bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulating the Activities of Multinational Corporations in Nigeria: A Case for the African Union?
Authors: Ekhator Eghosa Osa
Published: March 2018

Due to the ineffectiveness of the extant regulatory framework (not limited to home country, host country and international law) governing the activities of multinational corporations (mncs), new regulatory paradigms have been advocated by scholars. Arguably, the African Union (au) (and its mechanisms) can be the basis of mnc regulation in Africa. However, regulation of the activities of mncs operating in Africa appears not to be among the major or pressing priorities of the au and its institutions. There is no normative and institutional framework at the au level regulating the activities of mncs in Africa. There are, however, moves to design measures to redress this anomaly. This article will focus on the development of recent strategies by the au and its institutions to ‘regulate’ the activities of mncs in Africa and its implications in Nigeria.
Importance of the Resolution of Surface Topography in Indian Monsoon Simulation
Authors: Mishra Saroj K. , Anand Abhishek , Fasullo John , Bhagat Saurav
Published: March 2018

The influence of surface topography resolution in Indian summer monsoon simulation is investigated. Three sets of six-member ensemble simulations with climatological sea surface temperature are conducted with the Community Atmospheric Model, version 5.1 (CAM5.1): COARSE simulation at 1.9° × 2.5° latitude–longitude resolution, FINE simulation at 0.47° × 0.63° resolution, and HYBRID simulation, that is, using COARSE surface topography imposed on the FINE configuration. With regard to the representation of the surface topography, substantial differences occur at the regional scales between the simulations, especially over the foothills and steep flanks of the mountains. In the COARSE and HYBRID simulations, the orographic height of the foothills is overestimated whereas that of the steep flanks adjacent to the foothills is underestimated. The biases are severe (up to 1 km) over the Himalayas and Tibet and have detrimental effects on regional climate through barrier effects on the low-level flow, and the lapse rate and elevated heat source effects. Overall, the simulations show remarkable improvement with an increase in resolution, mainly because of the improved representation of atmospheric and surface processes. However, local climate—surface air temperature, sea level pressure, precipitable water, and wind—of the orographic regions, particularly where large orographic biases exist in COARSE, is found to benefit substantially from increased resolution of surface topography. Local precipitation and evaporation are exceptions, although, as they are negligibly sensitive to topographic resolution, showing strong dependence on the resolution of surface and atmospheric processes. Moreover, resolution of surface topography generally does not have notable remote impacts.
A PDRMIP Multimodel Study on the Impacts of Regional Aerosol Forcings on Global and Regional Precipitation
Authors: Liu L. , Shawki D. , Voulgarakis A. , Kasoar M. , Samset B. H. , Myhre G. , Forster P. M. , Hodnebrog Ø. , Sillmann J. , Aalbergsjø S. G. , Boucher O. , Faluvegi G. , Iversen T. , Kirkevåg A. , Lamarque J.-F. , Olivié D. , Richardson T. , Shindell D. , Takemura T.
Published: March 2018

Atmospheric aerosols such as sulfate and black carbon (BC) generate inhomogeneous radiative forcing and can affect precipitation in distinct ways compared to greenhouse gases (GHGs). Their regional effects on the atmospheric energy budget and circulation can be important for understanding and predicting global and regional precipitation changes, which act on top of the background GHG-induced hydrological changes. Under the framework of the Precipitation Driver Response Model Intercomparison Project (PDRMIP), multiple models were used for the first time to simulate the influence of regional (Asian and European) sulfate and BC forcing on global and regional precipitation. The results show that, as in the case of global aerosol forcing, the global fast precipitation response to regional aerosol forcing scales with global atmospheric absorption, and the slow precipitation response scales with global surface temperature response. Asian sulfate aerosols appear to be a stronger driver of global temperature and precipitation change compared to European aerosols, but when the responses are normalized by unit radiative forcing or by aerosol burden change, the picture reverses, with European aerosols being more efficient in driving global change. The global apparent hydrological sensitivities of these regional forcing experiments are again consistent with those for corresponding global aerosol forcings found in the literature. However, the regional responses and regional apparent hydrological sensitivities do not align with the corresponding global values. Through a holistic approach involving analysis of the energy budget combined with exploring changes in atmospheric dynamics, we provide a framework for explaining the global and regional precipitation responses to regional aerosol forcing.
Eastern Pacific ITCZ Dipole and ENSO Diversity
Authors: Xie Shang-Ping , Peng Qihua , Kamae Youichi , Zheng Xiao-Tong , Tokinaga Hiroki , Wang Dongxiao
Published: March 2018

