bluuebunny/crossref_metadata_2025 huggingface dataset:
Ceramide Remodeling and Risk of Cardiovascular Events and Mortality
Authors: Peterson Linda R. , Xanthakis Vanessa , Duncan Meredith S. , Gross Stefan , Friedrich Nele , Völzke Henry , Felix Stephan B. , Jiang Hui , Sidhu Rohini , Nauck Matthias , Jiang Xuntian , Ory Daniel S. , Dörr Marcus , Vasan Ramachandran S. , Schaffer Jean E.
Published: May 2018

Background

Recent studies suggest that circulating concentrations of specific ceramide species may be associated with coronary risk and mortality. We sought to determine the relations between the most abundant plasma ceramide species of differing acyl chain lengths and the risk of coronary heart disease (CHD) and mortality in community‐based samples.

Methods and Results

We developed a liquid chromatography/mass spectrometry assay to quantify plasma C24:0, C22:0, and C16:0 ceramides and ratios of these very–long‐chain/long‐chain ceramides in 2642 FHS (Framingham Heart Study) participants and in 3134 SHIP (Study of Health in Pomerania) participants. Over a mean follow‐up of 6 years in
FHS
, there were 88 CHD and 90 heart failure (HF) events and 239 deaths. Over a median follow‐up time in
SHIP
of 5.75 years for CHD and HF and 8.24 years for mortality, there were 209 CHD and 146 HF events and 377 deaths. In meta‐analysis of the 2 cohorts and adjusting for standard CHD risk factors, C24:0/C16:0 ceramide ratios were inversely associated with incident CHD (hazard ratio per average SD increment, 0.79; 95% confidence interval, 0.71–0.89;
P
<0.0001) and inversely associated with incident HF (hazard ratio, 0.78; 95% confidence interval, 0.61–1.00;
P
=0.046). Moreover, the C24:0/C16:0 and C22:0/C16:0 ceramide ratios were inversely associated with all‐cause mortality (C24:0/C16:0: hazard ratio, 0.60; 95% confidence interval, 0.56–0.65;
P
<0.0001; C22:0/C16:0: hazard ratio, 0.65; 95% confidence interval, 0.60–0.70;
P
<0.0001).

Conclusions

The ratio of C24:0/C16:0 ceramides in blood may be a valuable new biomarker of CHD risk, HF risk, and all‐cause mortality in the community.
Increase in Ischemic Stroke Incident Hospitalizations Among Bedouin Arabs During Ramadan Month
Authors: Zimhony Noa , Abu‐Salameh Ibrahim , Sagy Iftach , Dizitzer Yotam , Oxman Liat , Yitshak‐Sade Maayan , Novack Victor , Horev Anat , Ifergane Gal
Published: May 2018

Background

Previous studies have not shown any significant effect on stroke incidence during Ramadan. We aimed to investigate the association between ischemic stroke incident hospitalizations and Ramadan, accounting for seasonality and temperature.

Methods and Results

This retrospective cohort study included all patients admitted with acute ischemic stroke to Soroka University Medical Center from June 2012 to June 2016. We obtained daily mean temperatures and relative humidity rates from 2 monitoring stations in South Israel. We analyzed the association between stroke incidence and Ramadan month, adjusting for weekly temperature and seasonality using Poisson regression models. We compared the first versus the last Ramadan fortnight. We performed an effect specificity analysis by assessing stroke incidence in the non‐Bedouin population. We identified 4727 cases of ischemic stroke, 564 cases of which were Bedouin Arabs. Fifty‐one cases occurred during Ramadan. Ramadan was significantly associated with an increased risk for ischemic stroke (
RR
1.48; 95% confidence interval, 1.04–2.09), mainly during the first fortnight (
RR
1.73, 95% confidence interval, 1.13–2.66) when compared with non‐Ramadan periods. Mean weekly temperatures and the summer season were not associated with stroke incidence among Bedouin Arabs (
RR
0.98; 95% confidence interval, 0.82–1.18 and
RR
0.77; confidence interval 0.56–1.06 accordingly). Such association was not observed in the non‐Bedouin population.

Conclusion

The Ramadan month, particularly in its first 2 weeks, is an independent and ethnicity specific risk factor for ischemic stroke hospitalizations among the Bedouin Arab fasting population.
Review of the Poecilimon (Poecilimon) zonatus species group and description of new species from Turkey with data on bioacoustics and morphology (Orthoptera: Phaneropterinae)
Authors: SEVGİLİ HASAN , ŞİRİN DENİZ , HELLER KLAUS-GERHARD , LEMONNIER-DARCEMONT MİCHÈLE
Published: May 2018

