bluuebunny/crossref_metadata_2025 huggingface dataset:
The application of random regret minimization on commuter's mode choice behaviour: Model-Fit comparisons with Rum-Modelling (case: comparison between Matsuyama and Yogyakarta)
Authors: Virsa Leinia Audinda , Muthohar Imam , Fauzi Ibnu
Published: July 2018

Modelling the mode choice behaviours of travellers is a key to design effective transport management policies, particularly in shifting travellers to public transport. Abundant studies have analysed the impact of level of services on mode choice preferences through its Random Utility Maximization (RUM), but the possibility of minimalize the regret have been overlooked. This paper will discusses the possibility of using generalised Random Regret Minimization (G-RRM) model on choosing transportation modes. The study is performed in two cities for comparison: Jogjakarta in Indonesia and Matsuyama in Japan. A stated preference (SP) survey isconducted, in which respondents choose Bike or Bus under hypothetical situations. As the result of RUM revealed that travellers prefer the transportation mode with more ensuring level of service. While an empirical proof of concept, the G-RRM model is estimated on a stated mode choice dataset, and its outcomes are compared with RUM and RRM counterparts.
Sustainable road drainage system: Experimental model
Authors: Yunianta Andung , Suripin  , Hario Setiadji Bagus
Published: July 2018

Roadway as part of land transportation is very important to actualize human or commodity movements. Roadway should be able to show good performance. It is known that inundation at roadway is very serious problem, and often causes disruption to road users. Conventional drainage system that has been applied with the concept of discharging or draining water to the drainage channel has not been able to evade rain water that falls on the road surface. To date, the load of drainage channel is increasing. This is contributed by the decrease of the drainage function in order to flow water through the channel. To overcome the problem, a new concept of eco-drainage, that is a concept to minimize the change of water discharge and pollutant as an impact of region development, is introduced. To do so, an experimental method with laboratory test of aggregate and soil will be conducted, followed by developing a roadway drainage model. This study aims to develop a sustainable road drainage system by increasing the ability of the drainage system in infiltrating water that related to road construction to soil in the means of providing artificial facilities. This artificial facility includes side channels, filter layers and infiltration wells. At the end of this study, the expected result is the ability to measure the efficiency and effectiveness of the performance of the model.
The process of diagnosing an electrostatic precipitator's state during operation in the energy sector
Authors: Brzezińska Aleksandra , Żółtowski Bogdan
Published: July 2018

The paper proposes procedures for diagnosing the electrostatic precipitator's technical state in terms of its key function as a facility in a complex waste gas dedusting system. The presented state diagnosing procedures concern the assessment, genesis and forecast of the electrostatic precipitator's state during its rational operation.
Effect of functional solutions applied in machinery on fuel consumption and emissions
Authors: Napiórkowski Jerzy , Gonera Jarosław , Szczyglak Piotr , Czarnecki Robert
Published: July 2018

Because stricter norms of emission of hazardous substances are being introduced every few years, machinery manufacturers are also forced to introduce various modifications to reduce emissions. To this end, systems aimed at optimising the process of fuel combustion and reducing the amount of hazardous compounds are being applied. Three tractors used in agriculture, with various functional solutions, were examined in this study. The effect of various systems on reduction of hazardous emissions and fuel consumption was determined. The tests were conducted during the ploughing with a 4-bottom swivel plough. The effect of the selective reduction (SCR) system with AdBlue liquid, the exhaust gas recirculation (EGR) system, the particulate filter, the number of valves per cylinder and the type of a turbocharger in the engine’s inlet system were determined. It was observed during the tests that there were differences in fuel consumption and emissions depending on the constructional solutions applied in the tractors.
Statistical assessment of injection aparatus of diesel
Authors: Kupraszewicz Wiktor
Published: July 2018

The issue of estimating technological condition of internal combustion engine gathers special meaning mostly in using stage, in consideration of economic and ecological conditions. Appliances which are used now a days and which diagnose condition of subjects such as compression - ignition engines, are limited only to the measurements. This article discusses problems of methods diagnosis with special regard of fuel apparatus
Vibration measures in the diagnostics of technical systems
Authors: Żółtowski Bogdan , Dančová Petra , Novosád Jan
Published: July 2018

In the article author identifies a possible bone of mutual vibration energy measuring application used in the study of standard rail, as part of a dedicated research methodology and detailed methodologies developed in many previous author studies. Theoretical analysis and practical verification of susceptibility testing measurement information complex vibration processes indicates a possibility for their use. Recognizing the need to improve methods of machines and structures testing to assess their degradation state - this work presents important results of the research in the verification field of the proposed measures effectiveness of mutual research bench.
Antithrombotische Therapie bei peripherer arterieller Verschlusskrankheit
Authors: Espinola-Klein Christine
Published: July 2018

Was ist neu?

Antithrombotische Therapie bei stabiler PAVK Die aktuellen deutschen und europäischen Leitlinien empfehlen bei Patienten mit einer peripheren arteriellen Verschlusskrankheit (PAVK) die Monotherapie mit einem Thrombozytenaggregationshemmer (ASS 100 mg oder Clopidogrel 75 mg).

In der COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS) -Studie wurde Patienten mit PAVK 2 × 2,5 mg Rivaroxaban zusätzlich zu ASS 100 mg gegeben. Dies führte zur signifikanten Reduktion kardiovaskulärer Ereignisse (MACE = Major Adverse Cardiovascular Events) wie kardiovaskulärer Tod, Myokardinfarkt und Schlaganfall. Ebenfalls signifikant reduziert wurden periphere Ereignisse (MALE = Major Adverse Limb Events) wie ischämiebedingte Major-Amputation und eine akute schwere Ischämie.

