bluuebunny/crossref_metadata_2025 huggingface dataset:
Abrupt Transitions in Submesoscale Structure in Southern Drake Passage: Glider Observations and Model Results
Authors: Viglione Giuliana A. , Thompson Andrew F. , Flexas M. Mar , Sprintall Janet , Swart Sebastiaan
Published: May 2018

Enhanced vertical velocities associated with submesoscale motions may rapidly modify mixed layer depths and increase exchange between the mixed layer and the ocean interior. These dynamics are of particular importance in the Southern Ocean, where the ventilation of many density classes occurs. Here we present results from an observational field program in southern Drake Passage, a region preconditioned for submesoscale instability owing to its strong mesoscale eddy field, persistent fronts, strong down-front winds, and weak vertical stratification. Two gliders sampled from December 2014 through March 2015 upstream and downstream of the Shackleton Fracture Zone (SFZ). The acquired time series of mixed layer depths and buoyancy gradients enabled calculations of potential vorticity and classifications of submesoscale instabilities. The regions flanking the SFZ displayed remarkably different characteristics despite similar surface forcing. Mixed layer depths were nearly twice as deep, and horizontal buoyancy gradients were larger downstream of the SFZ. Upstream of the SFZ, submesoscale variability was confined to the edges of topographically steered fronts, whereas downstream these motions were more broadly distributed. Comparisons to a one-dimensional (1D) mixing model demonstrate the role of submesoscale instabilities in generating mixed layer variance. Numerical output from a submesoscale-resolving simulation indicates that submesoscale instabilities are crucial for correctly reproducing upper-ocean stratification. These results show that bathymetry can play a key role in generating dynamically distinct submesoscale characteristics over short spatial scales and that submesoscale motions can be locally active during summer months.
Subseasonal Tropical Cyclone Genesis Prediction and MJO in the S2S Dataset
Authors: Lee Chia-Ying , Camargo Suzana J. , Vitart Fréderic , Sobel Adam H. , Tippett Michael K.
Published: May 2018

Subseasonal probabilistic prediction of tropical cyclone (TC) genesis is investigated here using models from the Seasonal to Subseasonal (S2S) Prediction dataset. Forecasts are produced for basin-wide TC occurrence at weekly temporal resolution. Forecast skill is measured using the Brier skill score relative to a seasonal climatology that varies monthly through the TC season. Skill depends on models’ characteristics, lead time, and ensemble prediction design. Most models show skill for week 1 (days 1–7), the period when initialization is important. Among the six S2S models examined here, the European Centre for Medium-Range Weather Forecasts (ECMWF) model has the best performance, with skill in the Atlantic, western North Pacific, eastern North Pacific, and South Pacific at week 2. Similarly, the Australian Bureau of Meteorology (BoM) model is skillful in the western North Pacific, South Pacific, and across northern Australia at week 2. The Madden–Julian oscillation (MJO) modulates observed TC genesis, and there is a relationship, across models and lead times, between models’ skill scores and their ability to accurately represent the MJO and the MJO–TC relation. Additionally, a model’s TC climatology also influences its performance in subseasonal prediction. The dependence of the skill score on the simulated climatology, MJO, and MJO–TC relationship, however, varies from one basin to another. Skill scores increase with the ensemble size, as found in previous weather and seasonal prediction studies.
Communication skills scores of medical students and interview performance 3 years later
Authors: Lee Lan-Ting , Cheng Shu Hui , Lin Chii-Jeng , Chi Mei Hung , Lee I Hui , Yang Yen Kuang
Published: May 2018

Objective:

Communication skills are important, but the evaluation of these skills in the medical curriculum remains inconsistent. The aim of this study was to explore the relationship between the communication skills scores of junior medical students following curricula with different module evaluations and the clinical interview performance of the same students in a psychiatry department in their fifth year.

Design:

Prospective evaluation of communication and clinical interview skills.

Setting:

Medical school and psychiatry department inpatient setting.

Method:

The communication skills scores of 208 medical students in their second year (between 2009 and 2011) and their performance in interviews with patients in a psychiatry department in their fifth year (between 2012 and 2014) were assessed. Initial assessment was undertaken on the basis of problem-based learning (PBL) performance, evaluation of performance during conversation with patients, a related oral presentation and written report, students’ self-rating and a peer rating. Extra marks were given if students completed an optional special report inspired by the curriculum. To assess the interview performance of fifth-year medical students, the mini-Clinical Evaluation Exercise (mini-CEX) was used, together with weekly case-based discussions and the observation of a clinical interview with a real patient.

Results:

Tutors’ evaluations of the junior medical students’ performance during role-play ( ρ = .22, p = .001), its related reciprocal assessment ( ρ = .18, p = .010) and an extra-effort task ( ρ = .18, p = .009) as part of the communication skills curriculum were significantly correlated with the students’ later performance in a clinical interview with a patient.

