatory system that is fragmented, highly technical and slow to respond to the dynamic changes introduced to the marketplace. The EU Commission’s 2017 notice on the surveillance of products sold online and its latest proposal for a new regulation on enforcing product compliance rules testify to the unsatisfactory state of progress in this area. A reason for this may be seen in the history and nature of New Approach style product law, which outsources technical product regulation to the industry and entrusts enforcement tightly in the hands of specialized national regulators. New actors in the supply chain, such as fulfilment service providers or e-commerce platforms, have fallen between the cracks. This article argues that extending the principles of the New Approach to e-commerce marketplaces, by seeing their activities as affecting essential requirements, could be of interest to both the problems at hand and the wider debate on online platforms regulation.
The Role of Integration in Understanding Differences in Satisfaction Among Chinese, Indian, and South Korean International Students
Authors: Merola Rachael H. , Coelen Robert J. , Hofman W. H. A.
Published: July 2019

This study uses a quantitative approach drawing on data from the International Student Barometer ( N = 5,242) to investigate the relationship between integration, nationality, and self-reported satisfaction among Chinese, Indian, and South Korean undergraduate international students studying in the United Kingdom, the United States, and Australia. Results indicate that nationalities vary significantly in satisfaction levels, with Indian students more satisfied than Chinese or South Korean students. Furthermore, integration is predictive of satisfaction, and academic integration has a greater impact on satisfaction than does social integration. Compellingly, academic and social integration help explain the association between nationality and satisfaction. This study demonstrates that academic and social integration partly accounts for differences in satisfaction among nationalities, opening avenues for future research with practical implications for universities.
Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not Associated With Increased Bleeding Risk
Authors: Olson Logan M. , Nei Andrea M. , Dierkhising Ross A. , Joyce David L. , Nei Scott D.
Published: July 2019

Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.
What Is the Optimal Protocol for Performing Debridement, Antibiotics and Implant Retention (DAIR) in an Infected Total Ankle Arthroplasty (TAA) (Type and Volume of Irrigation Solution, and so on)?
Authors: Uçkay Ilker , Pedowitz David , Assal Mathieu , Stull Justin D.
Published: July 2019

Recommendation:

Debridement, antibiotics, and implant retention (DAIR) in acute total ankle arthroplasty (TAA) infections may be an acceptable treatment option. If performed, DAIR should be done meticulously, ensuring that all necrotic or infected tissues are removed and modular parts of the prosthesis, if any, exchanged. The infected joint should also be irrigated with antiseptic solutions.

Level of Evidence:

Consensus.

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Effectiveness of Community Intervention Program on Knowledge and Practice of HPV Prevention Among Married Females in Vietnam Rural Areas
Authors: Le Anh Thi-Kim , Tran Van Thi , Dinh Hoa Thi-Phuong , Dau Canh Xuan , Pham Binh Quoc , Nguyen Hau Thi , Nguyen Huong Thanh
Published: July 2019

Human papillomavirus (HPV) is identified as the leading cause of cervical cancer which is the second most common cancer of females in the world. This study aimed to evaluate the effects of a community-based intervention on knowledge and practice of HPV prevention among married females aged 15 to 49 in rural areas, Vietnam. This study used a quasi-experimental design with serial cross-sectional surveys at one intervention commune (Chi Linh, Hai Duong) and one control commune at other province (Thanh Thuy, Phu Tho). Number of participants in these surveys were respectively 317 and 320 in Chi Linh and 334 and 335 in Thanh Thuy at pre- and postintervention period. The time of intervention was 15 months from April 2015 to June 2016. The study used behavior models to build up a logical framework for identifying related factors of knowledge and practice among females and developing intervention strategies. A difference-in-differences analysis approach was used to evaluate the effects of this intervention program. The study identified that the intervention had a significant change of knowledge of HPV prevention among married females after the intervention (odds ratio = 3.16, 95% confidence interval: 1.3-7.66) after adjusting for other confounders but no any significant change of practice of HPV prevention (eg, condom use, numbers of sexual partner, HPV vaccination, and screening test for cervical cancer). This might be caused by a short intervention program that did not lead to changes of practice but only change of knowledge.
Imatinib Mesylate for Patients With Unresectable or Recurrent Gastrointestinal Stromal Tumors: 10-Year Experience From Vietnam
Authors: Hung Kien Do , Van Quang Le , Hoang Gia Nguyen , Bich Phuong Nguyen Thi
Published: July 2019

