bluuebunny/crossref_metadata_2025 huggingface dataset:
UKF‐based adaptive variable structure observer for vehicle sideslip with dynamic correction
Authors: Chen Jie , Song Jian , Li Liang , Jia Gang , Ran Xu , Yang Cai
Published: June 2016

Knowing vehicle sideslip angle is important and useful in various vehicle active safety applications. However, equipment which could directly measure sideslip angle is usually too expensive for industrial applications, so a reliable, affordable sideslip angle observer is necessary. Model‐based observer is affected by the model uncertainty, non‐linearity and the road friction inaccuracy. Sensor‐based observer might be easily affected by the sensor noise and the bias induced by the road micro‐uneven. Thus, an unscented Kalman filter (UKF)‐based adaptive variable structural observer with dynamic correction (AUKF) for vehicle body sideslip angle is brought forward in this study. First, an UKF observer with adaptive parameters is used to compensate the model uncertainty. Then, a sensor‐based observer is applied to realise a variable structure observer to compensate the estimation error in the highly non‐linear region. A pseudointegral method and a zero point reset method are adopted to dynamically correct the bias drift problem in the integral. Both simulations and real vehicle tests validated the proposed approach. The accurate vehicle sideslip angle is measured by a differential global positioning system. Results show that the proposed approach has better performance compared with traditional UKF method, and makes a good foundation for stability control.
Robust output tracking control of an unmanned aerial vehicle subject to additive state dependent disturbance
Authors: Tanyer İlker , Tatlıcıoğlu Enver , Zergeroğlu Erkan , Deniz Meryem , Bayrak Alper , Özdemirel Barbaros
Published: June 2016

In this study, an asymptotic tracking controller is developed for an aircraft model subject to additive, state‐dependent, non‐linear disturbance‐like terms. Dynamic inversion technique in conjunction with robust integral of the sign of the error term is utilised in the controller design. Compared to the previous studies, the need of acceleration measurements of the aircraft have been removed. In addition, the proposed controller design utilises only the output of aircraft dynamics. Lyapunov based analysis is applied to prove global asymptotic convergence of the tracking error signal. Numerical simulation results are presented to illustrate the performance of the proposed robust controller.
Multi‐objective approach for distribution network reconfiguration with optimal DG power factor using NSPSO
Authors: Tuladhar Subas Ratna , Singh Jai Govind , Ongsakul Weerakorn
Published: June 2016

In this study, a multi objective method for optimal network reconfiguration as well as reactive power dispatches of distributed generations (DGs) has been proposed to improve the network performances by using non‐dominated sorting particle swarm optimisation. The various network performances in terms of multi objective function include minimisation of system power loss, voltage deviation and energy wastage from solar and wind generation system. The effectiveness of the proposed method has been tested on the IEEE 33‐bus radial distribution system for different combinations of network reconfiguration and reactive power output of DGs or its varying power factor. The obtained results also compared and indicated that better network performances achieved with both network reconfiguration and power factor optimisation over other cases. In addition, this strategy also results in lesser energy wastage from distributed renewable generation over without network reconfiguration option; hence, this approach is also suitable for saving and utilising maximum capacity of available renewable sources.
Numerical polynomial homotopy continuation method to locate all the power flow solutions
Authors: Mehta Dhagash , Nguyen Hung Dinh , Turitsyn Konstantin
Published: June 2016

The manuscript addresses the problem of finding all solutions of power flow equations or other similar non‐linear system of algebraic equations. This problem arises naturally in a number of power systems contexts, most importantly the direct methods for transient stability analysis and voltage stability assessment. Here, the authors introduce a novel form of homotopy continuation method called the numerical polynomial homotopy continuation method that is mathematically guaranteed to find all the solutions without ever encountering a bifurcation. Since finding real solutions is much more challenging, first the authors embed the real form of power flow equation in complex space, and then track the generally unphysical solutions with complex values of real and imaginary parts of the voltages. The solutions converge to physical real form in the end of the homotopy. The so‐called gamma‐trick mathematically rigorously ensures that all the paths are well‐behaved along the paths, so unlike other continuation approaches, no special handling of bifurcations is necessary. The method is embarrassingly parallelisable. The authors demonstrate the technique performance by solving several test cases up to the 14 buses. Finally, they discuss possible strategies for scaling the method to large size systems, and propose several applications for security assessments.
Influence of optimal government subsidies for renewable energy enterprises
Authors: Yang Dong‐xiao , Nie Pu‐yan
Published: June 2016