Conclusion:

Observation of student interactions and motivations along with reciprocal peer evaluations offer better measures of communication skills in medical education than are oral presentations, self-ratings and conversations with real patients.
Knowledge in crisis: Cognitive capitalism and narrative form in Zia Haider Rahman’s In the Light of What We Know
Authors: del Valle Alcalá Roberto
Published: May 2018

In this article, I argue that Zia Haider Rahman’s In the Light of What We Know offers a suggestive but ultimately problematic interrogation of the link between knowledge and finance in the context of contemporary “cognitive capitalism” and the 2008 crisis. The novel’s almost fetishistic relation to knowledge, primarily represented by the narrator’s encyclopedic and relentless discursive presence, compounded with his insistence on a circumscribed and experientially detached narrative temporality, suggests a fundamentally evasive strategy. For all its complexity and stringency, “knowledge” functions as an ideological cover for a deeply political crisis, while narration itself signals a foreclosure of agency and responsibility which ultimately fails, exposing the limits of financialization’s own discursive justifications.
Mental Health and Stress Among Army Civilians, Spouses, and Soldiers in a Closing Military Community
Authors: Thomas Jeffrey L. , Adrian Amanda L. , Wood Michael D. , Crouch Coleen L. , Lee James D. , Adler Amy B.
Published: May 2018

When military community closure occurs, it can be challenging for service members and the surrounding community. Given that services and social networks disappear; this is particularly salient in overseas locations. Few studies have systematically assessed the impact of base closure on military community members. In the present study, 743 soldiers, 114 Army civilian employees, and 54 military spouses living in two closing U.S. military communities in Germany were surveyed about transformation stressors, mental health, and factors associated with better adjustment such as individual coping, leadership behaviors, and community cohesion. While individual coping was associated with fewer sleep problems, and individual coping and leadership were associated with less psychological distress, community cohesion generally overrode these effects in the final step of regression models. Thus, while coping and leadership are important, community connection appears to confer benefits to the affected individuals even in the context of base closure.
Applying the Criminal Narrative Experience Framework to Young Offenders
Authors: Ioannou Maria , Synnott John , Lowe Emma , Tzani-Pepelasi Calli
Published: May 2018

The present study applied the Criminal Narrative Experience for the first time with young offenders ( N = 23). The analysis was based on young people serving a community sentence and attending a Youth Offending Team. Participants completed questionnaires relating to their roles and emotions during a typical offence and data were examined with Smallest Space Analysis (SSA) to identify if the themes were replicated. Three themes were identified: Calm Professional, Elated Hero, and a combined theme of Distressed Revenger and Depressed Victim. Correlation indicated links between Narrative Experience and static and dynamic risk factors. Findings suggest that the Calm Professional theme correlates with Neighbourhood risk factors, the Elated Hero with Attitudes to Offending, and the Distressed Revenger/Depressed Victim theme with Living Arrangements and Family and Personal Relationships. Potential reasons for identifying three rather than four themes with this sample are discussed. Implications of findings in preventing reoffending are highlighted.
William James and 18th-century anthropology
Authors: Carroll Jerome
Published: May 2018

This article discusses the common ground between William James and the tradition of philosophical anthropology. Recent commentators on this overlap have characterised philosophical anthropology as combining science (in particular biology and medicine) and Kantian teleology, for instance in Kant’s seminal definition of anthropology as being concerned with what the human being makes of itself, as distinct from what attributes it is given by nature. This article registers the tension between Kantian thinking, which reckons to ground experience in a priori categories, and William James’s psychology, which begins and ends with experience. It explores overlap between James’s approach and the characteristic holism of 18th-century philosophical anthropology, which centres on the idea of understanding and analysing the human as a whole, and presents the main anthropological elements of James’s position, namely his antipathy to separation, his concerns about the binomial terms of traditional philosophy, his preference for experience over substances, his sense that this holist doctrine of experience shows a way out of sterile impasses, a preference for description over causation, and scepticism. It then goes on to register the common ground with key ideas in the work of anthropologists from around 1800, along with some references to anthropologists who come in James’s wake, in particular Max Scheler and Arnold Gehlen, in order to reconceptualise the connection between James’s ideas and the tradition of anthropological thinking in German letters since the late 18th-century, beyond its characterisation as a combination of scientific positivism and teleology.
Analysis of the metal-to-metal contact flange joint subject to external bending moment
Authors: Zhang Lanzhu , Xiao Guangkai
Published: May 2018

Metal-to-metal contact flange joints are widely used in nuclear and petrochemical industry for severe conditions, because of the relative stability of the sealing gasket stress under complex service condition. In the present work, finite element models were used for analyzing the stress distribution of metal-to-metal contact pipe flange connection under different internal pressures, temperatures, and external bending moments to evaluate the sealing and strength performance. A metal-to-metal contact pipe flange connection device was also experimented. It was found that the results of the axial bolt force and flange hub stress obtained from the experiments were in fairly good agreement with the finite element simulations. The leakage test of metal-to-metal contact type gasket was conducted to highlight its leakage characteristics under different temperatures. The methods to determine the maximum allowable bending moment of a metal-to-metal contact flange joint according the strength criterion and the sealing criterion were analyzed. The results showed that the maximum allowance bending moment was determined by the strength criterion rather than by the sealing criterion with different thermal loadings when the initial bolt-up stress was high enough to achieve metal-to-metal contact contact.
Pilot testing Fostering Open eXpression among Youth (FOXY), an arts-based HIV/STI prevention approach for adolescent women in the Northwest Territories, Canada
Authors: Lys Candice L , Logie Carmen H , Okumu Moses
Published: May 2018

