bluuebunny/crossref_metadata_2025 huggingface dataset:
Crack nucleation at forging flaws studied by non-local peridynamics simulations
Authors: Rezaul Karim Mohammad , Kadau Kai , Narasimhachary Santosh , Radaelli Francesco , Amann Christian , Dayal Kaushik , Silling Stewart , Germann Timothy C.
Published: December 2021

We present a computational study and framework that allows us to study and understand the crack nucleation process from forging flaws. Forging flaws may be present in large steel rotor components commonly used for rotating power generation equipment including gas turbines, electrical generators, and steam turbines. The service life of these components is often limited by crack nucleation and subsequent growth from such forging flaws, which frequently exhibit themselves as non-metallic oxide inclusions. The fatigue crack growth process can be described by established engineering fracture mechanics methods. However, the initial crack nucleation process from a forging flaw is challenging for traditional engineering methods to quantify as it depends on the details of the flaw, including flaw morphology. We adopt the peridynamics method to describe and study this crack nucleation process. For a specific industrial gas turbine rotor steel, we present how we integrate and fit commonly known base material property data such as elastic properties, yield strength, and S-N curves, as well as fatigue crack growth data into a peridynamic model. The obtained model is then utilized in a series of high-performance two-dimensional peridynamic simulations to study the crack nucleation process from forging flaws for ambient and elevated temperatures in a rectangular simulation cell specimen. The simulations reveal an initial local nucleation at multiple small oxide inclusions followed by micro-crack propagation, arrest, coalescence, and eventual emergence of a dominant micro-crack that governs the crack nucleation process. The dependence on temperature and density of oxide inclusions of both the details of the microscopic processes and cycles to crack nucleation is also observed. The results are compared with fatigue experiments performed with specimens containing forging flaws of the same rotor steel.
Temporary Intermediates of L-Trp Along the Reaction Pathway of Human Indoleamine 2,3-Dioxygenase 1 and Identification of an Exo Site
Authors: Mirgaux Manon , Leherte Laurence , Wouters Johan
Published: December 2021

Protein dynamics governs most of the fundamental processes in the human body. Particularly, the dynamics of loops located near an active site can be involved in the positioning of the substrate and the reaction mechanism. The understanding of the functioning of dynamic loops is therefore a challenge, and often requires the use of a multi-disciplinary approach mixing, for example, crystallographic experiments and molecular dynamics simulations. In the present work, the dynamic behavior of the JK-loop of the human indoleamine 2,3-dioxygenase 1 hemoprotein, a target for immunotherapy, is investigated. To overcome the lack of knowledge on this dynamism, the study reported here is based on 3 crystal structures presenting different conformations of the loop, completed with molecular dynamics trajectories and MM-GBSA analyses, in order to trace the reaction pathway of the enzyme. In addition, the crystal structures identify an exo site in the small unit of the enzyme, that is populated redundantly by the substrate or the product of the reaction. The role of this newer reported exo site still needs to be investigated.
Teaching second language pragmatics in the current era of globalization: An introduction
Authors: Sánchez-Hernández Ariadna , Barón Júlia
Published: December 2021

The increasing mobility of speakers of different languages to different countries, together with the globalized world we live in, have led to multilingual societies in which linguistic exchanges between both native and non-native speakers have become a very common practice. This reality emphasizes the need to help learners of foreign and second languages become not only linguistically competent but also pragmatically competent, in order not to sound impolite or inappropriate in the target language. Addressing this need, studies in interlanguage pragmatics (ILP) have explored which methodology is most effective for teaching pragmatics. Earlier ILP studies compared explicit versus implicit instruction, highlighting the key role of explicit metapragmatic explanations. More recently, scholars have investigated how to create opportunities to for authentic pragmatic practice inside the classroom. To do so, some studies have implemented task-based language teaching to provide students with goal-oriented meaningful activities that address their real-world needs. Other studies have incorporated technology-enhanced materials such as simulated immersive environments and computer-mediated communication to promote students’ engagement in authentic use of the language beyond the classroom. Another current concern in L2 pragmatic instruction is how to account for the emergence of English as an International Language (EIL), and the consequent need to guide learners into acquiring language as a tool to mediate across linguistic and cultural boundaries. Different studies have adopted an EIL perspective, proposing the enhancement of students’ metapragmatic awareness and strategies to deal with the hybrid nature of English and its associated varieties and cultures. The special issue ‘Teaching second language pragmatics in the current era of globalization’ aims to illustrate such current trends, with six contributions by distinguished scholars in the field of L2 pragmatics from all over the globe.
Examining adolescent maltreatment and connections to school engagement
Authors: Mielityinen Laura , Ellonen Noora , Ikonen Riikka , Paavilainen Eija
Published: December 2021