On the basis of the government subsidies for renewable energy electricity, this study builds a two‐stage duopoly model in an industry with a renewable electricity enterprise and a conventional electricity enterprise in the market. Under the assumption of the generalised social welfare maximisation authority, this study discusses the effects of three types of government subsidies, business fixed input subsidy, output subsidy and mixed subsidy. First, the mixed subsidy policy is the best one under generalised social welfare. However, when the cost of renewable energy production or the energy negative coefficient is low, this subsidy policy generates a high electricity price. Second, when the output subsidy is used, the optimal price and optimal output of renewable energy will decrease with the increase of production cost and negative externality coefficient of renewable energy enterprises. Finally, both the optimal price and optimal outputs depend on the level of negative externality and the cost of renewable energy production.
Effects of multiple parameters on static electrification and breakdown strength of transformer oil
Authors: Liu Daosheng , Du Boxue , Liu Feifei , Wang Shihui
Published: June 2016

Forced convection of insulation oil is the main heat transfer mode in large‐power and ultra‐high‐voltage (UHV) transformers. The electrification hazard caused by physicochemical phenomena between mineral oil and pressboard has been suspected to be responsible for several failures. The electrification measurement was carried out in an oil flow system. The influences of oil temperature, flow velocity, time and applied electric field of fresh and dry transformer oil have been investigated by a measurement system. The experimental results from the oil flow system show that the streaming current increases with the increase of the temperature when the temperature is below 50°C, while it reverses when the temperature is above 50°C. The streaming current increases with the increase of AC and DC electric fields under the different flow velocities, but the streaming current polarity reverses with DC electric field polarity under the 6.9 m/s flow velocity. The electrification phenomenon can lead to reduction of the breakdown strength of the oil. It is concluded that some effective measures should be taken to restrain the possible harm caused by the streaming electrification in UHV converter transformer.
Maximising network lifetime for target coverage problem in wireless sensor networks
Authors: Manju  , Chand Satish , Kumar Bijender
Published: June 2016

Target coverage problem is one of the important problems in wireless sensor network in which each target should be covered by at least one sensor. All the sensors are organised into different groups called sensor cover in such a way that each cover can monitor all the targets for a fixed duration. By keeping one sensor cover active at a time while others in sleep mode, sensors batteries can be utilised in efficient way. This helps in prolonging the network lifetime. In this study, the authors propose a new energy‐efficient heuristic to schedule the sensors in different non‐disjoint sensor covers which helps to maximise network lifetime. At first, the authors’ heuristic identify all the critical targets (least covered) and the critical sensors (covering critical targets). The critical targets, covered by minimum number of sensors, will be the targets that become uncovered first. Utilising critical sensors efficiently will help to increase the network lifetime. In their method, they try to select minimum number of critical sensors in each sensor cover so that the critical targets can be covered for longer period. Simulation results shows that the proposed heuristic outperforms many existing approaches for solving target coverage problem.
Porous ZnMnO3 plates prepared from Zn/Mn–sucrose composite as high‐performance lithium‐ion battery anodes
Authors: Zhao Chenhao , Teng Zhaoguo , Zhao Dan'ni , Hu Zhibiao , Liu Kaiyu
Published: June 2016

Porous ZnMnO3 plates have been prepared by an initial formation of Zn/Mn–sucrose composite and subsequent calcination route. The influences of calcination temperatures on the structures and electrochemical performances of target ZnMnO3 are clearly studied. At an optimal calcination temperature of 500°C, the ZnMnO3 composed of numerous nanoparticles possesses an obvious plate‐like structure and porous property, and a Brunauer–Emmett–Teller specific surface area of ∼25.50 m2 g−1 and average pore size of ∼19.69 nm can be reached. As lithium‐ion battery anode, the optimal ZnMnO3 delivers a reversible (second) discharge capacity of 709.6 mAh g−1 at 0.4 A g−1. After 100 cycles, a discharge capacity of 560.0 mAh g−1 can be retained. Even at a high current density of 1.2 A g−1, the sample still shows a discharge capacity of 403.1 mAh g−1. The good electrochemical performance of as‐prepared ZnMnO3 may be attributed to its unique porous structure.
High‐sensitivity microelectromechanical systems‐based tri‐axis force sensor for monitoring cellular traction force
Authors: Thanh‐Vinh Nguyen , Omiya Tomoki , Tsukagoshi Takuya , Hirayama Kayoko , Noda Kentaro , Matsumoto Kiyoshi , Shimoyama Isao
Published: June 2016

A high‐sensitivity tri‐axis force sensor designed to measure the traction force of a single cell is reported. The developed sensor consists of a micropillar that is supported by a cross‐shaped Si structure and a double‐layer photoresist cap. The piezoresistors formed on the Si structure allow for the simultaneous measurement of the normal and shear forces acting on the micropillar. Moreover, the cap prevents the cells from contacting the Si structure, which is not desirable when measuring the force acting on the micropillar. The effect of the culture medium on the impedance of the sensor and the noise level of the measurement circuit was evaluated. The temperature effect was compensated using a piezoresistor that does not possess a through‐hole underneath. For measurement, inside a culture medium, the resolution of the sensor obtained from the standard deviations of the measured signals was less than 2 nN. Finally, it was demonstrated that the sensor is capable of measuring the traction force in three dimensions generated by an osteosarcoma cell when it detaches from the micropillar under trypsin treatment.
Formation of Carbon Quaternary Stereogenic Center in Acyclic Systems via a Sequence of Carbometalation–Intramolecular Cyclization–Silicon Activation
Authors: Preshel-Zlatsin Maya , Zhang Fa-Guang , Eppe Guillaume , Marek Ilan
Published: June 2016