Fostering Open eXpression among Youth (FOXY) is an arts-based HIV prevention program developed by Northern Canadians to address sexual health, HIV, sexually transmitted infections (STIs), sexuality, and healthy relationships among Northern and Indigenous youth in Canada. We conducted a pilot study with Indigenous and Northern young women aged 13–17 years from 17 communities in the Northwest Territories to evaluate whether, in comparison to pre-intervention, FOXY participants demonstrated increased knowledge of STIs, increased safer sex self-efficacy, and increased resilience. Wilcoxon test results indicated significant increases in STI knowledge scores and safer sex self-efficacy scores. Findings suggest that FOXY holds promise as an effective method of delivering sexual health information through peer education, and increasing STI knowledge, safe sex self-efficacy, and resilience.
Adaptive neural network control of an arm-string system with actuator fault based on a PDE model
Authors: Cao Fangfei , Liu Jinkun
Published: May 2018

In this paper, an adaptive boundary controller for an undersea detection robot system with actuator failure, unknown disturbance and boundary deflection constraint is proposed. Using Hamilton’s principle, a partial differential equation (PDE) model is established for the detection system, which consists of a rigid arm, a flexible string and a sensor. Considering the actuator failure, a fault-tolerant scheme is proposed to tackle it. To handle the unknown disturbance, we employ radial basis function (RBF) neural networks (NNs) to neutralize the boundary uncertain nonlinear disturbance. The proposed adaptive controller includes a proportional–derivative (PD) feedback structure, a fault-tolerant strategy and a NN control scheme. By choosing an appropriate Lyapunov-Krasovskii function and applying LaSalle’s Invariance Principle, the asymptotic stability of the closed-loop system is rigorously proven. Simulation results validate the proposed controller.
Comparative analysis of osseointegration in various types of acetabular implant materials
Authors: Bondarenko Stanislav , Dedukh Ninel , Filipenko Volodymyr , Akonjom Mandus , Badnaoui Ahmed Amine , Schwarzkopf Ran
Published: May 2018

Background:

There is a lack of comparative data on osseointegration (BIC) of acetabular cup surfaces in hip arthroplasty in both normal bone mineral density and in conditions of osteoporosis.

Aim:

To compare osseointegration of acetabular implants with various types of surfaces in an animal model with normal and osteoporotic bone tissue.

Material and Methods:

The study was performed on 60 rats. To simulate osteoporosis ovariectomy was performed in 30 animals. Thirty healthy rats served as controls. In standardised defects of the distal metadiaphysis of the femur we implanted: porous tantalum Trabecular Metal (A), Trabecular Titanium (B), Titanium with Gription coating (C), Stiktite (D), and Tritanum (E). Bone apposition (osseointegration) was defined as all areas of direct “bone-to-implant contact” (BIC).

Results:

No qualitative morphological differences in the evaluation of BIC around different implant types was seen in normal rats and rats with osteoporosis. Connective tissue areas around implants were larger in rats with osteoporosis. Morphometric studies showed that the highest BIC were seen in implants A and B, both in healthy animals ([72.00 ± 3.48]% and [67.46 ± 1.69]%) and ones with osteoporosis ([59.19 ± 2.10]% and [53.36 ± 2.57]%). BIC was (60.10 ± 2.05)%, (60.26 ± 2.36)%, and (61.78 ± 2.27)% around implants C, D and E in healthy rats, respectively. BIC in osteoporosis was (45.39 ± 2.37)%, (47.81 ± 2.41)% and (42.10 ± 1.44)%, respectively.

Conclusion:

Our study showed that the evaluated implants have good BIC features. Furthermore, based on histomorthometry and histology, Porous tantalum Trabecular Metal (A) and Trabecular Titanium (B) implants exhibit higher BIC with bone tissue.
Does metal porosity affect metal ion release in blood and urine following total hip arthroplasty? A short term study
Authors: Bistolfi Alessandro , Cimino Andrea , Lee Gwo-Chin , Ferracini Riccardo , Maina Giovanni , Berchialla Paola , Massazza Giuseppe , Massè Alessandro
Published: May 2018

Introduction:

The surface area of exposed metal in a trabecular-titanium acetabular component is wider compared to traditional-titanium implants. The purpose of this study is to establish if this increase in surface area can lead to a significant increase in systemic metal levels.

Methods:

19 patients with conventional acetabular component and 19 with trabecular-titanium cup were compared. Aluminum, Vanadium and Titanium in blood and urine were assessed before surgery and at intervals for 2 years. The samples were analysed using an inductively coupled plasma mass spectrometry.

Results:

Patients with trabecular-titanium did not have significantly higher metal ion levels compared to patients with conventional cups up to 2 years. A trend over time was statistically significant in both blood and urine for aluminum and titanium concentrations.

