bluuebunny/crossref_metadata_2025 huggingface dataset:
An anisotropic porous media model for leakage analysis of finger seal
Authors: Wang Qiang , Hu Ya-Ping , Ji Hong-Hu
Published: July 2019

Finger seal is a new type of compliant seal configuration, which is an important part of an aero-engine and its accessory systems. It has superior sealing performance compared with conventional labyrinth seals and a lower manufacturing cost than brush seals. However, numerical simulation of the leakage characteristics of an entitative finger seal structure are very difficult to implement, because the finger laminates are in close contact with one another and the radial deformation of the fingers caused by interference between seal and rotor as well as the centrifugal and thermal expansion of the rotor can change the geometric structure of seal. The published leakage analysis models of finger seal ignore the leakage throughout the interstices between fingers or finger laminates. In view of this, the authors propose an anisotropic porous media model for leakage analysis of finger seal. The model considers the effects of the seal structure parameters, upstream and downstream axial pressure differences and the fit status between seal and rotor. First, the equations of the model and their parameters were obtained by theoretical derivations, while the correction factors were determined based on experiment leakage data in the literature. Second, the accuracy of the model was validated by calculating the leakage of a known seal structure in the literature and comparing these results with the experimental data. At last, a comparison between the anisotropic and isotropic porous media model is carried out. The results of the validation examples show that the model can simulate the leakage of finger seal very well with the errors between numerical results and experimental data are less than 10% for two-thirds of the data points.
The essential role of omni-capable research laboratories in advancing analytical spectroscopy
Authors: Beć Krzysztof B , Grabska Justyna , Huck Christian W
Published: July 2019

Contemporary analytical methods meet variety of demands originating from a magnitude of directions. This article reviews the current challenges and development trends unfolding at the frontier of analytical chemistry. A magnitude of research articles, conference meetings, and disseminations at scientific symposia take place nowadays. These figures rapidly increase on a year-to-year basis and the analytical strategies become increasingly diverse. Consequently, further advance depends on progressive improvements in the exchange of knowledge and boundary-crossing research. This fact highlights the fundamental role of multidisciplinary research laboratories in pushing the horizon in capabilities of novel methods of analysis. The advances in developing advanced analytical strategies at that accommodate a number of approaches and the resulting integrated analytical strategies are overviewed here.
An integrative sparse boosting analysis of cancer genomic commonality and difference
Authors: Sun Yifan , Sun Zhengyang , Jiang Yu , Li Yang , Ma Shuangge
Published: July 2019

In cancer research, high-throughput profiling has been extensively conducted. In recent studies, the integrative analysis of data on multiple cancer patient groups/subgroups has been conducted. Such analysis has the potential to reveal the genomic commonality as well as difference across groups/subgroups. However, in the existing literature, methods with a special attention to the genomic commonality and difference are very limited. In this study, a novel estimation and marker selection method based on the sparse boosting technique is developed to address the commonality/difference problem. In terms of technical innovation, a new penalty and computation of increments are introduced. The proposed method can also effectively accommodate the grouping structure of covariates. Simulation shows that it can outperform direct competitors under a wide spectrum of settings. The analysis of two TCGA (The Cancer Genome Atlas) datasets is conducted, showing that the proposed analysis can identify markers with important biological implications and have satisfactory prediction and stability.
The Quotidian Labour of High Tech: Innovation and Ordinary Work in Shenzhen
Authors: Stevens Hallam
Published: July 2019

The literature on the production of high-tech electronics in China—following a Silicon Valley model—focuses on either large-scale manufacturing or the role of start-ups and ‘makers’. The aim of this article is to turn to other kinds of spaces and work in the production of high-tech electronics. I focus here on three kinds of spaces in Shenzhen: the Huaqiangbei electronics market, small-scale factories and industrial design workshops. The electronics economy depends critically not just on ‘makers’ but on all kinds of other labour. In particular, it depends on lower middle-class and low-class work—devices made by small factories and shops, sold by small enterprises and designed for the less wealthy, especially in developing countries. The human networks that connect these individuals are critical to the size, speed and density of the markets, allowing devices to be built and shipped rapidly, for parts and customers to be available.
The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units
Authors: Daly Conor , Phillips Karen , Kanaan Richard
Published: July 2019

Objective:

The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay.

Methods:

Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared.

Results:

An increased length of stay for those with LEP was not statistically significant ( p=0.155). The LEP group did undergo more consultant reviews ( p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made ( p=0.018).

Conclusions:

This study provides evidence of significant effects of limited English on both service burden and outcome.
Effect of a mindfulness programme training to prevent the sport injury and improve the performance of semi-professional soccer players
Authors: Zadeh Majid Mozafari , Ajilchi Bita , Salman Zahra , Kisely Steve
Published: July 2019

Objective:

Mindfulness improves psychological outcomes. We examined whether greater mindfulness scores were associated with reduced injury rates in soccer players, as well as improved performance at both the individual and team level.

