bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of Ultrasound Scissors in Reducing Serous Drainage after Axillary Dissection for Breast Cancer: A Prospective Randomized Clinical Study
Authors: Lumachi Franco , Burelli Paolo , Basso Stefano M.M. , Iacobone Maurizio , Ermani Mario
Published: November 2022

Axillary dissection is usually associated with prolonged serous drainage that may result in several complications. We analyzed whether the use of ultrasound scissors may decrease the total amount of drainage from the axilla (AD) in patients requiring curative surgery for breast cancer. Seventy-six women (median age, 56 years; range, 32–73 years) with confirmed pT1–3, N0–1 breast cancer were prospectively randomly assigned to undergo mastectomy or breast-conserving surgery with axillary dissection by either using (group A) or not using (group B) ultrasound scissors. Overall, there was a linear relationship ( P < 0.05) between AD and both total number of the removed nodes and body mass index, whereas no correlation ( P = NS) was found with age and size of the tumor. Total AD was higher (492 ± 153 vs. 408 ± 136 mL, P = 0.013) in group B, whereas the postoperative hospital stay was shorter (2.4 ± 0.6 vs. 2.7 ± 0.7 days, P = NS) in group A. The three-way analysis of covariance using the number of total removed nodes as covariate showed that lymph node status, type of operation, and technique for axillary dissection significantly ( P < 0.05) correlated with AD. In conclusion, our initial study shows that the use of ultrasound scissors significantly reduced total AD in patients requiring axillary dissection and may shorten hospital stay.
Amish Buggy Injuries in the 21st Century: A Retrospective Review from a Rural Level II Trauma Center
Authors: Aaland Mary O. , Hlaing Thein
Published: November 2022

Horse-drawn buggies are rarely used in modern society except among certain religious groups. Northeastern Indiana has one of the largest populations of one such group: the Amish. Although there are papers written about the incidence of buggy crashes, no paper has specifically addressed the specific types of injuries sustained when buggies collide with motorized vehicles. This paper reviews the types of injuries sustained when such events occur.
Skin-Sparing and Nipple-Sparing Mastectomy: Preoperative, Intraoperative, and Postoperative Considerations
Authors: Chagpar Anees B.
Published: November 2022

The last several decades have witnessed significant advances in the surgical management of breast cancer. Although many have embraced breast conservation as the procedure of choice, some patients will still opt for mastectomy for a variety of reasons. Recently, the concept of skin sparing mastectomy and immediate breast reconstruction has emerged as an option that provides excellent cosmetic results while being oncologically safe. However, this surgical approach must be considered within a multidisciplinary context, and there are a number of perioperative issues that need to be considered. In addition, newer techniques, which spare the nipple and/or areola, warrant further examination.
Internet Use by Colorectal Surgery Patients: A Surgeon's Tool for Education and Marketing
Authors: Lake Jeffrey P. , Ortega Adrian , Vukasin Petar , Kaiser Andreas M. , Kaufman Howard S. , Beart Robert W.
Published: November 2022

The goal of this study is to understand the role of the Internet in the education and recruitment of patients within colorectal surgery practices. Surveys of Internet use were completed by 298 patients visiting five outpatient colorectal surgery clinics affiliated with the University of Southern California. Data collected included the patient's age, gender, level of education, zip code at home, type of clinic visited, and information on the respondent's Internet use. Overall, 20 per cent of the respondent patients visiting our clinics had used the Internet to research the medical condition that prompted their visit. Highest grade level completed ( P < 0.001), age ( P < 0.01), type of clinic ( P < 0.001), and household income ( P < 0.001) were all found to be associated with any prior use of the Internet whereas gender was not ( P = 0.58). Among Internet users, only household income and frequent use of the Internet were associated with searching the Internet for medical information ( P < 0.001). Ultimately, all of the Internet-using patients surveyed felt the medical information they found was “somewhat” or “very helpful.” Understanding which patients “go online” to search for medical information is essential for surgeons who wish to use the Internet for marketing their practices and educating their patients.
The Utility of a Rapid Parathyroid Assay for Uniglandular, Multiglandular, and Recurrent Parathyroid Disease
Authors: Arciero C.A. , Peoples G.E. , Stojadinovic A. , Shriver C.D.
Published: November 2022

