bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke
Authors: Roche Adam , Griffin Emma , Looby Seamus , Brennan Paul , O’Hare Alan , Thornton John , Boyle Karl , Williams David , Moynihan Barry , Power Sarah
Published: April 2019

Background

Mechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.

Methods and materials

A review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 – August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.

Results

Eleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b–3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.

Conclusion

This case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.
Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial
Authors: Gilmore Christopher , Ilfeld Brian , Rosenow Joshua , Li Sean , Desai Mehul , Hunter Corey , Rauck Richard , Kapural Leonardo , Nader Antoun , Mak John , Cohen Steven , Crosby Nathan , Boggs Joseph
Published: April 2019

Background and objectives

Chronic neuropathic pain is a common challenging condition following amputation. Recent research demonstrated the feasibility of percutaneously implanting fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves for postamputation pain. A multicenter, double-blinded, randomized, placebo-controlled study collected data on the safety and effectiveness of percutaneous PNS for chronic neuropathic pain following amputation.

Methods

Twenty-eight lower extremity amputees with postamputation pain were enrolled. Subjects underwent ultrasound-guided implantation of percutaneous PNS leads and were randomized to receive PNS or placebo for 4 weeks. The placebo group then crossed over and all subjects received PNS for four additional weeks. The primary efficacy endpoint evaluated the proportion of subjects reporting ≥50% pain reduction during weeks 1–4.

Results

A significantly greater proportion of subjects receiving PNS (n=7/12, 58%, p=0.037) demonstrated ≥50% reductions in average postamputation pain during weeks 1–4 compared with subjects receiving placebo (n=2/14, 14%). Two subjects were excluded from efficacy analysis due to eligibility changes. Significantly greater proportions of PNS subjects also reported ≥50% reductions in pain (n=8/12, 67%, p=0.014) and pain interference (n=8/10, 80%, p=0.003) after 8 weeks of therapy compared with subjects receiving placebo (pain: n=2/14, 14%; pain interference: n=2/13, 15%). Prospective follow-up is ongoing; four of five PNS subjects who have completed 12-month follow-up to date reported ≥50% pain relief.

Conclusions

This work demonstrates that percutaneous PNS therapy may provide enduring clinically significant pain relief and improve disability in patients with chronic neuropathic postamputation pain.

Trial registration number

NCT01996254.
Characterization of silty soil thin layering and groundwater conditions for liquefaction assessment
Authors: Beyzaei Christine Z. , Bray Jonathan D. , Cubrinovski Misko , Bastin Sarah , Stringer Mark , Jacka Mike , van Ballegooy Sjoerd , Riemer Michael , Wentz Rick
Published: April 2019

Tools for characterizing thin layering and groundwater table conditions are evaluated at silty soil sites being assessed for liquefaction. Thin interlayered stratigraphy and groundwater table fluctuation are two potential causes for inconsistencies observed during the Canterbury earthquake sequence, wherein liquefaction did not manifest at several silty soil sites, despite simplified liquefaction assessment procedures indicating severe manifestations would be expected. Site investigations should capture these features to allow for improved assessment of liquefaction potential at silty soil sites. Cone penetration tests (CPTs), mini-CPTs, and sonic borings do not adequately capture thin layering. However, detailed logging of high-quality samples captures the actual in situ layering that may help explain the limitations of simplified liquefaction assessment procedures at these sites, revealing the need to understand underlying limitations in current site investigation techniques. Piezometers, sonic borings, high-quality sampling, crosshole testing, and regional groundwater maps are evaluated to assess their ability to capture complex groundwater conditions. Multiple groundwater measurement methods are typically required to characterize groundwater fluctuations. An approach to using enhanced site characterization tools is recommended for liquefaction assessments at silty soil sites with thin layering and groundwater fluctuations.
Calibration of the zooplankton community size spectrum as an indicator of change in Canadian Shield lakes
Authors: Barth Lauren Emily , Shuter Brian John , Sprules William Gary , Minns Charles Kenneth , Rusak James Anthony
Published: April 2019

Developing the crustacean zooplankton community size spectrum into an indicator of change in lakes requires quantification of the natural variability in the size spectrum related to broad-scale seasonal, annual, and spatial factors. Characterizing seasonal patterns of variation in the size spectrum is necessary so that monitoring programs can be designed to minimize the masking effects that seasonal processes can have on detecting longer-term temporal change. We used a random effects model to measure monthly, annual, and interlake variability in the slope (i.e., relative abundance of small and large organisms) and centered height (i.e., total abundance) of the crustacean zooplankton normalized abundance size spectrum from 1981 to 2011 among eight Canadian Shield lakes. Consistent with theoretical predictions, the slope was a relatively stable characteristic of the zooplankton community compared with the height, which varied significantly among lakes. We identified a seasonal signal in height and slope and used a mixed effects model to characterize the linear rate of change from May to October; there was an overall decline in height and an overall increase in slope. Seasonal variance was greater than annual variance for both the height and the slope, suggesting that long-term monitoring of lakes and interlake comparisons using zooplankton size spectra should be based on temporally standardized sampling protocols that minimize the effects of seasonal processes. We recommend sampling the zooplankton community in midsummer because this results in size spectrum estimates close to seasonal mean values.
On a Diophantine equation with prime numbers
Authors: Li Sanhua
Published: April 2019

