bluuebunny/crossref_metadata_2025 huggingface dataset:
New techniques to improve the power control in the double-fed induction generator wind turbine
Authors: Ghoudelbourk S , Dib D , Omeiri A
Published: January 2016

The great interest shown today in the double-fed induction generator in wind chain prompted us to analyze the performance of the separate control of active and reactive power generated by the stator of double-fed induction generator connected to the grid. The objective of the separate control of active and reactive stator powers is to provide constant power to the power grid whatever the variation of the wind speed, and to provide reactive power to correct the power factor. In this article, we present the modeling and an integrated vector control in a double-fed induction generator wind chain, which aims to independently control the active and reactive power generated by the double-fed induction generator. Knowing that the direct control of active and reactive power delivered to the grid with conventional proportional integral controllers provides good performance in permanent diet but a variable speed wind, the measured powers hardly follow the set values. To remedy this problem, we replace the conventional proportional integral controllers with proportional integral–fuzzy controllers to ensure good performance and robustness of the control of separate powers. To justify this choice, it is necessary to evaluate and compare the separate control loop for active and reactive power with conventional proportional integral controllers than with proportional integral–fuzzy controllers under the same constraint variable speed wind. The second part treated in this article is to reduce the harmonic pollution caused by the supply of the double-fed induction generator–based inverters and controlled rectifiers, which strongly infect current line. This phenomenon can have an adverse effect on the loads connected to the grid and equipment of proximity. The insertion of a filter system in the chain is needed, except that the strain of the volume and the reflection require a high cost for a more advanced and more optimal solution. Our contribution to this part is to replace the supply of the double-fed induction generator rotor side by a matrix converter controlled by the modulation technique of the difference errors between the measured values and the desired output values (least mean square errors).
Vanishing calcification associated with a spontaneous ventral spinal cerebrospinal fluid leak
Authors: Schievink Wouter I , Ross Lindsey , Prasad Ravi S , Maya M Marcel
Published: January 2016

Background

Some patients with spontaneous intracranial hypotension have a ventral spinal cerebrospinal fluid (CSF) leak and these CSF leaks may be associated with calcified disk herniations. Identifying these calcifications is helpful in directing treatment. We report here the unusual case of a patient with a ventral CSF leak in whom the associated calcification absorbed over a five-month period.

Case report

A 42-year-old woman developed orthostatic headaches and bilateral abducens nerve palsies. Magnetic resonance imaging of her brain showed typical findings of spontaneous intracranial hypotension. Magnetic resonance imaging of her spine showed an extensive cervicothoracic CSF leak. Computed tomographic myelography showed calcification at the Th1–2 disk space. Three epidural blood patches were performed, but her symptoms persisted. Digital subtraction myelography performed five months later showed an upper thoracic ventral CSF, but the calcification was no longer present. A dural tear, found at surgery at the Th1–2 level, was repaired and the patient made an uneventful recovery.

Discussion

The resorption of calcifications at the level of a ventral spinal CSF leak could explain the absence of any calcifications in at least some patients with such leaks and demonstrates the usefulness of reviewing previous imaging in patients with ventral CSF leaks if the exact site of the leak remains unknown.
The Reduction in Stability From Combined Humeral Head and Glenoid Bony Defects Is Influenced by Arm Position
Authors: Walia Piyush , Patel Ronak M. , Gottschalk Lionel , Kuklis Matthew , Jones Morgan H. , Fening Stephen D. , Miniaci Anthony
Published: January 2016

Background:

Combined defects of the glenoid and humeral head are often a cause for recurrent shoulder instability.

Purpose/Hypothesis:

The aim of this study was to evaluate the influence of combined bony lesions on shoulder instability through varying glenohumeral positions. The hypothesis was that instability due to combined defects would be magnified with increasing abduction and external rotation.

Study Design:

Controlled laboratory study.

Methods:

Eighteen cadaveric shoulders were tested. Experiments were performed at combinations of glenohumeral abduction angles of 20°, 40°, and 60° and external rotations of 0°, 40°, and 80°. The various glenoid defect sizes created were 10%, 20%, and 30% of the glenoid width. Four humeral head defects were created based on humeral head diameter (6%, 19%, 31%, and 44%). Each experiment consisted of translating the glenoid in a posterior direction to simulate an anterior dislocation under a 50-N load. The instability was measured as a percentage of intact translation (ie, loss in translational distance normalized to the no-defect condition).

Results:

At 20° of abduction, instability increased from 100% to 85%, 70%, and 43% with increasing glenoid defect sizes of 10%, 20% and 30%, respectively, with a 6% humeral head defect. However, at a functional arm position of apprehension, these values were significantly decreased ( P < .05) for humeral head defect sizes of 19%, 31%, and 44%, with translation values of 49%, 27%, and 2%, respectively.

