bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a simplified light reflectance value assessment tool for indoor surface coverings
Authors: Villalba Ayelén María , Monteoliva Juan Manuel , Pattini Andrea Elvira
Published: May 2020

Light reflectance value (LRV) of indoor surfaces impacts on electricity consumption for lighting. For this reason, inner surface reflectance is one of the parameters required by building energy efficiency codes and standards. In countries with advanced building energy certification processes, the LRV of coatings and paints is given by manufacturers. However, at regional and local level, these data are generally not available. In this context, the following problem arises: regional standards demand certifiers to determine the LRV of interior surfaces for the calculation of electric energy consumption by artificial lighting without proposing any tool or methodology for its calculation. Against this background, the main objective of the present work is to develop a simplified and low cost tool for the determination of LRV of inner surfaces materials. The methodology used is divided into three stages: (i) data (LRV, colour, type of material) collection, systematization and classification of materials; (ii) statistical analysis; (iii) development of the surface material card. Results show that a sample of the same material and colour may show variations in its LRV of up to 86%. This highlights the importance of the development of methods and tools, according to socio-technological contexts, for the determination of the LRV.
An improved service quality measurement model for soundscape assessment in urban public open spaces
Authors: Li Rui , Ou Dayi , Pan Sensen
Published: May 2020

The well-known service quality measurement (SQM) models, Importance-Satisfaction (I-S) model and Improvement index (Ii) model, have been recently proved useful in the analysis of soundscape quality. By combining the concepts of soundscape and quality management, this paper proposes an improved SQM model for soundscape assessment in urban public open spaces. Instead of using the I-S model, the Preference-Satisfaction (P-S) model was developed for soundscape quality evaluation, which can simultaneously assess the importance, satisfaction and improvement direction of soundscape elements and provide more accurate and comprehensive information for guiding the soundscape management and improvement. The proposed methods were subsequently applied to case studies in eight ordinary urban public open spaces in Fujian Province, China, and provided detailed information about the soundscape quality of these surveyed open spaces as well as their improvement strategies. The results have demonstrated the practicality and effectiveness of the proposed method. To the authors' knowledge, practical applications of quality management methods (or its variations) to urban soundscape study are still limited in the literature; therefore, the proposed method and findings of the current study could be valuable for both practical soundscape design and academic research.
Decolonising the health and well-being of Aboriginal men in Australia
Authors: Prehn Jacob , Ezzy Douglas
Published: May 2020

Aboriginal and/or Torres Strait Islander men have the worst health of any group in Australia. Despite this, relevant policies do not specifically explain how the issue will be improved. Existing research demonstrates the complexity of the problems facing Australian Indigenous men. The intersection of masculinity and Indigeneity, compounded by colonisation, historical policies, stigma, marginalisation, trauma, grief and loss of identity are key factors that shape these poor health outcomes. These outcomes are acknowledged in federal and some state government policies but not implemented. The article argues for a holistic and decolonised approach to Australian Aboriginal men’s health. Effective models of intervention to improve men’s health outcomes include men’s health clinics, men’s groups, Men’s Sheds, men’s health camps/bush adventure therapy, fathering groups and mentoring programs. Further research needs to be undertaken, with a greater emphasis on preventative health measures, adequate specific funding, culturally and gender appropriate responses to health, and government policy development and implementation covering Aboriginal male health.
Influence of rotational speed on the impact characteristics caused by a localized defect of the outer raceway in a ball bearing under an axial load
Authors: Hou Pingping , Wang Liqin , Peng Qiuyang
Published: May 2020

The rotational speed is a crucial parameter for bearing condition monitor. The present study shows the influence of the rotational speed on the impact characteristics caused by a localized defect of the outer raceway. A 2 Nb + 5-degrees-of-freedom nonlinear dynamic model for a ball bearing is developed. The waviness of bearing components, a localized defect of the outer raceway, and the centrifugal forces of balls caused by rotational speed are involved in the ball bearing model. Spectral kurtosis (SK) analysis and envelope spectrum analysis are used to extract the impact signal and confirm the position of the optimal frequency band affected by the impact signal. The peak of the impact signal rises with the increase in rotational speed. The position of the optimal frequency band affected by the impact signal is a linear piecewise function of the rotational speed. These simulated results are verified through vibration experiments of a ball bearing with a localized defect of the outer raceway under an axial load. In addition, considering both a localized defect on the outer raceway and the waviness of bearing components, only when the size of the localized defect is large enough, can the impact signal overcome the influence of the structural vibration of the system to extract impact characteristics. The case studies of high-speed spindle bearing state diagnosis show that high speed is not conducive to the extraction of the impact characteristics.
The Peshiṭta of Isaiah in Past and Present Scholarship
Authors: Atwood Preston L.
Published: May 2020

