bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction in distortion of the synchronous generator voltage waveform using a new winding pattern
Authors: Asgharpour‐Alamdari Hossein , Alinejad‐Beromi Yousef , Yaghobi Hamid
Published: October 2016

Sinusoidal voltage waveform in synchronous generators is of great significance in power systems. Generally speaking, the output voltage of a synchronous generator is semi‐sinusoidal including some disturbance frequencies (known as harmonics) rather than the fundamental frequency. The harmonic contents cause them to increase in iron loss and reduction in efficiency of electrical machines. For this reason, the harmonic contents of synchronous generators should be carefully taken into consideration. In this study, a new winding pattern for stator of the synchronous generators is proposed to eliminate the harmonic contents of output voltage and so makes it more sinusoidal. In this method, the harmonic contents of output voltage are almost eliminated by selecting the optimal number of conductors per slot. Afterward, through several analytical and simulation studies the suggested winding pattern is compared with those of conventional ones. Moreover, the experimental setup is carried out based on a 3 kW, 1500 RPM synchronous generator. The conventional and proposed winding patterns are separately tested in this setup, and then the harmonic‐based behaviour of output voltage is studied for each case under different load conditions. The obtained results prove the superiority of the proposed winding pattern over the conventional patterns.
Three-Dimensional Custom-Made Titanium Ribs for Reconstruction of a Large Chest Wall Defect
Authors: Simal Isabel , García-Casillas Maria , Cerdá Julio , Riquelme Óscar , Lorca-García Concepción , Pérez-Egido Laura , Fernández-Bautista Beatriz , Torre Manuel , de Agustín Juan
Published: October 2016

Reconstruction of large chest wall defects always demand surgeons of having lots of means available (both materials and resourceful) to apply a cover to chest wall defects which can range from a few centimeters to the lack of a few entire ribs. In this study, we present the case of a teenager who suffered from a complete resection of three ribs because of Ewing sarcoma dependent on the sixth rib. Given the size of the defect, a multidisciplinary approach was chosen to provide rigid and soft tissue coverage and minimal functional and aesthetic impact. Custom-made titanium implants were designed based on three-dimensional computed tomography scan reconstruction. The surgical specimen via a left lateral thoracotomy (fifth, sixth, and seventh entire ribs) was resected, leaving a defect of 35 × 12 × 6 cm. A Gore-Tex patch (W. L. Gore & Associates, Arizona, United States) was placed and, after that, the implants were anchored to the posterior fragment of the healthy ribs and to the costal cartilage anteriorly. Finally, the surgical site was covered with a latissimus dorsi flap. The postoperative course was uneventful. After 9 months of follow-up, the patient has full mobility. This case shows that the implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects. The implant of custom-made ribs, combined with other techniques, is a good surgical choice for reconstruction of large chest wall defects.
Collective concerted motion in a molecular adlayer visualized through the surface diffusion of isolated vacancies
Authors: Urban Christian , Otero Roberto , Écija David , Trelka Marta , Martín Nazario , Gallego José M. , Miranda Rodolfo
Published: October 2016

We have measured STM movies to study the diffusion of individual vacancies in a self-assembled layer of a tetrathiafulvalene derivative (exTTF) on Au(111) at room temperature. The diffusion is anisotropic, being faster along the compact direction of the molecular lattice. A detailed analysis of the anisotropic displacement distribution of the single vacancies shows that the relative abundance of double jumps (that is, the collective motion of molecular dimers) with respect to single jumps is rather large, the number of double jumps being more than 20% of the diffusion events. We conjecture that the relative abundances of long jumps might be related to the strength of the intermolecular bonding and the misfit of the molecular overlayer with the substrate lattice.
Optical properties and internal quantum efficiency of InGaN/GaN core-shell microrods for solid state lighting
Authors: Mounir Christian , Schimpke Tilman , Rossbach Georg , Avramescu Adrian , Strassburg Martin , Schwarz Ulrich T.
Published: October 2016

We investigate, via temperature and excitation density dependent quasi-resonant confocal micro-photoluminescence, the optical properties and internal quantum efficiency (IQE) of InGaN/GaN single quantum wells (QWs) on Ga-polar GaN microrods selectively grown by continuous flow metal organic vapor phase epitaxy on patterned SiO2/n-GaN/sapphire template. Seven samples were grown with different growth parameters for the InGaN/GaN QW. The homogeneity of their optical properties is analyzed by mappings along the m-plane facet of the microrods in order to get insight on the growth mechanisms of the shell. Excitation density dependent measurements show that the IQE is affected by the high doping level of the core, which is required to grow such high aspect-ratio structures. Local IQEs between 15±1 % near the tip and 44±5 % near the base of microrods are estimated from measurements at room and low temperature. By comparison with results reported on planar c-plane QWs, we conclude that the radiative recombination rate is the main limitation for the emission efficiency.
Band gap narrowing models tested on low recombination phosphorus laser doped silicon
Authors: Dahlinger Morris , Carstens Kai
Published: October 2016