The aim of this study is to conduct a detailed taxonomic revision of the Poecilimon (Poecilimon) zonatus species-group (Orthoptera: Phaneropterinae) using both morphology and bioacoustics. Two new species (Poecilimon (Poecilimon) salmani, P. (P) azizsancar) and one new subspecies (P. (P) zonatus datca) are described. Based on the data, we conclude that the species complex can be separated into two subgroups (P. tauricola and P. zonatus). Within the P. zonatus subgroup, song structures indicate P. variicercis as basal branch since producing two syllable types is possibly a derived character. From both, from bioacoustics and morphology, it is concluded that the relationships between species of the group are as follows: P. tauricola subgroup (P. tauricola + P. azizsancar) + P. zonatus subgroup (P. variicercis + (P. varicornis + (P. zonatus zonatus+P. zonatus datca)) + (P. salmani+P. vodnensis)))). Except for two species (P. vodnensis and P. varicornis), the other species of the group are all distributed in Anatolia. P. vodnensis is known only from Macedonia, whereas, P. varicornis has been recorded only from Syria and Lebanon. We assume that the group originated from an Anatolian ancestral stock and expanded its distribution to the Balkans through Taurus Way and Dardanelles. Other ancestral populations may have also spread in the north-south directions through the appropriate steppe corridors in the Anatolian Diagonal Mountains and in its vicinity.
long range weather forecasting—history, current status and outlook1
Authors: Namias Jerome
Published: May 2018

Harry Wexler was a close student of developing techniques in the field of long range forecasting, and a contributor to them, realizing that improvement of long range forecasts represents one of the most important goals of meteorology. His scientifically-oriented administrative ability played a large part in enlarging the role of this subject in the United States. Indeed, one of the principal reasons he pioneered in inaugurating the World Weather Watch program was to lay a firmer foundation for long-range forecasting. I was one of many who gained benefit and stimulation from a long friendship with him, and my lecture will recall some of the instances.

First, I want to describe the nature of the long range prediction problem as seen through the eyes of a pragmatist, and to present a balanced picture of what is now possible and what may become possible in the next decade or so. One might hope that this 10-year forecast of “weather predictability” will turn out better than a 10-year forecast of the weather itself!

Next, I will speak on the history of long range forecasting over the past century, as traced through the work of inventors of synoptic, statistical and physical approaches to the problem. In spite of decades of frustration imposed by lack of adequate data, ignorance of large-scale physical processes, and the absence of intensive and large-scale effort, meteorologists working on longe range problems have made encouraging progress.
prospective applications of models to forecasting1,2
Authors: Kreitzberg Carl W.
Published: May 2018

Effective reasoning, analysis and communication regarding natural phenomena require the use of models to render tractable the complexities of nature. This paper attempts to put into perspective the proper roles of different types of models to maximize the effectiveness of their utilization. The advances in short term forecasting envisioned for the 1970's from full implementation of new knowledge, models and technology will materialize only if the managers and researchers join in an interagency effort to provide the operational meteorologists with the education, techniques, tools and, particularly, the challenging working environment needed to fully develop man's role in forecasting. A program to meet these requirements is outlined.

The types of models discussed include: descriptive or synoptic, dynamic or analytic, numerical or physical, statistical or optimized. The uses of models discussed include: education (basic concepts), research (experimental), operations (customized). Since the operational meteorologist is responsible for the intelligent use of these types of models, he must continually update his training and properly understand the potential contributions of the models.

It is anticipated that during the 1970's routine computer models will become more refined and specialized data such as trajectories and probabilities will become more common. Highly specialized products will be available from special purpose models on a special request basis as field forecasters gain access to remote terminals. Also, forecasters will have access to specialized consultants when unusual events or unusual forecast requirements arise. Background materials will be provided to the applied meteorologists so that he may gain physical understanding from educational and research models including systematic numerical experiments. Communication advances will provide for dynamic (motion picture) displays of radar, synchronous satellite, weather map and weather forecast data.

Only if the operational forecasters do receive the necessary management and scientific support, will their jobs be challenging and attractive to highly motivated and qualified students; only then will the customers of specialized short term forecasts receive the benefits made feasible by science and technology.
the BOMEX Project
Authors: Kuettner Joachim P. , Holland Joshua
Published: May 2018

This article, written a few days before the beginning of the field operations, summarizes the scientific and operational plans for BOMEX, the “Barbados Oceanographic Meteorological Experiment.” The basic concept of BOMEX has been described earlier by its former director, Ben Davidson (1968). His untimely death created a temporary crisis in the scientific direction of the project; however, his experiment design and his underlying thoughts have proved sound and no major changes in the layout or scientific objectives have been necessary. In the opinion of the project staff, Ben Davidson remains the man behind BOMEX. Continuity has been preserved throughout the BOMEX preparations by the Project Manager, William Barney, and his multi-agency staff.