The rapid parathyroid hormone assay (rPTH) is an effective tool in minimally invasive resections of parathyroid adenomas. However, there are relatively few reports examining its utility in the full spectrum of parathyroid disease. The purpose of this study was to examine the utility of the rapid parathyroid hormone assay in uniglandular, multiglandular, and recurrent hyperparathyroidism. A retrospective analysis of all patients undergoing parathyroid resection from June 2001 to March 2003 was undertaken. All patients underwent preoperative localization studies. Rapid parathyroid hormone (PTH) levels were drawn immediately prior to and 10 minutes following parathyroid resection. A decline of ≥50 per cent rPTH qualified as a successful/complete resection. Additional intraoperative samples were drawn as needed for patients with multiglandular disease. Of 46 treated patients who were examined (average age, 54 years), 30 had single, 12 patients had multigland disease, and 4 had recurrent/persistent hyperparathyroidism. Thirty-seven patients had primary hyperparathyroidism (32 with single and 3 with double adenomas; 2 with hyperplasia), 4 patients had secondary hyperparathyroidism, and 5 tertiary hyperparathyroidism. All procedures were considered successful, as every patient exhibited a postresection decrement in rPTH exceeding 50 per cent (average decrement, 91%). Although 2 patients exhibited a postoperative PTH increase exceeding 50 per cent of the preoperative value, all remained asymptomatic and eucalcemic (median follow-up, 21.5 months). The rPTH assay is an effective tool in determining success of parathyroidectomy in patients with primary uni- and multiglandular as well as recurrent hyperparathyroidism. It can be used to achieve minimally invasive neck dissections or guide surgical decision-making in more complex cases.
Incisional Hernioplasty with Extraperitoneal Onlay Polyester Mesh
Authors: Machairas Anastasios , Misiakos Evangelos P. , Liakakos Theodore , Karatzas Gabriel
Published: November 2022

Recurrent incisional hernia remains a major problem for the general surgeon. The high recurrence rate of incisional hernias after primary closure by tissue approximation led to the development of tension-free procedures using prosthetic materials. The goal of this study is to present the results of an extraperitoneal tension-free technique using a polyester mesh (Mersilene). A total of 43 patients with incisional hernias were surgically treated during a 9-year period in our department. Twenty-four patients (56%) had recurrent incisional hernias, 21 had primary repair by tissue approximation, and 3 had prolene mesh tension-free repair with wound infection. Patients’ mean age was 68.2 years, and the mean postoperative follow-up was 54.4 months. Immediate postoperative complications were noticed in 9 patients (21%) subcutaneous seroma in 6 (14%) and wound infection in 3 (7%). Recurrence was noticed in 4 patients (9%) during the first 9 postoperative months. Late minor complications such as restriction of abdominal wall motility and chronic pain was noticed in 3 (7%) patients. In conclusion, the extraperitoneal onlay tension-free incisional hernia repair using polyester mesh is an easy and safe procedure with no major morbidity or recurrence rate.
Intussusception Secondary to Metastasis from a Low-Grade Retroperitoneal Liposarcoma
Authors: Monjazeb Arta , Stanton Constance , Levine Edward A.
Published: November 2022

Liposarcomas are the most prevalent soft tissue sarcomas in adults. Low-grade liposarcomas are the most frequent and least aggressive and are noted as having a low risk of metastasis. We present a case of low-grade myxoid liposarcoma that metastasized to the small bowel resulting in intussusception. This case involves a 44-year-old woman with a recurrent retroperitoneal liposarcoma. Approximately 30 months after initial diagnosis, the patient was found to have a solitary metastasis to the small bowel that presented as a jejunal intussusception. Interestingly, there was no indication of a round cell component in either the metastasis or recurrent tumor, although the original tumor did contain a small round cell component. This is the first report in the English literature of liposarcoma metastasizing to the small bowel. We suggest that atypical presentations of liposarcoma metastases should always be considered in the management of patients with a history of liposarcoma.
Trauma in Nonagenarians and Centenarians: Review of 137 Consecutive Patients
Authors: Sieling Beth A. , Beem Karen , Hoffman Mary T. , Yuschak James V. , Morris Jon B.
Published: November 2022