In this study I outline the scholarship pertaining to the Peshiṭta of Isaiah (S-Isa) and expound on specific topics in need of further research. I begin by recounting the process of S-Isa’s manuscript collation and its culmination in Leiden’s editio minor. Relatedly, I explain the role of citations in the patristic literature for reconstructing the original text of S-Isa. Then, I address how scholars approach the question of S-Isa’s relation to the Old Greek (G-Isa) and Targum (T-Isa) of Isaiah. I move on to summarize the studies on the translation technique of S-Isa and explain how they have aided in determining the degree to which S-Isa may have been influenced by G- and T-Isa. I continue by adumbrating the debate on the authorship and theology of S-Isa and problematizing certain assumptions brought to the discussion. I conclude by offering a few reflections on the future of S-Isa scholarship.
The ‘Temporal Turn’ in New Testament Studies
Authors: Bahr Lynne Moss
Published: May 2020

Reflecting a recent trend across academic disciplines, New Testament scholars are beginning to explore the concept of time and temporality, a concept not well-developed in the field. This article surveys this scholarship from the basis of three inter-related categories: social memory and historical narrative; queer and feminist theory; and apocalypticism and messianism. It addresses the question: How does the concept of time (generally, the idea of continual change) and temporality (concepts and orientations related to the experience of time) serve historical, literary, and theological aims in the New Testament? Further, the article proposes new areas of research that would expand on earlier work and also draw upon the burgeoning field of time and temporality in other disciplines.
Thoracic Endovascular Aortic Repair With Left Subclavian Artery Coverage Is Associated With a High 30-Day Stroke Incidence With or Without Concomitant Revascularization
Authors: Varkevisser Rens R. B. , Swerdlow Nicholas J. , de Guerre Livia E. V. M. , Dansey Kirsten , Li Chun , Liang Patric , Latz Christopher A. , Carvalho Mota Mathijs T. , Verhagen Hence J. M. , Schermerhorn Marc L.
Published: May 2020

Purpose: To evaluate the perioperative stroke incidence following thoracic endovascular aortic repair (TEVAR) with differing left subclavian artery (LSA) coverage and revascularization approaches in a real-world setting of a nationwide clinical registry. Materials and Methods: The National Surgical Quality Improvement Program registry was interrogated from 2005 to 2017 to identify all nonemergent TEVAR and/or open LSA revascularization procedures. In this time frame, 2346 TEVAR cases met the selection criteria for analysis. The 30-day stroke incidence was compared between patients undergoing TEVAR with (n=888) vs without (n=1458) LSA coverage, for those with (n=228) vs without (n=660) concomitant LSA revascularization among those with coverage, and following isolated LSA revascularization for occlusive disease (n=768). Multivariable logistic regression was employed for risk-adjusted analyses and to identify factors associated with stroke following TEVAR. Results of the regression analyses are presented as the adjusted odds ratio (OR) with 95% confidence interval (CI). Results: The stroke incidence was 2.3% following TEVAR without vs 5.2% with LSA coverage (p<0.001). In TEVARs with LSA coverage, the stroke incidence was 7.5% when the LSA was concomitantly revascularized and 4.4% without concomitant revascularization, while stroke occurred in 0.5% of isolated LSA revascularizations. Of 33 TEVAR patients experiencing a perioperative stroke, 8 (24%) died within 30 days. LSA coverage was associated with stroke both with concomitant revascularization (OR 4.0, 95% CI 2.2 to 7.5, p<0.001) and without concomitant revascularization (OR 2.2, 95% CI 1.3 to 3.8, p=0.002). Other preoperative factors associated with stroke were dyspnea (OR 1.8, 95% CI 1.1 to 3.0, p=0.014), renal dysfunction (OR 2.2, 95% CI 1.0 to 3.8, p=0.049), and international normalized ratio ≥2.0 (OR 3.6, 95% CI 1.0 to 13, p=0.045). Conclusion: Stroke following TEVAR with LSA coverage occurs frequently in the real-world setting, and concurrent LSA revascularization was not associated with a lower stroke incidence.
Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry
Authors: Mwipatayi Bibombe P. , Oshin Olufemi A. , Faraj Joseph , Varcoe Ramon L. , Wong Jackie , Becquemin Jean-Pierre , Riambau Vincente , Böckler Dittmar , Verhagen Hence J.
Published: May 2020

Purpose:

To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR).