Conclusion:

A humeral defect leads to rotational instability with the arm rotated into a functional position rather than a resting position. However, a significant glenoid defect can lead to loss of translation independent of changes in arm position. Combined defects as large as 44% of humeral head and 20% glenoid did not show instability at 20° of abduction and neutral position; however, defects as small as 19% humeral defect and 10% glenoid defect led to significant instability in the position of apprehension.

Clinical Relevance:

Instability at lower levels of abduction and external rotation clinically indicates larger bony defects and may need to be directly addressed, depending on the patient’s age and function.
The Effects of an Injury Prevention Program on Landing Biomechanics Over Time
Authors: DiStefano Lindsay J. , Marshall Stephen W. , Padua Darin A. , Peck Karen Y. , Beutler Anthony I. , de la Motte Sarah J. , Frank Barnett S. , Martinez Jessica C. , Cameron Kenneth L.
Published: January 2016

Background:

Knowledge is limited regarding how long improvements in biomechanics remain after completion of a lower extremity injury prevention program.

Purpose:

To evaluate the effects of an injury prevention program on movement technique and peak vertical ground-reaction forces (VGRF) over time compared with a standard warm-up (SWU) program.

Study Design:

Controlled laboratory study.

Methods:

A total of 1104 incoming freshmen (age range, 17-22 years) at a military academy in the United States volunteered to participate. Participants were cluster-randomized by military company to either the Dynamic Integrated Movement Enhancement (DIME) injury prevention program or SWU. A random subsample of participants completed a standardized jump-landing task at each time point: immediately before the intervention (PRE), immediately after (POST), and 2 (POST2M), 4 (POST4M), 6 (POST6M), and 8 months (POST8M) after the intervention. VGRF data collected during the jump-landing task were normalized to body weight (%BW). The Landing Error Scoring System (LESS) was used to evaluate movement technique during the jump landing. The change scores (Δ) for each variable (LESS, VGRF) between the group’s average value at PRE and each time point were calculated. Separate univariate analyses of variance were performed to evaluate group differences.

Results:

The results showed a greater decrease in mean (±SD) VGRF in the DIME group compared with the SWU group at all retention time points: POST2M (SWU [Δ%BW], −0.13 ± 0.82; DIME, −0.62 ± 0.91; P = .001), POST4M (SWU, −0.15 ± 0.98; DIME,−0.46 ± 0.64; P = .04), POST6M (SWU, −0.04 ± 0.96; DIME, −0.53 ± 0.83; P = .004), and POST8M (SWU, 0.38 ± 0.95; DIME, −0.11 ± 0.98; P = .003), but there was not a significant improvement in the DIME group between PRE and POST8M (Δ%BW, −0.11 ± 0.98). No group differences in Δ LESS were observed.

Conclusion:

The study findings demonstrated that an injury prevention program performed as a warm-up can reduce vertical ground-reaction forces compared with a standard warm-up but a maintenance program is likely necessary in order for continued benefit.

Clinical Relevance:

Injury prevention programs may need to be performed constantly, or at least every sport season, in order for participants to maintain the protective effects against injury.
Relationship of the Duration of Ventilator Support to Successful Weaning and Other Clinical Outcomes in 437 Prolonged Mechanical Ventilation Patients
Authors: Sansone Giorgio R. , Frengley J. Dermot , Vecchione John J. , Manogaram Merlin G. , Kaner Robert J.
Published: January 2016

Objective:

To investigate the relationships between durations of ventilator support and weaning outcomes of prolonged mechanical ventilation (PMV) patients.

Methods:

Cohort study of 957 PMV patients sequentially admitted to a long-term acute care hospital (LTACH). The study population was 437 PMV patients who underwent weaning, having achieved ≥4 hours of sustained spontaneous breathing. They were divided into tertiles of mechanical ventilation (MV) durations and compared for differences (tertile A: 21-58 days, n = 146; tertile B: 59-103 days, n = 147; and tertile C: ≥104 days, n = 144).

Results:

Tertiles showed comparable weaning success rates and survival. As MV durations increased, LTACH postweaning days became progressively greater, whereas decannulations and discharge physical function diminished, and home discharges decreased while nursing facility discharges increased (all P < .001). Patients with lower physical function before critical illness or greater burdens of comorbidities were least likely to be weaned (all P < .001). Younger ages, lower comorbidity burdens, neurological diagnoses, higher admission prealbumin levels, and successful weaning, each independently reduced the risk of death (all P < .01).