At this time, ships, airplanes and scientists are converging on Barbados. Therefore, the plans described here are by necessity final. Only facts of life can change them.
The Coldest Places in Hawaii: The Ice-Preserving Microclimates of High-Altitude Craters and Caves on Tropical Island Volcanoes
Authors: Schörghofer Norbert , Businger Steven , Leopold Matthias
Published: May 2018

The coldest places on the Hawaiian island chain are not on the very summits of its tallest volcanoes, Mauna Kea (19.82°N; 4,207 m) and Mauna Loa (19.48°N; 4,169 m), but within craters and caves with perennial ice. Here, we explore unique microclimates in the alpine stone deserts of two tropical island volcanoes, report new temperature extremes for Hawaii, and study the role of microclimates in the preservation of perennial ice bodies. Nocturnal cold-air pools are common in the craters and are responsible for the coldest temperature ever reported from the Hawaiian Islands (–20°C). These cold-air pools are not frequent enough to substantially affect the annual heat budget of the ground, but cold air is frequently trapped between boulders and contributes to freezing conditions in this way. Perennial ice is found beneath even warmer environments in lava tube caves. The lowest annual-mean temperature (–0.7°C) was measured at the distal end of a spectacular ice cave on Mauna Loa, where the outside air temperature averages +8°C. In the current climate, the outside temperature rarely falls below freezing, so the air’s sensible heat cannot contribute to freezing conditions. Considering the effect of recent climate warming and the buoyancy of humid air, cold air that flowed down the lava tubes in winter nights, combined with sublimation cooling, is still a plausible explanation for the perennial ice ponds found there.
HRM and Small-Firm Employee Motivation: Before and After the Great Recession
Authors: Bryson Alex , White Michael
Published: May 2018

A long-running debate in the small-firms’ literature questions the value of formal human resource management (HRM) practices, which have been linked to high performance in larger firms. The authors contribute to this literature by exploiting linked employer–employee surveys for 2004 and 2011. Using employees’ intrinsic job satisfaction and organizational commitment as motivational outcomes, the authors find the returns to small-firm investments in HRM are U-shaped. Small firms benefit from intrinsically motivating work situations in the absence of HRM practices and find this advantage disturbed when formal HRM practices are initially introduced. Firms can restore positive motivation when they invest intensively in HRM practices in a way that characterizes high performance work systems (HWPS). Although the HPWS effect on employee motivation is modified somewhat by the Great Recession, it remains robust and continues to have positive promise for small firms.
Learning a programming language
Authors: Iskrenovic-Momcilovic Olivera
Published: May 2018

Today, it is believed that it is difficult to learn a programming language because it requires a completely different way of thinking from what students are accustomed to and need a lot of work and time to start thinking in this way. Each method for learning a programming language aims to improve the quality of learning, which is confirmed by a large number of successful students. This paper presents the influence of factors such as motivation, emotion and pre-knowledge of students on the choice of method, which is maximally adapted to the age, abilities and preferences of students. Adequate selection of the method is done by using the tests for checking the given factors to the students’ data, which are later used to select the most favorable method for learning a programming language.
Theoretical and experimental study of braid pattern in mandrels with arbitrary cross-sections
Authors: Hajrasouliha Jalil , Nedoushan Reza Jafari , Sheikhzadeh Mohammad , Na Wonjin , Yu Woong-Ryeol
Published: May 2018

Braid angle is a key factor associated with the mechanical properties of braided composites, so accurate prediction of this angle is of vital importance for the design and manufacture of braided preforms. This paper presents a theoretical model for the prediction of braid angle at any point of a mandrel with constant arbitrary cross-section by taking into account the kinematic parameters of circular braiding machine. The proposed theoretical model pays particular attention to two parameters that strongly affect the braid angle, namely the position of fell point on the mandrel’s surface and the yarn length between this point and the carrier. Both of these parameters undergo continuous change during braiding and thus should be calculated on a point-to-point basis. The model was validated by a series of braiding experiments conducted, using a circular braiding machine, on mandrels with circular, elliptical, and oval cross-sections and then determining the resulting braid angles over the mandrel’s surface by an image processing method. The experimental results showed the high accuracy of the proposed theoretical model in predicting the braid angle for mandrels with constant arbitrary cross-section. Thus, the proposed model can contribute to faster and more accurate design and manufacture of braided composite preforms.
War, Rebellion, and Intervention under Hierarchy: Vietnam–China Relations, 1365 to 1841
Authors: Kang David C. , Nguyen Dat X. , Fu Ronan Tse-min , Shaw Meredith
Published: May 2018

What does international hierarchy look like? The emerging literatures on hierarchy and international orders remain overwhelmingly focused on the contemporary era and on the great powers that comprise the top of the hierarchy. This article addresses that gap by examining diplomacy, war, and domestic politics in the premodern Vietnam–China relationship under the hierarchic tributary system. Specifically, we construct a unique data set of over 1,200 entries, which measures wars and other violence in the region from 1365 to 1789. The data revealed the stable and legitimate nature of tributary relations between formally unequal political units. The Vietnamese court explicitly recognized its unequal status in its relations with China through a number of institutions and norms. Vietnamese rulers also displayed very little military attention to their relations with China. Rather, Vietnamese leaders were clearly more concerned with quelling chronic domestic instability and managing relations with kingdoms to their south and west.
Energy and railway workshops: An archaeology of the FEPASA complex (Jundiaí, Brazil)
Authors: Cano Sanchiz Juan M
Published: May 2018