Let [Formula: see text] denote the integral part of the real number [Formula: see text]. In this paper, it is proved that for [Formula: see text], the Diophantine equation [Formula: see text] is solvable in prime variables [Formula: see text] for sufficiently large integer [Formula: see text].
FINANCIAL INTERMEDIARIES’ ASSET–LIABILITY DEPENDENCY AND LOW-INTEREST-RATE ENVIRONMENT: EVIDENCE FROM EU LIFE INSURERS
Authors: CURCIO DOMENICO , BORRI NICOLA , CERRONE ROSARIA , COCOZZA ROSA
Published: April 2019

This research studies the relationships between the two sides of life insurers’ balance sheet and investigates whether and how they changed during recent past years, when European Central Bank monetary policy drove market rates to unprecedented low levels. By using a canonical correlation analysis, we study the internal structure of the links within and between the asset and liability sides of 24 major European Union (EU) life insurers’ balance sheets over the 2007–2015 time horizon.

We find strong and substantial evidence that life insurers’ assets and liabilities have become more independent over time. We argue that the declining trend of market interest rates has contributed to the generalized reduction in the linkage between the asset side and the liability side of EU life insurers, and has made insurance companies more exposed to ALM-related risks relative to the period before the financial crisis.
Spontaneous Flexor Tendon Rupture due to Primary Distal Radioulnar Joint Osteoarthritis
Authors: Hashimoto Akira , Sonohata Motoki , Senba Hideyuki , Mawatari Masaaki
Published: April 2019

Spontaneous flexor tendon rupture is rare, occurring most commonly in the little finger or flexor pollicis longus. To the best of our knowledge, there have been no reports of spontaneous flexor tendon rupture due to primary distal radioulnar joint (DRUJ) osteoarthritis (OA). We present a case of spontaneous flexor tendon rupture in the index finger due to primary DRUJ OA in a 71-year-old female farmer. Surgical exploration confirmed that, at the wrist joint level, the flexor digitorum profundus of the index finger had undergone degeneration and complete rupture. The flexor digitorum superficialis of the index finger was elongated and thinned. A bony spur toward the volar side was covered with synovial fluid from a pinhole-sized perforation of the capsule. The combination of direct friction from the DRUJ spur and the matrix metalloproteinases in the synovial fluid from the perforation of the DRUJ capsule may have caused the spontaneous flexor tendon rupture. Palmar-side symptoms associated with DRUJ OA should be carefully examined because of the risk of spontaneous flexor tendon rupture.
Quadricuspid Aortic Valve: Report of Two Cases and Brief Review
Authors: Oladiran Oreoluwa , Nwosu Ifeanyi , Dhital Rashmi , Ezioma Gbujie
Published: April 2019

Quadricuspid aortic valve (QAV) is a rare congenital cardiac defect characterized by the presence of four aortic valve leaflets of equal or varying sizes. Even rarer is its clinical presentation with aortic stenosis. Diagnosis of QAV could be challenging but is of great importance as patients often present with progressive aortic regurgitation. We present 2 cases of QAV presenting differently: one with aortic stenosis requiring valve replacement and the other with aortic regurgitation requiring close monitoring.
Morphological and Immunophenotypic Clues to the WHO Categories of Acute Myeloid Leukaemia
Authors: Bain Barbara J. , Béné Marie C.
Published: April 2019

Diagnosis and classification of acute myeloid leukaemia (AML) require cytogenetic and molecular genetic investigation. However, while these evaluations are pending, morphology supplemented by immunophenotyping can provide clues to the diagnosis of specific cytogenetic/genetic categories of AML. Most importantly, acute promyelocytic leukaemia can be diagnosed with a high degree of certainty. However, provisional identification of cases associated with t(8; 21), inv(16), t(1; 22), and NPM1 mutation may also be possible. In addition, transient abnormal myelopoiesis of Down’s syndrome can generally be diagnosed morphologically.
Impact of Smoking Status on Stroke Recurrence
Authors: Chen Jingjing , Li Shun , Zheng Kuo , Wang Huaiming , Xie Yi , Xu Pengfei , Dai Zhengze , Gu Mengmeng , Xia Yaqian , Zhao Min , Liu Xinfeng , Xu Gelin
Published: April 2019

Background

Smoking is a well‐established risk factor of stroke and smoking cessation has been recommended for stroke prevention; however, the impact of smoking status on stroke recurrence has not been well studied to date.