Liegt bei Patienten mit einer PAVK die Indikation zur oralen Antikoagulation vor (z. B. bei Vorhofflimmern), empfehlen die aktuellen deutschen und europäischen Leitlinien die Monotherapie mit oralen Antikoagulantien ohne zusätzliche Thrombozytenaggregationshemmung.

Antithrombotische Therapie nach peripherer Revaskularisation Nach peripherer Intervention wird in Analogie zur Koronarintervention meist passager eine duale Plättchenhemmung durchgeführt. Nach peripherer Bypass-Anlage wird in der Regel die Monotherapie mit einem Thrombozytenaggregationshemmer empfohlen. In Einzelfällen kann bei komplexem Venenbypass eine orale Antikoagulation und bei Kunststoffbypass eine duale Plättchenhemmung eingesetzt werden.
The Influence of Smoking and of Oral and Transdermal Nicotine on Blood Pressure, and Haematology and Coagulation Indices
Authors: Blann Andrew D , Steele Christopher , McCollum Charles N
Published: July 2018

Nicotine is helpful in stopping smoking but its influence on cardiovascular risk factors is incomplete. Our aim was to determine its effect on blood pressure, routine haematology indices, and coagulation indices relevant to thrombosis. Eighteen subjects were seen whilst smoking (cotinine levels 1119 ± 414 ng/ml), again after stopping smoking but while using nicotine chewing gum and/or skin patches (392 ± 198 ng/ml), and again when not using nicotine (cotinine undetectable). There were no significant changes in blood pressures, platelet count, mean platelet volume, viscosity or anti-thrombin III. However, white blood cell count (p = 0.003), lymphocyte count (p = 0.016), red blood cell count (p = 0.02), haemoglobin (p <0.001), fibrinogen (p <0.001) and von Willebrand factor (p = 0.001) all fell between the first and second samples (when still using nicotine) but not between the second and third samples (when off nicotine). Oral and/or transdermal nicotine does not influence blood pressure or the haematology and coagulation indices we have measured.
Clinical Impact of Bleeding in Cancer-Associated Venous Thromboembolism: Results from the Hokusai VTE Cancer Study
Authors: Kraaijpoel Noémie , Di Nisio Marcello , Mulder Frits , van Es Nick , Beyer-Westendorf Jan , Carrier Marc , Garcia David , Grosso Michael , Kakkar Ajay , Mercuri Michele , Middeldorp Saskia , Hernandez Cristhiam , Santamaria Amparo , Schwocho Lee , Segers Annelise , Verhamme Peter , Wang Tzu-Fei , Weitz Jeffrey , Zhang George , Zwicker Jeffrey , Büller Harry , Raskob Gary
Published: July 2018

In the Hokusai VTE Cancer study, edoxaban was non-inferior to dalteparin for the composite outcome of recurrent venous thromboembolism (VTE) and major bleeding in 1,050 patients with cancer-associated VTE. The absolute rate of recurrent VTE was 3.4% lower with edoxaban, whereas the absolute rate of major bleeding was 2.9% higher. The present analysis focuses on the sites, clinical presentation, course and outcome of bleeding events, and the associated tumour types. Major bleeds and their severity (categories 1–4) were blindly adjudicated by a committee using a priori defined criteria, and data were analysed in the safety population. Major bleeding occurred in 32 of 522 patients given edoxaban (median treatment duration, 211 days) and in 16 of 524 patients treated with dalteparin (median treatment duration, 184 days); no patients had more than one major bleed. There were no fatal bleeds with edoxaban, and two with dalteparin. Severe bleeding at presentation (category 3 or 4) occurred in 10 (1.9%) and 11 (2.1%) patients in the edoxaban and dalteparin groups, respectively. The excess of major bleeding with edoxaban was confined to patients with gastrointestinal cancer. However, severe major bleeding at presentation (category 3 or 4) in this sub-group occurred in 5 of 165 (3.0%) and in 3 of 140 (2.1%) patients given edoxaban or dalteparin, respectively.

In conclusion, this analysis suggests that while oral edoxaban is an appropriate alternative to subcutaneous dalteparin for treatment of cancer-associated VTE, the use of edoxaban in patients with gastrointestinal cancer requires careful benefit–risk weighting.
Antimicrobial Activity of Different Solutions on Denture Base Materials
Authors: Tuncdemir Ali , Uğur Ayşe , Kahraman Kübra , Özdemir Bilgen
Published: July 2018