The eastern tropical Pacific features strong climatic asymmetry across the equator, with the intertropical convergence zone (ITCZ) displaced north of the equator most of time. In February–April (FMA), the seasonal warming in the Southern Hemisphere and cooling in the Northern Hemisphere weaken the climatic asymmetry, and a double ITCZ appears with a zonal rainband on either side of the equator. Results from an analysis of precipitation variability reveal that the relative strength between the northern and southern ITCZ varies from one year to another and this meridional seesaw results from ocean–atmosphere coupling. Surprisingly this meridional seesaw is triggered by an El Niño–Southern Oscillation (ENSO) of moderate amplitudes. Although ENSO is originally symmetric about the equator, the asymmetry in the mean climate in the preceding season introduces asymmetric perturbations, which are then preferentially amplified by coupled ocean–atmosphere feedback in FMA when deep convection is sensitive to small changes in cross-equatorial gradient of sea surface temperature. This study shows that moderate ENSO follows a distinct decay trajectory in FMA and southeasterly cross-equatorial wind anomalies cause moderate El Niño to dissipate rapidly as southeasterly cross-equatorial wind anomalies intensify ocean upwelling south of the equator. In contrast, extreme El Niño remains strong through FMA as enhanced deep convection causes westerly wind anomalies to intrude and suppress ocean upwelling in the eastern equatorial Pacific.
How Do Intelligent Goods Shape Closed-Loop Systems?
Authors: Rajala Risto , Hakanen Esko , Mattila Juri , Seppälä Timo , Westerlund Mika
Published: March 2018

Disruptive technologies can increase the intelligence of goods and revitalize business models in the circular economy. Applying an industrial ecology perspective, this article discusses how intelligent goods can boost the sustainability of industrial ecosystems. North American and European cases highlight how business model innovators can utilize goods-related information to develop more competitive closed-loop systems. The authors identify three archetypes of closed-loop systems—inner circles, decentralized systems, and open systems—and delineate how they leverage information resources for collaboration. This study advances the understanding of closed-loop systems in the circular economy, which is more dependent than ever on digital platforms.
Fall determinants and home modifications by occupational therapists to prevent falls
Authors: Maggi Patrick , de Almeida Mello Johanna , Delye Sam , Cès Sophie , Macq Jean , Gosset Christiane , Declercq Anja
Published: March 2018

Background.

Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls.

Purpose.

This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls.

Method.

We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls.

Findings.

The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls.

Implications.

Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.
Three-dimensional Visualization of Ultrasound Backscatter Statistics by Window-modulated Compounding Nakagami Imaging
Authors: Zhou Zhuhuang , Wu Shuicai , Lin Man-Yen , Fang Jui , Liu Hao-Li , Tsui Po-Hsiang
Published: March 2018

In this study, the window-modulated compounding (WMC) technique was integrated into three-dimensional (3D) ultrasound Nakagami imaging for improving the spatial visualization of backscatter statistics. A 3D WMC Nakagami image was produced by summing and averaging a number of 3D Nakagami images (number of frames denoted as N) formed using sliding cubes with varying side lengths ranging from 1 to N times the transducer pulse. To evaluate the performance of the proposed 3D WMC Nakagami imaging method, agar phantoms with scatterer concentrations ranging from 2 to 64 scatterers/mm3 were made, and six stages of fatty liver (zero, one, two, four, six, and eight weeks) were induced in rats by methionine-choline-deficient diets (three rats for each stage, total n = 18). A mechanical scanning system with a 5-MHz focused single-element transducer was used for ultrasound radiofrequency data acquisition. The experimental results showed that 3D WMC Nakagami imaging was able to characterize different scatterer concentrations. Backscatter statistics were visualized with various numbers of frames; N = 5 reduced the estimation error of 3D WMC Nakagami imaging in visualizing the backscatter statistics. Compared with conventional 3D Nakagami imaging, 3D WMC Nakagami imaging improved the image smoothness without significant image resolution degradation, and it can thus be used for describing different stages of fatty liver in rats.
How Is Public Housing Policy Implemented in China? A Tentative Analysis of the Local Implementation of Four Major Programs
Authors: Fan Yongmao , Yang Hongshan
Published: March 2018