Methods and Results

Patients with first‐ever stroke were enrolled and followed in the NSRP (Nanjing Stroke Registry Program). Smoking status was assessed at baseline and reassessed at the first follow‐up. The primary end point was defined as fatal or nonfatal recurrent stroke after 3 months of the index stroke. The association between smoking and the risk of stroke recurrence was analyzed with multivariate Cox regression model. At baseline, among 3069 patients included, 1331 (43.4%) were nonsmokers, 263 (8.6%) were former smokers, and 1475 (48.0%) were current smokers. At the first follow‐up, 908 (61.6%) patients quit smoking. After a mean follow‐up of 2.4±1.2 years, 293 (9.5%) patients had stroke recurrence. With nonsmokers as the reference, the adjusted hazard ratios for stroke recurrence were 1.16 (95%
CI
, 0.75–1.79) in former smokers, 1.31 (95%
CI
, 0.99–1.75) in quitters, and 1.93 (95%
CI
, 1.43–2.61) in persistent smokers. Among persistent smokers, hazard ratios for stroke recurrence ranged from 1.68 (95%
CI
, 1.14–2.48) in those who smoked 1 to 20 cigarettes daily to 2.72 (95%
CI
, 1.36–5.43) in those who smoked more than 40 cigarettes daily (
P
for trend <0.001).

Conclusions

After an initial stroke, persistent smoking increases the risk of stroke recurrence. There exists a dose–response relationship between smoking quantity and the risk of stroke recurrence.
Prevalence of Unexplained Left Ventricular Hypertrophy by Cardiac Magnetic Resonance Imaging in MESA
Authors: Massera Daniele , McClelland Robyn L. , Ambale‐Venkatesh Bharath , Gomes Antoinette S. , Hundley W. Gregory , Kawel‐Boehm Nadine , Yoneyama Kihei , Owens David S. , Garcia Mario J. , Sherrid Mark V. , Kizer Jorge R. , Lima Joao A. C. , Bluemke David A.
Published: April 2019

Background

Hypertrophic cardiomyopathy is defined as unexplained left ventricular (
LV
) hypertrophy (wall thickness ≥15 mm) and is prevalent in 0.2% of adults (1:500) in population‐based studies using echocardiography. Cardiac magnetic resonance imaging (
MRI
) allows for more accurate wall thickness measurement across the entire ventricle than echocardiography. The prevalence of unexplained
LV
hypertrophy by cardiac
MRI
is unknown.
MESA
(Multi‐Ethnic Study of Atherosclerosis) recruited individuals without overt cardiovascular disease 45 to 84 years of age.

Methods and Results

We studied 4972 individuals who underwent measurement of regional
LV
wall thickness by cardiac
MRI
as part of the
MESA
baseline exam. American Heart Association criteria were used to define
LV
segments. We excluded participants with hypertension,
LV
dilation (≥95% predicted end‐diastolic volume) or dysfunction (ejection fraction ≤50%), moderate‐to‐severe left‐sided valve lesions by cardiac
MRI
, severe aortic valve calcification by cardiac computed tomography (aortic valve Agatston calcium score >1200 in women or >2000 in men), obesity (body mass index >35 kg/m
2
), diabetes mellitus, and current smoking. Sixty‐seven participants (aged 64±10 years, 9% female) had unexplained
LV
hypertrophy (wall thickness ≥15 mm in at least 2 adjacent
LV
segments), representing 1.4% (1 in 74) participants, 2.6% of men and 0.2% of women. Prevalence was similar across categories of race/ethnicity. Hypertrophy was focal in 17 (25.4%), intermediate in 44 (65.7%), and diffuse in 5 (7.5%) participants.

Conclusions

The prevalence of unexplained
LV
hypertrophy in a population‐based cohort using cardiac
MRI
was 1.4%. This may have implications for the diagnosis of patients with hypertrophic cardiomyopathy and will require further study.
Heterogeneous Government Spending Multipliers in the Era Surrounding the Great Recession
Authors: Bernardini Marco , De Schryder Selien , Peersman Gert
Published: April 2019

We use novel quarterly data of U.S. states to examine the dynamics of relative spending multipliers in the decade surrounding the Great Recession. While multipliers were around 1 in expansions, they reached values above 4 when a state was in a recession. Also a high (low) degree of household indebtedness augmented (lowered) a state's multiplier by 0.5 in expansions and 2 in recessions. We further document modest positive spillover effects across states and show that a mere redistribution of spending across states also had a significant influence on the aggregate U.S. economy due to cross-state heterogeneity of the effects.
Key to the non-fossil species of the genus Taeniothrips (Thysanoptera, Thripidae)
Authors: MOUND L. A. , AZIDAH A. A. , NG Y. F.
Published: April 2019

A table is provided of the 24 non-fossil species currently listed in Taeniothrips. One species, pediculae, is clearly not a member of this genus, dealatus and sexnotatus remain nomina dubia, and angustiglandus is unrecognisable having been based on males only. A key is provided to the remaining 20 species of the genus, including Taeniothrips damansarae sp.n. from Malaysia that has unique setal apices. Many of these 20 species involve recognition problems that are discussed based largely on type material.
Reduction of Peak-to-Average Power Ratio in Orthogonal Frequency Division Multiplexing System Using Haar Wavelet Approach
Authors: Rajasekhar K. , Rao Prabhakara B.
Published: April 2019

