bluuebunny/crossref_metadata_2025 huggingface dataset:
Alone at work: Isolation, competition and co-dependency in flexibilised retail
Authors: Arman Rebecka , Gillberg Nanna , Norbäck Maria
Published: July 2019

Previous studies of flexibilisation through employer-controlled flexible scheduling and off-site isolated work have shown how such practices have detrimental effects on workers’ wellbeing. This qualitative study, set in Swedish retail, adds to previous findings by showing how flexible scheduling practices that include irregular variation of work hours and headcount have consequences also for worker interaction in the workplace. Even on-site work can be experienced as isolating if workers are ‘spread too thin’ in efforts to reduce labour costs. Set in two different retail settings, the study demonstrates and discusses how inter-employee competition and co-dependency are created, respectively. The authors also discuss how the flexibilisation described in this study reduced possibilities for face-to-face meetings and communication between co-workers, between workers and managers, and between workers and union representatives. Finally, it is discussed how the kind of flexibilisation described in this study coincides with defeatism and barriers to collective voice as well as action.
Modified Minerva Cervical Thoracic Orthosis for Postoperative Management of Cricotracheal Resection
Authors: Baerg Timothy N. , Ha Jennifer F. , Christ Megan , Green Glenn E.
Published: July 2019

The worst complication of cricotracheal resection (CTR) is anastomotic dehiscence, and to limit it, postoperative management at Michigan Medicine included the use of a modified Minerva cervical-thoracic orthosis (MMCTO). To date, there has been no analysis of the risks and benefits of the brace’s use following CTR. We analyze this with our retrospective study. A search with the keywords “cricotracheal resection” and “laryngotracheal reconstruction” was performed in the Electronic Medical Record Search Engine to identify patients retrospectively. The Statistical Package for Social Sciences was used for analysis; t test, χ2, and Fisher exact tests were used to analyze data. Fifteen males and 13 females with a median age of 4 years were identified, and almost 2/3 had a supra- and/or infrahyoid release performed. Postoperatively, 12 had a Grillo stitch and an MMCTO for a mean of 7 days. Most had no complications, but the most common complications were agitation due to brace discomfort and skin irritation. The worst complication was stroke. Our MMCTO’s design allowed for better head and neck control with relative comfortability, and most patients had no complications with its short-term use. Our modification may be useful adjunct in the postoperative management.
Sedation with alfentanil versus fentanyl in patients receiving extracorporeal membrane oxygenation: outcomes from a single-centre retrospective study
Authors: Barker Mike , Dixon Alison A , Camporota Luigi , Barrett Nick A , Wan Ruth Y Y
Published: July 2019

Introduction:

In November 2016, our institution switched from alfentanil to fentanyl for analgesia and sedation in adult patients receiving extracorporeal membrane oxygenation. There is no published evidence comparing the use of alfentanil with fentanyl for sedation in extracorporeal membrane oxygenation patients. We conducted a retrospective observational study to explore any significant differences in patient outcomes or in the prescribing of adjunct sedatives before and after the switch.

Methods:

Patients were retrospectively identified from a prospectively recorded database of all patients who received extracorporeal membrane oxygenation at our institution between January 2016 and October 2017. Patients included those sedated with alfentanil or fentanyl. The total daily doses of intravenous opioids (alfentanil or fentanyl) were calculated for each patient, and the prescribing of adjunctive sedative or analgesic agents was recorded. Patient demographics, extracorporeal membrane oxygenation modality, clinical outcomes including mortality and length of intensive care and hospital stay were recorded.

Results:

A total of 174 patients were identified, 69 on alfentanil and 95 on fentanyl. There was no difference found between groups for mode of extracorporeal membrane oxygenation, age, Acute Physiology and Chronic Health Evaluation 2 score (APACHE II) and Charlson score, except for body mass index (p = 0.002). No differences in patient outcomes was observed between groups, although patients in the alfentanil group received a significantly higher median total daily dose of adjuvant sedatives (quetiapine (p = 0.016) and midazolam (p = 0.009)).

Conclusions:

No differences in patient outcomes were found between extracorporeal membrane oxygenation patients sedated with alfentanil compared with fentanyl. There was a statistically significant reduction in some adjunctive sedatives in patients managed with a fentanyl-based regimen. Prospective studies are required to confirm these results.
Comparing in-patient extracorporeal cardiopulmonary resuscitation to standard cardiac treatment group of extracorporeal membrane oxygenation patients: 8 years of experience at a single institution
Authors: Liem Spencer , Cavarocchi Nicholas C , Hirose Hitoshi
Published: July 2019

Introduction:

Post-cardiac arrest survivals remain low despite the effort of cardiopulmonary resuscitation. Utilization of extracorporeal membrane oxygenation during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation) can provide immediate cardiovascular support and potentially improve outcomes of patients with cardiac arrest requiring cardiopulmonary resuscitation. There is renewed interest in the use of extracorporeal cardiopulmonary resuscitation due to improved outcomes over the years.

