bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of out-of-round wheels on the vehicle–flexible track interaction at rail welds
Authors: Lulu G Bethel , Chen Rong , Wang Ping , Xu Jingmang , An Boyang , Chen Jiayin
Published: May 2020

The dynamic analysis of the vehicle–flexible track interaction involves the study of vehicle motion and its dynamic impact transmitted to the track structure. This paper studies the influence of the out-of-round vehicle wheels running over rail welds on a flexible ballast track. The rails are modeled as an Euler-Bernoulli beam discretely supported by a spring-damper force element that represents the flexibility of the track structure. The dynamic behavior of the vehicle–flexible track interaction is studied using the combination of the finite element method and the multi-body system. In this paper, the simulation of the vehicle with the out-of-roundness wheel running over rail welds on a flexible ballast track in the high-frequency range and the vehicle–track interaction is coupled by a non-linear wheel–rail contact model. The effects of the out-of-roundness wheel on the vehicle–flexible track interaction at rail welds are investigated by comparing the effects of the round wheel under different vehicle speeds. Results indicate that the out-of-roundness wheel at rail welds creates a high magnitude dynamic effect on the vehicle and track components. The obtained simulation results were used to set a safety limitation for the wheel and rail irregularity size.
Engaging nurses in research and quality improvement is associated with higher job satisfaction and lower rates of unscheduled time off work: A pilot study
Authors: Fitzpatrick Colin , Buckingham Tracey , Merrell Jayne , McCooey Chris , Richardson Daniel
Published: May 2020

We aim to identify associations that may help support strategies to increase job satisfaction and reduce unscheduled time off work for nurses. Given current concerns regarding nursing workforce and retention, it is vital we identify strategies and factors which maintain job satisfaction, support staff retention and reduce unscheduled time off work. As part of a quality improvement project, we conducted and distributed an online anonymous survey. Likert scales were used to measure job satisfaction, perceived quality of care, wellbeing, and unscheduled time off work. We explored participation in project work of any kind in the preceding 12 months, and captured nursing experience and current area of practice (inpatient/outpatient). A total of 350 complete responses were analysed. Nurses engaged in research or Quality Improvement Projects (QIPs) were more likely to have higher perceived levels of patient care (p = 0.0001), wellbeing (p = 0.0001) and job satisfaction (p = 0.0001) and reported lower levels of unscheduled time off work (p = 0.0001). Nurses engaged in research or quality improvement projects reported higher levels of job satisfaction, wellbeing, perceived higher levels of care in their workplace, and had lower levels of unscheduled time off work. We suggest that involving nurses in research/QIPs may improve workforce instability and job satisfaction.
Disparities by age in depressive symptoms and substance use among men who have sex with men living with HIV
Authors: Brown Monique J , Serovich Julianne M , Laschober Tanja C , Kimberly Judy A
Published: May 2020

The aim of this study was to assess the association between age, depressive symptoms, and substance use among men who have sex with men (MSM) living with HIV. Baseline data were obtained from 337 MSM living with HIV. Linear and logistic regression models were used to determine the association between age and depressive symptoms and substance use. MSM aged 35–49 had higher depressive symptoms than MSM 50 and older (B = 3.53; 95% CI: 0.33, 6.72); MSM aged 25–34 and MSM 35–49 had higher substance use than MSM 50 and older (B = 2.66; 95% CI: 0.77, 4.54; and B = 1.68; 95% CI: 0.22, 3.14, respectively). MSM aged 35–49 were more likely to be at risk for clinical depression than MSM 50 and older (OR = 1.84; 95% CI: 1.06, 3.22); MSM aged 18–24 and MSM 35–49 were less likely and more likely to have substance abuse than MSM 50 and older (OR = 0.29; 95% CI: 0.09, 0.91; and OR = 1.83; 95% CI: 1.02, 3.29, respectively). Interventions addressing depressive symptoms and substance use tailored to individuals in different age groups should account for varying needs at different stages of life.
Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand
Authors: Pattanasin Sarika , Cadwell Betsy L , Smith Dawn K , Sukwicha Wichuda , Mock Philip A , Wimonsate Wipas , Ungsedhapand Chaiwat , Sirivongrangson Pachara , Dunne Eileen F , Thigpen Michael C
Published: May 2020