This article examines how maltreatment experienced by adolescents is related to school engagement. Maltreatment includes physical, mental, and sexual violence along with sexual harassment, neglect, and witnessing domestic violence. School engagement refers to the students’ relationship to all activities in the school. It describes students’ thoughts, activities and participation as well as their emotions in relation to school. Analysis is based on the Finnish School Health Promotion data ( N = 155,299) and analyzed by linear regression analysis. Results indicate that adolescents’ maltreatment experiences are related to school engagement, regardless of gender, age, family structure, or immigrant background. Maltreatment increases functional engagement and decreases emotional and cognitive engagement. These results thus confirm that maltreatment can also cause immersion in schoolwork. The results can be used to prevent lower school engagement and maltreatment of adolescents.
Estimates of the air-fuel ratio at the time of ignition in a pre-chamber using a narrow throat geometry
Authors: Hlaing Ponnya , Silva Mickael , Marquez Manuel Echeverri , Cenker Emre , Ben Houidi Moez , Im Hong G , Turner James WG , Johansson Bengt
Published: December 2021

The benefits of pre-chamber combustion (PCC), such as improved engine efficiency and reduced NOx emissions, are primarily observed when operating at lean conditions with an active pre-chamber, where auxiliary fuel is supplied directly to the pre-chamber. Estimating the pre-chamber excess air ratio (λ) is important in the active pre-chamber concept to gain insights into the pre-chamber combustion phenomenon. Experimental investigations were performed using a narrow-throat pre-chamber at global-λ 1.6, 1.8, and 2.0. The fraction of fuel energy injected in the pre-chamber over the total fuel energy was fixed at 3%, 7%, and 13% for each global-λ. The mixture formation process inside the pre-chamber is first simulated using the 1-D simulation software GT-Power to analyze the pre-chamber λ at the ignition timing. However, the 1-D results were unable to reproduce the experimental observations on the pre-chamber pressure buildup accurately. Upon simulating the same conditions using the 3-D CFD software CONVERGE, the pre-chamber λ estimated from the CFD model is well-correlated to the experimental data. The CFD results indicate that the amount of fuel trapped in the pre-chamber at the inlet valve closing timing is over-predicted by the 1-D simulations. A correlation between the injected and the trapped fuel in the pre-chamber is proposed by theoretical scavenging models and applied to the 1-D simulation results to improve pre-chamber λ prediction accuracy.
Analysis of elliptical diesel nozzle spray dynamics using a one-way coupled spray model
Authors: Jia Hekun , Wei Zhuangbang , Yin Bifeng , Liu Zhiyuan
Published: December 2021

The elliptical nozzle has the potential ability to increase the air-fuel mixture quality. A one-way coupled spray model and Homogenous Relaxation Model (HRM) was adopted to investigate the spray behaviors and the air-fuel mixture progress in real diesel combustion chamber with the application of elliptical and circular diesel nozzle. The results indicated that the spray cone angle and the air entrainment mass of elliptical nozzle were larger than that of the circular nozzle, while the spray penetration of the elliptical nozzle which the aspect ratio is 1.5 and 2 was shortened by 11% and 8.3% as compared to circular spray respectively. Also, the air entrainment mass of the elliptical spray with a ratio of 1.5 and 2 increased by 60% and 35% as compared with circular spray respectively. Furthermore, the partial equivalent ratio and the high concentration area in the cylinder is reduced for elliptical nozzle, and the air-fuel mixture is more uniform. The fuel evaporation rate of elliptical spray is always higher than that of the circular spray.
Control-oriented modeling, validation, and interaction analysis of turbocharged lean-burn natural gas variable speed engine
Authors: Harsha Rayasam Sree , Qiu Weijin , Rimstidt Ted , Shaver Gregory M , Van Alstine Daniel G , Graziano Michael
Published: December 2021

Accurate modeling and control of the gas exchange process in a modern turbocharged spark-ignited engine is critical for the control and analysis of different control strategies. This paper develops a simple physics-based, five-state engine model for a large four-stroke spark-ignited turbocharged engine fueled by natural gas that is used in variable speed applications. The control-oriented model is amenable for control algorithm development and includes the impacts of modulation to any combination of four actuators: throttle valve, bypass valve, fuel rate, and wastegate valve. The control problem requires tracking engine speed to provide propulsive power, differential pressure across the throttle valve to prevent compressor surge, air-to-fuel ratio to restrict engine emissions. Two validation strategies, open-loop and closed-loop, are used to validate the accuracy of both nonlinear and linear versions of the control-oriented model. The control models are able to capture the engine dynamics within 5%–10% error at most of the engine operating points. Finally, the relative gain array (RGA) is applied to the linearized engine model to understand the degree of interactions between plant inputs and outputs as a function of frequency for various operating points. Results of the RGA analysis show that the preferred input-output pairing changes depending on the linear plant model as well as frequency. Therefore, a coordinated controller is ideal to tackle the control problem in question.
Dynamic responses of elastic marine propellers in non-uniform flows
Authors: Li Jiasheng , Qu Yegao , Chen Yong , Hua Hongxing , Wu Junyun
Published: December 2021

