bluuebunny/crossref_metadata_2025 huggingface dataset:
Prioritizing and Funding Nepal’s Multisector Nutrition Plan
Authors: Pomeroy-Stevens Amanda , Shrestha Madhukar B. , Biradavolu Monica , Hachhethu Kusum , Houston Robin , Sharma Indu , Wun Jolene
Published: December 2016

Background:

Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed.

Objective:

We tracked the influence of Nepal’s multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016.

Methods:

This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews.

Results:

Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures all emerged as important factors within the enabling environment. Evidence suggests the MSNP influenced improvements in the last 3 factors. We also found notable increases in activities and financing for nutrition—allocations increased steadily between FY 2013–2014 and FY 2015–2016, and 28% of total nutrition allocations in the final year came from new or expanded MSNP-affiliated activities. Data from 3 districts highlight challenges linking local planning and budgeting to central-level structures.

Conclusions:

The MSNP appears to have strengthened the nutrition system in Nepal and increased priority and funding for nutrition. Next steps include strengthening linkages to the districts and below. Other countries can learn from the MSNP’s success in increasing investment for nutrition.
Laboring Under the Cross
Authors: Ban Zhuo
Published: December 2016

This study used Bakhtinean dialogism and contrapuntal analysis to examine how organizational identity in a Christian house church in China emerged through the interplay of competing discourses. I identified three sets of tensions: (a) religiosity versus secularity, (b) profit versus service, and (c) labor versus management. Church organizers and core members used many strategies to mitigate these tensions, including selection, separation, integration, and transcendence. Marginalized workers further complicated this discursive tension in resistance to a managerial monologue. The collective identity of the house church emerged from the interplay of competing discourses and was marked with complexity, contradictions, and dynamism. This research offers empirical evidence of how identity is constructed through interactions among diverse organizational members. It also contributes to the literature by focusing on the resistive voices of workers and subsequently expands the typology of tension management strategies beyond tension reduction and consent.
Shape optimization of a metallic flywheel using an evolutive system method: Design of an asymmetrical shape for mechanical interface
Authors: Pedrolli L , Zanfei A , Ancellotti S , Fontanari V , Benedetti M
Published: December 2016

In this work, a novel optimization approach is used to define the shape of a flywheel for energy storage. The procedure acts on a two-dimensional axisymmetric finite element method model, in which many parameters are used to describe the geometry. The optimization is performed by an evolutive system method, whereby the population’s genome is described with statistical quantities. An accurate definition of the fitness function allows for a broad spectrum of objectives. The evolution of the fitness value during population generation is discussed. The procedure does not benefit from parallelization: an alternative way of parallelizing the optimization process is presented, where the population is equally divided among the cores and calculated independently, allowing for an approximately linear performance scaling with the number of cores. The method is applied to the minimization of the mass in a flywheel for energy storage application, displaying great flexibility to the variation of the parameters describing the rotational speed, geometry constraints, and material properties. The true potential of the evolutive method is then demonstrated by optimizing an asymmetrical flywheel, where a mechanical interface lies on one side only. Usually additional parts are added manually on the optimized shape, increasing the thickness where necessary; this method permits to directly optimize to the final shape. The script used in this work is available upon request. Matlab and Ansys APDL software are needed.
Comparison of the road-holding abilities of a roll-plane hydraulically interconnected suspension system and an anti-roll bar system
Authors: Zhu Sangzhi , Xu Guangzhong , Tkachev Anton , Wang Lifu , Zhang Nong
Published: December 2016

This paper presents an investigation into the road-holding ability of a vehicle equipped with a roll-plane hydraulically interconnected suspension system. Ideally, the roll-plane hydraulically interconnected suspension system has the capability to decouple the roll mode from all the other vehicle suspension modes. However, anti-roll bars are unable to decouple the warp mode from the other modes, and therefore they limit the travel of the wheels and weaken the road-holding ability of a vehicle on uneven road surfaces. In this paper, vehicle dynamic analysis is carried out with three different configurations: a vehicle with only a spring–damper as a benchmark vehicle; a vehicle with a spring–damper in conjunction with anti-roll bars; a vehicle with a spring–damper in conjunction with a roll-plane hydraulically interconnected suspension. Simulations and corresponding experimental verification with different road excitations are then implemented. The experimental results agree well with the simulations under low-frequency road excitations. The results demonstrate that, when the vehicle undergoes off-road driving, the anti-roll bars weaken the road-holding ability of the vehicle while the hydraulically interconnected suspension system has a negligible effect.
The mother’s picong: A discursive approach to gender, identity and political leadership in Trinidad and Tobago
Authors: Esposito Eleonora
Published: December 2016