Conclusions:

The three-dimensionality and the wide surface of the trabecular-titanium acetabular component did not affect metal ion release compared to traditional implants after 2 years.
A comprehensive study of the effects of honing patterns on twin-land oil control rings friction using both a numerical model and a floating liner engine
Authors: Liu Yang , Kim Dallwoo , Westerfield Zachary , Meng Zhen , Tian Tian
Published: May 2018

Engine bores are finished with a multi-stage honing process and the finished surface roughness contributes significantly to the piston ring hydrodynamic pressure generation, especially for twin-land oil control rings whose land profile is parallel to the liner surface. In this paper, five different honing patterns on a cast iron liner and one on a spray-coated aluminum liner are studied with a floating liner engine and numerical models. The liner temperature and engine speed were varied such that all the lubrication regimes, namely boundary, mixed, and fully hydrodynamic, are present. It is found that the models based on deterministic approach with a patch of carefully measured liner roughness can match the trend of the Stribeck curves for different liner finishes observed in the experiment. Furthermore, the results show that the roughness height and structure of the honing affect the twin-land oil control rings lubrication differently. With the same honing structure, although rougher liner experiences mixed and boundary lubrication in larger range of Gumbel–Hersey number, it renders less friction than the smoother ones in the hydrodynamic regime. With the same plateau roughness height, a more continuous plateau can provide more flow resistance and thus generate higher hydrodynamic pressure at the ring–liner interface and less friction.
Nonlinear estimator design based on extended Kalman filter approach for state estimation of articulated heavy vehicle
Authors: Ahmadi Jeyed Hamze , Ghaffari Ali
Published: May 2018

In this article, in order to measure the state variables directly in an articulated heavy vehicle, the extended Kalman filter approaches are proposed. For this purpose, using Kane’s method, a nonlinear model is developed for the articulated vehicle, including the motion equations of longitudinal, lateral, and yaw motion of the tractor, and the hitch articulation angle between the tractor and the semi-trailer. Using TruckSim software, the articulated vehicle model is verified through high-velocity lane change maneuver (a single sinusoidal wave with an amplitude of 5° and a frequency of 0.5 Hz) under the dry and slippery road condition. The simulation results showed that the proposed model is close to the real vehicle model and can be used in the estimator development. Then, the state estimation algorithm is designed and implemented using extended Kalman filter for real-time estimation of the states. To evaluate the performance of the extended Kalman filter, simulations with two maneuvers including high-velocity lane change maneuvers in the dry road and slippery road are carried out. The simulation results demonstrate the impressive performance of the extended Kalman filter for state estimation of the articulated vehicle in critical conditions such as the slippery road and the high velocity.
Transformations in destination texture: Curry and Bollywood romance in the Swiss Alps
Authors: Gyimóthy Szilvia
Published: May 2018

This article takes heterogeographical approaches to understand Bollywood-induced destination transformations in Switzerland. Positioned within the theoretical field of mediatized mobility, the study contextualizes Bollywood-induced tourism in Europe the concept of texture. Textural analysis (based on Lefebvre’s trialectics of space) combines the analysis of material performances and communicative representations converging in the production/consumption of tourism spaces. The article contributes threefold. First, it reviews the phenomenon of nonwestern popular cultural tourism through the theoretical lens of mediatized mobility. Second, the article offers methodological reflections on textural analysis and strategies to capture the entanglements of popular cultural representations and performances simultaneously. Third, through an analytical deconstruction of Bollywood’s imaginaries and disruptive new tourism practices in Switzerland, it discusses the placemaking potentials and challenges of concurrent narratives in cosmopolitan tourism destinations.
Influence of an Equine-Assisted Activities Program on Dementia-Specific Quality of Life
Authors: Fields Beth , Bruemmer Jason , Gloeckner Gene , Wood Wendy
Published: May 2018

Institutional facilities face challenges providing experiences to residents with dementia that promote participation in meaningful activities. Guided by the Lived Environment Life Quality Model, this study investigated associations between 9 different activity situations—one an equine-assisted activities program (EAAP)—and positive, negative, and neutral behavioral indicators of quality of life (QoL) in 6 residents with dementia who expressed an interest in horses. Direct observational data were collected for 4 hours twice weekly over 8 weeks. Using χ2 tests, differences across activity situations were tested. More positive patterns of time use (conversation; χ2 = 44.3, P < .001) and emotional well-being (pleasure; χ2 = 21.8, P = .001) were found in EAAP compared to other activity situations. Further, EAAP was the only activity situation associated with all positive QoL indicators. These findings add to our understanding the importance of providing meaningful activities that promote use of abilities and provide environmental support, for enhancing QoL, especially for institutionalized people with dementia.
Olfactory Testing in Frontotemporal Dementia: A Literature Review
Authors: Tonacci Alessandro , Billeci Lucia
Published: May 2018