There are a few chemical solutions used for prosthetic cleaning and they have different antimicrobial effects on denture materials. The aim of this study is to evaluate the efficacy of various chemical solutions used in prosthetic cleaning. For this purpose, 40 specimens of polymethylmethacrylate (PMMA-Meliodent, HeraeusKulzer, Hanau, Germany), which is the most commonly used material in conventional prostheses, and 40 specimens of Deflex (Nuxen SRL, Ayacucho 1053 3-A, Cap. Fed. Buenos Aires, Argentina), which is polyamide-containing semi-flexible acrylic, were molded using a template at the laboratory of Dentistry Faculty. Leveling began with abrasive burs and Stones followed by the sanding with medium and thin discs. Surface preparation was done using wet pumice and felt followed by polishing with gypsum-alcohol and rotary soft brush. The evaluated three solutions are Corega cleaning tablets containing alkaline peroxide, 0.2% chlorhexidine gluconate (CG) and 1% sodium hypochlorite (NaOCl). Distilled water was used as the control group. When both groups of polymers were evaluated in respect to the Candida growth after they were kept in liquid containing NaOCl, Corega, and CG, it was observed that only the acrylics that were kept in Corega revealed Candida growth. It was concluded that Corega could not sufficiently inhibit the growth of Candida albicans which is the one of the most common microorganisms in the oral flora of pediatric and elderly patients. NaOCl and CG can be used safely and effectively for denture cleaning.
Analysis of ischaemic crisis using the informational causal entropy-complexity plane
Authors: Legnani Walter , Traversaro Francisco , Redelico Francisco O. , Cymberknop Leandro J. , Armentano Ricardo L. , Rosso Osvaldo A.
Published: July 2018

In the present work, an ischaemic process, mainly focused on the reperfusion stage, is studied using the informational causal entropy-complexity plane. Ischaemic wall behavior under this condition was analyzed through wall thickness and ventricular pressure variations, acquired during an obstructive flow maneuver performed on left coronary arteries of surgically instrumented animals. Basically, the induction of ischaemia depends on the temporary occlusion of left circumflex coronary artery (which supplies blood to the posterior left ventricular wall) that lasts for a few seconds. Normal perfusion of the wall was then reestablished while the anterior ventricular wall remained adequately perfused during the entire maneuver. The obtained results showed that system dynamics could be effectively described by entropy-complexity loops, in both abnormally and well perfused walls. These results could contribute to making an objective indicator of the recovery heart tissues after an ischaemic process, in a way to quantify the restoration of myocardial behavior after the supply of oxygen to the ventricular wall was suppressed for a brief period.
Invited Article: CARS molecular fingerprinting using sub-100-ps microchip laser source with fiber amplifier
Authors: Yoneyama Hiroaki , Sudo Kazuhiro , Leproux Philippe , Couderc Vincent , Inoko Akihito , Kano Hideaki
Published: July 2018

We have developed an ultrabroadband multiplex coherent anti-Stokes Raman scattering (CARS) microspectroscopic system using a supercontinuum (SC) seeded by sub-100-ps (85 ps) laser pulses with a sub-MHz (0.82 MHz) repetition rate. Because of the high peak power and ultrabroadband spectral profile of the SC, we can efficiently generate multiplex CARS signals in the spectral range of 600–3600 cm−1, which covers the entire molecular fingerprint region, as well as the C—H and O—H stretching regions. Due to the high peak power of the new laser source, the exposure time (pixel dwell time) for CARS imaging of polymer beads was reduced to less than 1 ms (0.8 ms), which was limited by the readout time of a CCD camera. Owing to the improvement in CARS spectral quality, clear molecular fingerprinting was achieved for living HeLa cells at different phases in the cell cycle.
Perspective: Wavefront shaping techniques for controlling multiple light scattering in biological tissues: Toward in vivo applications
Authors: Park Jung-Hoon , Yu Zhipeng , Lee KyeoReh , Lai Puxiang , Park YongKeun
Published: July 2018

Multiple light scattering has been regarded as a barrier in imaging through complex media such as biological tissues. Owing to recent advances in wavefront shaping techniques, optical imaging through intact biological tissues without invasive procedures can now be used for direct experimental studies, presenting promising application opportunities in in vivo imaging and diagnosis. Although most of the recent proof of principle breakthroughs have been achieved in the laboratory setting with specialties in physics and engineering, we anticipate that these technologies can be translated to biological laboratories and clinical settings, which will revolutionize how we diagnose and treat a disease. To provide insight into the physical principle that enables the control of multiple light scattering in biological tissues and how recently developed techniques can improve bioimaging through thick tissues, we summarize recent progress on wavefront shaping techniques for controlling multiple light scattering in biological tissues.
Flow separation control by dielectric barrier discharge plasma actuation via pulsed momentum injection
Authors: Vernet Julie A. , Örlü Ramis , Alfredsson P. Henrik
Published: July 2018

Control of a turbulent boundary layer separating on a half-cylinder mounted on a flat plate has been investigated using a Dielectric Barrier Discharge (DBD) plasma actuator placed along the apex of a cylinder. The main focus of the study has been to evaluate if the control ability of the actuator can be improved through pulsed actuation compared to its steady counterpart. Investigations of the electric wind induced by the DBD plasma actuator in still air, when mounted on the flat plate, revealed that while the steady actuation produces an electric wind similar to a wall jet, the pulsed actuation creates a train of co-rotating vortices. The vortices are the result of a starting vortex produced by the actuator at each actuation pulse. A parametric study showed a dependence of the size, shape and propagation velocity of the vortices on the pulse frequency and duty cycle. With the actuator mounted along the apex of the cylinder, Particle Image Velocimetry measurements of the uncontrolled and controlled flow with a free-stream velocity of 5 m/s showed a clear reduction of the recirculation region downstream the cylinder when using plasma actuation. An even higher control effect could be achieved with pulsed actuation compared to the steady actuation. Phase-locked measurements of the unsteady actuation showed that pulsed actuation periodically shifted the flow separation location resulting in the propagation of vortical structures in the recirculation region. The size of the vortical structures showed a dependence on the pulsed actuation timing parameters.
Circularly polarized terahertz radiation monolithically generated by cylindrical mesas of intrinsic Josephson junctions
Authors: Elarabi Asem , Yoshioka Yusuke , Tsujimoto Manabu , Kakeya Itsuhiro
Published: July 2018

