bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Once‐Weekly Exenatide on Clinical Outcomes According to Baseline Risk in Patients With Type 2 Diabetes Mellitus: Insights From the EXSCEL Trial
Authors: Mentz Robert J. , Bethel M. Angelyn , Merrill Peter , Lokhnygina Yuliya , Buse John B. , Chan Juliana C. , Felício João S. , Goodman Shaun G. , Choi Jasmine , Gustavson Stephanie M. , Iqbal Nayyar , Lopes Renato D. , Maggioni Aldo P. , Öhman Peter , Pagidipati Neha J. , Poulter Neil R. , Ramachandran Ambady , Reicher Barry , Holman Rury R. , Hernandez Adrian F. ,   the EXSCEL Study Group
Published: September 2018

Background

In the
EXSCEL
(Exenatide Study of Cardiovascular Event Lowering), exenatide once‐weekly resulted in a nonsignificant reduction in major adverse cardiovascular events (
MACEs
) and a nominal 14% reduction in all‐cause mortality in 14 752 patients with type 2 diabetes mellitus (T2
DM
) with and without cardiovascular disease. Whether patients at increased risk for events experienced a comparatively greater treatment benefit with exenatide is unknown.

Methods and Results

In the
EXSCEL
population, we created risk scores for
MACEs
and all‐cause mortality using step‐wise selection of baseline characteristics. A risk score was calculated for each patient, and a time‐to‐event model for each end point was developed including the risk score, treatment assignment, and risk‐treatment interaction. Interaction
P
values evaluating for a differential treatment effect by baseline risk were reported. Over a median follow‐up of 3.2 years (interquartile range, 2.2, 4.4), 1091 (7.4%) patients died and 1744 (11.8%) experienced a
MACE
. Independent predictors of
MACEs
and all‐cause mortality included age, sex, comorbidities (eg, previous cardiovascular event), body mass index, blood pressure, hemoglobin A1c, and estimated glomerular filtration rate. The all‐cause mortality and
MACE
risk models had modest discrimination with optimism‐corrected c‐indices of 0.73 and 0.71, respectively. No interaction was observed between treatment effect and risk profile for either end point (both interactions,
P
>0.1).

Conclusions

Baseline characteristics (eg, age, previous cardiovascular events) and routine laboratory values (eg, hemoglobin A1c, estimated glomerular filtration rate) provided modest prognostic value for mortality and
MACEs
in a broad population of patients with type 2 diabetes mellitus. Exenatide's effects on mortality and
MACEs
were consistent across the spectrum of baseline risk.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier:
NCT
01144338.
An unusual new species of the genus Paulianellus (Coleoptera: Scarabaeidae: Aphodiinae) from Yunnan, China
Authors: MINKINA ŁUKASZ , KRÁL DAVID
Published: September 2018

The genus Paulianellus was erected by Balthasar (1938) as a subgenus of the genus Aphodius Hellwig, 1798 for a single species, Aphodius maderi Balthasar, 1938 from Sichuan.
Bryozoan framework composition in the oddly shaped reefs from Abrolhos Bank, Brazil, southwestern Atlantic: taxonomy and ecology
Authors: RAMALHO LAÍS V. , TAYLOR PAUL D. , MORAES FERNANDO COREIXAS , MOURA RODRIGO , AMADO-FILHO GILBERTO M. , BASTOS ALEX C.
Published: September 2018

Bryozoans are a key group of sessile invertebrates in some reef frameworks but are typically neglected in environmental monitoring programs. Abrolhos Bank (Brazil) is the largest reef complex in the South Atlantic Ocean, encompassing several reef landscapes over an area of 46,000 km2. A transition takes place across the shelf from mangroves to soft sediments, coastal shallow reefs to a volcanic archipelago – surrounded by fringing reefs – and unique mushroom-shaped biogenic structures, with mesophotic pinnacle reefs, rhodolith beds, sink-holes and shelf break deep environments. The taxonomic composition of the bryozoan fauna was studied in 11 core samples taken from shallow to mesophotic mid-shelf reefs (4–25 m deep) on Abrolhos Bank by divers using a submersible drill. Of the 20 bryozoan species sampled, 17 are new records for Abrolhos Bank and seven species are new to science: Crassimarginatella winstonae n. sp., Parasmittina distincta n. sp., Parasmittina abrolhosensis n. sp., Hemismittoidea asymmetrica n. sp., Stylopoma variabilis n. sp., Stylopoma hastata n. sp., and Plesiocleidochasma acuminata n. sp. (described by Ramalho, Taylor & Moraes). The most conspicuous species is Celleporaria atlantica. These results increase to 48 the total number of bryozoan species known in this region and reinforce the importance of this group as one of the main components apart from crustose coralline algae and corals of the reef framework-building community of Abrolhos Bank.
Evaluation of the local employment impacts of enterprise zones: A critique
Authors: Chaudhary Nidhi , Potter Jonathan
Published: September 2018