Frontotemporal dementia (FTD) is a heterogeneous disorder featuring language impairment, personality changes, and executive defects, often due to the frontotemporal lobar degeneration (FTLD). Both FTD and FTLD are often associated with olfactory impairment, early biomarker for neurodegeneration, which can be evaluated with different techniques, among which low-cost olfactory tests are widely used. Therefore, we conducted a review of the literature focusing on papers published between January 1, 2007, and June 12, 2017, investigating the usefulness of olfactory testing in FTD/FTLD. A general decrease in the olfactory identification ability was seen in most of the articles and, taken together with a preserved odor discrimination, reveals a higher order impairment, possibly linked to cognitive decrease or language impairments, and not to a specific deficit of the olfactory system. This evidence could represent a useful add-on to the current literature, increasing the diagnostic value of olfactory assessment, particularly in cases where differential diagnosis is difficult.
Takayasu Arteritis Presenting as Unexplained Pulmonary Consolidation: A Case Report
Authors: Koike Hirofumi , Ashizawa Kazuto , Hayashi Hideyuki , Sakamoto Ichiro , Nakamura Shigeki , Nishino Ayako , Hayashi Tomayoshi , Uetani Masataka
Published: May 2018

Although Takayasu arteritis (TA) is rare as a form of chronic inflammatory arteritis, it is important that it is diagnosed early because the 10-year survival rate is only 84% to 87%. Many reported patients have been young women in East Asia. We report a case of a young woman who originally presented with unexplained pulmonary consolidation. Five years later, contrast-enhanced computed tomography (CT) imaging showed thickening of the walls of the aorta and its branches and of the main and right pulmonary artery (PA), and occlusion of the left subclavian and left PAs. A diagnosis of TA was made based on these CT findings. Patients with TA often have PA involvement, and this can be the initial site of arteritis. Therefore, TA should be included in the differential diagnosis of young women with unexplained pulmonary consolidation.
Field terrain recognition based on extreme learning theory using wavelet and texture features
Authors: Liu Caixia , Fang Jianjun , Liu Yanxia , Lu Yujiao
Published: May 2018

Terrain recognition technology plays a key role in enhancing autonomous mobility for Quadruped robot in off-road environments. However, feature extraction and classification algorithm are the key to accuracy and efficiency of the terrain recognition. Regarding the characteristics of different terrain surface properties and structures, it gets low-dimensional and high dimensional characteristics by texture features and wavelet transform and uses them as training features of classifier. Then its efficiency is not high and convergence speed is slow for traditional learning algorithm, which is difficult to meet the requirements. So the extreme learning machine is used to classify the terrain pictures collected by robot in real time. Experimental results show that the accuracy of extreme learning machine terrain classification is higher than the traditional neural network algorithm and the support vector machine, and algorithm efficiency is raised more than several times for the sample size of 6000, which meets the requirements for accuracy, especially for real time.
Postoperative Numbness: A Survey of Patients After Hip Arthroscopic Surgery
Authors: Reda Bashar , Wong Ivan
Published: May 2018

Background:

Hip arthroscopic surgery is a rapidly growing procedure that requires distraction of the leg to access the joint. A frequently reported complication of this procedure is postoperative numbness, with rates between 1% and 20% reported in the literature.

Purpose/Hypothesis:

The purpose of this study was to determine the factors contributing to the development and effect of numbness on functional outcomes. We hypothesized that this complication is underreported and that its prevalence is higher than what has been described in the literature.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who had undergone hip arthroscopic surgery between 2012 and 2016 were included, and a telephone survey was conducted to collect data. Data related to the procedure and outcome scores were collected via a systematic chart review for the included patients. Data analysis was conducted for means, SDs, frequencies, and percentages. For comparative statistics, t tests and multiple logistic regression models were used.

Results:

A total of 221 patients (113 male, 108 female; mean age, 39.8 ± 13.34 years) completed the survey out of 362 eligible patients. Overall, 37% (n = 82) of patients reported having experienced some form of numbness after surgery. Approximately 43% (35/82) of the patients reported resolution by 6 weeks postoperatively, and 68% (56/82) of numbness was reported to have completely resolved by 6 months. The duration of surgery was a significant factor for the development of postoperative numbness ( P = .010; odds ratio, 2.18) when comparing procedures longer than 50 minutes with procedures shorter than 50 minutes (first incision until closure). Postoperative numbness was associated with a negative effect on the International Hip Outcome Tool–33 (iHOT-33) score that reached statistical significance at the 1-year (numbness, 60.19; no numbness, 74.21; P = .006) and 2-year time points (numbness, 52.04; no numbness, 72.69; P = .01).

Conclusion:

This study confirmed our hypothesis that postoperative numbness is more common in our patient population than the incidence reported in the literature. This adverse event was also shown to be associated with decreased postoperative functional outcomes, as measured by the iHOT-33 at 1 and 2 years postoperatively.
Design and Study of a Next‐Generation Computer‐Assisted System for Transoral Laser Microsurgery
Authors: Deshpande Nikhil , Peretti Giorgio , Mora Francesco , Guastini Luca , Lee Jinoh , Barresi Giacinto , Caldwell Darwin G. , Mattos Leonardo S.
Published: May 2018

Objective

To present a new computer‐assisted system for improved usability, intuitiveness, efficiency, and controllability in transoral laser microsurgery (TLM).

Study Design

Pilot technology feasibility study.

Setting

A dedicated room with a simulated TLM surgical setup: surgical microscope, surgical laser system, instruments, ex vivo pig larynxes, and computer‐assisted system.