Methods:

Extracorporeal membrane oxygenation data between 2010 and 2018 were reviewed. Patients with extracorporeal membrane oxygenation placed under cardiopulmonary resuscitation were identified, and demographics, extracorporeal membrane oxygenation survival, survival to discharge, and neurological recovery were retrospectively analyzed with institutional review board approval.

Results:

Among 230 cases of extracorporeal membrane oxygenation, 34 (21 males and 13 females, age of 49 ± 13 years) underwent extracorporeal cardiopulmonary resuscitation. The mean duration of extracorporeal membrane oxygenation support after extracorporeal cardiopulmonary resuscitation was 8.3 ± 7.9 days. Extracorporeal membrane oxygenation mortality among extracorporeal cardiopulmonary resuscitation patients was 32% (11/34) and hospital survival was 38% (13/34), which are similar to standard cardiac extracorporeal membrane oxygenation (extracorporeal membrane oxygenation survival 62% and hospital survival 39% in cardiac extracorporeal membrane oxygenation). Among the extracorporeal membrane oxygenation death after extracorporeal cardiopulmonary resuscitation, the majority was due to neurological injury (73%, 8/11); 8/34 extracorporeal membrane oxygenation survival rate and 30-day survival rate were 63% and 25% in early half of study (2010-2014) and have improved to 70% and 60% in late half of study (2014-2018).

Conclusion:

Over years of experience with extracorporeal membrane oxygenation, the outcome of the extracorporeal cardiopulmonary resuscitation has been improving and appears to exceed those of traditional methods, despite limited sample size. Neurological complications still need to be addressed in order for survival and outcomes to improve.
Comparison of three pressure monitors used to measure interface pressure under compression bandages
Authors: Ning Junjie , Fish John , Trinh Felix , Abbas Jihad , Seiwert Andrew , Lurie Fedor
Published: July 2019

Background

Measuring the interface pressure produced by compression therapy devices is essential for research and clinical practice. New user-friendly measuring devices, such as Smart Sleeve Pressure Monitor (SSPM) and Juzo Pressure Monitor (JPM) allow longitudinal pressure measurement. However, their accuracy and agreement with well-established usage of the PicoPress (PP) are unknown. The aim of this study is to investigate measurement accuracy of PP, SSPM, and JPM.

Methods

The three devices were tested in 10 healthy volunteers by applying incrementally increasing pressure from 20 mm Hg to 50 mm Hg using a calibrated sphygmomanometer cuff. The linearity of the response and measurement accuracy were compared among the three devices. In a separate experiment, the three devices were compared by simultaneously recording the interface pressure under bandages immediately after bandaging and after 4 h of wearing the bandage.

Results

PP had the best performance with the reference of sphygmomanometer, while JPM had better linearity and accuracy than SSPM. The mean difference in the interface pressure under bandages was +13.36 mm Hg between SSPM and PP, and +0.50 mm Hg between JPM and PP. The 95% limits of agreement were −13.92 and +40.64 mm Hg, and −19.83 and +20.84 mm Hg, respectively.

Conclusions

JPM showed better agreement with both sphygmomanometer and PP compared to SSPM. JPM is a reasonable alternative for monitoring interface pressure continuously.
Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis
Authors: Ribeiro André Filipe , Martins Pereira Sandra , Gomes Barbara , Nunes Rui
Published: July 2019

Background:

Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care.

Aim:

To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration.

Design:

A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676).

Data sources:

Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.’s tool was used for quality appraisal.

Results:

A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients’ comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units.

Conclusion:

This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients’ comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.
NGOs, Controversies, and “Opening Up” of Regulatory Governance of Science in India
Authors: Pandey Poonam , Sharma Aviram
Published: July 2019

Nongovernmental organizations (NGOs) and scientific controversies are often the common denominators in most of the cases that have significantly shaped science and society relationships in the Global South during the past two decades. National and international NGOs and their network have often facilitated the “opening up” of regulatory governance in multiple sectors. This article draws from three cases—the bottled water controversy, the agribiotechnology debates, and the nanotechnology initiatives—and charts out the role of the NGOs and controversies in (re)defining the science-society relationship in India. The three cases illustrate how NGOs and controversies by their presence or absence at various stages of technology development shape the regulation-making exercise and the overall regulatory governance of science and technology.
microRNA-367-3p regulation of GPRC5A is suppressed in ischemic stroke
Authors: Tabet Fatiha , Lee Seyoung , Zhu Wanying , Levin Michael G , Toth Cynthia L , Cuesta Torres Luisa F , Vinh Antony , Kim Hyun Ah , Chu Hannah X , Evans Megan A , Kuzmich Meaghan E , Drummond Grant R , Remaley Alan T , Rye Kerry-Anne , Sobey Christopher G , Vickers Kasey C
Published: July 2019