The diastereoselective carbometalation reaction of cyclopropenyl esters followed by reaction with acylsilanes provides γ-silylated lactones that undergo a ‘sila-Grob’ fragmentation to give pyrone enolates as a new source of acyclic δ-diketones, δ-keto acid, and δ-keto ester derivatives possessing a quaternary stereocenter.
The effect of exchange-correlation coefficient in quantum semiconductor plasma in presence of electron-phonon collision frequency
Authors: Choudhury Sourav , Das Tushar Kanti , Ghorui Malay Kr. , Chatterjee Prasanta
Published: June 2016

The influence of exchange-correlation potential, quantum Bohm term, and degenerate pressure on the nature of solitary waves in a quantum semiconductor plasma is investigated. It is found that an amplitude and a width of the solitary waves change with variation of different parameters for different semiconductors. A deformed Korteweg-de Vries equation is obtained for propagation of nonlinear waves in a quantum semiconductor plasma, and the effects of different plasma parameters on the solution of the equation are also presented.
Pump laser-induced space-charge effects in HHG-driven time- and angle-resolved photoelectron spectroscopy
Authors: Oloff L.-P. , Hanff K. , Stange A. , Rohde G. , Diekmann F. , Bauer M. , Rossnagel K.
Published: June 2016

With the advent of ultrashort-pulsed extreme ultraviolet sources, such as free-electron lasers or high-harmonic-generation (HHG) sources, a new research field for photoelectron spectroscopy has opened up in terms of femtosecond time-resolved pump-probe experiments. The impact of the high peak brilliance of these novel sources on photoemission spectra, so-called vacuum space-charge effects caused by the Coulomb interaction among the photoemitted probe electrons, has been studied extensively. However, possible distortions of the energy and momentum distributions of the probe photoelectrons caused by the low photon energy pump pulse due to the nonlinear emission of electrons have not been studied in detail yet. Here, we systematically investigate these pump laser-induced space-charge effects in a HHG-based experiment for the test case of highly oriented pyrolytic graphite. Specifically, we determine how the key parameters of the pump pulse—the excitation density, wavelength, spot size, and emitted electron energy distribution—affect the measured time-dependent energy and momentum distributions of the probe photoelectrons. The results are well reproduced by a simple mean-field model, which could open a path for the correction of pump laser-induced space-charge effects and thus toward probing ultrafast electron dynamics in strongly excited materials.
Two Different Barium(II) 2D Coordination Polymers Constructed with Pyrazine-2,3-Dicarboxylate: Synthesis, Crystal Structures, and Thermal Decomposition to Barium(II) Carbonate Nanoparticles
Authors: Tabatabaee Masoumeh , Kukovec Boris-Marko , Amjad Saeed , Shishebor Masoud R.
Published: June 2016

Two novel barium(ii) 2D coordination polymers, {[Ba(µ-H2O)(H2O)2(µ-pyzdc)]}n (1) and {[Ba(H2O)2(µ-Hpyzdc)(Hpyzdc)]⋅2H2O}n (2) (pyzdcH2 = pyrazine-2,3-dicarboxylic acid), were prepared by reaction of barium(ii) chloride dihydrate and pyrazine-2,3-dicarboxylic acid under similar experimental conditions (slightly different pH values) and characterised by elemental analysis, IR spectroscopy, and thermogravimetric analysis/differential thermal analysis methods. Their crystal structures were determined by single-crystal X-ray structure analysis and it was revealed that the barium(ii) ion has a distorted bicapped square antiprismatic coordination geometry in 1 and a distorted tricapped trigonal prismatic geometry in 2, composed of water molecules, carboxylate O, and pyrazine N atoms in both cases. The polymers 1 and 2 have different connectivity, as the pyrazine-2,3-dicarboxylate ion acts as multidentate bridging ligand in both 1 and 2, but also as an N,O′-bidentate terminal ligand in 2. There are terminal coordinated water molecules in both 1 and 2, but bridging water molecules are present only in 1 and water molecules of crystallisation only in 2. BaCO3 nanoparticles were formed by thermal decomposition of 1 in the presence of polyethylene glycol, and their structure and morphology were studied by powder X-ray diffraction and scanning electron microscopy. According to the powder X-ray diffraction pattern, BaCO3 was formed with an orthorhombic witherite structure.
Translating stable sources in times of economic recession
Authors: Valdeón Roberto A.
Published: June 2016