In Thailand, pre-exposure prophylaxis (PrEP) is recommended for human immunodeficiency virus (HIV) prevention among at-risk men who have sex with men (MSM). We modeled the impact of PrEP and condom use as independent and combined interventions on the estimated number of HIV infections among a hypothetical population of 10,000 MSM in Bangkok, Thailand. Our model demonstrated a 92% (95% confidence interval 89.7, 94.2) reduction in HIV infections among Thai MSM who took daily PrEP and self-reported using condoms correctly and consistently (100% condom use). Increased use of PrEP and condoms likely would have a substantial impact on the HIV epidemic in Thailand.
The Adaptation of Older Adults’ Transition to Nursing Homes in Mainland China: A Qualitative Study
Authors: Sun Changxian , Zhou Rong , Cui Yan , Ding Yaping , Li Xuxu , Li Xianwen , Zhang Yangyang , Chen Shen , Xing Ying
Published: May 2020

Introduction: An increasing number of older adults have moved to nursing homes in China. This study was to explore the adaptation of older adults’ transition to nursing homes in mainland China. Method: A qualitative study was conducted in two nursing homes in Nanjing, China. Data were collected from 11 residents and 5 staff members through purposeful sampling with semistructured interviews, and content analysis was performed. Results: Three themes were identified: Chinese culture, policy, and adaptation (staying modest and prudent, feeling shy to speak with males, familism suppressing the inner voice, and the new policy “combination of medical service and care” bringing benefits); the adaptation to nursing homes (poor quality of sleep and catering, relationship development, and emotional reactions); and needs of residents (emotional support, more interactions, and self-realization). Discussion: Health care providers consider cultural assessments. Further work is expected to develop programs that help older adults adjust to nursing homes.
Direct Oral Anticoagulants in Obesity: An Updated Literature Review
Authors: Sebaaly Jamielynn , Kelley Denise
Published: May 2020

Objective:

To review literature on the use of direct-acting oral anticoagulants (DOACs) in patients with high body weight (BW) and/or high body mass index (BMI) and to make recommendations regarding use in this patient population.

Data Sources:

A search using PubMed was conducted (inception to April 13, 2020) using the term DOAC AND the terms obesity OR body weight. A separate search was also conducted with individual DOACs (dabigatran, apixaban, rivaroxaban, edoxaban) and the aforementioned terms.

Study Selection and Data Extraction:

Studies included examined the effect of BW and/or BMI on DOAC pharmacokinetics, efficacy, or safety. Included studies had DOAC indications of prevention of stroke in nonvalvular atrial fibrillation, or treatment or long-term prevention of venous thromboembolism.

Data Synthesis:

The efficacy and safety of DOACs in patients with high BW/BMI has not yet been elucidated by randomized trials; however, 2016 international guidelines suggest avoiding their use in patients with a BW >120 kg or BMI >40 kg/m2. Since 2016, several studies have been published examining use of DOACs in this patient population.

Relevance to Patient Care and Clinical Practice:

This review thoroughly discusses the literature on DOACs in patients with a BW >120 kg or BMI >40 kg/m2 pre-2016 and post-2016 guidelines.