Ischemic stroke is a major cause of mortality and long-term disability with limited treatment options, and a greater understanding of the gene regulatory mechanisms underlying ischemic stroke-associated neuroinflammation is required for new therapies. To study ischemic stroke in vivo, mice were subjected to sustained ischemia by intraluminal filament-induced middle cerebral artery occlusion (MCAo) for 24 h without reperfusion or transient ischemia for 30 min followed by 23.5 h reperfusion, and brain miRNA and mRNA expression changes were quantified by TaqMan OpenArrays and gene (mRNA) expression arrays, respectively. Sustained ischemia resulted in 18 significantly altered miRNAs and 392 altered mRNAs in mouse brains compared to Sham controls; however, the transient ischemic condition was found to impact only 6 miRNAs and 126 mRNAs. miR-367-3p was found to be significantly decreased in brain homogenates with sustained ischemia. G protein-coupled receptor, family C, group 5, member A ( Gprc5a), a miR-367-3p target gene, was found to be significantly increased with sustained ischemia. In primary neurons, inhibition of endogenous miR-367-3p resulted in a significant increase in Gprc5a expression. Moreover, miR-367-3p was found to be co-expressed with GPRC5A in human neurons. Results suggest that loss of miR-367-3p suppression of GPRC5A may contribute to neuroinflammation associated with ischemic stroke.
Hyperemia in subarachnoid hemorrhage patients is associated with an increased risk of seizures
Authors: Alkhachroum Ayham , Megjhani Murad , Terilli Kalijah , Rubinos Clio , Ford Jenna , Wallace Brendan K , Roh David J , Agarwal Sachin , Connolly E Sander , Boehme Amelia K , Claassen Jan , Park Soojin
Published: July 2019

The association between impaired brain perfusion, cerebrovascular reactivity status and the risk of ictal events in patients with subarachnoid hemorrhage is unknown. We identified 13 subarachnoid hemorrhage (SAH) patients with seizures and 22 with ictal-interictal continuum (IIC), and compared multimodality physiological recordings to 38 similarly poor-grade SAH patients without ictal activity. We analyzed 10,179 cumulative minutes of seizure and 12,762 cumulative minutes of IIC. Cerebrovascular reactivity (PRx) was not different between subjects with seizures, IIC, or controls. Cerebral perfusion pressure (CPP) was higher in patients with seizures [99 ± 6.5, p = .005] and IIC [97 ± 8.5, p = .007] when compared to controls [89 ± 12.3]. DeltaCPP, defined as actual CPP minus optimal CPP (CPPopt), was also higher in the seizure group [8.3 ± 7.9, p = .0003] and IIC [8.1 ± 10.3, p = .0006] when compared to controls [−0.1 ± 5]. Time spent with supra-optimal CPP was higher in the seizure group [342 ± 213 min/day, p = .002] when compared to controls [154 ± 120 min/day]. In a temporal examination, a supra-optimal CPP preceded increased seizures and IIC in SAH patients, an hour before and continued to increase during the events [ p < .0001].
Association of hemoglobin with incidence of in-hospital cardiac arrest in patients with acute coronary syndrome complicated by cardiogenic shock
Authors: Xu Tiancheng , Liang Dongjie , Wu Shengjie , Zhou Xiaodong , Shi Ruiyu , Xiang Wenhao , Zhou Jian , Wang Songjie , Shan Peiren , Huang Weijian
Published: July 2019

Objective

This study was performed to investigate the association of the admission hemoglobin level with the incidence of in-hospital cardiac arrest (IHCA) in patients with acute coronary syndrome (ACS) complicated by cardiogenic shock (CS).

Methods

In this retrospective study, we reviewed the medical records of consecutive patients with ACS complicated by CS admitted to the coronary care unit from January 2014 to October 2017. Logistic regression models were carried out to evaluate the association between hemoglobin and the incidence of IHCA. Interaction and subgroup analyses were also performed.

Results

In total, 211 patients were included in the study, and 61 (28.9%) patients developed IHCA. In the multivariable analysis, hemoglobin was a strong independent predictor of IHCA (odds ratio, 0.971; 95% confidence interval, 0.954–0.989). In the fully adjusted model, patients in the higher hemoglobin tertile were less likely to develop IHCA than patients in the lowest hemoglobin tertile (odds ratio, 0.194; 95% confidence interval, 0.071–0.530). The relationship remained stable in most subgroups except patients aged ≥70 years.

Conclusion

In patients with ACS complicated by CS, the incidence of IHCA is related to the hemoglobin concentration, and a high hemoglobin concentration is a protective factor against the development of IHCA.
MicroRNA expression profile is altered in the upper airway skeletal muscle tissue of patients with obstructive sleep apnea-hypopnea syndrome
Authors: Hou Jin , Zhao Lei , Yan Jing , Ren Xiaoyong , Zhu Kang , Gao Tianxi , Du Xiaoying , Luo Huanan , Li Zhihui , Xu Min
Published: July 2019

Objective

To investigate the involvement of microRNAs (miRNAs) in the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS).

Methods

In this study, we investigated miRNA profiles in the upper airway (UA) skeletal muscles of four patients with OSAHS and four matched controls using the miRCURY miRNA array. In another cohort of 12 OSAHS cases and 7 controls, the mRNA expression levels of interleukin (IL)-6 and Lin-28 homolog A (Lin28A), targets of the downregulated let-7 family members, were measured by real-time quantitative-PCR. The potential targets of the miRNAs were predicted by miRNA target prediction databases miRanda, Microcosm, and Targetscan.