This paper examines the translation of economic texts authored by Nobel Prize winner Paul Krugman, published originally byThe New York Timesin both their printed and Internet editions, and in Spanish byEl País. It comprises a small parallel corpus of eighteen original columns and their equivalent Spanish versions, a total of 31,196 words. The article will consider the translation of stable sources (Hernández Guerrero 2009) within the narrative of the economic recession that started in early 2010s. It will use Nord’s functional model (2005) to analyse the texts. The objectives of the study are: (1) to establish whether translators opt for instrumental or documentary translation, and (2) to consider whether stable sources such as the opinion columns written by prominent figures can be regarded as closed sources that do not accept major shifts during the translational process. I will look at extratextual factors such as time, space and motivation, as well as intratextual features such as linking devices, thematic organization, markers of text composition and lexis. In the final section, I will attempt to provide an interpretation from the perspective of communication studies, which might inform translation research as well. For the discussion I will draw on Castells’ proposal for the study of media discourse and its connection with the political power (2009).
Pragmatic failure in translating Arabic implicatures into English
Authors: Shehab Ekrema
Published: June 2016

The aim of this paper is twofold. First, it attempts to demonstrate that Arabic utterances involving euphemisms, tautologies and ironies (henceforth Arabic implicatures) lend themselves readily to a Gricean interpretation and, second, it shows how Arabic implicatures in their immediate, social context of use exhibit pragmatic failures when rendered into English. The study examines and analyzes ten Arabic utterances involving implicatures in their original contexts of situation taken from Mahfouz’s (1947)Ziqāqal-Midaqwhich was translated by LeGassick (1966) into ‘Midaq Alley’, and Ṭayib Ṣaleḥ’s (1966)Mawsimu al-Hijra ila ashShamāl, which was rendered by Davies (1969) into ‘the Season of Migration to the North’. The study argues that to avoid pragmatic failure when translating Arabic implicatures into English, emphasis should be placed on conveying the pragmatic import of these utterances by the employment of various translation strategies ranging from those capturing the form and/or function to those capturing the communicative sense independently.
Translators’ behaviors from a sociological perspective – A parallel corpus study of fantasy fiction translation in Taiwan
Authors: Liang Wayne Wen-chun
Published: June 2016

The aim of this study is to investigate translators’ behaviors in translating fantasy fiction in Taiwan, with the help of Pierre Bourdieu’s sociological model. The application of a sociological approach to translation studies allows an examination of the social and cultural nature of translation by locating this activity within a particular social structure. The investigation was conducted by employing a parallel corpus study of fantasy fiction translations: J.R.R. Tolkien’sThe Hobbit, C.S. Lewis’sThe Chronicles of Narnia, T.H. White’sThe Sword in the Stoneand Philip Pullman’sNorthern Lights. Translators’ textual behaviors when dealing with culture-specific items (CSIs) were analyzed. The results revealed a source-oriented tendency when translating CSIs. The evidence from the textual analysis was interpreted and discussed in terms of the interactions between the translators’ collective habitus and the social determinants in the literary field in Taiwan.
Applying assessment holistic method to the translation exam in Yemen
Authors: Bahameed Adel Salem
Published: June 2016

This paper is an attempt to guide the teachers how the assessment process should be and it highlights the effectiveness and suitability of adopting the holistic method of assessment. This method was applied to the correction of students’ translations of the final exam containing different texts to be translated in both directions between English and Arabic. The exam was done by 36 female students at the Faculty for Women – Seiyun, Yemen on the undergraduate degree course of Translation (2). The hypothesis regarding the suitability and effectiveness of using the assessment holistic method and the possibility to improve the quality of the assessing the students’ translations in future based on this method has not been verified. This study concluded that the main factor which is clearly identifiable was translation competence and that this method was found out to be too lenient to give impartial translation quality assessment for the students’ translations.
Demand for a Simple Weather Insurance Product in India: Theory and Evidence
Authors: Hill Ruth Vargas , Robles Miguel , Ceballos Francisco
Published: June 2016

This article analyzes the demand for a simple rainfall‐based weather insurance product among farmers in rural India. We explore the predictions of a standard expected utility theory framework on the nature of demand in terms of price, the basis of the hedge, and risk aversion using data from a randomized control trial. We find that demand behaves as predicted: it falls with price and basis risk and is hump‐shaped in risk aversion, with price sensitivity decreasing at higher levels of basis risk. We estimate a negative price elasticity of 0.58 and find that doubling the distance to a reference weather station decreases demand by 18%. These results indicate that improving pricing and quality of insurance products can directly increase demand. In addition, we examine the impact of insurance training relative to other mechanisms designed to increase understanding. The evidence suggests that increased incentives to learn or learning by using are more effective at increasing both understanding and demand. Finally, we contribute to the scarce evidence on the demand for insurance over time. In terms of our main interventions, we find that the effect of premium subsidies persists over time, while the impact of investments in new weather stations diminishes and the effect of increased training in the first season seems to disappear during the second season. Importantly, while having previously purchased insurance does not encourage future uptake, receiving a payout does. This could reflect issues of trust in the product or the insurance company, and constitutes an important topic for future research.
Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers
Authors: Tierney William M , Sidle John E , Diero Lameck O , Sudoi Allan , Kiplagat Jepchirchir , Macharia Stephen , Shen Changyu , Yeung Ada , Were Martin C , Slaven James E , Wools-Kaloustian Kara
Published: June 2016

Objective Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers.