One challenge that policy implementation studies face is how to build a structural framework using different variables. This article constructs a path-incentive model of implementation as an analytical framework with which to examine the relationship between central and local government. It consists of two key variables: policy path and incentive. The model embraces four types of implementation: administrative implementation, experimental implementation, flexible implementation, and symbolic implementation. Based on a case study of China’s major public housing policies from 1998 to 2013, the article finds that even if policy goals and the implementation path are sometimes unclear, a strong top-down incentive mechanism will encourage local governments to actively engage in policy experiments. This local explorative approach can enhance an understanding of the policy environment and avoid apportioning blame to the central government for defective policy making. In China, policy implementation not only turns policy goals into real outcomes but also is a means of improving policy paths and incentive mechanisms.
Benzoquinone induces ROS-dependent mitochondria-mediated apoptosis in HL-60 cells
Authors: Sun Shuqiang , Zhang Chunxiao , Gao Jiahao , Qin Qiongyu , Zhang Yaya , Zhu Hua , Yang Xinjun , Yang Dongren , Yan Hongtao
Published: March 2018

Benzene exposure affects the hematopoietic system and leads to the occurrence of various types of leukemia and hematotoxicity. It has been confirmed that active metabolites of benzene, including 1,4-benzoquinone (1,4-BQ), can induce reactive oxygen species (ROS) and apoptosis in the bone marrow, and recent studies have also suggested that benzene exposure can affect mitochondrial function in both experimental animals and cell lines. However, the potential relationship among ROS production, mitochondrial damages, and subsequent apoptosis following benzene exposure has not been well studied in detail. In the present study, we utilized HL-60 cells, a well-characterized human myeloid cell line, as an in vitro model and examined the effects of 1,4-BQ on intracellular ROS formation, mitochondria damage, and the occurrence of apoptotic events with or without using the ROS scavenger N-acetyl-l-cysteine (NAC). The results demonstrated that 1,4-BQ could dose-dependently induce production of ROS and mitochondrial damage as characterized by mitochondrial membrane potential disruption, mitochondrial ultrastructure alteration, and induced apoptosis and activated caspase-3 and caspase-9. Preincubation of HL-60 cells with NAC prior to 1,4-BQ treatment could block 1,4-BQ-induced production of ROS and the occurrence of apoptosis. These results demonstrated that 1,4-BQ induced apoptosis in HL-60 cells through a ROS-dependent mitochondrial-mediated pathway.
Flight control boosters for three-dimensional trajectory tracking of quadrotor: Theory and experiment
Authors: Bouzid Yasser , Siguerdidjane Houria , Bestaoui Yasmina
Published: March 2018

The performance of any flight control system strictly depends on the feedback control scheme. In this article, two redundant controllers that could be implemented without much difficulty are proposed to boost and improve the capabilities of the popular feedback linearization controller. The first one is built upon the model-free control theory while the second one is based on the sliding mode framework. Herein, the model-free control principle is used to deal with the unknown part of the plant only (i.e. unmodeled dynamics, disturbances, etc.) in addition to the feedback linearization controller that is used instead of the proportional–integral–derivative structure. Unlike the existing sliding mode techniques, the designed one uses an input-dependent sliding surface. An in-depth discussion is highlighted with detailed evaluation in terms of performance, consumed energy, and robustness by considering several scenarios and using several metrics. The numerical simulations have shown satisfactory results considering multi-input multi-output system model through an application to a small quadrotor. The effectiveness of this approach is validated by experimentation.
Moral Identity and Its Links to Ethical Ideology and Civic Engagement
Authors: Sunil Soorya , Verma Sunil K.
Published: March 2018

The study explored the role of moral identity (internalization and symbolization) in the civic engagement (attitude and behaviour) of youth through ethical ideology (idealism). A total of 217 individuals ( M = 22.5, SD = 3.4) comprising of 104 girls and 113 boys completed three scales, namely, moral identity scale, ethics position questionnaire (EPQ) and civic engagement scale.

The results showed that moral identity internalization significantly predicted civic engagement attitude and moral identity symbolization significantly predicted civic engagement behaviour. Furthermore, idealism partially mediated the relationship between moral identity and civic engagement (attitude).
Dispersion of polarized shear waves in viscous liquid over a porous piezoelectric substrate
Authors: Baroi Juhi , Sahu Sanjeev A , Singh Manoj Kumar
Published: March 2018

This article aims to study the propagation of polarized shear horizontal waves in viscous liquid layer resting over a porous piezoelectric half-space. An analytical solution is proposed using the separation of variables method. The dispersion relation is obtained using the proper boundary conditions for both electrically open and short cases in determinant form. The numerical example and graphical representation are provided in support of the findings. Dynamic response of affecting parameters (e.g. layer’s width, mass density, piezoelectric constant, dielectric constant, viscous coefficient, and dielectric coupling between the two phases of the porous aggregate) has been presented through graphs. It is observed that the phase velocity of considered wave remarkably affected by these parameters. Moreover, obtained result is matched with the existing result. Findings may contribute significantly toward optimization of surface acoustic wave devices and other liquid sensors. Moreover, this study may be utilized to frame a theoretical model for the problems of shear horizontal wave propagation in composite structures, involving piezoelectric medium.
A wind energy generation replication method with wind shear and tower shadow effects
Authors: Fu Lei , Wei Yan-ding , Fang Sheng , Tian Geng , Zhou Xiao-jun
Published: March 2018

