bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Cardiopulmonary Resuscitation Performance With CODE ACES
2
: A Resuscitation Quality Bundle
Authors: Hunt Elizabeth A. , Jeffers Justin , McNamara LeAnn , Newton Heather , Ford Kenneth , Bernier Meghan , Tucker Elizabeth W. , Jones Kareen , O'Brien Caitlin , Dodge Pamela , Vanderwagen Sarah , Salamone Cheryl , Pegram Tamara , Rosen Michael , Griffis Heather M. , Duval‐Arnould Jordan
Published: December 2018

Background

Over 6000 children have an in‐hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives.

Methods and Results

A prospective observational study of quality of chest compressions (
CC
) during pediatric in‐hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality
CC
, 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association (
AHA
) Pediatric Advanced Life Support
CC
guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had
CC
data captured via defibrillator‐based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123],
P
<0.001). There were 2135 1‐minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061,
P
<0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled
CPR
Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES
2
). The adjusted marginal probability of a
CC
epoch meeting the criteria for excellent
CPR
(compliant for rate, depth, and chest compression fraction) in 2015, after
CPR
Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3–53.3) versus 19.9%(6.9–32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3–8.1],
P
=0.01).

Conclusions

CODE ACES
2
was associated with progressively increased compliance with
AHA CPR
guidelines during in‐hospital cardiac arrest.
A new genus and species of Elcanidae (Insecta: Orthoptera) from Cretaceous Burmese amber
Authors: HEADS SAM W. , THOMAS M. JARED , WANG YINAN
Published: December 2018

A new genus and species of Elcanidae (Insecta: Orthoptera) is described from mid-Cretaceous Burmese amber. Elcanonympha diana gen. et sp. nov. is known from a single, complete nymph and is distinguished from other elcanids by the pronotum cut by a single transverse sulcus, the dorsal margin of the metafemoral genicula with a row of prominent apical denticles, and the distal third of the metabasitarsus bearing a row of apically directed scale-like spines on the ventral surface.
Digital space vector modulation decoupled control scheme grid connected 1-Ø riven bias inverter to suppress high-frequency current commutation
Authors: Ramya K , Ramesh Kumar KA
Published: December 2018

A single-juncture topology of 3-Ø boost inverter with riven DC supply configuration grieves from larger incidence current commutations across the diodepassive in connection with the DC source and the intricate study as the inductor charges with capricious duty cycle. This study focuses on 1-Ø riven bias inverter with improvised technique on inverter and modulation. The riven bias inverter is analyzed using state space averaging technique to derive the mathematical model that is suitable for both steady-state and dynamic behavior conditions considering main converter nonlinearities. Hence, the research is carry forwarded in modeling the riven bias inverter on DC section with digital space vector modulation control technique to obtain decoupled control structure in lattice network and the work is validated by means of MATLAB/SIMULINK.
Fuzzy control in H-Bridge MLI for solar photovoltaic system to enhance load sharing
Authors: Yuvaraja T , Ramesh Kumar KA
Published: December 2018

The electric power system is undergoing important changes and updates nowadays, particularly on a generation and transmission level. Initially, the move towards a distributed generation in distinction to the present centralized one implies a major assimilation of energy from undeleted supply and electricity storage systems. Advanced power physics interfacing systems are expected to play a key role within the development of such modern governable and economical large-scale grids and associated infrastructures. Throughout the last era, a worldwide analysis and development interest has been impressed within the field of segmental structure conversion; thanks to the well-known offered blessings over typical solutions within the medium and high voltage and power range. Within the context of battery energy storage systems, the segmental structure conversion device family exhibits a further attraction, i.e., the aptitude of embedding such storage parts in an exceedingly split manner, given the existence of many submodules operative at considerably lower voltages. This study deals with many technical challenges related to segmental structure converters and their development with battery energy storage parts to boost load sharing system.
Investigation of maleic anhydride effect on wood plastic composites behavior
Authors: Khamedi R , Hajikhani M , Ahmaditabar K
Published: December 2018

The aim of this study is to investigate the effect of maleic anhydride on mechanical properties of wood plastic composites using acoustic emission monitoring and wavelet analysis. Wood plastic composite samples were prepared by combining olive wood sawdust as reinforcing material with volume fraction of 40 wt% up to 60 wt% with polyethylene as matrix phase. Maleic anhydride with weight ratio of 1 to 3% as a coupling agent and stearic acid with weight ratio of 1% as a lubricant agent were used in all the compounds. Wood plastic composite samples were manufactured using extrusion and injection molding process in accordance with ASTM D638. Once specimens were produced, tensile tests were carried out in order to characterize their tensile properties. Results demonstrated that wood plastic composite sample containing 40 wt% sawdust and 3 wt% maleic anhydride possesses highest tensile strength. This experimental work established the criteria for the lower amount of reinforcement material and higher amount of compatibilization agent in improving mechanical properties. Failure micro-mechanisms were characterized by wavelet analysis of acoustic emission data. Ultimately, the experimental tests were proved by the scanning electron microscope observations.
The bastard verdict and its influence on jurors
Authors: Curley Lee J. , MacLean Rory , Murray Jennifer , Laybourn Phyllis , Brown David
Published: December 2018