Conclusion:

Durations of MV did not affect weaning success or survival, although deleterious effects were found in discharges, decannulations, LTACH postweaning days, and discharge physical function. Durations of MV alone should not guide transfer decisions for subsequent continuing care.
Optimal design of a power-split hybrid hydraulic bus
Authors: Ramdan Muhammad Iftishah , Stelson Kim A
Published: January 2016

The hydraulic power-split architecture, or the hydromechanical transmission, can exist in over 1000 configurations. Since a specific hydromechanical transmission configuration has a unique kinematic characteristic, the optimal hydromechanical transmission configuration for one application is different from the optimal hydromechanical transmission configurations for other applications. This study finds the optimal hydromechanical transmission configuration for a hybrid hydraulic city bus. Since a hydromechanical transmission uses at least one planetary gear set, the process of finding a suitable hydromechanical transmission configuration for a hybrid hydraulic city bus is very time consuming, but this study simplifies the procedure by utilizing the critical speed ratio ωcrit, where ωcrit is the missing link between the planetary gear set configuration, its gear ratio and its kinematic characteristic. This simplification also allows complex dual-stage hydromechanical transmission architecture configurations to be considered as candidates for the optimal drivetrain of the hybrid hydraulic city bus. The hydromechanical transmission configuration candidates are simulated over three city bus driving cycles and, to ensure that they operate at the optimal conditions for each driving cycle, dynamic programming is used. This study also establishes two power recirculation modes, one of which is useful because of its high efficiency. A single-stage power-split architecture configuration candidate is found to be the optimal drivetrain for a hydromechanical transmission bus.
Comparison of different ground simulation systems on the flow around a high-speed train
Authors: Xia Chao , Shan Xizhuang , Yang Zhigang
Published: January 2016

The influence of different ground simulation systems on the air flow around a high-speed train with zero yaw angle is investigated. Force values, force development graphs, surface pressures, the underbody flow and the wake are studied in detail with Computational Fluid Dynamics, which is initially validated by wind tunnel testing. It shows that the stationary ground has severe deviations from the full moving ground on the aerodynamic performance due to the inaccurate pressure distribution on the underbody. This is mainly attributed to the high level of interaction between the underbody and the boundary layer development. In addition, a ground boundary layer separation bubble can be observed under the tail end of the train for the stationary ground on account of insufficient energy to overcome the increasing adverse pressure gradient. In order to guarantee a correct underbody flow, a partially moving ground is proposed, including the “3-moving ground” and the “1-moving ground”. Such ground simulation systems are well compatible with the fixed rail tracks and the bottom support struts compared to the full moving ground. As a conceivable method to reduce the influence of the boundary layer, raising the high-speed train model with different ground clearances is also studied. Overall, the 3-moving ground is suggested to be the best choice for the ground simulation systems in high speed train wind tunnel testing.
Cervicitis: a prospective observational study of empiric azithromycin treatment in women with cervicitis and non-specific cervicitis
Authors: Lusk M Josephine , Garden Frances L , Cumming Robert G , Rawlinson William D , Naing Zin W , Konecny Pam
Published: January 2016

Treatment with 1 G azithromycin was observed prospectively in 130 women with cervicitis (>30 polymorphonuclear leucocytes/high-powered field) enrolled in a cervicitis aetiology study of 558 women at three sexually transmitted infection clinics in Sydney, Australia. Two overlapping groups of women with cervicitis were considered: ‘cervicitis group 1’ (n = 116) excluded women with Trichomonas vaginalis and a subgroup of this, ‘cervicitis group 2’ (non-specific cervicitis) (n = 96) further excluded women with Neisseria gonorrhoea, Chlamydia trachomatis and Mycoplasma genitalium at enrolment. Testing for Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis was by PCR and Neisseria gonorrhoea by PCR and culture. Treatment outcomes were cervicitis or vaginal symptoms at follow-up. Effect on cervicitis at follow-up was also assessed after additional reported partner treatment. In ‘cervicitis group 1’ where prevalence of Mycoplasma genitalium and/or Chlamydia trachomatis was 23/116 (19.8%), azithromycin reduced cervicitis at follow-up (RR = 0.62 (95% CI 0.39–0.97) p = 0.035), but there was no significant effect in non-specific cervicitis (‘cervicitis group 2’) (RR = 0.60 (95% CI 0.35–1.01) p = 0.056). Empiric treatment did not reduce vaginal symptoms at follow-up in either group. No effect of empiric partner treatment was seen. The conclusion was that empiric azithromycin treatment of cervicitis reduces cervicitis at follow-up in populations with high prevalence of Chlamydia trachomatis and/or Mycoplasma genitalium. There are no benefits of empiric azithromycin for non-specific cervicitis or empiric partner treatment.
Adolescents in Peer Groups Make More Prudent Decisions When a Slightly Older Adult Is Present
Authors: Silva Karol , Chein Jason , Steinberg Laurence
Published: January 2016

Adolescents make more reckless decisions when with peers than when alone, which poses a challenge for organizations that place adolescents in situations in which risky and myopic decision making is problematic. We asked whether the effect of peers on adolescents’ decision making is mitigated by the presence of a slightly older adult. We examined whether target subjects’ risk taking was greater when they were in groups of 4 late-adolescent males (ages 18–22) than when they were in groups that mixed 3 late-adolescent males with 1 slightly older adult (age 25–30); risk taking in both of these conditions was compared with that of adolescents tested alone. We found that adolescents took more risks and expressed stronger preference for immediate rewards when they were grouped with 3 same-age peers than when they were alone. When 1 adolescent was replaced by someone slightly older, however, adolescents’ decision making and reward processing resembled that seen when adolescents were tested alone. Adding a young adult to a work team of adolescents may improve group decision making.
Dynamic modeling and experimental investigations of a magnetostrictive nozzle–flapper servovalve pilot stage
Authors: Zhu Yuchuan , Yang Xulei , Fu Tiantian
Published: January 2016

