bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Genotype 1a and 1f of Hepatitis E Virus in Patients Treated at Tertiary Care Hospitals in Central India
Authors: Pathak  Ruchi , Barde Pradip V.
Published: March 2018

Background and Aims: An acute hepatitis, caused by hepatitis E virus (HEV), is a significant global health concern, especially in developing countries. HEV has 1 serotype and 8 genotypes, which are further divided into subtypes. Despite the availability of sporadic cases and outbreak data from India, specific information regarding HEV epidemiological data is lacking from central India. This study was conducted to understand epidemiological and molecular features of HEV in central India. Methods: In this 3-year study conducted from July 2012 to June 2015, IgM ELISA was used for the diagnosis of suspected HEV cases. For identifying the genotype, nRT PCR was conducted and the PCR products were sequenced and analysed. Clinical and demographic data were analysed using statistical tools to highlight the trends. Result: Out of 1,369 suspected cases, 341 (24.9%) were positive for HEV. The positivity was significantly higher in males (69.2%) and in the age group of > 15–45 years (72.5%). The HEV cases peaked during the summer. Subtypes 1a and 1f of genotype 1 were detected in the area during the study period. Conclusion: HEV is a major aetiological agent of viral hepatitis in central India with adults and males at higher risk of infection. Two subtypes of the virus were detected in the region. Continuous serological surveillance and molecular monitoring will help to understand the epidemiology of HEV infection, outbreak mitigation and aid in providing treatment.
Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus
Authors: Sasaki Takanori , Ide Takeshi , Toda Ikuko , Kato Naoko
Published: March 2018

We report a case of corneal melting through sterile infiltration presumably due to excessive use of nonsteroidal anti-inflammatory eye drops after corneal crosslinking (CXL). It was treated using steroids combined with amniotic membrane transplantation (AMT). A 33-year-old man with progressing keratoconus underwent left eye CXL. We prescribed betamethasone and levofloxacin eye drops 5 times daily and diclofenac sodium eye drops 3 times daily for 3 days. Three days after CXL, there was a persistent epithelial defect and the left corneal stroma was clouded. His visual acuity remained unchanged. We prescribed betamethasone hourly and 20 mg prednisolone daily. At 1 week after CXL, the corneal epithelial defect and infiltration were unchanged. He had not stopped using diclofenac at the prescribed time. On day 17, we performed AMT and his cornea and visual acuity improved. AMT may be effective against persistent epithelial defects and corneal melting after CXL.
Posterior Wall Collapse in High Myopia following Cataract Surgery
Authors: Deitz Galia A. , Sweeney Adam R. , Jung Hoon C.
Published: March 2018

Purpose: We report a case of posterior globe collapse of an eye after initial recovery from uncomplicated cataract surgery in a patient with high myopia and discuss the course of management involving recognition and emergent air injection with globe reformation. Case Report: A 64-year-old functionally monocular male with a history of high myopia presented for follow-up after uncomplicated cataract surgery. Uncorrected distance visual acuity (UCDVA) at postoperative day 1 was 20/150 with an intraocular pressure (IOP) of 19 mm Hg. At the week 1 visit, UCDVA had decreased to 20/200 with an IOP at 9 mm Hg. After preliminary exam, the keratome site suture was removed, after which the patient reported vision changes. A dilated fundus exam was performed revealing posterior scleral wall collapse. A clinical diagnosis of hypotony was made and a pars plana injection of 1 mL air was performed. This resulted in immediate subjective improvement of vision. Exam the next day revealed UCDVA 20/50 with pinhole improvement to 20/30 and IOP 15 mm Hg. Conclusion: This case demonstrates postoperative hypotony in a patient with pathologic myopia, following cataract surgery. Pathologically myopic eyes may have greater propensity to collapse in the setting of reduced IOP.
One-Year Outcome of Aflibercept and Photodynamic Therapy in a Caucasian Patient with Polypoidal Choroidal Vasculopathy Refractory to Ranibizumab and Photodynamic Therapy
Authors: Medina-Baena Marta , Huertos-Carrillo María Jesús , Rodríguez Laura , García-Pulido Juan Ignacio , Cornejo-Castillo Carlos , Calandria-Amiguetti José María
Published: March 2018

