bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and assessment of an experimental facility for the characterization of flow boiling of azeotropic refrigerants in horizontal tubes
Authors: Pietro Maria Colombo Luigi , Lucchini Andrea , Nhan Phan Thanh , Molinaroli Luca , Niro Alfonso
Published: May 2019

An experimental facility was designed to measure pressure drop and heat transfer coefficient during flow boiling of azeotropic refrigerants in horizontal tubes. The apparatus is made of the refrigerant circuit, including the test section; the water circuit, to provide the power for evaporation; the glycol-water circuit, to fix the refrigerant pressure. The test section is a counterflow tube-in-tube heat exchanger (refrigerant inside, water outside). Plant assessment involved the measurement of pressure drop and heat transfer during R134a flow boiling in a smooth tube (outer diameter 9.56mm, inner diameter 8.92mm). Such a case study is a benchmark for the availability of a wide experimental database in the literature, which has been also summarized in many correlations. Then further tests involved a microfin tube. The experimental conditions were: evaporation temperature, 5°C; mass flux, 111÷333kg/m2s; average quality, 0.15÷0.93; heat flux, 8.8kW/m2 and 17.6kW/m2. The uncertainty affecting the pressure drop and the heat transfer coefficient resulted lower than 1% and 5% respectively. The comparison with the literature shows satisfactory agreement with the major findings and enables using the data for the assessment of the existing models to predict both the pressure drop and the heat transfer coefficient.
Experimental results on local heat transfer coefficient inside a rectangular channel with chevron-shaped ribs
Authors: Gramazio P , Vitali L , Fustinoni D , Vignati F , Niro A
Published: May 2019

A non-intrusive measurement technique of the heat transfer coefficient field, based on IR-thermography, is applied on a 12-mm-height rectangular channel of 1:10 aspect ratio, whose lower surface is enhanced by chevron-shaped square-cross-section ribs. The channel is operated at imposed heat flux while forced-air flows for Reynolds numbers ranging from 700 to 8000. In particular, the technique uses local temperature measurements to retrieve the radiative heat flux with a three-wavelength-band model for partially transparent enclosures, and the conductive flux towards the backside with a FEM model, which allow an edge-to-edge estimation of the local convective heat transfer. The resulting local Nusselt number maps are presented and compared to data obtained operating both at fixed temperature and inside a channel with flat surfaces.
Bulk viscosity in 2D relativistic uids: the effects of temperature and modifications to the Rayleigh-Brillouin spectrum
Authors: García-Perciante A L , Franco-Pérez L , Méndez A R
Published: May 2019

The dependence of the bulk viscosity with the relativistic parameter z = kT/mc
2, obtained through the complete Boltzmann equation [1, 2], is thoroughly analyzed. A complete and rigorous examination of the relevant non-relativistic and ultra-relativistic limits is carried out in the case of a hard disk model and compared with the results obtained in the relaxation time approximation. The modifications of the non-vanishing bulk viscosity to the Rayleigh - Brillouin is briefly discussed.
From peace campaigns to peaceocracy: Elections, order and authority in Africa
Authors: Lynch Gabrielle , Cheeseman Nic , Willis Justin
Published: May 2019

Research on Kenya’s 2013 elections has suggested that a “peace narrative” was deliberately promoted by an establishment elite to delegitimize protest and justify the use of excessive force. It has also tended to see the Kenyan case as exceptional and to assume that such a narrative was only possible because of the 2007/2008 post-election violence. We agree that peace campaigns are often particularly intense in the wake of violence and that they can be manipulated to generate a “peaceocracy”, a system in which an emphasis on peace is used to prioritize stability and order to the detriment of democracy. However, by comparing Kenya to Ghana and Uganda, two countries that have had very different experiences of elections and election-related violence, we demonstrate that peace messaging is neither unique to countries that have experienced recent electoral conflict, nor a recent phenomenon. Instead, we highlight the pervasiveness of peace narratives across the sub-continent, which we show is due to a number of factors. These include but are not limited to the way that elections are used to assert and perform state autonomy and an associated ideal of elections as orderly processes; the capacity of multiple actors to instrumentalize the ideal of orderly elections; a popular fear of electoral violence even in countries where it is rare; a growing tendency to individualize responsibility for peace; and the availability of international funding. Taken together, these factors help to explain the rise of peace messaging. At the same time, we argue that the risk that this messaging will foster a “peaceocracy” varies markedly and that the likelihood of incumbent manipulation is greatest in countries with a recent history of civil conflict and where the quality of democracy is already low.
The expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in the compression area during orthodontic relapse
Authors: Li Hanyue , Xia Lulu , Wang Shuo , Al-balaa Maher , Liu Wei , Hua Xianming
Published: May 2019

Objective

This study investigated the expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in the compression area during orthodontic relapse in rat molars.