This manuscript discusses bandgap narrowing models for highly phosphorus doped silicon. We simulate the recombination current pre-factor J0,phos in PC1Dmod 6.2 of measured doping profiles and apply the theoretical band gap narrowing model of Schenk [J. Appl. Phys. 84, 3684 (1998)] and an empirical band gap narrowing model of Yan and Cuevas [J. Appl. Phys. 114, 044508 (2013)]. The recombination current pre-factor of unpassivated and passivated samples measured by the photo conductance measurement and simulated J0,phos agrees well, when the band gap narrowing model of Yan and Cuevas is applied. With the band gap narrowing model of Schenk, the simulation cannot reproduce the measured J0,phos. Furthermore, the recombination current pre-factor of our phosphorus laser doped silicon samples are comparable with furnace diffused samples. There is no indication of recombination active defects, thus no laser induced defects in the diffused volume.
Experimental and modeling analysis of asymmetrical on-off oscillation in coupled non-identical inverted bottle oscillators
Authors: Jia Ji , Shangguan Zhichun , Li Haihong , Wu Ye , Liu Weiqing , Xiao Jinghua , Kurths Jürgen
Published: October 2016

Upside-down bottles containing water which are common in our daily life exhibit rich vibration dynamics. Rich dynamic regimes are observed in bottle oscillators by directly measuring the pressure difference between inside and outside of a bottle with the aid of pressure sensors. We observe experimentally that an asymmetrical oscillation process between the outflow of water and the inflow of air is formed in a single bottle oscillator and, in addition, a kind of 2:1 frequency synchronization occurs in a coupled system of two non-identical bottle oscillators. The peak values of the oscillation of pressure differences between inside and outside of the bottle decease as the height of the liquid surface steps down, while the oscillation period increases gradually. The theoretical model of the oscillator is amended to understand the regimes in the experiment by introducing time-dependent parameters related to the asymmetrical oscillation processes. Our numerical results based on the model fit well with the experimental ones.
Breakdown dynamics of electrically exploding thin metal wires in vacuum
Authors: Sarkisov G. S. , Caplinger J. , Parada F. , Sotnikov V. I.
Published: October 2016

Using a two-frame intensified charge coupled device (iCCD) imaging system with a 2 ns exposure time, we observed the dynamics of voltage breakdown and corona generation in experiments of fast ns-time exploding fine Ni and stainless-steel (SS) wires in a vacuum. These experiments show that corona generation along the wire surface is subjected to temporal-spatial inhomogeneity. For both metal wires, we observed an initial generation of a bright cathode spot before the ionization of the entire wire length. This cathode spot does not expand with time. For 25.4 μm diameter Ni and SS wire explosions with positive polarity, breakdown starts from the ground anode and propagates to the high voltage cathode with speeds approaching 3500 km/s or approximately one percent of light speed.
Sub-20 nm patterning of thin layer WSe2 by scanning probe lithography
Authors: Dago Arancha I. , Ryu Yu K. , Garcia Ricardo
Published: October 2016

The electronic properties of thin layer transition metal dichalcogenides have raised considerable interest in the fabrication of advanced field-effect transistors and ultrasensitive sensors. Downscaling those devices to the nanoscale depends on the development of cost-effective and robust alternative nanolithographies. Here we demonstrate the direct, resist-less and reproducible nanopatterning of tungsten diselenide thin layers. By using oxidation scanning probe lithography (o-SPL) we have generated arrays of dots with a width of 13 nm and periodicity of 40 nm. We have also patterned a point contact of 35 nm and a nanoscale field-effect transistor. The direct and resistless fabrication of WSe2 nanoscale devices by oxidation scanning probe lithography opens a straightforward and reliable method for processing transition metal dichalcogenides materials.
Communication: A multiscale Bayesian inference approach to analyzing subdiffusion in particle trajectories
Authors: Hinsen Konrad , Kneller Gerald R.
Published: October 2016

Anomalous diffusion is characterized by its asymptotic behavior for t → ∞. This makes it difficult to detect and describe in particle trajectories from experiments or computer simulations, which are necessarily of finite length. We propose a new approach using Bayesian inference applied directly to the observed trajectories sampled at different time scales. We illustrate the performance of this approach using random trajectories with known statistical properties and then use it for analyzing the motion of lipid molecules in the plane of a lipid bilayer.
Capturing religious identity during hospital admission: a valid practice in our increasingly secular society?
Authors: Glenister David , Prewer Martin
Published: October 2016

Objective
Most major Victorian hospitals include religious identity in routine admission demographic questions. However, approximately 20% of admissions do not have their religious identity recorded. At the Royal Melbourne Hospital this missing 20% was surveyed throughout 2014–15 for two reasons: (1) to enable patient care; and (2) to provide an insight into the significance of religious identity for patients. There is scarce literature on this subject, so the present mixed-methods study, including a qualitative component, will start to bridge the gap.

Methods
Mixed methods, cross-sectional survey.