The purpose of this study was to examine the hospital course and outcomes of elderly trauma patients. We accomplished a retrospective review of all consecutive trauma patients admitted to a level II trauma center from January 2000 to April 2002. Gender, Injury Severity Score (ISS), length of stay (LOS), operative procedure, morbidity, and mortality of patients ≥90 years of age were compared with younger patients. Of 2645 trauma admissions, 137 patients (5%) were ≥90 years (range, 90 to 108 years; mean, 93.1 years); 5 patients were ≥100 years. One hundred eleven (81%) patients were female; 26 (19%) male. Average ISS for patients ≥90 was 8.75 and was 7.78 for younger patients. One hundred sixteen elderly patients (85%) had ISS < 15. Falls were the most common mechanism of injury (93%), usually ground-level falls (64%). Two hundred ninety-two injuries included 133 fractures and 102 soft tissue injuries. Thirty-four elderly patients (25%) and 733 younger patients (29%) required surgery. Complications developed in 8 per cent of older and 6 per cent of younger patients. Hospital LOS averaged 4.36 days for older and 3.51 days for younger patients. Six older (4.4%) and 63 younger (2.5%) patients died. ISS scores and LOS were slightly higher in elderly patients, but morbidity and mortality were comparable in both groups.
Multi-fault diagnosis scheme based on robust nonlinear observer with application to rolling mill main drive system
Authors: Zhang Ruicheng , Li Zhiwen
Published: November 2022

A fault diagnosis solution is proposed in this article for the uncertainty and external disturbance problems in the main drive system of a rolling mill based on analytical redundancy. Considering the nonlinear friction damping, a system is mathematically modeled, and a bank of nonlinear Luenberger observers is designed. The generalized residual set theory is used to isolate two typical fault types of the system. To optimize the anti-disturbance ability of the observer, the disturbance attenuation factor is introduced. The influence of external disturbance on fault estimation is reduced by adjusting the disturbance attenuation factor. Using Lyapunov stability theory, the convergence analysis of the observer dynamic error equation is provided. The observer gain is obtained through resolving the optimality issue under the linear matrix inequality constraint. Numerical simulations of a 2030-mm tandem cold rolling mill were conducted to demonstrate the practicability of the approach. This fault diagnosis scheme is important to improve the stability of system operation.
Perceived regulatory compliance in micro-firms: The case of English accommodation providers
Authors: Betton Marc E. , Branston J. Robert , Tomlinson Philip R.
Published: November 2022

Business regulation is only successful when firms comply. Compliance is determined by several factors, including knowledge-of/attitude-towards regulation, which we suggest consists of both burden and value. Existing literature generally ignores regulatory value and focuses on larger firms in “high-risk” industries. We explore Perceived Own-Firm and Perceived Competitor Compliance in English accommodation micro-firms. Perceived Own-Firm Compliance exceeds Perceived-Knowledge of regulation, and has the strongest (positive) association with Perceived-Value. Perceived Competitor Compliance is thought to be very low and is (negatively) associated with Perceived-Value and Perceived-Burden. Furthermore, the factors associated with greater Perceived Own-Firm Compliance are associated with lower Perceived Competitor Compliance.
Is change all in the mind? A study of leader mindfulness, leader behaviors in implementing change
Authors: Higgs Malcolm , Rowland Deborah
Published: November 2022

Organizations are facing an ever-growing need to implement continuous transformational change. This has led to an increase in interest in change leadership. However, this has not been supported by empirical research and the need for it has been widely recognized. In parallel, and related to, these developments there have been a significant growth in interest in the concept of mindfulness and in particular in its relationship to leadership. However, whist there is a lot of evidence of its value in clinical contexts, there is limited organizationally based evidence and a paucity of studies that explore mindfulness and leadership. In spite of this, there is an increasing interest in mindful leadership amongst practitioners and a growth in related development programs on offer. This paper reports a study that explored the nature of leader mindfulness and change leadership behaviors in the context of implementing organizational change. It was based on interviews with 63 leaders from 56 organizations. Analyses of the data showed clear relationships between leaders’ facilitating and engaging behaviors and leader mindfulness in the context of change.
Determinants of teleworkers' job performance in the pre-COVID-19 period: Testing the mediation effect of the organizational impact of telework
Authors: Park Seejeen , Jae Moon M
Published: November 2022