We report emissions of circular polarized electromagnetic waves from cylindrically shaped mesa structures of the high-temperature superconductor Bi2Sr2CaCu2O8+δ. The frequency range of circularly polarized emission of a cylindrical mesa with notched sides is between 400 and 430 GHz, which is wider than expected by the patch antenna theory. Three maxima recognized in emission intensity are presumably attributed to excitations of fundamental orthogonal modes and circularly polarized modes. Along with the demonstration of circularly polarized emission from truncated edge square mesas, the obtained results provide a wide variety of engineering designs of compact and solid-state electromagnetic sources which are able to generate circularly-polarized terahertz waves.
Double-stranded RNA binding protein, Staufen, is required for the initiation of RNAi in coleopteran insects
Authors: Yoon June-Sun , Mogilicherla Kanakachari , Gurusamy Dhandapani , Chen Xien , Chereddy Shankar C. R. R. , Palli Subba Reddy
Published: July 2018

Significance

The RNA interference (RNAi) discovered in nematodes has contributed to major advances in basic and applied sciences. RNAi-based methods are being developed for controlling pests and disease vectors. RNAi is highly efficient and systemic in coleopteran insects, but not in other insects. The lower efficiency of RNAi in economically important insects and concerns about resistance development are hindering the widespread use of this technology. To address these problems, a RNAi-sensitive Colorado potato beetle,
Leptinotarsa decemlineata
, and a cell line derived from this insect were used to identify a dsRNA-binding protein,
StaufenC
, as a major contributor to RNAi and its resistance. Interestingly,
StaufenC
homologs are present in only coleopteran insects and are essential for efficient RNAi response and its resistance in these insects.
Interrupting a joke validates thoughts and polarizes attitudes towards a recycling company / La interrupción de un chiste puede potenciar su efecto de validación del pensamiento y cambiar las actitudes hacia una empresa de reciclaje
Authors: Santos David , Stavraki Maria , Gandarillas Beatriz , Cancela Ana , Briñol Pablo
Published: July 2018

Positive emotions can validate either positive or negative thoughts. Previous research has demonstrated that people use their thoughts more when they recall past episodes of happiness and when they are induced to smile. This study was designed to evaluate whether a new induction of a happy mood (a joke) can influence thought use in response to a persuasive proposal. Two versions of the same joke were compared: a version that included an interruption before the punchline and another that did not include an interruption at that point. The aim was to examine whether this interruption increased or decreased the use of previously generated thoughts towards a persuasive communication. The results indicated that the participants who were interrupted before the punchline relied more on their own thoughts in forming their attitudes than did those who were in the control group. In consequence, an interruption during a pleasant experience (e.g., a joke) increased persuasion when thoughts were positive but decreased persuasion when thoughts were negative.
Mechanical and tribological behaviours of aluminium matrix composites reinforced by graphene nanoplatelets
Authors: Şenel Mahmut Can , Gürbüz Mevlüt , Koç Erdem
Published: July 2018

In the present study, the effects of graphene content (0.1, 0.3, 0.5 wt-%) on the mechanical and tribological properties of aluminium matrix composites were reported. The experimental results reveal that the best apparent density (2.58 ± 0.02 g cm−3), highest Vickers hardness (57 ± 2.5 HV), lowest mass loss (1.6 and 9.7 mg for 10 N and 40 N), and lowest wear rate (12 × 10−5 and 18 × 10−5 mm3/Nm for 10 N and 40 N) were obtained at aluminium–0.1% graphene composite when compared with pure aluminium. The ultimate compressive strength of composites increases from 106 ± 4 to 138 ± 4 MPa with increasing graphene nanoplatelet contents. All results showed that graphene has been a very effective reinforcement and solid-lubricant material for Al matrix composites.
Montmorency tart cherry (Prunus cerasus L.) supplementation accelerates recovery from exercise‐induced muscle damage in females
Authors: Brown Meghan A. , Stevenson Emma J. , Howatson Glyn
Published: July 2018

Tart Montmorency cherry concentrate (MC) has been reported to attenuate the symptoms of exercise‐induced muscle damage (EIMD) and to accelerate exercise recovery, which has been attributed to its high anti‐inflammatory and antioxidant properties. Although these data are promising, there are no data regarding exclusively female populations. Therefore, the aim of this investigation was to examine the efficacy of MC on recovery following EIMD in females. In a randomised, double‐blind, placebo‐controlled study, twenty physically active females (mean ± SD age 19 ± 1 y; stature 167 ± 6 cm; body mass 61.4 ± 5.7 kg) consumed MC or a placebo (PL) for eight days (30 mL twice per day). Following four days of supplementation, participants completed a repeated‐sprint protocol and measures of muscle soreness (DOMS), pain pressure threshold (PPT), limb girth, flexibility, muscle function, and systemic indices of muscle damage and inflammation were collected pre, immediately post (0 h) and 24, 48 and 72 h post‐exercise. Time effects were observed for all dependent variables (p < 0.05) except limb girth and high sensitivity C‐reactive protein. Recovery of countermovement jump height was improved in the MC group compared to PL (p = 0.016). There was also a trend for lower DOMS (p = 0.070) and for higher PPT at the rectus femoris (p = 0.071) in the MC group. The data demonstrate that MC supplementation may be a practical nutritional intervention to help attenuate the symptoms of muscle damage and improve recovery on subsequent days in females.
Actin and microtubule cross talk mediates persistent polarized growth
Authors: Wu Shu-Zon , Bezanilla Magdalena
Published: July 2018