Results
The quantitative component of the study found that religious identity was important for a significant proportion of our diverse population and that, in general, demographics were congruent with Australian Bureau of Statistics (ABS) census figures. The qualitative component also revealed significant complexity behind religious identity labels, which the census is unable to capture, providing an insight into the requirements of our growing multicultural population.

Conclusions
This study illustrates that religious identity is important for a majority of Royal Melbourne’s culturally diverse inpatients. This data would seem to give the practice of collecting religious identity data on admission new credence, especially as our culturally and linguistically diverse populations increase. In order to understand these nuances and provide appropriate care, skilled spiritual screening and assessment would appear to be not optional, but rather necessary in our increasingly complex healthcare future.

What is known about the topic?
A search of the literature using related terms (religious, religion, spiritual identity, care) revealed that there is scarce literature on the subject of religious identity and its importance and meaning to patients.

What does this paper add?
This mixed methods study approaches the issue of the importance of religious identity from the patient perspective via a spiritual screening survey that included a qualitative component, so will begin to bridge a gap in knowledge.

What are the implications for practitioners?
Improved understanding of the complexity of the spiritual needs of our Victorian multicultural population and commensurate emphasis on the need for individual spiritual screening and assessment.
Lamin-B1 contributes to the proper timing of epicardial cell migration and function during embryonic heart development
Authors: Tran Joseph R. , Zheng Xiaobin , Zheng Yixian
Published: October 2016

Lamin proteins form a meshwork beneath the nuclear envelope and contribute to many different cellular processes. Mutations in lamins cause defective organogenesis in mouse models and human diseases that affect adipose tissue, brain, skeletal muscle, and the heart. In vitro cell culture studies have shown that lamins help maintain nuclear shape and facilitate cell migration. However, whether these defects contribute to improper tissue building in vivo requires further clarification. By studying the heart epicardium during embryogenesis, we show that Lb1-null epicardial cells exhibit in vivo and in vitro migratory delay. Transcriptome analyses of these cells suggest that Lb1 influences the expression of cell adhesion genes, which could affect cell migration during epicardium development. These epicardial defects are consistent with incomplete development of both vascular smooth muscle and compact myocardium at later developmental stages in Lb1-null embryos. Further, we found that Lb1-null epicardial cells have a delayed nuclear morphology change in vivo, suggesting that Lb1 facilitates morphological changes associated with migration. These findings suggest that Lb1 contributes to nuclear shape maintenance and migration of epicardial cells and highlights the use of these cells for in vitro and in vivo study of these classic cell biological phenomena.
Identification of the endocytic sorting signal recognized by the Art1-Rsp5 ubiquitin ligase complex
Authors: Guiney Evan L. , Klecker Till , Emr Scott D.
Published: October 2016

Targeted endocytosis of plasma membrane (PM) proteins allows cells to adjust their complement of membrane proteins to changing extracellular conditions. For a wide variety of PM proteins, initiation of endocytosis is triggered by ubiquitination. In yeast, arrestin-related trafficking adaptors (ARTs) enable a single ubiquitin ligase, Rsp5, to specifically and selectively target a wide range of PM proteins for ubiquitination and endocytosis. However, the mechanisms that allow ARTs to specifically recognize their appropriate substrates are unknown. We present the molecular features in the methionine permease Mup1 that are required for Art1-Rsp5–mediated ubiquitination and endocytosis. A combination of genetics, fluorescence microscopy, and biochemistry reveals three critical features that comprise an ART sorting signal in the Mup1 N-terminal cytosolic tail: 1) an extended acidic patch, 2) in close proximity to the first Mup1 transmembrane domain, and 3) close to the ubiquitinated lysines. We show that a functionally similar ART sorting signal is also required for the endocytosis of a second Art1-dependent cargo, Can1, suggesting a common mechanism for recognition of Art1 substrates. We isolate two separate suppressor mutations in the Art1 C-terminal domain that allele-specifically restore endocytosis of two Mup1 acidic patch mutants, consistent with an interaction between the Art1 C-terminus and the Mup1 acidic patch. We propose that this interaction is required for recruitment of the Art1-Rsp5 ubiquitination complex.
Agreement in Archi: An LFG perspective
Authors: Sadler Louisa
Published: October 2016

In Lexical Functional Grammar (LFG), syntactic agreement is primarily modelled as sharing or co-specification of agreement features at the level of f(unctional)-structure, which represents abstract grammatical relations and their properties, rather than at the level of constituency or phrase structure. LFG’s projection architecture also accommodates a multi-dimensional approach. While many agreement relations refer solely to f-structure notions, others may also refer to or depend on further constraints at other levels of representation. Since evidence suggests that Archi is morphologically ergative, agreement generalizations can be modelled by means of parameterized templates called by lexical entries. This lexical treatment allows agreement across the lexicon to be specified in a succinct manner while allowing for lexical idiosyncrasy.
Introduction
Authors: Green Duncan
Published: October 2016