Enterprise zone policy is a potential tool for the regeneration of distressed areas, based primarily on tax incentives to businesses locating in the target areas. The tool has been tested in several countries over more than 35 years but there is no consensus on whether or not it is effective and efficient in creating jobs and reducing unemployment in targeted localities. This paper reviews seminal enterprise zone evaluations in the UK, USA and France. More than one-half of the studies reported local employment benefits but the others reported none and information is limited on what affects policy success. The paper argues that typically narrow-focus research designs and a-theoretical evaluation have contributed to the lack of consensus and policy insight, potentially exacerbated by non-exact data. It proposes richer evaluations with explicit theoretical frameworks, such as the one presented in the paper, more comparative work and the use of more accurate data.
Benefit-risk assessment of erenumab and current migraine prophylactic treatments using the likelihood of being helped or harmed
Authors: Vo Pamela , Wen Shihua , Martel Marie-Josée , Mitsikostas Dimos , Reuter Uwe , Klatt Jan
Published: September 2018

Objective

This study evaluated the benefit-risk profile of erenumab relative to other therapies approved for migraine prophylaxis and available in the majority of European countries.

Methods

Trials were identified via a published systematic literature review updated to December 2017 using MEDLINE. Erenumab’s pivotal trials study reports were also included (NCT02066415, NCT02456740). From these sources, ≥ 50% responder rates and discontinuations due to adverse events were extracted to generate numbers needed to treat and harm and likelihood of being helped or harmed, a quantitative benefit-risk measure.

Results

Eleven articles (nine randomized clinical trials) met the inclusion/exclusion criteria. Low numbers needed to treat (range: 4–13) were observed for most treatments, while numbers needed to harm showed substantial differences (erenumab’s higher numbers needed to harm indicating better tolerability). In chronic and episodic migraine, likelihoods of being helped or harmed for erenumab 70 mg were 143 and 167, and 42 and 167 for erenumab 140 mg. Likelihoods of being helped or harmed in chronic migraine were 2 and 3 for topiramate (two studies) and 4 for onabotulinumtoxinA. In episodic migraine, likelihoods of being helped or harmed were 2 for topiramate and 2 for propranolol.

Conclusions

While all prophylactic treatments were more likely to help than harm (likelihood of being helped or harmed > 1), erenumab showed a likelihood of being helped or harmed of high magnitude, supporting its favorable benefit-risk profile across the entire migraine frequency spectrum, in contrast with other prophylactic treatments.
Using Deep Learning in Severity Analysis of At-Fault Motorcycle Rider Crashes
Authors: Das Subasish , Dutta Anandi , Dixon Karen , Minjares-Kyle Lisa , Gillette George
Published: September 2018

Motorcyclists are vulnerable highway users. Unlike passenger vehicle occupants, motorcycle riders do not have either protective structural surrounding or the advanced restraints that are mandatory safety features in cars and light trucks. Per vehicle mile traveled, motorcyclist fatalities occurred 27 times more frequently than passenger car occupant fatalities in traffic crashes. In addition, there were 4,976 motorcycle crash-related fatalities in the U.S. in 2014—more than twice the number of motorcycle rider fatalities that occurred in 1997. It shows that, in addition to current efforts, research needs to be conducted with additional resources and in newer directions. This paper investigated five years (2010–2014) of Louisiana at-fault motorcycle rider-involved crashes by using deep learning, which is a competent tool for mapping a high-multidimensional input into a smaller multidimensional output. The current study contributes to the existing injury severity modeling literature by developing a deep learning framework, named as DeepScooter, to predict motorcycle-involved crash severities. The final deep learning model can predict severity types with 100% accuracy with training data, and with 94% accuracy with test data, which is not attainable by using a statistical method or machine learning algorithm. The intensity of severities was found to be more likely associated with rider ejection, two-way roadways with no physical separation, curved aligned roadways, and weekends. It is anticipated that the DeepScooter framework and the findings will provide significant contributions to the area of motorcycle safety.
Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination
Authors: Hippensteel K.J. , Brophy Robert , Smith Matthew , Wright Rick
Published: September 2018

Background:

High-grade acromioclavicular (AC) joint separations are relatively rare injuries that are often treated surgically, yet more information is needed about the risks of various surgical procedures in terms of considering and counseling patients regarding operative versus nonoperative treatment.

Purpose:

To calculate whether the volume of surgical treatment of AC joint separations increased over a recent 12-year period; to examine the nature and frequency of complications, reoperations, and readmissions associated with these procedures; and to assess whether patient- and surgeon-specific factors or surgical technique affected these rates.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The American Board of Orthopaedic Surgery (ABOS) database for orthopaedic surgeons taking the Part II examination was reviewed from 2005 to 2016 to identify surgical treatment of AC joint separations. The authors calculated the percentage of all surgical cases in the ABOS database and rates of complications, reoperations, and readmissions. Association of these sequelae with patient- and surgeon-specific factors and surgical techniques was assessed.