A magnetostrictive nozzle–flapper servovalve pilot stage is presented in this article, which is directly driven by a giant magnetostrictive actuator and features three nozzles for the development of large flow rate servovalve. According to the energy conversion sequence in this servovalve, a giant magnetostrictive actuator magnetization model, a giant magnetostrictive material rod eddy loss model and a servovalve dynamic pressure model are all established to enable quantitative depiction and modelling of the dynamic pressure response process of magnetostrictive nozzle–flapper servovalve pilot stage. Consequently, the matched simulation model of the magnetostrictive nozzle–flapper servovalve pilot stage with the mathematic model is followed to be established, and two unknown parameters of complex permeability are determined using the test data from the giant magnetostrictive actuator. By running this simulation model, flapper displacement and output pressure under different structural parameters and variational excited frequencies are determined, certain parameters that are sensitive to the dynamic characteristics of magnetostrictive nozzle–flapper servovalve pilot stage driven by giant magnetostrictive actuator are found and the accompanying rules are revealed. Finally, the experimental system of a magnetostrictive nozzle–flapper servovalve pilot stage driven by giant magnetostrictive actuator was built; both the step-input voltage response curve and the sine-input voltage response curve were captured; and these curves show that the amplitude bandwidth (−3 dB) and the phase bandwidth (−90°) of a magnetostrictive nozzle–flapper servovalve pilot stage can approach 150 and 110 Hz, respectively, which exhibit good agreement with the simulation results. Therefore, the magnetostrictive nozzle–flapper servovalve pilot stage offers a very promising prospect of the novel servovalves with the high-frequency response and the large flow rate.
Inborn errors of metabolism detectable by tandem mass spectrometry in Egypt: The first newborn screening pilot study
Authors: Hassan Fayza A , El-Mougy Fatma , Sharaf Sahar A , Mandour Iman , Morgan Marian F , Selim Laila A , Hassan Sawsan A , Salem Fadia , Oraby Azza , Girgis Marian Y , Mahmoud Iman G , El-Badawy Amira , El-Nekhely Ibrahim , Moharam Nadia , Mehaney Dina A , Elmonem Mohamed A
Published: January 2016

Objectives

To estimate the burden of metabolic disorders detectable by tandem mass spectrometry in Egypt, through a pilot expanded newborn screening programme at Cairo University Children's Hospital in 2008, and examining the results of 3,900 clinically at-risk children, investigated at Cairo University Children’s Hospital for the same disorders over the past 7 years using the same technology.

Methods

Dried blood spots of 25,276 healthy newborns from three governorates in Upper, Middle, and Lower Egypt were screened, to give a representative sample of the Egyptian newborn population. Based on the pilot study outcomes and the results of clinically suspected children, we estimated the total birth prevalence of tandem mass spectrometry detectable metabolic disorders, and the relative frequency of several individual disorders.

Results

Among the healthy newborns, 13 metabolic disorder cases (five phenylketonuria [1:5,000], two methylmalonic acidemia, and isovaleric acidemia [1:12,500], one each of maple syrup urine disease, propionic acidemia, β-ketothiolase deficiency, and primary carnitine deficiency [1:25,000]) were confirmed, giving a total birth prevalence of 1:1944 live births. Among the clinically suspected children, 235 cases were diagnosed, representing a much wider disease spectrum.

Conclusions

Egypt has one of the highest reported birth prevalence rates for metabolic disorders detectable by tandem mass spectrometry. Early diagnosis and management are crucial for the survival and well-being of affected children. A nationwide NBS programme by tandem mass spectrometry is recommended.
Damage index proposals applied to quasi-brittle materials simulated using the lattice discrete element method
Authors: Rodrigues Rodolfo S , Birck Gabriel , Iturrioz Ignacio
Published: January 2016

The process of damage in quasi-brittle materials is characterized by loss of isotropy for certain load levels. The strain localization, the cooperative effect between damaged regions and the avalanche of ruptures are particular features in measuring the damage in this kind of material. The mentioned features create different forms of energy dissipation, which are not easy to represent with a continuous approach. In the present work, a version of the lattice discrete element method (LDEM) is employed. In this method the fracture and fragmentation are taken into account in a natural manner, since the bars that reached their limit strength during the process are disabled of the system, respecting the energy balance. It is possible to introduce heterogeneity in the model considering the material properties as random fields with spatial Weibull probability distribution and known correlation length. The aim of the present paper is to describe the implementation, in the context of this version of the LDEM, of three classical indexes used to measure the level of damage: a scalar index, and a second- and a fourth-order tensorial index. A simple uniaxial tensile test is used to illustrate the implementation. A discussion about the advantages of applying this tool to analyse the damage evolution in quasi-brittle structures and the possibility to link these indexes with other forms of measurement of damage evolution, such as acoustic emission data, also are commented.
Do I Fit In? Perceptions of Organizational Fit as a Resource in the Workplace Stress Process
Authors: Mackey Jeremy D. , Perrewé Pamela L. , McAllister Charn P.
Published: January 2016