This introductory chapter recounts personal experiences as an individual ‘change agent’, which have shaped the making of this book. It laments the fact that many theories of change used by different academic disciplines each operate with separate and often conflicting ideas, without any ‘department of change studies’ to sort it out. Hence the chapter lays down some preliminary insights that inform the rest of this book, by expanding the definition of ‘activists’ to include a variety of actors, programmes, and institutions involved in campaigns of change. In addition, the chapter also lays out the framework of study to be undertaken in the book, particularly by using Amartya Sen’s definition of development as the progressive expansion of the freedoms to be and to do. Finally, the chapter outlines in brief the three individual sections of this book.
Systems Thinking Changes Everything
Authors: Green Duncan
Published: October 2016

This chapter examines the advantages of systems thinking in navigating the complexities of the future. A ‘system’ here is defined as an interconnected set of elements coherently organized in a way that achieves something. A defining property of human systems is complexity: because of the sheer number of relationships and feedback loops among their many elements, they cannot be reduced to simple chains of cause and effect. In complex systems, change results from the interplay of many diverse and apparently unrelated factors. Thus, change agents need to identify which elements are important and understand how they interact. Working in complex systems requires an iterative, collaborative, and flexible approach.
Accountability, Political Parties, and the Media
Authors: Green Duncan
Published: October 2016

This chapter discusses political parties and the media as two crucial institutions that provide avenues for accountability, as well as the burgeoning field of ‘social accountability’, in both elected and unelected regimes. The political party system is both an opportunity and a threat for activists and their organizations. Parties can be long-term institutional homes for policies and ideas. The media route is another method of ensuring accountability, as the media can echo, amplify, or substitute for citizens’ voices. Lastly, the social accountability route is a more recent phenomenon, driven both by new technology and the need for solutions when states are weak or unresponsive. This particular route attempts to promote accountability by approaching authorities directly, instead of relying on intermediaries, such as political parties or bureaucracies. All three routes provide valuable channels for activists to hold those in power to account for their decisions.
Leaders and Leadership
Authors: Green Duncan
Published: October 2016

This chapter turns to the role of leaders and leadership in driving change. Though these roles are often downplayed or outright neglected in academia, the chapter argues that leadership is central to any understanding of how change happens. ‘Leaders’ in this case are not limited to politicians only—the chapter also examines leadership from below—that which emerges from citizens’ movements, voluntary associations, trade unions, faith organizations, and indeed in every walk of life. Leaders operate at the interface between structure and agency, striving to leave their mark on the institutions, cultures, and traditions in which they live and work. Activists need to understand where leadership comes from and how to best identify, support, and work with progressive leaders.
The Power of Advocacy
Authors: Green Duncan
Published: October 2016

This chapter looks at how advocacy works. ‘Advocacy’ here is defined as the process of influencing decision makers to change their policies and practices, attitudes, or behaviours. It typically targets the institutions described in this book, be they formal (states, courts, political parties, corporations, and international bodies) or informal (norms and public attitudes). The chapter analyses advocacy work in the systems thinking framework. It argues that getting advocacy right requires political maturity, the right combination of tactics and allies, and making the most of windows of opportunity as they come along. More subtly, good advocacy requires a mindset that finds each different context fascinating, one that embraces ambiguity and complexity, one that empathizes with how different people see the world, and one that learns from mistakes and responds to changing events.
Conclusion
Authors: Green Duncan
Published: October 2016

This concluding chapter cautions that progressive change is not primarily about ‘us’ activists: it occurs when poor people and communities take power into their own hands; shifts in technology, prices, demography, and sheer accident can be far more important than the actions of would-be change agents. It argues that activists need humility despite their crucial roles in programmes of change. The chapter reiterates the ideal characteristics of activists on individual and organizational levels mentioned throughout this book, extolling the reader to work in ways that reflect an evolving understanding of power and systems. It is these characteristics, after all, that are vital to a successful campaign for change. Finally, the chapter (and the book) ends on an encouraging note by defining activism as a story of human development, as articulated by Amartya Sen’s definition, ‘the freedoms to be and to do’.
Mechanic
Authors: Hinton James
Published: October 2016

Life story of a garage mechanic who, despite ending his career as a manager in a local authority transport department, clung fiercely to a working-class identity in the face of what he saw as the two great disasters of his times: the permissive society of 1960s and the neo-liberal reforms of the Thatcher years. His world view combines an embattled rejection of progressive attitudes to immigration, education, sexuality, and female equality, with an ethic of public service, pride in his skill as a manual worker, and hostility to privatization, managerial arrogance, and capitalist profiteering. His testimony serves, as he intended, to remind the historian of the experience of large numbers of working-class people in late-twentieth-century Britain who felt themselves and what they stood for marginalized, excluded, and politically unrepresented. He votes for the UK Independence Party.
Approaching variation in PFC
Authors: Lyche Chantal
Published: October 2016