Subjects and Methods

The computer‐assisted laser microsurgery (CALM) system consists of a novel motorized laser micromanipulator and a tablet‐ and stylus‐based control interface. The system setup includes the Leica 2 surgical microscope and the DEKA HiScan Surgical laser system. The system was validated through a first‐of‐its‐kind observational study with 57 international surgeons with varied experience in TLM. The subjects performed real surgical tasks on ex vivo pig larynxes in a simulated TLM scenario. The qualitative aspects were established with a newly devised questionnaire assessing the usability, efficiency, and suitability of the system.

Results

The surgeons evaluated the CALM system with an average score of 6.29 (out of 7) in ease of use and ease of learning, while an average score of 5.96 was assigned for controllability and safety. A score of 1.51 indicated reduced workload for the subjects. Of 57 subjects, 41 stated that the CALM system allows better surgical quality than the existing TLM systems.

Conclusions

The CALM system augments the usability, controllability, and efficiency in TLM. It enhances the ergonomics and accuracy beyond the current state of the art, potentially improving the surgical safety and quality. The system offers the intraoperative automated scanning of customized long incisions achieving uniform resections at the surgical site.
Development of a microstructured surface using the FIB
Authors: Goswami A. , Umashankar R. , Gupta A. K. , Aravindan S. , Rao P. V.
Published: May 2018

Imparting periodic structures to a surface can make surfaces suitable for a specific functional performance in a variety of fields such as optical, electrical, biological and mechanical sciences. In this article, microstructures are fabricated on a cemented carbide tool using a focused ion beam (FIB) with the aim to reduce the cutting forces in a turning operation. The effects of FIB process parameters on the fabricated structures are analysed. The microtextured cemented carbide tool is utilized for the machining of an aluminium alloy. Compared to a non-textured tool, microtextured tool exhibited reduced cutting forces by 28% while machining. The microtextured tool reduces the friction between the chip–tool interfaces by reducing the chip–tool contact length.
Effects of nasal dilator strips on subjective measures of sleep in subjects with chronic nocturnal nasal congestion: a randomized, placebo-controlled trial
Authors: Schenkel Eric J. , Ciesla Renee , Shanga Gilbert Marava
Published: May 2018

Background

This exploratory study investigated effects of a new asymmetric butterfly-shaped prototype nasal dilator strip and the currently marketed clear Breathe Right Nasal Strip (BRNS) on subjective measures of nasal congestion and sleep quality.

Methods

In this randomized, double-blind study, subjects with chronic nasal congestion and sleep difficulties were assigned a BRNS clear strip, an asymmetric butterfly prototype, or an asymmetric butterfly placebo strip without springs, to use nightly for 2 weeks. The main outcomes included change from baseline to days 7 and 14 on the Pittsburgh Insomnia Rating Scale (PIRS), Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ), and Congestion Quantifier Seven-Item Test (CQ7).

Results

The intent-to-treat population included 59 subjects. The butterfly and BRNS strips showed significant (P < 0.05) improvement versus placebo on PIRS satisfaction with sleep at day 7 [least square (LS) mean changes: − 0.7, − 0.6, and − 0.2, respectively], and the butterfly strip also showed significant improvement from baseline on this outcome versus placebo at day 14 (− 1.0 vs − 0.5). On the NRQLQ, both the butterfly prototype and BRNS clear were more effective than placebo in improving symptoms on waking at day 7 (LS mean changes: − 7.9, − 7.2, and − 4.1, respectively); the BRNS clear was significantly more effective than placebo in improving sleep problems at day 7 (− 7.4 vs − 4.2). There were no between-treatment differences on the CQ7. All strips were well tolerated.

Conclusions

The asymmetric butterfly prototype and BRNS clear strip significantly improved some subjective measures of nasal congestion and sleep compared with placebo in subjects with nasal congestion and sleep difficulties.

Trial registration This study is registered at ClinicalTrials.gov (identifier: NCT01122849)
Suicide attempts and non-suicidal self-harm: national prevalence study of young adults
Authors: O'Connor Rory C. , Wetherall Karen , Cleare Seonaid , Eschle Sarah , Drummond Julie , Ferguson Eamonn , O'Connor Daryl B. , O'Carroll Ronan E.
Published: May 2018

Background

There are few prevalence studies of suicide attempts and non-suicidal self-harm (NSSH).

Aims

We aimed to estimate the prevalence of thoughts of NSSH, suicidal thoughts, NSSH and suicide attempts among 18- to 34-year-olds in Scotland.

Method

We interviewed a representative sample of young adults from across Scotland.

Results

We interviewed 3508 young people; 11.3 and 16.2% reported a lifetime history of suicide attempts and NSSH, respectively. The first episode of NSSH tended to precede the first suicide attempt by about 2 years. Age at onset of NSSH and suicide attempt was younger in females. Earlier age at onset was associated with more frequent NSSH/suicide attempts. Women are significantly more likely to report NSSH and suicide attempts compared with men.

Conclusions

One in nine young people has attempted suicide and one in six has engaged in NSSH. Clinicians should be vigilant, as suicide attempts and NSSH are relatively common.