Wind energy has become one of the most promising renewable energy in recent decades. However, severe rotor oscillations arose by the wind shear and tower shadow effects were not only harmful to the power quality but also threatening to the stability of the energy system. Meanwhile, it is difficult to simulate the effects under the local condition. Therefore, it is indispensable to develop an immersion environment for the wind energy conversion. To cover these requirements, a novel approach to simulate the process of the wind energy generation with wind shear and tower shadow effects is presented. In particular, the replication method is applicable to both fixed and variable speed turbines, for the rotor oscillations synchronizing with the rotations at a constant angle. The equivalent wind speed of the effects contributes to the aerodynamics model as nonstationary time series. For stationary processing the nonstationary signals in the time domain, the analysis of computer order tracking is imported to solve the spectral leakage in the fast Fourier transform spectrum. Finally, based on this method, an immersion environment is realized through two coupled induction motors in an electric closure test bed. Experimental results demonstrate that the proposed replication method is effective and accurate in terms of both static and dynamic performances.
Rule of Law, Violence and Exception: Deciphering the Indian State in the Thangjam Manorama Inquiry Report
Authors: Lokaneeta Jinee
Published: March 2018

In this article, I draw on Nasser Hussain’s conceptualizations on rule of law, violence, and exception to read the Inquiry Commission Report on the torture and murder of Thangjam Manorama in 2004. While clearly the Commission strongly condemns the torture and murder of Manorama, it continues to represent one of the most serious tensions that exist in the context of the rule of law and emergency that Hussain mentions in British colonial times. The Commission report attempts to resolve the tension between political exigencies and rule of law by restricting itself to being a procedural effort to deal with what is essentially a political and national security regime that ends up being curiously reminiscent of colonial reports. In other words, rather than recognizing the role of extraordinary laws such as AFSPA (Armed Forces Special Powers Act) in creating such situations, the report primarily recognizes procedural violations as responsible for the violence against Manorama. The report then ends up being a paternalistic symbolic act that fails to acknowledge the political authority of the state in conflict areas and the regime of impunity created by the very existence of the laws such as the AFSPA.

However, I note that in the postcolonial context, the contestations of hyperlegality also reflect a tension between a rejection of emergency provisions for the Northeast and an inability to embrace excessive violence that the Constitution otherwise prohibits. I argue that the postcolonial state is unable to contain this tension successfully between political exigencies and the rule of law in the Thangjam Manorama case due to the continued demands for accountability by those resisting this law and protesting her and other deaths. Regardless of the intent of the author, the report following this particular death appears to have generated a fissure in the postcolonial legal narrative that reveals the excessive violence embedded in the AFSPA regime that cannot be easily embraced and yet cannot be denied and becoming increasingly difficult to contain and legitimize.
Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection
Authors: Wongsurakiat Phunsup , Tulatamakit Sirapat
Published: March 2018

Background

We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB).

Methods

Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians’ decisions. In the PCT group, antibiotics were stopped if the PCT level on day 8 < 0.5 ng/ml. In the conventional group, antibiotics were stopped according to physicians’ discretion.

Results

There were 24 patients in the PCT group and 26 patients in the conventional group. NF-GNB were responsible for VAP in 79.2% of the PCT group and 65.4% of the conventional group. PCT group had a greater number of antibiotic-free days alive during the 28 days after VAP onset than the conventional group (14.6 ± 5.4 days versus 5.9 ± 5.7 days, respectively; p <.001). In the multivariate, propensity score-adjusted analysis, the PCT group [coefficient = −9.1 (–12.2 to −6); p <.001] and extrapulmonary infections [coefficient = 6.4 (3.3–9.5); p <.001] were independent predictors of total antibiotic exposure days. There was no relapse in both groups. Meanwhile, 12.5% of the PCT group and 26.9% of the conventional group subsequently developed recurrent VAP compatible with superinfections.

Conclusions

CPIS and a spot serum PCT level appeared effective and safe to guide discontinuation of antibiotic treatment in patients with VAP caused by NF-GNB.