This paper focuses on the development of a three-dimensional panel method in time and frequency domains combined with the finite element method for analyzing the hydroelastic responses of rotating marine propellers in the wake of ships. A fully non-penetration boundary condition imposed on the deformed blade surface is conducted, in which the corrections of both the incoming flow velocities and the normal vectors imposed on the deformed and undeformed blade surface are taken into account. The added-mass and -damping matrices due to strongly coupled fluid-structure interaction are considered. Results of the present method are compared with experimental data available in the literature. It is observed that the fully non-penetration boundary condition applied on the deformed blade surface should be imposed to predict the unsteady performance of elastic propellers, which is due to the change of the added damping predicted by considering different non-penetration boundary conditions.
Coauthoring collaborative strategy when voices are many and authority is ambiguous
Authors: Nathues Ellen , Endedijk Maaike , van Vuuren Mark
Published: December 2021

In interorganizational teams, processes are more complex and structures less clear than in intraorganizational settings. Different perspectives come together and authoritative positions are often ambiguous, which makes establishing what to do problematic. We adopt a ventriloquial analytical lens and pose the question: How exactly do interorganizational team members build a collaborative strategy under these conditions, in their situated interactions? Our findings show how many different voices (individual, organizational, team, and other) shape members’ strategy-making and reveal these voices’ performative authoritative effects: Members established their team’s strategy and produced the needed authority to do so through three coauthoring practices, namely, the proposition, appropriation, and expropriation of voices. When members switched between the practices and different voices, these voices were either woven together or moved apart. We sketch a conceptualization of strategy as a relational assemblage and develop a process model of strategy-coauthoring to illuminate these dynamics.
Proposing a Compensation Requirement for Audit Studies
Authors: Butler Daniel M , Desposato Scott
Published: December 2021

We examine compensation as a tool to encourage the thoughtful use of audit experimentation. If researchers had to compensate subjects or communities, they would be more likely to avoid excessively large studies and to only conduct high-value studies. We build on Desposato and propose that when conducting an audit study, (1) researchers donate time or money to the communities potentially affected by the study, (2) researchers preregister this donation, and (3) researchers provide evidence of the donation they made in publication and presentation.
Cost Disclosure of Surgeon “Scorecards”: Effects on Operating Room Costs for Total Hip and Knee Arthroplasty
Authors: Brustein Jason A. , Ponzio Danielle Y. , Duque Andres F. , Skibicki Hope E. , Tjoumakaris Fotios P. , Orozco Fabio R. , Post Zachary D. , Ong Alvin C.
Published: December 2021

Background: Rising health care costs, coupled with an emphasis on cost containment, continue to gain importance. Surgeon cost scorecards developed to track case-based expenditures can help surgeons compare themselves with their peers and identify areas of potential quality improvement. Purpose: We sought to investigate what effect surgeon scorecards had on operating room (OR) costs in orthopedic surgery. Methods: Our hospital distributed OR cost scorecards to 4 adult reconstruction fellowship-trained orthopedic surgeons beginning in 2012. The average direct per-case supply cost of procedures was calculated quarterly and collected over a 5-year period, and each surgeon’s data were compared with that of their peers. All 4 surgeons were made aware of the costs of other surgeons at the 2-year mark. The initial 2 years of data was compared with that of the final 2 years. Results: The average direct per-case supply cost ranged from $4955 to $5271 for total knee arthroplasty (TKA) and $5469 to $5898 for total hip arthroplasty (THA) during the initial 2-year period. After implementing disclosures, the costs for TKA and THA, respectively, ranged from $4266 to $4515 (14% annual cost savings) and from $5073 to $5727 (5% annual cost savings); 3 of the 4 surgeons said that cost transparency altered their practice. Conclusion: Our comparison suggests that orthopedic surgeons’ participation in a program of operative cost disclosure may be useful to them; we found a possible association with reduced per-case costs for TKA and THA at our institution over a 5-year period. More rigorous study that incorporates the effects of the scorecards on patient outcomes is warranted.
Numerical simulation and experimental study of off-axis tensile performance of triaxial woven fabric reinforced rubber composites
Authors: Zhou Hongtao , Jiang Weiqing , Zhao Lei , Li Guifu , Zhou Bin , Ma Qian
Published: December 2021