Results:

There was no difference in the number or percentage of cases per year over the study period. There was an overall complication rate of 24.5%, a reoperation rate of 7.3%, and a readmission rate of 1.9%. Patients ≥40 years of age had significantly higher complication, reoperation, and readmission rates as compared with patients <40 years of age. There were significant differences in complication, reoperation, readmission, and displacement rates dependent on the type of surgical procedure performed. The highest complication rates were seen with open suspensory fixation, screw fixation, open reduction internal fixation, and arthroscopic coracoclavicular ligament repair or reconstruction. The highest reoperation rates were seen with screw fixation, open reduction internal fixation, and open suspensory fixation.

Conclusion:

The volume of surgical treatment for AC joint separations did not change significantly over the study period. Complication, reoperation, and readmission rates were dependent on the type of surgical procedure performed and patient age. This information should assist surgeons in discussing risks when considering and counseling patients regarding operative versus nonoperative treatment.
Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions
Authors: Bell Jacob , Goyal Munish , Long Sallie , Kumar Anagha , Friedrich Joseph , Garfinkel Jonathan , Chung Suzi , Fitzgibbons Shimae
Published: September 2018

Background:

Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients.

Methods:

A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified.

Results:

In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications.

Conclusions:

These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.
Management of Tumor Necrosis Factor α Inhibitor Therapy After Renal Transplantation: A Comparative Analysis and Associated Outcomes
Authors: Quinn Caroline S. , Jorgenson Margaret R. , Descourouez Jillian L. , Muth Brenda L. , Astor Brad C. , Mandelbrot Didier A.
Published: September 2018

Background: Biologic agents inhibiting the tumor necrosis factor α pathway (TNFα-Is) are used to treat systemic inflammatory diseases. The best management of these agents after renal transplantation is unknown. Objective: Evaluate peritransplant use of TNFα-Is and associated outcomes. Methods: Retrospective, single-center study of adult renal-transplant-recipients (RTRs) transplanted between 1/1/1998-12/31/2017, who received TNFα-Is for inflammatory disease prior to transplant. Qualifying patients were divided into 2 cohorts: patients who resumed TNFα-Is after transplant and those who did not. Outcomes were evaluated. Results: A total of 5256 renal transplants occurred in the study window; 14 patients met inclusion criteria. Primary indication for TNFα-I was Crohn’s-disease (CD; 57.1%). Infliximab was utilized most frequently (50%). Seven RTRs resumed TNFα-I posttransplant; mean time to resumption of 10.6±4.35 months (median=6 months), 85.7% for CD. Immunosuppression was modified in 2 patients (28.6%) in response to restarting TNFα-I therapy. Seven RTRs did not resume TNFα-Is following transplant; the majority of these had rheumatic diseases. There was no significant difference in time to first bacterial or fungal infection, rejection, or patient survival between the 2 groups. Last measured estimated glomerular-filtration-rate was similar between groups (TNFα-I: 41 ± 14.2 vs 48.6 ± 8.6, P = 0.25). No patient had cytomegalovirus infection; however, 42.8% of each cohort had documented BK virus infection. Malignancy occurred more frequently in the cohort that resumed TNFα-Is (42.8% vs 14.3%, P = 0.24); however, this was not statistically significant. Conclusion and Relevance: TNFα-I therapy prior to renal-transplant is relatively uncommon. The decision to continue therapy after transplant must balance risks of infection and malignancy against inflammatory disease recurrence. A multidisciplinary treatment approach is necessary as use of TNFα-I affects immunosuppressive management and appears to affect transplant outcomes. Future studies are needed to further clarify the role of TNFα-I therapy use in RTRs with inflammatory disorders focusing on its correlation with both BK and malignancy.
Autoethnography and Activism: Movement, Intensity, and Potential
Authors: Gale Ken , Wyatt Jonathan
Published: September 2018

In this short article, we pay attention to what an autoethnography might do. In relationality, we understand autoethnographic practices as assembling and dissembling bodies that are active in always territorializing space and in world making. They have the capacity to affect and be affected and, therefore, as performing and performative practices, they act and are acted upon. With Madison, we see these acts as activist, and we, therefore, see autoethnographic practice as always shifting, always about movement, intensity, and potentiality; it never resides, it lives in the creation of the next moment, the next step into the not yet known.
Exploring ambivalent oxygen machine–people–world relations through the lens of postphenomenology
Authors: Wainwright Megan
Published: September 2018