The aim of this chapter is to present an overview of schwa variation across the PFC corpus. Schwa designates a vowel of limited distribution which alternates with zero. After a short presentation of the coding system, which enables the authors to test schwa behaviour throughout the corpus, the chapter considers the phonetic quality of the vowel susceptible to variation depending on the speech style and the region. The chapter studies the behaviour of schwa which exhibits marked differences between the southern regions (pointing to an ongoing change) and northern regions; varieties of French outside France proper are also considered. Finally, the chapter shows a clear age distinction regarding monosyllables, and the impact of the register on the rate of vowel presence.
Approaching variation in PFC
Authors: Durand Jacques , Lyche Chantal
Published: October 2016

This chapter shows how the study of large corpora can help renew the description and interpretation of liaison. It starts with an overview of the main questions facing anyone wishing to understand French liaison, arguing that labels such as obligatory, optional, forbidden, are not the same as categorical, variable, and unattested. The chapter then examines the coding system adopted within the PFC program for examining liaison across an orthographically transcribed spoken corpus. It is argued that the coding system elaborated within PFC and applied to all our surveys has enabled us to renew the empirical base on which theoretical analyses may now be couched. The results have established a new taxonomy of liaison usage, with very few contexts responsible for a very large percentage of realized liaisons, a factor which must find its way to the classroom, if the language taught in schools is to be grounded in current usage.
Variation in Switzerland
Authors: Andreassen Helene N. , Racine Isabelle
Published: October 2016

The chapter focuses on the presence and absence of the schwa vowel in the initial syllable of polysyllables (e.g. semaine, genou), a well-known phenomenon in the area of phonological variation. It presents a comparative study of schwa, based on conversational PFC data from 12 speakers originating from three investigation points in Switzerland (Martigny, Neuchâtel, and Nyon). The global results first confirm that schwa is more prone to deletion in the Swiss varieties as compared to Hexagonal French varieties. Second, the results show cross-regional variation in Switzerland: while speakers from Martigny and Nyon seem to employ extreme schwa reduction to a higher degree than speakers from Neuchâtel, speakers from Neuchâtel seem to employ complete schwa deletion to a higher degree than speakers from Martigny and Nyon.
Visual Temporal Acuity Is Related to Auditory Speech Perception Abilities in Cochlear Implant Users
Authors: Jahn Kelly N. , Stevenson Ryan A. , Wallace Mark T.
Published: October 2016

Objectives:

Despite significant improvements in speech perception abilities following cochlear implantation, many prelingually deafened cochlear implant (CI) recipients continue to rely heavily on visual information to develop speech and language. Increased reliance on visual cues for understanding spoken language could lead to the development of unique audiovisual integration and visual-only processing abilities in these individuals. Brain imaging studies have demonstrated that good CI performers, as indexed by auditory-only speech perception abilities, have different patterns of visual cortex activation in response to visual and auditory stimuli as compared with poor CI performers. However, no studies have examined whether speech perception performance is related to any type of visual processing abilities following cochlear implantation. The purpose of the present study was to provide a preliminary examination of the relationship between clinical, auditory-only speech perception tests, and visual temporal acuity in prelingually deafened adult CI users. It was hypothesized that prelingually deafened CI users, who exhibit better (i.e., more acute) visual temporal processing abilities would demonstrate better auditory-only speech perception performance than those with poorer visual temporal acuity.

Design:

Ten prelingually deafened adult CI users were recruited for this study. Participants completed a visual temporal order judgment task to quantify visual temporal acuity. To assess auditory-only speech perception abilities, participants completed the consonant–nucleus–consonant word recognition test and the AzBio sentence recognition test. Results were analyzed using two-tailed partial Pearson correlations, Spearman’s rho correlations, and independent samples t tests.

Results:

Visual temporal acuity was significantly correlated with auditory-only word and sentence recognition abilities. In addition, proficient CI users, as assessed via auditory-only speech perception performance, demonstrated significantly better visual temporal acuity than nonproficient CI users.

Conclusions:

These findings provide the first behavioral evidence that visual temporal acuity is related to post implantation CI proficiency as indexed by auditory-only speech perception performance. These preliminary data bring to light the possible future role of visual temporal acuity in predicting CI outcomes before implantation, as well as the possible utility of visual training methods in improving CI outcomes.
Limited Blood Transfusions Are Safe in Orthopaedic Trauma Patients
Authors: Dolenc Andrea J. , Morris William Z. , Como John J. , Wagner Karl G. , Vallier Heather A.
Published: October 2016

Objectives:

Controversy exists over association of blood transfusions with complications. The purpose was to assess effects of limited transfusions on complication rates and hospital course.

Setting:

Level 1 trauma center.

Patients and Methods:

Three hundred seventy-one consecutive patients with Injury Severity Score ≥16 underwent fixation of fractures of spine (n = 111), pelvis (n = 72), acetabulum (n = 57), and/or femur (n = 179). Those receiving >3 units of packed red blood cell were excluded.

Main Outcome Measurements:

Fracture type, associated injuries, treatment details, ventilation time, complications, and hospital stay were prospectively recorded.