Only limited data are available concerning the long-term outcomes of imatinib treatment among Vietnamese or Asian patients with unresectable or recurrent gastrointestinal stromal tumors (GISTs). Our study, which was conducted in 188 patients, aimed to assess the efficacy of imatinib mesylate against unresectable or recurrent GISTs. Imatinib had a high response rate and long survival. Some predictors favorable for progression-free survival and overall survival are good performance status and response with imatinib. Findings are discussed in relation to clinical practice in low- and middle-income country.
Hybrid simulation of a structure to tsunami loading
Authors: Forouzan Bahareh , Baragamage Dilshan SP Amarsinghe , Shaloudegi Koushyar , Nakata Narutoshi , Wu Weiming
Published: July 2019

A new hybrid simulation technique has been developed to assess the behavior of a structure under hydrodynamic loading. It integrates the computational fluid dynamics and structural hybrid simulation and couples the fluid loading and structural response at each simulation step. The conventional displacement-based and recently developed force-based hybrid simulation approaches are adopted in the structural analysis. The concept, procedure, and required components of the proposed hybrid simulation are introduced in this article. The proposed hybrid simulation has been numerically and physically tested in case of a coastal building impacted by a tsunami wave. It is demonstrated that the force error in the displacement-based approach is significantly larger than that in the force-based approach. The force-based approach allows for a more realistic and reliable structural assessment under tsunami loading.
Patients participating as co-researchers in health research: A systematic review of outcomes and experiences
Authors: Malterud Kirsti , Elvbakken Kari Tove
Published: July 2019

Aims: We aimed to map out the scope and type of health research studies with patients involved as co-researchers throughout the research process and to explore the outcomes and experiences of such research. Methods: We conducted a narrative review by systematically searching selected databases. A total of 1451 hits were identified and screened, and 17 studies were included and categorised by type of health problem, design, publication sources and modes of presentation. We conducted an inductive, iterative analysis of outcomes and experiences of patient involvement. Results: We identified two types of impact from studies with patients participating as co-researchers: (a) patient involvement as primary focus, where seven articles largely reported and reflected upon the shared experiences, and (b) patient involvement as strategy, where 10 articles presented results from empirical studies of specific health problems, with patient involvement used as a strategy to expand understanding. The first group of studies reported collaborative processes and resource investments, while the second group addressed specific health problems from a distinctive perspective due to patient involvement. Several studies in both groups repeated or confirmed positive values of user involvement rather than providing original findings. In both groups, methodological standards were often downgraded to provide access for the co-researchers. Conclusions: These articles, where the co-researcher model represents the contemporary superior level of patient involvement, may indicate that mere collaboration efforts are prioritised at the expense of knowledge outcomes and scientific quality. Collaboration formats other than participation as co-researchers may be necessary for patient involvement in medical research to add to the existing knowledge.
Refugee artists and memories of displacement: a visual semiotics analysis
Authors: Catalani Anna
Published: July 2019

This article considers the ways in which displaced artists represent the experience of displacement, their cultural traditions and the longing for home through paintings and how, by doing so, they become the visual interpreters of the current refugee crisis. The starting point of this article is that little attention has been paid towards the visual narratives of artworks produced by refugee artists and shared on online open platforms like, for example, Facebook. Through the visual semiotics analysis of 150 images of paintings (exhibited on the Facebook page Syria.Art) and through a number of individual interviews with the artists who produced such artworks, the article identifies three emerging visual narratives. These are concerned primarily with reminiscences about people, places and cultural practices lost (or in danger of being lost) because of forced journeys and displacement. Within this context, these visual discourses become part of an open repository, which mediates, re-organizes and preserves memories, both personal and collective, as a form of emotional survival and resilience. It is argued that these visual narratives and representations nurture empathy for the human condition of the refugees and universalize the migrant experience.
Perforator Flap Reconstruction for the Distal Third of Lower Extremity Defects: Clinical Application and Guideline Recommendation
Authors: Burusapat Chairat
Published: July 2019