The Scottish legal system is a unique jurisdiction, as jurors are able to give not proven verdicts in addition to the well-known Anglo-American verdicts (guilty and not guilty). The not proven verdict has never been legally defined, meaning that currently legal practitioners can only estimate why a not proven verdict has been given. The main aim of this study was to investigate if jurors violate the regularity principle, which is commonly incorporated in many rational choice models, by testing if the introduction of the not proven verdict has an impact on the outcomes given by jurors. In addition, this study aimed to test if the introduction of the not proven verdict has an impact upon how the not guilty verdict is perceived by jurors. In this study, 128 participants listened to two vignettes centred on homicide trials. Jurors could give one of two verdicts in one of the vignettes and one of three verdicts in the other vignette. The vignettes were counterbalanced in regard to how many verdicts could be given at the end of them. It was found that jurors in a three-verdict system were less likely to give a not guilty verdict in comparison to jurors in a two-verdict system, showing that jurors violate the regularity principle and that the not proven verdict may change how the not guilty verdict is perceived. The findings of this research have implications in relation to juror communication, article 6 of the European Convention of Human Rights and juror rationality.
Nonlinear thermal vibration and dynamic buckling of eccentrically stiffened sandwich-FGM cylindrical shells containing fluid
Authors: Van Phu Khuc , Huy Bich Dao , Xuan Doan Le
Published: December 2018

The governing equations for analysing thermal vibration and dynamic buckling of eccentrically stiffened sandwich functionally graded cylindrical shells full filled with fluid and surrounded by elastic foundations in thermal environment are derived by using the classical shell theory, the geometrical nonlinearity in von Karman-Donnell sense, the smeared stiffener technique and Pasternak’s foundation model. Solutions of the problem are established according to the Galerkin’s method and Runge–Kutta method. The effects of fluid pressure, stiffeners, geometrical ratios, temperature and elastic foundation on the dynamic responses of shells are investigated.
A novel approach for preload measurement and analysis of fixed position preload spindle
Authors: Li Jiandong , Zhu Yongsheng , Yan Ke , Yan Xiaoyun , Hong Jun
Published: December 2018

Spindle preload has a decisive influence on the performance of precision machine tool spindle and is usually defined as a constant parameter in most theoretical studies. In fact, the spindle preload changes with the operating conditions, such as temperature and speed of spindle. An in-depth understanding of preload variation mechanism becomes important for preload optimization and adjustment. Although some scholars have theoretically studied the relationship between operating conditions and preload, the results lack experimental verification since there is no effective way to measure the preload on-line. In this paper, a special pressure transducer for the preload continuous measurement of fixed position preload spindle was proposed, and the coupling effect of temperature and speed on the preload was experimentally tested and theoretically simulated based on the finite-element-method-based thermo-mechanical model considering the nonlinearity of bearing stiffness. The results show that the spindle speed contributes to the increase of the spindle preload, while the temperature causes a decrease of the preload. The preload variation is the trade-off effect of temperature and speed on it. The deformation of the spacer caused by temperature and speed is the most important factor leading to the change of the spindle preload.
Effects of misalignment and crowning on contact characteristics of crown gear coupling
Authors: Guan Yabin , Fang Zongde , Yang Xiaohui , Chen Guoding
Published: December 2018

Although crown gear couplings are widely used in rotating machinery, very little is known about their contact behavior and load distribution characteristics. In this study, the manufacturing methods are presented for crown gear coupling. Complete geometrical mathematical models from tools to crown gear coupling are proposed based on the theories of differential geometry and gear mesh. Then, a high-fidelity finite element model verified by tooth contact analysis under light load is employed to investigate load distribution along the crown gear coupling interfaces. The effects of meshing position, torque, and angular misalignment are investigated on load distributions along with crowning amount depending on the displacement circle radius. Finally, it is observed that when the contact position is 0.2 times the width of the tooth, the radius of the displacement circle is the optimal result for the performance of the crown gear coupling.
Experimental investigation of the aerodynamics of a freight train passing through a tunnel using a moving model
Authors: Iliadis P , Soper D , Baker C , Hemida H
Published: December 2018