A large number of research studies in the stress literature over the previous 20 years have examined how organizational demands influence experienced stress; however, little research has examined how perceptions of organizational fit influence experienced stress and the stress process. In the present study, we use the conservation of resources (COR) theory to examine how perceptions of hindrance stressors, challenge stressors, and organizational fit (i.e., a resource) affect employees’ intrapersonal (i.e., job satisfaction and work intensity) and interpersonal (i.e., interpersonal workplace deviance and work-to-family conflict) outcomes through job strain (i.e., job tension) and motivational (i.e., vigor) cognitive stress processes. Results from three samples of data ( nSample 1 = 268, nSample 2 = 259, nSample 3 = 168) largely supported the hypothesized model and suggested that perceptions of organizational fit can be a resource associated with favorable effects on employees’ stress processes. Thus, we contribute to the stress and fit literatures by proposing and demonstrating empirical support for a COR theoretical explanation of why perceptions of organizational fit are a resource for employees. The results are important because they help provide a broader view of the effects of perceptions of organizational fit on employees’ stress processes than offered by prior research and suggest that organizational leaders have the opportunity to help employees manage workplace stress by fostering perceptions of organizational fit. Implications of results for theory and practice, strengths, limitations, and directions for future research are presented.
Predictors of Societal Accident Proneness Across 92 Countries
Authors: Minkov Michael
Published: January 2016

This study finds that road death tolls, occupational fatality rates, and airline safety are strongly correlated across 92 countries, yielding a common factor: national societal accident proneness. It is independently predicted by national differences in transparency versus corruption and differences in education. This finding has important practical implications: Substantial reduction of a nation’s societal accident proneness requires strong gains in transparency and education.
Combination of map-based and adaptive feedforward control algorithms for active engine mounts
Authors: Hausberg F , Plöchl M , Rupp M , Pfeffer P , Hecker S
Published: January 2016

Active engine mounts significantly contribute to ensure the comfort in vehicles with emission-reducing engine technologies, e.g., cylinder-on-demand (COD), downsizing or turbochargers. To control active engine mounts, either adaptive or non-adaptive feedforward control is commonly employed. Since both approaches have previously been treated separately, this study proposes methods to connect them in terms of multiple-input-multiple-output Newton/FxLMS adaptive filters with self-trained, grid-based look-up tables. The look-up tables are incorporated as parameter-maps or parallel-maps, respectively. By combining the two feedforward control strategies, their inherent advantages, i.e., the adaptivity of adaptive filtering and the direct impact as well as the tracking behavior of map-based feedforward control, are utilized. The proposed control structures are illustrated by simulation and experimentally demonstrated in a vehicle with a V8-COD engine. While both methods significantly reduce the convergence time of the adaptive filter, the parallel implementation additionally improves the tracking behavior during fast engine run-ups.
Risk and protective factors for cats with naturally occurring chronic kidney disease
Authors: Piyarungsri Kakanang , Pusoonthornthum Rosama
Published: January 2016

Objectives

Chronic kidney disease (CKD) is a significant disease in cats. Identifying risk and protective factors may help to prevent this significant disease.

Methods

An age-matched case-control study was performed to determine the risk factors in cats with naturally occurring CKD. Twenty-nine clinically normal cats aged ⩾5 years and 101 cats with naturally occurring CKD were studied. Risk factors were determined by interviewing cat owners from the Small Animal Hospital, Faculty of Veterinary Science, Chulalongkorn University, and veterinary hospitals in the Bangkok Metropolitan area, through questionnaires completed between June 2004 and November 2014. Univariable and multivariable analyses were performed using two independent proportional test methods and logistic regression analysis with backward elimination.

Results

Male sex (odd ratios [OR] 2.80, 95% confidence interval [CI] 1.02–8.87; P = 0.02), tap water (OR 3.43, 95% CI 1.08–11.45; P = 0.03) and an outdoor lifestyle (OR 3.77, 95% CI 1.03–17.99; P = 0.04) were associated with an increased risk for CKD. Commercial dry cat food (OR 0.06, 95% CI 0.02–0.17; P = 0.00), filtered water (OR 0.13, 95% CI 0.03–0.52; P = 0.01) and an indoor lifestyle (OR 0.28, 95% CI 0.07–0.98; P = 0.02) were associated with a decreased risk. Logistic regression analysis using backward elimination demonstrated that cats fed commercial dry cat food (OR 0.042, 95% CI 0.01–0.17; P = 0.00) had a decreased risk for CKD compared with cats on other types of diet.