Technologies for medicinal oxygen delivery at home are increasingly part of the global health technology landscape in the face of rising rates of chronic lung and heart diseases. From the mere notion of harvesting and privatizing oxygen from the atmosphere to its status as both dangerous and therapeutic, and finally to its capacity to both extend and limit life, oxygen as therapy materializes its status as an ambivalent object in global health. This analysis of ethnographic material from Uruguay and South Africa on the experience of home oxygen therapy is guided by philosopher Don Ihde’s postphenomenology – a pragmatic philosophical approach for analysing the relationships between humans and technologies. Participants related to their oxygen devices as limiting-enablers, as markers of illness and measures of recovery, and as precious and limited resources. Oxygen was materialized in many forms, each with their own characteristics shaping the ‘amplification/reduction’ character of the relationship as well as the degree to which the devices became ‘transparent’ to their users. Ihde’s four types of human–technology relations – embodiment, hermeneutic, alterity and background relations – are at play in the multistability of oxygen. Importantly, the lack of technological ‘transparency’, in Ihde’s sense of the term, reflects not only the materiality of oxygen but inequality too. While postphenomenology adds a productive material and technological flavour to phenomenology, the author argues that a critical postphenomenology is needed to engage with the political-economy of human–oxygen technology relations.
Weight concerns as a predictor of smoking cessation according to nicotine dependence
Authors: Tuovinen Eeva-Liisa , Saarni Suoma E. , Kinnunen Taru H. , Ollila Hanna , Ruokolainen Otto , Patja Kristiina , Männistö Satu , Jousilahti Pekka , Kaprio Jaakko , Korhonen Tellervo
Published: September 2018

Background:

Nicotine-dependent smokers find it difficult to quit smoking. Additionally, smoking-specific weight concerns may affect smoking cessation although the evidence is controversial. We investigated whether smoking-specific weight concerns predict the probability of cessation and, if so, whether the effect varies according to the level of nicotine dependence.

Methods:

The study was conducted with a population-based sample of 355 adult daily smokers who participated in the baseline examination in 2007 and in the 2014 follow-up. Baseline nicotine dependence was classified as low or high (Fagerström Test for Nicotine Dependence; 0–3 vs. 4–10 points). Within these groups, we examined whether baseline weight concerns predict smoking status (daily, occasional, ex-smoker) at follow-up by using multinomial logistic regression with adjustment for multiple covariates.

Results:

Among low-dependent participants at baseline, 28.5% had quit smoking, while among highly dependent participants 26.1% had quit smoking. The interaction between weight concerns and nicotine dependence on follow-up smoking status was significant. Among participants with low nicotine dependence per the fully adjusted model, greater weight concerns predicted a lower likelihood of both smoking cessation (relative risk ratio 0.93 [95% CI 0.87–1.00]) and smoking reduction to occasional occurrence (0.89 [95% CI 0.81–0.98]). Weight concerns were not associated with follow-up smoking status among participants with high nicotine dependence.

Conclusions:

Weight concerns are associated with a smaller likelihood of quitting among smokers with low nicotine dependence. Weight concerns should be addressed in smoking cessation interventions, especially with smokers who have low nicotine dependence.
“They all have a different vibe”: A rhythmanalysis of climbing mobilities and the Red River Gorge as place
Authors: Rickly Jillian M
Published: September 2018

This article integrates a mobilities perspective and Lefebvre’s notion of rhythmanalysis as a means to interrogate place as an entanglement of mobilities, moorings, and rhythms. By investigating one popular rock climbing destination, this article demonstrates that mobilities invite encounters with and enactments of place such that travel rhythms, everyday rhythms, and natural rhythms coalesce, interrupt, and even emerge anew. Focusing on lifestyle rock climbers (a particular type of lifestyle mobility dedicated to the pursuit of climbing) and climbing events provides evidence for the ways informational and physical mobilities contribute to and even regiment rock climbing travel rhythms, while the everyday rhythms of place illustrate embodiment as crucial to the enfolding of rhythm and mobilities. Building from Lefebvre’s theory of rhythm and Edensor and Holloway’s re-articulation of its potential for mobilities studies, this article emphasizes the ongoing relationality of embodied mobilities and bodily rhythms, seasonal rhythms and informational mobilities, collective mobilities and institutional rhythms.
Explaining the Offending Behaviour of Young People on Educational Programmes Incarcerated in Educational Institutions in Vietnam
Authors: Hayden Carol , Nguyen Hai Ngoc , Twigg Liz
Published: September 2018

This article is based on original research in Vietnam and is focused on explaining the offending behaviour of young people on educational programmes incarcerated in educational institutions. The primary research includes a self-report survey of young people in custody (n = 2009) in the four national educational institutions as well as interviews with young people (n = 98) and staff (n = 34). The research concludes that the interaction of problematic family circumstances; community-based issues – specifically on-line gaming; and individual disposition, within a context of the problems created by rapid socio-economic change, explains the offending of these young people.
A Novel In-Home Relapse Prevention Treatment for Anorexia Nervosa
Authors: Sproch Laura Elizabeth , Anderson Kimberly Peddicord
Published: September 2018