Trial registration:

TCTR20160726002
Dupuytren’s Contracture With Heterotopic Ossification
Authors: MacInnis Natasha M. , Gillis Joshua A. , Paletz Justin
Published: March 2018

Heterotopic ossification (HO), the formation of ectopic lamellar bone in soft tissues, is often reported in the literature as a result of trauma, orthopaedic procedures, burns, or neurological injury. One previous case describes finding HO within a Dupuytren contracture. As this finding was during a surgical case, no preoperative images were captured. We report a case of a 61-year-old male who demonstrated HO of the left fifth digit on radiography, intraoperatively, and confirmed by histology.
MEDPOR Nipple Implant Causing Failure of Previously Stable Breast Implant
Authors: Zhang Zach , Allen Murray , Boyd Kirsty U.
Published: March 2018

Reconstruction of the nipple–areolar complex usually marks the final stage of breast reconstruction in postmastectomy patients. There are many approaches to the nipple reconstruction using autologous, allogenic, and synthetic materials. However, different methods have their own pros and cons and there is no current consensus for the best technique. A review of the literature showed that there is a low level of evidence for synthetic material–based nipple reconstruction providing the best nipple projection, but it is also associated with more complication. We present a case where revision of nipple reconstruction with MEDPOR implant overlying an implant-based breast reconstruction preceded the loss of both the nipple and breast construction secondary to infection.
Pilot Study of Personalized Video Visit Summaries for Patients With Cancer
Authors: Krauss John C. , Sahai Vaibhav , Kirch Matthias , Simeone Diane M. , An Lawrence
Published: March 2018

Purpose

The treatment of cancer is complex, which can overwhelm patients and lead to poor comprehension and recall of the specifics of the cancer stage, prognosis, and treatment plan. We hypothesized that an oncologist can feasibly record and deliver a custom video summary of the consultation that covers the diagnosis, recommended testing, treatment plan, and follow-up in < 5 minutes. The video summary allows the patient to review and share the most important part of a cancer consultation with family and caregivers.

Methods

At the conclusion of the office visit, oncologists recorded the most important points of the consultation, including the diagnosis and management plan as a short video summary. Patients were then e-mailed a link to a secure Website to view and share the video. Patients and invited guests were asked to respond to an optional survey of 15 multiple-choice and four open-ended questions after viewing the video online.

Results

Three physicians recorded and sent 58 video visit summaries to patients seen in multidisciplinary GI cancer clinics. Forty-one patients logged into the secure site, and 38 viewed their video. Fourteen patients shared their video and invited a total of 46 visitors, of whom 36 viewed the videos. Twenty-six patients completed the survey, with an average overall video satisfaction score of 9 on a scale of 1 to 10, with 10 being most positive.

Conclusion

Video visit summaries provide a personalized education tool that patients and caregivers find highly useful while navigating complex cancer care. We are exploring the incorporation of video visit summaries into the electronic medical record to enhance patient and caregiver understanding of their specific disease and treatment.
Out of Sight, Out of Mind? Measuring the Relationship between Privatization and Medicaid Self-Reporting
Authors: Tallevi Ashley
Published: March 2018

Privatization has grown exponentially, both in salience and in form, over the past several decades. This shifting of administrative authority away from the state can make it difficult for program recipients to link their use of a federal program back to government, a disconnect known as “submerging” the state. However, privatization is a process that occurs in degrees, and not all privatization initiatives look alike. This study leverages variation in the implementation of Medicaid managed care, which is the most widespread form of Medicaid privatization, to examine how privatization maps onto state submersion and affects state visibility. This analysis shows that, although Medicaid managed care enrollment, at large, does not relate to recipients' self-reported Medicaid enrollment, when privatized Medicaid plans introduce administrative designs that obscure the role of government, Medicaid self-reporting declines. These findings demonstrate that policy recipients are less able to recognize both the personal relevance of a specific public program and the public nature of this interaction when privatized programs utilize design features that attenuate signals of government involvement. In highlighting this disconnect, this article shows how privatization makes it more difficult for policy recipients to engage in the civic sphere as informed advocates for their self-interest.
How Intense Policy Demanders Shape Postreform Politics: Evidence from the Affordable Care Act
Authors: Rocco Philip , Haeder Simon F.
Published: March 2018

The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that “intense policy demanders” played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda.
State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits
Authors: Singh Simone R. , Young Gary J. , Loomer Lacey , Madison Kristin
Published: March 2018

Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009–11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals.
Influence of Estradiol Status on Physical Activity in Premenopausal Women
Authors: MELANSON EDWARD L. , LYDEN KATE , GIBBONS ELLIE , GAVIN KATHLEEN M. , WOLFE PAMELA , WIERMAN MARGARET E. , SCHWARTZ ROBERT S. , KOHRT WENDY M.
Published: March 2018

Purpose

This study aimed to determine the effects of 5 months of ovarian hormone suppression in premenopausal women on objectively measured physical activity (PA).