The Caribbean twin-island nation of Trinidad and Tobago entered a new era on 24 May 2010 by electing its first woman Prime Minister, Kamla Persad-Bissessar. Breaking out of the country’s rigid bipolar political mold, the East Indian Persad-Bissessar won a landslide victory as the leader of the People’s Partnership, a new coalition party that comprised both East Indian and African political forces and movements. Adopting a Discourse-Historical Approach, this study sets to analyze how Persad-Bissessar discursively constructed her claim to leadership in the election speeches of the 2010 We Will Rise Campaign. Both the processes of bonding with her electorate and demontage of her opponent Patrick Manning are achieved by Persad-Bissessar with careful linguistic choices, encompassing the use of the ritual picong satire and strategic switching to Trinidadian English Creole. This article investigates complexities, struggles and contradictions of the Trinbagonian political scene by integrating a detailed analysis of political discourse and the investigation of the social and political environment within which discourse as social practice is embedded.
Zinda Park: Rural Community Eco-park Complex in Bangladesh
Authors: Ahmed Jashim Uddin , Hoque Sabrina , Rubaiyat-i-Siddique  , Khan Nazmul A.
Published: December 2016

The rural and natural areas are diminishing with the flow of urbanization. Villages are being turned into metropolitan areas. The case focuses on Zinda Park rural community eco-park complex which is located near the capital, Dhaka, close to Purbachal which is a government project of Rajdani Unnayan Kartripakka (RAJUK). With the wave of development, the Zinda village where the park is located along with the other surrounding villages is affected by urbanization. The park was built with the motive of social welfare and the development of the livelihood of the local people. The article discusses how the community works and helps the society by sharing a certain portion of revenue generated from the park. Its aim is to save the environment by developing the social condition of the villagers and this was achieved through the strong determination of the founder(s). RAJUK has been trying to acquire the park along with the village with the purpose of development; however, the locals have voiced strong protest against it. This article also explains how the Zinda community eco-park complex survived these difficulties with help of the villagers and other stakeholders.
Electroelastic Green’s function of one-dimensional piezoelectric quasicrystals subjected to multi-physics loads
Authors: Wu Di , Zhang Liangliang , Xu Wenshuai , Yang Lianzhi , Gao Yang
Published: December 2016

Green’s functions of infinite and semi-infinite plane problems of one-dimensional quasicrystals with piezoelectric effect are obtained in a closed form by Stroh formalism. Some numerical examples under different loading conditions, such as line forces, line dislocations, and a line charge, are given to explain the mechanical and electric behaviors of the quasicrystals. Various elastic–electric constants of quasicrystals are analyzed and the coupling effects between the phonon and phason fields are studied. The presented solutions will be useful for many boundary value problems of one-dimensional quasicrystals with piezoelectric effect. Moreover, the numerical results can be used to verify the accuracy of the solutions by some numerical methods, such as the finite element and boundary element methods. Furthermore, the Stroh formalism can be generalized to the researches on more complex problems of quasicrystals.
Impact source identification for pipe structure based on a one-dimensional fiber Bragg grating sensor array
Authors: Lee Yeon-Gwan , Kim Chun-Gon
Published: December 2016

This article presents a spatial impact source identification based on a one-dimensional fiber Bragg grating sensor array for application in tubular structures. The effective number of sensors and the sensor arrangement method were investigated for the plumbing pipe structure as the application subject. The fiber Bragg grating sensors were used to determine the impact location via the signal processing of the measured acoustic emission signals with a sampling frequency of 100 kHz. The root mean squared value–based algorithm, which was newly verified for a stiffened composite structure, was employed to identify the impact source in this article. Impact source identification was implemented according to the sensor arrangement and number of sensors, which were selectively used on the pipe structure among six multiplexed fiber Bragg grating sensors in one optical fiber line. This process shows that impact location detection is possible with only a one-dimensional sensor array compared to the results of a two-dimensional sensor array. The impact location could be predicted within a maximum error range of 31.12 mm, even if only one sensor was used to identify the impact source.
Crime Control Measures, Individual Liberties, and Crime Rates
Authors: Albanese Jay
Published: December 2016

The balance between crime control methods and individual liberties is always problematic, creating tension, because in order to investigate crime, and adjudicate and punish offenders, it is necessary to make reasonable intrusions into the liberty of citizens. This study uses data from 40 countries to examine the crime control measures (police per capita and conviction rates) that reflect government investments in criminal justice apparatus to control crime and criminals, as well as the use of these crime control measures through government intervention in the lives of its citizens (formal citizen contacts with police, prosecution rate, and detention rate), to examine their impact on crime victimization rates (homicide rates and crimes included in the international crime victim survey). The purpose is to examine whether these government interventions have any impact on crime rates across countries, controlling other independent variables that might help to explain any observed relationships among these variables (such as measures of civil liberties, democracy, human development, available information and communications technologies, political rights, corruption perceptions, education, economic freedom, freedom of the press, and prosperity).
Accuracy and Measurement Error of the Medial Clear Space of the Ankle
Authors: Metitiri Ogheneochuko , Ghorbanhoseini Mohammad , Zurakowski David , Hochman Mary G. , Nazarian Ara , Kwon John Y.
Published: December 2016

Background:

Measurement of the medial clear space (MCS) is commonly used to assess deltoid ligament competency and mortise stability when managing ankle fractures. Lacking knowledge of the true anatomic width measured, previous studies have been unable to measure accuracy of measurement. The purpose of this study was to determine MCS measurement error and accuracy and any influencing factors.