In Orthogonal Frequency Division Multiplexing (OFDM) based systems, with the increasing demand for data rate and reliability in Wireless communications and devices, several issues become very important like bandwidth efficiency, quality of service and radio coverage. However, OFDM is
very sensitive to nonlinear effects due to the high peak-to-average power ratio (PAPR) owned by the transmitted signals and does not show robustness to spectral null channels. This paper proposes a novel BPSK OFDM system based on Haar wavelet transformation. The PAPR reduced by 10 log10
2 ≈ 3 dB at most, compared with the conventional OFDM system and shows robustness to spectral null channels, improving BER performance 3 dB at most. Finally, theoretical and simulated results of the Cumulative Distribution Functions (CDFs) of both Conventional and Proposed OFDM are compared
to show that the Proposed OFDM has better performance than the Conventional OFDM.
Minimizing Energy Consumption Based on Neural Network in Clustered Wireless Sensor Networks
Authors: Vadivelan N. , Ramamurthy A. , Padmaja P.
Published: April 2019

Wireless sensor networks were organized with the collections of sensor nodes for the purpose of monitoring physical phenomenon such as temperature, humidity and seismic events, etc., in the real world environments where the manual human access is not possible. The major tasks of this
type of networks are to route the information to sink systems in the sensor network from sensor nodes. Sensors are deployed in a large geographical area where human cannot enter such as volcanic eruption or under the deep sea. Hence sensors are not rechargeable and limited with battery backup;
it is very complicated to provide the continuous service of sending information to sink systems from sensor nodes. To overcome the drawback of limited battery power, this paper proposes the concept of minimizing energy consumption with the help of neural networks. The modified form of HRP
protocol called energy efficient HRP protocol has been implemented in this paper. Based on this concept, the workload of cluster head is shared by the cluster isolation node in order to increase the lifetime of the cluster head node. Also cluster monitoring node is introduced to reduce the
re-clustering process. The implementation procedure, algorithm, results and conclusions were proved that the proposed concept is better than the existing protocols.
Cloud Data Center Based Dynamic Optimizing Replica Migration
Authors: Narmadha T. , Gowrishankar J. , Ramkumar M. , Vengatesan K.
Published: April 2019

Cloud Storage Providers (CSPs) over topographically scattered data stores furnishing a few storage classes with various costs. An imperative issue looked by application providers is the means by which to misuse value contrasts crosswise over data stores to limit the financial cost of
utilizations that incorporate problem area objects that are acquired much of the time and spot objects that are regularly becoming to far less. This financial cost comprises of reproduction, creation, storage, Put, Get, and potential migration costs. To advance such costs, we initially propose
the ideal arrangement that uses dynamic and direct programming methods with the supposition that the workload on objects is known ahead of time. We likewise star represents a lightweight heuristic arrangement, motivated from a rough algorithm for the Set Covering Problem, which does not make
any presumption on the object workload. This arrangement together decides object imitations area, object reproductions migration times, and redirection of Get (read) solicitations to object copies with the goal that the fiscal cost of data storage administration is improved while the client
saw idleness is fulfilled.
Integrated Security System for Residential Home
Authors: Saranya G. , Senthamilarasi C. , Vidhya B.
Published: April 2019

In today's growing concern for home security, we have developed an advanced security system using integrated digital signature and DNA cryptography. The digital signature is formed using multifeature biometric traits which include both fingerprints as well as iris image. We further
increase the security by using DNA cryptography which is embedded on a smart card. In order to prevent unauthorized access manually or digitally, we use geo-detection which compares the unregistered devices location with the user's location using any of their personal devices such as smart
phone or tab.
Quality of Service Aware Resource Allocation Using Hybrid Opposition-Based Learning-Artificial Bee Colony Algorithm
Authors: Shameer A. P. , Subhajini A. C.
Published: April 2019

In the recent days the Cloud Computing is the top most challenging and upcoming topic and is more being used in corporate IT industry. The rapid growth of IT trade is strongly varying and is not sufficient enough to handle big data. In the recent trend is to transfer all types of data
from desk top to huge data centers for computing. This model is quite different and services provided to the end user based on pay-as-you-use model to public and provide dynamic resource allocation for guaranteed services to the user. The proper allocation of resources is one of the major
issues in cloud computing. The term resource management is the process of share out existing resources and helps to coordinate IT resources and application over the internet. The objective of the successful resource allocation is to minimizing the costs benefits for providers and achieving
client happiness. One of the foremost issues in cloud is proper resource allocation. In this paper, hybrid OBL and ABC algorithm is used to find out reliable RA problems in cloud workflow. Usually RA is a troublesome optimization problem. In our work we aim to consider QoS requirements and
issues. QOS parameter like execution time, response time, throughput, cost as taken in our algorithm and tries to allocate the resource in efficient manner. The algorithms were executed maximum 50 times with different VM and task. The proposed algorithm were compared with the existing PSO,
GA and ABC and the Cloudsim simulation output prove that OABC algorithm performed improved against existing algorithms. The output shows better allocation to achieve QoS with customer satisfaction as well ensuring an optimum resources use.
Tensile and Wear Behaviour of Aluminium Alloy LM6 Reinforced with Magnesium and Copper
Authors: Rubesh Prabhu G. , Jayaseelan P. , Sahu Mona
Published: April 2019