In this paper, the off-axis tensile behaviors of triaxial woven fabric reinforced rubber composites (TWFR) was studied experimentally and numerically. The tensile failure morphologies and stress-strain curves of specimens cut at seven different off-axis angles (0°, 15°, 30°, 45°, 60°, 75°, and 90°) were obtained by finite element analysis and experiment. The finite element analysis results were found to be in good agreement with the experimental results. Stress-strain curves indicated the TWFR exhibited nonlinear tensile behavior under off-axial tension loading, and could be divided into the coupling working stage of yarns and rubber matrix in TWFR, and the stressed stage of yarns. Similar tensile properties were observed for specimens cut along the direction of angle bisector of any two sets of adjacent yarns. The tensile failure morphologies indicated that the failure mechanism of TWFR was tensile-shear mixed failure.
Failure analysis and fatigue life prediction of high-speed rail clips based on DIC technique
Authors: Liu Yan , Jiang Xiujie , Li Qiutong , Liu Huan
Published: December 2021

With the development of rail transportation, the fatigue failure of rail clips has become an issue, which affects the operational safety of trains. In this study, reasons for the fatigue failure of rail clips were investigated to improve their service life. A digital image correlation (DIC) technique was conducted to obtain strain fields, vibration modes, and natural frequencies of a rail clip. The strain and displacement of a rail clip under dynamic cyclic loading were also obtained. A fastener system refinement model was developed to analyze the static, dynamic, and modal responses of the clip. The experimental tests and modal simulation results were mutually verified. The fatigue life was analyzed based on the verified FE model. The results revealed that the maximum strain and minimum fatigue life occur at the heel of the clip, in good agreement with the actual fracture position. As the amplitude and frequency of dynamic cyclic load increased, the fatigue life of the clip decreased sharply. Moreover, the normal wheel–rail force accompanied by high-frequency rail corrugations accelerated crack initiation and reduced the fatigue life. The findings of this study provide guidance for improving the service life of rail clips.
Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis
Authors: Jackson Garrett R , Meade Joshua , Young Bradley L , Trofa David P , Schiffern Shadley C , Hamid Nady , Saltzman Bryan M
Published: December 2021

Background

Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA.

Methods

A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included.

Results

Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) ( p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) ( p = 0.02). Postoperative scapular fractures and acromial fractures did not differ.

Conclusion

Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.
Phase II study of DHP107 (oral paclitaxel) in the first-line treatment of HER2-negative recurrent or metastatic breast cancer (OPTIMAL study)
Authors: Kim Sung-Bae , Seo Jae Hong , Ahn Jin-Hee , Kim Tae-Yong , Kang Seok Yun , Sohn Joohyuk , Yang Yaewon , Park Kyong Hwa , Moon Yong Wha , Lim Seungtaek , Kang Myoung Joo , Yoon Koung Eun , Cho Hyun Ju , Lee Keun Seok
Published: December 2021

Background:

Standard intravenous (IV) paclitaxel is associated with hypersensitivity/toxicity. Alternative IV formulations have improved tolerability but still require frequent hospital visits and IV infusion. DHP107 is a novel oral formulation of paclitaxel that is approved in South Korea for the treatment of gastric cancer.

Methods:

This multicenter, phase II study using a Simon’s two-stage design investigated the efficacy and safety of DHP107 200 mg/m2 administered orally twice daily on days 1, 8, and 15 every 4 weeks for the first-line treatment of recurrent or metastatic HER2-negative breast cancer.

Results:

Thirty-six patients were enrolled and 31 were assessable for efficacy. Patient median age was 57 years (range = 34–81) and 11 (31%) had triple-negative disease. A median of seven cycles (range = 1–28) of DHP107 was administered. Objective response rate was 55% (17 patients), all partial responses, according to the investigator’s decision and independent central review (ICR), and 44% (4/9 patients) in those with triple-negative disease. Disease control rate (partial response and stable disease) was 74% (23 patients) according to the investigator’s decision and ICR. In the intention-to-treat (ITT) population of all enrolled participants, the objective response rate was 50% (18/36 patients). Median progression-free survival was 8.9 months [95% confidence interval [CI]: 5.2–12.3) and median time to treatment failure was 8.0 months (95% CI: 4.2–10.0). DHP107 had an acceptable toxicity profile. All patients experienced treatment-emergent adverse events; the most common adverse events were decreased neutrophil count (81% all grades and 78% grade ⩾ 3) followed by peripheral sensory neuropathy (61% all grades and 8% grade 3). However, there was no febrile neutropenia or sepsis.