A distal third of lower extremity defect is challenging for plastic surgeons. The standard for treatment is microsurgery. Recently, perforator flap has been reported for small to medium defects. The objective was to analyze the outcomes of perforator flaps for distal third of lower extremity defects and to establish surgical guidelines. A retrospective review of patients with defects in distal third of lower extremities was conducted. Patients with multiple levels of lower extremity defects were excluded. A total of 8 patients with distal third of lower extremity defects were included. Seven patients were male. Overall mean age was 35.3 (18-60) years. Patients had 3 anterior, 3 lateral, and 2 medial defects. Lateral and anterior defects in 6 patients were closed using a peroneal-based propeller perforator flap with an angle of rotation of 90° to 160°. Medial defects in 2 patients were closed using a posterior tibial-based perforator advancement flap. Three patients (37.5%) developed venous congestion. No complications occurred for patients with medial defect closure using an advancement posterior tibial-based perforator flap. No total flap loss was observed. The perforator flap provides a similar texture to the skin at recipient area and a wide range of rotation. Perforator flaps should be the first choice for defects reconstruction in distal third lower extremities. Perforator flaps can be used for small to large defects, and can be moved by propeller or advancement depending on the perforator location. A guideline for perforator flaps reconstruction of the distal third of lower extremity defects was established.
Effective Salvage Surgery of a Severely Congested Propeller Perforator Flap Using a Postoperative Delay Technique and Negative-Pressure Wound Therapy
Authors: Ishii Naohiro , Kiuchi Tomoki , Uno Takahiro , Uoya Yuichiro , Kishi Kazuo
Published: July 2019

Wound edge–based propeller perforator flaps have often been applied to soft tissue reconstruction of sacral pressure sores. Although this flap often causes necrosis due to overtension and twisting of the perforators, salvage surgery using a postoperative delay technique has not been reported thus far. In this article, we present a case in which we successfully reconstructed a sacral pressure sore using a wound edge–based propeller perforator flap. The flap caused severe congestion, which had a concern due to the potential wide-ranging flap loss; it was subsequently salvaged by an emergent delay procedure and negative-pressure wound therapy on day 2 postoperatively.
Neural Correlates of Passive Position Finger Sense After Stroke
Authors: Ingemanson Morgan L. , Rowe Justin R. , Chan Vicky , Riley Jeff , Wolbrecht Eric T. , Reinkensmeyer David J. , Cramer Steven C.
Published: July 2019

Background. Proprioception of fingers is essential for motor control. Reduced proprioception is common after stroke and is associated with longer hospitalization and reduced quality of life. Neural correlates of proprioception deficits after stroke remain incompletely understood, partly because of weaknesses of clinical proprioception assessments. Objective. To examine the neural basis of finger proprioception deficits after stroke. We hypothesized that a model incorporating both neural injury and neural function of the somatosensory system is necessary for delineating proprioception deficits poststroke. Methods. Finger proprioception was measured using a robot in 27 individuals with chronic unilateral stroke; measures of neural injury (damage to gray and white matter, including corticospinal and thalamocortical sensory tracts), neural function (activation of and connectivity of cortical sensorimotor areas), and clinical status (demographics and behavioral measures) were also assessed. Results. Impairment in finger proprioception was present contralesionally in 67% and bilaterally in 56%. Robotic measures of proprioception deficits were more sensitive than standard scales and were specific to proprioception. Multivariable modeling found that contralesional proprioception deficits were best explained ( r2 = 0.63; P = .0006) by a combination of neural function (connectivity between ipsilesional secondary somatosensory cortex and ipsilesional primary motor cortex) and neural injury (total sensory system injury). Conclusions. Impairment of finger proprioception occurs frequently after stroke and is best measured using a quantitative device such as a robot. A model containing a measure of neural function plus a measure of neural injury best explained proprioception performance. These measurements might be useful in the development of novel neurorehabilitation therapies.
Path and policy analyses: a sustainability study of military workforce supply chains
Authors: Wang Jun
Published: July 2019