Anorexia nervosa (AN) is a difficult-to-treat mental illness associated with dangerous behavioral symptomatology. Interventions that augment the outcomes of existing inpatient and outpatient protocols for AN are critically needed. In-home treatments that address environmental change as a means to further promote behavior change have been applied for the care of multiple behaviorally based psychiatric illnesses, but not for eating disorders. The present study outlines the pilot application of a posthospitalization, four-session in-home relapse prevention treatment for a woman with a long history of AN. Over a 1-, 3-, and 6-month follow-up period, the patient exhibited substantial improvements in eating disorder symptomatology, sustained a healthy body mass index, and maintained positive environmental changes made by the end of treatment. The treatment was feasible and readily accepted by the patient. These positive findings suggest that more formalized research to further evaluate this novel adjunctive treatment for AN is warranted.
Interferon-α Combined With Herbal Compound “Songyou Yin” Effectively Inhibits the Increased Invasiveness and Metastasis by Insufficient Radiofrequency Ablation of Hepatocellular Carcinoma in an Animal Model
Authors: Zhang Ning , Wang Long-Rong , Li Dou-Dou , Ma De-Ning , Wang Cheng-Hao , He Xi-Gan , Gao Dong-Mei , Wang Lu , Tang Zhao-You
Published: September 2018

Objective: We had previously proved that insufficient radiofrequency ablation (RFA) could enhance invasiveness and metastasis of hepatocellular carcinoma (HCC) through epithelial-mesenchymal transition (EMT), which is mediated by activating β-catenin signaling. Thus, the aim of the present study was to demonstrate whether the combined treatment of interferon-α (IFN-α) and “Songyou Yin” (SYY) minimizes the pro-metastatic effects of insufficient RFA, as well as to explore its underlying mechanism. Methods: Insufficient RFA was performed in an orthotopic nude mice model of HCCLM3 with high metastatic potential. The effects of IFN-α, SYY, and combined IFN-α and SYY were observed in the animal model. Tumor sizes, lung metastasis, and survival time were assessed. Immunochemistry staining, real-time polymerase chain reaction, and Western blot were used to examine gene expression related to metastasis and angiogenesis in residual cancer after insufficient RFA. Results: For up to 8 weeks of treatment, the combined therapy significantly decreased the residual cancer sizes, minimized the lung metastasis rate, and prolonged the survival time of nude mice, which might be due to suppression of the EMT via β-catenin signal blockade, in addition to attenuating angiogenesis in residual cancer after insufficient RFA. Conclusion: IFN-α combined with SYY significantly weakened the enhanced metastatic potential of residual cancer after insufficient RFA by attenuating EMT, which is mediated through inhibiting activation of β-catenin. In addition, decreasing angiogenesis of residual cancer might also play a certain role.
Experience of Stress and Coping Strategies among Pastors’ Wives in China
Authors: Chan Kara , Wong Miranda
Published: September 2018

A qualitative study was conducted to examine the experience of stress and coping strategies among 15 pastors’ wives from a city in mainland China. Results indicated that nearly all interviewees experienced financial stress and loneliness, a phenomenon consistent with that seen in literature in the West. However, stress arising from role expectations among the spouses’ congregations was low. Most interviewees coped with stress through family and social support, as well as through praying.
Health Impacts of Low-Dose Ionizing Radiation: Current Scientific Debates and Regulatory Issues
Authors: Vaiserman Alexander , Koliada Alexander , Zabuga Oksana , Socol Yehoshua
Published: September 2018

Health impacts of low-dose ionizing radiation are significant in important fields such as X-ray imaging, radiation therapy, nuclear power, and others. However, all existing and potential applications are currently challenged by public concerns and regulatory restrictions. We aimed to assess the validity of the linear no-threshold (LNT) model of radiation damage, which is the basis of current regulation, and to assess the justification for this regulation. We have conducted an extensive search in PubMed. Special attention has been given to papers cited in comprehensive reviews of the United States (2006) and French (2005) Academies of Sciences and in the United Nations Scientific Committee on Atomic Radiation 2016 report. Epidemiological data provide essentially no evidence for detrimental health effects below 100 mSv, and several studies suggest beneficial (hormetic) effects. Equally significant, many studies with in vitro and in animal models demonstrate that several mechanisms initiated by low-dose radiation have beneficial effects. Overall, although probably not yet proven to be untrue, LNT has certainly not been proven to be true. At this point, taking into account the high price tag (in both economic and human terms) borne by the LNT-inspired regulation, there is little doubt that the present regulatory burden should be reduced.
Neural adaptive sliding mode controller for unmanned surface vehicle steering system
Authors: Wan Lili , Su Yixin , Zhang Huajun , Tang Yongchuan , Shi Binghua
Published: September 2018