Conclusion:

DHP107 showed promising efficacy and acceptable tolerability in this phase II study and is currently being investigated in the OPTIMAL phase III study (NCT03315364).

Trial registration:

This trial was registered with ClinicalTrials.gov identifier: NCT03315364.
Risky Therefore Not Beneficial: Replication and Extension of Finucane et al.’s (2000) Affect Heuristic Experiment
Authors: Efendić Emir , Chandrashekar Subramanya Prasad , Lee Cheong Shing , Yeung Lok Yan , Kim Min Ji , Lee Ching Yee , Feldman Gilad
Published: December 2021

Risks and benefits are negatively related in people’s minds. Finucane et al. causally demonstrated that increasing risks of a hazard leads people to judge its benefits as lower. Vice versa, increasing benefits leads people to judge its risks as lower (original: r = −.74 [−0.92, −0.30]). This finding is consistent with an affective explanation, and the negative relationship is often presented as evidence for an affect heuristic. In two well-powered studies, using a more stringent analytic strategy, we replicated the original finding. We observed a strong negative relationship between judgments of risks and benefits across three technologies, although we do find that there was no change in risks when highlighting low benefits. We note that risks seem to be more responsive to manipulation (as opposed to benefits) and find evidence that the negative relationship can depend on incidental mood. We provided materials, data sets, and analyses on https://osf.io/sufjn/?view_only=6f8f5dc6ff524149a4ed5c6de9296ae8 .
Crouching carcinoma, hidden ureter: A blind ending burnt out cancerous moiety
Authors: Storey Benjamin , Thirugnanasundralingam Vaisnavi , Raman Avi
Published: December 2021

Background:

A 76-year-old male presenting with macroscopic haematuria was found to have a lobulated mass infiltrating along the urothelium at the site of insertion of the upper moiety of a complete duplex right kidney. Suspected of being upper tract urothelial carcinoma, cystoscopy, bilateral retrograde pyelograms and transurethral resection of bladder tumour were attempted. Intra-operative findings revealed no tumour burden in the bladder or left ureter. The insertion of the upper pole moiety of the right ureter was not identified intra-operatively. Pelvic MRI demonstrated a markedly dilated upper pole moiety of the right ureter with a soft tissue mass in its distal aspect. Interestingly, the distal portion of the ectopic upper pole moiety was found to insert into the bladder neck.

Objective and Methods:

We report on an unusual case of upper tract urothelial carcinoma arising from the upper moiety of a complete duplex kidney. Our aim was to demonstrate the importance of thorough investigation of suspected urothelial carcinomas occurring in association with variant upper tract anatomy.

Results and Conclusion:

This case demonstrates the importance of thorough radiological and endourological investigation of suspected upper tract urothelial carcinoma and the various congenital abnormalities that may complicate the surgical management of this common malignancy.

Level of evidence:

4 (case report)
Epidemiology of Pediatric Baseball and Softball Player Injuries
Authors: Farooqi Ali S. , Lee Alexander , Abreu Eric , Talwar Divya , Maguire Kathleen J.
Published: December 2021

Background:

Baseball and softball are popular sports in the United States and are responsible for a large number of youth sports injuries each year.

Purpose:

To investigate recent differences in youth baseball and softball injuries evaluated in nationwide emergency departments.

Study Design:

Descriptive epidemiology study.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was examined for softball and baseball injuries in pediatric patients (age, 7-21 years) from 2010 through 2019. Patients were classified as children (age, 7-13 years), adolescents (age, 14-18 years), or young adults (age, 19-21 years). Case narratives were used to categorize injuries as contact injuries (hit by bat or ball), field injuries (sliding into base, collision with another player, catching, or running), throwing injuries, or other.

Results:

An unweighted total of 24,717 baseball injuries and 13,162 softball injuries were recorded. A nationwide estimate of 861,456 baseball injuries and 511,117 softball injuries were sustained during the studied time period, with estimated respective injury rates of 86,146 and 51,112 per year. Injured softball players were most commonly adolescent (47%) and female (92%), while injured baseball players were most commonly children (54%) and male (90%). There was a greater proportion of baseball-related injuries involving the head/neck (41%) as compared with softball-related injuries (30%) ( P < .01). Conversely, a greater proportion of softball-related injuries involved the lower extremity (32%) as compared with baseball-related injuries (19%) ( P < .01). When comparing diagnosis, softball injuries were more often sprains/strains (28%) than baseball injuries (18%) ( P < .01). When comparing mechanisms of injury, baseball athletes were more likely to be evaluated with contact injuries than were softball athletes (49% vs 40%, P < .01).