This article presents two case studies using system dynamics to analyze the sustainability of military workforce supply chains. The first case is about multi-period force expansion. An analytical expression is presented to relate the expansion target, training capacity, and expansion period. The system dynamics model forecasts the personnel level achievable against the expansion target for varying input of training capacities. This can be used to inform military force planners about the required training capacity and timeframe to achieve the expansion. The second case examines the sustainability of the deployment of a volunteer-based Army reserve unit. The soldiers’ behavior changes due to their deployment experiences (in terms of willingness to deploy) are modeled and their impact on personnel availability is simulated. The second system dynamics model predicts the personnel level sustainability against the required number of soldiers to deploy. It provides insights regarding the required size of the pool of soldiers to support a deployed Army reserve unit, and promotes policy exploration to boost soldiers’ willingness to deploy. In conclusion, this work demonstrates the applicability of system dynamics to assist decision makers in “raising, training, and sustaining” military workforce supply chains.
Structural model and dynamic analysis of six-axis Cartesian coordinate robot for sheet metal bending
Authors: Xu Fengyu , Jiang Quansheng , Rong Lina , Zhou Pengfei , Hu Jinlong
Published: July 2019

Bending is an important procedure for processing sheet metals, while it is a key link in the realization of automatic processing of sheet metal. To improve the efficiency and accuracy of bending processing, this article proposed a structure model and a prototype of a six-axis Cartesian coordinate robot for sheet metal bending to replace workers completing automatic bending processes. Based on the analysis of overall structure schemes of the robot, kinematic simulation is conducted by using the automatic dynamic analysis of mechanical system (ADAMS). Furthermore, the dynamic performance of the structural model of the robot for sheet metal bending is analysed and design optimization is performed. A prototype of the robot based on the optimal structural model of six-axis Cartesian coordinate robot for sheet metal bending is made. Finally, under the work conditions, the efficiencies and accuracies of sheet metal bending by a worker and the robot are compared and tested. The structural model of six-axis Cartesian coordinate robot for sheet metal bending presented in this article is found to be applicable to sheet metal bending robot and improves the stability of sheet metal bending machine. The laboratory testing and experimental results verified the feasibility of the proposed robot.
Improvement of localization with artificial landmark for mobile manipulator
Authors: Guo Shuai , Yan Zhong-Xiang , Song Tao , Xu Zhen , Zeng Ling-Dong
Published: July 2019

A method is presented for improving the localization accuracy of a mobile manipulator. The system consists of an industrial manipulator mounted on a mobile platform to perform fuselage drilling/riveting tasks in indoor environment. The localization is based on dual laser range finders mounted on the system and a number of artificial landmarks preset in the environment. Localization based on trilateration method is presented in this study. The adaptive unscented Kalman filter method is used to improve the accuracy of localization as well. The proposed method has been verified through experiments and the localization accuracy of mobile manipulator can be improved to 8 mm in most cases.
The synthesis and preliminary cytotoxicity evaluation of hexahydrodispiro[indole-3,3′-indolizine-2′,3″-piperidine]-2(1H),4″-dione compounds
Authors: Tao Hongwen , Ling Yulin , Wang Xia , Chen Jian , Yu Xianyong , Yi Pinggui
Published: July 2019