Method:

This was a parallel-group, pre- and post-test, randomised controlled pilot trial. Forty-five male amateur soccer players from Tehran, Iran, were randomly assigned into experimental (n=23) and control groups (n=22). Outcomes were scores on the mindfulness sport inventory, as well as injury rates and recovery as assessed by a physiotherapist using standardised criteria. Expert observers assessed the effect on individual and team performance. Data were analysed using mixed analysis of variance and, where indicated, its non-parametric alternative, the Friedman test.

Results:

Significantly greater mindfulness scores in the intervention group were associated with both reduced injury and improved performance.

Conclusion:

Mindfulness training shows promise in preventing injury and improving performance. The intervention could be applied to other sports and be helpful in clinical settings given the importance of exercise in promoting psychological well-being.
Simple and high-performance stick-slip piezoelectric actuator based on an asymmetrical flexure hinge driving mechanism
Authors: Gao Qi , He Meng , Lu Xiaohui , Zhang Chi , Cheng Tinghai
Published: July 2019

This article presented a new type of stick-slip piezoelectric actuator based on an asymmetrical flexure hinge driving mechanism. The key of the driving mechanism was a four-bar mechanism with different minimum thicknesses of right-circle flexure hinges. Combined with a symmetrical indenter, the asymmetrical flexure hinge driving mechanism generated controllable tangential displacement by changing the locking force. Therefore, the simple structured stick-slip piezoelectric actuator achieved considerable improvements especially in output speed and efficiency. In order to obtain improved actuator properties, the minimum thicknesses of asymmetrical flexure hinge driving mechanism, the tangential and normal displacements of the indenter were analyzed and investigated by finite element method. A prototype was fabricated and experiment investigation of the actuator characteristics was presented. Testing results indicated that the actuator achieved the maximum velocity of 15.04 mm/s and its maximum load reached 440 g under a voltage of 100 Vp-p and a frequency of 490 Hz. The maximum efficiency of the actuator was 3.66% with a load of 280 g under a locking force of 5 N and the actuated velocity of 10.17 mm/s.
Efficacy and Safety of Tolvaptan in Patients More Than 90 Years Old With Acute Heart Failure
Authors: Sato Yusuke , Uzui Hiroyasu , Mukai Moe , Shiomi Yuichiro , Hasegawa Kanae , Ikeda Hiroyuki , Tama Naoto , Fukuoka Yoshitomo , Morishita Tetsuji , Ishida Kentaro , Kaseno Kenichi , Miyazaki Shinsuke , Nakano Akira , Tada Hiroshi
Published: July 2019

Background:

The oral vasopressin-2 receptor antagonist, tolvaptan, causes aquaresis and improves symptoms in patients with congestive heart failure. However, few studies have explored the effect of tolvaptan in acute heart failure (AHF) patients ≥90 years old.

Methods:

This study enrolled 106 AHF patients treated with tolvaptan added to standard therapy. The subjects were divided into 2 groups: ≥90-year-old patients (over-90 group, mean 92 ± 2 years, n = 45) and <90-year-old patients (under-90 group, mean 76 ± 11 years, n = 61). Patients’ characteristics were assessed, and efficacy and safety were compared between the 2 groups.

Results:

The over-90 group had a lower proportion of male patients, lower body weight, and higher ejection fraction. The under-90 group had significantly higher prevalence of ischemic heart disease and diabetes mellitus. There were no significant differences between the 2 groups in total urine volume at 24 and 48 hours (1934 ± 983 mL vs 1816 ± 1028 mL, P = 0.58 and 3806 ± 1444 mL vs 4078 ± 1851 mL, P=0.47, respectively), the mean change in body weight (−3.0 ± 2.7 kg vs −2.6 ± 2.6 kg, P = 0.50), improvement of congestive symptoms, changes in serum sodium and creatinine levels, the incidences of hypernatremia (n = 0, 0% vs n = 1, 1.6%, P = 0.63), and worsening renal function (n = 9, 20% vs n = 17, 28%, P = 0.48).

Conclusion:

The efficacy and safety of tolvaptan in AHF patients aged more than 90 years were comparable to those of <90 years old. Tolvaptan provides a complementary therapeutic option for AHF patients aged more than 90 years.
Osteoporosis in Patients With Hemophilia: Single-Center Results From a Middle-Income Country
Authors: Sahin Serdar , Sadri Sevil , Baslar Zafer , Ar Muhlis Cem
Published: July 2019