Materials and Methods:

Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups.

Results:

Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07).

Conclusion:

EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.
Median Arcuate Ligament Syndrome With Celiac Artery Aneurysm and Dissection
Authors: Michell Hans , Nezami Nariman , Dewald Aaron , Bhave Anant , Morris Christopher , Akselrod Dmitriy
Published: May 2020

Median arcuate ligament syndrome (MALS) is the chronic symptomatic compression of the celiac artery by the median arcuate ligament. A known potential sequela of MALS is celiac artery aneurysm, which could predispose the diseased artery to dissection. However, the presence of celiac artery dissection and MALS is yet to be reported. Here, we present a case of MALS with a coincident celiac artery aneurysm and dissection.
Exploring Participant Perceptions of a Community-Based Program for People With Brain Injury
Authors: White Barbara Prudhomme
Published: May 2020

An acquired brain injury presents complex challenges to survivors returning to the community, and as more individuals survive, the need for programs that support optimal quality of life increases. To explore participant perceptions of a community-based program. To accomplish objectives, 10 individuals living with chronic brain injury who were attendees of the community program were interviewed. Applying qualitative study procedures, all narrative data were transcribed and analyzed. All participants expressed that the program positively impacted several personal life satisfaction factors as well as their participation within their respective communities. Themes included (1) Acceptance, (2) Sense of Community, (3) Sense of Purpose, (4) Autonomy, and (5) Personal Development. Discussion includes analysis of program elements that help explain participant responses. Description of the occupational therapy grounded program offers a guide to others wishing to develop similar programs for individuals living with brain injury.
Evidence From Meta-Analysis Supports Ictal Magnetoencephalographic Source Imaging as an Accurate Method in Presurgery Evaluation of Patients With Drug-Resistant Epilepsy
Authors: Brændholt Malthe , Jensen Mads
Published: May 2020

Background.

Successful epilepsy surgery relies on localization and removal of the brain area responsible for initializing the seizures called the epileptogenic zone (EZ). Intracranial EEG (icEEG) is gold standard of this localization but has several limitations like invasiveness and limited covered area. A noninvasive method with accurate localization precision is therefore desirable. The aim of this article is to investigate the following hypotheses: (1) Ictal onset zone as localized by magnetic source imaging (iMSI) can reliably localize the EZ in focal epilepsy and (2) this localization is as good as that of icEEG.

Methods.

Six original studies and a total of 59 unique patients were included in a meta-analysis.

Results.

Sensitivity and specificity of iMSI based on surgery outcome were 77% (95% CI 60%-90%) and 75% (95% CI 53%-90%), respectively. Specificity of iMSI was statistically higher than that of icEEG. There was no significant difference between sensitivity of iMSI and icEEG.

Conclusion.

The meta-analysis supports that iMSI is an accurate method, achieving similar sensitivity and higher specificity than icEEG. However, at present the use of the method is limited by short recording times. A limitation that might be overcome in the future using technical advances.
An adaptive method based on contextual anomaly detection in Internet of Things through wireless sensor networks
Authors: Yu Xiang , Lu Hui , Yang Xianfei , Chen Ying , Song Haifeng , Li Jianhua , Shi Wei
Published: May 2020

With the widespread propagation of Internet of Things through wireless sensor networks, massive amounts of sensor data are being generated at an unprecedented rate, resulting in very large quantities of explicit or implicit information. When analyzing such sensor data, it is of particular importance to detect accurately and efficiently not only individual anomalous behaviors but also anomalous events (i.e. patterns of behaviors). However, most previous work has focused only on detecting anomalies while generally ignoring the correlations between them. Even in approaches that take into account correlations between anomalies, most disregard the fact that the anomaly status of sensor data changes over time. In this article, we propose an unsupervised contextual anomaly detection method in Internet of Things through wireless sensor networks. This method accounts for both a dynamic anomaly status and correlations between anomalies based contextually on their spatial and temporal neighbors. We then demonstrate the effectiveness of the proposed method in an anomaly detection model. The experimental results show that this method can accurately and efficiently detect not only individual anomalies but also anomalous events.
Cannulation Strategies for Minimally Invasive Cardiac Surgery
Authors: Lamelas Joseph , Aberle Corinne , Macias Alejandro E. , Alnajar Ahmed
Published: May 2020

Objective

Operative techniques for minimally invasive cardiac surgery (MICS) have evolved dramatically over the past decade to include a wide demographic of patients. Mastering a variety of cannulation techniques is of paramount importance in performing a safe perfusion strategy and operation. Our aim is to describe cannulation strategies utilized in various MICS procedures.