Conclusions and relevance

Multivariable analysis found only feeding commercial dry cat food to be significant, suggesting that commercial dry cat food may be a potential protective factor for CKD in cats.
Effectiveness and efficiency in the treatment of gambling disorder: reflections on the Dodo Bird Conjecture
Authors: Harvey Peter
Published: January 2016

In the field of research into the treatment of problem gambling, researchers have been attempting to identify the treatment pathways that are effective in remediating gambling disorder among people seeking help. In spite of these efforts, research results remain equivocal in relation to which components of the various treatment options are effective, echoing the familiar claim that all psychotherapy treatments are effective, the Dodo Bird Conjecture.

This recent tendency towards the revival of the Dodo Bird Conjecture in the field of gambling research is due to factors ranging from a continuing lack of clarity about the effective components of treatments, subjective therapist effects and the lack of validated repeated measures of outcome to assess changes in self-reported data on gambling urge: anxiety, depression and changes in the ‘gambling disorder’ diagnosis over time.
Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy
Authors: Akthar Adil S. , Ferguson Mark K. , Koshy Matthew , Vigneswaran Wickii T. , Malik Renuka
Published: January 2016

Purpose/Objectives:

Patients receiving stereotactic body radiotherapy for stage I non-small cell lung cancer are typically staged clinically with positron emission tomography–computed tomography. Currently, limited data exist for the detection of occult hilar/peribronchial (N1) disease. We hypothesize that positron emission tomography–computed tomography underestimates spread of cancer to N1 lymph nodes and that future stereotactic body radiotherapy patients may benefit from increased pathologic evaluation of N1 nodal stations in addition to N2 nodes.

Materials/Methods:

A retrospective study was performed of all patients with clinical stage I (T1-2aN0) non-small cell lung cancer (American Joint Committee on Cancer, 7th edition) by positron emission tomography–computed tomography at our institution from 2003 to 2011, with subsequent surgical resection and lymph node staging. Findings on positron emission tomography–computed tomography were compared to pathologic nodal involvement to determine the negative predictive value of positron emission tomography–computed tomography for the detection of N1 nodal disease. An analysis was conducted to identify predictors of occult spread.

Results:

A total of 105 patients with clinical stage I non-small cell lung cancer were included in this study, of which 8 (7.6%) patients were found to have occult N1 metastasis on pathologic review yielding a negative predictive value for N1 disease of 92.4%. No patients had occult mediastinal nodes. The negative predictive value for positron emission tomography–computed tomography in patients with clinical stage T1 versus T2 tumors was 72 (96%) of 75 versus 25 (83%) of 30, respectively ( P = .03), and for peripheral versus central tumor location was 77 (98%) of 78 versus 20 (74%) of 27, respectively ( P = .0001). The negative predictive values for peripheral T1 and T2 tumors were 98% and 100%, respectively; while for central T1 and T2 tumors, the rates were 85% and 64%, respectively. Occult lymph node involvement was not associated with primary tumor maximum standard uptake value, histology, grade, or interval between positron emission tomography–computed tomography and surgery.

Conclusion:

Our results support pathologic assessment of N1 lymph nodes in patients with stage Inon-small cell lung cancer considered for stereotactic body radiotherapy, with the greatest benefit in patients with central and T2 tumors. Diagnostic evaluation with endoscopic bronchial ultrasound should be considered in the evaluation of stereotactic body radiotherapy candidates.
Progression to stage 3 and 4 chronic kidney disease and risk factor stratification following endovascular aortic aneurysm repair
Authors: Mohammed Somala , Kougias Panagiotis , Mandviwala Taher M , Barshes Neal R , Pisimisis George T
Published: January 2016

Background

Risk of progression to various stages of chronic kidney disease (CKD) after endovascular aortic aneurysm repair (EVAR) is unknown. This study estimates progression rates to stage 3 and 4 CKD after EVAR and identifies potential predictors for progression.

Methods

EVAR cases (2006–2012) were retrospectively reviewed. Freedom of progression to CKD was estimated using Kaplan–Meier analysis, and predictors for progression were identified using Cox proportional hazards model.

Results

Two hundred and twelve consecutive patients at a single academic institution underwent EVAR for infrarenal aneurysms. Estimated freedom from progression to stage 3 CKD was 80%, 76%, and 63% at 6, 12, and 18 months, respectively, and for stage 4, 97%, 96%, and 93% at 6, 12, and 18 months, respectively. Stage 3 CKD predictors of progression included age (odds ratio (OR): 1.106, p = 0.001), diabetes (OR: 3.052, p = 0.04), perioperative use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (OR: 3.249, p = 0.02), and operative blood loss (OR: 1.002, p < 0.01). Stage 4 predictors included preoperative hemoglobin (OR: 0.473, p = 0.04) and baseline renal function (OR: 0.928, p = 0.001). Intraoperative contrast administration did not impact CKD development.