Method Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR.

Results Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training.

Conclusions We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.
The utility of web mining for epidemiological research: studying the association between parity and cancer risk
Authors: Tourassi Georgia , Yoon Hong-Jun , Xu Songhua , Han Xuesong
Published: June 2016

Background The World Wide Web has emerged as a powerful data source for epidemiological studies related to infectious disease surveillance. However, its potential for cancer-related epidemiological discoveries is largely unexplored.

Methods Using advanced web crawling and tailored information extraction procedures, the authors automatically collected and analyzed the text content of 79 394 online obituary articles published between 1998 and 2014. The collected data included 51 911 cancer (27 330 breast; 9470 lung; 6496 pancreatic; 6342 ovarian; 2273 colon) and 27 483 non-cancer cases. With the derived information, the authors replicated a case-control study design to investigate the association between parity (i.e., childbearing) and cancer risk. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each cancer type and compared to those reported in large-scale epidemiological studies.

Results Parity was found to be associated with a significantly reduced risk of breast cancer (OR = 0.78, 95% CI, 0.75-0.82), pancreatic cancer (OR = 0.78, 95% CI, 0.72-0.83), colon cancer (OR = 0.67, 95% CI, 0.60-0.74), and ovarian cancer (OR = 0.58, 95% CI, 0.54-0.62). Marginal association was found for lung cancer risk (OR = 0.87, 95% CI, 0.81-0.92). The linear trend between increased parity and reduced cancer risk was dramatically more pronounced for breast and ovarian cancer than the other cancers included in the analysis.

Conclusion This large web-mining study on parity and cancer risk produced findings very similar to those reported with traditional observational studies. It may be used as a promising strategy to generate study hypotheses for guiding and prioritizing future epidemiological studies.
[C ii] emission in z ∼ 6 strongly lensed, star-forming galaxies
Authors: Knudsen Kirsten K. , Richard Johan , Kneib Jean-Paul , Jauzac Mathilde , Clément Benjamin , Drouart Guillaume , Egami Eiichi , Lindroos Lukas
Published: June 2016

The far-infrared fine-structure line [C ii] at 1900.5 GHz is known to be one of the brightest cooling lines in local galaxies, and therefore it has been suggested to be an efficient tracer for star formation in very high redshift galaxies. However, recent results for galaxies at z > 6 have yielded numerous non-detections in star-forming galaxies, except for quasars and submillimetre galaxies. We report the results of ALMA observations of two lensed, star-forming galaxies at z = 6.029 and z = 6.703. The galaxy A383-5.1 (star formation rate [SFR] of 3.2 M⊙ yr−1 and magnification of μ = 11.4 ± 1.9) shows a line detection with $L_{\rm [C\,\small {II}]} = 8.9\times 10^{6}$ L⊙, making it the lowest $L_{\rm [C\,\small {II}]}$ detection at z > 6. For MS0451-H (SFR = 0.4 M⊙ yr−1 and μ = 100 ± 20) we provide an upper limit of $L_{\rm [C\,\small {II}]} < 3\times 10^{5}$ L⊙, which is 1 dex below the local SFR–$L_{\rm [C\,\small {II}]}$ relations. The results are consistent with predictions for low-metallicity galaxies at z > 6; however, other effects could also play a role in terms of decreasing L[CII]. The detection of A383-5.1 is encouraging and suggests that detections are possible, but much fainter than initially predicted.
Histopathologic review of pineal parenchymal tumors identifies novel morphologic subtypes and prognostic factors for outcome
Authors: Raleigh David R. , Solomon David A. , Lloyd Shane A. , Lazar Ann , Garcia Michael A. , Sneed Penny K. , Clarke Jennifer L. , McDermott Michael W. , Berger Mitchel S. , Tihan Tarik , Haas-Kogan Daphne A.
Published: June 2016

Background.

Pineal parenchymal tumors (PPTs) are rare neoplasms of the central nervous system, and data concerning clinical outcomes are limited. The purpose of this study was to define the clinical behavior of PPT according to current histopathologic criteria and identify prognostic factors to guide therapeutic decisions.

Methods.

Seventy-five patients treated for PPT at a single institution between 1992 and 2015 were retrospectively identified. Forty-five resection specimens were available and re-reviewed. Freedom from progression (FFP) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using log-rank tests.

Results.

Median follow-up was 4.1 years. All patients initially underwent surgery; 78% of patients with PPT of intermediate differentiation (PPTID) and all patients with pineoblastoma received adjuvant therapy. Pathologic re-review refined classification in 27% of cases, with the majority of these being adult patients with pineal tumors originally classified as pineoblastomas that more accurately resembled PPTID based on the 2007 WHO classification.