Conclusions:

Evidence indicates that each DOAC may have differences in outcomes when used in patients with a high BW/BMI. Currently, low-quality data are available that support avoiding dabigatran and considering apixaban or rivaroxaban; lack of sufficient data preclude a recommendation for edoxaban use in this patient population.
Introduction: Working the Tensions of the Post-Qualitative Movement in Qualitative Inquiry
Authors: Carlson David Lee , Wells Timothy C. , Mark Lauren , Sandoval Jorge
Published: May 2020

In this introduction, the authors briefly survey the field of post-qualitative inquiry, outlining innovations, tensions, and questions that reside within the current field. The authors follow this survey with a review of the special issue, detailing the call and the individual contributions.
A rare case of gastric cancer with bilateral breast metastasis during pregnancy
Authors: Basoglu Tugba , Telli Tugba Akin , Demircan Nazim Can , Arikan Rukiye , Ercelep Ozlem , Ozguven Salih , Soysal Sunullah , Memisoglu Asli , Dane Faysal , Yumuk Perran Fulden
Published: May 2020

Background

Gastric cancer is rare during pregnancy and often diagnosed at a later stage due to overlapping symptoms of pregnancy. Breast metastasis of gastric cancer is another uncommon entity. We present a rare case of breast metastasis of gastric cancer during pregnancy.

Case report

A 26-year-old female was diagnosed with gastric cancer at 14 weeks of gestation and underwent total gastrectomy. She rejected adjuvant chemotherapy and continued pregnancy without any follow-up. Cancer recurred in bilateral breasts at 34th week of gestation mimicking primary inflammatory breast cancer.

Management and outcome

It was difficult to diagnose breast metastasis during pregnancy because of overlapping pregnancy symptoms. Following an unresponsive period to antibiotherapy, a fine needle biopsy on breast was performed and signet cell adenocarcinoma metastasis was determined. We started chemotherapy after delivery. There was a near complete response after first line of chemotherapy. Unfortunately, cancer was relapsed within three months and we started second-line chemotherapy.

Discussion

To our knowledge, this is the fourth case reported in medical literature of gastric cancer presented with breast metastasis during pregnancy. We will try to draw attention to diagnosis, treatment and different presentation of gastric cancer during pregnancy with review of the literature.
Gender Analysis of COVID-19 Outbreak in South Korea: A Common Challenge and Call for Action
Authors: Kim Saerom , Kim Jin-Hwan , Park Yukyung , Kim Sun , Kim Chang-yup
Published: May 2020

This study aims to analyze South Korea’s experience during the COVID-19 outbreak through a gendered lens. We briefly introduce the COVID-19 outbreak in Korea, scrutinize gendered vulnerability in contracting the virus, and then analyze the gendered aspects of the pandemic response in two phases: quarantine policy and mitigation policy. The authors elicit four lessons from the analysis. First, gender needs to be mainstreamed at all stages of a public health emergency response. Second, in addition to medical care, all formal and informal care work should be considered as an essential component of health care systems. Third, a people-centered approach in health governance should be prioritized to make women’s voices heard at every level. Fourth, medical technology and resources to cope with pandemic should be produced and distributed in an equitable manner, acknowledging differential vulnerability and susceptibility.
Application of topological optimisation methodology to finitely wide slider bearings operating under incompressible flow
Authors: Kalliorinne Kalle , Almqvist Andreas
Published: May 2020

The search for the optimal bearing geometry has been on for over a century. In a publication from 1918, Lord Rayleigh revealed the infinitely wide bearing geometry that maximises the load carrying capacity under incompressible flow, i.e. the Rayleigh step bearing. Four decades ago, Rohde, who continued on the same path, revealed the finitely wide bearing geometry that maximises the load carrying capacity, referred to as the Rayleigh-pocket bearing. Since then, the numerical results have been perfected with highly refined meshes, all converging to the same Rayleigh-pocket bearing. During recent years new methods for performing topology optimisations have been developed and one of those is the method of moving asymptotes, frequently used in the area of structural mechanics. In this work, the method of moving asymptotes is employed to find optimal bearing geometries under incompressible flow, for three different objectives. Among the results obtained are (i) show new bearing geometries that maximise the load carrying capacity, which performs better than the ones available, (ii) new bearing geometries minimising the coefficient of friction and (iii) new bearing geometries minimising the friction force for a given load carrying capacity are presented as well.
Applying load-sharing method to the sliding contact in the presence of nano-lubricants
Authors: Gholami R , Akbarzadeh Saleh , Ziaei-Rad S , Khonsari MM
Published: May 2020

