bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis of magnetorheological fluid and its application in a twin-tube valve mode automotive damper
Authors: Madhavrao Desai Rangaraj , Acharya Subash , Jamadar Mohibb-e-Hussain , Kumar Hemantha , Joladarashi Sharnappa , Sekaran SC Raja
Published: May 2020

The change in rheological properties of smart materials like magnetorheological fluid when brought under the influence of a magnetic field can be utilized to develop magnetorheological devices where the output has to be continuously and quickly varied using electronic control interface. In the present study, magnetorheological fluid is synthesized and used as a smart fluid in a twin-tube magnetorheological damper operating in valve mode. The behavior of the magnetorheological fluid is experimentally characterized in a rheometer and mathematically modeled using Herschel–Bulkley model. The parameters of the Herschel–Bulkley model are expressed as polynomial functions of strength of the magnetic field in order to find the shear stress developed by the magnetorheological fluid at any given strength of the magnetic field applied. The magnetorheological damper, which was designed for application in a passenger van, is tested in the damper testing machine. The performance of the damper at different damper velocities and current supplied is studied. The range of values for the parameters of the experimental testing are chosen to emulate the actual conditions of operation in its intended application. Nondimensional analysis is performed, which links magnetorheological fluid rheological properties and geometrical parameters of magnetorheological damper design with the force developed by the damper. Finite element method magnetics is used to find the strength of the magnetic field at the fluid flow gap. Analytical methods are used to calculate the damper force developed due to the field-dependent yield stress and compared with experimental force values. The resulting dynamic range of the magnetorheological damper is also assessed.
Deep learning multidimensional projections
Authors: Espadoto Mateus , Hirata Nina Sumiko Tomita , Telea Alexandru C
Published: May 2020

Dimensionality reduction methods, also known as projections, are often used to explore multidimensional data in machine learning, data science, and information visualization. However, several such methods, such as the well-known t-distributed stochastic neighbor embedding and its variants, are computationally expensive for large datasets, suffer from stability problems, and cannot directly handle out-of-sample data. We propose a learning approach to construct any such projections. We train a deep neural network based on sample set drawn from a given data universe, and their corresponding two-dimensional projections, compute with any user-chosen technique. Next, we use the network to infer projections of any dataset from the same universe. Our approach generates projections with similar characteristics as the learned ones, is computationally two to four orders of magnitude faster than existing projection methods, has no complex-to-set user parameters, handles out-of-sample data in a stable manner, and can be used to learn any projection technique. We demonstrate our proposal on several real-world high-dimensional datasets from machine learning.
Evaluation of a Culturally Tailored Educational Video Intervention to Promote Bike Helmet Safety for Urban Children: A Pilot Study
Authors: Ryan Leticia Manning , Solomon Barry S. , Ziegfeld Susan , Gielen Andrea , Malloy Lauren , Foster Daniel , McDonald Eileen
Published: May 2020

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. Given the lack of educational interventions for urban youth, our research team created a youth-informed, culturally relevant educational video on bike helmet safety, which was informed by focus groups with Baltimore City youth. This video, You Make the Call, linked the concept of use of cases to protect phones to use of helmets to protect heads and can be viewed at http://bit.ly/2Kr7UCN . The impact of the video as part of an intervention (coupled with a free helmet, fit instructions, and a parent guidance document) was tested with 20 parent–child dyads. The majority (80%) of youth (mean age 9.9 ± 1.8 years) reported not owning or wearing a helmet. At 1-month follow-up (n = 12, 60% response rate), helmet use was higher in the five youth reporting bike-riding after the intervention; 100% “always” used helmets compared to 0% preintervention. There were increases in youth reporting that parents required helmet use (35% pre vs. 67% post) and that is was possible to fall when bike-riding (60% pre vs. 92% post). These pilot results support the use of this video and educational intervention along with further evaluation in a larger sample size. This youth-informed and culturally tailored approach could be explored as a strategy to address other pediatric injury topics.
Readiness of Non-Veteran Health Administration Advanced Practice Registered Nurses to Care for Those Who Have Served: A Multimethod Descriptive Study
Authors: Maiocco Gina , Vance Billie , Dichiacchio Toni
Published: May 2020

Federal, state, and educational policy, as well as public and professional initiatives, should influence how care is delivered to veterans from non-Veteran Health Administration (VHA) advanced practice registered nurses (APRNs) located in civilian health care facilities. Due to the MISSION Act, more veterans are receiving care outside the VHA, but little is known about the readiness of APRNs to address the needs of this population. This mixed-methods study describes the perceptions of 340 non-VHA APRNs concerning practice, clinical needs, and challenges they face while delivering care to veterans. Survey results show only 8% of APRNs consistently asked about military service; less than 1% asked if the patient has a family member with military history; and only 25% applied research by inquiring into military history when patients presented with conditions like chronic pain, interpersonal violence, or insomnia. Technology use via mobile application was minimally reported (<1%). “Missing in Action,” the overarching theme from qualitative data, included three subthemes: (a) absence facilitated collaboration with VHA, (b) concerns regarding personal competency in the care of the military person, and (c) lack of recognition of the significance of the need to know about military status. Practice implications proffered include implementation of mandatory inquiry into military service and enactment of APRN veteran-centric nursing competencies. Education actions involve updating graduate nursing programs to include veteran health content and increased policy awareness. Future research should encompass replication of this study in specific APRN roles and consist of ongoing evaluation of veteran care by the civilian sector as the MISSION Act is implemented.
Human Papillomavirus (HPV) Vaccine Acceptability in Hispanic Males Living on the U.S./Mexico Border
Authors: Frietze Gabriel , Oliva Raymond , Shenberger-Trujillo Jessica M.
Published: May 2020