The objective of this study was to investigate the aerodynamic effects of a freight train passing through a tunnel. The nose entry generates a complex pattern of reflective pressure waves (piston effect) which can lead to intense aerodynamic forces. Previous research on the topic has focused on passenger trains because of higher speeds. The experiments of this study use a 1/25th scaled moving model at the TRAIN Rig at a speed of 33.5 m/s with a blockage ratio of 0.202. The monitored pressure along the tunnel wall can increase up to almost 1000 Pa because of the initial compression wave, while it drops when an expansion wave or the tail passes by. The maximum pressure is observed at the train nose due to air stagnation (1500 Pa) where the flow is steady, while the roof and sides experience negative pressures due to unsteady flow separation. The effect of loading configuration is significant as partially loaded trains can create a second pressure peak on the tunnel walls (after the initial compression wave) and affect the flow at the tunnel entrance wall. Under the current testing conditions, the results indicated compliance with the requirements of the Technical Specification for Interoperability and a constant pressure gradient of the initial compression wave which is in contrast with the passenger train's two-part gradient. Further work on the topic could provide visual information about the exiting jet towards the portal and the separation bubble around the train.
Gaze Amplifies Value in Decision Making
Authors: Smith Stephanie M. , Krajbich Ian
Published: December 2018

When making decisions, people tend to choose the option they have looked at more. An unanswered question is how attention influences the choice process: whether it amplifies the subjective value of the looked-at option or instead adds a constant, value-independent bias. To address this, we examined choice data from six eye-tracking studies ( Ns = 39, 44, 44, 36, 20, and 45, respectively) to characterize the interaction between value and gaze in the choice process. We found that the summed values of the options influenced response times in every data set and the gaze-choice correlation in most data sets, in line with an amplifying role of attention in the choice process. Our results suggest that this amplifying effect is more pronounced in tasks using large sets of familiar stimuli, compared with tasks using small sets of learned stimuli.
Multidisciplinary Neonatal Emergencies Simulation Team-Training (NEST) Improves Participant’s Confidence in Dealing With Simulated Neonatal Emergencies
Authors: Swamy Ravi , Chandrasekaran Manigandan , Venkatagiri Praveen K. , Grover Anuj , Datta Vikram , Sinha Ajay , Mohinuddin Syed
Published: December 2018

Background: A traditional medical curriculum has limited emphasis on communication skills, teamworking, and human factors. Simulation-based training emphasizes these skills and positively impacts patient safety. A group of Indian neonatologists in collaboration with their UK colleagues conducted adapted Neonatal Emergencies Simulation Team-training (NEST) courses in India.

Aim: To evaluate the effectiveness of NEST courses in India and analyze the participant’s feedback

Methods: A total of 16 NEST courses were conducted between November 2014 and February 2016. Structured pre- and postcourse feedback from participants was analyzed. Key domains studied included structured approach, human factors, situation-background-assessment-recommendation tool, and teamwork in an emergency. Each category was rated from 1 to 5, indicating a low to high scale. Pre- and posttraining scores and scores between centers were compared using the Wilcoxon signed-rank test and Kruskal-Wallis test, respectively.

Results: A total of 191 feedbacks from 58 nurses and 133 doctors from 4 centers were analyzed. The comparison of self-reported pre- and postcourses showed a significant improvement across all domains. There was no statistical difference between scores from different centers showing consistent course results.

Conclusions: We have demonstrated that the NEST multiprofessional course can be collaboratively delivered. The analysis of feedback shows a significant improvement in the candidate’s self-reported ability across all domains related to the application of the course principles to simulated neonatal emergencies.
Ertugliflozin: A New Option in the SGLT-2 Inhibitor Market for the Treatment of Type 2 Diabetes Mellitus
Authors: Powell Jason , Garland Scott G.
Published: December 2018

Objective: The purpose of this article is to review the pharmacological aspects of ertugliflozin and its clinical trials, which led to Food and Drug Administration (FDA) approval for the treatment of type 2 diabetes mellitus (T2DM). Data Sources: A MEDLINE/PubMed (May 2013 to October 2018) search was conducted using the following keywords: ertugliflozin, sodium glucose co-transporter 2 inhibitor, SGLT2 inhibitor, type 2 diabetes mellitus, hyperglycemia. Study Selection and Data Extraction Quantify: We included English-language articles evaluating ertugliflozin pharmacology, pharmacokinetics, efficacy, and safety in humans for blood glucose reduction in human subjects. Data Synthesis: Ertugliflozin has been FDA approved and considered both safe and efficacious for the treatment of T2DM with hemoglobin A1C reductions ranging from −0.6% to −1.16%. Safety outcomes appear to be similar to that of other SGLT2 inhibitors. Relevance to Patient Care and Clinical Practice: With this approval, patients and clinicians now have another oral option for treating this difficult disease while minimizing hypoglycemia and other unwanted adverse drug reactions. Conclusions: With the number of patients with diabetes growing, additional safe and effective treatment options available for clinicians and patients is important. Ertugliflozin appears to be an effective and safe therapy as both single and add-on therapy.
The hidden health care costs of power of attorney legislation in Scotland: what needs to be done?
Authors: Levin Kate , Carson Jill
Published: December 2018