The aim of this research is to fabricate aluminum based metal matrix composite and reviewing its tensile strength and wear behavior of produced test specimen. In this work an attempt is made to develop an aluminium based MMCs with reinforcing material and stir casting technique has
been used to achieve this. Aluminum alloy (LM6) and Magnesium (Mg), Copper (Cu) was chosen as metal matrix and composite materials respectively, tensile and wear experiments has been conducted by varying the composition of Cu (0.150%, 0.175% and 2%) while keeping Mg (0.150%) as constant. The
result shows that the increase in addition of copper increases the tensile strength and wears resistance and decreases the percentage of elongation.
Work-Family Conflict and Depression Among Women Working Professionals
Authors: Susi S. , Kumar K. R. , Jothikumar R.
Published: April 2019

In India women working professionals engage in paid work. Currently, many women working professionals have been continuing to work through the childrearing life stage, and the number of women working professionals who leave jobs due to wedding, childbearing and childcare has been declining.
The influence of work-family conflict on psychological well-being among women working professionals has not been completely studied. The aim of this paper is to examine the relationship between work-family conflict and depression. This paper also determines whether there is a significant difference
between work-family conflict and depression among women working professionals. The sample size includes 210 women working professionals (lecturers only) in Hyderabad. This study result shows that there is significant relationship between work-family conflict and depression. Further, the findings
state that there are significant differences between work-family conflict and depression among women working professionals.
Electronic Voting System with Cloud Based High Performance Computing
Authors: Jothikumar R. , Subramaniam Kumar , Shanmugam Siva G. , Susi S.
Published: April 2019

Traditional voting system has been replaced by electronic voting systems in most places increasingly. It is efficient, but not efficient enough in terms of cost and capacity. High Performance Computing (HPC) in Cloud computing is a relatively new concept which has been replacing the
traditional systems. The HPC has been widely used over the recent years because of its efficiency, reliability, speed and cost. Whereas in the traditional super computing system a lot of cost is involved. The ability of integration of HPC with cloud provided enormous growth in the area of
parallel processing and computing. This system may advocate to push the case of promoting electronic voting system for higher traffic scenarios with lower cost requirements. This paper proposes an idea of implementing a fully formed e-voting system integrated with both HPC and Cloud Computing.
An Enhanced Image Dehazing Method for the Application in Urban Computing
Authors: Prakash Anju J. , Christopher Ferdinand
Published: April 2019

The appearance of images captured in some weather conditions is often degraded due to the presence of haze or fog. These hazy images affect the visibility in the field of computer vision applications, object recognition systems, intelligent transportation, traffic analysis etc. Multi-scale
Gradient enhancement is the most popular method used as part of dehazing. But manipulating the image easily turns low dynamic range into high dynamic range images. As a result the restored image become dark or overexposure so that it degrades the quality of the image. As an aim to resolve
this problem a better image enhancement as well as classification method is employed. The projected work takes benefit of SVD as this solo value allow us to characterize the picture with a minimal set of value that shrink storage space and progress the quality. For a superior quality and feature
improvement a rate based alteration is completed with the help of gaussian filter. The eventual dehazed image is then classified using an improved KNN as part of geographical data analysis. Overall the platform research theme focuses on two key areas-Image processing and data mining.
Impact of Dry Midlevel Air on the Tropical Cyclone Outer Circulation
Authors: Wang Shuai , Toumi Ralf
Published: April 2019

The impact of dry midlevel air on the outer circulation of tropical cyclones is investigated in idealized simulations with and without a moist envelope protecting the inner core. It is found that a dry midlevel layer away from the cyclone center can broaden the outer primary circulation and thus the overall destructive potential at both developing and mature stages. The midlevel outer drying enhances the horizontal gradient of latent heating in the rainbands and drives the expansion of the outer circulation. The moist convection at large radii is suppressed rapidly after the midlevel air is dried in the outer rainbands. An enhanced horizontal gradient of latent heating initiates a radial–vertical overturning circulation anomaly in the rainbands. This anomalous overturning circulation accelerates the radial inflow of the main secondary circulation, increases the angular momentum import, and thus increases the cyclone size. The dry air, mixed into the boundary layer from the midtroposphere, is “recharged” by high enthalpy fluxes because of the increased thermodynamical disequilibrium above the sea surface. This recharge process protects the eyewall convection from the environmental dry-air ventilation. The proposed mechanism may explain the continuous expansion in the tropical cyclone outer circulation after maturity, as found in observations.
Improving Satellite-Based Subhourly Surface Rain Estimates Using Vertical Rain Profile Information
Authors: Utsumi Nobuyuki , Kim Hyungjun , Turk F. Joseph , Haddad Ziad. S.
Published: April 2019