Increased number of patients with hemophilia have been identified to have osteoporosis at early ages. Low bone mineral density in the setting of hemophilia has been associated with decreased mobility, sedentary life style, on demand treatment or delayed prophylaxis, low body weight and viral infections. The aim of this study was to investigate the impact of hemophilia on bone health of adult patients living in a middle income country. A total of 61 adult patients with hemophilia who were followed at the Hematology Department of Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa were consecutively included in this study. Bone health of the patients was assessed using the bone mineral density (BMD) and vitamin D levels. Z and t scores are used for evaluation of BMD in patients with hemophilia aged < 50 and ≥ 50 years, respectively. Information on treatment and co-morbidities including viral diseases were obtained from the medical files of the recruited patients. Bone mineral density was found normal in 30, and low in 29 patients. Vitamin D levels were below 20 ng/ml in 46 patients. No significant relationship was found between the severity of hemophilia and bone density. Vitamin D levels were significantly lower in patients who had a history of joint intervention. Neither annual bleeding rate nor the treatment modality (on demand versus prophylaxis) were associated with the bone mineral density and vitamin D levels. Annual factor consumption was higher in patients whose bone mineral densities was low both in femoral and lumbar regions. The results of this study depicting the situation of adult hemophilia population from a middle income country show that bone mineral density and vitamin D levels were decreased in a considerable amount of patients at early ages.
Becoming Research With Shadow Work: Combining Artful Inquiry With Research-Creation
Authors: Sweet Joseph D. , Nurminen Emppu , Koro-Ljungberg Mirka
Published: July 2019

The authors explore different wonderings to illustrate some possible ways in which postqualitative inquiry and scholarship is becoming and shaping the lives of scholars. To do this, we draw from previous work in arts-influenced inquiry and make connections with arts-based research and “research-creation” to explore how researchers can generate possibilities and becoming through the process of creating art in a purposefully relational manner. In these creations, our becomings intersect with shadow-philosophy, each other, and event happenings we conducted with postqualitative researchers. Rather than conceptually discussing various forms of postqualitative inquiry, we attempt to practice it. In this way, we use arts-inspired research to explore intersections between research and creation. These types of relational encounters produce thinking and materials which belong to life, senses, and affect, and could have a (scholarly) life of their own.
Critical Social Justice Inquiry Circles: Using Counter-Story as a Counter-Hegemonic Project
Authors: Hoffman Julie Wasmund , Martin Jennifer L.
Published: July 2019

This article presents a qualitative dialogic poetic response in the form of a critical social justice inquiry circle and a critical reading of Long Way Down by Jason Reynolds as poetry and as an intentional gesture of listening as activism. This discourse is one of resistance to the acritical/apolitical nature of schooling and to prepare hegemonic/White educators to become culturally responsive (ala Milner) and to devise a new critical methodology, we embark on this radical proposition. Our use of critical social justice inquiry circles using poetic dialogue is inspired by Denzin’s conception of Critical Performance Pedagogy.
Phaco-antigenic glaucoma following uncomplicated cataract surgery
Authors: Chiu Alexander Kin Chiang , Mathews Divya
Published: July 2019

Introduction:

Phaco-antigenic glaucoma occurs in less than 1% of cataract surgeries. Managing this rare complication is challenging, especially when there are few documented cases reported. We describe the challenges of managing a case of bilateral phaco-antigenic glaucoma following uncomplicated cataract surgery requiring viscocanalostomy.

Case description:

An 82-year-old atopic lady presented with a 2-day history of painful injected right eye. She was 4 days post left and 8 days post right uncomplicated cataract surgery. On examination, the anterior chambers were deep with no hypopyon. Intraocular pressure was raised at 38 mmHg in the right eye and 24 mmHg in the left eye initially. However, intraocular pressure remained uncontrolled despite maximum medical treatment; she attended A + E six times within 11 days with intraocular pressures of up to 48 mmHg in the right eye and 46 mmHg in the left eye. A vitreous biopsy was reported negative for infective organisms. Eventually, bilateral viscocanalostomies were performed and vision improved to 0.24 logMAR in both eyes with intraocular pressures of 8 mmHg in the right eye and 10 mmHg in the left eye.

Conclusion:

We present a rare presentation of phaco-antigenic glaucoma following an uncomplicated cataract surgical procedure with good results following timely intervention.
Congenital ectropion uveae (CEU) with refractory glaucoma: Early trabeculectomy saves vision
Authors: Singh Kirti , Bhattacharyya Mainak , Gotmare Nikhil , Joon Annu , Aggarwal Himshikha , Singh Arshi
Published: July 2019

We report the case of congenital ectropion uveae in a 10-year-old boy with intractable unilateral glaucoma but no systemic association. Glaucoma in congenital ectropion uveae is often poorly responsive to medial therapy and requires surgical intervention. Satisfactory results are possible if diagnosis is established early and timely surgery performed, as was the case in our patient.
Small incision lenticule extraction for the correction of high myopia
Authors: Taneri Suphi , Kießler Saskia , Rost Anika , Schultz Tim , Dick H Burkhard
Published: July 2019

Purpose:

Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to −8 D with astigmatism of −3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis.

Methods:

Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾−8 or−3 to −7.75 D with astigmatism ⩽−3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better.

Results:

A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of −0.28 ± 0.41 D (range: −1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable.