Methods

We review numerous cannulation strategies and their application in different minimally invasive procedures.

Results

Cannulation strategies will vary depending on the MICS procedure and other anatomical variations and obstacles. Utilizing the appropriate cannulation strategy will allow for a safe and effective operation.

Conclusions

Mastering the art of cannulation will provide surgeons with a toolbox to choose from when performing MICS in a wide variety of procedures.
Off-label use of Proglide percutaneous closure device in iatrogenic arterial catheterizations: Our experience
Authors: Lorenzo Javier Fernández , Rey Jorge Vidal , Arquillo Irene López , Encisa de Sá Jose Manuel
Published: May 2020

Introduction

Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications.

Objectives

Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation.

Methods

Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA).

Results

All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described.

Conclusions

Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.
Dual-optimization trajectory planning based on parametric curves for a robot manipulator
Authors: Kuo Yong-Lin , Lin Chun-Chen , Lin Zheng-Ting
Published: May 2020

This article presents a dual-optimization trajectory planning algorithm, which consists of the optimal path planning and the optimal motion profile planning for robot manipulators, where the path planning is based on parametric curves. In path planning, a virtual-knot interpolation is proposed for the paths required to pass through all control points, so the common curves, such as Bézier curves and B-splines, can be incorporated into it. Besides, an optimal B-spline is proposed to generate a smoother and shorter path, and this scheme is especially suitable for closed paths. In motion profile planning, a generalized formulation of time-optimal velocity profiles is proposed, which can be implemented to any types of motion profiles with equality and inequality constraints. Also, a multisegment cubic velocity profile is proposed by solving a multiobjective optimization problem. Furthermore, a case study of a dispensing robot is investigated through the proposed dual-optimization algorithm applied to numerical simulations and experimental work.
Clinical practice and procedures for postoperative care in Sweden: Results from a nationwide survey
Authors: Juhász Edit H , Iversen Magnus , Samuelson Anders , Bäckström Ragnar , Nilsson Ulrica
Published: May 2020

A nationwide survey describing Swedish post-anaesthesia care units (PACUs), n = 75 was undertaken. The patients most commonly cared for at PACUs were patients who had undergone laparoscopic surgery, 69.3%, followed by patients who had undergone minor orthopaedic surgery, 68%. At the majority of the PACUs, 86.7%, the staff cared for emergency surgery patients and 48% for day surgery patients. In 31% of the PACUs, a pain relief service was offered through a specific pain service team. During the daytime, the anaesthetist in charge most frequently worked in the operating room 42.7%, and on call in the intensive care unit, 37.3% of the time. In 88% of the PACUs, either all or most registered nurses had a specialist education at an advanced level. The most frequent ratio of registered nurses to patients was 1 to 4, 37.3%. However, Swedish PACUS are also staffed by assistant nurses and the most frequent ratio of registered nurse to assistant nurse was 1:1. Thirty-three (44%) of the PACUs had access to a physiotherapist during the daytime. Almost all PACUs (93.3%) had predetermined discharge criteria but in the majority of PACUs' high-risk patients (68%) were not followed up by an anaesthetist after discharge from the PACU.
Overuse syndrome of the hand and wrist in musicians: a systematic review
Authors: Betzl Julia , Kraneburg Ursula , Megerle Kai
Published: May 2020

We systematically searched medical publication databases for articles in English on upper extremity overuse syndrome in musicians. We focused on non-specific pain disorders, including diagnostic definitions, epidemiology, pathophysiology, risk factors, symptoms, treatment, and prevention. We included 42 out of 156 identified articles. The point prevalence of playing-related musculoskeletal disorders ranges from 37% to 47% in musicians with the hand and wrist among the most commonly affected areas, and the lifetime prevalence is reported as high as 89%. Leading symptoms are pain, weakness, stiffness, and loss of control. Intense repetitive use during practice, or before an audition or concert, recent changes in conductors or teachers, psychological stress, the effort of holding a weighty instrument, wrong technique, and joint laxity have all been identified as risk factors. The need for prevention is highlighted. Today’s therapy is mostly based on individual rehabilitation programmes rather than on long-term rest. However, treatment remains predominantly based on beliefs rather than on evidence. The entire subject needs intensive future research.
The strengths of one-, two-, and three-weave Pulvertaft tendon repairs
Authors: Choke Abby , Rung Wong Yoke , McGrouther Duncan A. , Bin Abd Razak Hamid Rahmatullah
Published: May 2020