The main goal of this study is to present a model to investigate the effect of nano-particles’ weight fraction on the friction coefficient of rough contact in the mixed-lubrication regime. Experimental testing involves pin-on-disk measurements of the friction coefficient with CuO nano-particles added to engine oil. Theoretical analyses involve developing a method for treating an EHL line contact with provision for surface roughness that takes into account the load-carrying capacity of surface asperities, lubricant, and nano-particles. Results show that theoretical and experimental results for friction coefficients are in good agreement. A parametric study is conducted to investigate effect of load, the geometry of the nano-particles, and their mechanical properties as well as their weight fraction on the friction coefficient.
Attachment representations in children with disruptive behavior disorders: A special focus on insecurity in middle childhood
Authors: Bizzi Fabiola , Pace Cecilia Serena
Published: May 2020

According to the emotional and social problems encountered in disruptive behaviour disorder (DBD), there is little available information regarding the attachment processes during middle childhood. Therefore, this study aims to investigate the attachment representations to both caregivers in a sample of 84 children, aged 8–12 years ( N = 42 with a diagnosis of DBD; N = 42 as a comparison group). Attachment is assessed through the Child Attachment Interview, a semi-structured interview that incorporates both narrative and behavioural assessments of attachment, permits the assessment of attachment representations using dimensional and categorical approaches, and allows for the detection of disorganisation to both parents individually. Our results point to the presence of high frequencies of insecure attachment (more than 80%) in the DBD group, with a higher percentage of dismissing attachment, and an over-representation of disorganised attachment (more than 50%). Higher levels of dismissal and lower levels of security are found in DBD than in the comparison group. No attachment differences with respect to both parents are found. Understanding how different aspects of attachment during a specific developmental phase plays a role within the broader emotional functioning of DBD has great potential to lead to innovations in evaluations and treatment processes.
Mapping HIV-related figures of risk in Europe’s blood donation regime
Authors: Dziuban Agata , Sekuler Todd
Published: May 2020

Grasping blood donation as contested grounds for enacting notions of belonging, responsibility and citizenship, this article analyses the role of donor deferral policies in the emergence of a European blood donation regime. We demonstrate how shifts in the moral economy of blood donation that followed from the outbreak of the human immunodeficiency virus (HIV) epidemic led to the prioritisation of donor deferral policies in efforts to enhance blood safety across Europe. We propose the notion ‘figures of risk’ – condensed figurations of those understood to pose risks of HIV infection to themselves and to others – to describe the categories of persons implicated in changing European donor restriction policies. We explore how the Council of Europe’s annually revised Guide to the preparation, use and quality assurance of blood components, first published in 1992, came to legitimise and sustain increasingly contested deferral practices, which have produced shifting groups of persons as European ‘figures of risk’. Qualitative analyses of the Guide’s 19 editions reveal 3 dimensions through which these figures have become increasingly stabilised over time: in terms of their ontology, temporality and risk-related exceptionality. We conclude by asking how collectivising figurations of donors, framed through literature on ‘profiling’, shape notions of European citizenship.
Factors influencing volatile organic compounds in Canadian homes
Authors: Cakmak Sabit , Kauri Lisa Marie , Andrade Julie , Dales Robert
Published: May 2020

Volatile organic compounds, several of which may impact health, have many possible indoor sources. To further investigate this, we tested the association between indoor concentrations of 47 passively collected volatile organic compounds and both home characteristics and occupant behaviours in a Canadian population-based sample of 3454 participants. Homes with smokers were excluded from analysis. Homes with a door connecting to an attached garage had greater concentrations of hexanal, benzaldehyde, all the measured alkyl benzenes and ketones, most of the simple hydrocarbons and terpenes. Major home renovations within the past month were associated with higher concentrations of most or all of the volatile organic compounds in the categories of alcohols, alkyl benzenes, ketones, simple hydrocarbons and terpenes. Using paints and stains within the past week were associated with an increase in concentrations of the majority of alcohols, alkyl benzenes and simple hydrocarbons. Several building characteristics and occupant’s behaviours appear to increase exposure to volatile organic compounds. Modification of these factors is generally under the control of the occupant(s), suggesting that education could result in reduced indoor volatile organic compound exposure in the Canadian population.
Numerical analysis of the effect of external opening on fire safety of refuge floors in tall buildings
Authors: Lau K. W. , Yue T. K. , Chow W. K.
Published: May 2020