Results

The array identified 370 differentially expressed miRNAs, of which 181 were upregulated and 189 were downregulated in OSAHS patients (based on a fold-change >2.0 and p < 0.05). Upregulation of IL-6 and Lin28A was validated by quantitative reverse transcription PCR. The 612 targets predicted by all three algorithms were subjected to gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The results revealed perturbations in signaling pathways and cellular functions.

Conclusion

This study demonstrated profoundly altered miRNA expression profiles in upper airway muscular tissues of patients with OSAHS, which might contribute to the formation and development of OSAHS.
Demystifying Urban Curbside Freight Management: Strategic Incremental Approach from Washington, D.C.
Authors: Dey Soumya S. , Pérez Benito O. , Richards Laura , Pochowski Alek , Sanders Meredyth , Darst Matt , Sanchez Eduardo Cardenas , Dock Stephanie
Published: July 2019

Loading zones and commercial vehicle activity are issues in cities across the country including the District of Columbia. Like other major U.S. cities, the District Department of Transportation (DDOT) has tried a variety of initiatives to alleviate the strain commercial vehicle activity places on the overall transportation system. These include metering or otherwise pricing loading zones and parking, expanding the size and increasing the number of loading zones, increasing the number of metered parking spaces, extending loading and metering time periods, simplifying and standardizing truck parking rules, and encouraging nighttime or off-peak goods delivery. These initiatives have had some success but a more targeted approach was needed, especially to address non-commercial vehicles parking in loading zones and thus pushing delivery vehicles to double park while loading and unloading. As part of the parkDC: Penn Quarter/Chinatown performance parking pilot, DDOT attempted to reduce the number of illegally parked cars blocking loading zones by raising prices to the highest prevailing rate on the blockface and increasing loading zone availability by extending the hours of operation of loading zones. Moving forward, DDOT has identified several next steps including: oversize/overweight vehicle routing, increased and targeted loading zone enforcement, increased disincentives for violations, data-driven modifications to the loading zone program, and modifications to the pay-by-cell program to mitigate non-trucks paying to park in loading zones. As gaps in understanding curbside movement close with increased data availability, the District expects the programs associated with curbside management to evolve to reflect smarter policy, program, and management practices.
Complex Tears, Extrusion, and Larger Excision Are Prognostic Factors for Worse Outcomes 1 and 2 Years After Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tears: A Secondary Explorative Study of the Surgically Treated Group From the Odense-Oslo Meniscectomy Versus Exercise (OMEX) Trial
Authors: Kise Nina Jullum , Aga Cathrine , Engebretsen Lars , Roos Ewa M. , Tariq Rana , Risberg May Arna
Published: July 2019

Background:

Few studies have examined morphological findings from preoperative magnetic resonance imaging (MRI) and arthroscopic findings as prognostic factors for outcomes 1 and 2 years after arthroscopic partial meniscectomy (APM).

Purpose/Hypothesis:

The purpose was to evaluate prognostic factors of preoperative findings from MRI and arthroscopic evaluation on lower extremity performance at 1 year and patient-reported outcomes at 1 to 2 years after APM. The hypothesis was that medial compartment abnormalities would be prognostic for 1- and 2-year functional outcomes.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This secondary analysis from the OMEX (Odense-Oslo Meniscectomy Versus Exercise) trial included 40 patients treated surgically. Regression analyses with adjustments for age, sex, and body mass index explored associations between MRI findings (tear complexity and extrusion), arthroscopic findings (tear length, cartilage injury, and amount of excised meniscal tissue), and the following: lower extremity performance tests and thigh muscle strength at 1 year and the 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at 1 and 2 years.

Results:

A complex meniscal tear was a significant and clinically relevant prognostic factor for worse KOOS Symptoms subscores at 2 years (mean, 14.1 points [95% CI, 6.1-22.2]). Meniscal extrusion of at least 11%, 25%, and 20% were significant and clinically relevant prognostic factors for worse KOOS Activities of Daily Living (ADL) subscores at 1 year and worse KOOS Sports and Recreation (Sports/Rec) subscores at 1 and 2 years, respectively. Tear lengths of at least 7.0 mm, 6.7 mm, and 6.5 mm were significant and clinically relevant prognostic factors for better KOOS Symptoms subscores at 1 year and better KOOS Sports/Rec subscores at 1 and 2 years, respectively. A cartilage injury in the medial compartment was a significant and clinically relevant prognostic factor for worse KOOS ADL and Quality of Life (QoL) subscores at 2 years (mean, 10.4 and 19.4 points, respectively [95% CI, 3.4-17.4 and 7.7-31.1, respectively]). More than 20% meniscal tissue excised was a significant and clinically relevant prognostic factor for worse KOOS Pain, Symptoms, ADL, and Sports/Rec subscores at 1 and 2 years (mean, 8.9-41.5 points [95% CI, 2.2-15.5 to 21.0-62.0]) and worse KOOS QoL subscores at 2 years (mean, 25.3 points [95% CI, 13.6-37.0]).