Materials and methods

Thirty Wistar rats (6 weeks old) underwent orthodontic tooth movement (OTM) of the left first maxillary molar for 21 days, followed by removal of the force device. The contralateral maxillary molar served as a control with no mechanical force stimuli. Animals were sacrificed at 0, 1, 3, 7, and 14 days of relapse after force withdrawal. Tooth relapse and alveolar bone parameters were measured using microcomputed tomography (micro-CT). Maxilla sections were obtained for haematoxylin and eosin (HE), immunohistochemical staining [EMMPRIN, nuclear factor kappa B ligand (RANKL) and vascular endothelial growth factor (VEGF)] and tartrate-resistant acid phosphatase (TRAP). Correlation analyses were then performed.

Results

After force removal, nearly 79.88% of the total relapse occurred within the initial 3 days. The number of osteoclasts clearly increased while the alveolar bone density decreased on the pressure side on Day 3 of relapse. Moreover, the EMMPRIN expression level significantly increased on Day 1, peaked up on Day 3 and decreased on Days 7 and 14. Statistically, a strong positive correlation was found between EMMRPIN expression and the osteoclast number and RANKL and VEGF expression.

Conclusion

EMMPRIN was highly expressed on the pressure side during the orthodontic tooth relapse, which could be involved in osteoclastogenesis and alveolar bone resorption in association with RANKL and VEGF expression.
Determination of Moisture Content and Basic Density of Poplar Wood Chips under Various Moisture Conditions by Near-Infrared Spectroscopy
Authors: Liang Long , Fang Guigan , Deng Yongjun , Xiong Zhixin , Wu Ting
Published: May 2019

The potential of near-infrared (NIR) spectroscopy coupled with partial least-squares (PLS) regression was used to determine the moisture content and basic density of poplar wood chips. NIR spectra collected from the surface of wood chips were used to develop calibration models for moisture content and basic density predication, and various spectral preprocessing techniques were applied to improve the accuracy and robustness of the prediction models. The models were tested using totally independent sample sets and exhibited acceptable predictive performance for moisture content (coefficient of determination for prediction [R2p] = 0.98 and standard error of prediction [SEP] = 2.51 percent) and basic density (R2p = 0.87 and SEP = 17.61 kg m–3). In addition, the effect of moisture variations on prediction of basic density was investigated based on NIR spectra from wood chips under various moisture levels. The results demonstrated that broad absorption bands from water molecules, especially when free water exists in the cell lumen, overlap with informative signals related to wood properties and weaken the calibration relation between spectral features and basic density. Thus, maintaining wood chips in a low and even moisture state would help achieve reliable estimates of wood density by NIR analysis models.
Rice Galaxy: an open resource for plant science
Authors: Juanillas Venice , Dereeper Alexis , Beaume Nicolas , Droc Gaetan , Dizon Joshua , Mendoza John Robert , Perdon Jon Peter , Mansueto Locedie , Triplett Lindsay , Lang Jillian , Zhou Gabriel , Ratharanjan Kunalan , Plale Beth , Haga Jason , Leach Jan E , Ruiz Manuel , Thomson Michael , Alexandrov Nickolai , Larmande Pierre , Kretzschmar Tobias , Mauleon Ramil P
Published: May 2019

Background

Rice molecular genetics, breeding, genetic diversity, and allied research (such as rice-pathogen interaction) have adopted sequencing technologies and high-density genotyping platforms for genome variation analysis and gene discovery. Germplasm collections representing rice diversity, improved varieties, and elite breeding materials are accessible through rice gene banks for use in research and breeding, with many having genome sequences and high-density genotype data available. Combining phenotypic and genotypic information on these accessions enables genome-wide association analysis, which is driving quantitative trait loci discovery and molecular marker development. Comparative sequence analyses across quantitative trait loci regions facilitate the discovery of novel alleles. Analyses involving DNA sequences and large genotyping matrices for thousands of samples, however, pose a challenge to non−computer savvy rice researchers.

Findings

The Rice Galaxy resource has shared datasets that include high-density genotypes from the 3,000 Rice Genomes project and sequences with corresponding annotations from 9 published rice genomes. The Rice Galaxy web server and deployment installer includes tools for designing single-nucleotide polymorphism assays, analyzing genome-wide association studies, population diversity, rice−bacterial pathogen diagnostics, and a suite of published genomic prediction methods. A prototype Rice Galaxy compliant to Open Access, Open Data, and Findable, Accessible, Interoperable, and Reproducible principles is also presented.