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration characterised by an abnormal branching vascular network with aneurysmal polypoidal choroidal vascular lesions. PCV is more prevalent in Asian populations than in Caucasians, which may explain its underdiagnosis in Western countries. Evidence regarding the efficacy of different anti-vascular endothelial growth factor (anti-VEGF) agents on PCV is scarce, with most of these studies being conducted in Asian treatment-naïve patients. Ranibizumab was the first anti-VEGF agent to demonstrate the superiority of a combination of photodynamic therapy (PDT) and anti-VEGF over PDT or anti-VEGF monotherapy for inducing polyp regression in Asian patients with PCV. The efficacy of other anti-VEGF agents has been less studied. Resistance to ranibizumab has been described. Aflibercept offers another mechanism of targeting choroidal neovascular lesions. A 75-year-old Caucasian woman presenting to our office was diagnosed with PCV using indocyanine green angiography. Combination therapy with a loading dose of 0.5 mg intravitreal ranibizumab followed by PDT at standard fluence at month 4 and a fourth dose of ranibizumab at month 5 yielded no visual or anatomic outcomes. Treatment was switched to intravitreal aflibercept at month 6 (3 monthly loading doses of 2.0 mg) followed by half-fluence PDT (month 9). Optical coherence tomography revealed remission of the anatomic lesions. Right-eye visual acuity increased to 0.6. Aflibercept injections were administered bimonthly afterwards. Follow-up during 1 year has shown functional and anatomic stability.
A 58-Year-Old Woman with Left-Sided Weakness and a History of a Pediatric Brain Tumor: A Case Report
Authors: Hasan Shaakir , Gigliotti Michael J. , Deutsch Melvin , Reed Stacey L. , Wegner Rodney E.
Published: March 2018

Background: An uncommon but well-established complication of cranial irradiation is secondary neoplasm. This case presentation documents a radiation-induced malignant glioma 55 years after being diagnosed with “cerebral sarcoma,” now defined as atypical meningioma. This not only represents the longest reported latency period for a patient initially receiving over 30 Gy, but also provides a valuable historical perspective of neuro-oncology. Clinical Presentation: A 58-year-old female presenting with progressive left-sided upper and lower extremity weakness with a past medical history significant for “cerebral sarcoma” was diagnosed with glioblastoma multiforme. This patient had previously been treated with resection and adjuvant radiation therapy via a 280-kVP orthovoltage machine and received 3,390 rad to the posterior three-quarters of the skull for “cerebral sarcoma.” Conclusion: A comprehensive investigation of the past medical history helped uncover a mysterious pediatric diagnosis, helped drive the management 5 decades later, and serves as a reminder that seemingly safe interventions may still cause harm.
Endocardial Cell Plasticity in Cardiac Development, Diseases and Regeneration
Authors: Zhang Hui , Lui Kathy O. , Zhou Bin
Published: March 2018

Endocardial cells are specialized endothelial cells that form the innermost layer of the heart wall. By virtue of genetic lineage–tracing technology, many of the unexpected roles of endocardium during murine heart development, diseases, and regeneration have been identified recently. In addition to heart valves developed from the well-known endothelial to mesenchymal transition, recent fate-mapping studies using mouse models reveal that multiple cardiac cell lineages are also originated from the endocardium. This review focuses on a variety of different cell types that are recently reported to be endocardium derived during murine heart development, diseases, and regeneration. These multiple cell fates underpin the unprecedented roles of endocardial progenitors in function, pathological progression, and regeneration of the heart. Because emerging studies suggest that developmental mechanisms can be redeployed and recapitulated in promoting heart disease development and also cardiac repair and regeneration, understanding the mechanistic regulation of endocardial plasticity and modulation of their cell fate conversion may uncover new therapeutic potential in facilitating heart regeneration.
The Networked Sensory Landscape: Capturing and Experiencing Ecological Change Across Scales
Authors: Mayton Brian , Dublon Gershon , Russell Spencer , Lynch Evan F. , Haddad Don Derek , Ramasubramanian Vasant , Duhart Clement , Davenport Glorianna , Paradiso Joseph A.
Published: March 2018

What role will ubiquitous sensing play in our understanding and experience of ecology in the future? What opportunities are created by weaving a continuously sampling, geographically dense web of sensors into the natural environment, from the ground up? In this article, we explore these questions holistically, and present our work on an environmental sensor network designed to support a diverse array of applications, interpretations, and artistic expressions, from primary ecological research to musical composition. Over the past four years, we have been incorporating our ubiquitous sensing framework into the design and implementation of a large-scale wetland restoration, creating a broad canvas for creative exploration at the landscape scale. The projects we present here span the development and wide deployment of custom sensor node hardware, novel web services for providing real-time sensor data to end user applications, public-facing user interfaces for open-ended exploration of the data, as well as more radical UI modalities, through unmanned aerial vehicles, virtual and augmented reality, and wearable devices for sensory augmentation. From this work, we distill the Networked Sensory Landscape, a vision for the intersection of ubiquitous computing and environmental restoration. Sensor network technologies and novel approaches to interaction promise to reshape presence, opening up sensorial connections to ecological processes across spatial and temporal scales.
FPAA-Based Control of Bilateral Teleoperation Systems for Enhanced User Task Performance
Authors: Yang Ting , Hu Junfeng , Geng Wei , Fu Yili , Tavakoli Mahdi
Published: March 2018