Although pre-COVID-19 research on telework is well established, most research has compared teleworkers against nonteleworkers to assess the adoption of telework. Thus, the investigation of the determinants of teleworker performance is limited. The current study seeks to identify the determinants of teleworker job performance in the pre-COVID-19 period. Using U.S. federal government employee telework data, the current study tests the effects of work, technology, and management factors on teleworker performance mediated by the organizational impact of telework. The findings revealed that work similarity, telework frequency, accessibility of technologies, and quality of performance management positively affected the organizational impact of telework. Telework frequency, quality of performance management, and quality of supervision showed a positive association with job performance. However, in contrast to expectations, evidence of a mediation effect was not found as the organizational impact of telework was negatively associated with teleworker performance. Implications for telework implementation and research in the post-COVID-19 period are offered.
Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders
Authors: Slomp Caitlin , Morris Emily , Edwards Louisa , Hoens Alison M. , Landry Ginny , Riches Linda , Ridgway Lisa , Bryan Stirling , Austin Jehannine
Published: November 2022

Objectives

With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada.

Methods

We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description.

Results

Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants’ prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing.

Conclusions

While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.
Understanding Challenges and Coping Strategies Experienced by Chinese American Family Caregivers of Persons with Dementia
Authors: Lee Kathy , Cassidy Jessica , Zhao Joe , Mitchell Jaci
Published: November 2022

The purpose of this study was to explore the caregiving experience of Chinese American family caregivers of persons with dementia with a focus on challenges and coping strategies. Using a qualitative study design, we conducted semi-structured interviews with 26 Chinese American family caregivers and analyzed the data using thematic analysis. We also identified their caregiving experience specific to the COVID-19 pandemic. First, four themes were discovered: (1) filial obligations, (2) preference for utilizing home- and community-based supports, (3) relying on primary care doctors, and (4) helping behaviors. Two additional COVID-19-related themes were identified: (1) social isolation and (2) perceived discrimination. We suggested interventions at the individual, community, and societal level not only to support various challenges experienced by this ethnic group but also to promote their coping strategies.
Study on mechanical efficiency in a 2D piston pump with rail rotation based on Hertz contact theory
Authors: Huang Yu , Shao Wei , Yu Wen , Liu Li , Ding Chuan , Ruan Jian
Published: November 2022

A 2D piston pump’s mechanical efficiency is limited at high rotational speeds, in particular, its mechanical efficiency decreases as its load pressure rises. In this paper, the conventional 2D piston pump is redesigned by changing its suspension rotation into rail rotation to decrease mechanical loss. The mechanical efficiency of this new 2D piston pump is studied by building a mathematical model for analyzing the relationship between the load and the mechanical loss caused by the rolling of the cone rollers on the guiding rails. Hertz contact theory is used for the first time for such analysis. Test results prove that the mechanical efficiency of the 2D piston pump with rail rotation is better than that of a 2D piston pump with suspension rotation, with the former’s mechanical efficiency increasing with the load. According to theoretical analysis and test results, the material used to manufacture the cone rollers and guiding rails is changed from 45 steel to GCr15 to improve the mechanical efficiency of the developed 2D piston pump further.
An effective tyre to road friction estimation applied to heavy vehicles
Authors: Sharifzadeh Mojtaba , Bruzelius Fredrik , Jacobson Bengt , Henderson Leon , Timpone Francesco
Published: November 2022

Knowledge about the tyre to road friction is central to many vehicle functions as well as the overall performance of the vehicle. In this paper, a new real-time algorithm is presented for estimating the coefficient of friction using available on-board sensor information. A computationally efficient algorithm is presented, that reduces resources usage compared to previously published approaches. Issues connected to heavy vehicles and friction estimation is addressed, such as wind up of hub assembly and vehicle speed sensing. The performance of the algorithm is illustrated on data sets acquired from the test track recordings in winter conditions.
Experimental study of mosquito-inspired needle to minimize insertion force and tissue deformation
Authors: Gidde Sai Teja Reddy , Islam Sayemul , Kim Albert , Hutapea Parsaoran
Published: November 2022