Conclusions

Rice Galaxy is a freely available resource that empowers the plant research community to perform state-of-the-art analyses and utilize publicly available big datasets for both fundamental and applied science.
Gender-Specific Acaricidal Properties and Sexual Transmission of Spirotetramat in Two-Spotted Spider Mite (Tetranychidae: Acariformes)
Authors: Popov Sergei Ya , Alyokhin Andrei
Published: May 2019

Two-spotted spider mite, Tetranychus urticae Koch (Tetranychidae: Acariformes), is one of the most important agricultural pests in the world. Their populations have a tendency of rapidly developing resistance to acaricides, making it necessary to have a variety of active ingredients for sustainable chemical control of this pest. We investigated acaricidal properties of a relatively new insecticide spirotetramat using its commercial formulation, Movento Energy. Spirotetramat applied at concentrations equivalent to the field rates of 78 and 90 g ai/ha had a strong negative effect on the survival of the treated T. urticae, with ca. 95% of females and ca. 65% of males dying after the treatment. Spirotetramat appeared to interfere with female reproductive system. Many of the dead treated females had eggs stuck in the oviduct and protruding from their bodies. Surviving treated females did not lay eggs. Furthermore, untreated females that mated with treated males did not produce female offspring and displayed the symptoms of spirotetramat poisoning. Toxic effects continued manifesting themselves after female mites were transferred from treated onto untreated plant culture. Contrary to previous studies, contact toxicity was also detected. None of the treated immature stages survived to adulthood. Based on these results, spirotetramat may be a good option for integrated pest management in crops that are simultaneously affected by sucking insects and spider mites and in pesticide rotation sequences that are a part of integrated resistance management programs.
Persistent Rivaroxaban Effect Due to Impaired Renal Clearance and Medication Effects
Authors: Milito Chelsea , McRae Hannah , Victor Adrienne , Refaai Majed A , Schmidt Amy E
Published: May 2019

Rivaroxaban (Xarelto; Johnson & Johnson Services, Inc) is a direct oral anticoagulant (DOAC) that works by directly inhibiting the active site of factor Xa (FXa). Rivaroxaban is metabolized and cleared via the kidney and liver. The results of various studies have shown that patients with severe renal impairment should receive reduced dosages of rivaroxaban or another anticoagulant due to impaired clearance. Although it is not required, monitoring rivaroxaban is useful in some conditions; however, the assays required for such monitoring are not readily available. Herein, we present a case of a 68-year-old Caucasian male patient who was receiving rivaroxaban (20 mg/day) for atrial flutter and had mild renal impairment. The patient was found to have increased effect of rivaroxaban due to further impairment of renal clearance caused by several renally cleared medications. This case highlights the importance of closely examining the renal function of and medication list for a patient before starting DOACs such as rivaroxaban.
Must I Accept Prosecution for Civil Disobedience?
Authors: Weltman Daniel
Published: May 2019

Piero Moraro argues that people who engage in civil disobedience do not have a pro tanto reason to accept punishment for breaking the law, although they do have a duty to undergo prosecution. This is because they have a duty to answer for their actions, and the state serves as an agent of the people by calling the lawbreaker to answer via prosecution. I argue that Moraro does not go far enough. Someone who engages in civil disobedience does not even have to show up for the trial, provided that they answer for their actions adequately via some other means. This is because sometimes states are not agents of the people who can call lawbreakers to account, and even those states which are agents cannot demand that lawbreakers answer for their crimes in the form of a trial.
A random matrix model with non-pairwise contracted indices
Authors: Lionni Luca , Sasakura Naoki
Published: May 2019

We consider a random matrix model with both pairwise and non-pairwise contracted indices. The partition function of the matrix model is similar to that appearing in some replicated systems with random tensor couplings, such as the $p$-spin spherical model for the spin glass. We analyze the model using Feynman diagrammatic expansions, and provide an exhaustive characterization of the graphs that dominate when the dimensions of the pairwise and (or) non-pairwise contracted indices are large. We apply this to investigate the properties of the wave function of a toy model closely related to a tensor model in the Hamilton formalism, which is studied in a quantum gravity context, and obtain a result in favor of the consistency of the quantum probabilistic interpretation of this tensor model.
ROUTINE METHOD FOR THE DETERMINATION OF TRACE AMOUNTS OF 226Ra IN URINE BY ALPHA SPECTROMETRY
Authors: Guérin Nicolas , McMullin Danielle , Fabian Xenia , Kramer-Tremblay Sheila , Gagné Alexandre , Gale Ashley
Published: May 2019

226Ra is considered one of the most radiotoxic naturally occurring radionuclides. A new routine method was developed to measure traces of 226Ra in urine. Radium was pre-concentrated from a 2 l urine sample using manganese oxide (MnO2) particles. The MnO2 precipitate was dissolved and the organic matter was broken down. Then, potential radiological interferents were removed using DGA and AGMP1 stacked resin columns. A barium sulphate (BaSO4) micro-precipitation was performed before measuring the sample by alpha spectrometry. A good recovery of 60 ± 10% and excellent alpha resolution were obtained. The minimum detectable activity (MDA) was 0.2 ± 0.1 mBql−1. The method was validated using spiked samples and can be completed in 5 hours.
Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging
Authors: Cross Nathan E , Carrier Julie , Postuma Ronald B , Gosselin Nadia , Kakinami Lisa , Thompson Cynthia , Chouchou Florian , Dang-Vu Thien Thanh
Published: May 2019

Objectives

This study examined the differences in cognitive function between middle-aged and older adults with insomnia disorder, insomnia symptoms only (ISO) or no insomnia symptoms (NIS), in the context of other health and lifestyle factors.