The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and the prevalence rate of infections is approximately 79 million. Research investigating HPV vaccine acceptability has primarily focused on female populations. The current study investigates factors associated with HPV vaccine acceptability in an underrepresented population within the literature, Hispanic males. Ninety-seven male participants ( M age = 21.68 years; SD = 3.97) were recruited from a large urban university along the U.S./Mexico border to complete a 15- to 20-minute survey. More than half of the sample reported to have had a sexual experience within the past 12 months and a fifth of these participants reported that they never use protection such as condoms. Furthermore, about half of the sample reported that they did not receive the HPV vaccine or were unaware if they received the HPV vaccine. A strong correlation emerged between individual vaccine risk perceptions and family vaccine risk perceptions ( r = .82; p < .001). The following factors emerged as predictors of vaccine acceptability: having recommendations from health care providers, having a family with positive attitudes toward vaccines, and having a family that perceives less risks associated with vaccines. Implications of the findings are discussed.
Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity Without Structural Brain Lesion
Authors: Kim Keun Tae , Roh Young-Nam , Cho Nan Hee , Jeon Jae Cheon
Published: May 2020

Frontal intermittent rhythmic delta activity (FIRDA), rhythmic slow wave pattern lasting several seconds over the anterior leads of electroencephalography (EEG), has been reported in a wide variety of clinical conditions. We investigated the clinical significance of FIRDA without structural brain lesions. We reviewed 7689 EEGs between October 2017 and September 2019 at a university hospital. Patients (age >18 years) who were confirmed to have “nonsignificant neuroimaging” were examined. Clinical data were retrospectively collected, and the estimated cause was carefully decided. We found 83 FIRDA among 7689 EEGs (1.08%). After patients with any structural lesion identified on neuroimaging were excluded, 37 FIRDAs were reviewed. There were 20 (51.35%) patients of metabolic encephalopathy. Six patients showed FIRDA due to neurodegenerative disease (16.21%). In addition, we found 6 (16.21%) of neurodegenerative disease and 5 (13.51%) of hypoxic encephalopathy (cardiac arrest). Four (16.21%) patients were related to systemic infection (10.81%), whereas 2 were related to encephalitis (5.40%). We demonstrated several potential etiologies, including metabolic encephalopathy, neurodegenerative disease, hypoxic encephalopathy, and infections, which should be considered in the case of FIRDA without structural brain lesions.
From Preconception Care to the First Day of School: Transforming the Health of New Families With Lifestyle Medicine
Authors: McHugh John , Dalal Michelle , Agarwal Neeta
Published: May 2020

Lifestyle medicine holds great promise to transform health during the period from preconception to early childhood. Genetic, epigenetic, nutritional, and environmental factors have lifetime impact on the newborn and family. Little is known about the full potential of lifestyle medicine to improve maternal, child, and family health. Additionally, health care providers face limits in time and may have gaps in knowledge, that preclude discussion of the impact lifestyle medicine can the mother, newborn, and family. Greater understanding of the potential impact of lifestyle medicine provides opportunities to identify current deficiencies in care and areas for improvement and highlights the need for further research. This article reviews current evidence supporting the 6 pillars of lifestyle medicine: nutrition, physical activity, sleep, avoiding risky substance use, stress management and social connectedness as applied to maternal child care from preconception to early childhood, examines the current state of practice, and identifies opportunities for both practice change and further research. Rather than view each component of care in isolation, viewing care as a continuum from preconception to childhood can best establish healthy habits and optimize outcomes for the entire family.
Exophthalmos following mechanical thrombectomy for anterior circulation stroke: A retrospective study and review of literature
Authors: Volders D , Labrie M , Keezer M , Poppe AY , Jacquin G , Stapf C , Gioia L , Deschaintre Y , Odier C , Daneault N , Iancu D , Raymond J , Roy D , Weill A
Published: May 2020

Background

Anecdotal cases of exophthalmos after acute mechanical thrombectomy have been described. We sought to estimate the incidence in a large cohort of patients with acute anterior circulation stroke treated with mechanical thrombectomy. Secondarily, we aimed to evaluate the underlying mechanism and to differentiate it on imaging from other pathology with similar clinical orbital features.

Methods

Between November 2016 and November 2018, we performed a retrospective single-center study of 250 patients who underwent anterior circulation mechanical thrombectomy. Development of exophthalmos was independently evaluated by two readers on preprocedure and 24-h postprocedure non-contrast cerebral CT.