Conclusion:

Complex meniscal tears, larger extrusion, cartilage injuries, and larger meniscal excision were significant and clinically relevant prognostic factors for worse outcomes 1 and 2 years after APM.

Registration:

NCT01002794 (ClinicalTrials.gov identifier)
Osteochondral Autologous Transplantation Versus Dorsal Closing Wedge Metatarsal Osteotomy for the Treatment of Freiberg Infraction in Athletes: A Randomized Controlled Study With 3-Year Follow-up
Authors: Georgiannos Dimitrios , Tsikopoulos Kostas , Kitridis Dimitrios , Givisis Panagiotis , Bisbinas Ilias
Published: July 2019

Background:

Dorsiflexion closing wedge metatarsal osteotomy (DCWMO) has been considered the traditional treatment of Freiberg disease. Several case reports presented osteochondral autologous transplantation (OAT) as an alternative treatment.

Purpose/Hypothesis:

The purpose was to compare the results of DCWMO versus OAT for the treatment of Freiberg infraction in an athletic population. It was hypothesized that OAT was superior to DCWMO regarding functional outcomes, pain, and the time that the athletes returned to training and to previous sport level.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

Between 2008 and 2013, 27 consecutive patients with Freiberg disease were randomly assigned to either the DCWMO group (14 patients) or the OAT group (13 patients). The primary outcomes collected were as follows: postoperative complications, range of motion of the metatarsophalangeal joint, length of the metatarsal, function of the foot (measured with the American Orthopaedic Foot and Ankle Society–lesser metatarsophalangeal-interphalangeal [AOFAS-LMI] score), and pain (assessed with the visual analog scale–foot and ankle score).

Results:

Mean follow-up was 46 months (range, 36-60 months). The mean ± SD AOFAS-LMI score in the DCWMO group was 63.4 ± 14.4 preoperatively, 81.8 ± 6.6 at 1 year postoperatively, and 84.4 ± 5.6 at 3 years postoperatively, while in the OAT group, it was 62.8 ± 14, 89.9 ± 7.1, and 92 ± 6.9, respectively ( P < .001). The differences in the AOFAS-LMI scores favoring the OAT group at 1 and 3 years reached statistical but not clinical significance. The mean visual analog scale–foot and ankle score was improved significantly from 48.1 ± 11.5 to 91.8 ± 9.5 in the DCWMO group and from 49.9 ± 10.9 to 95.4 ± 4.4 in the OAT group. There was a shortening of the metatarsals by a mean 1.9 ± 0.5 mm in the DCWMO group, as opposed to a metatarsal lengthening of 0.2 ± 0.1 mm in the OAT group. In the OAT group, patients were able to start training at 6 ± 1 weeks ( P < .001) and return to full sport action at 10 ± 2.5 weeks ( P < .05), while in the DCWMO group, the time was 8 ± 1.5 and 13 ± 2.5 weeks, respectively.

Conclusion:

The authors concluded that OAT is equal to DCWMO. Acceptable clinical results were reported, as well as very low morbidity and early return to sport activities. That makes the OAT procedure a safe, effective, and optimal treatment for an athletic population experiencing Freiberg infraction.
Long-term discontinuation of antithrombotic therapy in patients with HeartMate II continuous-flow left ventricular assist device support
Authors: Schurr James W , Seifert Frank C , McLarty Allison J
Published: July 2019

Recurrent bleeding events are a common complication of left ventricular assist devices leading to significant morbidity. Clinicians may be reluctant to discontinue all antithrombotic therapies in this setting because of the risk of thrombotic events. To evaluate the safety of this strategy, we conducted a retrospective review of patients within our institution’s left ventricular assist device program from February 2010 to July 2018 who had all antithrombotic therapies discontinued in response to recurrent bleeding events requiring hospitalization. Thrombotic and bleeding outcomes after discontinuation of therapy were assessed and compared. Seven patients out of 87 (8%) were identified and included in this analysis. One patient experienced pump thrombosis in the setting of driveline infection with an overall rate of thrombotic events of 0.08 per-patient-year. Sixteen gastrointestinal bleeding events occurred after discontinuation of antithrombotic therapy (1.35 per-patient-year) compared with 37 prior to discontinuation (4.28 per-patient-year) resulting in a significant reduction (reduction rate = 0.32; 95% confidence interval = [0.17, 0.58]; p < .001). Thrombotic complications were rare among patients with HeartMate II left ventricular assist device support who suffered recurrent bleeding events and in whom antithrombotic therapy was, therefore, discontinued. Gastrointestinal bleeding was significantly reduced in this group; however, angioectasia-related gastrointestinal bleedings remained problematic.
URPE’s Early Years: A Personal Memoir
Authors: Benería Lourdes
Published: July 2019

In this memoir, I recollect key debates in URPE, how URPE helped me survive graduate school, and my experience as one of the few women in the early years of URPE.

JEL Classification: B3, Y9
Child Sexual Abuse among a Representative Sample of Quebec High School Students: Prevalence and Association with Mental Health Problems and Health-Risk Behaviors
Authors: Hébert Martine , Amédée Laetitia Mélissande , Blais Martin , Gauthier-Duchesne Amélie
Published: July 2019

Objective:

The objective of this study was to estimate the prevalence of child sexual abuse in a representative sample of Quebec high school youths and document its associations with mental health problems and health-risk behaviors.