Railway workshops overlapped the fields of energy and transport and witnessed profound technological evolution over time due to changes in energy production, distribution and consumption. Here, I use archaeological methods to investigate the railway workshop owned by the Companhia Paulista de Estradas de Ferro in Jundiaí (Brazil), in operation from the end of the nineteenth century to 1998 and today known as FEPASA Complex. In doing so, I aim to highlight the role of energy and power supply in the evolution of railway workshops, and how this influenced its organization of space and labour. I state that, even when written sources are available and abundant, archaeology can offer an important angle to understand the transport industry.
Religious Preference and Hospice Choice
Authors: Turley Alan , Larson Emma B. , Silver Jenny , Klingler Catherine
Published: May 2018

This article will employ a database from a large hospice provider with offices in 16 states to examine the impact of religious preference on hospice choice. Little work has been done on this issue, even though religion is the only social institution that specifically addresses the end of life. Hospice work, in particular, has drawn little attention despite it effecting millions of patients and their families. Of all the medical subspecialties, hospice is one of the most effected by society’s views on death and religious views of dying. It is also the only government-funded medical service that requires religious support be made available to patients. Our hypothesis is that certain religious groups have a predisposition against end-of-life interventions and will be less likely to utilize hospice. This impacts a multibillion dollar a year industry that supplies hospice service to millions of patients, and our research points to one major religious group not accessing their hospice benefit at the same rate as other denominations.
Game-changing trends and forces for agricultural financing in sub-Saharan Africa toward 2055: Verification and prioritization through the real-time Delphi method
Authors: Oberholster Cobus , Adendorff Chris
Published: May 2018

This article reports on a research effort that looked at the future of agricultural financing in sub-Saharan Africa (SSA) toward 2055. The real-time Delphi method was used to verify key megatrends that should define the future of agriculture and agricultural development in the region. The implications of these trends for agricultural financing, together with potential game-changing forces with regard to the future delivery of financial services to agricultural producers, were also prioritized. The real-time Delphi method was employed to check both the future importance and probability of occurrence of the identified trends and corresponding disruptive technologies, business models, innovations in value-chain financing, market configurations, and institutional innovations. In addition, the method was also used to investigate the future perspectives of experts and to identify any specific, promising technological areas, innovations, and business models. Key elements of a desired future for agricultural financing in SSA were also confirmed.
Chinese Postgraduates’ Explanation of the Sources of Sentence Initial Bundles in their Thesis Writing
Authors: Li Liang , Franken Margaret , Wu Shaoqun
Published: May 2018

Lexical bundles, recurrent multiword combinations in a register, are extremely common and important discourse building blocks in academic writing. An increasing number of studies have investigated lexical bundles in academic writing in recent years, but few studies have explored L2 learners’ interpretations of their own bundle production, particularly sentence initial bundle production. Investigating the sources that have appeared to influence learners’ choices and knowledge of bundles is important as it complements what we know about the structural and functional features of lexical bundles and provides useful first-hand information for second language writing pedagogy. The present study interviewed five Chinese postgraduate students to probe possible reasons for their use of the typical sentence initial bundles identified in the self-built Chinese Masters and PhD thesis corpora. The interviews revealed diverse explanations including interlingual transfer, classroom learning, noticing in reading, a lack of rhetorical confidence, and misunderstanding of rhetorical conventions. The results suggest the need for raising students’ awareness of the common sentence starters in postgraduate academic writing, increasing their confidence as student writers, familiarizing them with rhetorical conventions, and incorporating effective corpus-based tools into pedagogical practices.
An investigation into the anti-icing properties of fabrics used for the outer layer of firefighter clothing
Authors: Han Lun , Zhao Xiaoming , Kidalla Jannette Eveline
Published: May 2018

The anti-icing properties of fabrics can be considered as involving two parts, the super-hydrophobic property and the ease of ice removal property. In this study, a super-hydrophobic surface was built on to the outer layer of firefighter clothing using nano-silica, C13H13F17O3Si, C19H42O3Si and PU-2540 using a coating method. This coating stops water drops from staying on the fabric surface easily. At the same time, an ultra-smooth surface was built on to the super-hydrophobic surface already created on the fabric using perfluoropolyethers (PFPE) oil by a dipping method, which adds an ice removal function to the fabrics. The anti-icing properties of the samples prepared in the research described in this paper have been investigated using field emission scanning electron microscopy (FESEM), X-ray photoelectron spectroscopy (XPS), ease of ice removal property tests and static water contact angle analysis. At the same time, the thermal protective performance (TPP) of the samples, before and after super-hydrophobic treatment, was studied by a TPP tester. Results show that the super-hydrophobic coating with an ultra-smooth surface can significantly increase the anti-icing properties of the fabrics used for the outer layer of firefighter clothing. C13H13F17O3Si and C19H42O3Si can improve the hydrophobic properties of the coating. The anti-icing coating in this paper can increase the TPP of the fabrics.
“If It Weren’t for Them, I’d Probably Be Lost”: The Diversity and Function of Natural Mentors Among Young Black Men Who Have Sex With Men
Authors: Reed Sarah J. , Strzyzykowski Trevor , Chiaramonte Danielle , Miller Robin Lin
Published: May 2018