Seven hexahydrodispiro[indole-3,3′-indolizine-2′,3″-piperidine]-2(1 H),4″-dione compounds were synthesized by a catalyst-free 1,3-dipolar cycloaddition reaction in a one-pot three-component system containing 3,5-diarylidene-1-benzylpiperidin-4-one, isatin and l-pipecolic acid. The structures of these compounds were characterized by nuclear magnetic resonance, high-resolution mass spectrometry and X-ray data analysis. These chemical entities were evaluated for their cytotoxicity (brine shrimp assay), and five compounds were found potential in this bioassay. Compound 2e was the most prominent target against Artemia salina with an LC50 value of 7.27 μg/mL.
Synthesis and biological evaluation of novel 6-alkoxy-3-aryl-[1,2,4]triazolo[4,3-b][1,2,4,5] tetrazines
Authors: Shi Run-Jie , Yang Zhen-Zhen , Gao Ye-Tao , Cai Wen-Jin , Ye Can , Xu Feng , Wang John
Published: July 2019

A series of 6-alkoxy-3-aryl-[1,2,4]triazolo[4,3- b][1,2,4,5] tetrazine derivatives is synthesized and evaluated for their antitumor activities. These compounds exhibit potent antiproliferative activities against A549, Bewo, and MCF-7 cells. Molecular docking is performed to study the inhibitor–c-Met kinase interactions, and the results show that 6-ethoxyl-3-phenylethyl-[1,2,4]triazolo[4,3- b][1,2,4,5] tetrazine is potently bound to c-Met kinase with two hydrogen bonds and one π–π interaction. Based on these preliminary results, it is thought that compound 6-ethoxyl-3-phenylethyl-[1,2,4]triazolo[4,3- b][1,2,4,5] tetrazine with potent inhibitory activity may be a potential anticancer agent.
Towards a postmodern national narrative? The Algerian war memorial and contemporary French landscapes of memory
Authors: Brazzoduro Andrea
Published: July 2019

Based on the analysis of files from the Department of Defence, and drawing on interviews with veterans and on their associations’ press, the article focuses on the Algerian War National Memorial in Paris, its long gestation and particularly its double, paradoxical status: that it is at the same time new and old, post-ideological and hyper-ideological. Thanks to its palimpsest configuration, this ‘third millennium memorial’ – as it was described by its creator (the artist Gérard Collin-Thiébaut) – has demonstrated itself to be perfectly tuned to that peculiar mode of relationship to the past that we can define as ‘postmodern’, a mode that is characteristic of what historian François Hartog called the presentist ‘regime of historicity’.
Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis
Authors: Hayashi Keigo , Ohashi Keiji , Watanabe Haruki , Sada Ken-Ei , Shidahara Kenta , Asano Yosuke , Asano Sumie Hiramatsu , Yamamura Yuriko , Miyawaki Yoshia , Morishita Michiko , Matsumoto Yoshinori , Kawabata Tomoko , Wada Jun
Published: July 2019

Background:

This study aimed to identify the clinical subgroups of polymyalgia rheumatica (PMR) using cluster analysis and compare the outcomes among the identified subgroups.

Methods:

We enrolled patients with PMR who were diagnosed at Okayama University Hospital, Japan between 2006 and 2017, met the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria for PMR, and were treated with glucocorticoids. Hierarchical cluster analysis using variables selected by principal component analysis was performed to identify the clusters. Subsequently, the outcomes among the identified clusters were compared in the study. The primary outcome was treatment response at 1 month after commencement of treatment. The secondary outcome was refractory clinical course, which was defined as the requirement of additional treatments or relapse during a 2-year observational period.

Results:

A total of 61 consecutive patients with PMR were enrolled in the study. Their mean age was 71 years, and 67% were female. Hierarchical cluster analysis revealed three distinct subgroups: cluster 1 ( n = 14) was characterized by patients with thrombocytosis (all patients showed a platelet count of >45 × 10⁴/µl), cluster 2 ( n = 38), by patients without peripheral arthritis, and cluster 3 ( n = 9), by patients with peripheral arthritis. The patients in cluster 1 achieved treatment response less frequently than those in cluster 2 (14% versus 47%, p = 0.030). Refractory cases were more frequent in cluster 1 than in cluster 2; however, no significant difference was noted (71% versus 42%, p = 0.06).