In a bilateral teleoperation system, discrete-time implementation of the controller can cause performance degradation. This is due to a well-known stability-imposed upper bound on the product of the discrete-time controller's gain and the sampling period. In this article, for a bilateral teleoperation system, a continuous-time controller based on a Field Programmable Analog Array (FPAA) is deployed and compared in terms of performance with its discrete-time counterpart. Experimental results show that, unlike the discrete-time controller, the FPAA-based controller helps the human user complete teleoperation tasks that require high controller gains such as when a large impedance needs to be displayed against the user's hand. Also, an experimental object stiffness discrimination study shows that large sampling periods, necessitating low control gains for maintaining stability, lead to unacceptable task performance by the user; however, the users show an improved ability to discriminate the various objects if the teleoperation controller is implemented using an FPAA.
Notomicrus petrareptans sp. n., a new seep-dwelling species of Noteridae
from Suriname (Coleoptera: Adephaga)
Authors: BACA STEPHEN M. , SHORT ANDREW EDWARD Z.
Published: March 2018

Notomicrus petrareptans sp. n. is described from an inselberg seepage in southwestern Suriname. This species is diagnosable by a combination of its weakly punctate elytra, respective shapes of the pro- and mesotarsal claws (males), and long and slender median lobe of the aedeagus. This is the first member of the subfamily Notomicrinae to be described from hygropetric seep habitats and only the second known seep-dwelling species of the family Noteridae. Diagnostic characters are illustrated and habitat images are provided.
Radiative Invigoration of Tropical Convection by Preceding Cirrus Clouds
Authors: Masunaga Hirohiko , Bony Sandrine
Published: March 2018

This work seeks evidence for convective–radiative interactions in satellite measurements, with a focus on the variability over the life cycle of tropical convection in search of the underlying processes at a fundamental level of the convective dynamics. To this end, the vertical profiles of cloud cover and radiative heating from the CloudSat–CALIPSO products are sorted into a composite time series around the hour of convective occurrence identified by the TRMM PR. The findings are summarized as follows. Cirrus cloud cover begins to increase, accompanied by a notable reduction of longwave cooling, in moist atmospheres even 1–2 days before deep convection is invigorated. In contrast, longwave cooling stays efficient and clouds remain shallow where the ambient air is very dry. To separate the radiative effects by the preceding cirrus clouds on convection from the direct effects of moisture, the observations with enhanced cirrus cover are isolated from those with suppressed cirrus under a moisture environment being nearly equal. It is found that rain rate is distinctly higher if the upper troposphere is cloudier regardless of moisture, suggesting that the cirrus radiative effects may be linked with the subsequent growth of convection. A possible mechanism to support this observational implication is discussed using a simple conceptual model. The model suggests that the preceding cirrus clouds could radiatively promote the moistening with the aid of the congestus-mode dynamics within a short period of time (about 2 days) as observed.
Laboratory Measurements of Heat Transfer and Drag Coefficients at Extremely High Wind Speeds
Authors: Komori Satoru , Iwano Koji , Takagaki Naohisa , Onishi Ryo , Kurose Ryoichi , Takahashi Keiko , Suzuki Naoya
Published: March 2018

Heat and momentum transfer across the wind-driven breaking air–water interface at extremely high wind speeds was experimentally investigated using a high-speed wind-wave tank. An original multi-heat-balance method was utilized to directly measure latent and sensible heat transfer coefficients. The results show that both heat transfer coefficients level off at low and normal wind speeds but increase sharply at extremely high wind speeds. The coefficients have a similar shape for wind speeds at a height of 10 m. Therefore, the wind speed dependence on the latent and sensible heat transfer coefficients can be represented by that of the enthalpy coefficient even in the extremely high-speed region. To show how significantly the drag and enthalpy coefficients affect the intensity of tropical cyclones, the coefficients were applied to Emanuel’s analytic model. The analytic model shows that the difference between the present laboratory and conventional correlations significantly affects the maximum storm intensity predictions, and the present laboratory enthalpy and drag coefficients have the remarkable effect on intensity promotion at extremely high wind speeds. In addition, the simulations of strong tropical cyclones using the Weather Research and Forecasting (WRF) Model with the present and conventional correlations are shown for reference in the appendix. The results obtained from the models suggest that it is of great importance to propose more reliable correlations, verified not only by laboratory but also by field experiments at extremely high wind speeds.
Access to health professionals by children and adolescents with mental disorders: Are we meeting their needs?
Authors: Sawyer Michael G , Reece Christy E , Sawyer Alyssa CP , Johnson Sarah E , Hiscock Harriet , Lawrence David
Published: March 2018