Results

In the mechanical thrombectomy cohort, six individuals (2.4%) developed interval ipsilateral exophthalmos at 24 h. Of these, at least two patients developed clinical symptoms. There was almost perfect agreement between assessments of the two readers (Cohen’s kappa = 0.907 (95% confidence interval: 0.726, 1.000)). In two patients, there was delayed ophthalmic artery filling on digital subtraction angiography. None of the patients had features of a direct carotid-cavernous fistula.

Conclusions

Exophthalmos is not uncommon after mechanical thrombectomy (2.4%). The underlying mechanism is difficult to confirm, but it is most likely due to orbital ischemia from hypoperfusion or distal emboli.
An intelligent approach for data pre-processing and analysis in predictive maintenance with an industrial case study
Authors: Bekar Ebru Turanoglu , Nyqvist Per , Skoogh Anders
Published: May 2020

Recent development in the predictive maintenance field has focused on incorporating artificial intelligence techniques in the monitoring and prognostics of machine health. The current predictive maintenance applications in manufacturing are now more dependent on data-driven Machine Learning algorithms requiring an intelligent and effective analysis of a large amount of historical and real-time data coming from multiple streams (sensors and computer systems) across multiple machines. Therefore, this article addresses issues of data pre-processing that have a significant impact on generalization performance of a Machine Learning algorithm. We present an intelligent approach using unsupervised Machine Learning techniques for data pre-processing and analysis in predictive maintenance to achieve qualified and structured data. We also demonstrate the applicability of the formulated approach by using an industrial case study in manufacturing. Data sets from the manufacturing industry are analyzed to identify data quality problems and detect interesting subsets for hidden information. With the approach formulated, it is possible to get the useful and diagnostic information in a systematic way about component/machine behavior as the basis for decision support and prognostic model development in predictive maintenance.
Analysis of fluid–solid coupling characteristics of tripod sliding universal coupling based on cavitation and thermal effects
Authors: Yang Fuqin , Jiang Jingwei , Li Dong , Sun Linlin
Published: May 2020

In this article, a fluid–solid coupling analysis of tripod sliding universal coupling and lubricating oil film was conducted by taking into consideration cavitation and thermal effects. The coupling of the sleeve and slip pin with the lubricant oil film under different pressure differences and frequencies was investigated. Moreover, the study results were compared with the results of fluid–solid coupling under the ideal condition of negligible cavitation and thermal effects. When considering these effects, the deformation and stress values of the sleeve and the slip pin gradually increase as the pressure difference and frequency increase. The deformation and stress values of the sleeve are reduced relative to the calculation results of fluid–solid coupling in ideal conditions. However, the values of the slip pin are increased. Furthermore, when considering the thermal effect, the deformation and stress differences for the sleeve and slip pin decrease as the pressure difference increases. The stress difference of the sleeve grows sharply, whereas the deformation difference of the slip pin increases only slightly as the frequency increases.
Diet and exercise in pregnancy
Authors: Chuah Chee Kuan , Mulla Ebrahim
Published: May 2020

Pregnancy can provide a window of opportunity for healthcare professionals to promote healthy lifestyle choices. Pregnant women often receive inaccurate advice about diet and exercise. GPs have an important role in advocating a healthy lifestyle with dietary advice and the promotion of appropriate physical activity. This article aims to empower healthcare professionals to provide evidence-based advice to patients in pregnancy.
The combination of quantitative faecal occult blood test and faecal calprotectin is a cost-effective strategy to avoid colonoscopies in symptomatic patients without relevant pathology
Authors: Lué Alberto , Hijos Gonzalo , Sostres Carlos , Perales Alba , Navarro Mercedes , Barra Maria Victoria , Mascialino Barbara , Andalucia Carmen , Puente Juan José , Lanas Ángel , Gomollon Fernando
Published: May 2020

Background:

Faecal occult blood test (FOBT) has demonstrated effectiveness in colorectal cancer (CRC) screening. Faecal calprotectin (FC) has proven efficient for evaluating activity in inflammatory bowel disease (IBD), but its value in CRC detection is less established. Most symptomatic patients have benign pathologies, but still undergo colonoscopy in many settings.

Aims:

To evaluate the diagnostic accuracy and cost-effectiveness of the combination of FOBT plus FC in symptomatic patients.

Methods:

Patients who completed colonic investigations and returned stool samples, on which FOBT and FC were performed, were recruited prospectively. CRC, advanced adenoma, IBD and angiodysplasia were considered as relevant pathologies.

Results:

A total of 404 patients were included, of whom 87 (21.5%) had relevant pathologies. Sensitivity and specificity were 50.6% and 69.6% for FOBT, 78.2% and 54.4% for FC. Negative predictive value (NPV) was 90.1% for FC and 86.9% for FOBT. NPV for the combination of FOBT and FC was 94.1%, with a sensitivity and specificity of 88.5% and 50.3%. The area under ROC (receiver operator curve) (AUC) was 0.741 for FOBT, 0.736 for FC and 0.816 for the combination. The total cost for visits and procedures was €233,016 (€577/patient). Using a combination of FOBT and FC as pre-endoscopic tool allows colonoscopies to be reduced by 39.4%, reducing total costs by 20.5%.