Conclusion:

We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.
Using Smartphones to Improve Treatment Retention Among Impoverished Substance-Using Appalachian Women: A Naturalistic Study
Authors: Johnston Darcie C , Mathews W David , Maus Adam , Gustafson David H
Published: July 2019

Objectives:

Longer retention in treatment is associated with positive outcomes. For women, who suffer worse drug-related problems than men, social technologies, which are more readily adopted by women, may offer promise. This naturalistic study examined whether a smartphone-based relapse-prevention system, A-CHESS (Addiction-Comprehensive Health Enhancement Support System), could improve retention for women with substance use disorders in an impoverished rural setting.

Methods:

A total of 98 women, age 18 to 40, in southeastern Kentucky and mandated to treatment, received A-CHESS with intensive outpatient treatment for 6 months. For comparison, data were obtained for a similar but non-equivalent group of 100 same-age women also mandated to treatment in the same clinics during the period. Electronic medical record data on length-of-stay and treatment service use for both groups were analyzed, with A-CHESS use data, to determine whether those using A-CHESS showed better retention than those without.

Results:

Women with A-CHESS averaged 780 service units compared with 343 for the comparison group. For those with discharge dates prior to the study’s end, A-CHESS patients stayed in treatment a mean of 410 vs 262 days for the comparison group.

Conclusions:

Given associations between retention and positive outcomes, mobile health technology such as A-CHESS may help improve outcomes among women, especially in settings where access to in-person services is difficult. The findings, based on a non-equivalent comparison, suggest the need for further exploration with rigorous experimental designs to determine whether and to what degree access to a smartphone with A-CHESS may extend and support recovery for women.
Low noise, vibration and harshness solutions for in-line three-cylinder range extender and hybrid electric vehicles
Authors: Hooper Peter R
Published: July 2019

Consideration of internal combustion engine formats suitable for hybrid or range extender electric vehicles usually focuses on selecting a power plant, which is as compact as possible to meet the demands and constraints of the installation. In-line three-cylinder engines often provide an attractive solution for such vehicles. This article presents a low emission two-stroke engine of in-line three-cylinder format and draws a comparison with an equivalent four-stroke engine. The particular focus of the analysis is on strategies for minimization of noise, vibration and harshness with significant reduction in piston lateral force compared with the four-stroke unit. The design also considers a balance shaft arrangement to further assist with noise, vibration and harshness reduction. The presented arrangement demonstrates an integrated induction control/balance shaft arrangement, which erodes the usual cost penalties typical of balance shaft consideration in three-cylinder engines.
Numerical analysis of the influence of early fuel injection on charge motion in a direct injection spark ignition engine using scale-resolving simulations
Authors: Theile Martin , Reißig Martin , Hassel Egon , Thévenin Dominique , Hofer Martin , Michels Karsten
Published: July 2019

This work summarizes the numerical analysis of the effect of early fuel injection on the charge motion in a direct injection spark ignition engine concerning cyclic fluctuations of the flow field. The combination of the scale-resolving turbulence model “Scale Adaptive Simulation” and post-processing routines for vortex trajectory visualization allows for a detailed insight into the temporal resolved and cycle-dependent behavior of the charge motion. In the first part, a simplified engine set-up is presented and used as a validation case to ensure correct behavior of the turbulence model and post-processing routines. In the second part, the computational fluid dynamics model of the real engine is introduced. The application of the proposed vortex tracking algorithm is shown, and a short discussion about the transient behavior of the charge motion in this engine set-up is given. The third part describes the analysis of the influence of the fuel injection on the charge motion at different engine speeds from 1000 to 3000 r/min and variations of the intake pressure from 1 to 2 bar. Finally, the impact on different flow field properties at possible ignition timings is discussed. Changes in mean flow field quantities as well as in aerodynamic fluctuations are found as a consequence of fuel injection.
Learner-centred education as a tool for enhancing adult learning in distance learning universities
Authors: Gravani Maria N
Published: July 2019

This paper presents a critical account of the extent and the ways in which learner-centred education approaches are used as a tool for enhancing adult learning in distance learning universities as well as the conditions and restrictions they face. The exploration is illustrated by qualitative data from interviews with eight adult educators and 16 adult learners/students and adopts a case study approach within a phenomenological mode. In this study, learner-centred education approaches are seen as being at one end of the educational practice continuum and comprise of a number of elements, namely: motivation, epistemology, techniques and relationships that are used as a conceptual framework to guide data analysis and interpretation. Findings reveal the partial and unintentional use of learner-centred education approaches in the distance learning programmes explored and make recommendations for the implementation of learner-centred education in the teaching of adults in distance education universities.
The Use of Nonword Keywords in the Speech Assessment of English Second Language Learners
Authors: Ross Lauren , Geertsema Salomé , le Roux Mia , Alet Graham Marien
Published: July 2019