Conclusion:

Youth baseball athletes were more likely to be injured through contact mechanisms and had a higher proportion of injuries related to the head/neck/face, whereas softball injuries more frequently involved the lower extremity and resulted in a sprain/strain. League guidelines should focus on reducing contact injuries within youth baseball, and injury-prevention programs should focus on reducing lower extremity injuries in youth softball.
Foot and Ankle Injuries in Elite Taekwondo Athletes: A 4-Year Descriptive Analysis
Authors: Willauschus Maximilian , Rüther Johannes , Millrose Michael , Walcher Matthias , Lambert Christophe , Bail Hermann Josef , Geßlein Markus
Published: December 2021

Background:

Foot and ankle injuries are a common but underestimated problem in taekwondo. Detailed data on injury incidence rates (IIRs), patterns, and injury mechanism are missing.

Purpose:

The primary aims were to evaluate the prevalence of foot and ankle injuries and the exposure-adjusted IIR of elite taekwondo athletes during matches while training (ie, sparring) and in competitions. The secondary aims were to evaluate injury site, type, sport-specific mechanism, and time loss.

Study Design:

Descriptive epidemiology study.

Methods:

Athletes from a single national Olympic taekwondo training center were assessed prospectively for foot and ankle injuries over 4 years (between January 1, 2016, and December 31, 2019). Data were collected regarding number and type of injuries, anatomic location, and total exposure time during training and competition for each athlete. Injury mechanism and dominant foot were assessed via personal interview. Time loss from sport was analyzed retrospectively. The injury prevalence and IIR were calculated. Correlation between mechanism and injury type, location, and dominant foot was evaluated. Time loss according to location and injury type was assessed. The chi-square test and Fisher exact test were used to test for differences in sex, age, and taekwondo experience and for comparison of injury location and type, injury mechanism, and side dominance, respectively. Training and competition IIRs and prevalence were calculated with 95% CIs (for Poisson rates).

Results:

From an initial 107 athletes, 79 (73.8%) were included in the final data set. Of these athletes, 38 were injured (n = 112 injuries) for a prevalence of 48.1% (95% CI, 43%-52%). The overall IIR of the ankle joint was 13.14 injuries per 1000 athletes (95% CI, 1.5-25.9) and was significantly higher during competition versus training ( P < .001). Ankle joint injuries were most common (n = 71; 63%). Significantly more noncontact versus contact ankle ligament injuries (n = 46; 83%) occurred ( P < .001). The forefoot (n = 18; 66%) was mainly affected by contact injuries ( P < .001). Time loss was the highest for midfoot fractures (mean ± SD, 23.0 ± 0.6 days; range, 23-24 days).

Conclusion:

Noncontact ligamentous ankle injuries were most common, with a higher incidence during competition. Improvement of strength, endurance, and postural stability under strain is recommended for prevention.
Revisiting the role of pulmonary surfactant in chronic inflammatory lung diseases and environmental exposure
Authors: Milad Nadia , Morissette Mathieu C.
Published: December 2021

Pulmonary surfactant is a crucial and dynamic lung structure whose primary functions are to reduce alveolar surface tension and facilitate breathing. Though disruptions in surfactant homeostasis are typically thought of in the context of respiratory distress and premature infants, many lung diseases have been noted to have significant surfactant abnormalities. Nevertheless, preclinical and clinical studies of pulmonary disease too often overlook the potential contribution of surfactant alterations – whether in quantity, quality or composition – to disease pathogenesis and symptoms. In inflammatory lung diseases, whether these changes are cause or consequence remains a subject of debate. This review will outline 1) the importance of pulmonary surfactant in the maintenance of respiratory health, 2) the diseases associated with primary surfactant dysregulation, 3) the surfactant abnormalities observed in inflammatory pulmonary diseases and, finally, 4) the available research on the interplay between surfactant homeostasis and smoking-associated lung disease. From these published studies, we posit that changes in surfactant integrity and composition contribute more considerably to chronic inflammatory pulmonary diseases and that more work is required to determine the mechanisms underlying these alterations and their potential treatability.
Rice with Multilayer Aleurone: A Larger Sink for Multiple Micronutrients
Authors: Yu Ronald , Wu Xiaoba , Liu Jinxin , Howitt Crispin A. , Bird Anthony R. , Liu Chun-Ming , Larkin Philip J.
Published: December 2021