Methods

Twenty-eight thousand four hundred eighty-five participants >45 years completed questionnaires, physical examinations, and neuropsychological testing across domains of processing speed, memory, and executive functions. An eight-question instrument assessed participants’ sleep, defining subjects with insomnia symptoms, probable insomnia disorder (PID), or NIS. The associations between these three groups and cognitive performance were examined with linear regression models adjusted for lifestyle and clinical factors.

Results

PID was identified in 1,068 participants (3.7% of the sample) while 7,813 (27.5%) experienced ISO. Participants with PID exhibited greater proportions of adverse medical and lifestyle features such as anxiety, depression, and diabetes than both other groups. Analyses adjusting for age, sex, education, as well as medical and lifestyle factors demonstrated that adults with PID exhibited declarative memory deficits (Rey Auditory Verbal Learning Test) compared with ISO or NIS. Adults with insomnia symptoms exhibited better performance on a task of mental flexibility than both other groups.

Conclusions

These findings suggest that insomnia disorder in middle-aged and older adults is associated with poorer health outcomes and worse memory performance than adults with insomnia symptoms alone or without any sleep complaints, even after adjustment for comorbidities. The assessment of longitudinal data within this cohort will be critical to understand if insomnia disorder may increase the risk of further cognitive decline.
Pharmacological Modulation of Sleep Homeostasis in Rat: Novel Effects of an mGluR2/3 Antagonist
Authors: Hanley Nicola , Paulissen Jerome , Eastwood Brian J , Gilmour Gary , Loomis Sally , Wafford Keith A , McCarthy Andrew
Published: May 2019

Increasing vigilance without incurring the negative consequences of extended wakefulness such as daytime sleepiness and cognitive impairment is a major challenge in treating many sleep disorders. The present work compares two closely related mGluR2/3 antagonists LY3020371 and LY341495 with two well-known wake-promoting compounds caffeine and d-amphetamine. Sleep homeostasis properties were explored in male Wistar rats by manipulating levels of wakefulness via (1) physiological sleep restriction (SR), (2) pharmacological action, or (3) a combination of these. A two-phase nonlinear mixed-effects model combining a quadratic and exponential function at an empirically estimated join point allowed the quantification of wake-promoting properties and any subsequent sleep rebound. A simple response latency task (SRLT) following SR assessed functional capacity of sleep-restricted animals treated with our test compounds. Caffeine and d-amphetamine increased wakefulness with a subsequent full recovery of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep and were unable to fully reverse SR-induced impairments in SRLT. In contrast, LY3020371 increased wakefulness with no subsequent elevation of NREM sleep, delta power, delta energy, or sleep bout length and count, yet REM sleep recovered above baseline levels. Prior sleep pressure obtained using an SR protocol had no impact on the wake-promoting effect of LY3020371 and NREM sleep rebound remained blocked. Furthermore, LY341495 increased functional capacity across SRLT measures following SR. These results establish the critical role of glutamate in sleep homeostasis and support the existence of independent mechanisms for NREM and REM sleep homeostasis.
The Drafters’ Dance: The Complexity of Drafting Legislation and the Limitations of ‘Plain Language’ and ‘Good Law’ Initiatives
Authors: Webb Thomas E , Geyer Robert
Published: May 2019

Can we provide legislative drafters with tools to simplify and clarify legislation, and make it more accessible? In the United Kingdom, United States, Canada, Australia, and European Union, through strategies such as the ‘Plain Language’ and ‘Good Law’ (PL/GL) initiatives, it is claimed that the answer is ‘yes’. Though many of the normative intentions underlying such initiatives are commendable, we argue that the pursuit of legislative and legal simplicity, clarity, and accessibility ignores the distinctly ‘complicated’ and ‘complex’ role of legislation and legislative drafters. This leads to a range of contradictory and paradoxical outcomes that undermine these goals. Following a review of the role of legislative drafters and PL/GL initiatives, we use a complexity tool, the Stacey Diagram, to demonstrate and visualize the inherent tensions in the PL/GL position. We show how legislative drafters negotiate their complex environment in a much more subtle, human way than is commonly recognized in PL/GL discourse.
6Ecocriticism
Authors: Ryan John Charles
Published: May 2019

This review of publications in the field of ecocriticism in 2018 is divided into six sections: 1. Introduction: Anthropocene Timescales and Affects; 2. Affective Ecocriticism; 3. Material and Empirical Ecocriticisms; 4. Ecocriticism and Ecopoetics; 5. Ecocritical Convergences; 6. Conclusion.