Use of nonwords is a potentially more appropriate method of assessment for English second language (EL2) learners. A mixed comparative design was used to compare the effects when using nonwords instead of picture-based stimuli to assess articulation of EL2 learners. Subaims were to compare results between two tests and age groups. In all, 16 Setswana L1 children assigned to two age cohorts were assessed using the Goldman-Fristoe Test of Articulation–second edition (GFTA-2), and nonword list was created via a registered Speech Motor Learning website. Results of the two assessments differed significantly, indicating that lack of semantic information may yield different outcomes for articulation assessments of EL2 learners. Speech sound differences on the GFTA-2 were sounds not found in L1. This agrees with previous research indicating incorrect diagnosis due to speech and language differences. There was no significant difference between the two age cohorts. This research forms the basis for investigations into nonwords as a more accurate method for assessment of EL2 learners.
Looking, But Not Listening? Theorizing the Practice and Ethics of Online Ethnography
Authors: Winter Rachel , Lavis Anna
Published: July 2019

There are debates across disciplines regarding how to research and represent digital cultures ethically. Against this background, there is a need to reflect on the practice and ethics of online ethnography. Ambiguities surrounding researcher “participation” online have led this to be equated largely with observation. This has deprivileged the act of listening in both research practice and the methodological and ethical debates that underpin this. Utilizing ethnographic research into self-harm and social media as a critical lens, this article advocates for listening as a mode of participating in, as well as observing, online spaces. In proposing “active listening” and “adaptive listening” to explore the polyphonic and heterogeneous nature of social media, we argue that listening is key to representing online spaces in all their cultural diversity and emotional complexity. Reflecting on listening is necessary to forging a practical ethics of online ethnography, and is relevant to digital research more widely.
Online control programming algorithm for human–robot interaction system with a novel real-time human gesture recognition method
Authors: Chen Bo , Hua Chunsheng , Dai Bo , He Yuqing , Han Jianda
Published: July 2019

This article proposes an online control programming algorithm for human–robot interaction systems, where robot actions are controlled by the recognition results of gestures performed by human operators based on visual images. In contrast to traditional robot control systems that use pre-defined programs to control a robot where the robot cannot change its tasks freely, this system allows the operator to train online and replan human–robot interaction tasks in real time. The proposed system is comprised of three components: an online personal feature pretraining system, a gesture recognition system, and a task replanning system for robot control. First, we collected and analyzed features extracted from images of human gestures and used those features to train the recognition program in real time. Second, a multifeature cascade classifier algorithm was applied to guarantee both the accuracy and real-time processing of our gesture recognition method. Finally, to confirm the effectiveness of our algorithm, we selected a flight robot as our test platform to conduct an online robot control experiment based on the visual gesture recognition algorithm. Through extensive experiments, the effectiveness and efficiency of our method has been confirmed.
A Direct and General Synthesis of 5-Substituted 3-Trifluoromethyl-1,2,4-triazoles via the Three Component Condensation Reaction of Ethyl Trifluoroacetate, Hydrazine and Amidines
Authors: Funabiki Kazumasa , Noma Naoko , Kuzuya Gouhaku , Matsui Masaki , Shibata Katsuyoshi
Published: July 2019

The three component condensation reaction of ethyl trifluoroacetate, hydrazine and amidines in the presence of sodium hydroxide in tetrahydrofuran at reflux temperature gave the corresponding 3-trifluoromethyl-5-substituted 1,2,4-triazoles in good to excellent yields.
Total Partial Synthesis of (3S, 6S)-(+)-3,7-Dimethyl-6-hydroxy-3-acetoxyocta-1,7-diene and (3S, 6S)-(-)-3,7-Dimethylocta-1,7-diene-3,6-diol from Geraniol
Authors: Liu Zuosheng , Lan Jiong , Li Yulin , Xing Yacheng , Cen Wen
Published: July 2019

The synthesis of (3 S, 6 S)-(+)-3,7-dimethyl-6-hydroxy-3-acetoxyocta-1,7-diene and (3 S, 6 S)-(-)-3,7-dimethylocta-1,7-diene-3,6-diol via the rearrangement of the chiral 2,3-epoxy alcohol, with the system Ph3P, pyridine, I2 and H2O, is described.
Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus
Authors: Shivaprasad Channabasappa , Aiswarya Yalamanchi , Kejal Shah , Sridevi Atluri , Anupam Biswas , Ramdas Barure , Gautham Kolla , Aarudhra Premchander
Published: July 2019

Background:

To compare glycemic variability (GV) indices between patients with fibrocalculous pancreatic diabetes (FCPD) and type 2 diabetes mellitus (T2D) using continuous glucose monitoring (CGM).

Methods:

We measured GV indices using CGM (iPro™2 Professional CGM, Medtronic, USA) data in 61 patients each with FCPD and T2D who were matched for glycated hemoglobin A1c (HbA1c) and duration of diabetes. GlyCulator2 software was used to estimate the CGM-derived measures of GV (SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [%CV]), hypoglycemia (time spent below 70 mg/dL, AUC below 70 mg/dL, glycemic risk assessment diabetes equation hypoglycemia, Low Blood Glucose Index), and hyperglycemia (time spent above 180 mg/dL at night [TSA > 180], AUC above 180 mg/dL [AUC > 180], glycemic risk assessment diabetes equation hyperglycemia, High Blood Glucose Index [HBGI], and J index). The correlation of GV indices with HbA1c, duration of diabetes, and demographic and biochemical parameters were also assessed.