The aim of this work is to propose a mosquito-inspired (bioinspired) design of a surgical needle that can decrease the insertion force and the tissue deformation, which are the main causes of target inaccuracy during percutaneous procedures. The bioinspired needle was developed by mimicking the geometrical shapes of mosquito proboscis. Needle prototypes were manufactured and tested to determine optimized needle shapes and geometries. Needle insertion tests on a tissue-mimicking polyvinylchloride (PVC) gel were then performed to emulate the mosquito-proboscis stinging dynamics by applying vibration and insertion velocity during the insertion. An insertion test setup equipped with a sensing system was constructed to measure the insertion force and to assess the deformation of the tissue. It was discovered that using the proposed bioinspired design, the needle insertion force was decreased by 60% and the tissue deformation was reduced by 48%. This finding is significant for improving needle-based medical procedures.
Wind farms in contested landscapes: Procedural and scale gaps of wind power facility constructions in Japan
Authors: Kohyama Satomi , Kohsaka Ryo
Published: November 2022

The legal system for renewable energy in Japan, Feed-in Tariff system, was deregulated in 2021 by the central government to reflect the international calls to reduce greenhouse gas emissions. However, this sudden change has raised concerns about social, environmental, and long-term economic sustainability. Thus, we conducted a state-of-the-art review of legal and policy frameworks of wind power projects in Japan and discussed the multi-layered structure at national- and municipal-level ordinances. By doing so, several gaps are highlighted. First, there are procedural gaps that business operators can de facto bypass by checking the environmental procedures. Second, there are issues at the scale (national or local), where the decisions are met. For example, while the overall framework is decided at the national level, the most contentious issues of the location of wind power facilities are left at the local level, where residents, municipalities, and developers are burdened to solve these issues. Third, in the current legal system, environmental impacts on popular natural landscapes are not taken into consideration. In the face of deregulation and concerns about multiple factors, there has been an increase in the number of municipalities opposing the construction of wind farms. Finally, existing legal cases related to wind power projects are provided to illustrate changes and disputes at different sites across Japan. These cases demonstrated how landscape elements (e.g. biodiversity) can be vital for wind power project development in Japan.
Temporariness of refugee protection: For what and in whose interest Cessation of status as related to revocation of residence permits
Authors: Stoyanova Vladislava
Published: November 2022

Temporariness of refugee protection has started to emerge as a new standard in the policies of European countries. Given this development, the article focuses on one specific issue related to this temporariness: how refugee status intertwines with the conditions for the granting, revocation and prolongation of national residence permits. What are the interconnections between refugee status, including its cessation and revocation, on the one hand, and national residence permits and their revocation and prolongation, on the other? How are these interconnections regulated by international law, EU law and national law (with Sweden as an example)? Inaddition to the detailed analysis of the relevant legal norms, the article situates the questions within a more general discussion about residence in the national community. In this way, it is shown how temporariness creates tensions at national level where the refugee qua resident in the national community, benefits from safeguards in favour of individual certainty. This explains why residence permits, as opposed to refugee status, have central organizing role at national level.
An actuator with tuneable resonant frequency for active vibration damping
Authors: Hendijanizadeh Mehdi , Sharkh Suleiman , Mosca Pietro , Daley Steve
Published: November 2022

This paper explores implementing active resonance frequency tuning of adaptive tuned vibration absorbers (ATVA) by coupling a vibration absorber comprising a voice coil actuator (VCA) and a sprung inertial mass to a solenoid actuator (SA). In this device, the DC current flowing through the SA generates negative magnetic stiffness and varies the equilibrium position of the nonlinear spring of the VCA, thus changing the effective stiffness of the system and its resonant frequency. The paper details the analytical design steps and the parametric sizing process of designing the SA to maximize its force density within defined magnetic, dimensions and thermal constraints. The design of the SA was verified using finite element analysis (FEA), manufactured and coupled to a VCA to make the complete ATVA system. The experimental results demonstrate the tunability of the resonance frequency of the ATVA by controlling the SA’s DC current. It is shown that the system’s resonance frequency can be shifted by up to 23% of the fundamental resonance frequency, which improves the effectiveness of the ATVA at damping a broader range of excitation frequencies.
Hygro-magneto-thermally induced vibration of spinning viscoelastic Y-shaped bifurcated tubes containing magnetic fluid based on nonlocal strain gradient theory
Authors: Sivaraman Ramaswamy , Kumar Tulluri Chiranjeevi Anil , Patra Indrajit , AL-Khafaji Rusul Mohammed , Izzat Samar Emad , Smitt John
Published: November 2022