Quantifying time-averaged rain rate, or rain accumulation, on subhourly time scales is essential for various application studies requiring rain estimates. This study proposes a novel idea to estimate subhourly time-averaged surface rain rate based on the instantaneous vertical rain profile observed from low-Earth-orbiting satellites. Instantaneous rain estimates from the Tropical Rainfall Measuring Mission (TRMM) Precipitation Radar (PR) are compared with 1-min surface rain gauges in North America and Kwajalein atoll for the warm seasons of 2005–14. Time-lagged correlation analysis between PR rain rates at various height levels and surface rain gauge data shows that the peak of the correlations tends to be delayed for PR rain at higher levels up to around 6-km altitude. PR estimates for low to middle height levels have better correlations with time-delayed surface gauge data than the PR’s estimated surface rain rate product. This implies that rain estimates for lower to middle heights may have skill to estimate the eventual surface rain rate that occurs 1–30 min later. Therefore, in this study, the vertical profiles of TRMM PR instantaneous rain estimates are averaged between the surface and various heights above the surface to represent time-averaged surface rain rate. It was shown that vertically averaged PR estimates up to middle heights (~4.5 km) exhibit better skill, compared to the PR estimated instantaneous surface rain product, to represent subhourly (~30 min) time-averaged surface rain rate. These findings highlight the merit of additional consideration of vertical rain profiles, not only instantaneous surface rain rate, to improve subhourly surface estimates of satellite-based rain products.
Dynamics on Seasonal Variability of EKE Associated with TIWs in the Eastern Equatorial Pacific Ocean
Authors: Wang Minyang , Du Yan , Qiu Bo , Xie Shang-Ping , Feng Ming
Published: April 2019

Energetic mesoscale eddies (vortices) associated with tropical instability waves (TIWs) exist in the eastern equatorial Pacific Ocean between 0° and 8°N. This study examines the seasonal variations in eddy kinetic energy (EKE) of TIWs using in situ and satellite observations and elucidates the underlying dynamical mechanisms. The results reveal that the cross-equatorial southerly winds are key to sustaining the high-level EKE (up to ~600 cm2 s−2) from boreal summer to winter in 0°–6°N and 155°–110°W. Because of the β effect and the surface wind divergence, the southerly winds generate anticyclonic wind curls north of the equator that intensify the sea surface temperature (SST) fronts and force the downwelling annual Rossby waves. The resultant sea surface height ridge induces strong horizontal current shears between 0° and 5°N. The intensified current shears and SST fronts generate EKE via barotropic and baroclinic instabilities, respectively. To the extent that the seasonal migration of a northward-displaced intertropical convergence zone intensifies the southerly winds north of, but not south of, the equator, our study suggests that the climatic asymmetry is important for the oceanic eddy generations in the eastern equatorial Pacific Ocean—a result with important implications for coupled climate simulation/prediction.
Mastoid Surgery under Local Anesthesia for Medically Unfit Patients: Techniques and Outcome
Authors: Neumann Codruta , Yung Jennifer , Carroll Paul H.
Published: April 2019

Objectives

We present the surgical techniques and outcomes of mastoid surgery under local anesthesia in patients who were unfit for general anesthesia.

Methods

Five tertiary-referred patients with multiple comorbidities and failed conservative treatment for chronic otitis media were operated on under local anesthesia. No sedation was administered. The principles of cholesteatoma surgery were observed, but the technique was adapted to keep surgical time to a minimum.

Results

None of the patients had perioperative problems, and all have dry, waterproof ears with preservation of hearing after surgery. So far, none of the patients have had recurrent or residual disease.

Conclusions

Cholesteatoma surgery can be successfully performed with a local anesthetic in patients who are medically unfit for general anesthesia. Surgery requires a good coordination of the operating team in order to shorten the operating time. Otologists should develop and maintain their skills by performing ear surgery with local anesthetic on a regular basis.
Antisecretory Factor–Inducing Therapy Improves Patient-Reported Functional Levels in Meniere's Disease
Authors: Leong Samuel C. , Narayan Surya , Lesser Tristram H.
Published: April 2019

Objectives

The aim of this study was to evaluate the effectiveness of specially processed cereal (SPC) as a suitable adjunctive treatment for Meniere's disease.

Methods

We performed a randomized double-blinded, placebo-controlled, crossover study in a tertiary referral center of patients who had a diagnosis of Meniere's disease based on the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). The main outcome measure was the AAO-HNS Functional Level Scale (FLS).

Results

Thirty-nine patients completed the study without any reported complications. The mean pretreatment FLS score for the entire study cohort was 3.8 (median, 4; range, 1 to 6). The overall FLS score improved significantly (p < 0.001), to 2.8 (median, 3), after SPC treatment. No patients showed worsening on the FLS during SPC or placebo treatment. Of the 39 patients, 23 showed improvement on the FLS, and no change was observed in the remaining 16. The median improvement on the FLS in these 23 patients was 2 points (mean, 1.7; range, 1 to 4). The mean FLS score after placebo cereal treatment was not significantly different from baseline (p = 0.452), but was significantly higher than that after SPC treatment (mean, 3.7; p < 0.001). The marginal difference observed between the baseline FLS score and the placebo FLS score was due to the fact that 5 patients reported 1-point improvements on the FLS after placebo treatment. Nevertheless, significantly fewer patients improved on placebo than on SPC (p < 0.001).