Results:

All the CGM-derived measures of GV (SD, MAGE, CONGA, MODD, and %CV), except M value, were significantly higher in the FCPD group than in the T2D group ( P < 0.05). Measures of hyperglycemia (TSA >180, AUC >180, HBGI, and J index) were significantly higher in the FCPD group than in the T2D group ( P < 0.05). The measures of hypoglycemia were not significantly different between the two groups. All the hyperglycemia indices showed a positive correlation with HbA1c in both groups.

Conclusions:

FCPD is associated with higher GV than is T2D. The findings of higher postprandial glycemic excursions in patients with FCPD could have potential therapeutic implications.
Variation in Diabetes Management: A National Assessment of Primary Care Providers
Authors: Peabody John W. , de Belen Enrico , Dahlen Jeffrey R. , Acelajado Maria Czarina , Tran Mary T. , Paculdo David R.
Published: July 2019

Background:

Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States.

Methods:

We measured provider practice in a representative sample of 156 PCPs. All providers cared for simulated patients with diabetes presenting with symptoms of glycemic variability. Provider responses were reviewed by trained clinicians against evidence-based care standards and accepted standard of care protocols.

Results:

Care varied widely—overall quality of care averaged 51.3%±10.6%—with providers performing just over half the evidence-based practices necessary for their cases. More worryingly, provider identified the underlying etiology of the poor glycemic control only 36.3% of the time. HbA1c was routinely ordered in 91.3% of all cases but often (59.5%) inappropriately. Ordering other tests of glycemic control (done in 15% of cases) led to significant increases in identifying the etiology of the hyperglycemia. Correctly modifying their patient’s treatment was more likely to occur if doctors first identified the underlying etiology (65.9% vs 49.0%, P<0.001). We conservatively estimated a US $65/patient/visit in unnecessary testing and US $389 annually in additional care costs when the etiology was missed, translating potentially into millions of dollars of wasteful spending.

Conclusion:

Despite established evidence that HbA1c misses short-term changes in diabetes, we found PCPs consistently ordered HbA1c, rarely using other available blood tests. However, if the factors leading to poor glycemic control were recognized, PCPs were more likely to correctly alter their patient’s hypoglycemic therapy.
Regulatory T-cells and their impacts on cytokine profile of end-stage renal disease patients suffering from systemic lupus erythematosus
Authors: Fathi Farshid , Atapour Abdolamir , Eskandari Nahid , Keyhanmehr Niloufar , Hafezi Hossein , Mohammadi Shohreh , Motedayyen Hossein
Published: July 2019

Autoimmunity is an identified factor for development of end-stage renal disease (ESRD). Regulatory T-cells (Tregs) play a fundamental role in preventing autoimmunity. This study aimed to determine Treg frequency and its effects on cytokine profile of ESRD patients with and without systemic lupus erythematosus (SLE). Moreover, this study also determines how Treg number is affected by blood transfusion and gender. Peripheral blood mononuclear cells were isolated from 26 ESRD and 10 healthy subjects and stained with anti-CD4, anti-CD25, and anti-FoxP3 antibodies. Treg frequencies in ESRD patients with and without blood transfusion were determined by flow cytometry. Antibodies against human leukocyte antigens (HLAs) were investigated by panel-reactive antibodies screening. Tumor growth factor (TGF)-β1, interleukin (IL)-4, IL-10, TNF-α, IL-17A, and interferon (IFN)-γ serum levels in participants were measured by enzyme-linked immunoasorbent assay (ELISA). ESRD patients with SLE, unlike the patients without SLE, showed a significant reduction in Treg percentage compared to healthy subjects ( P < 0.01). All women had a reduced number of Tregs compared to men. Treg number was significantly decreased in ESRD patients with HLA antibodies ( P < 0.05). Blood transfusion enhanced Treg development in ESRD patients without SLE, unlike the patients with SLE ( P  < 0.05). ESRD patients with low Treg showed a reduction in TGF-β1 and IL-4 and an increase in TNF-α and IL-17A levels compared to control groups ( P  < 0.05–0.0001). However, no change was observed in IL-10 and IFN-γ levels. Treg frequency was negatively associated with the age of patients ( P < 0.01), while this association was not observed in healthy subjects. Based on these findings, it can be observed that reduction in Treg number may contribute to ESRD development in patients with SLE.
Exploring Interpersonal Relationships in a Nurse-Managed Clinic and Their Impact on Clinical Outcomes
Authors: Lee Charlotte T. , Phillips Susanne , Tiso Susan , Fitzpatrick Camille
Published: July 2019

This study explores the impact of interpersonal relationships on processes and outcomes of care at a nurse-managed, primary care clinic in Southern California serving a vulnerable population. Ten semistructured interviews were conducted with all health care providers in the clinic to explore patient characteristics, types of relationships experienced, and how they may have affected processes and outcomes of care. Themes in interviews were identified through thematic analysis. We found that (a) patients with limited access to health care and resources establish different types of relationships to support their needs, and (b) interpersonal relationships, including those among providers, affect quality of care.
Work–Family Conflict Scale: Psychometric Properties of the Italian Version
Authors: Loscalzo Yura , Raffagnino Rosalba , Gonnelli Claudia , Giannini Marco
Published: July 2019