Refuge floors are fire safety requirements for tall buildings in many Asia-Oceania cities. However, there are concerns on the adequate provision of cross-ventilation and drencher system to openings on refuge floors. To review the existing situation, a survey of 44 building developments involving 51 blocks of both residential and non-residential tall buildings was conducted. A new fire safety parameter, i.e. the ratio of external wall openings areas to the nominal total wall areas of refuge floors (wall opening area ratio, or WOAR), was introduced to provide a quantitative measure in analysing fire safety level of tall buildings. To study how the ventilation provision is affected by WOAR, numerical simulations for the effect of natural ventilation on fire growth on the refuge floor were conducted by incorporating the wind data collected from the tallest building in Hong Kong. In the simulations, an office layout was adopted on both upper and lower floors for the sake of illustrating the possible smoke and heat spread from lower floor to upper floor (refuge floor). Finally, fire safety issues in relation to natural ventilation on fire in tall buildings were discussed. Suggestions in improving the fire safety design of tall buildings are proposed.
Effect of inclusions on microstructure and mechanical behavior of multi-pass welded naval grade steel
Authors: Venkatesh Kannan M , Arivazhagan N , Nageswara Rao M , Madhusudhan Reddy G
Published: May 2020

This paper assesses the metallurgical characteristics and mechanical properties of multi-pass gas tungsten arc welding (GTAW) and gas metal arc welding (GMAW) of micro-alloyed steel DMR 249-A. The prime objective was to carry out a comparative study of the microstructure and mechanical properties of the joints produced by the two types of welding. A high volume of larger sized inclusions in GMAW contributed to inferior mechanical properties. The coarse-grained part of the heat-affected zone (CGHAZ) showed a lower microhardness. Fracture always occurred in the heat-affected zone, and it is believed that it is associated with CGHAZ. GTAW joints showed low tensile residual stress, higher hardness, and tensile strength. GTA weldment also showed superior impact toughness at sub-zero temperature (–60 °C). Mn-containing inclusions were seen in GTA weldments; it is believed that they promote the formation of acicular ferrite. This is believed to be responsible for the superior mechanical properties of GTA weldments. The microstructural analysis of the two weldments revealed the presence of a higher volume fraction of acicular ferrite in the GTAW. All in all, GTAW joint was found to perform better than GMAW joint.
Livestreaming the ‘wretched of the Earth’: The Christchurch massacre and the ‘death-bound subject’
Authors: Ibrahim Yasmin
Published: May 2020

The livestreaming of terror, its co-production through live consumption and the massacre of lives as ‘entertainment’ propelled us into another long abyss of ethical challenges in the case of the xenophobic terrorist attack in Christchurch, New Zealand, in 2019. Livestreaming, as part of the convergence of technologies, enables narration in ‘real’ time, dragging us into a new ‘banalisation of evil’ where terror and torture can be co-produced by inviting audiences to consume through the vantage point of the perpetrator. This article examines the Muslim ‘body’ through JanMohamed’s notion of the ‘death-bound subject’ where the continual threat of death foreshadows the Muslim body, imbricating it within a political and ideological archaeology wherein both its possibility of death and the performance of death enter into a realm of theatrics of production incumbent upon invoking new moralities around consumption and its residues as a screen image. The ‘wretched of the Earth’ and their residues as immaterial matter online as the ‘wretched of the screen’ connote a new architecture of violence conjoining the temporalities of liveness with the sharing features of ‘semiotic capitalism’.
Vertex Exchange Method for non-parametric estimation of mixing distributions in logistic mixed models
Authors: Marquart Louise , Verbeke Geert
Published: May 2020