Current power of attorney legislation in many European countries seeks to protect the rights of adult patients who lack capacity by ensuring that discharge from hospital to an alternative care setting only occurs when there is legal authority to do so, via a named guardian or power of attorney. In Scotland, a clause introduced in 2007 allows some patients who lack capacity to be transferred from hospital to a community care service provided all relevant parties are agreed that this is in keeping with the legislation (the ‘least restrictive option’) and the patient does not resist the move. However, there is variation in the understanding and use of this clause by local authorities across Scotland, often resulting in avoidable hospital delays, which are costly and cause ‘bed blocking’. This essay illustrates the costs of hospital delays due to current power of attorney legislation in Scotland and highlights the need for the systematic monitoring of power of attorney data and related hospital delays, and for alternative legislation to be considered in the future.
Nonlinear vibration analysis of vehicle–bridge interaction for condition monitoring
Authors: Meng Dejian , Xiao Feng , Zhang Lijun , Xu Xiaotian , Chen Gang S , Zatar Wael , Hulsey J Leroy
Published: December 2018

In this paper, we investigate vehicle–bridge interactions and propose a new method for assessing bridge conditions based on nonlinear vibration analysis. A vehicle model is presented, and the dynamic load on the bridge is quantified based on bridge road roughness. The vibration of a river bridge under a moving vehicle is recorded and analyzed. The Fourier spectrum of the bridge response due to vehicle loading exhibits complicated cluster bands in addition to multiple peaks, some of which are correlated with the bridge natural modes characterized by finite element method analysis and free decay testing, and some of which are correlated with the vehicle dynamic load spectrum. To characterize the unidentified narrow band in the bridge response spectrum, the Lyapunov exponent of the response is estimated, which is found to be a positive value indicating the nonlinear properties of the bridge’s large response under vehicle loading. This finding correlates with the bridge inspection, which shows that some supporting roller bearings do not properly contact the superstructure of the bridge. To elaborate this phenomenon, a model of beam with nonideal supporting condition is analyzed, and a narrow band spectrum is characterized using He’s variational-iteration method. This research offers insight to using the vehicle–bridge interaction to monitor the health status of a bridge by using nonlinear properties, as well as linear properties.
What stories should a ‘National Nature Monument’ tell? Lessons from the German Green Belt
Authors: Pieck Sonja K
Published: December 2018

For four decades, Germany was ground zero of the Cold War, cut in two by an 870-mile-long wall and sophisticated military infrastructure that separated the capitalist west and the communist east. This border region, shaped by demographic and economic decline, became an ecological refuge for over a thousand of Germany’s endangered plant and animal species. In 1989, when the wall fell, West and East German conservationists launched an effort to convert the borderlands into a protected ecological corridor called the ‘Green Belt’. This essay takes a closer look at the on-the-ground implications of such a project by examining what, and whose, stories it tells. As a case study, it looks at the German federal state of Thuringia’s recent decision to create the country’s first ‘National Nature Monument’, a new protected area category, out of the section of the Green Belt that runs through that state. The article argues that there are three deftly interwoven narratives: the story of German Democratic Republic oppression, of ecological resurgence, and of the rural idyll. All are powerfully evocative of some of the historical meanings of this border space and together they manage to craft an intriguing, hopeful, and pragmatic story of nature–culture hybridity. In the process, however this storyline silences others, including that of local farmers, some of whom reject what they see as an overreach of conservation. Rethinking the audience and in turn developing narratives about protected areas that more accurately represent local histories could be one component of creating ownership and increasing the acceptance of these spaces among local communities. Conservation and restoration, both in Germany and beyond, may well require plurivocal narratives.
Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis
Authors: Olmedo Wilman , Villablanca Pedro A , Sanina Cristina , Walker Jonathan , Weinreich Michael , Brevik Jeannine , Avendano Ricardo , Bravo Claudio A , Romero Jorge , Ramakrishna Harish , Babaev Anvar , Attubato Michael , Hernandez-Suarez DF , Cox-Alomar P , Pyo Robert , Krishnan Prakash , Wiley Jose
Published: December 2018

Background

Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention.

Methods

For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications.

Results

Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05).