Diet-related noncommunicable diseases impose a heavy burden on human health worldwide. Rice is a good target for diet-related disease prevention strategies because it is widely consumed. Liu et al. (Proc Natl Acad Sci USA 115(44):11327–11332, 2018. https://doi.org/10.1073/pnas.1806304115) demonstrated that increasing the number of cell layers and thickness of putative aleurone in ta2-1 (thick aleurone 2-1) mutant rice enhances simultaneously the content of multiple micronutrients. However, the increases of aleurone-associated nutrients were not proportional to the increases in the aleurone thickness. In this study, first, cytohistological analyses and transmission electron microscopy demonstrated that the multilayer in ta2-1 exhibited aleurone cell structural features. Second, we detected an increase in insoluble fibre and insoluble bound-phenolic compounds, a shift in aleurone-specific neutral non-starch polysaccharide profile, enhancement of phytate and minerals such as iron, zinc, potassium, magnesium, sulphur, and manganese, enrichment of triacylglycerol and phosphatidylcholine but slight reduction in free fatty acid, and an increase in oleic fatty acid composition. These findings support our hypothesis that the expanded aleurone-like layers in ta2-1 maintained some of the distinctive aleurone features and composition. We provide perspectives to achieve even greater filling of this expanded micronutrient sink to provide a means for multiple micronutrient enhancements in rice.
Limited need for hospital resources among patients brought to hospital by the emergency medical services
Authors: Magnusson Carl , Ryge Helena , Scott Filip , Herlitz Johan , Axelsson Christer
Published: December 2021

Background

In Sweden, the majority of patients who are transported to hospital by the emergency medical services (EMS) are relatively old and the majority suffer from comorbidity. About half these patients are admitted to a hospital ward and will stay in hospital. However, the other half will only make a visit to the emergency department (ED). The burden on the ED is extensive and many elderly patients have to stay for many hours in the ED.

Aim

To describe the patients who are brought to hospital by the EMS, with particular emphasis on those that were discharged from the ED, and to assess the proportion of these patients who did not require hospital resources, which could mean that they were candidates for primary care (PC).

Methods

An observational analysis of a cohort of patients who were transported to hospital by the EMS in 2016 in the Municipality of Gothenburg.

Results

In all, 5,326 patients were transported to hospital by the EMS of which 52% were discharged directly from the ED. These patients included 37% assessed as not requiring hospital resources. The three most common causes of contact with the EMS in this subset were abdominal pain (15%), back pain (8%) and non-specified disease (7%). Of these patients, 77% had contact with a physician in the ED, whereas 6% had contact with a nurse and 17% left the ED without any contact. Twenty-six per cent were given advice on follow-up in PC.

Conclusions

Among patients who were brought to hospital by the EMS, more than half were discharged directly from the ED. Among these patients, 37% were assessed as not requiring hospital resources. These patients comprised 15% of the overall study cohort and may be candidates for primary care.
Predictive value of fibrinogen in identifying inflammatory bowel disease in active stage
Authors: Chen Xiao-Fu , Zhao Yuan , Guo Yu , Huang Zhi-Ming , Huang Xie-Lin
Published: December 2021

Background

We aimed to externally validate for the first time the diagnostic ability of fibrinogen to identify active inflammatory bowel disease (IBD).

Methods

The research totally involved 788 patients with IBD, consisted of 245 ulcerative colitis (UC) and 543 Crohn’ s disease (CD). The Mayo score and Crohn disease activity index (CDAI) assessed disease activity of UC and CD respectively. The independent association between fibrinogen and disease activity of patients with UC or CD was investigated by multivariate logistic regression analyses. Area under the receiver operating characteristic curve (AUROC) assessed the performance of various biomarkers in discriminating disease states.

Results

The fibrinogen levels in active patients with IBD significantly increased compared with those in remission stage (P < 0.001). Fibrinogen was an independent predictor to distinguish disease activity of UC (odds ratio: 2.247, 95% confidence interval: 1.428–3.537, P < 0.001) and CD (odds ratio: 2.124, 95% confidence interval: 1.433–3.148, P < 0.001). Fibrinogen was positively correlated with the Mayo score (r = 0.529, P < 0.001) and CDAI (r = 0.625, P < 0.001). Fibrinogen had a high discriminative capacity for both active UC (AUROC: 0.806, 95% confidence interval: 0.751–0.861) and CD (AUROC: 0.869, 95% confidence interval: 0.839–0.899). The optimum cut-off values of fibrinogen 3.22 was 70% sensitive and 77% specific for active UC, and 3.87 was 77% sensitive and 81% specific for active CD respectively.