Conclusions:

Thrombocytosis could predict the clinical course in patients with PMR.
Adultization and blurring the boundaries of childhood in the late modern era
Authors: Firinci Orman Turkan
Published: July 2019

Although the modern Western concept of childhood is rapidly disappearing in the age of late modernity, this study asserts that childhood (as it is lived) has not disappeared but has been transformed. An integrated approach to childhood is employed in order to go beyond binary oppositions such as the Global North versus the Global South and/or childhood versus childhoods. It is argued that children while constructing their childhoods are confronted with processes of individualisation and globalisation through which new forms of adultization have emerged as concepts of ‘child consumerism’ and ‘child citizenship’. Beyond the opposing views involving the disappearance of childhood or its liberation, this study concludes that the concept of adultization can be used to problematise and analyse childhood in its current state.
Rates of hospitalization associated with the use of aldosterone receptor antagonists in patients with pulmonary arterial hypertension
Authors: Corkish Morgan E. , Devine Lauren T. , Clarke Megan M. , Murray Brian P. , Rose‐Jones Lisa J.
Published: July 2019

We show that spironolactone use was associated with an increased rate of all‐cause hospitalizations, but no difference in hospitalizations for heart failure or pulmonary arterial hypertension, in patients with World Health Organization Group 1 pulmonary arterial hypertension. A possible reason for this finding is confounding from retrospective study design.
A Case of Methotrexate Neurotoxicity Presented as Status Epilepticus, Encephalopathy, and High Fever
Authors: Ayalon Itay , Friedman Shirley , Binenbaum Yoav , Oppenheimer Noga , Shiran Shelly , Grisaru-Soen Galia , Uliel-Sibony Shimrit , Glatstein Miguel , Kaplan Jennifer Melissa , Sadot Efraim
Published: July 2019

High-dose methotrexate is used to treat a range of adult and childhood cancers including osteosarcoma. Significant neurotoxicity is reported in 1% to 4.5% of patients treated with high-dose methotrexate and can present in a wide variety of symptoms. We present a case of a 14-year-old boy with a recent diagnosis of osteosarcoma who presented to the emergency department with status epilepticus, altered mental status, and very high fever secondary to methotrexate neurotoxicity. We review current literature and discuss some controversies related to this state. We also describe high fever as one of the possible symptoms associated with this condition and suggest using specific magnetic resonance imaging sequence to uncover abnormal findings related to this state. Since high-dose methotrexate is not a rare treatment in this era, we believe that in addition to oncologists, emergency department and intensive care providers should be aware of the potential role of methotrexate in causing significant neurotoxicity and include it in the differential diagnosis when treating a patient presenting with new neurological symptoms in the setting of recent high-dose methotrexate treatment.
Regional lung function in nonsmokers and asymptomatic current and former smokers
Authors: Vogt Barbara , Deuß Kathinka , Hennig Victoria , Zhao Zhanqi , Lautenschläger Ingmar , Weiler Norbert , Frerichs Inéz
Published: July 2019

Electrical impedance tomography (EIT) is able to detect rapid lung volume changes during breathing. The aim of our observational study was to characterise the heterogeneity of regional ventilation distribution in lung-healthy adults by EIT and to detect the possible impact of tobacco consumption.

A total of 219 nonsmokers, asymptomatic ex-smokers and current smokers were examined during forced full expiration using EIT. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were determined in 836 EIT image pixels for the analysis of spatial and temporal ventilation distribution. Coefficients of variation (CVs) of these pixel values were calculated. Histograms and medians of FEV1/FVCEITand times required to exhale 50%, 75%, 90% of FVCEIT(t50, t75and t90) were generated.

CV of FEV1/FVCEITdistinguished among all groups (mean±sd: nonsmokers 0.43±0.05, ex-smokers 0.52±0.09, smokers 0.62±0.16). Histograms of FEV1/FVCEITdifferentiated between nonsmokers and the other groups (p<0.0001). Medians of t50, t75and t90showed the lowest values in nonsmokers. Median t90separated all groups (median (interquartile range): nonsmokers 0.82 (0.67–1.15), ex-smokers 1.41 (1.03–2.21), smokers 1.91 (1.33–3.53)).