The conventional normality assumption for the random effects distribution in logistic mixed models can be too restrictive in some applications. In our data example of a longitudinal study modelling employment participation of Australian women, the random effects exhibit non-normality due to a potential mover–stayer scenario. In such a scenario, the women observed to remain in the same initial response state over the study period may consist of two subgroups: latent stayers—those with extremely small probability of transitioning response states—and latent movers, those with a probability of transitioning response states. The similarities between estimating the random effects using non-parametric approaches and mover–stayer models have previously been highlighted. We explore non-parametric approaches to model univariate and bivariate random effects in a potential mover–stayer scenario. As there are limited approaches available to fit the non-parametric maximum likelihood estimate for bivariate random effects in logistic mixed models, we implement the Vertex Exchange Method (VEM) to estimate the random effects in logistic mixed models. The approximation of the non-parametric maximum likelihood estimate derived by the VEM algorithm induces more flexibility of the random effects, identifying regions corresponding to potential latent stayers in the non-employment category in our data example.
Sequential Monte Carlo methods in Bayesian joint models for longitudinal and time-to-event data
Authors: Alvares Danilo , Armero Carmen , Forte Anabel , Chopin Nicolas
Published: May 2020

The statistical analysis of the information generated by medical follow-up is a very important challenge in the field of personalized medicine. As the evolutionary course of a patient's disease progresses, his/her medical follow-up generates more and more information that should be processed immediately in order to review and update his/her prognosis and treatment. Hence, we focus on this update process through sequential inference methods for joint models of longitudinal and time-to-event data from a Bayesian perspective. More specifically, we propose the use of sequential Monte Carlo (SMC) methods for static parameter joint models with the intention of reducing computational time in each update of the full Bayesian inferential process. Our proposal is very general and can be easily applied to most popular joint models approaches. We illustrate the use of the presented sequential methodology in a joint model with competing risk events for a real scenario involving patients on mechanical ventilation in intensive care units (ICUs).
A Matter of Conscience: Examining the Law and Policy of Conscientious Objection in Health Care
Authors: Fry-Bowers Eileen K.
Published: May 2020

Conscientious objection refers to refusal by a health care provider (HCP) to provide certain treatments, including the standard of care, to a patient based upon the provider’s personal, ethical, or religious beliefs. Federal and state rules regarding conscientious objection have expanded the scope of legal protections that HCPs and institutions can invoke in support of refusal. Opponents of these rules argue that allowing refusal of care deprives patients of care that conforms to professionally established guidelines, contradicts long-standing principles related to informed consent, interferes with the ability of health care facilities to provide safe and efficient care, and leaves the patient without means of redress for injury. Proponents respond that such rules are necessary to preserve the moral integrity of providers, including institutions. Although refusal rules are most often associated with abortion, some HCPs have cited moral concerns regarding contraception, sterilization, prevention/treatment of sexually transmitted infections, transition-related care for transgender individuals, medication-assisted treatment of substance use disorders, the use of artificial reproductive technologies, and patient preferences for end-of-life care. Evidence suggests that the burden of conscientious refusal falls disproportionately on vulnerable populations, and legitimate concern exists that moral disagreement is merely pretext for discrimination. A careful balance must be struck between the defending the conscience rights of HCPs and the civil rights of patients.
Influence of matrix systems on the deformation behavior of adaptive fiber-reinforced plastics
Authors: Ashir Moniruddoza , Cherif Chokri
Published: May 2020