Conclusion

Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.
The Impact of Religious Freedom Laws on Destination Image
Authors: Olson Eric D. , Park Heelye (Jason)
Published: December 2018

Religious Freedom Laws (RFL), aimed at prohibiting laws that burden a person’s freedom of religion, have become a source of contention in the United States. Drawing on boycott literature, this article tested a structural model involving five constructs: egregiousness, lesbian/gay/bisexual/transgender (LGBT) support, self-enhancement, boycott, and destination image. A three-path mediation model was adopted to explore how the tourist’s perception of egregiousness against RFL leads to a destination boycott decision via LGBT support and self-enhancement. The results were based on a sample of 306 respondents. The findings revealed two paths, direct and indirect, to boycott decisions from perceived egregiousness. This suggests boycott decisions in terms of RFL were determined by individual tourists’ perceptions of the egregious act and the intrinsic rewards of self-enhancement from supporting the LGBT movement. In addition, boycott decisions led to a negative destination image. The implications for researchers and destination marketers were discussed.
The cultural spaces of young children: Care, play and learning patterns in early childhood among the Guji people of Ethiopia
Authors: Jirata Tadesse Jaleta
Published: December 2018

In this article, I address African indigenous knowledge of early childhood development by discussing young children’s cultural spaces of care, play and learning among the Guji people of Ethiopia. I analyze practices in the cultural spaces of young children and show how participatory community-based care and learning are pivotal in the tradition of early childhood development in the Guji people. Furthermore, I present the features of play and learning traditions in which young children are social actors in sustaining social interaction and stability in their neighborhoods. My discussion is based on data drawn from 10 months ethnographic fieldwork carried out in the rural villages of the Guji people.
Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland
Authors: Kaufmann Marco , Kuhle Jens , Puhan Milo A , Kamm Christian P , Chan Andrew , Salmen Anke , Kesselring Jürg , Calabrese Pasquale , Gobbi Claudio , Pot Caroline , Steinemann Nina , Rodgers Stephanie , von Wyl Viktor ,   for the Swiss Multiple Sclerosis Registry (SMSR)
Published: December 2018

Background

Recent studies emphasise the importance of timely diagnosis and early initiation of disease-modifying treatment in the long-term prognosis of multiple sclerosis.

Objectives

The objective of this study was to investigate factors associated with extended time to diagnosis and time to disease-modifying treatment initiation in the Swiss Multiple Sclerosis Registry.

Methods

We used retrospective data (diagnoses 1996–2017) of the survey-based Swiss Multiple Sclerosis Registry and fitted logistic regression models (extended time to diagnosis ≥2 years from first symptoms, extended time to disease-modifying treatment initiation ≥1 year from diagnosis) with demographic and a priori defined variables.

Results

Our study, based on 996 persons with multiple sclerosis, suggests that 40% had an extended time to diagnosis, and extended time to disease-modifying treatment initiation was seen in 23%. Factors associated with extended time to diagnosis were primary progressive multiple sclerosis (odds ratio (OR) 5.09 (3.12–8.49)), diagnosis setting outside of hospital (neurologist (private practice) OR 1.54 (1.16–2.05)) and more uncommon first symptoms (per additional symptom OR 1.17 (1.06–1.30)). Older age at onset (per additional 5 years OR 0.84 (0.78–0.90)) and gait problems (OR 0.65 (0.47–0.89)) or paresthesia (OR 0.72 (0.54–0.95)) as first symptoms were associated with shorter time to diagnosis. Extended time to disease-modifying treatment initiation was associated with older age at diagnosis (per additional 5 years OR 1.18 (1.09–1.29)). In more recent years, time to diagnosis and time to disease-modifying treatment initiation tended to be shorter.

Conclusions

Even in recent periods, substantial and partially systematic variation regarding time to diagnosis and time to disease-modifying treatment initiation remains. With the emerging paradigm of early treatment, the residual variation should be monitored carefully.
Effect of Playing and Training at Altitude on Concussion Incidence in Professional Football
Authors: Connolly James G. , Nathanson John T. , Sobotka Stanislaw , Haider Syed , Gometz Alex , Lovell Mark , Choudhri Tanvir
Published: December 2018

Background:

Despite the increased attention to sports-related concussion, the literature lacks information about the environmental factors that contribute to concussion incidence. Previous investigators have noted a decreased rate of concussion in football games played at higher altitude.

Purpose/Hypothesis:

The purpose of this study was to investigate whether the protective effects of altitude on concussion rate, as described by previous investigators, were due to acute effects of altitude exposure or chronic adaptations to training at altitude. Our hypothesis was that these protective effects are not attributable to relative cerebral edema that occurs in conditions of altitude-associated hypobaric hypoxia, known as the “slosh effect,” but rather result from long-term adaptations to training at altitude.