Unmanned surface vehicle has the properties such as complexity, nonlinearity, time variability, and uncertainty, which lead to the difficulty of obtaining a precise kinematics model. A neural adaptive sliding mode controller for the unmanned surface vehicle steering system is developed based on the sliding mode control technique and the radial basis function neural network. In the new approach, two parallel radial basis function neural networks are used to reduce the influence of the system uncertainties and eliminate the dependency of the controller on the precise kinematics model of the system. Among these two radial basis function neural networks, one is used to approximate the unknown nonlinear yaw dynamics and the other is used to adjust the control gain as well as realize the variable gain sliding mode control. The weights of the two neural networks are trained online using the sliding surface variable and the control, where the Lyapunov method is used to derive the adaptive laws to ensure the stability of the whole closed-loop system. The proposed adaptive controller is suitable for the steering control at different cruising speeds with bounded external disturbances. The simulation results show that the proposed controller has a good control performance regarding the smooth control, fast response, and high accuracy.
Transformational leadership and group cohesion in sport: Examining the mediating role of interactional justice using a within- and between-team approach
Authors: Bosselut Grégoire , Boiché Julie , Salamé Bastien , Fouquereau Evelyne , Guilbert Laure , Serrano Oscar C
Published: September 2018

The present cross-sectional study aimed to investigate the mediating role of interactional justice, in the relationship between transformational leadership and cohesion in team sports. Multilevel Structural Equation Modeling was employed to test individual- and group-level models using a sample of 315 athletes from 25 team sports. The results suggest that interactional justice acts as a mediator in the relationship between transformational leadership and cohesion. Nevertheless, results are contingent on the level of analysis (i.e. individual- or group-level) and the specific dimension of interactional justice (i.e. interpersonal or informational justice). Implications for coaches are discussed.
First identification of a single amino acid change in the spike protein region of feline coronavirus detected from a coronavirus-associated cutaneous nodule in a cat
Authors: Osumi Takafumi , Mitsui Ikki , Leutenegger Christian M , Okabe Ryo , Ide Kaori , Nishifuji Koji
Published: September 2018

Case summary

A 32-month-old spayed female Singapura cat presented with a non-pruritic erythematous nodule on the upper lip. The cat also had multiple nodules in the liver but exhibited no other clinical signs consistent with classical feline infectious peritonitis (FIP), such as pleural effusion or ascites, uveitis or neurological symptoms. Histopathological and immunohistochemical analyses of the cutaneous nodule revealed pyogranulomatous dermatitis with intralesional macrophages laden with feline coronavirus (FCoV) antigen. Real-time reverse transcription (RT)-PCR of a cutaneous sample revealed a single nucleotide substitution in the spike protein gene of FCoV (mutation M1058L), which is consistent with an FCoV genotype commonly associated with FIP. The cat received a blood transfusion and supportive therapy, but the owner declined to continue the treatments owing to poor response. The cat was lost to follow-up 5 months after discharge.

Relevance and novel information

This report describes a case of a coronavirus-associated cutaneous nodule in which the evidence of amino acid changes in the spike protein gene identified by RT-PCR were consistent with an FCoV genotype commonly seen in cases of FIP. To the best of our knowledge, this is the first report of a case of cutaneous disease associated with the mutated FCoV that was confirmed by molecular diagnostic testing.
Addressing the Bottle Necks of Global Oral Health to Tackle the Growing Epidemic of Noncommunicable Diseases
Authors: Nandakumar Venkata Abinaya , Chattu Vijay Kumar , Kumary Soosanna , Naidu Rahul
Published: September 2018

Background:

Oral health touches every aspect of our lives and still it is been taken for granted. The access and affordability to oral health care services are very limited and expensive especially in developing countries.

Objectives:

The article highlights the importance of global oral health and how it can tackle the growing noncommunicable diseases (NCDs) epidemic. Dental caries remains a significant problem even among the developed nations affecting 60% to 70 % of the children. Oral cancers, Qat chewing, craniofacial anomalies, and dental trauma contribute significantly to the global burden of diseases. Despite the magnitude of oral illness, there is neglect in global oral health, resulting in lack of combined action and support within the arena.

Conclusions:

Oral conditions share many common risk factors with NCDs and are also affected by similar social determinants. The Political Declaration of the High-level Meeting on the prevention and control of NCDs recognizes that oral diseases pose a significant burden for many countries and these diseases also share common risk factors of NCDs and can benefit from the multisectoral and multipronged approaches to NCDs. To address the existing inequities and inequalities in oral health care services globally, it is vital to ensure coverage for the poor and disadvantaged populations.