Conclusion:

The combination of FOBT and FC has a better diagnostic accuracy compared with each test alone. Performing both tests before colonoscopy is a less costly and more effective strategy, reducing unnecessary procedures and complications.
Antimycobacterial Activity of Milemaronol, a New Squalene-Type Triterpene, and Other Isolate?
Authors: Boeno Samyra I. S. , Passos Michel de S. , Félix Mariana , Calixto Sanderson D. , Júnior Almir R. C. , Barbosa Siqueira Lara F. , Muzitano Michelle F. , Braz-Filho Raimundo , Vieira Ivo J. Curcino
Published: May 2020

A new triterpene, named milemaronol (1), was isolated from Homalolepis suffruticosa Engl., Simaroubaceae, along with 10 known metabolites, chaparrinone (2), scopoletin (3), 5-methoxycanthin-6-one (4), eurylene (5), hispidol A (6), hispidol B (7), nilocitine (8), α-dihydronylocytine (9), β-dihydronylocytine (10), and teurilene (11). These compounds were characterized based on their spectral data, mainly 1D (1H, 13C-APT) and 2D (1H-1H-COSY, NOESY, HSQC, HMBC) NMR and their mass spectra (HR-ESI-MS), in comparison with data from the literature. Compounds 1 to 6, 8, and 9 were evaluated for their antimycobacterial activity against 2 strains (H37Rv and M299).
Employment relations via the web with international elements: Issues and proposals as to the applicable law and determination of jurisdiction in light of EU rules and principles
Authors: Carinci Maria Teresa , Henke Albert
Published: May 2020

The article addresses the issues of which, from the EU perspective, are the applicable law and the competent courts in respect of employment contracts/relationships performed via the web and characterised by international elements. The study adopts a legal-regulatory approach, focusing, on one hand, on the issues related to the applicable law and, on the other hand, on those concerning the determination of the competent courts in respect of employment contracts/relationships performed via the web and characterised by international elements. The article outlines the possible detrimental effects on the weaker party of the contractual relationship, deriving from the application of the current connecting factors based on EU rules and regulations, in respect of the applicable law and the competent courts. The article considers only the EU legal framework, but suggests an evolutionary interpretation of EU law, aimed at preserving the anti-dumping rationale underlying the legal regime governing the applicable law and investigates the potential of collective redress mechanisms.
Rationale, design and baseline characteristics of the MyoVasc study: A prospective cohort study investigating development and progression of heart failure
Authors: Göbel Sebastian , Prochaska Jürgen H , Tröbs Sven-Oliver , Panova-Noeva Marina , Espinola–Klein Christine , Michal Matthias , Lackner Karl J , Gori Tommaso , Münzel Thomas , Wild Philipp S
Published: May 2020

Background

Heart failure (HF) is a poly-aetiological syndrome with large heterogeneity regarding clinical presentation, pathophysiology, clinical outcome and response to therapy. The MyoVasc study (NCT04064450) is an epidemiological cohort study investigating the development and progression of HF.

Methods

The primary objective of the study is (a) to improve the understanding of the pathomechanisms of HF across the full spectrum of clinical presentation, (b) to investigate the current clinical classifications of HF, and (c) to identify and characterize homogeneous subgroups regarding disease development using a systems-oriented approach. Worsening of HF, that is, the composite of transition from asymptomatic to symptomatic HF, hospitalization due to HF, or cardiac death, was defined as the primary endpoint of the study. During a six-year follow-up period, all study participants receive a highly standardized, biannual five-hour examination in a dedicated study centre, including detailed cardiovascular phenotyping and biobanking of various biomaterials. Annual follow-up examinations are conducted by computer-assisted telephone interviews recording comprehensively the participants´ health status, including subsequent validation and adjudication of adverse events.

Results

In total, 3289 study participants (age range: 35 to 84 years; female sex: 36.8%) including the full range of HF stages were enrolled from 2013 to 2018. Approximately half of the subjects (n=1741) presented at baseline with symptomatic HF (i.e. HF stage C/D). Among these, HF with preserved ejection fraction was the most frequent phenotype.

Conclusions

By providing a large-scale, multi-dimensional biodatabase with sequential, comprehensive medical-technical (sub)clinical phenotyping and multi-omics characterization (i.e. genome, transcriptome, proteome, lipidome, metabolome and exposome), the MyoVasc study will help to advance our knowledge about the heterogeneous HF syndrome by a systems-oriented biomedicine approach.