Results:

Ninety-eight patients with 107 fractures received limited transfusion, and 119 patients with 123 fractures were not transfused. The groups did not differ in age, fracture types, time to fixation, or associated injuries. Lowest hematocrit was lower in the transfused group (22.8 vs. 30.0, P < 0.0001). Surgical duration (3:23 vs. 2:28) and estimated blood loss (462 vs. 211 mL) were higher in transfused patients (all P < 0.003). Pulmonary complications occurred in 12% of transfused and 4% of nontransfused, (P = 0.10). Mean days of mechanical ventilation (2.51 vs. 0.45), intensive care unit days (4.5 vs. 1.5) and total hospital stay (8.8 vs. 5.7) were higher in transfused patients (all P ≤ 0.006). After multivariate analysis, limited transfusion was associated with increased hospital and intensive care unit stays and mechanical ventilation time, but not with complications.

Conclusions:

Patients receiving ≤3 units of packed red blood cell had lower hematocrit and greater surgical burden, but no difference in complications versus the nontransfused group. Limited blood transfusions are likely safe, excepting a possible association with longer mechanical ventilation times and hospital stays.

Level of Evidence:

Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
The Open Lung Approach Improves Pulmonary Vascular Mechanics in an Experimental Model of Acute Respiratory Distress Syndrome
Authors: Santos Arnoldo , Lucchetta Luca , Monge-Garcia M. Ignacio , Borges Joao Batista , Tusman Gerardo , Hedenstierna Goran , Larsson Anders , Suarez-Sipmann Fernando
Published: October 2016

Objective:

To test whether positive end-expiratory pressure consistent with an open lung approach improves pulmonary vascular mechanics compared with higher or lower positive end-expiratory pressures in experimental acute respiratory distress syndrome.

Design:

Experimental study.

Setting:

Animal research laboratory.

Subjects:

Ten pigs, 35 ± 5.2 kg.

Interventions:

Acute respiratory distress syndrome was induced combining saline lung lavages with injurious mechanical ventilation. The positive end-expiratory pressure level resulting in highest compliance during a decremental positive end-expiratory pressure trial after lung recruitment was determined. Thereafter, three positive end-expiratory pressure levels were applied in a random order: hyperinflation, 6 cm H2O above; open lung approach, 2 cm H2O above; and collapse, 6 cm H2O below the highest compliance level. High fidelity pressure and flow sensors were placed at the main pulmonary artery for measuring pulmonary artery resistance (Z0), effective arterial elastance, compliance, and reflected pressure waves.

Measurements and Main Results:

After inducing acute respiratory distress syndrome, Z0 and effective arterial elastance increased (from 218 ± 94 to 444 ± 115 dyn.s.cm–5 and from 0.27 ± 0.14 to 0.62 ± 0.22 mm Hg/mL, respectively; p < 0.001), vascular compliance decreased (from 2.76 ± 0.86 to 1.48 ± 0.32 mL/mm Hg; p = 0.003), and reflected waves arrived earlier (0.23 ± 0.07 vs 0.14 ± 0.05, arbitrary unit; p = 0.002) compared with baseline. Comparing the three positive end-expiratory pressure levels, open lung approach resulted in the lowest: 1) Z0 (297 ± 83 vs 378 ± 79 dyn.s.cm–5, p = 0.033, and vs 450 ± 119 dyn.s.cm–5, p = 0.002); 2) effective arterial elastance (0.37 ± 0.08 vs 0.50 ± 0.15 mm Hg/mL, p = 0.04, and vs 0.61 ± 0.12 mm Hg/mL, p < 0.001), and 3) reflection coefficient (0.35 ± 0.17 vs 0.48 ± 0.10, p = 0.024, and vs 0.53 ± 0.19, p = 0.005), comparisons with hyperinflation and collapse, respectively.

Conclusions:

In this experimental setting, positive end-expiratory pressure consistent with the open lung approach resulted in the best pulmonary vascular mechanics compared with higher or lower positive end-expiratory pressure settings.
Inflammatory regulation of stem-like cells in melanoma
Authors: Lim Ming-Sheng , Wang Jiang Huai , Power Derek G. , Redmond H. Paul
Published: October 2016

The link between inflammation, immunity and cancer is well established. In the last decade, there has been considerable excitement over cancer stem cells, believed to be a subset of tumour cells responsible for their initiation, propagation and resistance to conventional chemoradiotherapy. In this review, we discuss the characterization of cancer stem cells and describe their modulation by inflammation with a focus on melanoma.
Adjuvant external beam radiotherapy after therapeutic groin lymphadenectomy for patients with melanoma: a dosimetric comparison of three-dimensional conformal and intensity-modulated radiotherapy techniques
Authors: Adams Gerard , Foote Matthew , Brown Simon , Burmeister Bryan
Published: October 2016