Methods:

Using 3 normal transtibial ankle cadaver specimens, deltoid and syndesmotic ligaments were transected and the mortise widened and affixed at a width of 6 mm (specimen 1) and 4 mm (specimen 2). The mortise was left intact in specimen 3. Radiographs were obtained of each cadaver at varying degrees of rotation. Radiographs were randomized, and providers measured the MCS using a standardized technique.

Results:

Lack of accuracy as well as lack of precision in measurement of the medial clear space compared to a known anatomic value was present for all 3 specimens tested. There were no significant differences in mean delta with regard to level of training for specimens 1 and 2; however, with specimen 3, staff physicians showed increased measurement accuracy compared with trainees.

Conclusion:

Accuracy and precision of MCS measurements are poor. Provider experience did not appear to influence accuracy and precision of measurements for the displaced mortise.

Clinical Relevance:

This high degree of measurement error and lack of precision should be considered when deciding treatment options based on MCS measurements.
Sustainability in the Air: The Modernization of International Air Navigation
Authors: Lutte Rebecca K. , Bartle John R.
Published: December 2016

In a recent article in this journal, Leuenberger, Bartle, and Chen called for public administrators to take a new role, utilizing collaborative skills, to design implementable solutions to promote sustainability in transportation. We examine this call by exploring the case of an international aviation initiative. The International Civil Aviation Organization (ICAO) Aviation System Block Upgrades (ASBU) policy has been developed to provide a road map to modernize global air navigation. This article explores the case of the ASBU as an example of meeting the call for the new role for public administrators to implement sustainable practices. We find that this policy improves international air transportation sustainability in several dimensions, and that this approach is a model for implementing sustainable policies.
Effect of diabetes mellitus on walking distance parameters after supervised exercise therapy for intermittent claudication: A systematic review
Authors: Hageman David , Gommans Lindy NM , Scheltinga Marc RM , Teijink Joep AW
Published: December 2016

Some believe that certain patients with intermittent claudication may be unsuitable for supervised exercise therapy (SET), based on the presence of comorbidities and the possibly increased risks. We conducted a systematic review (MEDLINE, EMBASE and CENTRAL) to summarize evidence on the potential influence of diabetes mellitus (DM) on the response to SET. Randomized and nonrandomized studies that investigated the effect of DM on walking distance after SET in patients with IC were included. Considered outcome measures were maximal, pain-free and functional walking distance (MWD, PFWD and FWD). Three articles met the inclusion criteria ( n = 845). In one study, MWD was 111 meters (128%) longer in the non-DM group compared to the DM group after 3 months of follow-up ( p = 0.056). In a second study, the non-DM group demonstrated a significant increase in PFWD (114 meters, p ⩽ 0.05) after 3 months of follow-up, whereas there was no statistically significant increase for the DM group (54 meters). On the contrary, the largest study of this review did not demonstrate any adverse effect of DM on MWD and FWD after SET. In conclusion, the data evaluating the effects of DM on SET were inadequate to determine if DM impairs the exercise response. While trends in the data do not suggest an impairment, they are not conclusive. Practitioners should consider this limitation when making clinical decisions.
The making of mobilities in online work-learning practices
Authors: Thompson Terrie Lynn
Published: December 2016

In this study of mobilities of work-learning practices, I draw on sociomaterial theorizing to explore how the everyday work and learning practices of contingent workers are changing through the infusion of web and mobile technologies. I use Ingold’s notions of becoming and meshwork and Law’s work on collateral realities to explore curation of screens, different flows of mobilities and the importance of place to enact work-learning practices that move and mobilize. This study suggests that the making of mobilities is a fluid and provisional process that asks for a more thoughtful and critical posthuman reckoning with human–technology interactions on learning practices and spaces. I conclude with implications of these shifts in new mobilities of work-learning for workers and educators.
Addressing transnational needs through migration? An inquiry into the reach and consequences of migrants’ social protection across borders
Authors: Boccagni Paolo
Published: December 2016