The vibration and stability of spinning viscoelastic Y-shaped bifurcated nanotubes conveying fluid in complex environments by considering additional concentrated masses and springs are studied based on the nonlocal strain gradient theory (NSGT). A detailed investigation is also performed to clarify the effect of influential parameters such as Knudsen number, magnetic nanoflow, scale parameter ratio, spin speed, fluid velocity, downstream bifurcation angle, viscoelastic coefficient, attached springs, localized masses, boundary conditions, and magneto-hygro-thermal environments on the system dynamics. The size-dependent dynamical equations of the system are derived utilizing Hamilton’s principle. The Galerkin discretization scheme is adopted, and the eigenvalue problem is numerically solved. Campbell diagrams, forward and backward frequencies, divergence and flutter instability maps are acquired. Besides, the static instability threshold of the system is determined analytically. Results revealed that although the magnetic nanoflow has a decreasing effect on system vibrational frequencies, it delays the occurrence of the dynamical instability and prevents the buckling phenomenon. It is demonstrated that by considering simultaneous stiffness-softening effects induced by nonlocality and hygro-thermal environments, the flutter instability could occur instead of divergence condition in the system stability evolution. The present modeling and results could be applied as a benchmark for the performance improvement of innovative bi-gyroscopic nanofluidic devices.
An energy-based elastoplastic damage model for concrete at high temperatures
Authors: Wang Yu-Shuang , Wu Jian-Ying
Published: November 2022

Although structural concrete is widely used in civil engineering, the proper modeling of its thermo-mechanical behavior remains a challenging issue for the academic and engineering communities due to the complexity involved in the underlying micro-cracking process. In this work, the previous thermodynamically consistent energy-based elastoplastic damage model is extended to concrete at high temperatures, with the aim to describe the material nonlinear behavior and provide numerical predictions of concrete structures. Both the thermal expansion and transient creep strain are incorporated in the kinematics. Within the framework of continuum damage mechanics, two mechanical damage variables that lead to a fourth-order damage tensor are introduced to describe stiffness degradation of concrete under predominant tension and compression, respectively. Moreover, temperature-dependent mechanical properties are adopted to describe the thermal degradation and the thermo-mechanically coupled behavior of concrete at high temperatures. The plastic flow is described by the effective stress space plasticity and the evolution laws for the mechanical damage variables are driven by the conjugate elastoplastic damage energy release rates. The proposed model is validated by several benchmark experiments of plain concrete and then applied to reinforced concrete (RC) structures. The well agreement between the numerical predictions and experimental results indicates that the proposed model is promising in quantifying the global responses and assessing the safety of plain concrete and RC structures at high temperatures.
Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience
Authors: Salisbury Taylor , Gurung Ananta , Koonmee Supinda , Ali Leila , Ondic Ondrej , Bhan Rohan , Pivovarcikova Kristyna , Hes Ondrej , Alaghehbandan Reza
Published: November 2022

Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size ( P = .004) and atypia on core biopsy ( P = .009) were significantly associated with upgrade. Older age (>55 years) (OR =  5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.
Metastatic Thyroid Carcinoma to the Kidneys Presenting Initially as Bilateral Renal Masses: A Rare Case Report and Literature Review
Authors: Youssef Bahaaldin , Hanna Karina , Bowman Andrew , Ardor Gokce Deniz , Alhaj Ahmed M. , Nassar Aziza
Published: November 2022

Thyroid cancers exist in multiple forms. Papillary and follicular carcinomas of the thyroid are often referred to as well-differentiated thyroid cancers. Well-differentiated thyroid cancers rarely present as a distant metastatic cancer on initial diagnosis. Papillary thyroid cancer tends to have a good prognosis; however, if distant metastasis of PTC is present, there is usually a poor clinical outcome with a less favorable prognosis. In this study, we report a 90-year-old female who presented with right-sided abdominal discomfort. A renal ultrasound revealed bilateral upper pole renal masses. A percutaneous biopsy was ordered, and the microscopic examination revealed bilateral renal metastasis with a follicular variant of papillary thyroid carcinoma. The patient underwent thyroidectomy and sustained radiation therapy for her bilateral renal metastases. She died 6 years after her initial diagnosis, due to sepsis. This is the second study in literature to report bilateral renal metastasis of follicular variant of papillary thyroid cancer.
Help-Seeking Among Pregnant and Postpartum Women With Lifetime Experiences of Opioid Use Disorder and Intimate Partner Violence
Authors: Hill Amber L. , Keil Meghan A. , Chang Judy C. , Krans Elizabeth E. , Kim Esther , Nostrand Elizabeth Van , Miller Elizabeth , Pallatino Chelsea
Published: November 2022