Classification.

Our histologic review also identified that PPTIDs can be classified into small-cell and large-cell morphologic subtypes, which have distinct clinical outcomes. Tumor grade, extent of resection, and neuraxis spread were prognostic for FFP. PPTID subtype, extent of resection, and neuraxis spread were prognostic for OS. Genetic analysis of a pineoblastoma case identified somatic mutations of DICER1, ARID1A, and KDM5C genes.

Conclusions.

PPTIDs can be classified into 1 of 2 novel morphologic subtypes that are associated with distinct clinical outcomes. Tumor grade, neuraxis spread, and extent of resection also influence outcome for patients with PPT.
Epinephrine auto-injector needle length: what is the ideal length?
Authors: Song T. Ted , Lieberman Phil
Published: June 2016

Purpose of review

The purpose of this manuscript is to review the literature on the clinical effects of the needle length of epinephrine (adrenaline) auto-injectors.

Recent findings

Epinephrine has maximal pharmacodynamic effect within 10 min of intramuscular administration into the thigh. Prefilled epinephrine auto-injectors are designed for simplicity of use and safety. Auto-injectors are primarily used by patients in an unsupervised setting in cases of anaphylaxis. There are weight-appropriate doses of epinephrine available with auto-injectors that are prefilled, to prevent dosing errors, with 0.15, 0.30, and 0.50 mg amounts. In addition, needle lengths vary from 1.17 to 2.50 cm. The recommended needle lengths differ between adults and pediatric patients. In addition, the needle lengths differ between devices as well. There are concerns that the needle length may be too short in select obese patients. Yet, there are also concerns that the needle length may be too long in some patients. Factors that affect the depth of the injection, and therefore the pharmacokinetics of the drug, include not only the needle length but also the BMI, obesity, compression of soft tissue, and propulsion.

Epinephrine auto-injectors have different needle lengths. Using the right device with appropriate needle length based on BMI, obesity, and employing the proper technique can improve the outcome in an anaphylactic event.
The Recognition, Incidence, and Management of Spinal Cord Monitoring Alerts in Early-onset Scoliosis Surgery
Authors: Phillips Jonathan H. , Palmer Robert C. , Lopez Denise , Knapp Dennis R. , Herrera-Soto Jose , Isley Michael
Published: June 2016

Background:

The objective of the research was to study the relevance of intraoperative neuromonitoring throughout all stages of surgical management in patients with progressive early-onset scoliosis (EOS).

The routine monitoring of spinal cord potentials has gradually become standard of practice among spinal surgeons. However, there is not a consensus that the added expense of this technique necessitates monitoring in all stages of surgical management.

Methods:

A retrospective review of 180 surgical cases of 30 patients with EOS from July 2003 to July 2012 was performed. All monitoring alerts as judged by the neuromonitoring team were identified. Both somatosensory-evoked potentials and transcranial electric motor-evoked potentials were studied and no limiting thresholds for reporting electrophysiological changes were deemed appropriate.

Results:

Of 150 monitored cases there were 18 (12%) monitoring alerts. This represented 40% of the patient cohort over the 9-year study period.

Conclusions:

Index versus routine lengthening rate of alerts showed no significant difference in incidence of monitoring alerts. Conversely, several patients whose primary implantation surgeries were uneventful had monitoring alerts later in their treatment course. Intraoperative neuromonitoring is warranted throughout all stages of surgical management of EOS.

Level of Evidence:

Level IV. This study is a retrospective review of surgical cases of 30 patients with EOS.
Results of Ponseti Brasil Program: Multicentric Study in 1621 Feet: Preliminary Results
Authors: Nogueira Monica P. , Queiroz Ana C.d.B.F. , Melanda Alessandro G. , Tedesco Ana P. , Brandão Antonio L.G. , Beling Claudio , Violante Francisco H. , Brandão Gilberto F. , Ferreira Laura F.A. , Brambila Leandro S. , Leite Leopoldina M. , Zabeu Jose L. , Kim Jung H. , Fernandes Kalyana E. , Arima Marcia A.S. , Aguilar Maria D.P.Q. , Farias Filho Orlando C.d. , Oliveira Filho Oscar B.d.A. , Pinho Solange d.S. , Moulin Paulo , Volpi Reinaldo , Fox Mark , Greenwald Miles F. , Lyle Brandon , Morcuende Jose A.
Published: June 2016

Background:

The Ponseti method has been shown to be the most effective treatment for congenital clubfoot. The current challenge is to establish sustainable national clubfoot treatment programs that utilize the Ponseti method and integrate it within a nation’s governmental health system. The Brazilian Ponseti Program (Programa Ponseti Brasil) has increased awareness of the utility of the Ponseti method and has trained >500 Brazilian orthopaedic surgeons in it.

Methods:

A group of 18 of those surgeons had been able to reproduce the Ponseti clubfoot treatment, and compiled their initial results through structured spreadsheet.