This article draws a conceptual map of the mechanisms, dynamics and consequences of transnational social protection (TSP) for low-skilled labour migrants and their family members. While migrants’ social needs have also a transnational side, the responses of welfare institutions, if available at all, are typically territorialised. This brings to the fore the prospects for TSP of those affected by migration – most notably, here, migrants’ dear ones in home societies. TSP can be analysed as a field of evolving interactions between a formal, thinner dimension and a more substantive, informal one. The latter builds on the circulation of remittances and transnational care practices, primarily within migrants’ kinship networks. Informal TSP is then discussed as a privileged terrain to assess, first, the promises and pitfalls of migration as social protection and, second, the social consequences of emigration on welfare arrangements in home communities. An analytical framework is eventually advanced, with a view to systematising research on migration-driven transnational needs, on the ways of addressing them, on the dilemmas of informal social protection across state borders.
Development of a Nutrition Education Intervention for Food Bank Clients
Authors: Dave Jayna M. , Thompson Deborah I. , Svendsen-Sanchez Ann , McNeill Lorna Haughton , Jibaja-Weiss Maria
Published: December 2016

The focus of this article is the development of a nutrition education intervention for food bank clients. Formative research using mixed-methods (qualitative and quantitative) and community-based participatory research principles was conducted to assess the nutrition education needs of clients obtaining service from the Houston Food Bank (HFB). Participants were HFB and pantry staff and clients. Interview data were coded and analyzed using grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Data were used to tailor the curriculum to the target population. Six HFB staff, 49 pantry staff from 17 pantries, and 54 clients from 10 pantries participated in interviews and focus groups and completed questionnaires. The participants provided opinion on the current nutrition education provided via the food bank and made suggestions on strategies for development of an intervention. Their feedback was used to develop the six-session intervention curriculum to be delivered over 6 months. This research provides evidence that it is critical for members of the target audience be included in formative research to develop behavior change programs that are relevant and appealing and target their needs and interests.
Influence of a Moderate-Intensity Exercise Program on Early NK Cell Immune Recovery in Pediatric Patients After Reduced-Intensity Hematopoietic Stem Cell Transplantation
Authors: Chamorro-Viña Carolina , Valentín Jaime , Fernández Lucía , González-Vicent Marta , Pérez-Ruiz Margarita , Lucía Alejandro , Culos-Reed S. Nicole , Díaz Miguel Ángel , Pérez-Martínez Antonio
Published: December 2016

Introduction: After allogeneic hematopoietic stem cell transplantation (HSCT), NK cell reconstitution, which is crucial for positive outcomes, is dominated by the CD56bright subset with low NK cell cytotoxicity (NKCC) activity. Moderate exercise has been described as a potent NK cell stimulus in adults with cancer. Purpose: To determine the effects of a moderate-intensity exercise program on NK cell recovery early after HSCT and the feasibility of this intervention. Methods: Six children undergoing allogeneic HSCT were randomized to an exercise program (EP) or control (CT) group. The EP group performed a 10-week training combining in-hospital and home-based EP. Results: We observed a significant increase in the posttraining/pretraining ratio of the CD56dim subset (EP = 1.27 ± 0.07; CT = 0.99 ± 0.08; P < .005) of the EP group. The ratio of NKCC was 8 times greater in the EP group. Conclusion: Data suggest that a moderate-intensity EP program performed early after HSCT is feasible and might redistribute the CD56dim/CD56brigh NK cell subset, improving NKCC. The results are still preliminary and must be interpreted with caution.
A Comprehensive Lifestyle Randomized Clinical Trial: Design and Initial Patient Experience
Authors: Arun Banu , Austin Taylor , Babiera Gildy V. , Basen-Engquist Karen , Carmack Cindy L. , Chaoul Alejandro , Cohen Lorenzo , Connelly Lisa , Haddad Robin , Harrison Carol , Li Yisheng , Mallaiah Smitha , Nagarathna Raghuram , Parker Patricia A. , Perkins George H. , Reuben James M. , Shih Ya-Chen Tina , Spelman Amy , Sood Anil , Yang Peiying , Yeung Sai-Ching J.
Published: December 2016

Background: Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). Methods: CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. Results: Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions). Adherence to components of the behavior change intervention is high and compliance with the intensive amount of data collection is exceptional. Qualitative data collected from the participants reveals testimonials supporting the importance of the comprehensive nature of intervention, especially the mind-body/mindfulness component and social support, and meaningful lifestyle transformations. Conclusion: Conducting a comprehensive, multicomponent, lifestyle change clinical trial for women with breast was feasible and collection of biobehavioral outcomes successful. Adherence to behavior change was high and patient experience was overwhelmingly positive.
A Management Algorithm for Retained Rectal Foreign Bodies
Authors: Cawich Shamir O. , Thomas Dexter A. , Mohammed Fawwaz , Bobb Nahmorah J. , Williams Dorothy , Naraynsingh Vijay
Published: December 2016