We tested the tensile strength of the proximal juncture of tendon grafts with Pulvertaft tendon repairs in 18 cadaveric digital flexor tendons. These tendons were divided into three groups of six: single, two, or three weaves. Each of the interlacing weaves was secured with eight anchoring sutures. The specimens were loaded in a biomechanical tester until failure. The ultimate tensile strength did not show any significant differences across all three groups with statistical power of 0.77. The mean tendon elongation before repair failure showed significant difference at 10 mm (standard deviation (SD) 2), 16 mm (SD 3), and 15 mm (SD 3), respectively. All specimens failed by intra-tendinous pull-out of the weaves. We conclude that the two-weave Pulvertaft construct demonstrated comparable tensile strength to three weaves and tendon elongation was similar when two or three weaves were used.
Magnetic resonance imaging in the assessment of pancreatic cancer with quantitative parameter extraction by means of dynamic contrast-enhanced magnetic resonance imaging, diffusion kurtosis imaging and intravoxel incoherent motion diffusion-weighted imaging
Authors: Granata Vincenza , Fusco Roberta , Sansone Mario , Grassi Roberto , Maio Francesca , Palaia Raffaele , Tatangelo Fabiana , Botti Gerardo , Grimm Robert , Curley Steven , Avallone Antonio , Izzo Francesco , Petrillo Antonella
Published: May 2020

Background:

Despite great technical advances in imaging, such as multidetector computed tomography and magnetic resonance imaging (MRI), diagnosing pancreatic solid lesions correctly remains challenging, due to overlapping imaging features with benign lesions. We wanted to evaluate functional MRI to differentiate pancreatic tumors, peritumoral inflammatory tissue, and normal pancreatic parenchyma by means of dynamic contrast-enhanced MRI (DCE-MRI)-, diffusion kurtosis imaging (DKI)-, and intravoxel incoherent motion model (IVIM) diffusion-weighted imaging (DWI)-derived parameters.

Methods:

We retrospectively analyzed 24 patients, each with histopathological diagnosis of pancreatic tumor, and 24 patients without pancreatic lesions. Functional MRI was acquired using a 1.5 MR scanner. Peritumoral inflammatory tissue was assessed by drawing regions of interest on the tumor contours. DCE-MRI, IVIM and DKI parameters were extracted. Nonparametric tests and receiver operating characteristic (ROC) curves were calculated.

Results:

There were statistically significant differences in median values among the three groups observed by Kruskal–Wallis test for the DKI mean diffusivity (MD), IVIM perfusion fraction (fp) and IVIM tissue pure diffusivity (Dt). MD had the best results to discriminate normal pancreas plus peritumoral inflammatory tissue versus pancreatic tumor, to separate normal pancreatic parenchyma versus pancreatic tumor and to differentiate peritumoral inflammatory tissue versus pancreatic tumor, respectively, with an accuracy of 84%, 78%, 83% and area under ROC curve (AUC) of 0.85, 0.82, 0.89. The findings were statistically significant compared with those of other parameters ( p value < 0.05 using McNemar’s test). Instead, to discriminate normal pancreas versus peritumoral inflammatory tissue or pancreatic tumor and to differentiate normal pancreatic parenchyma versus peritumoral inflammatory tissue, there were no statistically significant differences between parameters’ accuracy ( p > 0.05 at McNemar’s test).

Conclusions:

Diffusion parameters, mainly MD by DKI, could be helpful for the differentiation of normal pancreatic parenchyma, perilesional inflammation, and pancreatic tumor.
Prediction of motor recovery using indirect connectivity in a lesion network after ischemic stroke
Authors: Lee Jungsoo , Park Eunhee , Lee Ahee , Chang Won Hyuk , Kim Dae-Shik , Kim Yun-Hee
Published: May 2020

Background:

Recovery prediction can assist in the planning for impairment-focused rehabilitation after a stroke. This study investigated a new prediction model based on a lesion network analysis. To predict the potential for recovery, we focused on the next link-step connectivity of the direct neighbors of a lesion.