The purpose of this study was to examine one interpersonal relationship—natural mentoring relationships—that may promote healthy development among young Black men who have sex with men (YBMSM), a population at disproportionate risk of multiple psychosocial health issues. We analyzed data from interviews with 168 YBMSM. We used content analysis to identify who participants cited as mentors, their personal characteristics, and the functions they played in youths’ lives. Participants frequently cited women and family members as mentors. Participants preferred as mentors people with whom they shared key attributes and who they considered successful and resilient. Mentors played roles in participant’s identity construction, cognitive development, and emotional development. Findings suggest that mentors have significant influence in the development of YBMSM. Incorporating natural mentors into health promotion interventions may be one means of enhancing the cultural relevance of interventions for this population.
Assessing the Impact of Textual Content Concreteness on Helpfulness in Online Travel Reviews
Authors: Shin Seunghun , Chung Namho , Xiang Zheng , Koo Chulmo
Published: May 2018

The online travel review has become one of the most influential information sources for travelers’ decision making. This research primarily aims to examine the relationship between review textual content concreteness and review helpfulness in the tourism context. In particular, we examine how this relationship plays out under two individual circumstances, namely, temporal distance and risk–benefit tendency. Based on the construal level theory and feeling-as-information theory, two experiments are conducted to test whether the influence of review concreteness is moderated by temporal distance and risk–benefit tendency. The results show that the main effect of review concreteness is significant; however, in contrast to the assumptions of theories and results of relevant studies, both interaction effects of temporal distance and risk–benefit tendency are not. Finally, we interpret the findings and discuss the implications and limitations of this research.
H∞ Dynamic output feedback control of LPV time-delay systems via dilated linear matrix inequalities
Authors: Nejem Imen , Bouazizi Mohamed Hechmi , Bouani Faouzi
Published: May 2018

This paper uses the linear matrix inequality dilation approach to deal with robust stability and H∞ dynamic output feedback controller synthesis for linear parameter varying delayed systems with variable delay. This approach can express the original non-convex problem in terms of convex linear matrix inequalities and consequently reduces the conservatism of linear matrix inequality synthesis without dilation. Both delay-dependent stability and H∞ performance are studied in a quadratic context. Furthermore, a Lyapunov–Krasovskii functional is used to derive a delay-dependent criterion formulated in terms of a linear matrix inequality that will be used to search for an H∞ linear parameter varying delayed dynamic output feedback controller. To achieve this aim we use an integral inequality which plays a key role in the derivation of this criterion and enables the reduction of the H∞ cost in comparison to other results.
Flipping the (Surname) Script: Men’s Nontraditional Surname Choice at Marriage
Authors: Shafer Emily Fitzgibbons , Christensen MacKenzie A.
Published: May 2018

Using unique, nationally representative data that asks individuals about their surname choice in marriage, we explore heterosexual men’s nontraditional surname choice. We focus on how education—both absolute and relative to wives’—correlates with nontraditional surname choice. Following class-based masculinities theory, we find that men with more education are less likely to choose a nontraditional surname. Despite being more egalitarian in attitudes, men with more education are more likely to have careers that give them privileged status in their marriages and may have “more to lose” in their career by changing their name. In addition, men with less education than their wives are less likely to change their surnames. We argue that this is consistent with compensatory gender display theory. Men having less education in marriage may translate into having less earning power, which is gender nonnormative as men are culturally expected to be primary breadwinners in marriage.
The usefulness of a trans-illuminated introducer during the Nuss procedure
Authors: Song In-Hag , Lee Seung Jin , Lee Seock Yeol
Published: May 2018

Background

There has been an increase in the number of patients undergoing the Nuss procedure for cosmetic purposes, thus increasing the need for safer surgery. However, there are reports of massive hemorrhage and organ damage during the Nuss procedure which involves dissection of the anterior mediastinum. We have developed the trans-illuminated introducer that allows safe surgery while maintaining a small surgical incision of less than 1 cm.

Methods

This study was a retrospective review of 306 patients aged 3–40 years who underwent the Nuss procedure using the trans-illuminated introducer at our hospital between April 2006 and December 2014.

Results

There were 29 (9.5%) early postoperative complications. The most common early complication was pneumothorax (15 cases, 4.9%). Five (1.6%) patients developed hemothorax in the early postoperative period, which occurred independently of the dissection process of the anterior mediastinum. None of these patients required reoperation or blood transfusion. There were no complications caused by the introducer during dissection of the anterior mediastinum.

Conclusions

Using the trans-illuminated introducer, we were able to dissect the anterior mediastinum without a major complication, such as massive hemorrhage from the mediastinum, while maintaining a small surgical incision for cosmetic purposes. Therefore, we consider that the trans-illuminated introducer is useful for improving the outcome of the Nuss procedure.
Surgical perspective of percutaneous device closure of atrial septal defect
Authors: Thingnam Shyam Kumar Singh , Mahajan Sachin , Kumar Vikas
Published: May 2018

Background

Percutaneous device closure of an ostium secundum atrial septal defect is associated with excellent outcomes and cosmetic results but at the cost of occasional serious and sometimes fatal complications as well as lifelong follow-up. Surgical intervention is required in cases of device-related complications, which carries a slightly higher risk compared to primary closure of an atrial septal defect. We present a surgical perspective of device closure of atrial septal defect.