Method:

Data were drawn from the Quebec Youths’ Romantic Relationships Survey, which involved a one-stage stratified cluster sampling of 34 Quebec high schools from Grades 10 to 12. A total of 8,194 youths (mean age = 15.35) were recruited. The survey assessed child sexual abuse, mental health problems (psychological distress, post-traumatic stress symptoms, suicidality), health services utilization, and health-risk behaviors (alcohol, drug, and cannabis use). Gender-stratified multivariate analyses were used to assess associations between child sexual abuse and mental health problems and health-risk behaviors while controlling for confounding demographic variables and other forms of child maltreatment experienced in childhood.

Results:

A total of 14.9% of girls and 3.9% of boys reported having experienced child sexual abuse. Child sexual abuse was independently associated with an increased risk of psychological distress, greater health services utilization, and increased health-risk behaviors, after controlling for other forms of childhood maltreatment experienced.

Conclusions:

Child sexual abuse is prevalent among youths in Quebec and is associated with an increased risk of a host of negative consequences. Continued efforts in the development of early detection strategies as well as prevention and intervention programs are warranted.
A Quasi-Experimental Analysis of the Adult Learning Effect on Problem-Solving Skills
Authors: Kim Suehye
Published: July 2019

This study builds an empirical research model that explores societal and individual antecedents of adult learning and examines the adult learning effect on problem-solving skills in the Organization for Economic Cooperation and Development (OECD) countries. Considering national differences, it uses multilevel data sources available from the Programme for the International Assessment of Adult Competencies (PIAAC) 2008-2013 and the OECD data lab. The results from this study suggest that young adults (25- to 34-year-olds) with more favorable backgrounds benefit from their social origin and occupational environment in terms of nonformal learning participation. It was also found that the participants outperform nonparticipants in the PIAAC problem-solving skill assessment. The key findings of this study advocate for the importance of policy interventions to combat the cumulative effects of multiple disadvantages in the educational trajectory from initial education to adult learning as well as to reduce the problem-solving skill gaps of young disadvantaged adults.
Diversity Issues and the Special Education Teaching Force: Advancing the Discussion
Authors: Voltz Deborah L.
Published: July 2019

This piece is a commentary on the papers included in the special issue on the racial/ethnic diversity of the special education teacher workforce.
Lessons learned from a health authority research capacity-building initiative
Authors: Trytten Cindy , Wale Martin , Hayes Michael , Holmes Bev
Published: July 2019

Health systems worldwide are under pressure to deliver better care to more people with increasingly complex needs within constrained budgets. Research capacity building has been shown to help alleviate these challenges and is underway at hospitals and health authorities across the country; however, approaches vary widely and little exists in the Canadian literature to share experience and best practices. This article describes how a health authority in British Columbia, Canada, implemented and evaluated a 5-year research capacity-building program in partnership with a provincial health research funder. We offer lessons learned for those leading similar innovation-focused change management initiatives, including vision and buy in, complexity thinking, infrastructure, leadership, and coalition development. We suggest that collective learning and building a more robust research capacity-building literature can help health organizations and their partners take significant steps toward integrating research and care for a more effective, efficient, and patient-centred health system.
Associations Between Reproductive Coercion, Partner Violence, and Mental Health Symptoms Among Young Black Women in Baltimore, Maryland
Authors: Alexander Kamila A. , Willie Tiara C. , McDonald-Mosley Raegan , Campbell Jacquelyn C. , Miller Elizabeth , Decker Michele R.
Published: July 2019

This study examined the associations of reproductive coercion (RC) with mental health of Black adolescent and young adult women. We tested RC as a predictor of depression and post-traumatic stress disorder (PTSD) symptoms. We also explored the interaction of exposure to RC and physical and sexual intimate partner violence (IPV) as they relate to depression and PTSD symptoms. A primarily community-based convenience sample of 188 self-identified Black women, aged 18 to 25 years, in Baltimore, Maryland, completed computer-based cross-sectional surveys. Lifetime RC (37.8%) and IPV (48.9%) were prevalent in this sample. Nearly 10% of the young women reported experiencing RC without IPV; 38% of the sample reported experiencing both types of violence. Depression (69%) and PTSD (47.1%) symptoms were more prevalent among women with RC than among women without RC. Adjusted results revealed RC and IPV were independently associated with depression (adjusted odds ratioRC = 2.86, 95% CI = [1.38, 5.94] and adjusted odds ratioIPV = 5.15, 95% CI = [2.47, 10.76]). Similarly, RC and IPV were independently associated with PTSD (adjusted odds ratioRC = 2.41, 95% CI = [1.15, 5.08] and adjusted odds ratioIPV = 3.04, 95% CI = [1.39, 6.63]). Findings suggest that RC and IPV independently contribute to mental health morbidities among this population of women. Current policies in health care practice increasingly recommend provision of screening for IPV, including RC. These practices should extend to women receiving services in community-based settings, thus strengthening the linkage to referral for further mental health treatment and victim service support. In the context of the social burdens affecting young Black women’s health, a comprehensive approach that integrates mental health and reproductive/sexual health care is essential for women reporting RC experiences.
A facile synthesis of soluble polyimides with high glass transition temperature and excellent mechanical properties due to intermolecular hydrogen bonds
Authors: Li Ke , Zhou Lan , Wu Simin , Yu Qiyu , Yang Long
Published: July 2019