 The review focuses on four single-authored monographs, three edited book collections, three journal issues, and three stand-alone articles. The biospheric urgencies of the Anthropocene and its cataclysmic signature—climate change—have attracted ecocritical attention to concerns of time, scale, and affect. In particular, 2018 marked the further maturation of material and queer ecocriticisms, the florescence of affective ecocriticism, and the germination of empirical ecocriticism. The field in 2018 explores, in depth, the role of affect—emotions, intensities, corporealities, and modes of relations—in the Anthropocene. All the while, confluences between affective, material, and queer ecocriticisms continue to broaden the scope of environmental affect to include ‘bad’ and irreverent modes. What’s more, new publications in material ecocriticism draw attention to environmental narratives as vehicles for concretizing the highly abstract spatiotemporalities of the Anthropocene whereas empirical ecocriticism applies qualitative methods to understanding the transformative potential of narratives. 2018 saw major studies of ecopoetics in addition to convergences between ecocriticism, animal studies, performance studies, crime fiction studies, and the environmental humanities. The year also brought the extension of ecocritical approaches to the genre of crime fiction and the literature of the Global South.
NP student encounters with obesity bias in clinical practice
Authors: Hauff Caitlyn , Fruh Sharon M. , Graves Rebecca J. , Sims Brook M. , Williams Susan G. , Minchew Leigh A. , Hall Heather R. , Platt Terrie H. , Barclay Mi'Asia
Published: May 2019

This study explores NP students' encounters with obesity stigma and bias in their clinical environment as well as recommendations to decrease obesity stigma and bias. Results indicate a need for continued education on the topic of weight management within NP curricula.
Cytologic Grading of Cutaneous Sebaceous Neoplasms: Does it Help to Differentiate Benign From Malignant?
Authors: Tirado Mariantonieta , Metze Dieter , Sahlmann Jörg , Böer-Auer Almut
Published: May 2019

Both architectural and cytologic characteristics are used to distinguish benign from malignant sebaceous neoplasms; however, specific cytopathologic features of sebocytes have not been well defined. The authors assessed architectural and cytological features of 63 sebaceous neoplasms [15 sebaceous hyperplasias, 12 sebaceomas, 16 sebaceous adenomas (SA), 14 sebaceous carcinomas (SC), and 6 ocular sebaceous carcinoma (OSC)] to investigate whether cytological grading may facilitate classification of lesions. Among other criteria, nuclear pleomorphism (size, nucleolar appearance, membrane irregularity, crowding, mitoses, and chromatin pattern) was assessed and 3 theoretical nuclear grades established. Immunohistochemistry for CK10, p16, adipophilin and ki67 was performed on 7 cases of each type of tumor. Most sebaceous neoplasms, except OSC, showed a bland architectural silhouette. However, SA, SC, and OSC revealed larger nuclei (≥14 μm in ≥50% of cases), evident to multiple nucleoli, membrane irregularity, coarse to clumped chromatin, and nuclear grade ≥2 (latter in ≥56% of cases); by contrast, sebaceous hyperplasia and sebaceomas showed smaller nuclei (≤10 μm in ≥50% of cases), smooth borders, inconspicuous nucleoli, fine chromatin, and grade 1 nuclei (latter in 100% of cases). In the setting of a well-circumscribed architecture, cytologic features gain importance in the classification of sebaceous neoplasms. Interestingly, cytologic similarities found in SA and SC may indicate a close relationship of both neoplasms.
Superficial Nodular Fasciitis With Atypical Presentations: Report of 3 Cases and Review of Recent Molecular Genetics
Authors: Maloney Nolan , LeBlanc Robert E. , Sriharan Aravindhan , Bridge Julia A. , Linos Konstantinos
Published: May 2019

Nodular fasciitis is a benign proliferation of fibroblasts/myofibroblasts that can be mistaken for an aggressive neoplasm because of its spectrum of appearances and anatomical locations, rapid growth, infiltrative growth pattern, and high mitotic rate. The presence of fusions involving USP6 gene in most cases provides a useful tool for diagnostic confirmation. Nodular fasciitis is often deep, in association with fascia, but less commonly, it arises superficially and can be biopsied by dermatologists. We present herein 3 such cases with confirmed USP6 rearrangement by fluorescence in situ hybridization (FISH) in which the diagnosis of nodular fasciitis was not initially obvious because of atypical morphologic and clinical features. These cases illustrate that in cutaneous myofibroblastic proliferations, nodular fasciitis should be given consideration even when encountered in unusual locations.
Multilevel Interaction Effects of Family and Community Factors on Mothers' Engagement in Evidence-Based Home Visiting
Authors: Bae Dayoung , Cho Junhan , Terris Darcey D. , Glisson Rachael E. , Brown Anita , Nelson Twanna
Published: May 2019