Methods

Our database was searched over 4 years for complications related to percutaneous device closure of atrial septal defect, which required surgical retrieval of the device and closure of the defect. We identified 14 cases that required surgical intervention.

Results

The median age of the 14 patients was 18 years (range 4–58 years). The size of the defect ranged from 15 to 40 mm (median 30 mm). Device embolization into any part of the cardiovascular system ( n = 8) was the most common complication, followed by malalignment of the device ( n = 5). One patient had left atrial appendage perforation causing pericardial effusion and cardiac tamponade, and underwent surgical repair. The other 13 patients underwent removal of the device and atrial septal defect closure. One patient developed severe mitral regurgitation requiring mitral valve replacement. There was no mortality.

Conclusion

Although the incidence of device-related complications may be small, they carry a high risk of death or long-term morbidity, even with a small atrial septal defect, unlike primary surgical closure of isolated atrial septal defect.
Optimal neuromuscular blocking effects of remifentanil during tracheal intubation under general anesthesia
Authors: Kwon So Young , Chung Si Wook , Joo Jin Deok
Published: May 2018

Objective

This study was performed to determine the effect of the remifentanil dose on the onset time of rocuronium with electromyography.

Methods

This retrospective comparative study included 75 patients undergoing general anesthesia for elective surgery. Patients received lidocaine (40 mg) and propofol (2 mg/kg) followed by rocuronium (0.6 mg/kg) with either saline infusion (Group S), remifentanil at 0.5 µg/kg/minute (Group R 0.5), or remifentanil at 1.0 µg/kg/minute (Group R 1.0). Neuromuscular block was monitored by train-of-four (TOF) electromyography, and the times taken to reach TOF 0 and TOF ratio (TOFR) 25% were recorded.

Results

The times taken to reach TOF 0 and TOFR 25% were significantly higher in Groups R 0.5 and R 1.0 than in Group S. The time taken to reach TOF 0 was 130.0 ± 6.4 s in Group S, 142.6 ± 6.0 s in Group R 0.5, and 183.0 ± 11.6 s in Group R 1.0. The time taken to reach TOFR 25% was also higher in Groups R 0.5 and R 1.0 than in Group S.

Conclusions

As the remifentanil dose increases, the intubation time required to reach TOF 0 also increases. Remifentanil has an effect on the onset of rocuronium.
Sustained reductions in migraine days, moderate-to-severe headache days and days with acute medication use for HFEM and CM patients taking fremanezumab: Post-hoc analyses from phase 2 trials
Authors: Halker Singh Rashmi B , Aycardi Ernesto , Bigal Marcelo E , Loupe Pippa S , McDonald Mirna , Dodick David W
Published: May 2018

Background

In phase 2 and 3 studies, fremanezumab, a monoclonal CGRP antibody, was an effective preventive treatment for high-frequency episodic migraine (HFEM) and chronic migraine (CM).

Objective

Post-hoc analyses evaluated population-wise 50%, 75% and 100% responder rates, and the extent to which individual responders sustained a 50%, 75% and 100% reduction in migraine days, moderate-to-severe (M/S) headache days and days of acute medication use during all three treatment months of the fremanezumab phase 2 studies.

Design/methods

HFEM patients received either placebo or three once-monthly injections of 225 mg or 675 mg. CM patients received either placebo or three once-monthly injections of 900 mg, or an initial loading dose of 675 mg and subsequent injections of 225 mg. Patients reported headache-related data daily using an electronic diary.

Results

In the HFEM study, the percent of patients on fremanezumab doses 225 mg and 675 mg were greater compared to the percent of placebo patients with sustained 50% reduction in migraine days (39% and 35% vs. 10% for placebo, both p < 0.0001), M/S headache days (36% and 38% vs. 16% placebo, p = 0.0017 and p = 0.0007 respectively), and acute medication use days (36% and 27% vs. 8% placebo, p < 0.0001 and p = 0.0003). Likewise, although there were fewer patients with sustained 75% reduction, there were increases in the percent of patients on fremanezumab 225 mg and 675 mg in the HFEM study relative to placebo patients in migraine days (19% and 11% vs. 3% placebo, p = 0.0002 and p = 0.0176), M/S headache days (19% and 15% vs. 2% placebo, p = 0.0001 and p = 0.0011) and days of acute medication use (16% and 8% vs. 2% placebo, p = 0.0005 and p = 0.0377). In the CM study, there were increases in the percent of patients on fremanezumab 675/225 mg and 900 mg with 50% sustained reduction in M/S headache days (32% and 40% vs. 15% placebo, p = 0.0058 and p = 0.0002) and days of acute medication use (26% and 22% vs. 11% placebo, p = 0.0098 and p = 0.0492). There were also increases in the percent of patients on fremanezumab 675/225 mg and 900 mg compared to patients on placebo with 75% sustained reduction in M/S headache days (10% and 13% vs. 3%, p = 0.0665 and p = 0.0203). Few patients had 100% sustained reductions in these parameters in either study.