Study Design:

Descriptive epidemiology study.

Methods:

Athletes from the 2012, 2013, 2014, and 2015 National Football League (NFL) seasons were included in this analysis of publicly available data. Concussion rates were subdivided into 4 groups: (1) low-altitude teams playing below 644 feet (low-low), (2) low-altitude teams playing above 644 feet (low-high), (3) high-altitude teams playing below 644 feet (high-low), and (4) high-altitude teams playing above 644 feet (high-high).

Results:

Away teams had a significantly higher rate of concussion (0.32 concussions per exposure) compared with their home team counterparts (0.27 concussions per exposure; P = .03). Teams training and playing at high altitude had a 28% decreased concussion rate, which was significantly lower compared with concussion incidence rates for overall, low-low, and high-low groups ( P < .05). In comparison, teams that trained at altitude but played below 644 feet had the highest rate of concussion, at 0.36 concussions per exposure ( P < .05).

Conclusion:

These data indicate that living and training at altitude may have a protective effect on concussion rate, as evidenced by the significant reduction in the high-high group and the lack of an effect in the low-high group. However, teams from low altitude playing at high altitude did not have a statistically significant reduction in concussion rate. These results show that the slosh theory does not completely explain the effects of altitude on concussion incidence rate in the NFL. Further analyses are needed to investigate the true cause of altitude-induced protection in the NFL.
An ATF6-tPA pathway in hepatocytes contributes to systemic fibrinolysis and is repressed by DACH1
Authors: Zheng Ze , Nayak Lalitha , Wang Wei , Yurdagul Arif , Wang Xiaobo , Cai Bishuang , Lapping Stephanie , Ozcan Lale , Ramakrishnan Rajasekhar , Pestell Richard G. , Jain Mukesh K. , Tabas Ira
Published: December 2018

Tissue-type plasminogen activator (tPA) is a major mediator of fibrinolysis and, thereby, prevents excessive coagulation without compromising hemostasis. Studies on tPA regulation have focused on its acute local release by vascular cells in response to injury or other stimuli. However, very little is known about sources, regulation, and fibrinolytic function of noninjury-induced systemic plasma tPA. We explore the role and regulation of hepatocyte-derived tPA as a source of basal plasma tPA activity and as a contributor to fibrinolysis after vascular injury. We show that hepatocyte tPA is downregulated by a pathway in which the corepressor DACH1 represses ATF6, which is an inducer of the tPA gene Plat. Hepatocyte-DACH1–knockout mice show increases in liver Plat, circulating tPA, fibrinolytic activity, bleeding time, and time to thrombosis, which are reversed by silencing hepatocyte Plat. Conversely, hepatocyte-ATF6–knockout mice show decreases in these parameters. The inverse correlation between DACH1 and ATF6/PLAT is conserved in human liver. These findings reveal a regulated pathway in hepatocytes that contributes to basal circulating levels of tPA and to fibrinolysis after vascular injury.
The Effect of Cadence on the Mechanics and Energetics of Constant Power Cycling
Authors: BRENNAN SCOTT F. , CRESSWELL ANDREW G. , FARRIS DOMINIC J. , LICHTWARK GLEN A.
Published: December 2018

At a constant power output, cyclists prefer to use a higher cadence than those that minimize metabolic cost. The neuromuscular mechanism underpinning the preferred higher cadence remains unclear.

Purpose

The aim of this study was to investigate the effect of cadence on joint level work and vastus lateralis (VL) fascicle mechanics while cycling at a constant, submaximal, power output. We hypothesized that preferred cycling cadence would enhance the power capacity of the VL muscle when compared with a more economical cadence. Furthermore, we predicted that the most economical cadence would coincide with minimal total electromyographic activity from the leg muscles.

Methods

Metabolic cost, lower-limb kinematics, joint level work, VL fascicle mechanics, and muscle activation of the VL, rectus femoris, biceps femoris, gastrocnemius medialis, and soleus muscles were measured during cycling at a constant power output of 2.5 W·kg−1 and cadences of 40, 60, 80, and 100 rpm. A preferred condition was also performed where cadence feedback was hidden from the participant.

Results

Metabolic cost was lowest at 60 rpm, but the mean preferred cadence was 81 rpm. The distribution of joint work remained constant across cadences, with the majority of positive work being performed at the knee. The preferred cadence coincided with the highest VL power capacity, without a significant penalty to efficiency, based on fascicle shortening velocity.