Conclusions

Progression to stage 3 CKD after EVAR occurs more frequently and at a higher rate compared with progression to stage 4. Different risk factors are associated with progression to each of those stages of CKD.
Probability of collapse of a bridge system under seismic and scour hazards
Authors: Guo Xuan , Guo Ya
Published: January 2016

For a bridge pier, scour is the formation of a hole around the pier, which reduces the carrying capacity of the foundation and may cause a bridge system to fail. Once a scour hole is formed around the pier, it may last permanently. The scoured soil foundation bridge system may be subject to earthquake loads. The combined hazards may reduce the life of the bridge more significantly compared to a single hazard. Therefore, it is necessary to investigate the reliability of a bridge under the combination of seismic and scour hazards. In this research, a probabilistic framework is proposed to investigate the cumulative collapse probability of a scoured bridge system under seismic loads. Numerical experiments were employed to demonstrate the effectiveness of the proposed framework.
Update on inherited disorders of haemostasis and pregnancy
Authors: Lavee Orly , Kidson-Gerber Giselle
Published: January 2016

Inherited bleeding disorders have the potential to cause bleeding complications during pregnancy, childbirth and the postpartum period as well as effect fetal outcomes. There is an evolving understanding of the need for specialised and individualised care for affected women during these times. The aim for each patient is to estimate the risk to mother, fetus and neonate; to implement measures to minimise these risks; and to anticipate complications and develop contingencies for these scenarios. This includes accurate diagnosis, preconceptual care, prenatal diagnostic options, antenatal care, delivery and postpartum care as well as care of an affected neonate. An understanding of the physiologic haemostatic changes associated with pregnancy as well as the scope of defects, inheritance and management of inherited bleeding disorders is paramount when caring for these women. Collaborative and prospective management in conjunction with haematology services underpins the approach advocated. This review draws on the available literature, and outlines the principles of care for women with inherited bleeding disorders before, during and after pregnancy, as well as their babies, based on both available data and collective clinical experience.
Health Promotion Through Existing Community Structures
Authors: Wesevich Austin , Chipungu Jenala , Mwale Mercy , Bosomprah Samuel , Chilengi Roma
Published: January 2016

Introduction: Rural populations, particularly in Africa, suffer worse health outcomes from poor health services access. Community health workers (CHWs) effectively improve health outcomes, but the best means for CHWs reaching rural populations is unknown. Since Zambia is predominantly Christian, this study explored the use of CHWs through churches as an existing community structure for promoting preventive health behaviors, specifically rotavirus vaccine uptake. Methods: A noncontrolled cross-sectional study of 32 churches receiving a packaged intervention of diarrhea prevention and treatment messaging was conducted with repeated time points of data collection over 13 months (2013-2014) in the Kafue District of Zambia. Two churches were selected for each of the 17 catchment areas, and CHWs were identified and trained in the intervention of promoting 4 key messages related to diarrhea prevention and treatment: hand washing with soap, exclusive breast-feeding, rotavirus vaccination, and treating diarrhea with oral rehydration solution and zinc. The intervention was conducted within existing church’s women’s groups, and data was collected on attendance and the distribution of Rota Cards for tracking rotavirus immunizations. Results: Nineteen (59%) churches completed the study, and CHWs delivered health messages at a total of 890 women’s group meetings. The overall reach of the intervention was to 37.0% of church-attending women, and the efficacy was 67.7% (317 of 468 Rota Cards collected at health centers). Discussion: Implementing community health programs is often expensive and unsustainable, but the reach and efficacy levels achieved through existing structures like churches are encouraging in resource-constrained countries. Churches can be effective channels for delivering health prevention strategies to often difficult-to-reach rural populations. Further research is needed to investigate the impact of the intervention on health outcomes.
Activating Patients for Sustained Chronic Disease Self-Management
Authors: Dye Cheryl J. , Williams Joel E. , Evatt Janet H.
Published: January 2016

This article describes the impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups. Compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active ( P < .001), practicing healthy eating habits ( P = .001), handling stress well ( P = .001), and living an overall healthy lifestyle ( P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, η2 = .036, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005, η2 = .094. Enduring lifestyle changes necessary for chronic disease self-management require that psychosocial determinants of health behavior are instilled, which is typically beyond standard medical practice. We recommend peer-led, community-based programs as a complement to clinical care and support the increasing health system interest in promoting population health beyond clinical walls.
Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis and Guillain-Barre Syndrome in a 16-Month-Old Child
Authors: Matsui Motohiro , Shimizu Mariko , Ioi Aya , Mayumi Azusa , Higuchi Kohei , Sawada Akihisa , Sato Maho , Yasui Masahiro , Yanagihara Keiko , Inoue Masami
Published: January 2016