Conclusions

Post-hoc results must be interpreted with caution; nonetheless, a statistically significant percentage of patients who initially responded to fremanezumab within 1 month sustained this response over the subsequent 2 months. Sustained reduction in individual patients may provide a novel patient-centric, clinically meaningful endpoint for future trials assessing the effectiveness of preventive migraine treatments. Trials are registered as http://clinical trials.gov as NCT02025556 and NCT02021773.
Patellar Redislocation Rates and Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction: Suture Anchor Versus Double Transpatellar Tunnel Fixation
Authors: Heo Jae-Won , Ro Kyung-Han , Lee Dae-Hee
Published: May 2018

Background:

Few studies to date have compared clinical outcomes in patients who have undergone medial patellofemoral ligament (MPFL) reconstruction using the suture anchor and double transpatellar tunnel fixation methods. This meta-analysis therefore compared the clinical results, including the patellar redislocation rate and improvement in functional scores, of suture anchor and double transpatellar tunnel fixation.

Hypothesis:

The recurrence rate and improvement in functional outcomes after surgery would be similar using the suture anchor and double transpatellar tunnel fixation methods.

Study Design:

Meta-analysis.

Methods:

Studies evaluating MPFL reconstruction using either the suture anchor or double transpatellar tunnel technique for patellar site fixation were included if they reported the patellar redislocation rate after surgery and/or validated patient-reported outcomes such as the Kujala and Lysholm scores.

Results:

Twenty-one studies were included in this meta-analysis. The mean patellar redislocation rates were similar using the suture anchor (3.2% [95% CI, 1.6%-6.2%]) and double transpatellar tunnel (3.4% [95% CI, 2.1%-5.4%]) techniques ( P = .879). The mean improvement in the Kujala score from before to after MPFL reconstruction was greater using the suture anchor (37.2 [95% CI, 31.1-43.4]) method than the double transpatellar tunnel method (28.7 [95% CI, 21.2-36.1]) ( P = .018). However, the mean improvement in the Lysholm score did not differ significantly using the 2 techniques.

Conclusion:

The patellar redislocation rate did not differ significantly in patients who underwent MPFL reconstruction using the suture anchor and double transpatellar tunnel fixation methods. The suture anchor fixation method, however, resulted in a greater degree of improvement in patient-reported outcomes.
Cross-Cultural Psychometric Properties of the Hamilton Depression Rating Scale
Authors: Vindbjerg Erik , Makransky Guido , Mortensen Erik Lykke , Carlsson Jessica
Published: May 2018

Objective:

The Hamilton Depression Rating Scale (HDRS) is considered the gold standard measure of depression. The factor structure of the HDRS is generally unstable, but 4 to 8 items appear to form a general depression factor. As transcultural studies of the HDRS have received little attention, and as most of the studies have taken a data-driven approach with a tendency to yield fragmented results, it is not clear if an HDRS general depression factor can also be found in non-Western populations. This is an important issue in deciding on the appropriateness of the scale as a gold standard in transcultural psychiatry.

Method:

A systematic review was carried out to compare previously reported factor structures of the HDRS in non-Western cultures. Overlapping clusters across studies were identified and subsequently tested with confirmatory factor analysis (CFA) of responses from an independent sample.

Results:

Fourteen relevant studies were identified, 12 of which were obtained. A general depression factor was identified, consisting of the following symptoms: depressed mood, guilt, loss of interests, retardation, suicide, and psychological anxiety. The subsequent CFA analysis supported the fit of this model.

Conclusions:

This study indicates that a general depression cluster is manifest in responses to the HDRS across cultures. While psychometric properties of the full-length HDRS are still debated, the general depression cluster appears pertinent to the assessment of depression across cultures. We recommend that cross-cultural clinicians and researchers focus on the use of unidimensional depression scales, which are in agreement with this cluster.
A Guide to Designing Engaged Learning Courses in Community Planning
Authors: Botchwey Nisha , Umemoto Karen
Published: May 2018

This article provides a guide for developing engaged learning pedagogy in the area of community planning. It is based on a capacity-building approach to community planning that emphasizes the strengthening of individual and collective abilities to plan and shape community futures, ideally toward greater equality, livability, and democratic governance. The article discusses a capacity-building approach to community planning and presents a series of steps in designing and teaching a service learning course, with a succession of issues, questions, and considerations in stepwise order that can aid in the design of a course with community capacity building in mind.
Prevalence, Risk Factors, and Clinical Consequences of Recurrent Activation of a Rapid Response Team: A Multicenter Observational Study
Authors: Fernando Shannon M. , Reardon Peter M. , Scales Damon C. , Murphy Kyle , Tanuseputro Peter , Heyland Daren K. , Kyeremanteng Kwadwo
Published: May 2018

Introduction:

Rapid response teams (RRTs) are groups of health-care providers, implemented by hospitals to respond to distressed hospitalized patients on the hospital wards. Patients assessed by the RRT for deterioration may be admitted to the intensive care unit (ICU) or may be triaged to remain on the wards, putting them at risk of recurrent deterioration and repeat RRT activation. Previous studies evaluating outcomes of patients with recurrent deterioration and multiple RRT activations have produced conflicting results.