Recommendations:

There is a great need to develop some measurable oral health goals for global comparison in order to track, reduce oral disease burden, and to promote good oral health thereby advancing global public health.
Shame Cultures, Fear Cultures, and Guilt Cultures: Reviewing the Evidence
Authors: Cozens Simon
Published: September 2018

Eugene Nida’s distinction between “shame cultures,” “fear cultures,” and “guilt cultures” has become a foundational assumption of the “global Gospel” / “honor-shame” streams of missiology. It is periodically necessary to test such assumptions, particularly in the light of later developments within the disciplines of anthropology and sociology and the availability of empirical evidence. I argue here that the shame/guilt division is not clearly demarcated and that subsequent critique has cast doubt on its validity as a categorical concept. Missiology operating under its assumptions needs to reflect both the conceptual complexity and the limited empirical evidence for such a distinction.
Total Ankle Arthroplasty Is Safer than Total Hip and Knee Arthroplasty
Authors: Bohl Daniel , Hamid Kamran , Holmes George , Lin Johnny , Lee Simon
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total hip and knee arthroplasty (THA and TKA) are performed far more commonly than total ankle arthroplasty (TAA), so patients and the orthopaedic community have a better understanding of the complication profile for THA and TKA than for TAA. The present study compares adverse event rates, the rate of blood transfusion, operative times, length of stay, and the rate of hospital readmission between TAA, THA, and TKA procedures.

Methods:

Patients were identified who underwent TAA, THA, or TKA during 2006-2016 as part of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Multivariate regression was used to compare TAA to THA and TKA in terms of adverse event rates, the rate of blood transfusion, operative times, length of stay, and the rate of hospital readmission. All analyses were fully adjusted for differences in baseline demographic, comorbidity, and procedural characteristics, including type of anesthesia. The level of significance was set at p<0.05.

Results:

A total of 138,325 patients were identified as having undergone THA, 223,587 TKA, and 839 TAA. The total complication rate was lower for TAA (2.98%) compared to THA (4.92%, p=0.011) and TKA (4.56%, p=0.049; Table 1). Similarly, the rate of blood transfusion was lower for TAA (0.48%) compared to THA (9.66%, p<0.001) and TKA (6.44%, p<0.001). Interestingly, operative time was approximately an hour longer for TAA (157.7 minutes) compared to THA (93.6 minutes, p<0.001) and TKA (93.7 minutes, p<0.001). Length of stay was approximately one day shorter for TAA (1.9 days) compared to THA (2.9 days, p<0.001) and TKA (3.0 days, p<0.001). Finally, the rate of readmission was lower for TAA (1.5%) compared to THA (3.7%, p=0.002) and TKA (3.4%, p=0.005).

Conclusion:

TAA is a relatively rare procedure to which patients may not have had much exposure. Patients considering TAA are more likely to have had exposure to more common procedures such as THA and TKA (through family, friends, their own procedures, etc.). Patients can be counseled that relative to THA and TKA, TAA is a safer procedure in the perioperative time frame, with significantly lower rates of adverse events, blood transfusion, additional surgery, and hospital readmission. Their procedures can be expected to take longer, but their hospital stays can be expected to be shorter.
Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty
Authors: Lachman James , Ramos Jania A. , Adams Samuel , Easley Mark , DeOrio James
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Metal component failure in total ankle arthroplasty(TAA) is difficult to treat. Traditionally, to an arthrodesis has been advocated. Revision TAA surgery has become more and more common with availability of revision implants and refinement of bone conserving primary implants. It this study, patient reported results and clinical outcomes are analyzed for patients undergoing revision total ankle arthroplasty.

Methods:

We retrospectively reviewed prospectively collected data on 45 patients (cases) with a mean age of 63.7 +/-10.2 years who developed loosening or collapse of either major metal component in the primary total ankle arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Prospectively collected patient reported outcomes measures including the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score, Visual Analog Scale (VAS), Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and the Foot and Ankle Outcomes Score (FAOS) questionnaires were collected. Clinical data was collected through thorough review of the electronic medical record to identify clinical failure defined as explant and second revision or conversion to arthrodesis or amputation.

Results:

The causes of failure of primary TAA in this study were aseptic loosening of both components (40%), talar component subsidence/loosening (37.7%), tibial loosening (8.8%), coronal talar subluxation (8.8%) and talar malrotation (2.2%). Twenty-four patients (53.3%) underwent revision of all components, nineteen (42.2%) just the talar and polyethylene components, and two (4.4%) the tibial and polyethylene components. The average time to revision was 5.56 years +/- 5.71 with a follow-up of 3.02 years +/- 1.25 after revision. Ten (22.2%) revision arthroplasties required further surgery; five required conversion to arthrodesis and five required second revision TAA. VAS scores, SF36 scores, SMFA scores, AOFAS Hindfoot scores, and FAOS all improved after revision surgery but took 2 years to reach scores comparable to 1 year after primary TAA.