Methods:

We hypothesized that this connectivity would contribute to recovery after stroke onset. Each lesion in a patient who had suffered a stroke was transferred to a healthy subject. First link-step connectivity was identified by observing voxels functionally connected to each lesion. Next (second) link-step connectivity of the first link-step connectivity was extracted by calculating statistical dependencies between time courses of regions not directly connected to a lesion and regions identified as first link-step connectivity. Lesion impact on second link-step connectivity was quantified by comparing the lesion network and reference network.

Results:

The lower the impact of a lesion was on second link-step connectivity in the brain network, the better the improvement in motor function during recovery. A prediction model containing a proposed predictor, initial motor function, age, and lesion volume was established. A multivariate analysis revealed that this model accurately predicted recovery at 3 months poststroke ( R 2 = 0.788; cross-validation, R 2 = 0.746, RMSE = 13.15).

Conclusion:

This model can potentially be used in clinical practice to develop individually tailored rehabilitation programs for patients suffering from motor impairments after stroke.
The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty
Authors: Cancienne Jourdan M , Werner Brian C
Published: May 2020

Background

There is little literature examining the association of corticosteroid injections into shoulders with a pre-existing arthroplasty. The aim of the current study was to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty.

Methods

The PearlDiver database was retrospectively reviewed to identify patients with a pre-existing shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis.

Results

Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty and compared to 3832 control patients. After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31–2.98), p = 0.0253).

Conclusions

There is a significant association between intra-articular shoulder corticosteroid injections in patients with pre-existing shoulder arthroplasties and prosthetic joint infection compared to matched controls without postoperative injections.

Study Design

Level III, retrospective cohort study.
Fechner (1866): The Aesthetic Association Principle—A Commented Translation
Authors: Ortlieb Stefan A. , Kügel Werner A. , Carbon Claus-Christian
Published: May 2020

Most of the groundbreaking works of Gustav Theodor Fechner (1801–1887), who paved the way for modern experimental psychology, psychophysics, and empirical aesthetics, are so far only available in German. With the first full text translation of Fechner’s article on The Aesthetic Association Principle ( Das Associationsprincip in der Aesthetik), we want to fill in one of the blank spots in the reception of his Aesthetics from Below (Aesthetik von Unten). In his 1866 article, Fechner devises a fundamental principle that accounts for the role of associations in the formation of aesthetic preferences. Based on concrete everyday examples and thought experiments, he demonstrates how aesthetic choices are largely shaped by the observer’s learning history (associative factors) rather than by an object’s formal properties (direct factors). Fechner’s Aesthetic Association Principle has lost nothing of its initial relevance as the role of content and personal meaning is still grossly underrated in theory and practice of empirical aesthetics today.
Effect of Force Level and Gender on Pinch Force Perception in Healthy Adults
Authors: Li Lin , Li Yanxia , Wang Huihui , Chen Wenqi , Liu Xinyu
Published: May 2020

This study investigated the effects of both force level and gender on pinch force reproduction errors in normal participants during an ipsilateral force reproduction task. In total, 20 healthy participants were asked to generate a range of levels of reference forces ranging from 5% to 60% maximal voluntary isometric contraction (MVIC) in increments of 5% MVIC using the tip pinch and to reproduce these forces using the same hand. The results showed that the males more accurately and consistently reproduced the forces than did the females, and the most accurate estimation occurred at approximately 20% to 35% MVIC. This finding can help us better understand the reasons for the higher rate of musculoskeletal disorders in females than in males and to develop tools and preventive strategies to decrease the rate of hand injuries in both genders.
The role of the renin–angiotensin system in regulating endometrial neovascularization during the peri-implantation period: literature review and preliminary data
Authors: Qi Ruofan , Li Tin Chiu , Chen Xiaoyan
Published: May 2020

Background:

Implantation is initiated when the blastocyst attaches to the endometrium during the peri-implantation period, and appropriate neovascularization is a prerequisite for the success of the subsequent process. The role of the renin–angiotensin system (RAS) in regulation of blood pressure and hydro-electrolyte balance has long been recognized, while its role in the peri-implantation endometrium remains unclear. This manuscript discusses endometrial RAS and its possible pathways in regulating endometrial angiogenesis and its influence on subsequent pregnancy outcomes.