Objective:

To identify the percentage of 4–17 year olds with mental disorders in Australia who attended health professionals for single or repeat visits to get help for emotional and behavioural problems during a 12-month period. To identify factors associated with single and repeat visits, and the average length of time between visits. To compare the number of parent-reported visits with visits recorded in the Medicare Benefits Schedule.

Method:

The study used data from the national survey of the mental health and wellbeing of 4–17 year olds conducted in 2013–2014 ( n = 6310). Participants were randomly selected from all 4 to 17 year olds in Australia. Information about visits was available from face-to-face interviews with parents, the Medicare Benefits Schedule and self-reports from 13 to 17 year olds. Mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV completed by parents.

Results:

Parents reported that 51.1% of 4–17 year olds with mental disorders had attended a health professional during the previous 12 months. However, 13.6% of these children had attended on only a single occasion, most commonly with a general practitioner. With the exception of occupational therapists, 2–4 visits was the most common number of repeat visits. Children with comorbid disorders and severe functional impairment and those aged 12–17 years were more likely to have repeat visits. Among those with linked Medicare Benefits Schedule data, more children were reported by parents to have attended Medicare Benefits Schedule-funded health professionals (47.9%) than were recorded in Medicare Benefits Schedule data (38.0%).

Conclusion:

The typical number of visits to health professionals by children with mental disorders during a 12-month period is relatively small. Furthermore, parent-reports may overestimate the number of visits during this time. It seems unlikely that current patterns of attendance are of sufficient duration and frequency to allow full implementation of evidence-based treatment programmes for child and adolescent mental disorders.
Structural and physico-mechanical properties of natural rubber/GTR composites devulcanized by microwaves: Influence of GTR source and irradiation time
Authors: Colom Xavier , Marín-Genescà Marc , Mujal Ramon , Formela Krzysztof , Cañavate Javier
Published: March 2018

Ground tire rubber from car and truck was modified using microwave irradiation at variable time. The irradiated ground tire rubber was used as filler in composites based on natural rubber. The composites, with high content of ground tire rubber, were prepared using an internal batch mixer and subsequently cross-linked at 160℃. The influence of the ground tire rubber source (car/truck) and irradiation time on structure, physico-mechanical behaviour, thermal properties and morphology of natural rubber/ground tire rubber composites was studied. The interfacial interactions between ground tire rubber and natural rubber as function of ground tire rubber source and irradiation time were evaluated by Fourier transform infrared spectroscopy, thermogravimetric analysis, tensile tests, swelling measurements and scanning electron microscopy. The results showed that irradiation of ground tire rubber slightly enhanced tensile properties and cross-link density of natural rubber/ground tire rubber composites. This effect was more evident in the case of ground tire rubbertruck because of its higher content of natural rubber and was reflected in changes in the interfacial adhesion, which were confirmed by the results of Fourier transform infrared spectroscopy, thermogravimetric analysis and scanning electron microscopy analysis.
Turkey’s governance of irregular migration at European Union borders: Emerging geographies of care and control
Authors: İşleyen Beste
Published: March 2018

Combining insights from critical studies on humanitarianism and scholarly work emphasising everyday practices, this study examines Turkish policing of human mobility at European Union borders in two border cities: Edirne and İzmir. Through a focus on the central understandings, justifications and operational responses by Turkish border officials, the article highlights the intertwinement of care and control as inherent to humanitarianism in the daily governance of mobile populations at Turkey’s western borders. In so doing, the findings draw attention to discursive articulations and practices, while pointing to their moral, emotional and cultural elements. The article advances the literature by underlining the centrality of geography in impacting on the logics and practices of governing mobility within the territory of the nation state. The findings also underscore variations in border practices and the embodiment of humanitarianism between the two border cities under investigation as well as across the country. In addition, the article adds to debates on the emerging spaces of humanitarianism by bringing into focus the operation of humanitarian border policing in Turkey before departure and/or after the unsuccessful attempt of border crossing.
Visual Occlusion Decreases Motion Sickness in a Flight Simulator
Authors: Ishak Shaziela , Bubka Andrea , Bonato Frederick
Published: March 2018