Radiotherapy after lymph node dissection is recommended in high-risk melanoma cases. The aim of this study is to assess whether intensity-modulated radiotherapy (IMRT) offers advantages over three-dimensional conformal radiotherapy (3DCRT) in the groin nodal basin. Fifteen consecutively treated patients (5 3DCRT and 10 IMRT) were selected. Optimized theoretical plans using the other modality were created – enabling direct comparisons of 3DCRT and IMRT. Target volume and organs at risk constraints were assessed as achieved or as having minor (≤5%) or major (>5%) deviations. The Wilcoxon signed-rank test was used to compare the dose received from each patient plan (3DCRT vs. IMRT), whereas the Mann–Whitney U-test was used to compare clinical plans with theoretical plans. Fisher’s exact test was used to compare categorical data. Target coverage was achievable in most patients (major deviations – 1 IMRT and 3 3DCRT). Conformity index improved with IMRT – median 0.65, range 0.48–0.81, versus median 0.44, range 0.29–0.60 for 3DCRT; P value less than 0.001. All 3DCRT plans had major deviations for femoral head/neck constraints. Twelve and 13 IMRT plans achieved the high (V42<5%) and low (V36<35%) constraints; P value less than 0.001. IMRT delivered statistically significant lower doses to small bowel volumes up to 40 ml. There were no differences in beam numbers used nor dosimetric endpoints measured when clinical plans were compared with theoretical plans. IMRT appears to allow superior conformity of dose to the target volume while relatively sparing the adjacent the bowel and femoral head/neck. This may reduce toxicity while maintaining control rates.
Effects of Reiki on Pain and Vital Signs When Applied to the Incision Area of the Body After Cesarean Section Surgery
Authors: Sagkal Midilli Tulay , Ciray Gunduzoglu Nazmiye
Published: October 2016

This study was conducted to determine the effects of Reiki on pain and vital signs when applied for 15 minutes to the incision area of the body after cesarean section surgery. The study was single-blinded, randomized, and double-controlled (Reiki, sham Reiki, and control groups). Forty-five patients, equalized by age and number of births, were randomly assigned to the Reiki, sham Reiki, and control groups. The treatment, which was applied to the patients in these 3 groups, was applied for 15 minutes to the incision area of body in the first 24 and 48 hours after the operation within 4 to 8 hours of the application of standard analgesics. The study data were collected using a patient follow-up form and a visual analog scale. Mean visual analog scale measurement values were significantly different from each other according to groups and times (P < .05). A reduction in pain of 76.06% was determined in the Reiki group patients between day 1 pre-tx and after application on the second day (day 2 post-tx) measurements. Mean breathing rate and systolic blood pressure measurement values were significantly different from each other according to groups (P < .05). The Reiki group was observed to use fewer analgesics throughout the study and to need them after a longer time than the sham Reiki and control groups (P < .05). It was concluded that Reiki applied for 15 minutes to the incision area after a cesarean operation had the expected effects on pain and the need for the use of analgesics, but it had no effect on vital signs.
Myocardial T2 Mapping in Patients With Hypertrophic Cardiomyopathy
Authors: Amano Yasuo , Yanagisawa Fumi , Tachi Masaki , Hashimoto Hidenobu , Imai Shogo , Kumita Shinichiro
Published: October 2016

Objective

The aim of this study was to evaluate the usefulness of T2 mapping for detecting myocardial injuries in patients with hypertrophic cardiomyopathy (HCM).

Methods

Twenty-one HCM patients and 7 healthy volunteers were examined. The T2 values were measured at hyperintense areas (high-T2 areas) identified with T2 mapping, at late gadolinium enhancement (LGE) areas, and in nullified myocardium of the HCM patients. The associations between T2 values and laboratory data or LGE areas were assessed.

Results

High-T2 areas had significantly greater T2 values than LGE areas (P < 0.05) and nullified areas (P < 0.01) of HCM and normal myocardium (P < 0.01). The presence of high-T2 areas was associated with an increase in troponin T levels (P = 0.02), and T2 values correlated with the levels of brain natriuretic peptide (P = 0.036, r = 0.86).

Conclusions

T2 mapping identified myocardial injuries suggested by the laboratory data in HCM.
Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the United States
Authors: Stewart Darren E. , Garcia Victoria C. , Rosendale John D. , Klassen David K. , Carrico Bob J.
Published: October 2016

Background

The proportion of deceased donor kidneys recovered for transplant but discarded increased steadily in the United States over 2 decades, from 5.1% in 1988 to 19.2% by 2009. Over 100 000 patients are waiting for a kidney transplant, yet 3159 kidneys were discarded in 2015.

Methods

We evaluated trends in donor characteristics, discard reasons, and Organ Procurement Organization–specific discard rates. Multivariable regression and propensity analysis were used to estimate the proportion of the discard rate rise in the 2000s attributable to changes in donor factors and decisions to biopsy and pump kidneys.

Results

This study found that at least 80% of the discard rate rise can be explained by the recovery of kidneys from an expanding donor pool and changes in biopsy and pumping practices. However, a residual discard rate increase could not be explained by changes in these factors. From 1987 to 2009, median donor age rose from 26 to 43 years; median Kidney Donor Risk Index increased from 1.1 in 1994 to 1.3 in 2009. Our findings suggest that the increase from 10% to 30% in the proportion of kidneys pumped during the 2000s served as a buffer, keeping the discard rate from rising even higher than it did.