We performed content analysis using a qualitative descriptive approach of 15 semistructured interviews with pregnant and postpartum women who have experienced opioid use disorder (OUD) and intimate partner violence (IPV) regarding their experiences seeking help with both issues. Participants described that their partners impacted their ability to seek OUD care; seeking help for OUD and IPV was siloed; they felt more comfortable disclosing OUD than IPV; they perceived pregnancy as a barrier and facilitator to OUD care; and they wished for integrated services. Pregnant and postpartum women experiencing OUD and IPV acknowledged these phenomena intersect and identified a need for more comprehensive services.
Microscope-assisted pneumatic retinopexy for the management of primary rhegmatogenous retinal detachment
Authors: Besozzi Gianluca , Montericcio Alessio , Costa Maria Carmela , Nitti Giuseppe , Parolini Barbara , Giancipoli Ermete , Greggio Angelo , Tozzi Luigi , Gius Irene , Frisina Rino
Published: November 2022

Purpose

Outcomes of pneumatic retinopexy (PnR) using surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted pneumatic retinopexy) for primary rhegmatogenous retinal detachment (RRD)

Methods

Retrospective study. 43 consecutive eyes with RRD undergoing microscope-assisted PnR surgery (MAPR) were analysed. Inclusion criteria comprehend phakic eyes with single retinal break or a group of breaks in detached retina in the same quadrant above 8- and 4-o’clock meridians. Follow-up was at least 6 months.

Results

Of the 43 eyes, a total of 25 (58%) presented preoperatively a single retinal break, 15 (35%) had two retinal breaks in the same quadrant and 3 (7%) presented three or more retinal breaks in the same quadrant. Other retinal breaks not observed preoperatively were discovered intraoperatively in 12 eyes (28%). In 9 (21%) the missed retinal breaks were in the same quadrant as the main diagnosed break(s), while 3 (7%) had missed retinal breaks in a different one. These 3 eyes as no longer adhering to the PnR indication criteria switched intraoperatively to other surgical procedures and were excluded in the reattachment rate results. The total primary reattachment rate with MAPR was achieved in 37 eyes (92.5%). No significant BCVA changes were observed postoperatively.

Conclusion

MAPR is an effective and safe surgical option, it allows to work with both hands free and provides an adequate visualization of the retina during the procedure minimizing the risk of missed retinal breaks potentially leading to surgical failure.
Impairments in Emotion Recognition and Positive Emotion Regulation Predict Social Difficulties in Adolescent With ADHD
Authors: McKay Erin , Cornish Kim , Kirk Hannah
Published: November 2022

Background

Emotional dysregulation, poor emotion recognition and impaired response inhibition have been highlighted as potential contributors to social difficulties in adolescents with attention-deficit/hyperactivity disorder (ADHD). It is currently unknown how these areas of impairment relate to one another; therefore, this study aims to identify the areas of emotion regulation which are associated with social difficulties in adolescents with ADHD, and determine whether emotion regulation mediates the relationship between deficits in response inhibition and emotion recognition, and social functioning, in this cohort.

Methods

Thirty Australian adolescents (Male = 21) with ADHD completed measures of response inhibition, emotion recognition, and emotion regulation.

Results

Positive emotion regulation was significantly associated with social difficulties. Although emotion recognition significantly predicted social difficulties, there was no relationship between emotion recognition and emotion regulation in this sample, ruling out emotion regulation as a mediator of emotion recognition and social difficulties. Whilst response inhibition was significantly correlated with positive emotion regulation, positive emotion regulation did not mediate the relationship between response inhibition and social difficulties.