EIT detects regional ventilation heterogeneity during forced expiration in healthy nonsmokers and its increase in asymptomatic former and current smokers. Therefore, EIT-derived reference values should only be collected from nonsmoking lung-healthy adults.
Implementation of and Early Outcomes From Anal Cancer Screening at a Community-Engaged Health Care Facility Providing Care to Nigerian Men Who Have Sex With Men
Authors: Nowak Rebecca G. , Ndembi Nicaise , Dauda Wuese , Jibrin Paul , Bentzen Søren M. , Nnaji Chinedu H. , Olaomi Oluwole , Darragh Teresa M. , Madukwe Jonathan , Crowell Trevor A. , Baral Stefan D. , Blattner William A. , Charurat Manhattan E. , Palefsky Joel M. , Cullen Kevin J. ,   on behalf of the TRUST/RV368 Study Group
Published: July 2019

PURPOSE

Anal cancer risk is substantially higher among HIV-infected men who have sex with men (MSM) as compared with other reproductive-age adults, but screening is rare across sub-Saharan Africa. We report the use of high-resolution anoscopy (HRA) as a first-line screening tool and the resulting early outcomes among MSM in Abuja, Nigeria.

METHODS

From August 2016 to August 2017, 424 MSM enrolled in an anal cancer screening substudy of TRUST/RV368, a combined HIV prevention and treatment cohort. HRA-directed biopsies were diagnosed by histology, and ablative treatment was offered for high-grade squamous intraepithelial lesions (HSIL). HRA proficiency was assessed by evaluating the detection of squamous intraepithelial lesions (SIL) over time and the proportion biopsied. Prevalence estimates of low-grade squamous intraepithelial lesions and HSIL with 95% CIs were calculated. Multinomial logistic regression was used to identify those at the highest risk of SIL.

RESULTS

Median age was 25 years (interquartile range [IQR], 22-29), median time since sexual debut was 8 years (IQR, 4-12), and 59% (95% CI, 54.2% to 63.6%) were HIV infected. Rate of detection of any SIL stabilized after 200 screenings, and less than 20% had two or more biopsies. Preliminary prevalence estimates of low-grade squamous intraepithelial lesions and HSIL were 50.0% (95% CI, 44.7% to 55.3%) and 6.3% (95% CI, 4.0% to 9.3%). HIV infection, at least 8 years since anal coital debut, concurrency, and external warts were independently statistically associated with SIL.

CONCLUSION

Proficiency with HRA increased with experience over time. However, HSIL detection rates were low, potentially affected by obstructed views from internal warts and low biopsy rates, highlighting the need for ongoing evaluation and mentoring to validate this finding. HRA is a feasible first-line screening tool at an MSM-friendly health care facility. Years since anal coital debut and external warts could prioritize screening.
Inhalation of marijuana affects Drosophila heart function
Authors: Gómez I. M. , Rodríguez M. A. , Santalla M. , Kassis G. , Colman Lerner J. E. , Aranda J. O. , Sedán D. , Andrinolo D. , Valverde C. A. , Ferrero P.
Published: July 2019

We investigated the effect of inhalation of vaporized marijuana on cardiac function in Drosophila melanogaster, a suitable genetic model for studying human diseases. Adult flies were exposed to marijuana for variable time periods and the effects on cardiac function were studied. Short treatment protocol incremented heart rate variability. Contractility was augmented only under prolonged exposure to cannabis and it was associated to incremented calcium transient within cardiomyocytes. Neither the activity of the major proteins responsible for calcium handling nor the calcium load of the sarcoplasmic reticulum were affected by the cannabis treatment. The observed changes manifested in the cardiomyocytes even in absence of the canonical cannabinoid receptors described in mammals. Our results are the first evidence of the in vivo impact of phytocannabinoids in Drosophila melanogaster. By providing a simple and affordable platform prior to mammalian models, this characterization of cardiac function under marijuana exposure opens new paths for conducting genetic screenings using vaporized compounds.