Few authors have proposed therapeutic protocols to manage retained rectal foreign bodies (RFBs). All patients with retained RFBs in hospitals across Trinidad and Tobago over 5 years were identified. Hospital records were retrieved and manually reviewed to extract the following data: demographics, history, foreign body retrieved, clinical signs at presentation, management strategy, duration of hospitalization, and morbidity and mortality. There were 10 patients with RFBs over the study period. The annual incidence of this phenomenon was 0.15 per 100,000 population. All patients were men at a mean age of 50.6 years (range: 27-83; SD = 15.3) who presented after a voluntary delay of 1.4 days (range: 0.5-2.5; SD = 0.7). Only one patient gave an accurate history on presentation, but all eventually admitted to self-insertion for sexual gratification. At presentation, one patient had a spontaneous rectal perforation (10%). The remaining nine patients had attempts at bedside transanal extraction, which was unsuccessful in 89% (8/9) of cases. The RFB was pushed beyond the grasp of forceps, making removal under anesthesia unsuccessful in 62.5% (5/8) cases. These patients required more invasive extraction methods including transanal minimally invasive surgery (1), laparoscopic-assisted advancement with transanal retrieval (1), and open surgery with transmural extraction and anastomoses (3). A management algorithm is proposed for the management of RFBs. Important points in this algorithm are the importance of clinician–patient rapport, early surgical referral, avoidance of bedside extraction in the emergency room, early examination under anesthesia, and the inclusion of emerging therapies such as transanal minimally invasive surgery.
Changing the Paradigm of Cancer Screening, Prevention, and Treatment
Authors: Doss Mohan
Published: December 2016

The war on cancer has been fought during the past several decades primarily based on the somatic mutation model of cancer. This has resulted in the emphasis on cancer screening and elimination of any detected cancerous/precancerous cells as the primary method of cancer prevention. This approach has reduced mortality from some cancers, but age-adjusted cancer mortality rates continue to be high. The lack of significant progress in reducing cancer mortality rates may be indicative of a fundamental flaw in the cancer model used. An alternative model of cancer is the immune suppression model of cancer based on the tremendous increase in cancers when the immune system is suppressed. According to this model, the key carcinogenic event is the suppression of the immune system which enables the already existing covert cancers to grow uncontrollably, causing cancer. Hence, cancer screening would consist of identifying those with weak immune system response. The primary mode of cancer prevention and treatment would be boosting of the immune system, for example, through exercise, infection, and low-dose radiation, as they are all known to enhance immune system response and reduce cancers. There is sufficient evidence to justify clinical trials of this approach for cancer screening, prevention, and treatment.
Using Television-Viewing Hours and Total Hours Sitting as Interchangeable Measures of Sedentary Behavior
Authors: McGrane Minton Heather A. , Thevenet-Morrison Kelly , Fernandez I. Diana
Published: December 2016

Sedentary behaviors, activities spent sitting, or lying down during waking hours, are of significant public health importance. Television-viewing (TV-viewing) hours and total hours sitting are common self-report measures of sedentary behaviors. Given the widespread usage of these measures, the study purpose was to measure the concordance between TV-viewing hours and total hours sitting to determine whether they can be used as interchangeable measures of time spent in sedentary behavior. Using a sample (n = 2687) of workers from a group-randomized control trial, the current study assessed the concordance between weekday total hours sitting and TV-viewing hours. Tertiles were created based on the distribution of total hours sitting and TV-viewing hours. Weighted Kappa (Kappaw) statistics were calculated for the full sample and subgroups. Half of the sample reported 2 to 3 daily hours of TV-viewing hours and the most reported total hours sitting was 8 hours (14%). Kappaw statistics for tertiles of total hours sitting and TV-viewing hours were 0.005 (95% CI = −0.02 to 0.03), indicating little agreement. Kappaw statistics for subgroup analyses (body mass index categories, gender, and intervention assignment) showed poor agreement. Results do not support the use of total hours sitting and TV-viewing hours as interchangeable measures of sedentary behavior.
Onyx extravasation during embolization of a brain arteriovenous malformation
Authors: Ikeda Hiroyuki , Imamura Hirotoshi , Agawa Yuji , Imai Yukihiro , Tani Shoichi , Adachi Hidemitsu , Ishikawa Tatsuya , Mineharu Yohei , Sakai Nobuyuki
Published: December 2016