An unsymmetrical heterocyclic diamine monomer containing proton donor (–NH–), 2-(4-aminophenyl)-5-aminobenzimidazole (PABZ), which can form hydrogen bond interactions with carbonyl functional group, was copolymerized with 4,4′-(hexafluoroisopropylidene)diphthalic anhydride (6FDA) and 2,2′-bis(trifluoromethyl)-4,4′-diaminobiphenyl (TFMB) through two-step synthetic methods to obtain a series of homo- and co-polyimide (PI). The corresponding homo- and co-PI both exhibited good solubility in aprotic polar solvents, such as N, N-dimethylacetamide, N-methyl-2-pyrrolidone, N, N-dimethylformamide, pyridine, and dimethyl sulfoxide. In addition, the PI-containing PABZ units showed excellent tensile strength ranging from 83 to 164 MPa, 130–260% higher than 6FDA/TFMB homo-PIa films. These PIs, especially PABZ/6FDA, showed very high glass transition temperatures, 430°C.
Tool wear and resulting surface finish during micro slot milling of polycarbonates using uncoated and coated carbide tools
Authors: Jahan Muhammad Pervej , Ma Jianfeng , Hanson Craig , Arbuckle Greg K
Published: July 2019

A growing application of polycarbonates is in the microfluidic disks and DNA detection devices, where surface finish of the micro-channels plays an important role. This study intends to investigate the tool wear and surface finish generated during micro slot milling of polycarbonate using uncoated, TiN-coated, and TiAlN-coated tungsten carbide tools. The effects of tool coating and the machining parameters on the possible reduction of tool wear and improvement of surface finish were investigated. It was found that with careful selection of cutting parameters and tool coating, micro-channels with smoother surface finish, minimum burrs around the edges, and controlled tool wear can be obtained using micro-milling. A combination of medium range of depth of cut and feed rate was found to improve the surface finish in polycarbonates, as well as minimize the tool wear. The TiAlN tool coating was found to only be effective in reducing tool wear without much effect on the machined surface. The adhesion was found to be the most dominating tool wear mechanism in uncoated carbide tool, followed by cutting edge chipping and tool nose’s plastic failure. The adhesion wear was found to be reduced in coated tools, especially in TiAlN-coated tools, although delamination wear started to dominate in the coated tools when higher feed rate and depth of cut were used. Both lower and higher of depths of cut were found to generate higher tool wear and leave traces of tool marks on the machined surface.
Aerodynamics of a two-dimensional flapping wing hovering in proximity of ground
Authors: Zheng Yunlong , Qu Qiulin , Liu Peiqing , Qin Yunpeng , Agarwal Ramesh K
Published: July 2019

The difference in aerodynamic forces of a two-dimensional flapping wing hovering in unbounded flow field and ground effect is studied. The unsteady laminar Navier–Stokes equations are solved by the finite volume method to simulate the flow field around the wing. In the unbounded flow field, the correspondence between the aerodynamic force, pressure distribution on wing, and typical vortex structures is established, and then the high-lift mechanism of the flapping wing is further explained. In the ground effect, based on the lift variation, the dimensionless height H/ C ( H is the height of the wing above ground and C is the chord length of the wing) can be divided into transition and ground effect regimes. In the transition regime ( H/ C > 2.5), the lift decreases with the decreasing height, and the ground indirectly impacts the vortices near wing by changing the shed vortices in space. In the ground effect regime ( H/ C < 2.5), the lift increases with the decreasing height, and the ground directly impacts the vortices near the wing.
A novel metamodel management strategy for robust trajectory design of an expendable launch vehicle
Authors: Roshanian J , Bataleblu AA , Ebrahimi M
Published: July 2019

Uncertainty-based design optimization has been widely acknowledged as an advanced methodology to address competing objectives of aerospace vehicle design, such as reliability and robustness. Despite the usefulness of uncertainty-based design optimization, the computational burden associated with uncertainty propagation and analysis process still remains a major challenge of this field of study. The metamodeling is known as the most promising methodology for significantly reducing the computational cost of the uncertainty propagation process. On the other hand, the nonlinearity of the uncertainty-based design optimization problem's design space with multiple local optima reduces the accuracy and efficiency of the metamodels prediction. In this article, a novel metamodel management strategy, which controls the evolution during the optimization process, is proposed to alleviate these difficulties. For this purpose, a combination of improved Latin hypercube sampling and artificial neural networks are involved. The proposed strategy assesses the created metamodel accuracy and decides when a metamodel needs to be replaced with the real model. The metamodeling and metamodel management strategy are conspired to propose an augmented strategy for robust design optimization problems. The proposed strategy is applied to the multiobjective robust design optimization of an expendable launch vehicle. Finally, based on non-dominated sorting genetic algorithm-II, a compromise between optimality and robustness is illustrated through the Pareto frontier. Results illustrate that the proposed strategy could improve the computational efficiency, accuracy, and globality of optimizer convergence in uncertainty-based design optimization problems.
Autoantibodies’ titre modulation by anti-BlyS treatment in systemic lupus erythematosus
Authors: Cavazzana I , Kumar R , Pozzari C , Ottaviani R , Fredi M , Piantoni S , Andreoli L , Tincani A , Franceschini F
Published: July 2019

Objective

The objective of this study was to analyse autoantibodies’ titres modulation during belimumab treatment in 50 patients with systemic lupus erythematosus (SLE).