Adaptive structures contain actuators that enable the controlled modification of system states and characteristics. Furthermore, their geometric configuration as well as physical properties can be varied purposefully. The geometric configuration of adaptive fiber-reinforced plastics can be changed by varying the bending modulus of the matrix material. Hence, this research work presents the influence of thermosetting matrix material with different bending moduli on the deformation behavior of adaptive fiber-reinforced plastics. Firstly, shape memory alloys were converted into shape memory alloy hybrid yarn in order to realize this goal. Subsequently, shape memory alloy hybrid yarn was textile-technically integrated into reinforcing fabrics by means of weaving technology. The bending modulus of the thermosetting matrix material was changed by mixing modifier into it. The Seemann Corporation Resin Infusion Molding Process was used for infusion. Later, the deformation behavior of adaptive fiber-reinforced plastics was characterized. Results revealed that the maximum deformations of adaptive fiber-reinforced plastics with resin and modifier at a mixing ratio of 9:1 and 8:2 were increased to 34% and 63%, respectively, compared to adaptive fiber-reinforced plastics infiltrated by the reference resin. The maximum deformation speed during heating and cooling of adaptive fiber-reinforced plastic with the mixing ratio of resin and modifier at a value of 8:2 were 41.17 mm/s and 26.89 mm/s, respectively.
Three Validation Tests of the Shor–McCarty State Legislator Ideology Data
Authors: Remmel Megan L. , Mondak Jeffery J.
Published: May 2020

The Shor–McCarty state ideology data provide a valuable resource for students of state legislative politics, but, as with any important new measures, the properties of those data warrant independent examination. Toward that end, we report results from three validation tests, two tests of convergent validity and one test of construct validity, with all tests focused on Shor and McCarty’s legislator, or individual-level, data. Collectively, results of the validation exercises offer strong evidence the Shor–McCarty measures provide valid representations of state legislator ideology.
Gender Conformity and Suicide: A Case Study Integrating Structural Family Therapy and Satir Experiential Therapy
Authors: Romney Justin S. , Hawkins Lindsey G. , Soloski Kristy L.
Published: May 2020

Recent studies have shown that suicidality among transgender youth are 3.6 times more likely to report suicidal ideation and 3.2 times more likely to attempt suicide compared with cisgender youth. To alleviate the suicide rates among transgender youth, research suggests the need for family-based interventions. This case study explores the integration of structural family therapy and the Satir growth model to increase connection and support within the family, while also creating clear boundaries that are protective and growth-enhancing. This study provides a session by session overview of how the therapist integrated the models while working with the entire family unit.
Utilization of Complementary Alternative Medicine, Diet, and Exercise Among Women at High Risk for Developing Breast Cancer
Authors: Lee Richard T. , Amico Andrea , Malaka David , Lewin Rachel , Cummings Shelly A. , Verp Marion , Patrick-Miller Linda , Bradbury Angela R. , Olopade Olufunmilayo I.
Published: May 2020

Background: Women diagnosed as having a high risk for breast cancer (HR-BC) often seek different health behaviors (HBs) such as complementary and alternative medicine (CAM), diet, and exercise to improve their health and cancer outcome. Methods: Women already enrolled in a multimodality screening study for patients at HR-BC (gene mutation carrier or >20% cumulative lifetime risk) were given a questionnaire to evaluate their use of CAM therapies, diet, and exercise before and after a diagnosis of HR-BC. Patients were also asked to complete the Short-Form 36, State-Trait Anxiety Inventory, and Beck Depression Inventory. Results: A total of 134 (67%) subjects completed the survey from the original cohort. General characteristics included a median age of 46 years (range = 24-73 years), majority were White (91%), BRCA1/2 gene mutation carrier (49%), and prior diagnosis of breast and/or ovarian cancer (30%). Almost all of the patients reported a lifetime prevalence of any HB (97%) and CAM utilization (91%). Subjects also had a high lifetime utilization of exercise (83%), herbs and supplements(72%), and diet programs (58%). All of these HBs declined in utilization after diagnosis of HR-BC by as much as 30%. After diagnosis of a HR-BC, a personal history of breast and/or ovarian cancer was significantly correlated with increased use of CAM (odds ratio [OR] = 5.9, P < .01), herbs and supplements (OR = 4.3, P < .01), and diet program (OR = 4.4, P < .01) in multivariate analysis. Conclusions: HBs such as CAM, diet, and exercise are highly prevalent among women with HR-BC, and the utilization of HB decreases significantly after diagnosis of HR-BC.
Attitudes and Perceptions to Prehabilitation in Lung Cancer
Authors: Shukla Anna , Granger Catherine L. , Wright Gavin M. , Edbrooke Lara , Denehy Linda
Published: May 2020