Methods

Participants (age, 35 ± 8 yr; body mass index, 27 ± 6 kg·m−2) received monthly intramuscular injections of gonadotropin-releasing hormone agonist (GnRHAG) therapy, which suppresses pituitary gonadotropins and results in suppression of ovarian sex hormones. Women were randomized to receive concurrent transdermal E2 (GnRHAG + E2; n = 30) or placebo (GnRHAG + PL, n = 31). PA was assessed for 1 wk before and during each month of the 5-month intervention using a hip-worn accelerometer (Actical, Mini Mitter Co., Inc., Bend, OR). Estimates of time spent in sedentary, light, and moderate-to-vigorous PA (MVPA) were derived using a previously published equation. Subsets of participants in each group were also randomized to a supervised progressive resistance exercise training program.

Results

Total MVPA tended toward being higher (P = 0.08) in the GnRHAG + E2 group at month 4. There were no significant effects of intervention or time in sedentary or light PA. In the subset of women who did not participate in structured exercise training for which Actical data were obtained (n = 16 in each group), total MVPA was higher at month 4 (P = 0.01).

Conclusions

PA levels seem to be maintained at a higher level in women undergoing pharmacological suppression of ovarian function with E2 add-back when compared with women treated with placebo. These data provide proof-of-concept data that E2 contributes to the regulation of PA in humans. However, given the exploratory nature of this study, future confirmatory investigations will be necessary.
The utility of contrast-enhanced hypodense sign for the diagnosis of pulmonary invasive mould disease in patients with haematological malignancies
Authors: Sassi Claudia , Stanzani Marta , Lewis Russell E , Facchini Giancarlo , Bazzocchi Alberto , Cavo Michele , Battista Giuseppe
Published: March 2018

Objective:

The hypodense sign (HyS) on CT imaging is highly suggestive of pulmonary invasive mould disease (IMD) in patients with haematological malignancies, but its diagnostic utility has not been systematically evaluated on contrast-enhanced CT. The objective of this study was to compare the diagnostic performance of the HyS to other common CT findings in a cohort of haematology patients with proven, probable or possible IMD based on European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.

Methods:

We analysed the diagnostic performance of the HyS to other common CT signs among 127 neutropenic patients with haematological malignancies submitted to both non-contrast-enhanced and contrast-enhanced CT scans of the lungs, including CT pulmonary angiography.

Results:

The HyS was detected in 15.7% of patients imaged without contrast, and 44.1% after contrast administration. A contrast-aided HyS was detected in 86.6, 78.0 and 15.5% of patients with European Organization for Research and Treatment of Cancer/Mycoses Study Group proven, probable and possible IMD, respectively. When analysed per clinical diagnosis (proven, probable and highly possible IMD—i.e. no alternative diagnosis to mould disease reached), the contrast-enhanced HyS was as sensitive as the halo sign but significantly more specific [halo sign 0.56, 95% CI (0.39–0.71) vs HyS 0.98, 95% CI (0.87–1.00)]. Only the vessel occlusion sign was more sensitive [0.97, 95% CI (0.91–0.99)] and specific [0.97, 95% CI (0.86–0.99)] than the HyS for IMD diagnosis.

Conclusion:

The high specificity of the HyS strongly supports the diagnosis of pulmonary IMD in neutropenic patients, and is highly suggestive breakthrough fungal disease in patients on mould-active antifungal prophylaxis.

Advances in knowledge:

This is the first systematic analysis of the hypodense sign on contrast-enhanced CT; the sign can support the diagnosis of IMD when other CT signs are uncertain.
Impact of Allura Clarity Technology on Radiation Dose Exposure During Left Atrial Appendage Closure
Authors: Studzińska Emilia , Staniszewska Maria Anna
Published: March 2018

Background: To evaluate the impact of the Clarity IQ technology on reducing radiation risk in patients undergoing cardiac interventional radiology (IR) procedures.

Material/Methods: Phantom studies were performed with two angiographic systems, FD10 Allura Xper and FD10 Allura Clarity. In the study, we performed left atrial appendage closure. Dosimetric measurements were performed with thermoluminescent dosimeters (TLD) placed inside a CIRS anthropomorphic phantom. Radiation risk was estimated based on the TLD readings and expressed as the dose absorbed by particular organs. The Mann–Whitney U test was carried out to test for significance of differences in the absorbed radiation doses between the techniques.

Results: During left atrial appendage closure, the estimated dose absorbed by particular organs was lower in the case of the FD10 Allura Clarity system in comparison to the Allura Xper. In this procedure, dose reduction for particular organs ranged between 49–86%.