Conclusions

Cycling at a higher cadence is preferred to ensure that the muscle’s ability to produce positive power remains high. Further investigations are required to examine what feedback mechanism could be responsible for the optimization of this motor pattern.
Recent advances in improving the effectiveness and reducing the complications of abortion
Authors: Cameron Sharon
Published: December 2018

When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman’s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.
Neuromodulation influences synchronization and intrinsic read-out
Authors: Scheler Gabriele
Published: December 2018

Background: The roles of neuromodulation in a neural network, such as in a cortical microcolumn, are still incompletely understood. Neuromodulation influences neural processing by presynaptic and postsynaptic regulation of synaptic efficacy. Neuromodulation also affects ion channels and intrinsic excitability.

Methods: Synaptic efficacy modulation is an effective way to rapidly alter network density and topology. We alter network topology and density to measure the effect on spike synchronization. We also operate with differently parameterized neuron models which alter the neuron's intrinsic excitability, i.e., activation function.

Results: We find that (a) fast synaptic efficacy modulation influences the amount of correlated spiking in a network. Also, (b) synchronization in a network influences the read-out of intrinsic properties. Highly synchronous input drives neurons, such that differences in intrinsic properties disappear, while asynchronous input lets intrinsic properties determine output behavior. Thus, altering network topology can alter the balance between intrinsically vs. synaptically driven network activity.

Conclusion: We conclude that neuromodulation may allow a network to shift between a more synchronized transmission mode and a more asynchronous intrinsic read-out mode. This has significant implications for our understanding of the flexibility of cortical computations.
Establishing an international laboratory network for neglected tropical diseases: Understanding existing capacity in five WHO regions
Authors: Dean Laura , Njelesani Janet , Mulamba Charles , Dacombe Russell , Mbabazi Pamela S. , Bates Imelda
Published: December 2018

Background. Limited laboratory capacity is a significant bottleneck in meeting global targets for the control and elimination of neglected tropical diseases (NTD). Laboratories are essential for providing clinical data and monitoring data about the status and changes in NTD prevalence, and for detecting early drug resistance. Currently NTD laboratory networks are informal and specialist laboratory expertise is not well publicised, making it difficult to share global expertise and provide training, supervision, and quality assurance for NTD diagnosis and research. This study aimed to identify laboratories within five World Health Organisation regions (South-East Asia, Eastern Mediterranean, Americas, Western Pacific and Europe) that provide NTD services and could be regarded as national or regional reference laboratories, and to conduct a survey to document their networks and capacity to support NTD programmes.

Methods. Potential NTD reference laboratories were identified through systematic searches, snowball sampling and key informants.

Results. Thirty-two laboratories responded to the survey. The laboratories covered 17 different NTDs and their main regional and national roles were to provide technical support and training, research, test validation and standard setting. Two thirds of the laboratories were based in academic institutions and almost half had less than 11 staff. Although greater than 90 per cent of the laboratories had adequate technical skills to function as an NTD reference laboratory, almost all laboratories lacked systems for external verification that their results met international standards.

Conclusions. This study highlights that although  many laboratories believed they could act as a reference laboratory, only a few had all the characteristics required to fulfil this role as they fell short in the standard and quality assurance of laboratory processes. Networks of high quality laboratories are essential for the control and elimination of disease and this study presents a critical first step in the development of such networks for NTDs.
Strong association between higher-risk sex and HIV prevalence at the regional level: an ecological study of 27 sub-Saharan African countries
Authors: Kenyon Chris R. , Buyze Jozefien , Schwartz Ilan S.
Published: December 2018

Background: It is unclear why HIV prevalence varies by nearly two orders of magnitude between regions within countries in sub-Saharan Africa. In this ecological study, we assess if HIV prevalence by region is associated with any of four markers of higher risk sexual behavior: lifetime number of partners, multiple partners in past year, higher risk sex (defined as sex with non-cohabiting, non-marital partners) and age at debut.

Methods: We performed Pearson’s correlation between the 4 behavioral risk factors and HIV prevalence by region in 47 nationally representative surveys from 27 sub-Saharan African countries, separately by gender. In addition, principal components analysis was used to reduce the eight risk factors (four for each gender) to two principal components (PCs). Mixed effects linear regression was used to assess the relationship between the resulting two PCs and HIV prevalence after controlling for the prevalence of male circumcision.

Results: HIV prevalence varied by a median 3.7 fold (IQR 2.9-7.9) between regions within countries. HIV prevalence was strongly associated with higher risk sex and, to a lesser extent, the other risk factors evaluated. Both PCs were strongly associated with HIV prevalence when assessed via linear regression.