Conclusions

Treatment with SPC appears to be well tolerated by most patients (91%) without any complications. More than half (59%) of the study cohort reported subjective improvement in functional level.
Are You Ready for Gen Z in the Workplace?
Authors: Schroth Holly
Published: April 2019

Gen Z (1997-2013) is just now entering the labor market and employers need to be prepared for their arrival. While Gen Z shares many traits with the Millennial Generation, they also bring in new patterns of behavior. Managers today not only have to understand how to best manage youthful, inexperienced employees, but also the unique characteristics of the generation shaped by their experiences. Every generation has its doubts about the younger generation’s culture and technologies. Understanding their behavior and the distinct needs that they have in the workplace will lead to better integration of the new employees and mutual success.
Poesia, musica, società: I’inedita fisionomia del rapporto Quasimodo-Gaslini
Authors: Cerchiari Luca
Published: April 2019

Il poeta Salvatore Quasimodo, premio Nobel 1959, e il pianista e compositore Giorgio Gaslini, attivo nel jazz e nella musica contemporanea, hanno condiviso un ventennio che li ha visti prima uno insegnante dell’altro (al Conservatorio di Milano), quindi collaboratori di esperienze professionali sia nella ricerca nell’ambito delle avanguardie sia nelle relazioni tra arti, ideologie e società. L’articolo fa luce su un rapporto sinora inedito, attingendo a fonti e testimonianze primarie, tra cui quella del figlio di Quasimodo, Alessandro.
Sustaining professional identity during the initial post-qualification period: Implications for retention strategies
Authors: Moorhead Bernadette
Published: April 2019

This article discusses findings from a phenomenological Australian study exploring how the professional identities of newly qualified social workers are fostered and/or eroded during the first 12 months post-qualification. A total of 17 participants each completed three semi-structured interviews. The participants revealed individual and systemic factors that impacted how and whether professional identity was fostered and/or eroded. It is proposed from the findings that a combination of multilevel approaches for sustaining professional identity could improve the experiences and retention of newly qualified social workers. The implications for action by educators, employers and the social work profession in Australia and other countries are outlined.
Effects of Internal and External Attentional Focus on Postural Response to a Sliding Stance Surface
Authors: Kunimura Hiroshi , Matsuoka Masakazu , Hamada Naoki , Hiraoka Koichi
Published: April 2019

The present study examined whether an internal or external attentional focus would affect participants’ feet-in-place balance response to postural stance perturbations. A movable platform automatically slid forward or backward while healthy participants stood on it and (a) performed no cognitive activity (control), (b) focused on the pelvis or upper body sway (internal focus), (c) memorized a number displayed immediately before the platform slid (external focus), or (d) kept the equilibrium of an unstable cylinder over the arm (external focus). The forward displacement of the pelvis induced by the platform sliding forward was smaller when participants focused on their pelvic sway, although such effect was absent when they focused on their upper body sway, indicating that the internal focus was effective for the postural response when attention was paid to the pelvic sway. Regarding an external attention focus, the forward displacement of the pelvis induced by the platform sliding forward was smaller when participants focused on the equilibrium of an unstable object over the arm, but this effect was absent when they focused on the number, indicating that an external focus was only effective when the unstable object focused upon was relevant to the equilibrium of one’s own body. No attentional intervention was effective during backward sliding of the support surface, indicating that central set for responding to postural perturbation depends on the direction of the postural perturbation.
Predicting Attitudes towards Lesbians and Gay Men: The Effects of Social Conservatism, Religious Orientation, and Cultural Humility
Authors: Choe Elise , Srisarajivakul Emily , Davis Don E. , DeBlaere Cirleen , Van Tongeren Daryl R. , Hook Joshua N.
Published: April 2019

This study explores the role cultural humility plays in attitudes and discrimination towards people identifying as gay or lesbian among religious individuals. Specifically, we explore cultural humility as a possible predictor of less discriminatory attitudes towards lesbians and gay men above and beyond the effects of conservatism and religious orientation. Consistent with prior work, we expected that (a) intrinsic religious orientation, extrinsic religious orientation, and conservatism would be positively related to discriminatory attitudes and (b) that quest religious orientation and cultural humility would be negatively related to discriminatory attitudes. Participants ( N = 231) were recruited through MTurk after the 2016 Pulse Nightclub shooting in Orlando, Florida to understand the attitudes and experiences held by Americans. Participants completed measures of religious orientation, attitudes, and behaviors towards lesbians and gay men, and cultural humility regarding LGBT issues. Results supported the hypothesis that cultural humility predicts less discrimination towards lesbians and gay men beyond conservatism and religious orientation. Results, limitations, and future directions are discussed.
Psychological capital is associated with higher levels of life satisfaction and school belongingness
Authors: Datu Jesus Alfonso D. , Valdez Jana Patricia M.
Published: April 2019

Psychological capital (PsyCap) has been associated with key organizational and well-being outcomes. However, limited investigations have been carried out regarding the role of PsyCap in the educational settings. The present study assessed the association of PsyCap with life satisfaction and school belongingness in the academic context. Four hundred and sixty-two Filipino high school students participated in the current investigation. Structural equation modeling showed that PsyCap was positively linked to school belongingness via the intermediate variable life satisfaction. An alternative structural model also provided evidence of the indirect effects of PsyCap on life satisfaction via school belongingness. Theoretical and practical implications of these results are discussed.
One-Year Results: Transantral Balloon Dilation of the Ethmoid Infundibulum
Authors: Stankiewicz James , Truitt Theodore , Atkins James
Published: April 2019