Conclusions: Application of the FD10 Allura Clarity system resulted in a significant dose reduction, thereby leading to a significant decrease in radiation risk for patients undergoing IR procedures.
Role of Diffusion-Weighted Magnetic Resonance (MR) Imaging in Differentiation Between Graves’ Disease and Painless Thyroiditis
Authors: Razek Ahmed Abdel Khalek Abdel , Allah Sieza Samir Abd , El-Said Amr Abd El-hamid
Published: March 2018

Background: To assess the role of diffusion-weighted MR imaging in differentiation between Graves’ disease and painless thyroiditis.

Material/Methods: A prospective study was conducted among 37 consecutive patients with untreated thyrotoxicosis (25 female and 12 male; mean age of 44 years) and 15 age- and sex-matched controls. Diffusion- weighted MR imaging of the thyroid gland was performed in patients and controls. The apparent diffusion coefficient (ADC) value of the thyroid gland was calculated and correlated with Tc-99m uptake and thyroid function tests of the patients.

Results: There was a significant difference in the ADC value of the thyroid gland between patients and the control group (P=0.001). The mean ADC value of the thyroid gland in Graves’ disease was 2.03±0.28×10–3 mm2/sec, and in patients with painless thyroiditis 1.46±0.22×10–3 mm2/sec, respectively. There was a significant difference in the ADC values between Graves’ disease and painless thyroiditis (P=0.001). When the ADC value of 1.45×10–3 mm2/sec was used as a threshold value for differentiating Graves’ disease from painless thyroiditis, the best result was obtained with area under the curve of 0.934, accuracy of 83.8%, sensitivity of 95.8%, and specificity of 61.5%. The mean ADC value of the thyroid gland in patients positively correlated with serum TRAb and Tc-99m uptake (r=0.57, P=0.001 and r=0.74, P=0.001, respectively).

Conclusions: We concluded that ADC values of the thyroid gland can be used to differentiate Graves’ disease from painless thyroiditis in patients with untreated thyrotoxicosis.
Imaging Diagnosis of Chronic Encapsulated Intracerebral Hematoma, a Comparison of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) characteristics
Authors: Cai Sainan , Zhou Bing , Liao Haiyan , Tan Changlian
Published: March 2018

Background: Chronic encapsulated intracerebral hematoma (CEICH) is a rare type of intracerebral hematoma that is often misdiagnosed. To explore the characteristics of CEICH on computerized tomography (CT) and magnetic resonance imaging (MRI).

Material/Methods: Clinical, CT, MRI, and susceptibility weighted imaging (SWI) data of 5 patients who were diagnosed with CEICH on surgery and pathology were retrospectively analyzed.

Results: CT showed quasi-circular or elliptical lesions with clear borders in all 5 cases and iso-density or low-density in the center of lesions that were surrounded by peripheral edema in 2 cases. CT showed mass effect in 5 patients. On contrast-enhanced CT, 2 cases exhibited mild ring enhancement, and 3 cases exhibited moderate ring enhancement. MRI showed cystic lesions with high uniform signal on T1-weighted images (T1WI) and T2-weighted images (T2WI), a lowsignal ring sign on the coated cystic lesions on T2WI, a lower signal ring sign on SWI, and ring enhancement after administration of contrast.

Conclusions: CT imaging of CEICH did not reveal any typical characteristics in the studied patients. MRI showed an envelope with a “ring” and intra-capsular bleeding features. MRI is an effective imaging modality for the diagnosis of CEICH.
Diffusion-Weighted Imaging in the Oral and Maxillofacial Region: Usefulness of Apparent Diffusion Coefficient Maps and Maximum Intensity Projection for Characterization of Normal Structures and Lesions
Authors: Ogura Ichiro , Sasaki Yoshihiko , Kameta Ayako , Sue Mikiko , Oda Takaaki
Published: March 2018

Background: The aim of this study was to investigate diffusion-weighted imaging (DWI) in the oral and maxillofacial region, with a special focus on the usefulness of apparent diffusion coefficient (ADC) maps and maximum intensity projection (MIP) for characterization of normal structures and lesions.

Material/Methods: Thirty-five patients who underwent magnetic resonance imaging (MRI) for diagnosis of oral and maxillofacial lesions were included in this prospective study. DWI was performed on a 1.5 T unit, with b factor of 0 and 800 s/mm2; moreover, ADC maps were generated. ADC values were measured for normal structures, odontogenic infections, squamous cell carcinomas (SCC), and hemangiomas.