Informed by ecological and family system frameworks, our study investigated the relationship between family- and community-level factors, and their cross-level interactions, with evidence-based home visiting program participation in a sample of 2409 mothers (mean age: 24.15 years). Using 2-level hierarchical linear modeling, we observed that mothers living in disadvantaged communities demonstrated less active engagement in evidence-based home visiting. Cross-level interaction effects revealed that mothers' unstable living conditions and psychiatric problems amplified the negative influence of disadvantaged communities on program engagement. Conversely, mothers who were first-time parents showed higher levels of participation in family support programs when they resided in disadvantaged communities.
Northwestern and Other Historical Vignettes regarding the Vascular Anastomotic Coupling Device
Authors: Dumanian Gregory A. , Janes Lindsay E. , Dumanian Zari P.
Published: May 2019

The vascular anastomotic coupling device is a widely used and effective aid to reconstructive microsurgery. Although there is a long history of innovators connected with this device, the current design of 6 interdigitating holes and pins was created de novo by a Northwestern medical student in 1960.
Current Trends in Management of Nonsyndromic Unilateral Coronal Craniosynostosis: A Cross-sectional Survey
Authors: Moderie Christophe , Govshievich Alexander , Papay Frank , Fearon Jeffrey , Gosain Arun , Doumit Gaby
Published: May 2019

Background:

Although the natural history of nonsyndromic unilateral coronal craniosynostosis has been extensively described, optimal management remains controversial due to lack of Level 1 evidence. This study aims to assess the current state of practice among craniofacial surgeons.

Methods:

Ninety-four craniofacial surgeons were approached to complete a survey consisting of 15 questions. Data were collected assessing surgeons’ primary surgical indication, timing of intervention, preoperative imaging, and choice of technique for patients presenting with nonsyndromic unilateral coronal craniosynostosis. Choice of technique and timing of intervention in case of recurrence were also investigated.

Results:

After 5 mailings, the response rate was 61%. The combination of both appearance and raised intracranial pressure was the primary indication for treatment for 73.2% of surgeons. Preoperative CT scan of the skull was “always” performed by 70.1% of respondents. Open surgical management was most commonly performed at 8–10 months of age (38.6%). Bilateral frontal craniectomy with remodeling of the supraorbital bandeau and frontal bone was the most common choice of procedure (84.2%). In case of mild to moderate and moderate to severe recurrences at 1 year of age, 89.5% and 47.4% of surgeons opted for conservative management, respectively. Optimal timing for repeat cranioplasty was after 4 years of age (65.5%). Overall, 43.4% quoted lack of evidence as the greatest obstacle to clinical decision-making when dealing with unilateral synostosis.

Conclusion:

This survey exposes the lack of consensus and the disparity of opinion among craniofacial surgeons regarding the management of nonsyndromic coronal synostosis, particularly in the setting of recurrence.
An Update on Measures of Preoperative Glycemic Control
Authors: Ngaage Ledibabari M. , Osadebey Emmanuel N. , Tullie Sebastian T.E. , Elegbede Adekunle , Rada Erin M. , Spanakis Elias K. , Goldberg Nelson , Slezak Sheri , Rasko Yvonne M.
Published: May 2019

Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.
Adoption of Enhanced Recovery after Surgery Protocols in Breast Reconstruction in Alberta Is High before a Formal Program Implementation
Authors: Redwood Jennifer N. , Matkin Ashlee E. , Temple-Oberle Claire F.
Published: May 2019

Background:

Enhanced recovery after surgery (ERAS) techniques have consistently demonstrated improved patient outcomes across multiple surgical specialties. We have lead international consensus guidelines on ERAS protocols for breast reconstruction and recently implemented these guidelines in Alberta. This study looks at adoption rates of ERAS pathways for breast reconstruction within Alberta, whereas also addressing barriers to ERAS implementation.

Methods:

A retrospective analysis of online operative reports in the Synoptec database consisting of patients undergoing alloplastic or autogenous breast reconstruction in Alberta was conducted. Primary outcomes of interest included whether ERAS protocols were utilized and what the reported barriers to ERAS utilization were.

Results:

Of the 372 patients undergoing breast reconstruction surgery, 215 (57%) patients were placed on an ERAS protocol. Autogenous reconstruction patients were more likely than alloplastic reconstruction patients to be placed on ERAS protocols (72% versus 53%, P = 0.002). A lack of resources was the most commonly cited reason for not adopting ERAS protocols for both autogenous and alloplastic reconstruction groups (53% and 53%). Surgeons in Southern Alberta were more likely than surgeons in Northern Alberta to utilize ERAS protocols for their alloplastic (73% versus 8%, P < 0.001) and autogenous (99% versus 4%, P < 0.001) reconstructions.