A 16-month-old girl was diagnosed with Epstein-Barr virus hemophagocytic lymphohistiocytosis and transferred to our hospital on the 58th day of the hemophagocytic lymphohistiocytosis after treatment failure according to the Hemophagocytic Lymphohistiocytosis-2004 protocol. On admission to our hospital, she had a flaccid paralysis of her lower limbs. Nerve conduction studies showed a acute motor axonal neuropathy, and a diagnosis of Guillain-Barre syndrome was established. Intravenous immunoglobulin G was started on the 57th day of the Guillain-Barre syndrome. To date, her neurological recovery is incomplete. For hemophagocytic lymphohistiocytosis, after treatment failure of THP-COP regimen (pirarubicin, cyclophosphamide, vincristine, and prednisone) and 2 courses of ESCAP regimen (etoposide, prednisone, cytarabine, L-asparaginase), we are now in the process of coordinating unrelated umbilical cord blood transplantation. To the best of our knowledge, we report the youngest case of Guillain-Barre syndrome accompanied by Epstein-Barr virus hemophagocytic lymphohistiocytosis. Rapid progression of Guillain-Barre syndrome, the electrophysiological subtype of Guillain-Barre syndrome, and treatment delay possibly led to poor neurological outcome.
Team Communication Platforms and Emergent Social Collaboration Practices
Authors: Anders Abram
Published: January 2016

Team communication platforms (TCPs), including the Slack software service, are an emergent class of social collaboration technology that combine features of multiple enterprise social media including social networking platforms and instant messaging. The media capabilities of these platforms, including integrations for diverse information and communication technologies, enable affordances for both highly adaptable and centralized team communication practices. In order to understand emergent practices in TCPs, this study offers a quantitative and qualitative content analysis of the reflective practice of early adopter organizations and individuals based on a sample of self-published blog posts. Results indicate that TCPs enable affordances for communication visibility that support situated knowledge sharing and collaborative workflows. TCPs also enable affordances for multicommunication and attention allocation including flexible scaling of media modality and synchronicity. This latter affordance is conceptualized as polysynchronicity, a term that describes the dynamic synchronicity characteristic of communication practices in TCPs.
The EMBARC European Bronchiectasis Registry: protocol for an international observational study
Authors: Chalmers James D. , Aliberti Stefano , Polverino Eva , Vendrell Montserrat , Crichton Megan , Loebinger Michael , Dimakou Katerina , Clifton Ian , van der Eerden Menno , Rohde Gernot , Murris-Espin Marlene , Masefield Sarah , Gerada Eleanor , Shteinberg Michal , Ringshausen Felix , Haworth Charles , Boersma Wim , Rademacher Jessica , Hill Adam T. , Aksamit Timothy , O'Donnell Anne , Morgan Lucy , Milenkovic Branislava , Tramma Leandro , Neves Joao , Menendez Rosario , Paggiaro Perluigi , Botnaru Victor , Skrgat Sabina , Wilson Robert , Goeminne Pieter , De Soyza Anthony , Welte Tobias , Torres Antoni , Elborn J. Stuart , Blasi Francesco
Published: January 2016

Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies.

The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1) a clinical history consistent with bronchiectasis; and 2) computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1) bronchiectasis due to known cystic fibrosis; 2) age <18 years; and 3) patients who are unable or unwilling to provide informed consent.

The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitudinal data on outcomes, treatment patterns and quality of life. Data from the registry will be available in the form of annual reports. and will be disseminated in conference presentations and peer-reviewed publications.

The European Bronchiectasis Registry aims to make a major contribution to understanding the natural history of the disease, as well as guiding evidence-based decision making and facilitating large randomised controlled trials.
Don’t sell out safety: a call to preserve risk evaluation and mitigation strategies to reduce harm to patients and the public in the U.S.
Authors: Worthy Stacey L.
Published: January 2016

Background

As medicines are becoming more targeted and complex in the U.S., ensuring patients’ safe use of medications with known dangerous risks is critical for public health and safety. Therefore, the Risk Evaluation and Mitigation Strategies (REMS) program is more important than ever. The REMS programs mandates that manufacturers utilize tools to manage known or potential serious risks (e.g., death, severe birth defects, prolonged hospitalization) associated with certain drugs while still making these medications available to patients with unmet medical needs. Yet, recently federal policy makers have proposed legislation to force manufacturers to sell medications with known serious risks in a manner that weakens the medications’ REMS programs.

Methods

The author reviewed U.S. legislation, statutes, case law, government agency policies and guidelines, scholarly articles, and news stories published between January 1, 2004 and December 1, 2015 and provided legal and policy analysis.

Results

REMS are necessary to make medications with known severe risks available to certain patient populations for whom treatment may not be available otherwise.

Conclusion

In order to ensure that proper safety measures are preserved and medications with known risks are not diverted to parties who will not follow safety requirements, legislation should not be passed to require a forced sale of drugs subject to REMS with restricted distribution for bioequivalence testing purposes. Generic manufacturers must be held to the same REMS safety standards as brand manufacturers. Systems currently in place adequately balance risk and safety.