Trial registration

ClinicalTrials.gov; NCT04064450.
India under Modi’s second term: Democratic resilience amidst illiberal impulses
Authors: Sharma Shalendra
Published: May 2020

Almost all observers believed that India’s 2019 general election would result in a hung parliament and a coalition government. Yet, the election returned Prime Minister Narendra of the pro-Hindu Bharatiya Janata Party (BJP) to a second five-year term in office. The BJP not only increased its parliamentary majority, it also won seats in states and regions beyond the Hindi heartland. Indeed, Modi is the first prime minister since Indira Gandhi in 1971 to be reelected with a larger majority. What explains Modi’s spectacular electoral victory, and what does his victory bode for India’s representative democratic political order? Will India turn towards illiberalism as Modi tries to turn India into a Hindu majoritarian state? The following pages argue that such pessimism is unwarranted since India’s democracy is far more resilient, with built-in mechanisms against potential strongmen.
Shanghai Teachers’ Perceptions of Distributed Leadership: Resources and Agency
Authors: Tian (田梦) Meng , Virtanen Tuomo
Published: May 2020

Purpose:

Drawing on distributed leadership and motivation theories, this study investigates teachers’ perceptions of resource and agency distributions and identifies the key factors motivating leadership among teachers.

Design/Approach/Methods:

This quantitative study collected data from 327 teachers in nine schools in Shanghai. Chi-square tests of independence were conducted to examine the associations between leadership structures and power distance, while Spearman’s correlation tests were used to identify changes in leadership resource impact. A nonparametric Friedman’s test was applied to detect discrepancies between the agency of principals, team leaders, and teachers. Finally, Chi-square tests were conducted to discern the associations between teachers’ workload and motivation to lead.

Findings:

Most teachers identified the pyramid and spider’s web structures—which feature one power center and a high power distance—in their schools. The leadership resources and agency distributions corresponded to the school hierarchy: the higher position held by a teacher or a leader, the more resources they received, and the greater the agency they exercised. Results indicate that support from the principal is the most important factor in teachers’ participation in distributed leadership, while extra pay and leadership title are the least effective motivators.

Originality/Value:

This study has theoretical and practical value. First, it demonstrates the value of the resource–agency duality model for analyzing distributed leadership. Second, this study shows that promoting distributed leadership in Shanghai schools requires re-designing organizational resources and individual agency.
Associations Between Patients’ Unmet Social Needs and Self-Reported Health Confidence at One Primary Care Clinic
Authors: Bleacher Heather , English Aimee , Leblanc William , Dickinson L. Miriam
Published: May 2020

Social determinants of health affect a person’s health at least as much as their interactions with the healthcare system. Increased patient activation and self-efficacy are associated with decreased cost and improved quality. Patient-reported health confidence has been proposed as a more easily measured proxy for self-efficacy. Evaluation of the association between unmet social needs and health confidence is limited. Our objective was to identify and address our patients’ unmet social needs and assess health confidence levels. From November 2017 through July 2018 we screened 2018 patients of an urban academic family medicine residency practice for unmet social needs, measured their health confidence, and made referrals to community resources if desired. Patients reporting the presence of any social need reported lower health confidence scores on average than those with no needs (8.49 vs 9.30, median 9 vs 10, Wilcoxon test P < .001). Low health confidence scores (<7) were strongly associated with number of needs ( P < .001) after adjusting for age, gender, race, ethnicity, payer, and visit type (1 vs 0 needs, odds ratio [OR] = 2.566, 95% CI 1.546-4.259; 2 or more vs 0 needs, OR = 6.201, 95% CI 4.022-9.561). Results of this quality improvement project suggest that patients with unmet social needs may have decreased perceived ability to manage health problems. Further study is needed to determine if this finding is generalizable, and if interventions addressing unmet social needs can increase health confidence.
Nurses in an Ebola Viral Hemorrhagic Fever Outbreak: Facing and Preparing for Psychosocial Challenges
Authors: Paillard-Borg Stéphanie , Holmgren Jessica , Saaristo Panu , von Strauss Eva
Published: May 2020

The purpose of this study was to describe the psychosocial experience of the International Federation of Red Cross and Red Crescent Societies’ nurses upon their return from deployment at an Ebola Treatment Center during an Ebola virus disease outbreak in Kenema, Sierra Leone, between 2014 and 2015. The following three psychosocial aspects related to pre-, during, and postdeployment were explored: stress management, sociocultural exposure, and attitudes from others. This is a descriptive qualitative study with a cross-sectional design. Questionnaires were administered to 50 nurses, of which 44 responded. Eight themes were identified in relation to the three psychosocial aspects of interest: professional- and self-confidence, pragmatism, wellness activities, human contact, cultural competency, professionalism, pariah, and/or hero. One of the most important findings in this article relates to the essential mental health support pre- and during deployment with an emphasis upon return when the risk of isolation and stigmatization is greater. In conclusion, more research is needed about the psychosocial challenges met by nurses to prepare and support them as increasing threat of emerging infectious diseases puts pressure on global health systems.
Need and Capacity of a Toolkit for Occupational Health Nurses to Promote a New or Enhanced Drug-Free Workplace Program
Authors: Betcher Cynthia A. , Standish Michele D. , Gillespie Gordon Lee
Published: May 2020