During Onyx embolization to treat brain arteriovenous malformation (AVM), carefully observing the penetration of Onyx to the nidus is important in order to avoid complications such as hemorrhage, ischemia, and difficulty with microcatheter removal. We encountered a case of Onyx extravasation during embolization of a cerebellar AVM confirmed by surgical resection and pathological analysis. The patient was a 44-year-old man with Spetzler-Martin grade I cerebellar AVM who underwent Onyx embolization prior to resection of the brain AVM. While injecting Onyx into the nidus using the “plug-and-push” technique, Onyx extravasation was observed. Onyx injection was paused and subsequently restarted, thereby allowing continuation of embolization. An oblate Onyx cast that was entirely covered in cerebellar tissue was removed during total resection of the AVM, performed the same day. The surgically removed oblate Onyx cast did not contain brain tissue or vessel wall, and immunohistochemical staining against glial fibrillary acidic protein (GFAP) showed Onyx penetration into GFAP-positive cerebellar tissue. Onyx extravasation was confirmed based on intraoperative findings during resection as well as pathological findings. The patient has been followed for four years postoperatively, and adverse events caused by Onyx extravasation have not been observed. Unexpected cast of Onyx, remote from the vascular architecture of the AVM, may represent an intra-parenchymal extravasation.
Understanding the Key Tenets of Heidegger’s Philosophy for Interpretive Phenomenological Research
Authors: Horrigan-Kelly Marcella , Millar Michelle , Dowling Maura
Published: December 2016

Martin Heidegger’s phenomenology provides methodological guidance for qualitative researchers seeking to explicate the lived experience of study participants. However, most phenomenological researchers apply his philosophy loosely. This is not surprising because Heidegger’s phenomenological philosophy is challenging and the influence of his philosophy in shaping the conduct of interpretive phenomenological research is broadly debated. This article presents an exploration of Dasein, a key tenet of Martin Heidegger’s interpretive phenomenology and explicates its usefulness for phenomenological research. From this perspective, we present guidance for researchers planning to utilize Heidegger’s philosophy underpinning their research.
Comparison of perioperative outcomes in endovascular versus open repair for juxtarenal and pararenal aortic aneurysms: A propensity-matched analysis
Authors: Orr Nathan T , Davenport Daniel L , Minion David J , Xenos Eleftherios S
Published: December 2016

Objective

Endoluminal aortic aneurysm repair is suitable within certain anatomic specifications. This study aims to compare 30-day outcomes of endovascular versus open repairs for juxtarenal and pararenal aortic aneurysms (JAA/PAAs).

Methods

The ACS-NSQIP database was queried from 2012 to 2015 for JAA/PAA repairs. Procedures characterized as emergent were included in the study; however, failed prior repairs and ruptured aneurysms were excluded. The preoperative and perioperative patient characteristics, operative techniques, and outcome variables were compared between the open aortic repair and the endovascular aortic repair groups. Propensity scoring was performed to clinically match open aortic repair and endovascular aortic repair groups on preoperative risk and select perioperative factors that differed significantly in the unmatched groups. Outcome comparisons were then performed between matched groups.

Results

A total of 1005 (789 JAAs and 216 PAAs) aneurysm repairs were included in the study. Of these, there were 395 endovascular aortic repairs and 610 open aortic repairs. Propensity scoring created a matched group of 263 endovascular aortic repair and 263 open aortic repair patients. There was no statistically significant difference in 30-day mortality rates between matched endovascular aortic repair and open aortic repair patients (2.7% vs. 5.7%). The endovascular aortic repair group had a shorter ICU length of stay and overall hospital stay. The 30-day morbidity significantly favored endovascular aortic repair over open aortic repair (16% vs. 35%, p < 0.001). The main drivers of morbidity for endovascular aortic repair versus open aortic repair included return to the OR (6.8% vs. 15%, p < 0.001), rate of cardiac or respiratory failure (7.6% vs. 21%, p = 0.001), rate of renal insufficiency or failure (3.8% vs. 9.9%, p = 0.009), and rate of pneumonia (1.5% vs. 6.8%, p = 0.004).

Conclusions

There is no difference in mortality rates between endovascular aortic repair versus open aortic repair when repairing JAAs/PAAs. There is a significant difference in overall morbidity, and ICU and hospital length of stay favoring endovascular aortic repair over open aortic repair. This supports the expanded applicability and efficacy of endovascular repair for complex aneurysms.
Event-triggered sensor data transmission policy for receding horizon recursive state estimation
Authors: Li Yunji , Peng Li
Published: December 2016

We consider a sensor data transmission policy for receding horizon recursive state estimation in a networked linear system. A good tradeoff between estimation error and communication rate could be achieved according to a transmission strategy, which decides the transfer time of the data packet. Here we give this transmission policy through proving the upper bound of system performance. Moreover, the lower bound of system performance is further analyzed in detail. A numerical example is given to verify the potential and effectiveness of the theoretical results.
Emerging strategies in the management of essential tremor
Authors: Hedera Peter
Published: December 2016