Methods:

A comprehensive search of electronic databases was carried out to identify relevant published articles, and a literature review was then performed. Using immunohistochemistry, we also performed a pilot study to examine expression of angiotensin II receptors, including angiotensin II type 1 (AT1) receptor (AT1-R) and angiotensin II type 2 (AT2) receptor (AT2-R) in the human endometrium around the time of implantation.

Results:

The results of the pilot study showed expression of AT1-R and AT2-R in all endometrial compartments (luminal epithelium, glandular epithelium, stroma cells, and blood vessels), and altered expression was witnessed in women with recurrent miscarriage when compared with fertile control women from our preliminary result.

Conclusion:

Altered vasculature of the endometrium in the peri-implantation period is detrimental to implantation and may lead to recurrent miscarriage. Being an angiogenic mediators, endometrial RAS may play a role around the time of embryo implantation, affecting subsequent pregnancy outcomes.
Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension
Authors: Tanyeri Seda , Akbal Ozgur Y. , Keskin Berhan , Hakgor Aykun , Karagoz Ali , Tokgoz Hacer Ceren , Dogan Cem , Bayram Zubeyde , Kulahcioglu Seyhmus , Erdogan Emrah , Balaban Ismail , Ceneli Dogancan , Acar Rezzan Deniz , Tanboga Ibrahim H. , Ozdemir Nihal , Kaymaz Cihangir
Published: May 2020

We evaluated whether updated pulmonary hypertension definitive criteria proposed in sixth World Symposium on Pulmonary Hypertension had an impact on diagnosis of overall pulmonary hypertension and pre‐capillary and combined pre‐ and post‐capillary phenotypes as compared to those in European Society of Cardiology/European Respiratory Society 2015 pulmonary hypertension Guidelines. Study group comprised the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 807, 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. Mean pulmonary arterial pressure ≥25 mmHg (European Society of Cardiology) and PAMP (mean pulmonary arterial pressure) >20 mmHg (World Symposium on Pulmonary Hypertension) right heart catheterization definitions criteria were used, respectively. For pre‐capillary pulmonary hypertension, pulmonary artery wedge pressure ≤15 mmHg and pulmonary vascular resistance ≥3 Wood units criteria were included in the both definitions. Normal mean pulmonary arterial pressure (<21 mmHg), borderline mean pulmonary arterial pressure elevation (21–24 mmHg), and overt pulmonary hypertension (≥25 mmHg) were documented in 21.1, 9.8, and 69.1% of the patients, respectively. The pre‐capillary and combined pre‐ and post‐capillary pulmonary hypertension were noted in 2.9 and 1.1%, 8.7 and 2.5%, and 34.6 and 36.6% of the patients with normal mean pulmonary arterial pressure, borderline, and overt pulmonary hypertension subgroups, respectively. The World Symposium on Pulmonary Hypertension versus European Society of Cardiology/European Respiratory Society definitions resulted in a net 9.8% increase in the diagnosis of overall pulmonary hypertension whereas increases in the pre‐capillary pulmonary hypertension and combined pre‐ and post‐capillary pulmonary hypertension diagnosis were only 0.8 and 0.3%, respectively. The re‐definition of mean pulmonary arterial pressure threshold seems to increase the frequency of the overall pulmonary hypertension diagnosis. However, this increase was mainly originated from those in post‐capillary pulmonary hypertension subgroup whereas its impact on pre‐capillary and combined pre‐ and post‐capillary pulmonary hypertension was negligible. Moreover, criteria of pre‐capillary pulmonary vascular disease and combined pre‐ and post‐capillary phenotypes were still detectable even in the presence of normal mean pulmonary arterial pressure. The obligatory criteria of pulmonary vascular resistance ≥3 Wood units seems to keep specificity for discrimination between pre‐capillary versus post‐C pulmonary hypertension after lowering the definitive mean pulmonary arterial pressure threshold to 20 mmHg.
Plasma adrenomedullin peptides and precursor levels in pulmonary arterial hypertension disease severity and risk stratification
Authors: Bouzina Habib , Rådegran Göran
Published: May 2020