Methods

Sera were collected at belimumab start (T0) and every six months until the 24th month. Disease activity index (SLEDAI-2K) was analysed at every timepoint. High avidity anti-dsDNA was detected by radioimmunological method, anti-ENA, anti-cardiolipin antibodies (aCL), anti-β2 glycoprotein I (anti-β2GPI) were analysed by ELISA.

Results

Fifty patients with SLE (mean SLEDAI-2K: 7.18 ± :3), mean age of 39 ± 11 years and mean follow-up of 13 ± 7.8 years were enrolled. A significant decrease of anti-dsDNA and anti-β2GPI IgM titres was observed at all timepoints. IgG aCL titre showed significant decrease only at T18. Anti-dsDNA negativization was detected in 21%, anti-β2GPI IgG in 33% and aCL IgG in 30% of sera, mostly at T6. Anti-ribosomal showed a significant titre decrease at T6 and T12, with negative seroconversion at T18. Anti-Sm titre significantly dropped down at T6, then remained stable during the time. Significant correlations were found between anti-dsDNA and anti-ribosomal titre and between SLEDAI ratio (SLEDAI value/SLEDAI T0) and anti-ribosomal titre ratio (value/value T0).

Conclusions

Belimumab treatment induced a significant reduction of SLE-specific autoantibodies titre and IgM anti-β2GPI. Anti-ribosomal titre decrease correlates with anti-dsDNA titre and disease activity improvement.
The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts
Authors: Frodlund M , Reid S , Wetterö J , Dahlström Ö , Sjöwall C , Leonard D
Published: July 2019

Background

Although the survival of patients with systemic lupus erythematosus (SLE) has improved, irreversible organ damage remains a critical concern. We aimed to characterize damage accrual and its clinical associations and causes of death in Swedish patients.

Methods

Accumulation of damage was evaluated in 543 consecutively recruited and well-characterized cases during 1998−2017. The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI) was used to estimate damage.

Results

Organ damage (SDI ≥ 1) was observed in 59%, and extensive damage (SDI ≥ 3) in 25% of cases. SDI ≥ 1 was significantly associated with higher age at onset, SLE duration, the number of fulfilled SLICC criteria, neurologic disorder, antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia, depression and secondary Sjögren's syndrome (SS). In addition, SDI ≥ 3 was associated with serositis, renal and haematological disorders and interstitial lung disease. A multiple regression model identified not only well-known risk factors like APS, antihypertensives and corticosteroids, but pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked to SDI. Malignancy, infection and cardiovascular disease were the leading causes of death.

Conclusions

After a mean SLE duration of 17 years, the majority of today's Swedish SLE patients have accrued damage. We confirm previous observations and report some novel findings regarding disease phenotypes and damage accrual.
Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response: a multicentre, retrospective cohort study in Japan
Authors: Nakano M , Kubo K , Shirota Y , Iwasaki Y , Takahashi Y , Igari T , Inaba Y , Takeshima Y , Tateishi S , Yamashita H , Miyazaki M , Sato H , Kanda H , Kaneko H , Ishii T , Fujio K , Tanaka N , Mimori A
Published: July 2019

Objective

The objective of this study was to investigate possible differences in treatment responses between two categories for the onset of lupus nephritis.

Methods

We performed a multicentre, retrospective cohort study of class III–V lupus nephritis patients diagnosed between 1997 and 2014. The renal responses to initial induction therapy were compared between patients who developed lupus nephritis within one year from diagnosis of systemic lupus erythematosus (early (E-) LN) and the remainder (delayed (D-) LN) using the Kaplan–Meier method. We determined the predictors of renal response as well as renal flares and long-term renal outcomes using multivariate Cox regression analyses.

Results

A total of 107 E-LN and 70 D-LN patients were followed up for a median of 10.2 years. Log-rank tests showed a lower cumulative incidence of complete response in D-LN compared with E-LN patients. Multivariate analysis identified D-LN (hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.33–0.70), nephrotic syndrome at baseline, and a chronicity index greater than 2 as negative predictors of complete response. D-LN patients were more likely to experience renal flares. D-LN (HR 2.54, 95% CI 1.10–5.83) and decreased renal function were significant predictors of chronic kidney disease at baseline.

Conclusion

D-LN was a predictor of poorer treatment outcomes, in addition to renal histology and severity of nephritis at lupus nephritis onset.