In literature, there are many instruments for measuring the work–family conflict (W-F-C). The Work–Family Conflict Scale (WFCS) is one of the most used tools. This study aimed to evaluate its psychometric properties on a sample of 684 Italian workers (42.1% males, 57.9% females, mean age = 45.51 ± 10.91). We also evaluated if there were some demographic differences in the W-F-C, with relation to gender, the presence of children, and the kind of job (i.e., medical doctors and other health professionals, teachers and researchers, employees, manual workers, self-employed workers). We found that the Italian WFCS has good psychometric properties. Moreover, contrary to our hypotheses, males experience higher W-F-C than females, and the lowest level of W-F-C characterize doctors and other health professionals. Manual workers and self-employed workers seem to be the two job categories that experience the highest level of W-F-C.
Processing of Phonological and Orthographic Information in Word Recognition in Discourse Reading
Authors: Wang Xiaoyun , Li Degao
Published: July 2019

To examine the processing of phonological and configurational information in word recognition in discourse reading, we conducted two experiments using the self-paced reading paradigm. The materials were three-sentence discourses, in each of which the last word of the second sentence and the third word from the end of the last sentence formed a prime–target pair. The discourse in which the target word (T) was semantically congruent or incongruent with the prime word was converted into a new version by replacing the T with its homophone or with the control word (con-T) in Experiment 1. Similarly, the Ts were replaced by words that were similar to them in configuration or by the con-Ts in Experiment 2. We adopted mixed-effects modeling to analyze the participants’ reading times to the targets, the first words after the targets, and the second words after the targets. It is concluded that the processing of phonological information begins earlier than that of configurational information in activating the semantic representations for the upcoming words that fit the context in discourse reading.
Three-Tiered Advocacy: Using a Longitudinal Curriculum to Teach Pediatric Residents Advocacy on an Individual, Community, and Legislative Level
Authors: Lax Yonit , Braganza Sandra , Patel Milani
Published: July 2019

Background:

Pediatricians play a critical role as health advocates. Teaching residents to advocate for their patients on an individual, community, and legislative level is a priority for residency training programs. This study examined the effects of a longitudinal curriculum teaching 3-tiered advocacy on pediatric residents’ attitudes, knowledge, and practice.

Methods:

This was a prospective pre- and postintervention study using an anonymous survey of pediatric residents (N = 78) in an urban academic children’s hospital. The survey assessed advocacy on an individual level through comfort and experience in discussing social determinants of health (SDH), on a community level through comfort and practice referring patients to community resources, and on a legislative level through comfort and practice with legislative advocacy. Descriptive statistics and chi-square tests were used to analyze the data.

Results:

Postimplementation, pediatric residents reported the curriculum changed their clinical practice (66%), encouraged them to take a more in-depth social history (46%), and helped them guide patients to more community resources (38%). Comfort in discussing SDH with patients in the ambulatory clinic increased (27% vs 76%; P = .001). Reported frequency in inquiring about SDH significantly improved in the following areas: income (39% vs 60%; P = .025), education (71% vs 93%; P = .008), and legal issues (13% vs 26%; P = .012).

Conclusions:

Most of the residents reported that the curriculum changed their clinical practice. Residents reported knowledge and comfort with advocating for their patients on an individual level improved. However, there was no significant difference on the community or legislative level. This curriculum raised awareness and armed residents with practical skills to be health advocates on an individual level. Further research is needed to explore effective means of creating 3-tiered advocates.
BK polyoma virus nephropathy in hematopoietic cell transplant recipients
Authors: Lee Yeon Joo , Glezerman Ilya G , Tamari Roni , Sauter Craig S , Prockop Susan E , Boulad Farid , Salvatore Steven P , Seshan Surya V , Jaimes Edgar A , Giralt Sergio A , Papadopoulos Esperanza B , Jakubowski Ann A , Papanicolaou Genovefa A
Published: July 2019

Background:

The epidemiology of BK polyoma virus nephropathy in hematopoietic cell transplant recipients is poorly characterized. Kidney dysfunction after hematopoietic cell transplant is often attributed to treatment toxicities and kidney biopsies are rarely performed.

Methods:

We reviewed pathology-confirmed BK polyoma virus nephropathy cases in adult and pediatric patients who had undergone a hematopoietic cell transplant between 1 January 2015 and 31 December 2017 at our institution. Plasma and urine BK polyoma virus was assessed by a quantitative polymerase chain reaction assay and were obtained at the clinician discretion. Glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration equation. BK polyoma virus nephropathy was scored by the Banff Working Group Proposal.