Declaration of interest

None.
Medical Oncologists’ Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study
Authors: Braun Ilana M. , Wright Alexi , Peteet John , Meyer Fremonta L. , Yuppa David P. , Bolcic-Jankovic Dragana , LeBlanc Jessica , Chang Yuchiao , Yu Liyang , Nayak Manan M. , Tulsky James A. , Suzuki Joji , Nabati Lida , Campbell Eric G.
Published: May 2018

Background

Although almost every state medical marijuana (MM) law identifies cancer as a qualifying condition, little research supports MM’s use in oncology. We hypothesized that the discrepancy between these laws and the scientific evidence base poses clinical challenges for oncologists. Oncologists’ beliefs, knowledge, and practices regarding MM were examined in this study.

Methods

In November 2016, we mailed a survey on MM to a nationally-representative, random sample of 400 medical oncologists. Main outcome measures included whether oncologists reported discussing MM with patients, recommended MM clinically in the past year, or felt sufficiently informed to make such recommendations. The survey also queried oncologists’ views on MM’s comparative effectiveness for several conditions (including its use as an adjunct to standard pain management strategies) and its risks compared with prescription opioids. Bivariate and multivariate analyses were performed using standard statistical techniques.

Results

The overall response rate was 63%. Whereas only 30% of oncologists felt sufficiently informed to make recommendations regarding MM, 80% conducted discussions about MM with patients, and 46% recommended MM clinically. Sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies, and 65% thought MM is equally or more effective than standard treatments for anorexia and cachexia.

Conclusion

Our findings identify a concerning discrepancy between oncologists’ self-reported knowledge base and their beliefs and practices regarding MM. Although 70% of oncologists do not feel equipped to make clinical recommendations regarding MM, the vast majority conduct discussions with patients about MM and nearly one-half do, in fact, recommend it clinically. A majority believes MM is useful for certain indications. These findings are clinically important and suggest critical gaps in research, medical education, and policy regarding MM.
Phase III Trial Comparing Intraperitoneal and Intravenous Paclitaxel Plus S-1 Versus Cisplatin Plus S-1 in Patients With Gastric Cancer With Peritoneal Metastasis: PHOENIX-GC Trial
Authors: Ishigami Hironori , Fujiwara Yoshiyuki , Fukushima Ryoji , Nashimoto Atsushi , Yabusaki Hiroshi , Imano Motohiro , Imamoto Haruhiko , Kodera Yasuhiro , Uenosono Yoshikazu , Amagai Kenji , Kadowaki Shigenori , Miwa Hiroto , Yamaguchi Hironori , Yamaguchi Takuhiro , Miyaji Tempei , Kitayama Joji
Published: May 2018

Purpose

Intraperitoneal paclitaxel plus systemic chemotherapy demonstrated promising clinical effects in patients with gastric cancer with peritoneal metastasis. We aimed to verify its superiority over standard systemic chemotherapy in overall survival.

Patients and Methods

This randomized phase III trial enrolled patients with gastric cancer with peritoneal metastasis who had received no or short-term (< 2 months) chemotherapy. Patients were randomly assigned at a two-to-one ratio to receive intraperitoneal and intravenous paclitaxel plus S-1 (IP; intraperitoneal paclitaxel 20 mg/m2 and intravenous paclitaxel 50 mg/m2 on days 1 and 8 plus S-1 80 mg/m2 per day on days 1 to 14 for a 3-week cycle) or S-1 plus cisplatin (SP; S-1 80 mg/m2 per day on days 1 to 21 plus cisplatin 60 mg/m2 on day 8 for a 5-week cycle), stratified by center, previous chemotherapy, and extent of peritoneal metastasis. The primary end point was overall survival. Secondary end points were response rate, 3-year overall survival rate, and safety.

Results

We enrolled 183 patients and performed efficacy analyses in 164 eligible patients. Baseline characteristics were balanced between the arms, except that patients in the IP arm had significantly more ascites. The median survival times for the IP and SP arms were 17.7 and 15.2 months, respectively (hazard ratio, 0.72; 95% CI, 0.49 to 1.04; stratified log-rank P = .080). In the sensitivity analysis adjusted for baseline ascites, the hazard ratio was 0.59 (95% CI, 0.39 to 0.87; P = .008). The 3-year overall survival rate was 21.9% (95% CI, 14.9% to 29.9%) in the IP arm and 6.0% (95% CI, 1.6% to 14.9%) in the SP arm. Both regimens were well tolerated.

Conclusion

This trial failed to show statistical superiority of intraperitoneal paclitaxel plus systemic chemotherapy. However, the exploratory analyses suggested possible clinical benefits of intraperitoneal paclitaxel for gastric cancer.
Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D)
Authors: Young Annie M. , Marshall Andrea , Thirlwall Jenny , Chapman Oliver , Lokare Anand , Hill Catherine , Hale Danielle , Dunn Janet A. , Lyman Gary H. , Hutchinson Charles , MacCallum Peter , Kakkar Ajay , Hobbs F.D. Richard , Petrou Stavros , Dale Jeremy , Poole Christopher J. , Maraveyas Anthony , Levine Mark
Published: May 2018

Purpose

Venous thromboembolism (VTE) is common in patients with cancer. Long-term daily subcutaneous low molecular weight heparin has been standard treatment for such patients. The purpose of this study was to assess if an oral factor Xa inhibitor, rivaroxaban, would offer an alternative treatment for VTE in patients with cancer.