Sensory conflict theories of motion sickness (MS) assert that symptoms may result when incoming sensory inputs (e.g., visual and vestibular) contradict each other. Logic suggests that attenuating input from one sense may reduce conflict and hence lessen MS symptoms. In the current study, it was hypothesized that attenuating visual input by blocking light entering the eye would reduce MS symptoms in a motion provocative environment. Participants sat inside an aircraft cockpit mounted onto a motion platform that simultaneously pitched, rolled, and heaved in two conditions. In the occluded condition, participants wore “blackout” goggles and closed their eyes to block light. In the control condition, participants opened their eyes and had full view of the cockpit’s interior. Participants completed separate Simulator Sickness Questionnaires before and after each condition. The posttreatment total Simulator Sickness Questionnaires and subscores for nausea, oculomotor, and disorientation in the control condition were significantly higher than those in the occluded condition. These results suggest that under some conditions attenuating visual input may delay the onset of MS or weaken the severity of symptoms. Eliminating visual input may reduce visual/nonvisual sensory conflict by weakening the influence of the visual channel, which is consistent with the sensory conflict theory of MS.
Integrated Care for Depression in Older Primary Care Patients
Authors: Bruce Martha L. , Sirey Jo Anne
Published: March 2018

For decades, depression in older adults was overlooked and not treated. Most treatment was by primary care providers and typically poorly managed. Recent interventions that integrate mental health services into primary care have increased the number of patients who are treated for depression and the quality of that treatment. The most effective models involve systematic depression screening and monitoring, multidisciplinary teams that include primary care providers and mental health specialists, a depression care manager to work directly with patients over time and the use of guideline-based depression treatment. The article reviews the challenges and opportunities for providing high-quality depression treatment in primary care; describes the 3 major integrated care interventions, PRISM-E, IMPACT, and PROSPECT; reviews the evidence of their effectiveness, and adaptations of the model for other conditions and settings; and explores strategies to increase their scalability into real world practice.
Enhanced Vancomycin Elimination in an Infant Following an Unsuccessful Gastroschisis Repair Surgery
Authors: Prunty Leesa , Miskell David
Published: March 2018

Objective:

To report the case of an infant who required high-dose vancomycin therapy after an unsuccessful gastroschisis repair surgery.

Case Summary:

An infant born at 35 weeks and 5 days of gestation underwent a gastroschisis repair on day of life 47. The repair was unsuccessful causing fluid backup and accumulation into the stomach. A replogle was placed to allow for suctioning of this fluid. During this admission, the patient received 3 courses of vancomycin. During the first course, the patient had minimal output via the replogle tube. On the infant’s second and third courses of vancomycin, the infant necessitated vancomycin dosing above that of the neonatal protocol, and subsequent levels were still found to be below goal. Vancomycin was increased to a maximum of 15 mg/kg every 4 hours (90 mg/kg/d) in order to achieve serum trough levels greater than 10 mg/L. Residuals were drawn from the replogle ranging from 0.76 to 4.33 mL/kg/h during the second and third course of vancomycin.

Discussion:

A premature male infant required up to 90 mg/kg/d of vancomycin to achieve trough levels above 10 mg/L after an unsuccessful gastroschisis repair surgery and gastric suctioning.

Conclusion:

Clinicians should be aware of the possibility for decreased vancomycin levels and the potential need for increased monitoring in postsurgical infants receiving gastric suctioning.
Instructor approaches to creativity in engineering design education
Authors: Tekmen-Araci Yasemin , Mann Llewellyn
Published: March 2018

Creativity is essential in the engineering design process. Researchers, academics, educators, and engineering organisations all agree that further improvement is necessary in training methods for fostering creativity in engineering education. Even though studies exist about how creativity should be taught in engineering education, there is still limited research about the challenges of practical implementation. To address this gap, an action research project has been conducted in two undergraduate Mechanical Engineering design subjects at a prominent university in Australia with the aim of enhancing creativity during the problem-solving process. The study shows the many challenges that arose when enhancing creativity in engineering design education, and the issues that surrounded this implementation. Although teaching creativity to engineering students is a challenge, this study illuminates the difficulties of convincing the engineering instructors to embed creativity in the subjects they teach. Overall, the study found that instructors' understandings and beliefs about creativity influence their teaching approach and what they value. These influences were around four main areas: the instructors' focus on the design product being produced, their educational backgrounds and training, the subjective nature of creativity and their beliefs about it, and the performance mindset of the instructors. These findings suggest that enhancing creativity among engineering students is not possible until the engineering educators and practitioners understand and value creativity practice.
Study on the stiffness property of a variable stiffness joint using a leaf spring
Authors: Fang Lijin , Wang Yan
Published: March 2018