Background: A drug-free workplace program (DFWP) has been shown to be effective in reducing workers’ drug misuse. The purpose of this project was to determine the need and capacity for a new or enhanced DFWP in a large health system. If determined to be needed, the next step would be to develop, implement, and evaluate a toolkit to assist occupational health nurses to promote a new or enhanced DFWP. Methods: A strategic prevention framework was used to assess the need and capacity for a toolkit to prepare occupational health nurses to promote a new or enhanced DFWP. The project was conducted in the occupational health services department at a large health system in the Midwest U.S. occupational health nurses and employee assistance counselors in the hospital system completed a survey assessing the need and capacity for a new or enhanced DFWP. Findings: A gap was identified in the perceived effectiveness of training about DFWP and current DFWP components. The findings reflect the need and capacity for a DFWP toolkit. Optimally, a DFWP toolkit would include evidence-based drug and alcohol screening tools. We found that a toolkit for occupational health nurses to promote a new or enhanced DFWP in the project site was warranted. Conclusion/Application to practice: A DFWP can be an effective method of promoting workplace health and safety. Occupational health nurses can contact state and national representatives to encourage monitoring of drug-related work injuries to provide evidence to influence health policies to support effective DFWPs.
Accuracy of the Critical Shoulder Angle for Predicting Rotator Cuff Tears in Patients With Nontraumatic Shoulder Pain
Authors: Lin Che-Li , Chen Yi-Wen , Lin Li-Fong , Chen Cho-Pang , Liou Tsan-Hon , Huang Shih-Wei
Published: May 2020

Background:

The critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. Although studies have reported that the CSA is associated with rotator cuff tears (RCTs), few studies have examined the accuracy of the CSA for predicting RCTs in patients with shoulder pain.

Purpose:

To investigate the accuracy of the CSA for predicting RCTs among patients with nontraumatic shoulder pain.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Data were retrospectively collected from 301 patients who had RCTs and underwent arthroscopic rotator cuff repair between January 2014 and December 2018 (RCT group). During that same period, we also included 300 patients with shoulder pain but without RCTs, confirmed through ultrasound (non-RCT group). Baseline demographic data, the CSA, and the acromion index (AI) were compared using an independent t test. Categorical variables were analyzed using the chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to investigate the accuracy of the CSA and AI for predicting RCTs, and the optimal cutoff point was determined using the Youden index. Multiple stepwise and binary logistic regressions were used to determine the predictors of RCTs.

Results:

A total of 301 patients (123 males, 178 females) and 300 patients (116 males, 184 females) were included in the RCT and non-RCT groups, respectively. The RCT group had a higher CSA ( P < .001) than the non-RCT group. The area under the ROC curve (AUC) was 70.5% ( P < .001) for the CSA, but there was no significance for the AI, with an AUC of 47.7% for predicting RCTs in patients. Stepwise logistic regression revealed the CSA as an independent predictor of RCTs, with an adjusted odds ratio of 1.295 (95% CI, 1.019-1.571; P = .006). For patients with a CSA greater than 37.52°, binary logistic regression revealed an adjusted odds ratio of 3.92 (95% CI, 2.79-5.51; P < .001) for the presence of an RCT.

Conclusion:

The CSA was an objective assessment tool to identify patients with shoulder pain who may have RCTs. Our study indicated that the CSA predicted RCTs more accurately than did the AI for patients with shoulder pain.
Advances in imaging of uveitis
Authors: Marchese Alessandro , Agarwal Aniruddha , Moretti Alessio Grazioli , Handa Sabia , Modorati Giulio , Querques Giuseppe , Bandello Francesco , Gupta Vishali , Miserocchi Elisabetta
Published: May 2020

Advances in multimodal imaging have significantly contributed to the management of many uveitis diseases in recent years. The most significant developments include the use of optical coherence tomography to obtain a more accurate and reproducible assessment of ocular inflammation, the application of optical coherence tomography angiography in choroiditis and retinal vasculitis, new possibilities for studying vitritis with ultrawide field imaging, and the most recent applications of fundus autofluorescence in uveitis. In this review, we provide an overview of the most significant advances in multimodal imaging of uveitis achieved in recent years.
Noise and turn-taking impact postanesthesia care unit handoff efficiency
Authors: Webster Kristen LW , Lazzara Elizabeth H , Keebler Joseph R , Roberts Laura L , Abernathy James H
Published: May 2020

Background

Optimal handoffs are pivotal for patient safety, yet some of the underlying communication mechanisms which support effective handoffs remain to be understood. As handoffs are conversations between providers, understanding communication mechanisms is necessary to improve handoff protocol development. The objective of this study was to characterize communication variables influencing the efficiency of handoffs in the postanesthesia care unit.

Methods

We conducted a single-center, observational study of handoffs over a three-week period in June/July of 2017. We recorded 96 handoffs between the cardiac operating room and postanesthesia care unit. We defined and measured efficiency by dividing the count of unique, nonrepetitive pieces of information by duration of the handoff conversation. Furthermore, we calculated and measured two communication variables: turn-taking and noise. We utilized West and Zimmerman’s Syntactic Scale to analyze turn taking by segregating noise into three subcategories: environmental noise caused by equipment, environmental noise caused by staff, and third-party interruptions. Finally, we recorded and measured the frequency and duration of noise and turn-taking during the handoff events.