Coordination between actin and microtubules is important for numerous cellular processes in diverse eukaryotes. In plants, tip-growing cells require actin for cell expansion and microtubules for orientation of cell expansion, but how the two cytoskeletons are linked is an open question. In tip-growing cells of the moss Physcomitrella patens, we show that an actin cluster near the cell apex dictates the direction of rapid cell expansion. Formation of this structure depends on the convergence of microtubules near the cell tip. We discovered that microtubule convergence requires class VIII myosin function, and actin is necessary for myosin VIII–mediated focusing of microtubules. The loss of myosin VIII function affects both networks, indicating functional connections among the three cytoskeletal components. Our data suggest that microtubules direct localization of formins, actin nucleation factors, that generate actin filaments further focusing microtubules, thereby establishing a positive feedback loop ensuring that actin polymerization and cell expansion occur at a defined site resulting in persistent polarized growth.
Design, construction, and stability test of aerial wireless coastal buoy
Authors: Wahidin L O , Jaya I , Atmadipoera A S
Published: July 2018

Due to its highly dynamic nature, coastal waters are necessary to be continuously monitor. Aerial wireless coastal buoy (AWCB) is one of the ocean instrument commonly deployed for observing oceanographic phenomena in coastal waters and around small islands. In this paper we describe the design, construction and the stability test result of new AWCB. The new AWCB is using water temperature sensors to collect data and transferring them through specific aerial wavelengths at real time and low cost in coastal areas. The AWCB is completed three steps. First, the buoy was designed using CAD software to determine its size, form and color. Next, the buoy was constructed using material from fiberglass. Last buoy was tested for its buoyancy and stability at the Acoustic and Instrument Laboratory, Faculty of Fisheries and Marine Sciences, Bogor Agricultural University. At sea-trial was also carried out around Pramuka Island, and during the trial it shows that the buoy is stable condition within waves swaying and surface water current. It is floating well on seawater surface and stable for six days installing duration.
Community resilience and narratives of community empowerment in Scotland
Authors: Revell Philip , Dinnie Elizabeth
Published: July 2018

The concept of resilience is now routinely put forward by both policymakers and social activists as a way for communities to use and develop their resources and respond positively to change, including decarbonization to address climate change. The extent to which a community is able to utilize all its resources depends on the extent to which it feels empowered to take action and is a major determinant of its resilience. A narrative of community empowerment has recently emerged from Scottish Government, driven in part by the situation in Scotland, in which a skewed pattern of landownership and distant structure of ‘local’ democracy combine to disempower communities by disconnecting them from local resources and local representative democracy. Recent Scottish legislation appears to provide new opportunities for community groups to gain control of local assets, become more financially sustainable, undertake climate-related mitigation actions and overcome some of the current local democratic deficit. At the same time, an increasingly well-organized and networked community sector and some within the Scottish Government are actively exploring new ways to enable public participation and deliver public services. This paper analyses the current Scottish policy framework and aspirations for community empowerment and, through interviews with stakeholders, assesses the potential, this may provide for communities to become truly resilient and to actively engage with transformational change.
Stability and Change in Health Behavior Profiles of U.S. Adults
Authors: Burgard Sarah A , Lin Katherine Y P , Segal Brian D , Elliott Michael R , Seelye Sarah
Published: July 2018

Objectives

While understanding of complex within-person clustering of health behaviors into meaningful profiles of risk is growing, we still know little about whether and how U.S. adults transition from one profile to another as they age. This study assesses patterns of stability and change in profiles of tobacco and alcohol use and body mass index (BMI).

Method

A nationally representative cohort of U.S. adults 25 years and older was interviewed up to 5 times between 1986 and 2011. Latent transition analysis (LTA) models characterized the most common profiles, patterning of transitions across profiles over follow-up, and assessed whether some were associated with higher mortality risk.

Results

We identified 5 profiles: “health promoting” with normal BMI and moderate alcohol consumption; “overweight”; “current smokers”; “obese”; and “nondrinkers”. Profile membership was largely stable, with the most common transitions to death or weight gain. “Obese” was the most stable profile, while “smokers” were most likely to transition to another profile. Mortality was most frequent in the “obese” and “nondrinker” profiles.

Discussion

Stability was more common than transition, suggesting that adults sort into health behavior profiles relatively early. Women and men were differently distributed across profiles at baseline, but showed broad similarity in transitions.
Characterizing Workflow to Inform Clinical Decision Support Systems in Nursing Homes
Authors: Ozkaynak Mustafa , Reeder Blaine , Drake Cynthia , Ferrarone Peter , Trautner Barbara , Wald Heidi
Published: July 2018

Background and Objectives

Clinical decision support systems (CDSS) hold promise to influence clinician behavior at the point of care in nursing homes (NHs) and improving care delivery. However, the success of these interventions depends on their fit with workflow. The purpose of this study was to characterize workflow in NHs and identify implications of workflow for the design and implementation of CDSS in NHs.

Research Design and Methods

We conducted a descriptive study at 2 NHs in a metropolitan area of the Mountain West Region of the United States. We characterized clinical workflow in NHs, conducting 18 observation sessions and interviewing 15 staff members. A multilevel work model guided our data collection and framework method guided data analysis.