Conclusions:

Adoption of ERAS protocols in Alberta was strong (57% adherence) before a formal program implementation. We are encouraged that the recent official launch of ERAS protocols in breast reconstruction within the province will further enhance the uptake and care of this unique surgical population.
PEELING OF THE INTERNAL LIMITING MEMBRANE WITH FOVEAL SPARING FOR TREATMENT OF DEGENERATIVE LAMELLAR MACULAR HOLE
Authors: Morescalchi Francesco , Russo Andrea , Gambicorti Elena , Cancarini Anna , Scaroni Nicolò , Bahja Hassan , Costagliola Ciro , Semeraro Francesco
Published: May 2019

Purpose:

To compare the functional and anatomical results of fovea-sparing internal limiting membrane peeling during vitrectomy with those of observation for degenerative lamellar macular hole with lamellar hole–associated epiretinal proliferation.

Design:

A prospective, randomized, comparative pilot study.

Methods:

Thirty-six eyes were randomized to undergo surgery with foveal internal limiting membrane sparing (Group S) or observation only (Group C). The main outcome measures were foveal retinal sensitivity, visual acuity, and central retinal thickness.

Results:

After 6 months, a significant difference was found in foveal retinal sensitivity between Group S (12.8 ± 1.7 dB) and Group C (9.39 ± 1.8 dB; P < 0.001). Similarly, best-corrected visual acuity improved in Group S and remained stable in Group C (respectively, 0.17 ± 0.13 and 0.46 ± 0.21 logMAR; P < 0.001). A significant increase in central retinal thickness was observed in Group S, but not in Group C (272 ± 24 vs. 147 ± 20 µm, P < 0.001).

Conclusion:

Fovea-sparing internal limiting membrane peeling is a feasible treatment for degenerative lamellar macular hole with lamellar hole–associated epiretinal proliferation, yielding better improvements in best-corrected visual acuity and foveal retinal sensitivity than observation alone. Further studies are needed to optimize this new surgical approach.
Translation, Adaptation, and Validation of the Malay Version of the Cardiac Rehabilitation Barriers Scale
Authors: CHAI Li Sze , SIOP Sidiah , PUTIT Zabidah , LIM Lily , GUNGGU Azylina , TIE Suk Fong
Published: May 2019

Background

The rate of cardiac rehabilitation attendance at the Sarawak Heart Centre was identified as very low, and the reason has not been investigated. A scale is needed to identify barriers to participation in cardiac rehabilitation among patients with heart disease in Sarawak, Malaysia.

Purpose

The purposes of this study were to translate, adapt, and evaluate the Malay-language version of the Cardiac Rehabilitation Barriers Scale (CRBS) and to measure the psychometric properties of the Malay-version CRBS to justify its use in Sarawak.

Methods

A forward and back-translation method was used. Content validity was assessed by three experts. Psychometric testing was conducted on a sample of 283 patients who were eligible to participate in cardiac rehabilitation. A construct validity test was performed using factor analysis. Cronbach's alpha was used to examine the internal consistency. The test–retest reliability was calculated using the intraclass correlation coefficient on 22 participants. Independent-samples t test and analysis of variance were conducted to assess the criterion validity. Mean scores for total barriers of the scale and each individual factor were compared among the different patient characteristics.

Results

The Malay-version CRBS showed an item level of content validity index of 1.00 for all of the items after improvements were made based on the experts' suggestions. The factor analysis, using principal component analysis with direct oblimin rotation, extracted four factors that differed from the original study. These four factors explained 52.50% of the cumulative percentage of variance. The Cronbach's alphas ranged from .74 to .81 for the obtained factors. Test–retest reliability was established using the intraclass correlation coefficient value of .78. Criterion validity was supported using the significant differences in the mean score for total barriers among educational level, driving distance, travel time to the hospital, and cardiac rehabilitation attendance.

Conclusions/Implications for Practice

This study found the Malay-version CRBS to be a valid and reliable instrument. It may be used with inpatients to identify barriers to participation in cardiac rehabilitation to promote rehabilitation attendance and improve patient care.
Assessment of Dietary Habits in Patients With Chronic Heart Failure
Authors: UYSAL Hilal , ÖZ ALKAN Havva , ENÇ Nuray , YIĞIT Zerrin
Published: May 2019

Background

Nutritional deficiency is a critical factor in the development and prognosis of heart failure. An optimal diet should be ensured and maintained to manage the symptoms of heart failure.

Purpose

This study assessed the dietary habits of patients with chronic heart failure using diet quality indices with the goal of determining their nutritional status.

Methods

Forty-four female patients and 56 male patients (mean age: 66 ± 11.38 years) who had been admitted to the cardiology clinics of a university hospital in Istanbul between March 2012 and August 2014 were included in this study.