Variable stiffness joints designed to ensure physical safety or adjust stiffness actively have attracted much attention in recent years. Springs are used in the internal kinematic structures of variable stiffness joints to achieve the compliance. In this paper, the stiffness property of a variable stiffness joint using a leaf spring is studied on the basis of geometric nonlinearity associated with large deflections of leaf springs. A new end structure is used in the variable stiffness joint to exert the external force on the leaf spring. Based on the elliptic integral solution to large deflection problems of cantilever beams, the effects of different end exertion force structures and geometric nonlinearity of leaf springs on the stiffness property are analyzed when the deflected angle of the joint is larger. It is found that the end exertion force structure and large deflection of leaf springs have a great impact on the changes of the joint stiffness during the joint deflection. A new variable stiffness joint using two leaf springs is proposed to meet different application requirements by changing the end exertion force structure. The experiment of the proposed joint is carried out to verify the validity of the stiffness analysis results.
Variable pitch spring for nonlinear energy sink: Application to passive vibration control
Authors: Qiu Donghai , Paredes Manuel , Seguy Sébastien
Published: March 2018

This paper aims to propose a generalized methodology for designing a novel nonlinear energy sink with variable pitch springs. To this end, a generic model of the nonlinear energy sink system providing the nonlinearity of pure cubic stiffness is introduced. Key features of the model include: (i) specifically sizing two variable pitch springs to provide the force polynomial components with only linear and cubic terms; (ii) pre-compressing two springs at the transition point to produce smooth nonlinear force characteristics; (iii) adding a negative stiffness mechanism to counterbalance the linear term. To generate the variable pitch spring, design parametrization is implemented. The type of shape and the pitch distribution adopted for the spring are shown to fit the objective force–displacement function well. To validate the concept, a special sized nonlinear energy sink system is developed. Identification of the force–displacement relation and experiments for the whole system embedded on an electrodynamic shaker are studied. The results show that this nonlinear energy sink can not only output the anticipated nonlinearity, but can also produce energy pumping to protect the primary system in a large band of frequencies, thus making it practical for the application of passive vibration control.
Prognostic Value and Changes of Auditory Brain Stem Response in Children With Bacterial Meningitis in Luanda, Angola
Authors: Karppinen Mariia , Sjövall Atte , Pelkonen Tuula , Bernardino Luis , Roine Irmeli , Pitkäranta Anne , Aarnisalo Antti A , Nevalainen Päivi , Lauronen Leena
Published: March 2018

Objective:

To assess the role of single and repeated auditory brain stem response (ABR) in predicting mortality and severe neurological injury among children having bacterial meningitis (BM) in Luanda, Angola.

Methods:

The morphology of ABR traces of 221 children (aged 2 months to 12 years) from admission day was analyzed and compared with age-matched normative data. Absence and delay of traces were compared with mortality and mortality or severe neurological injury in subgroup analyses. Outcome was also evaluated with repeated ABR of 166 children based on presence or absence of responses at 80 dB nHL (normal hearing level) stimulation level.

Results:

Individually, the absence of typical ABR waveform did not signify poor outcome. At the group level, latencies and interpeak latencies (IPLs) were significantly prolonged among patients with BM in comparison with controls, and the prolongation correlated with higher mortality or severe neurological sequelae.

Conclusions:

We confirmed the effect of BM on neural conduction time in auditory pathway. However, ABR in similar settings seems not useful for individual prognostication, although at the group level, delayed latencies, IPLs, or both associated with poorer outcome.
The Uses of Terror and the Limits of Cultural Studies
Authors: Frow John
Published: March 2018

The plot of the event of September 11 — the destruction of the twin towers of the World Trade Center by terrorists — might have been written by Hollywood, or by Baudrillard. So fantasmatic, so familiar was the scenario that it fitted seamlessly into the manichaean agenda of the Pentagon hawks planning the next American war, and the next. Indeed, a perfectly plausible paranoid response reads this plot as a plot on the part of those who have most thoroughly benefited from it. How do we take fantasms seriously when they come true?
Evaluation systems in local eldercare governance
Authors: Hanberger Anders , Lindgren Lena
Published: March 2018

This article explores how three evaluation systems in eldercare governance, two national and one local, operate and interact at the municipal, administrative, and service levels in a Swedish municipality. The case study focuses on the three systems’ contributions to accountability and to improving eldercare quality. It is based on multiple sources, including 28 interviews with local key actors involved in local eldercare governance, and the results derive from a directed content analysis guided by four research questions.