Results

Due to technical issues, we transcribed and analyzed a total of 85 observations. Providers passed an average of 31.68 unique pieces of information during each handoff with the average length being 1 min and 46 s. Overlaps was the most common type of turn-taking behavior. Activity noise was the most common type of noise. Activity noise took place an average of 3.64 times per handoff and lasted an average of 9.83 s. Turn-taking accounted for 15.6% of variance in handoff efficiency. Together, noise and turn-taking accounted for 25.2% of the variance in handoff efficiency.

Conclusion

Because turn-taking and noise account for over a quarter the variance in handoff efficiency, recommendations include providing quiet locations for handoffs to take place. Additionally, we recommend that receivers provide input in any handoff interventional studies as their involvement would decrease the need to interrupt or clarify information from the sender.
Multi-HLA class II tetramer analyses of citrulline-reactive T cells and early treatment response in rheumatoid arthritis
Authors: Gerstner Christina , Turcinov Sara , Hensvold Aase H. , Chemin Karine , Uchtenhagen Hannes , Ramwadhdoebe Tamara H. , Dubnovitsky Anatoly , Kozhukh Genadiy , Rönnblom Lars , Kwok William W. , Achour Adnane , Catrina Anca I. , van Baarsen Lisa G. M. , Malmström Vivianne
Published: May 2020

Background

HLA class II tetramers can be used for ex vivo enumeration and phenotypic characterisation of antigen-specific CD4+ T cells. They are increasingly applied in settings like allergy, vaccination and autoimmune diseases. Rheumatoid arthritis (RA) is a chronic autoimmune disorder for which many autoantigens have been described.

Results

Using multi-parameter flow cytometry, we developed a multi-HLA class II tetramer approach to simultaneously study several antigen specificities in RA patient samples. We focused on previously described citrullinated HLA-DRB1*04:01-restricted T cell epitopes from α-enolase, fibrinogen-β, vimentin as well as cartilage intermediate layer protein (CILP). First, we examined inter-assay variability and the sensitivity of the assay in peripheral blood from healthy donors (n = 7). Next, we confirmed the robustness and sensitivity in a cohort of RA patients with repeat blood draws (n = 14). We then applied our method in two different settings. We assessed lymphoid tissue from seropositive arthralgia (n = 5) and early RA patients (n = 5) and could demonstrate autoreactive T cells in individuals at risk of developing RA. Lastly, we studied peripheral blood from early RA patients (n = 10) and found that the group of patients achieving minimum disease activity (DAS28 < 2.6) at 6 months follow-up displayed a decrease in the frequency of citrulline-specific T cells.

Conclusions

Our study demonstrates the development of a sensitive tetramer panel allowing simultaneous characterisation of antigen-specific T cells in ex vivo patient samples including RA ‘at risk’ subjects. This multi-tetramer approach can be useful for longitudinal immune-monitoring in any disease with known HLA-restriction element and several candidate antigens.
Comparison of bioresorbable vs durable polymer drug-eluting stents in unprotected left main (from the RAIN-CARDIOGROUP VII Study)
Authors: Iannaccone Mario , Barbero Umberto , De Benedictis Michele , Imori Yoichi , Quadri Giorgio , Trabattoni Daniela , Ryan Nicola , Venuti Giuseppe , Montabone Andrea , Wojakowski Wojciech , Rognoni Andrea , Helft Gerard , Parma Radoslaw , De Luca Leonardo , Autelli Michele , Boccuzzi Giacomo , Mattesini Alessio , Templin Christian , Cerrato Enrico , Wańha Wojciech , Smolka Grzegorz , Huczek Zenon , Tomassini Francesco , Cortese Bernardo , Capodanno Davide , Chieffo Alaide , Nuñez-Gil Ivan , Gili Sebastiano , Bassignana Antonia , di Mario Carlo , Doronzo Baldassarre , Omedè Pierluigi , D’Amico Maurizio , Tedeschi Delio , Varbella Ferdinando , Luscher Thomas , Sheiban Imad , Escaned Javier , Rinaldi Mauro , D’Ascenzo Fabrizio
Published: May 2020

Background

There are limited data regarding the impact of bioresorbable polymer drug eluting stent (BP-DES) compared to durable polymer drug eluting stent (DP-DES) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations.

Methods

In the RAIN registry (ClinicalTrials NCT03544294, june 2018 retrospectively registered) patients with a ULM or bifurcation stenosis treated with PCI using ultrathin stents (struts thinner than 81 μm) were enrolled. The primary endpoint was the rate of target lesion revascularization (TLR); major adverse cardiovascular events (MACE, a composite of all-cause death, myocardial infarction, TLR and stent thrombosis) and its components, along with target vessel revascularization (TVR) were the secondary ones. A propensity score with matching analysis to compare patients treated with BP-DES versus DP-DES was also assessed.