Results

In terms of body mass index, 34% of the participants were normal weight, 37% were overweight, and 21% were obese. Furthermore, this study found the mean daily total energy intake to be inadequate and the total mean score of the Healthy Eating Index to be 74.6 ± 9.32. The diet quality of most participants fell into the “needs improvement” category.

Conclusions

This study used the Healthy Eating Index, a measure developed to assess diet quality, to assess the food consumption patterns of patients with chronic heart failure. The findings support using this index before providing diet recommendations to patients.
Norfloxacin, ciprofloxacin, trimethoprim–sulfamethoxazole, and rifaximin for the prevention of spontaneous bacterial peritonitis: a network meta-analysis
Authors: Wang Wancong , Yang Jiahui , Liu Chuan , Song Pan , Wang Wenzhen , Xu Huimei , Xia Xingzhou
Published: May 2019

For the prevention of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites, prophylactic antibiotics are recommended as a standard regimen. This study aimed to assess the efficacy of norfloxacin (N), ciprofloxacin (C), trimethoprim–sulfamethoxazole (T-S), and rifaximin (R) in the prevention of SBP. We searched the electronic databases including PubMed, Cochrane Library, Embase, and Web of Science from inception till 1 August 2018. The randomized-controlled trials that compared N, C, T-S, R, and placebo (P) were identified. A network meta-analysis (NMA) was carried out using the software STATA 14.0 and Revman 5.3. We included 16 studies involving 1984 participants in the NMA for SBP prevention. The NMA results showed that, compared with those treated with P (reference), patients treated with C, N, or R had a lower incidence of SBP and mortality. Similarly, the incidences of SBP and mortality for R were lower than those for N. The probabilities of ranking results showed that R ranked first with respect to the outcomes of the incidence of SBP and mortality. According to our results, R seemed to be the optimal regimen for protecting against SBP in patients with cirrhosis and ascites. However, considering the limitations of our study, additional high-quality studies are required in this respect.
Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study
Authors: Masika Golden M. , Gottvall Maria , Kohi Thecla W. , von Essen Louise , Dol Justine S.
Published: May 2019

Background

Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment.

Objective

To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania.

Method

Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis.

Results

Guardians experienced several issues during the initial stages of their child’s cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope.

Conclusion

Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment.

Implications for practice

Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders’ support needs.
Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana
Authors: Ilechie Alex Azuka , Abokyi Samuel , Boadi-Kusi Samuel , Enimah Eugene , Ngozi Ezinne
Published: May 2019

SIGNIFICANCE

Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries.

PURPOSE

The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed.

METHODS

A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]).

RESULTS

Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were “loss” (32%; 18/57) and “breakage” (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02).

CONCLUSIONS

Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.
Impact of Dry Eye on Visual Acuity and Contrast Sensitivity: Dry Eye Assessment and Management Study
Authors: Szczotka-Flynn Loretta B. , Maguire Maureen G. , Ying Gui-shuang , Lin Meng C. , Bunya Vatinee Y. , Dana Reza , Asbell Penny A.
Published: May 2019

SIGNIFICANCE

Identification of the association of specific signs of dry eye disease with specific visual function deficits may allow for more targeted approaches to treatment.

PURPOSE

The purpose of this study was to explore the association of dry eye signs and symptoms with visual acuity (VA) and contrast sensitivity in the Dry Eye Assessment and Management study.

METHODS

Baseline data from participants in the Dry Eye Assessment and Management study were used in this secondary cross-sectional analysis. Standardized procedures were used to obtain results on the Ocular Surface Disease Index (OSDI), high-contrast logMAR VA, contrast sensitivity, tear film debris, tear breakup time (TBUT), corneal fluorescein staining, meibomian gland evaluation, conjunctival lissamine green staining, and Schirmer test scores. Generalized linear models that included age, refractive error status, and cataract status were used to assess the association between VA and contrast sensitivity with OSDI score and each dry eye sign. The Hochberg procedure was used to account for multiple comparisons.

RESULTS

Among 487 participants (974 eyes), worse VA was associated with worse mean score on the OSDI vision subscale (39.4 for VA 20/32 or worse vs. 32.4 for VA 20/16 or better; adjusted linear trend, P = .02); scores were not associated with contrast sensitivity. Severe meibomian gland plugging and abnormal secretions were associated with worse mean log contrast sensitivity (1.48 for severe vs. 1.54 for not plugged [P = .04] and 1.49 for obstructed vs. 1.57 for clear [P = .002], respectively). Longer TBUT was associated with better mean log contrast sensitivity (1.57 for TBUT >5 seconds and 1.51 for TBUT ≤2 seconds, P < .0001).

CONCLUSIONS

Worse VA rather than worse contrast sensitivity drives vision-related symptoms in dry eye. Greater tear film instability was associated with worse contrast sensitivity.