Conclusions: Differences in sexual behavior may underpin the large differences in HIV-prevalence between subpopulation within sub-Saharan African countries.
It’s the network, stupid: a population’s sexual network connectivity determines its STI prevalence
Authors: Kenyon Chris R. , Delva Wim
Published: December 2018

There is little consensus as to why sexually transmitted infections (STIs), including HIV and bacterial vaginosis (BV) are more prevalent in some populations than others. Using a broad definition of sexual network connectivity that includes both structural and conductivity-related factors, we argue that the available evidence suggests that high prevalence of traditional STIs, HIV and BV can be parsimoniously explained by these populations having more connected sexual networks. Positive feedback, whereby BV and various STIs enhance the spread of other STIs, then further accentuates the spread of BV, HIV and other STIs. We review evidence that support this hypothesis and end by suggesting study designs that could further evaluate the hypothesis, as well as implications of this hypothesis for the prevention and management of STIs.
What does the actor need to perform in health care? Emotional demands, skills and competencies
Authors: Sextou Persephone , Karypidou Anatoli
Published: December 2018

This article aims to explore the required skills and competencies of the actor who works in health-care systems. A narrative inquiry gave the opportunity for participants to elaborate on their understandings of their direct or indirect engagement with theatre in hospitals. Data were collected in the form of ten narrative interviews with experienced actors in hospitals and drama trainees. Inductive thematic analysis of this collection of qualitative data was used to allow findings to emerge from frequent or significant themes inherent in the semi-structured interviews. The study demonstrates a defensible emphasis on key themes, including the predictable professional skills such as acting in participatory dramas, using theatre improvisation and puppetry, and interpersonal skills such as emotional intelligence and empathetic awareness.
Fugitive knowledge: Performance pedagogies, legibility and the undercommons
Authors: Walsh Aylwyn
Published: December 2018

In Held, the criminal justice project I conducted at the University of Leeds with second-year theatre and performance students, performance pedagogies were structured to produce an ethnodrama. As part of the course, I developed partnerships with community-based partners Leeds Magistrates, Her Majesty’s Prison and Probation Service, and Ripon House. Students presented the performed ethnodrama to partners and invited guests. In this article, I examine how such performance-making enables students to interrogate their own understandings about the criminal justice system. In particular, they were asked to think about precarity and criminalization, and how institutions rely on authoritative readings of ex-prisoners’ records. I reflect on how higher education institutions produce knowledge. Throughout, I offer critical framing influenced by Stefano Harney and Fred Moten’s The Undercommons.
The responsible citizen: An investigation of the Theatre of the Oppressed
Authors: Songe-Møller Anna S. , Bjerkestrand Karin Brunvathne , Bjørnstad Gunhild Brænne
Published: December 2018

This article investigates the competencies promoted by the Theatre of the Oppressed, and examines how they may stimulate the empowerment of minority groups in Slovenia. The text is based on staged research interviews with participants of different ethnic and social backgrounds in a workshop in Koper, Slovenia. Analysis of the interviews show that participants experienced increased consciousness of themselves as oppressors and oppressed at an individual level, as well as an understanding that belonging in a group gives one the courage and security to raise one’s voice and that increased competence in diversity can be achieved at a societal level by using Theatre of the Oppressed. These abilities are then connected to the cognitive, affective and social competencies needed to develop democratic citizens.
Shared experiencing, shared understandings: Intersubjectivity as a key phenomenon in drama education
Authors: Viirret Tuija Leena
Published: December 2018

This article is a philosophical reflection on intersubjectivity in the context of drama education; it draws on the concept’s most recent neuroscientific basis as well as the perspectives of Merleau-Ponty, Buber and Husserl. Its purpose is to deepen our understanding of the mechanisms of interaction in learning processes in drama education. In the stream of interaction in drama, the central conditions are shared experiencing and shared understandings. Intersubjectivity encompasses both of these. This study views intersubjectivity as an innate capacity and a real phenomenon – one that is a key phenomenon in the interactions of drama education.
Process drama and co-creation: Democratic participation in museum education
Authors: Tetlie Odette
Published: December 2018

Norwegian museums play a role as institutions of democratization, their goal being – among other things – the implementation of dialogue-based and participatory education programmes. This article is based on the process drama Gundell Olsdatter, developed in 2014–15 at Steilneset Memorial in Vardø, associated with Varanger Museum, in the very north of Norway. The project focuses on the pupils’ opportunities for participation and involvement in the process drama, in conjunction with philosopher Carl Cohen’s three dimensions of democracy: breadth, depth and width. In this article, I analyse and discuss how process drama as a framework may facilitate co-creation within museum education, thus helping to make the education more democratic and participatory. The findings show that certain dramatic conventions provide a deeper degree of participation by providing the students with practice in involvement and decision-making. Through the dramatic process, the pupils become not only spectators, but also contributors to the knowledge and mediation process.