Adrenomedullin is a potent vasodilatory peptide, linked to pulmonary arterial hypertension pathology. Proximity extension assays were utilized to study plasma biomarkers related to vasoregulation, with focus on adrenomedullin peptides and precursor levels, collectively referred to as ADM. ADM was measured in 48 treatment‐naïve pulmonary arterial hypertension patients at diagnosis, and in 31 of them at an early treatment follow‐up. Plasma ADM was additionally assessed in patients with chronic thromboembolic pulmonary hypertension (n = 20) and pulmonary hypertension due to heart failure with preserved (HFpEF(PH)) (n = 33) or reduced (HFrEF(PH)) (n = 36) ejection fraction, as well as healthy controls (n = 16). ADM was studied in relation to pulmonary arterial hypertension hemodynamics, risk assessment, prognosis, treatment response, and differentiation. Plasma ADM levels in pulmonary arterial hypertension patients at diagnosis were higher than in healthy controls (p < 0.001), similar as in chronic thromboembolic pulmonary hypertension patients (p = ns), but lower compared to HFpEF(PH) (p < 0.03) and HFrEF(PH) (p < 0.001). In pulmonary arterial hypertension, specifically, plasma ADM at diagnosis correlated mainly to mean right atrial pressure (r = 0.73, p < 0.001), N‐terminal prohormone of brain natriuretic peptide (r = 0.75, p < 0.001), six‐minute walking distance (r = –0.57, p < 0.001), and venous oxygen saturation (r = –0.57, p < 0.001). ADM also correlated to the ECS/ERS‐ (r = 0.74, p < 0.001) and REVEAL risk scores (r = 0.54, p < 0.001) at pulmonary arterial hypertension diagnosis. Plasma ADM in pulmonary arterial hypertension patients was unaltered at early treatment follow‐up compared to baseline (p = ns). Pulmonary arterial hypertension patients with supra‐median ADM at diagnosis showed worse overall survival than those with infra‐median levels (median survival 34 versus 66 months, p = 0.0077). In conclusion, the present results suggest that baseline plasma ADM levels mirror disease severity, correlating to both ECS/ERS‐ and the REVEAL risk scores.
Study on drug use pattern in primary healthcare centers of Kathmandu valley
Authors: Aryal Amrita , Dahal Asmita , Shrestha Rajeev
Published: May 2020

Background:

The basic health service is a fundamental right of every citizen. Appropriate use of medicine is an essential component for the quality of health. Drug use evaluation is a systematic and criteria-based drug evaluation, which ensures the appropriate use of the drug. The purpose of this study was to analyze the drug use situation in primary healthcare centers of Kathmandu valley.

Methodology:

A cross-sectional descriptive study was performed in all primary healthcare centers of Kathmandu valley. Six hundred prescriptions were analyzed retrospectively, choosing a simple random sampling method for prescribing indicators. One hundred twenty patients were interviewed for patient-care indicators, and health facility representatives were interviewed for health facility indicators. Drug use indicators developed by World Health Organization/International Network for Rational Use of Drugs were used with slight modification.

Result:

The average number of drugs per encounter was 2.6. The percentage of drugs prescribed by generic names and from the essential medicine list was 60% and 80.9%, respectively. The prescriptions encounters with antibiotics and injections were 58% and 4.2%, respectively. The average consultation and dispensing time were 3.6 min and 54.4 s, respectively. The percentage of drugs actually dispensed was 76.6%. Only half of the patients knew the correct dose of the dispensed drug and no adequate labeling at all. The majority of dispensers were intern nursing students (42%), and all prescribers were medical officers. Ten out of 12 primary healthcare centers had a copy of EML. The availability of key drugs in primary healthcare centers was incomplete (64.7%).

Conclusion:

The observed values for all World Health Organization indicators deviated from the optimal range. Patient care provided by health facilities was insufficient and thus an effective intervention program for the promotion of rational drug use practice is recommended.
Promoting Resilience in Medicine: The Effects of a Mind–Body Medicine Elective to Improve Medical Student Well-being
Authors: Williams Michelle K , Estores Irene M , Merlo Lisa J
Published: May 2020

Background

Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting.

Methods

First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board.

Results

Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 ( SD =  6.17, range = 3–26) and at posttest was 14.2 ( SD =  4.17, range = 8–22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 ( SD =  6.10, range = 24–47) at pretest to 41.8 ( SD =  4.81, range = 33–49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being.

Conclusion

A mind–body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost–benefit of providing instruction in mind–body medicine techniques to all medical students.
Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery
Authors: Sun Liang , Guo Rui , Feng Yi
Published: May 2020

Background:

Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS.

Methods:

We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity.

Results:

Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed.

Conclusions:

Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.