Conclusions

Difficulties recognising and regulating emotions appear to independently contribute to social difficulties in adolescents with ADHD. Interventions to increase emotional understanding and developing strategies to down-regulate positive emotions may be beneficial.
Dynamic numerical prediction of plasticity and damage in a turbofan blade containment test
Authors: Sepúlveda Héctor , Valle Rodrigo , Pincheira Gonzalo , Prasad Chandra Shekhar , Salas Alexis , Medina Carlos , Tuninetti Víctor
Published: November 2022

For the light designs of new aircraft engines, constitutive plasticity and fracture models sensitive to strain rate and temperature are essential for the accurate prediction of deformations and internal stresses of the components during simulations of impact and explosion events. The work described in this article consists of the development and numerical analysis by finite elements of the blade containment test of a commercial aircraft turbofan engine, conducted to evaluate the structural integrity of the casing after being impacted by a detached fan blade. Two simulation models of the test are proposed, in which the resistance behavior of the strain rate-dependent material is described by isotropic laws of strain hardening and Johnson–Cook damage. The strength analysis is based on the numerical field results of equivalent stresses and deformations, along with the internal damage rates of the casing. The first simplified model considers half of the casing impacted by a blade at different speeds and angles of impact. The second model consists of a complete discretization of casing and rotating turbofan, with the initial detached condition of a blade simulated at different rotating speeds of the fan. The material used in this study is the Ti-6Al-4V alloy. The results analysis and advances obtained make it possible to approach an efficient computational tool with more accurate calculations to study a casing redesign with a safe reduction in mass and that fulfills the certification requirements using the blade containment test.
Navigating Multiple Approaches to Qualitative Research in HRD
Authors: Zarestky Jill
Published: November 2022

Qualitative research can be used to accomplish a variety of purposes for HRD scholarship, particularly when researchers wish to deeply understand the perspectives and experiences of individuals or groups of people. Given the infinite variety of research aims, there are necessarily multiple approaches to qualitative research. Because many qualitative research methods employ similar data collection strategies, such as interviews and observations, and outputs may appear similar (e.g. a collection of interrelated themes), the important differences among qualitative approaches can become muddy or lost. Making choices about approach, building an appropriate, corresponding design, and describing methods is an ongoing challenge for qualitative researchers in HRD and beyond. This article provides an accessible overview and comparison of select qualitative approaches in HRD, both traditional and emerging, to clarify decision-making in research design, guide methodological alignment, and explore the distinct contribution each approach can make for developing theory and practice in HRD.
Yield of Sleep Deprivation EEG in Suspected Epilepsy. A Retrospective Study
Authors: Guerrero-Aranda Alioth , Enríquez-Zaragoza Andrea , López-Jiménez Karla , González-Garrido Andrés Antonio
Published: November 2022

Background. Sleep is an activation procedure and is considered the most potent and best-documented modulator of seizures and interictal epileptiform discharges (IEDs) on electroencephalogram (EEG). The precise role of sleep deprivation in the diagnostic process of epilepsy has not been fully clarified after more than 50 years of use. Sleep deprivation is a procedure that is accompanied by discomfort for patients and their families. Therefore, an accurate indication according to each patient-specific characteristic is needed. This study aims to assess the effectiveness of sleep deprivation EEG in the diagnostic process of patients with suspected epilepsy in our center. Methods. We included patients with a first unprovoked seizure and patients with paroxysmal events suspecting seizures who underwent a sleep deprivation EEG (sdEEG) or routine EEG (rEEG). All patients were subsequently classified with confirmed epilepsy or not. Results. We included 460 patients. The group with sdEEG consisted of 115 patients, while the group with rEEG comprised 345 patients. In the sdEEG group, 19 patients (17%) were confirmed with epilepsy, of which 17 presented interictal epileptiform discharges (IEDs). For the rEEG group, 66 patients (19%) were confirmed with epilepsy, of which 63 presented IEDs. The difference was not statistically significant. Conclusion. Our study failed to find a difference in the yield of sleep deprivation versus routine EEG in patients with epilepsy, but there are many significant confounders/sample biases that limit the generalizability of the findings, particularly to the majority of adult practices.
Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker
Authors: Yuksel Ahmet , Velioglu Yusuf , Korkmaz Ufuk Turan Kursat , Deser Serkan Burc , Topal Dursun , Badem Serdar , Taner Temmuz , Ucaroglu Erhan Renan , Kahraman Nail , Demir Deniz
Published: November 2022

Objective

To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA).

Methods

A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group ( n = 23) and favorable outcome group ( n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates.

Results

A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004–1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64–0.851).

Conclusions

Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.