A prospective, multicenter research study is under way to demonstrate long-term improvement in chronic rhinosinusitis symptoms after transantral balloon dilation of the ethmoid infundibulum. Trial results from an interim analysis of symptomatic status using the Sino-Nasal Outcome Test 20 survey demonstrate significant and sustained improvement through post-procedure 1-year follow-up. Additionally, these data provide evidence that the symptomatic improvements following balloon expansion within the ostiomeatal unit to treat medically refractory inflammation of the maxillary sinuses, either alone or with concomitant anterior ethmoid disease, are similar.
Cervical Necrotizing Fasciitis: Our Experience with 11 Cases and Our Technique for Surgical Debridement
Authors: Bakshi Jaimanti , Virk Ramandeep S. , Jain Ajay , Verma Mayuresh
Published: April 2019

We conducted a retrospective review of 11 cases of adult cervical necrotizing fasciitis that were treated at our institution over a period of 5-plus years. The most common etiology was a dental infection, which was seen in 7 of the 11 patients (64%). Most cultures were sterile because all of these patients had been referred to us after they had already been treated elsewhere with intravenous antibiotics and without surgical intervention. Under our management, patients spent an average of 21.6 days in the hospital, and they underwent an average of 1.6 debridements under general anesthesia. Aggressive wound care, broad-spectrum antibiotic therapy, and timely surgical intervention resulted in an overall survival rate of 91% (10/11), including a 75% survival (3/4) for patients with thoracic extension.
Nasolacrimal Duct Oncocytoma: An Unusual Cause of Chronic Epiphora
Authors: Delas Benoît , Bertrand Marine , Babin Emmanuel , Francois Arnaud , Marie Jean-Paul , Dehesdin Danièle , Choussy Olivier
Published: April 2019

Epiphora has traditionally fallen under the purview of ophthalmologists. However, owing to the development of endoscopic dacryocystorhinostomy, this condition has been increasingly observed in otolaryngologic practice. We report the case of a woman with a 4-month history of right epiphora and dacryocystitis. Nasal endoscopy revealed the presence of a tumor at the inferior meatus. Histopathologic examination of a biopsy specimen identified the tumor as an oncocytoma. Surgical excision via a lateral rhinotomy approach was performed. At 3 years postoperatively, the patient was disease-free. Lacrimal sac and nasolacrimal duct tumors are rare, but they should be considered as a possible etiology in patients with acquired epiphora because most of these tumors are malignant.
Lingual Tonsil Hypertrophy Causing Severe Dysphagia: Treatment with Plasma-Mediated Radiofrequency-Based Ablation (Coblation)
Authors: Mowry Sarah E. , Ament Marvin , Shapiro Nina L.
Published: April 2019

Lingual tonsil hypertrophy is an uncommon cause of upper aerodigestive tract pathology. We present the case of a 17-year-old boy who developed severe dysphagia and subsequent weight loss as a result of lingual tonsil hypertrophy. He was successfully treated with plasma-mediated radiofrequency-based ablation (Coblation). In the past, traditional surgical procedures for lingual tonsil hypertrophy were difficult to perform and recovery was difficult, but the introduction of Coblation has made lingual tonsillectomy much easier.
CT Imaging Categorization and Biomarker Study of Anomalous Tympanic Segment of the Facial Nerves in Patients With Hearing Loss in the Absence of Microtia
Authors: Oren Nisa , Ginat Daniel Thomas
Published: April 2019

The purpose of this study is to categorize anomalous tympanic facial nerve (FN) on high-resolution computed tomography (HRCT) and to determinate the significance of associated temporal bone anomalies and congenital syndromes without microtia in patients with hearing loss. A retrospective analysis of HRCT findings in 30 temporal bones in 18 patients with anomalous FN was performed. Abnormalities of the tympanic FN were categorized as follows: category 1: FN medially positioned, but above the oval window; category 2: FN in the oval window niche; and category 3: FN below the oval window. Potential associated findings that were assessed included stapes abnormalities, oval window atresia, and inner ear anomalies, as well as the presence of a known congenital syndrome with hearing loss. The most common type of anomalous tympanic FN was category 1 (67%, n = 20), following by group 2 (20%, n = 6) and group 3 (13%, n = 4). Stapes anomalies were detected in 77% of temporal bones (n = 23), oval window atresia was detected in 43% of temporal bones (n = 13), and inner ear anomalies were detected in 70% of temporal bones (n = 21). Anomalous tympanic facial nerves in temporal bone with conductive hearing loss were often (60%) not associated with oval window atresia. The combination of aberrant tympanic FN and inner ear anomalies was significantly ( P = .038) associated with a known congenital syndrome (6 patients), including CHARGE syndrome, oculo-auriculo-vertebral spectrum, Pierre-Robin sequences, and Down syndrome. Therefore, an anomalous tympanic FN in conjunction with inner ear anomalies appears to be a biomarker for certain congenital syndromes with hearing loss in the absence of microtia.