Results: As regards the normal structures, the mean ADC value of the cerebrospinal fluid (3.65±0.60×10–3 mm2/s) in the upper neck area was higher than that of the spinal cord (0.74±0.15×10–3 mm2/s, P=0.000), lymph nodes (0.87±0.17×10–3 mm2/s, P=0.000), and Waldeyer’s ring (0.92±0.29×10–3 mm2/s, P=0.000). The mean ADC value of hemangiomas (1.52±0.31×10–3 mm2/s) was higher than that of odontogenic infections (0.85±0.36×10–3 mm2/s, P=0.034) and SCC (1.38±0.22×10–3 mm2/s, P=0.840). Furthermore, MIP (DWI) showed the normal structures and lesions in the oral and maxillofacial region in an improved way.

Conclusions: DWI, ADC maps, and MIP can be used to characterize and differentiate normal structures and lesions in the oral and maxillofacial region.
Real-Time Elastography for Differentiation of Breast Lesions
Authors: Yılmaz Ebru , Yılmaz Ayhan , Aslan Ahmet , Inan Ibrahim , Evren Mujgan Calıskan , Tekesin Kemal
Published: March 2018

Background: To investigate the diagnostic performance of the elastography-based strain index ratio in the differential diagnosis of malignant and benign breast lesions.

Material/Methods: Seventy-nine breast masses that were classified as BI-RADS category 3, 4, and 5 on B-mode ultrasonography (US) were further prospectively evaluated by real-time sonoelastography (RTE). To obtain an optimal cut-off value of the strain ratio for differentiating between malignant and benign breast lesions, RTE findings were compared with histopathology of core needle biopsy samples or with ultrasound follow-up data of the analyzed masses.

Results: Seventy-nine breast lesions [BI-RADS category 3 (n=15), BI-RADS category 4 (n=34), and BI-RADS category 5 (n=30)] were classified as malignant (n=36) or benign (n=43). The mean strain index value was 6.59±3.44 (range 0.6–14) for malignant lesions and 2.79±2.16 (range 0.6–8.7) for benign lesions, respectively (p<0.05). As regards the detection of malignant lesions, US was characterized by sensitivity and specificity of 100% (CI 95%; 88–100) and 90% (CI 95%; 76–97), respectively. When an optimal value of the strain ratio (4.25) was obtained by ROC curve analysis, the sensitivity and specificity for diagnosing malignant lesions were 86% (CI 95%; 70–95) and 76% (CI 95%; 60–87), respectively.

Conclusions: RTE can play an important role in the differentiation between malignant and benign breast masses, but it should be used in conjunction with ultrasonography.
Ultrasound is Not Useful as a Screening Tool for Dengue Fever
Authors: Parmar Jitendra , Mohan Chander , Kumar G. Prem , Vora Maulik
Published: March 2018

Background: Dengue fever is a tropical disease that is transmitted by female Aedes Aegypti mosquitos. Early diagnosis is necessary to reduce the mortality and morbidity associated with the disease. A combination of clinical, laboratory, and sonography findings can be potentially helpful in making an early diagnosis of dengue fever. There is paucity of literature on the use of ultrasound for dengue fever screening; hence, the primary objective of the study was to evaluate the utility of ultrasound as a screening tool in dengue fever.

Material/Methods: A total of 160 patients of suspected dengue fever were included in the study. They underwent ultrasound examinations in order to search for thickening of the gallbladder wall, pleural effusion, and ascites. On the basis of ultrasound findings, 65 cases were positive and 95 cases were negative for dengue fever. Serological tests were also used for diagnosing dengue fever, 93 cases were seropositive and 67 cases were seronegative. The ultrasonically diagnosed cases were compared with serologically diagnosed cases, and appropriate descriptive statistical analyses were applied.

Results: The ultrasound findings included gall bladder wall thickening in 66 patients (41.2%). The sensitivity, specificity, and positive predictive value of ultrasound in diagnosing dengue fever were 58%, 84%, and 83%, respectively. The negative predictive value and accuracy were 59% and 68.8%, respectively.

Conclusions: The present study suggests that increased gall bladder wall thickness, pleural effusion, ascites, hepatomegaly, and splenomegaly are highly suggestive of dengue fever in clinically suspected cases. However, ultrasound should not be used as a screening tool, as negative ultrasound findings cannot rule out dengue fever due to the low sensitivity of this examination.
Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement
Authors: Ghobrial Fady Emil Ibrahim , Eldin Manal Salah , Razek Ahmed Abdel Khalek Abdel , Atwan Nadia Ibrahim , Shamaa Sameh Sayed Ahmed
Published: March 2018

Background: To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer.

Material/Methods: A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1).

Results: Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good (k=0.793, percent agreement of 89.29%).

Conclusions: We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).