Findings

The study demonstrates that the three evaluation systems support accountability and quality improvement in different ways and have different consequences for local actors. The systems create multiple accountability problems and have multiple constitutive effects, for example, creating different notions of what quality in eldercare means. The systems’ contributions to improving eldercare quality differed: the net effect of the two national systems was negative, whereas the local system has helped improve eldercare quality without any identified negative effects so far.

Applications

The article broadens our theoretical understanding and knowledge of regulatory mechanisms in eldercare governance. It has significance for eldercare policy by finding that policymakers and service providers must be aware of and manage multiple evaluation systems and accountability problems. Its implication for eldercare practice is that local actors must build evaluation capacity to manage existing evaluation systems in order to improve their own practices.
Visual methods and voice in disabled childhoods research: troubling narrative authenticity
Authors: McLaughlin Janice , Coleman-Fountain Edmund
Published: March 2018

Visual methods are a popular way of engaging children and young people in research. Their growth comes out of a desire to make research practice more appropriate and meaningful to them. The auteur approach emphasises the need to explore with young participants why they produce the images they do, so that adult researchers do not impose their own readings. This article, while recognising the value of such visual techniques, argues that their benefit is not that they are more age appropriate, or that they are more authentic. Instead it lies in their capacity to display the social influences on how participants, of any age, represent themselves. The article does so through discussion of an Economic and Social Research Council research project, which made use of visual and other creative methods, undertaken in the UK with disabled young people. The research involved narrative and photo elicitation interviews, the production of photo journals, and creative practice workshops aimed at making representational artefacts. Through analysing the photography, the journals and interviews the article examines what it was research participants sought to capture and also what influenced the types of photographs they gathered and the type of person they wanted to represent. We argue that they aimed to counter negative representations of disability by presenting themselves as happy, active and independent, in doing so they drew from broader visual iconography that values certain kinds of disabled subject, while disvaluing others.
Measuring the effects of Coulomb repulsion via signal decay in an atmospheric pressure laser ionization ion mobility spectrometer
Authors: Ihlenborg Marvin , Schuster Ann-Kathrin , Grotemeyer Jürgen , Gunzer Frank
Published: March 2018

Using lasers in ion mobility spectrometry offers a lot of advantages compared to standard ionization sources. Especially, the ion yield can be drastically increased. It can, however, reach levels where the Coulomb repulsion leads to unwanted side effects. Here, we investigate how the Coulomb repulsion can be detected apart from the typical signal broadening by measuring effects created already in the reaction region and comparing them with corresponding finite element method simulations.
Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients
Authors: Malm Dan , Fridlund Bengt , Ekblad Helena , Karlström Patric , Hag Emma , Pakpour Amir H
Published: March 2018

Background:

The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation.

Methods:

A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT ( n=56) or a treatment as usual (TAU) group ( n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13).

Results:

At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence ( z=2.07, P=0.04).

Conclusions:

A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients.
In Other Spaces: Contestations of National Identity in “New” India’s Globalized Mediascapes
Authors: Goel Koeli Moitra
Published: March 2018

The sense of a nation as a cohesive entity bound by a distinct language, culture, and traditions has been increasingly challenged in the age of globalization. Any discussion of national identity unfolds on a ground which is complicated and fluid. It is often defined by mass migrations across volatile regions and immigration debates within most organized societies, and also contingent upon unforeseen roles played by social media in crucial fields of politics, democratic participation, and communication. India’s national identity has undergone a drastic transformation in the era of globalization and media proliferation. This monograph examines conspicuous spaces and moments of material and digital life in the National Capital Region to understand the underlying momentum for the metaphorical construction of a “New India” and to provide an analytical framework for political and cultural transactions that have defined the nation’s journey toward a new identity and national imagination. Drawing from ethnographic fieldwork in India, print and new media analysis, and archival research, I examine globalization’s uneven effects and how global culture has often destabilized, but numerously reinforced, various power structures within the nation.
Patient Experience of Recovery After Major Leg Amputation for Arterial Disease
Authors: Columbo Jesse A. , Davies Louise , Kang Ravinder , Barnes J. Aaron , Leinweber Kathleen A. , Suckow Bjoern D. , Goodney Philip P. , Stone David H.
Published: March 2018

Objectives:

To date, studies of vascular amputees primarily examine quantitative outcomes following limb loss. Less is known about the patient’s perspective after major lower limb amputation. Here, we define and describe the postamputation recovery period.