Results

From 3001 enrolled patients, after propensity score analysis 1400 patients (700 for each group) were selected. Among them, 352 had ULM disease and 1048 had non-LM bifurcations. At 16 months (12–22), rates of TLR (3.7% vs 2.9%, p = 0.22) and MACE were similar (12.3% vs. 11.6%, p = 0.74) as well as for the other endpoints. Sensitivity analysis of outcomes after a two-stents strategy, showed better outcome in term of MACE (20.4% vs 10%, p = 0.03) and TVR (12% vs 4.6%, p = 0.05) and a trend towards lower TLR in patients treated with BP-DES.

Conclusion

In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform similarly to DP-DES: the trends toward improved clinical outcomes in patients treated with the BP-DES might potentially be of value for speculating the stent choice in selected high-risk subgroups of patients at increased risk of ischemic events.

Trial registration

ClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
Relation between quantity and quality of peri-coronary epicardial adipose tissue and its underlying hemodynamically significant coronary stenosis
Authors: Du Yu , Yang Lin , Liu Yan , Yang Bangguo , Lv Sai , Hu Chenping , Zhu Yong , Zhang Hongkai , Ma Qian , Wang Zhijian , Liu Yuyang , Shi Dongmei , Zhao Yingxin , Xu Lei , Zhou Yujie
Published: May 2020

Background

We aimed to investigate the association of lesion-specific epicardial adipose tissue (EAT) volume and density with the presence of myocardial ischemia.

Methods

We enrolled 45 patients (55 lesions) with known or suspected coronary artery disease who underwent coronary computed tomography angiography (CTA) followed by invasive fractional flow reserve (FFR) assessment within 30 days. EAT volume (index) and density in patient-, vessel- and lesion-level were measured on CTA images. Lesion-specific ischemia was defined as a lesion with stenosis diameter > 90% or FFR ≤0.80. Multivariate analysis determined the independent association of EAT parameters with lesion-specific ischemia.

Results

Mean age of the patients was 60 years, and 75% were male. Overall, 55.6% of patients had ischemic lesions and a mean FFR baseline value of 0.82 ± 0.10. Total EAT volume index was significantly higher in patients with functionally or anatomically significant stenosis. Specifically, peri-lesion EAT volume index, not the density, was positively correlated with lesion-specific ischemia independent of luminal stenosis and plaque characteristics (hazard ratio 1.56, 95% confidence interval 1.04–2.33, P = 0.032; per 0.1 ml/m2 increase). Moreover, peri-lesion EAT volume was negatively correlated with lesion FFR values, whereas total EAT volume was positively correlated with fat accumulation and glucose metabolism. In addition, there was no association of EAT volume or density with myocardial ischemia in vessel-level analysis.

Conclusions

Lesion-specific EAT volume index, but not density, seems positively and independently associated with myocardial ischemia, while its incremental diagnostic value of lesion-specific ischemia should be further investigated.
Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery
Authors: Larmann Jan , Handke Jessica , Scholz Anna S. , Dehne Sarah , Arens Christoph , Gillmann Hans-Jörg , Uhle Florian , Motsch Johann , Weigand Markus A. , Janssen Henrike
Published: May 2020

Background

Preoperative risk prediction in patients at elevated cardiovascular risk shows limited accuracy. Platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) indicate systemic inflammation. Both have been investigated for outcome prediction in the field of oncology and cardiovascular medicine, as well as risk prediction of adverse cardiovascular events in non-surgical patients at increased cardiovascular risk.

Methods

For this post-hoc analysis, we included all 38 coronary heart disease patients from the Leukocytes and Cardiovascular Perioperative Events cohort-1 study scheduled for elective non-cardiac surgery. We evaluated preoperative differential blood counts for association with major adverse cardiovascular and cerebrovascular events (MACCE) defined as the composite endpoint of death, myocardial ischemia, myocardial infarction, myocardial injury after non-cardiac surgery, or embolic or thrombotic stroke within 30 days after surgery. We used Youden’s index to calculate cut-off values for PLR and NLR. Additive risk-predictive values were assessed using receiver operating characteristic curve and net reclassification (NRI) improvement analyses.

Results

Patients with the composite endpoint MACCE had higher PLR and NLR (309 [206; 380] vs. 160 [132; 203], p = 0.001; 4.9 [3.5; 8.1] vs. 2.6 [2.2; 3.4]), p = 0.001). Calculated cut-offs for PLR > 204.4 and NLR > 3.1 were associated with increased risk of 30-day MACCE (OR 7, 95% CI [1.2; 44.7], p = 0.034; OR 36, 95% CI [1.8; 686.6], p = 0.001). Furthermore, NLR improved risk prediction in coronary heart disease patients undergoing non-cardiac surgery when combined with hs-cTnT or NT-proBNP (NRI total = 0.23, p = 0.008, NRI total = 0.26, p = 0.005).

Conclusions

Both PLR and NLR were associated with perioperative cardiovascular adverse events in coronary heart disease patients. NLR proved to be of additional value for preoperative risk stratification. Both PLR and NLR could be used as inexpensive and broadly available tools for perioperative risk assessment.

Trial registration

NCT02874508, August 22, 2016.