Results

The qualitative analysis revealed specific aspects of multilevel workflow in NHs: (a) individual, (b) work group/unit, (c) organization, and (d) industry levels. Data analysis also revealed several additional themes regarding workflow in NHs: centrality of ongoing relationships of staff members with the residents to care delivery in NHs, resident-centeredness of care, absence of memory aids, and impact of staff members’ preferences on work activities. We also identified workflow-related differences between the two settings.

Discussion and Implications

Results of this study provide a rich understanding of the characteristics of workflow in NHs at multiple levels. The design of CDSS in NHs should be informed by factors at multiple levels as well as the emergent processes and contextual factors. This understanding can allow for incorporating workflow considerations into CDSS design and implementation.
FOREST Unbiased Galactic Plane Imaging Survey with the Nobeyama 45 m telescope (FUGIN). IV. Galactic shock wave and molecular bow shock in the 4 kpc arm of the Galaxy
Authors: Sofue Yoshiaki , Kohno Mikito , Torii Kazufumi , Umemoto Tomofumi , Kuno Nario , Tachihara Kengo , Minamidani Tetsuhiro , Fujita Shinji , Matsuo Mitsuhiro , Nishimura Atsushi , Tsuda Yuya , Seta Masumichi
Published: July 2018

The FUGIN CO survey revealed the three-dimensional structure of a galactic shock wave in the tangential direction of the 4 kpc molecular arm. The shock front is located at G30.5+00.0 + 95 km s−1 on the upstream (lower longitude) side of the star-forming complex W 43 (G30.8−0.03), and comprises a molecular bow shock (MBS) concave to W 43, exhibiting an arc-shaped molecular ridge perpendicular to the galactic plane with width ∼0${^{\circ}_{.}}$1(10 pc) and vertical length ∼1° (100 pc). The MBS is coincident with the radio continuum bow of thermal origin, indicating association of ionized gas and similarity to a cometary bright-rimmed cloud. The upstream edge of the bow is sharp, with a growth width of ∼0.5 pc indicative of the shock front property. The velocity width is ∼10 km s−1, and the center velocity decreases by ∼15 km s−1 from the bottom to the top of the bow. The total mass of molecular gas in the MBS is estimated to be ∼1.2 × 106 M⊙, and ionized gas ∼2 × 104 M⊙. The vertical disk thickness has a step-like increase at the MBS by ∼2 times from lower to upper longitudes, which indicates hydraulic jump in the gaseous disk. We argue that the MBS was formed by the galactic shock compression of an accelerated flow in the spiral-arm potential encountering the W 43 molecular complex. A bow-shock theory can reproduce the bow morphology well. We argue that molecular bows are common in galactic shock waves, not only in the Galaxy but also in galaxies, where MBSs are associated with giant cometary H ii regions. We also analyzed the H i data in the same region to obtain a map of H i optical depth and molecular fraction. We found firm evidence of the H i to H2 transition in the galactic shock as revealed by a sharp molecular front at the MBS front.
Fibromyalgia as a Predictor of Increased Postoperative Complications, Readmission Rates, and Hospital Costs in Patients Undergoing Posterior Lumbar Spine Fusion
Authors: Donnally Chester J. , Vakharia Rushabh M. , Rush Augustus J. , Damodar Dhanur , Vakharia Ajit J. , Goz Vadim , Lebwohl Nathan H.
Published: July 2018

Study Design.

Retrospective review.

Objective.

The aim of this study was to identify whether a concomitant diagnosis of fibromyalgia (FM) influences postoperative complications, readmission rates or cost following primary 1 to 2 level lumbar fusions in an elective setting.

Summary of Background Data.

Patients with FM often are limited by chronic lower back pain, many of whom will seek operative treatment. No previous study has evaluated whether patients with a concomitant diagnosis of FM have more complications following spine surgery.

Methods.

Medicare data (2005–2014) from a national database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion for degenerative lumbar pathology. Thirty- and 90-day postoperative complication rates, readmission rates, and treatment costs were queried. To reduce confounding, FM patients were matched with a control cohort of non-FM patients using patient demographics, treatment modality, and comorbid conditions, and then analyzed by multivariable logistic regression.

Results.

Within the first 30-day postoperative, acute post hemorrhagic anemia (odds ratio [OR]: 2.58; P 
< 0.001) and readmission rates were significantly higher in FM patients compared to controls. There was no significant difference in wound related complications within first 30-days (0.19% vs. 0.23%; P = 0.520) or with length of stay (3.60 vs. 3.53 days; P = 0.08). Within 90-day postoperative, FM patients had higher rates of pneumonia (OR: 3.73; P < 0.001) and incurred 5.31% more in hospital charges reimbursed compared to the control cohort.

Conclusion.

Primary 1 to 2 level lumbar fusions performed on FM patients have higher rates of postoperative anemia, pneumonia, cost of care, and readmission compared to match controls. FM patients and surgeons should be aware of these increased risks in an effort to control hospital costs and potential complications.

Level of Evidence: 3
Association Between Transfusion of RBCs and Subsequent Development of Delirium in Critically Ill Children*
Authors: Nellis Marianne E. , Goel Ruchika , Feinstein Sydney , Shahbaz Sevini , Kaur Savneet , Traube Chani
Published: July 2018

Objectives:

To determine the temporal relationship between the transfusion of RBCs and the subsequent development of delirium in a cohort of critically ill children.