Results:

The study compiled 1040 patients for a total of 1621 feet. The average follow-up time was 2.3 years with an average correction time of approximately 3 months. Patients required an average of 6.40 casts to achieve correction.

Conclusions:

This study demonstrates that good initial correction rates are reproducible after training; from 1040 patients only 1.4% required a posteromedial release.

Level of Evidence:

Level IV.
Evaluation of a Mobile Application for Multiplier Method Growth and Epiphysiodesis Timing Predictions
Authors: Wagner Pablo , Standard Shawn C. , Herzenberg John E.
Published: June 2016

Background:

The multiplier method (MM) is frequently used to predict limb-length discrepancy and timing of epiphysiodesis. The traditional MM uses complex formulae and requires a calculator. A mobile application was developed in an attempt to simplify and streamline these calculations. We compared the accuracy and speed of using the traditional pencil and paper technique with that using the Multiplier App (MA).

Methods:

After attending a training lecture and a hands-on workshop on the MM and MA, 30 resident surgeons were asked to apply the traditional MM and the MA at different weeks of their rotations. They were randomized as to the method they applied first. Subjects performed calculations for 5 clinical exercises that involved congenital and developmental limb-length discrepancies and timing of epiphysiodesis. The amount of time required to complete the exercises and the accuracy of the answers were evaluated for each subject.

Results:

The test subjects answered 60% of the questions correctly using the traditional MM and 80% of the questions correctly using the MA (P=0.001). The average amount of time to complete the 5 exercises with the MM and MA was 22 and 8 minutes, respectively (P<0.0001).

Conclusions:

Several reports state that the traditional MM is quick and easy to use. Nevertheless, even in the most experienced hands, performing the calculations in clinical practice can be time-consuming. Errors may result from choosing the wrong formulae and from performing the calculations by hand. Our data show that the MA is simpler, more accurate, and faster than the traditional MM from a practical standpoint.

Level of Evidence:

Level II.
A Novel Technique for Correcting Extensor Lag in Vascularized Toe PIP Joint Transfers
Authors: Lin Yu-Te , Loh Charles Yuen Yung
Published: June 2016

The use of the vascularized second-toe proximal interphalangeal joint (PIPJ) for vascularized joint transfers (VJTs) allows for restoration of powerful pinch/grasp and range of movement of a PIPJ in the hand. However, because of the lack of central slip formation in the majority of toes, the reconstructed PIPJ often results in extension lag. Extension lag associated with poor central slip formation in the lesser toes can be corrected using central slip reconstruction methods such as the Stack method. However, such methods are often cumbersome and involve extensive dissection and soft tissue manipulation. We present a novel, reproducible, simple yet effective technique in recreating the insertion point of the extensor tendon in the reconstructed finger, hence correcting the issue of extensor lag in vascularized toe joint transfers. The crux of this technique empowers the surgeon with the ability to correct inherent extensor lag of toes in VTJs. This will hence nullify “toe PIPJ angles” as a preselection criteria in determining patients suitable for VJT, thus enabling more patients to benefit from VJTs.
Patient Comorbidity and Serious Adverse Events after Outpatient Colonoscopy: Population-based Study From Three States, 2006 to 2009
Authors: Chukmaitov Askar , Siangphoe Umaporn , Dahman Bassam , Bradley Cathy J. , BouHaidar Doumit
Published: June 2016

BACKGROUND AND OBJECTIVE:

Serious GI adverse events in the outpatient setting were examined for patients with a full spectrum of comorbid conditions and combinations of multiple comorbidities.

DESIGN:

This is a retrospective follow-up study.

SETTING:

Ambulatory surgery and hospital discharge data sets from California, Florida, and New York, 2006 to 2009, were used.

PATIENTS:

The outpatient colonoscopies of 4,234,084 adults aged 19 to 85 and over and payers were examined.

MAIN OUTCOME:

Thirty-day hospitalizations due to colonic perforations and GI bleeding, measured as cumulative outcomes, were investigated.

RESULTS:

About 24% of patients undergoing outpatient colonoscopy had a comorbid condition. In comparison with patients without comorbidities, the adjusted risks of adverse events were greater for patients with several single comorbidities and combinations of multiple comorbid conditions. Elderly patients and those treated in freestanding Ambulatory Surgery Centers had higher odds of colonic perforations and GI bleeding than younger patients and patients treated in hospital outpatient departments.

LIMITATION:

The study was constrained by limitations inherent in administrative data.

CONCLUSIONS:

Given the large number of outpatient colonoscopies performed in the United States, these procedures should be provided with caution to patients with chronic and multiple comorbidities and the elderly, because these populations are associated with higher rates of colonic perforations and GI bleeding.
Development of The American Society of Colon and Rectal Surgeons’ Rectal Cancer Surgery Checklist
Authors: Glasgow Sean C. , Morris Arden M. , Baxter Nancy N. , Fleshman James W. , Alavi Karim S. , Luchtefeld Martin A. , Monson John R. T. , Chang George J. , Temple Larissa K.
Published: June 2016

BACKGROUND:

There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality.