Patient and Methods

In this multicenter, randomized, open-label, pilot trial in the United Kingdom, patients with active cancer who had symptomatic pulmonary embolism (PE), incidental PE, or symptomatic lower-extremity proximal deep vein thrombosis (DVT) were recruited. Allocation was to dalteparin (200 IU/kg daily during month 1, then 150 IU/kg daily for months 2-6) or rivaroxaban (15 mg twice daily for 3 weeks, then 20 mg once daily for a total of 6 months). The primary outcome was VTE recurrence over 6 months. Safety was assessed by major bleeding and clinically relevant nonmajor bleeding (CRNMB). A sample size of 400 patients would provide estimates of VTE recurrence to within ± 4.5%, assuming a VTE recurrence rate at 6 months of 10%.

Results

A total of 203 patients were randomly assigned to each group, 58% of whom had metastases. Twenty-six patients experienced recurrent VTE (dalteparin, n = 18; rivaroxaban, n = 8). The 6-month cumulative VTE recurrence rate was 11% (95% CI, 7% to 16%) with dalteparin and 4% (95% CI, 2% to 9%) with rivaroxaban (hazard ratio [HR], 0.43; 95% CI, 0.19 to 0.99). The 6-month cumulative rate of major bleeding was 4% (95% CI, 2% to 8%) for dalteparin and 6% (95% CI, 3% to 11%) for rivaroxaban (HR, 1.83; 95% CI, 0.68 to 4.96). Corresponding rates of CRNMB were 4% (95% CI, 2% to 9%) and 13% (95% CI, 9% to 19%), respectively (HR, 3.76; 95% CI, 1.63 to 8.69).

Conclusion

Rivaroxaban was associated with relatively low VTE recurrence but higher CRNMB compared with dalteparin.
Are There Any Clinically Relevant Subgroups of Triple-Negative Breast Cancer in 2018?
Authors: Chan Jack J. , Tan Tira J.Y. , Dent Rebecca A.
Published: May 2018

The working immunohistochemical definition of triple-negative breast cancer (TNBC) is admittedly reductionist and has only limited usefulness for informing oncologists about therapeutic decisions beyond chemotherapy. Early molecular taxonomies of TNBC based heavily on gene expression profiling, which is not readily available in the clinic today, do not necessarily encompass other molecular targets already incorporated into rationally designed clinical trials. We state that it is possible to delineate five subgroups of TNBC relevant to present-day clinical practice and cover the evidence that lends credence to emerging biomarker-directed treatment strategies for each subgroup.
Thyroid Function in Early Pregnancy, Child IQ, and Autistic Traits: A Meta-Analysis of Individual Participant Data
Authors: Levie Deborah , Korevaar Tim I M , Bath Sarah C , Dalmau-Bueno Albert , Murcia Mario , Espada Mercedes , Dineva Mariana , Ibarluzea Jesús M , Sunyer Jordi , Tiemeier Henning , Rebagliato Marisa , Rayman Margaret P , Peeters Robin P , Guxens Mònica
Published: May 2018

Context

Low maternal free T4 (FT4) has been associated with poor child neurodevelopment in some single-center studies. Evidence remains scarce for the potential adverse effects of high FT4 and whether associations differ in countries with different iodine status.

Objective

To assess the association of maternal thyroid function in early pregnancy with child neurodevelopment in countries with a different iodine status.

Design, Setting, and Participants

Meta-analysis of individual participant data from 9036 mother–child pairs from three prospective population-based birth cohorts: INMA [Infancia y Medio Ambiente (Environment and Childhood project) (Spain)], Generation R (Netherlands), and ALSPAC (Avon Longitudinal Study of Parents and Children, United Kingdom). The exclusion criteria were multiple pregnancies, fertility treatments, thyroid-interfering medication usage, and known thyroid disease.

Main Outcomes

Child nonverbal IQ at 5 to 8 years of age, verbal IQ at 1.5 to 8 years of age, and autistic traits within the clinical range at 5 to 8 years of age.

Results

FT4 <2.5th percentile was associated with a 3.9-point (95% CI, −5.7 to −2.2) lower nonverbal IQ and a 2.1-point (95% CI, −4.0 to −0.1) lower verbal IQ. A suggestive association of hypothyroxinemia with a greater risk of autistic traits was observed. FT4 >97.5th percentile was associated with a 1.9-fold (95% CI, 1.0 to 3.4) greater risk of autistic traits. No independent associations were found with TSH.

Conclusions

Low maternal FT4 was consistently associated with a lower IQ across the cohorts. Further studies are needed to replicate the findings of autistic traits and investigate the potential modifying role of maternal iodine status. FT4 seems a reliable marker of fetal thyroid state in early pregnancy, regardless of the type of immunoassay.