Conclusions

Fibrinogen is a convenient and practical biomarker to identify active IBD.
A study of students’ use of restraint systems in school transportation services in primary and secondary schools in northern Iran: an observational study
Authors: Yousefzade-Chabok Shahrokh , Azari Samira , Kouchakinejad-Eramsadati Leila , Rad Enayatollah Homaie , Hosseinnia Marjan , Khodadadi-Hassankiadeh Naema
Published: December 2021

Background

Traffic accidents are one of the leading causes of death and severe injury among child occupants of vehicles in most countries. This has led to the consideration of how to use restraint systems for students in school buses. The purpose of the present study was to determine the percentage of students’ use of restraint systems in school transportation services in 2020.

Methods

In the present cross-sectional observational study, seatbelt use was assessed in 400 students in school transport vehicles using a checklist. The observation team sat at their vehicle, at the nearest location on one of the three sides of the school’s entrance: they had by manually registering the variable in the checklist. They focused on exactly the first vehicle parked next to the school entrance. There were two other observers to validate the observations. Data were analyzed by SPSS software (version 21).

Results

The rate of using restraint systems was 11.3%, use of restraint systems in the Sport Utility Vehicles (SUVs) was significantly higher (P < 0.03), in areas with medium income (P < 0.009) and low income (p < 0.012) as well as when the students were sitting in the rear seats, using the seatbelt were significantly lower (P < 0.001). Seatbelt use in students was less in services driven by drivers over the age of 40 (P < 0.01) and more in vehicles driven by female drivers (P < 0.003) and newer vehicles (p < 0.001).

Conclusion

School authorities must enforce traffic safety rules for school transportation services. These rules should be taught to drivers, families, and students. A restraint system must be mandatory for all students. School officials must equip their buses with seatbelts and employ school bus assistants to encourage wearing seatbelts and prevent students from standing.
Clinicopathological characteristics of IgG4-related lung disease
Authors: Liu Jia , Liu Yuxiang , Shen Ximing , He Zhanghai , Yu Tingfeng , Pang Li , Jin Xiaoyan , Wang Lingyun
Published: December 2021

Background

Immunoglobulin G4-related lung disease (IgG4-RLD) is a rare entity. We retrospectively analyzed the clinical and histopathological characteristics of patients with pathologically confirmed IgG4-RLD to improve the diagnosis rate and reduce the risk of misdiagnosis.

Methods

We screened the pathological reports of 4838 patients with pulmonary surgery and/or biopsy specimens from April 2017 to April 2021 at Sun Yat-Sen Memorial Hospital affiliated with Sun Yat-Sen University, and specimens from 65 patients with suspected IgG4-RLD were subjected to immunohistochemical staining for IgG4 and IgG. Finally, 10 patients with definite IgG4-RLD that was pathologically confirmed were enrolled and analyzed.

Results

The incidence of pathologically confirmed IgG4-RLD was 0.2% (10/4838). The ten patients had an average age of 59.7 years at diagnosis, and the male-to-female ratio was 9:1. The initial clinical manifestations were nonspecific, and cough was the most common symptom (4/10). More than one organ was involved in most patients (8/10), and mediastinal/hilar lymph node involvement was often observed (7/10). Serum IgG4 was analyzed in 6 patients and found to be elevated. Serum tumor marker levels were within the normal range or were slightly elevated. Computed tomography (CT) of the chest and/or 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) imaging revealed that 5 patients had a mixed type, 3 patients had the solid nodular type, and 2 patients had the bronchovascular type. All pulmonary masses and large nodules with solid patterns had spiculated margins and inhomogeneous enhancement with or without pleural indentation and a lobulated appearance. Abundant lymphoplasmacytic cell infiltration and fibrosis were observed in all patients. The expression of IgG4 and IgG was upregulated in the pulmonary sections. Seven patients were treated with glucocorticoids with or without additional immunosuppressants and responded well.

Conclusions

The results of our study suggest that multiple imaging findings, an elevated serum IgG4 concentration, and no significant increase in serum tumor biomarkers could provide diagnostic support for IgG4-RLD, especially for isolated IgG4-RLD or IgG4-RLD that includes other organ involvement that does not aid in establishing the diagnosis.
Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees
Authors: Heskin L. , Simms C. , Traynor O. , Galvin R.
Published: December 2021

Background

Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma.

Methods

Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis.

Results

Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.

Conclusion

There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design.
Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?
Authors: Drachev Sergei N. , Galieva Alexandra S. , Yushmanova Tatiana N. , Polivanaya Elena A. , Stangvaltaite-Mouhat Lina , Al-Mahdi Rania , Leinonen Jukka , Stein Linda Maria , Davidova Nadezhda G. , Al-Haroni Mohammed
Published: December 2021

Background

The concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions.

Methods

We included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis.

Results

For the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite.

Conclusions

The majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results.