Conclusions

The majority of the kidney discard rate rise can be explained by the broadening donor pool. However, the presence of an unexplained, residual increase suggests behavioral factors (eg, increased risk aversion) and/or allocation inefficiencies may have played a role. Reducing risk aversion, improving allocation, and more often pumping less-than-ideal, yet potentially transplantable kidneys, may help reverse the trend.
Linkage disequilibrium dependent architecture of human complex traits reveals action of negative selection
Authors: Gazal Steven , Finucane Hilary K. , Furlotte Nicholas A , Loh Po-Ru , Palamara Pier Francesco , Liu Xuanyao , Schoech Armin , Bulik-Sullivan Brendan , Neale Benjamin M , Gusev Alexander , Price Alkes L.
Published: October 2016

Recent work has hinted at the linkage disequilibrium (LD) dependent architecture of human complex traits, where SNPs with low levels of LD (LLD) have larger per-SNP heritability after conditioning on their minor allele frequency (MAF). However, this has not been formally assessed, quantified or biologically interpreted. Here, we analyzed summary statistics from 56 complex diseases and traits (average N = 101,401) by extending stratified LD score regression to continuous annotations. We determined that SNPs with low LLD have significantly larger per-SNP heritability. Roughly half of the LLD signal can be explained by functional annotations that are negatively correlated with LLD, such as DNase I hypersensitivity sites (DHS). The remaining signal is largely driven by our finding that common variants that are more recent tend to have lower LLD and to explain more heritability (P= 2.38 × 10−104); the youngest 20% of common SNPs explain 3.9x more heritability than the oldest 20%, consistent with the action of negative selection. We also inferred jointly significant effects of other LD-related annotations and confirmed via forward simulations that these annotations jointly predict deleterious effects. Our results are consistent with the action of negative selection on deleterious variants that affect complex traits, complementing efforts to learn about negative selection by analyzing much smaller rare variant data sets.
Customer perceptions of quality – a study in the SPA industry
Authors: Lagrosen Yvonne , Lagrosen Stefan
Published: October 2016

Purpose

The purpose of this study is to explore dimensions of customer perceptions of factors important for a quality experience in the SPA industry and to assess service quality implications for these dimensions.

Design/methodology/approach

The empirical study involved seven Swedish SPA hotels. The first part was qualitative, consisting of seven focus-group interviews with hotel guests. In addition, service providers’ perceptions of customer quality were collected through seven quality cafés. The qualitative parts were analysed with the constant comparative technique from the grounded theory approach. Based on the findings from the interviews, a questionnaire was delivered to 400 randomly accessed women. The responses were analysed with exploratory factor analysis and cluster analysis.

Findings

The focus-group interviews showed that the customers’ perception of quality could be expressed in the following dimensions: physical effects, mental effects, pleasure and flexibility. The dimensions for customer quality seen from the staff’s perspective were treatments, climate and the SPA facility itself. The exploratory factor analysis defined the following underlying factors: enjoyment, treatments, practicality, fitness, cost and calm. The cluster analysis resulted in four groups of customer profiles: the more of everything group, the enjoyers, the savers and the fitness freaks.

Research limitations/implications

A limitation is that the study has only been carried out in one country. The main implication for research is a better understanding of quality dimensions and perceptions of service quality in the SPA industry.

Practical implications

The study provides a comprehensive insight into the dimensions of quality for SPA visitors. Moreover, four distinct groups of customers have been identified. This knowledge should be useful for SPA managers.

Originality/value

Only limited amounts of research have previously been carried out in the SPA industry. The paper provides a framework depicting perceptions of quality dimensions in SPA hotels.
A strategic use of technology: case of Vodafone Egypt
Authors: Amin Azab Nahed , El Sheikh Yasmin , Moharram Arwa , Ibrahim Basma , Yehia Nouran
Published: October 2016

Subject area

Information management, IS alignment.

Study level/applicability

Undergraduate.

Case overview

The case examines the use of Information and Communication Technology (ICT) in one of Egypt’s top mobile service providers, through closely analyzing their systems, the way they work and how technology could be optimized to provide greater benefit and value to support an organization’s business goals. The main objective of the case was to identify business problems that information systems have managed to solve as well as grab a potential opportunity that the organization can or have captured. The main contribution of this case is to emphasize and provide real case application on information management concepts and theories related to Information Systems Alignment (IS Alignment), business value from IS adoption, IS implementation issues and information and process integration.

Expected learning outcomes

This case was written to present a practical example about the strategic use of ICT within a specific organizational context. It enables students to apply some theoretical concepts studied in information management courses (such as IS alignment – or strategic alignment –, IS assessment and IS implementation) on a real-case study. In particular, teaching this case aims to realize a number of learning objectives: understand telecom industry and acquire an overview about its environment and the challenges it faces in general and within a developing context in particular; identify the different technologies used by telecom companies; develop a business strategy based on a thorough analysis of an organization’s internal business operations as well as its external environment; and learn how to align IT use with organizational strategies and analyze critically both its tangible and intangible added values.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Subject codes

CSS 11: Strategy.