Design:

Nested retrospective cohort study within prospective cohort study.

Setting:

Urban academic tertiary care PICU.

Patients:

All consecutive admissions from September 2014 through August 2015.

Interventions:

Children were screened twice daily for delirium during their PICU admission.

Measurements and Main Results:

Among 1,547 independent admissions screened for delirium, 166 (10.7%) were transfused RBCs. Children who were transfused RBCs were more than twice as likely to be delirious during their admission compared with children who were never transfused, after controlling for known predictors of delirium development (adjusted odds ratio, 2.16; 95% CI, 1.38–3.37; p = 0.001). Among transfused children, a temporal relationship was observed between receipt of RBCs and the subsequent development of delirium. For each additional 10 mL/kg of RBCs transfused, the recipients were 90% more likely to develop delirium or coma in the 72 hours following the transfusion, after controlling for confounders (adjusted odds ratio, 1.90; 95% CI, 1.14–3.17; p = 0.01). Anemia (represented by nadir hemoglobin prior to transfusion) was not associated with delirium development.

Conclusions:

In this cohort of critically ill children, there is an independent association between the receipt of an RBC transfusion and the subsequent development of delirium. Further prospective studies are warranted to replicate this finding and investigate possible pathophysiologic mechanisms for this association.
An Analysis of Risk Factors for Hemolysis in Children on Extracorporeal Membrane Oxygenation*
Authors: Okochi Shunpei , Cheung Eva W. , Barton Sunjay , Zenilman Ariela , Shakoor Aqsa , Street Cherease , Streltsova Svetlana , Chan Christine , Brewer Michael P. , Middlesworth William
Published: July 2018

Objectives:

Hemolysis is a known complication of pediatric extracorporeal membrane oxygenation associated with renal failure and mortality. We sought to identify predictors of hemolysis in pediatric extracorporeal membrane oxygenation patients and determine its influence on outcomes.

Design:

Retrospective, single-center study.

Setting:

Urban, quaternary care center pediatric and neonatal ICU.

Patients:

Ninety-six patients requiring extracorporeal membrane oxygenation.

Interventions:

None.

Measurements and Main Results:

Daily measurements of plasma-free hemoglobin were obtained while patients were on extracorporeal membrane oxygenation. Patients with a prior extracorporeal membrane oxygenation run, on extracorporeal membrane oxygenation for less than 24 hours, or without complete medical records were excluded from the study. Ninety-six patients met inclusion criteria, of which, 25 patients (26%) had plasma-free hemoglobin greater than 30 mg/dL. Of those patients, 15 of 25(60%) had plasma-free hemoglobin greater than 50 mg/dL, and 21 of 25(84%) occurred during the first 7 days on extracorporeal membrane oxygenation. Compared with patients without hemolysis, those with hemolysis were younger (0.2 mo [0.06–3.2 mo] vs 8.2 mo [0.6–86 mo]; p < 0.001), had a higher pericannulation international normalized ratio (3.9 [3.5–5.5] vs 2.6 [1.8–3.7]; p = 0.003), lower pericannulation platelet count (33 × 103/μL [22–42 × 103/μL] vs 61 × 103/μL [38–86 × 103/μL]; p < 0.001), and had a less negative inlet pressure (–3.5 mm Hg [–14 to 11.5 mm Hg] vs –19 mm Hg [–47 to 0 mm Hg]; p = 0.01). A greater proportion of patients with hemolysis had a heparin assay less than 0.2 mg/dL (50% vs 17%; p = 0.001) and had fluid removal via slow continuous ultrafiltration (32% vs 6%; p < 0.001). Patients with hemolysis had increased risk of in-hospital mortality (odds ratio 10.0; 95% CI 3.4–32; p < 0.001). On multivariable analysis, continuous ultrafiltration (odds ratio, 8.0; 95% CI, 1.9–42; p = 0.007) and pericannulation international normalized ratio greater than 3.5 (odds ratio, 7.2; 95% CI, 2.3–26; p = 0.001) were significantly associated with hemolysis.

Conclusions:

Hemolysis is a common complication of pediatric extracorporeal membrane oxygenation. We found that patients with hemolysis (plasma-free hemoglobin > 30 mg/dL) had a 10-fold increase in in-hospital mortality. In our study cohort, hemolysis was associated with continuous ultrafiltration use, but not continuous renal replacement therapy. Additionally, our results suggest that the degree of coagulopathy (international normalized ratio > 3.5) at the time of cannulation influences hemolysis. Additional prospective studies are necessary to define further strategies to prevent hemolysis and improve outcomes in pediatric extracorporeal membrane oxygenation patients.
Treatment of Intraosseous Ganglion Cyst of the Lunate
Authors: Li Sunlong , Sun Chao , Zhou Xijie , Shi Jialu , Han Tao , Yan Hede
Published: July 2018

Purpose

Intraosseous ganglion cyst (IGC) is a rare disease, particularly in lunate. The objective of this study was to summarize current knowledge on the treatment of IGC of the lunate, through a literature review, to provide a therapeutic strategy for this rare disease.

Methods

The PubMed, ISI Web of Science, Cochrane Library, EMBASE, Science Direct database were searched with a set of predefined inclusion and exclusion criteria. Manual searches for references were performed to find potential relevant studies. The authors extracted data from the articles selected.