Results:

Eight (7 adult and 1 pediatric) cases of BK polyoma virus nephropathy were identified among 685 hematopoietic cell transplant recipients, 14 of whom had undergone a kidney biopsy. Five patients (62.5%) had received a CD34+-selected peripheral blood hematopoietic cell transplant; two had received a cord blood allograft and one an unmodified peripheral blood hematopoietic cell transplant. Two patients developed acute graft-versus-host disease grade II. Early post–hematopoietic cell transplant BK polyoma viruria was documented with onset at a median of 54 days (range, 6–91) post–hematopoietic cell transplant and median urine BK polyoma viral load was 9.6 log10 copies/mL (range, 8.6–10.0). BK polyoma virus nephropathy was diagnosed at a median of 267 days after hematopoietic cell transplant (range, 133–637). At BK polyoma virus nephropathy diagnosis, all patients had decreased renal function with glomerular filtration rate (median 29 mL/min/1.73 m2; range, 9–98 ) and creatinine (median 2.4 mg/dL; range, 0.8–7.5) ; median plasma BK polyoma viral load was 6.3 log10 copies/mL (range, 5.5–7.1) and median CD4+ lymphocyte count was 82 cell/mcL (range, 21–172).

Conclusions:

We report eight biopsy-proven BK polyoma virus nephropathies in hematopoietic cell transplant recipients from a single center. BK polyoma virus nephropathy should be considered in hematopoietic cell transplant recipients with worsening kidney function and high BK polyoma viremia.
Foveal Avascular Zone Area Analysis Using OCT Angiography After Pneumatic Retinopexy for Macula-Off Rhegmatogenous Retinal Detachment Repair
Authors: Francisconi Carolina L. M. , Kim David Ta , Juncal Verena , Qian Jenny , Brosh Koby , Wong David T. , Giavedoni Louis R. , Berger Alan R. , Altomare Filiberto , Muni Rajeev H.
Published: July 2019

Purpose:

Recent publications have reported that the deep capillary plexus (DCP) area of the foveal avascular zone (FAZ) is significantly larger in eyes following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair when compared with controls. To the best of the authors’ knowledge, there have been no publications on the evaluation of the macular microvasculature using optical coherence tomography angiography (OCTA) in post–pneumatic retinopexy (PnR) eyes. Therefore, the purpose of this study was to investigate FAZ-area changes following PnR.

Methods:

This retrospective cohort included 19 patients with macula-off RRD who underwent PnR repair. Each patient’s fellow eye was used as a control. The FAZ area in the superficial capillary plexus and DCP was investigated with OCTA and the areas were measured by 2 masked graders.

Results:

Both superficial (PnR: 0.22 [0.16-0.35] vs control: 0.24 [0.18-0.34] mm2; P = .715) and deep (PnR: 0.56 [0.51-0.76] vs control: 0.7 [0.59-0.89] mm2; P = .105) FAZ areas were not significantly different between eyes.

Conclusions:

Our results suggest that the lack of FAZ-area enlargement after PnR repair may indicate that there is less ischemic damage to the retinal capillary plexus in the fovea when compared with that described in the literature for PPV. The PIVOT trial demonstrated that PnR is associated with superior visual acuity and less metamorphopsia when compared with PPV at 1 year. The results of the current study may provide insight into the potential advantages of PnR. Further studies are needed to elucidate how the macular microvasculature is affected after RRD and to clarify how the FAZ area changes following PnR and PPV.
Adherence to Antifungal Guidelines in Malignant Hematology Patients: A Review of the Literature
Authors: Reslan Zainab , Lindsay Julian , Kerridge Ian , Gellatly Rochelle
Published: July 2019

Objective: To review the published literature assessing adherence rates to antifungal guidelines and reasons for nonadherence in the adult malignant hematology inpatient setting. Data sources: The databases Embase, MEDLINE, and PubMed (from data inception to May 2019) were searched using the terms hematology, oncology, antifungal, guidelines, adherence, and stewardship with the search limited to adult human subjects and published in English. This yielded 123 articles. From this list, studies that were published in peer-reviewed journals were extracted, leaving 10 citations that met the final inclusion criteria. Study Selection and Data Extraction: Ten studies were selected assessing adherence to consensus antifungal guidelines in the malignant hematology setting. These included studies investigating the introduction of antifungal stewardship programs in tertiary hospitals. Data Synthesis: Although the studies were heterogeneous, all focused on appropriateness of antifungal therapy in the inpatient setting. Adherence to antifungal guidelines for optimal antifungal prophylaxis and treatment was low in most studies, with rates of inappropriate antifungal therapy ranging from 25% to 70% of fungal prescriptions. Relevance to Patient Care and Clinical Practice: Adherence rates with guidelines for antifungal therapy are low in the hematology inpatient setting. This may affect infection rates influencing morbidity and mortality in this high-risk population. Conclusion: Given the prevalence of invasive fungal infections in malignant hematology inpatients, suboptimal adherence with antifungal guidelines is concerning. This demands a focus on education, antifungal stewardship, and updating guidelines to meet real-world scenarios. Adherence with antifungal guidelines in the outpatient hematology setting is unknown and requires further research.