OBJECTIVE:

The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer.

DESIGN:

A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed.

SETTINGS:

The study was conducted through meetings and discussion to consensus.

PATIENTS:

Patient data were extracted from an initial literature review.

MAIN OUTCOME MEASURES:

The checklist was measured by its ability to improve care in complex rectal surgery cases by reducing the possibility of omission through the division of treatment into 3 distinct phases.

RESULTS:

The process generated a 25-item checklist covering the spectrum of care for patients with rectal cancer who were undergoing surgery.

LIMITATIONS:

The study was limited by its lack of prospective validation.

CONCLUSIONS:

The American Society of Colon and Rectal Surgeons rectal cancer surgery checklist is composed of the essential elements of preoperative, intraoperative, and postoperative care that must be addressed during the surgical treatment of patients with rectal cancer.
Do Appendicitis and Diverticulitis Share a Common Pathological Link?
Authors: Harvey Jesslynne , Roberts Patricia L. , Schoetz David J. , Hall Jason F. , Read Thomas E. , Marcello Peter W. , Francone Todd D. , Ricciardi Rocco
Published: June 2016

OBJECTIVE:

The aim of this study was to determine whether there is an association between appendicitis and diverticulitis.

DESIGN:

This study is a retrospective cohort analysis.

SETTING:

This study was conducted in a subspecialty practice at a tertiary care facility.

PATIENTS:

We examined the rate of appendectomy among 4 cohorts of patients: 1) patients with incidentally identified diverticulosis on screening colonoscopy, 2) inpatients with medically treated diverticulitis, 3) patients who underwent left-sided colectomy for diverticulitis, and 4) patients who underwent colectomy for left-sided colorectal cancer.

INTERVENTIONS:

There were no interventions.

MAIN OUTCOME MEASURES:

The primary outcome measured was the appendectomy rate.

RESULTS:

We studied a total of 928 patients in this study. There were no differences in the patient characteristics of smoking status, nonsteroidal use, or history of irritable bowel syndrome across the 4 study groups. Patients with surgically treated diverticulitis had significantly more episodes of diverticulitis (2.8 ± 1.9) than the medically treated group (1.4 ± 0.8) (p < 0.0001). The rate of appendectomy was 8.2% for the diverticulosis control group, 13.5% in the cancer group, 23.5% in the medically treated diverticulitis group, and 24.5% in the surgically treated diverticulitis group (p < 0.0001). After adjusting for demographics and other clinical risk factors, patients with diverticulitis had 2.8 times higher odds of previous appendectomy (p < 0.001) than the control groups.

LIMITATIONS:

The retrospective study design is associated with selection, documentation, and recall bias.

CONCLUSIONS:

Our data reveal significantly higher appendectomy rates in patients with a diagnosis of diverticulitis, medically or surgically managed, in comparison with patients with incidentally identified diverticulosis. Therefore, we propose that appendicitis and diverticulitis share similar risk factors and potentially a common pathological link.
Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome
Authors: Kwik Michele , Maxwell Elizabeth
Published: June 2016

Purpose of review

Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS.

Recent findings

The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.

Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers.

More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.
Juvenile-onset Normal Tension Glaucoma From Chronic, Recurrent Low Cerebrospinal Fluid Pressure
Authors: Yusuf Imran H. , Ratnarajan Gokularaj , Kerr Richard S. , Salmon John F.
Published: June 2016

Introduction:

The evidence for low cerebrospinal fluid pressure (CSFP) as a key parameter in the pathogenesis of glaucoma is increasing. Primate models have demonstrated the onset normal tension glaucoma (NTG) from experimentally induced chronic intrathecal hypotension; an approach not possible in human subjects.

Case Presentation:

A 27-year-old man presented with a central scotoma in his left eye. He had undergone 8 CSF shunt revision procedures over a 25-year period secondary to recurrent low CSFP following surgical excision of a pinealoblastoma, aged 2. A focal nerve fiber layer defect was detected in the left eye associated with reduced retinal sensitivity on microperimetry. Three adjacent optic disc hemorrhages had been documented in the same position over an 18-month period. A diagnosis of left-sided NTG was made; the patient was started on Latanoprost 0.005%. A new generation CSF shunting device (ProGAV)—which neutralizes CSFP fluctuations analogously to trabeculectomy surgery for intraocular pressure—was considered necessary in this patient to alleviate persistent headaches and reduce the risk of progressive glaucomatous visual loss.

Conclusions:

This exceptional case illustrates how premature onset NTG may occur as a result of chronic, recurrent intrathecal hypotension—a “pure” human model. We describe an original management approach of implanting an adjustable, programmable CSF shunt valve (ProGAV) to reduce fluctuations in the translaminar cribrosa pressure difference, and reduce the risk of glaucomatous visual loss.