Currently available therapies for essential tremor (ET) provide sufficient control only for less than a half of patients and many unmet needs exist. This is in part due to the empiric nature of existing treatment options and persisting uncertainties about the pathogenesis of ET. The emerging concept of ET as a possible neurodegenerative disorder, better understanding of associated biochemical changes, including alterations in the γ-aminobutyric acid (GABA)-ergic system and gap junctions, and the identification of the role of the leucine-rich repeat and immunoglobulin-like domain-containing 1 (LINGO-1) gene in ET pathogenesis suggest new avenues for more targeted therapies. Here we review the most promising new approaches to treating ET, including allosteric modulation of GABA receptors and modifications of the LINGO-1 pathway. Medically refractory tremor can be successfully treated by high-frequency deep brain stimulation (DBS) of the ventral intermediate nucleus, but surgical therapies are also fraught with limitations due to adverse effects of stimulation and the loss of therapeutic response. The selection of additional thalamic and extrathalamic targets for electrode placements and the development of a closed-loop DBS system enabling automatic adjustment of stimulation parameters in response to changes in electrophysiologic brain activity are also reviewed. Tremor cancellation methods using exoskeleton and external hand-held devices are also briefly discussed.
Urban distribution center location
Authors: Sopha Bertha Maya , Asih Anna Maria Sri , Pradana Frendy Dimas , Gunawan Hendra Edi , Karuniawati Yuni
Published: December 2016

Location of urban distribution center (UDC) has played an important role in reducing distribution cost, environmental impact, and traffic congestion in urban areas. The article aims at evaluating potential location of UDC for sugar commodity using a combined approach that comprises two stages: spatial analysis and multi-objective mixed-integer linear programming. Results demonstrate that different locations of UDC correspond to different costs and environmental implications. It is suggested that a new UDC for the sugar commodity can be located at the east part of the city outskirt. Using more than two UDCs in the studied case appears to be not economically and environmentally beneficial.
Bunionette
Authors: Ceccarini Paolo , Rinonapoli Giuseppe , Nardi Andrea , Bisaccia Michele , Di Giacomo Lorenzo Maria , Caraffa Auro
Published: December 2016

Purpose. The purpose of this study is to review the most recent literature available on the treatment of bunionette (also named tailor’s bunion) with percutaneous and minimally invasive techniques. Focusing especially on clinical outcomes, studies related to this type of techniques were examined in order to evaluate the success of this practice that is, fusion rate and complications. The hypothesis is that these techniques are safe and successful procedures. Methods. In July 2015, a topical review of the PubMed/MEDLINE, EMBASE, and Google Scholar databases was conducted using the keywords percutaneous (OR mini-invasive OR minimally invasive) AND bunionette (OR tailor’s bunion) AND treatment (OR surgery). Studies reporting the outcomes of the surgical treatment of bunionette were also included in our review. Results. The search yielded a total of 111 publications from PubMed/MEDLINE, EMBASE, and Google Scholar. After evaluating abstracts and full-text reviews, 9 articles were included in this review. Treatment methods were divided into 2 main surgical treatment categories: with or without fixation of the osteotomy. The most commonly used technique was that with fixation. The scores of success for techniques with and without fixation were 93.5 and 97.8, respectively. Conclusion. The current evidence for the treatment of bunionette deformity is limited to retrospective case series. Therefore, no conclusion can be made regarding the gold standard technique for bunionette deformity. The results published are very satisfactory, but the literature is still poor.

Levels of Evidence: IV: Topical review
A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus
Authors: Lanham Nathan S. , Carroll John J. , Cooper Minton T. , Perumal Venkat , Park Joseph S.
Published: December 2016

Background. Articular cartilage lesions of the talus remain a challenging clinical problem because of the lack of natural regeneration and limited treatment options. Microfracture is often the first-line therapy, however lesions larger than 1.5 cm2 have been shown to not do as well with this treatment method. Methods. The objective of this retrospective study was to evaluate the outcomes of iliac crest bone marrow aspirate concentrate/collagen scaffold (ICBMA) and particulated juvenile articular cartilage (PJAC) for larger articular cartilage lesions of the talus. Fifteen patients undergoing ICBMA or PJAC for articular cartilage lesions of the talus from 2010 to 2013 were reviewed. Twelve patients, 6 from each treatment option, were included in the study. American Orthopaedic Foot and Ankle Surgeons (AOFAS), Foot and Ankle Ability Measure (FAAM), and Short Form–12 (SF-12) outcome scores were collected for each patient. Results. The mean age was 34.7 ± 14.8 years for ICBMA and 31.5 ± 7.4 years for PJAC. Lesion size was 2.0 ± 1.1 cm2 for ICBMA and 1.9 ± 0.9 cm2 for PJAC. At a mean follow-up of 25.7 months (range, 12-42 months), the mean AOFAS score was 71.33 for ICBMA and 95.83 for PJAC (  P = .019). The FAAM activities of daily living subscale mean was 77.77 for ICBMA and 97.02 for PJAC (   P = .027). The mean FAAM sports subscale was 45.14 for ICBMA and 86.31 for PJAC (  P = .054). The SF-12 physical health mean was 47.58 for ICBMA and 53.98 for PJAC (  P = .315). The SF-12 mental health mean was 53.25 for ICBMA and 57.8 for PJAC (  P = .315). One patient in treated initially with ICBMA underwent revision fixation for nonunion of their medial malleolar osteotomy, which ultimately resulted in removal of hardware and tibiotalar arthrodesis at 2 years from the index procedure. Conclusion. In the present analysis, PJAC yields better clinical outcomes at 2 years when compared with ICBMA for articular cartilage lesions of the talus that were on average greater than 1.5cm2.