Conclusion:

Clinical and patient reported results of revision ankle arthroplasty after metal component failure were comparable to those after primary ankle arthroplasty. In our series, 22.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prosthesis performed similarly when used in revision scenarios. Patients recovered faster from primary ankle arthroplasty when compared to revision ankle arthroplasty but all scores were comparable by the two-year follow-up visit after revision arthroplasty surgery.
Decreasing Postoperative Narcotic Utilization with the Use of Concentrated Bone Marrow Aspirate in First Metatarsophalangeal Joint Interposition Arthroplasty
Authors: Maccario Camilla , Aynardi Michael , Tan Eric , Schon Lew
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Interposition arthroplasty is an interim procedure for the treatment of first metatarsophalangeal osteoarthritis demonstrating excellent survivorship. The procedure is commonly performed at our institution and successful long-term results have been described. Furthermore, we have utilized concentrated, autologous, bone marrow aspirate (BMAC) to augment and accelerate patient recovery, decrease postoperative pain, reduce postoperative narcotic requirement, and improve tissue healing for a variety of ankle and foot pathology. The purpose of this study was to compare the early outcomes of interpositional arthroplasty with patients receiving BMAC augmentation versus controls and to evaluate postoperative analgesia and narcotic requirements.

Methods:

After IRB approval, patients undergoing interposition arthroplasty for hallux rigidus at our institution from 2009-2014 were identified. All cases were performed using autograft capsular interposition by a single surgeon. 18 BMAC cases with complete records were identified. These were matched to controls in a 1:1 manner by age, gender, and laterality. A retrospective analysis of prospectively collected data was performed. Demographics, clinical range of motion, complications, VAS scoring, FAAM, FFI, AOFAS scores were recorded and analyzed. Postoperative analgesia requirements, narcotic usage, and prescription data were collected. Follow-up was conducted at 2,6,12,24, & 52 weeks postoperatively. Time experiencing pain and time to achieve maximum functional satisfaction were recorded.

Results:

89% (32/36) of patients undergoing interposition arthroplasty were female, average age 58 years (range, 39-74). The average number of weeks experiencing pain, narcotic utilization, and time to achieve functional satisfaction was statistically lower in the BMAC group, 11 weeks (range, 6-24) versus controls, 27.4 weeks (range, 6-52), (p=0.001). The number of post-operative days of pain requiring narcotic analgesia was significantly lower in patients receiving BMAC 4.2 days (range, 1-14) compared to controls averaging 13.8 days (range, 2-48) (p=0.02). Both groups demonstrated improvements in pre- and postoperative VAS scores, increase in motion, SF-36, FAAM, FFI, and AOFAS scores at 52 week follow up. There were no failures and there was one superficial infection requiring oral antibiotics.

Conclusion:

This study confirms that patients undergoing interpositional arthroplasty demonstrate excellent clinical improvements in short-term follow-up with few complications. Moreover, augmentation of this procedure with BMAC results in a significant decrease in narcotic utilization and recovery time post-operatively. BMAC may be a useful adjunct in diminishing postoperative narcotics we prescribe to our patients.
Factors influencing medial sesamoid arthritis in patients with hallux valgus deformity
Authors: Choi Jun Young , Suh Jin Soo , Lee Dong Joo
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints.

Methods:

We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes.

Results:

The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P <0.001, 0.001. 0.006, respectively).

Conclusion:

Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis.
The modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion
Authors: Feng Shi-Ming
Published: September 2018

Category:

Lesser Toes

Introduction/Purpose:

To explore the surgical method of using the modified coughlin osteotomy for surgical treatment of high-grade tailor’s bunion and report the clinical outcomes

Methods:

From March 2013 to April 2015, the modified coughlin osteotomy was used for surgical treatment of high-grade tailor’s bunion. Twenty-two patients with 31 feet high-grade tailor’s bunion were hospitalized for treament in Xuzhou Central Hospital. There were 3 male (3 feet) and 19 female (28 feet) cases, aged 26 -78 years (mean 45.3y) old. The mean course of the painful bunionette disease was 6.7 years (range, 2 to 38 y). The average 4-5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 16.3°±5.1°, 10.7°±3.5° and 5.8°±2.6°, respectively. Main outcome measures included the 4-5 intermetatarsal angle, the fifth metatarsophalangeal angle, pain and appearance. Patients were scored using the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale.

Results:

All operations were performed with no complications. Primarily healing of the wound was achieved in all cases. All the patients were followed up for a mean time of 17.8 months (range, 6 to 30 months). The mean fracture healing time was 11.6 weeks(range, 6 to 14 weeks), X-ray photograph proved fracture healing with a good positoin.All the patients had satisfactory appearance and sensory function witout callosum and metastatic metatarsalgiaat the final follow-up. The preoperatively average 4- 5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 5.9°±1.6°, 6.1°±2.3° and 2.2°±1.2°, respectively. The mean AOFAS score was 89.0±8.4.

Conclusion:

The modified coughlin osteotomy is a safe and easy treatment option for the high-grade tailor’s bunion deformity and provides patient satisfaction results