Results

Different treatment modalities of IGC of the lunate were described, all of which were divided into 3 categories: conservative treatment, classical surgical procedures, and novel surgical procedures. An overview on the main treatment modalities for IGC of the lunate was provided.

Conclusions

Conservative treatments can be the doctors' first choice for patients with IGC. Surgical procedure is advised when conservative treatment fails. Traditional surgical curettage with autologous bone grafting is the mainstay of treatment with satisfactory outcomes; however, novel surgical techniques like arthroscopically assisted minimally invasive technique or filling with bone cement are considered as more promising attempts with less trauma and shorter recovery period. Nonetheless, studies with high levels of evidence are guaranteed for developing widely accepted clinical treatment guidelines.
Different Embolization Approaches for the Treatment of Posttraumatic Pseudoaneurysm of the Internal Maxillary Artery
Authors: Granata Francesca , Mormina Enricomaria , Cinquegrani Antonella , Cervino Gabriele , Cicciù Marco , Longo Marcello , Nastro Siniscalchi Enrico
Published: July 2018

Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or traumatic events and it is associated with high rupture risk. Pseudoaneurysm rarely involves internal maxillary artery. Computed tomography angiography and digital subtraction angiography are essential tools to perform a proper diagnosis and treatment of pseudoaneurysms. The authors described 2 different cases of internal maxillary artery pseudoaneurysm, treated by different embolization approaches. The first case was treated by a well-known arterial catheterism technique, whereas the second one was performed by an uncommon approach with a direct percutaneous puncture.
Socioeconomic Factors, Perioperative Complications, and 30-Day Readmission Rates Associated With Delayed Cranial Vault Reconstruction for Craniosynostosis
Authors: Sergesketter Amanda R. , Elsamadicy Aladine A. , Lubkin David T. , Kemeny Hanna , Harward Stephen C. , Krucoff Kate B. , Krucoff Max O. , Fuchs Herbert , Thompson Eric M. , Allori Alexander C. , Marcus Jeffrey R. , Muh Carrie R.
Published: July 2018

Background:

Premature fusion of the cranial sutures can lead to significant neurocognitive, developmental, and esthetic consequences, especially if not corrected within the first year of life. This study aimed to identify the drivers of delayed cranial vault reconstruction (CVR) and its impact on complication and 30-day readmission rates among craniosynostosis patients.

Methods:

The medical records of all children who underwent CVR for craniosynostosis between 2005 and 2017 at an academic institution were retrospectively reviewed. A delay in operation was defined by surgery performed >12 months of age. Patient demographics, comorbidities, perioperative complication rates, and 30-day readmission rates were collected.

Results:

A total of 96 patients underwent primary CVR, with 79 (82.3%) patients undergoing nondelayed surgery and 17 (17.7%) patients undergoing surgery >12 months of age. Children undergoing delayed surgery were significantly more likely to be non-White (P < 0.0001), have Medicaid insurance (P = 0.023), and have a non-English primary language (P < 0.005). There was increased incidence of developmental disability identified at first consult (no-delay: 3.9% vs delay: 41.2%, P < 0.0001) and increased intracranial pressure (no-delay: 6.3% vs delay: 29.4%, P < 0.005) among children undergoing delayed surgery. The delayed cohort had a significantly higher unplanned 30-day readmission rate (no-delay: 0.0% vs delay: 5.9%, P = 0.03).

Conclusion:

Our study suggests that craniosynostosis patients who are non-White, have a non-English primary language, and have Medicaid insurance are at risk for delayed primary surgery, which may lead to increased 30-day readmission. Interventions are necessary to reduce craniosynostosis patients’ barriers to care to minimize the sequelae associated with delayed surgery.
Facing up to the hard question of consciousness
Authors: Dennett Daniel C.
Published: July 2018

The so-called hard problem of consciousness is a chimera, a distraction from the hard question of consciousness, which is once some content reaches consciousness, ‘then what happens?’. This question is seldom properly asked, for reasons good and bad, but when asked it opens up avenues of research that promise to dissolve the hard problem and secure a scientifically sound theory of how the human brain produces the (sometimes illusory) convictions that mislead us.

This article is part of the theme issue ‘Perceptual consciousness and cognitive access'.
Inflation versus filling-in: why we feel we see more than we actually do in peripheral vision
Authors: Odegaard Brian , Chang Min Yu , Lau Hakwan , Cheung Sing-Hang
Published: July 2018

Do we perceive fine details in the visual periphery? Here, we propose that phenomenology in the visual periphery can be characterized by an
inflated
sense of perceptual capacity, as observers overestimate the quality of their perceptual inputs. Distinct from the well-known perceptual phenomenon of ‘filling-in’ where perceptual content is generated or completed endogenously, inflation can be characterized by incorrect introspection at the subjective level. The perceptual content itself may be absent or weak (i.e. not necessarily filled-in), and yet such content is mistakenly regarded by the system as rich. Behaviourally, this can be reflected by
metacognitive
deficits in the degree to which confidence judgements track task accuracy, and
decisional
biases for observers to think particular items are present, even when they are not. In two experiments using paradigms that exploit unique attributes of peripheral vision (crowding and summary statistics), we provide evidence that both types of deficits are present in peripheral vision, as observers' reports are marked by overconfidence in discrimination judgements and high numbers of false alarms in detection judgements. We discuss potential mechanisms that may be the cause of inflation and propose future experiments to further explore this unique sensory phenomenon.

This article is part of the theme issue ‘Perceptual consciousness and cognitive access’.