Methods:

We used a prospectively collected multicenter registry from 2 hospitals within a single tertiary-level hospital system between 2012 and 2016. Comparisons were made between patients with a single RRT activation and those with multiple RRT activations over the course of their admission. Primary outcome was in-hospital mortality, which was analyzed using multivariable logistic regression.

Results:

A total of 5995 patients who had any RRT activation were analyzed. Of that, 1183 (19.7%) patients had recurrent deterioration and multiple RRT activations during their admission. Risk factors for recurrent deterioration included admission from a home setting (as opposed to a long-term care facility), RRT activation during nighttime hours, and delay (>1 hour) to RRT activation. Recurrent deterioration was associated with increased odds of mortality (adjusted odds ratio [OR]: 1.44 [1.28-1.64], P = <.001). Increasing number of RRT activations were associated with increasing risk of mortality. Patients with recurrent deterioration had prolonged median hospital length of stay (21.0 days vs 12.0 days, P < .001), while patients with only a single activation were more likely to be admitted to the ICU (adjusted OR: 2.30 [1.96-2.70], P < .001).

Conclusions:

Recurrent deteriorations leading to RRT activations among hospitalized patients are associated with increased odds of mortality and prolonged hospital length of stay. This work identifies a group of patients who warrant closer attention to help reduce adverse outcomes.
Microwave-assisted synthesis and evaluation of type 1 collagen–apatite composites for dental tissue regeneration
Authors: Ilyas Kanwal , Qureshi Saba W , Afzal Sadia , Gul Roquyya , Yar Muhammad , Kaleem Muhammad , Khan Abdul S
Published: May 2018

The aim was to develop an economical and biocompatible collagen-based bioactive composite for tooth regeneration. Acid-soluble collagen was extracted and purified from fish scales. The design was innovated to molecularly tailor the surface charge sites of the nano-apatite providing chemical bonds with the collagen matrix via microwave irradiation technique. The obtained collagen was identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis. The composites were characterized by Fourier transform infrared spectroscopy, thermogravimetric analysis/differential scanning calorimetry, and scanning electron microscopy. MC3T3-E1 cell lines were used to assess the biological effects of these materials by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetra zolium bromide (MTT) assay. Indirect contact test was performed by extracting representative elutes in cell culture media and sulforhodamine B analysis was performed. Chorioallantoic membrane assay was conducted to define the new vessels formation behavior. The purity of collagen extracts was determined and showed two α-chains, i.e. the characteristic of type I collagen. Fourier transform infrared spectroscopy showed the characteristic peaks for amide I, I, III, and phosphate for collagen and composites. Scanning electron microscopy images showed three-dimensional mesh of collagen/apatite nano-fibers. Nontoxic behavior of composites was observed and there were graded and dose-related effects on experimental compounds. The angiogenesis and vessels formation behavior were observed in bioactive collagen composite. The obtained composites have potential to be used for tooth structure regeneration.
Factors Affecting Breastfeeding Outcomes at Six Months in Preterm Infants
Authors: Wang Ying , Briere Carrie-Ellen , Xu Wanli , Cong Xiaomei
Published: May 2018

Background:

Preterm mother-infant dyads often face many obstacles to breastfeeding. Preterm infants are at highest risk for low rates of exclusive breastfeeding.

Research Aim:

To determine the prevalence of breastfeeding at 6 months among preterm infants and to identify factors that influenced mothers’ breastfeeding practices.

Methods:

A longitudinal observational study was conducted in a metropolitan hospital in Beijing, China. Mothers ( N = 270) and their preterm infants ( N = 280) were included in the study. Characteristics of preterm mothers and their perceptions of breastfeeding self-efficacy, knowledge, social support, and postpartum depression symptoms were measured at the discharge of neonatal intensive care. Breastfeeding data were collected by phone interview at 6 months corrected age.

Results:

At discharge, mothers of very preterm infants perceived a lower level of breastfeeding self-efficacy (measured with the Breastfeeding Self-Efficacy Scale–Short Form) and had a higher level of depression symptoms (measured with the Edinburgh Postnatal Depression Scale [EPDS]) than mothers of moderate and late preterm infants ( p < .05-.01). Nearly half of all mothers had an elevated EPDS score, considered to be symptomatic of postpartum depression. At 6 months, only 22.5% of all infants were exclusively breastfeeding. Factors associated with exclusive breastfeeding, including younger maternal age, previous breastfeeding experience, shorter mother-infant separation time during intensive care, older infant gestational age, and a higher level of breastfeeding self-efficacy, significantly predicted exclusive breastfeeding practice ( p < .05-.001).

Conclusion:

The prevalence of breastfeeding at 6 months for preterm infants in this sample was low. Strategies to improve breastfeeding duration for preterm infants are needed, including support and education of mothers while in the hospital.