Levels of Evidence: Therapeutic, Level IV: Retrospective, Case series
Survey of Canadian Kidney Transplant Specialists on the Management of Morbid Obesity and the Transplant Waiting List
Authors: Chan Gabriel , Soucisse Mikael
Published: December 2016

Background:

Obesity is associated with increased surgical complications and long-term cardiovascular mortality. Studies of access in kidney transplantation have found a bias against obese patients on the wait-listing.

Objective:

To determine the current state of clinical practice for the management of obesity in kidney transplantation.

Design:

A survey in two versions, PDF and traditional paper, composed of categorical questions.

Setting:

A pan-Canadian survey of transplant nephrologists and surgeons.

Methods:

The survey PDF was distributed electronically to the Kidney Group of the Canadian Society of Transplantation. A shorter, hardcopy version was distributed subsequently at a national transplant meeting.

Results:

There were 47 responses, including almost every Canadian adult transplant program. Most (81%) reported the use of a body mass index limit for access to the waiting list. However, only 40% reported a strict enforcement. There were several instances of intra-hospital disagreements regarding the use of a policy, among the centers with multiple responses. The body mass index limit was most commonly 40 kg/m2 (62%), followed by 35 kg/m2 (36%). Despite the body mass index limit, few centers (30%) reported having a weight management program. The reported experience with bariatric surgery was small, though nearly all replied that they would refer to a bariatric specialist in the future.

Limitations:

This national survey provides a broad assessment of clinical practice. The distinction between an official policy and informal clinical tendencies is difficult. The results cannot be used to support any specific limit or policy.

Conclusions:

This survey found that the body mass index limit for access to the kidney transplant waiting list was common in Canada. Several inconsistencies suggest a lack of official policy. To achieve equity in access, clear guidelines for obesity should be established and enforced. Bariatric surgery has the promise of rapid weight loss. Resource allocation to study obesity in transplant patients will be essential.
An affordable, adaptable, and hybrid assistive device for upper-limb neurorehabilitation
Authors: Malosio Matteo , Caimmi Marco , Cotti Cottini Michele , Crema Andrea , Dinon Tito , Mihelj Matjaz , Molinari Tosatti Lorenzo , Podobnik Janez , Prini Alessio , Seneci Carlo , Spagnuolo Giulio
Published: December 2016

The paper presents a multisensory and multimodal device for neuromuscular rehabilitation of the upper limb, designed to enable enriched rehabilitation treatment in both clinical and home environments. Originating from an existing low-cost, variable-stiffness rehabilitation device, it expands its functionalities by integrating additional modules in order to augment application scenarios and applicable clinical techniques. The newly developed system focuses on the integration of a wearable neuromuscular electrical stimulation system, a virtual rehabilitation scenario, a low-cost unobtrusive sensory system and a patient model for adapting training task parameters. It also monitors the user behavior during each single session and its evolution throughout the entire training period. The result is a modular, integrated and affordable rehabilitation device, enabling a biomechanical, neurological, and physiological-based training of patients, including innovative features currently unavailable within off-the-shelf rehabilitation devices.
Teaching Personal Finance Mathematical Problem Solving to Individuals With Moderate Intellectual Disability
Authors: Root Jenny , Saunders Alicia , Spooner Fred , Brosh Chelsi
Published: December 2016

The ability to solve mathematical problems related to purchasing and personal finance is important in promoting skill generalization and increasing independence for individuals with moderate intellectual disabilities (IDs). Using a multiple probe across participant design, this study investigated the effects of modified schema-based instruction (MSBI) on personal finance problem solving skills, purchasing an item on sale or leaving a tip, and using a calculator or iDevice (i.e., iPhone or iPad) for three middle school students diagnosed with a moderate ID. The results showed a functional relation between MSBI using a calculator on the participant’s ability to solve addition and subtraction personal finance word problems and generalize to iDevices. The findings of this study provide several implications for practice and offer suggestions for future research.