Methods:

Qualitative study using purposive, maximum variation sampling on the variables of amputation level and times since surgery. We first conducted structured interviews with 20 participants (median age: 65 years, range: 45-88 years; 85% male; below knee amputation n = 14; above knee amputation n = 6; median time from amputation to interview = 16 months, range: 4-51 months). Findings were validated via a focus group with 5 amputees. Data were coded, analyzed, and interpreted by 2 reviewers.

Results:

All participants expressed the desire to have an active role in the decision to undergo amputation, even while acknowledging that limb salvage options were exhausted. Following amputation, participants described a 6-month recovery period when they learned to modify daily activities to accommodate their new functional and psychological needs. Participants defined recovery as when they had regained functional independence, which was described as a level of mobility that allowed them to perform daily activities with minimal assistance. Concerns that participants felt were poorly addressed included uncontrolled pain, feeling unprepared to live with an amputation, and questions about prosthetics. Two of the 5 focus group participants stated a preference for amputation earlier in the treatment course.

Conclusions:

Postamputation recovery has an early (up to 6 months) and late phase (after 6 months) and concludes when amputees regain what they perceive as independence. Patients desire to participate in amputation decision-making; in this study, some would have preferred amputation earlier in their clinical course. Attention to the domains that impact quality of life, and fostering a shared decision-making process, are opportunities to enhance postamputation recovery.
Non-Small Cell Lung Cancer Invading the Descending Thoracic Aorta: Surgical Resection Without Using Cardiopulmonary Bypass and Without Cross-Clamping the Aorta: Long-Term Follow-Up of 2 Cases
Authors: Honguero-Martínez A. F. , García-Jiménez M. D. , León-Atance P. , Landaluce-Chaves M.
Published: March 2018

Lung cancer can sometimes invade vital adjacent mediastinal structures, such as the descending thoracic aorta. We describe 2 cases where pulmonary resection was performed en bloc including a patch of the descending thoracic aorta. These procedures were easily performed using an aortic endoprosthesis in the same anesthetic procedure. We also comment some aspects about an intraoperative endoleak, postoperative evolution, and long-term follow-up.
Ultrasound diagnosis of molar pregnancy
Authors: Ross Jackie A. , Unipan Alina , Clarke Jackie , Magee Catherine , Johns Jemma
Published: March 2018

Introduction

The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis.

Methods

This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed.

Results

One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery.

Conclusion

Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.
Development and simulation of a passive upper extremity orthosis for amyoplasia
Authors: Jensen Erik F , Raunsbæk Joakim , Lund Jan N , Rahman Tariq , Rasmussen John , Castro Miguel N
Published: March 2018

Introduction

People who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort.

Methods

This study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL.

Results

For a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400 Nm−1 and of 1029 Nm−1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized.

Conclusion

By augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.
Concurrent Chemoradiotherapy or Radiotherapy Alone for Locally Advanced Cervical Cancer in Elderly Women
Authors: Park Jin-hong , Kim Young Seok , Ahn Seung Do , Choi Eun Kyung , Shin Seong Soo , Kim Young-Tak , Kim Yong-Man , Kim Jong-Hyeok , Yi Seong Yoon , Nam Joo-Hyun
Published: March 2018

Aims and background

To evaluate the efficacy and toxicity of concurrent chemoradiotherapy or radiotherapy alone in elderly patients with locally advanced cervical carcinoma (stage IB2-IVA).

Methods and study design

We retrospectively reviewed the medical records of 105 women aged ≥65 years who received radiotherapy (group I, n = 61) or concurrent chemoradiotherapy (group II, n = 44). Patients received a median dose of 76.4 Gy to point A, including 30-35 Gy of high-dose intracavity brachytherapy. The concurrent chemoradiotherapy group received platinum-based chemotherapy.

Results

The median follow-up was 65 months for surviving patients. There was no significant difference in compliance to radiotherapy between the two groups. Most acute toxicities were hematologic; acute hematologic and gastrointestinal toxicity were significantly more common in group II. Five-year overall survival and cancer-specific survival rates were, respectively, 53.5% and 66.6% in group I and 61.8% and 68.8% in group II. Performance status, comorbidity index, tumor size, and stage were independent prognostic factors for overall survival, whereas stage was the only prognostic factor for cancer-specific survival.

Conclusions

The analysis showed no benefit of concurrent chemoradiotherapy with respect to overall survival and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. Free full text available at www.tumorionline.it