Background: Prehabilitation to maximize exercise capacity before lung cancer surgery has the potential to improve operative tolerability and patient outcomes. However, translation of this evidence into clinical practice is limited. Aims: To determine the acceptability and perceived benefit of prehabilitation in lung cancer among thoracic surgeons. Procedure: 198 cardiothoracic surgeons within Australia and New Zealand were surveyed to evaluate their attitudes and perceived benefits of prehabilitation in lung cancer. Results: Response rate was 14%. A moderate proportion of respondents reported that there is a need to refer lung resection patients to preoperative physiotherapy/prehabilitation, particularly high-risk patients or those with borderline fitness for surgery. 91% of surgeons were willing to delay surgery (as indicated by cancer stage/type) to optimize patients via prehabilitation. The main barriers to prehabilitation reported were patient comorbidities and access to allied health professionals, with 33% stating that they were unsure who to refer to for prehabilitation in thoracic surgery. This is despite 60% of the cohort reporting that pulmonary rehabilitation is available as a preoperative resource. 92% of respondents believe that further research into prehabilitation in lung cancer is warranted. Conclusion: The benefits of prehabilitation for the oncology population have been well documented in the literature over recent years and this is reflected in the perceptions surgeons had on the benefits of prehabilitation for their patients. This survey demonstrates an interest among cardiothoracic surgeons in favor of prehabilitation, and therefore further research and demonstration of its benefit is needed in lung cancer to facilitate implementation into practice.
Can Electric Nose Breath Analysis Identify Abdominal Wall Hernia Recurrence and Aortic Aneurysms? A Proof-of-Concept Study
Authors: Mommers Elwin H. H. , van Kooten Lottie , Nienhuijs Simon W. , de Vries Reilingh Tammo S. , Lubbers Tim , Mees Barend M. E. , Schurink Geert Willem H. , Bouvy Nicole D.
Published: May 2020

Introduction. This pilot study evaluates if an electronic nose (eNose) can distinguish patients at risk for recurrent hernia formation and aortic aneurysm patients from healthy controls based on volatile organic compound analysis in exhaled air. Both hernia recurrence and aortic aneurysm are linked to impaired collagen metabolism. If patients at risk for hernia recurrence and aortic aneurysms can be identified in a reliable, low-cost, noninvasive manner, it would greatly enhance preventive options such as prophylactic mesh placement after abdominal surgery. Methods. From February to July 2017, a 3-armed proof-of-concept study was conducted at 3 hospitals including 3 groups of patients (recurrent ventral hernia, aortic aneurysm, and healthy controls). Patients were measured once at the outpatient clinic using an eNose with 3 metal-oxide sensors. A total of 64 patients (hernia, n = 29; aneurysm, n = 35) and 37 controls were included. Data were analyzed by an automated neural network, a type of self-learning software to distinguish patients from controls. Results. Receiver operating curves showed that the automated neural network was able to differentiate between recurrent hernia patients and controls (area under the curve 0.74, sensitivity 0.79, and specificity 0.65) as well as between aortic aneurysm patients and healthy controls (area under the curve 0.84, sensitivity 0.83, and specificity of 0.81). Conclusion. This pilot study shows that the eNose can distinguish patients at risk for recurrent hernia and aortic aneurysm formation from healthy controls.
Prophylactic Antibiotics Prior to Hand Surgery in Patients with Prosthetic Joints
Authors: Warnick Eugene , Ilyas Asif M.
Published: May 2020

Background: To determine the prevalence of prosthetic joint infections (PJIs) after elective clean hand surgery in order to determine whether prophylactic antibiotics are warranted in patients who have previously undergone total joint arthroplasty (TJA). Methods: All patients undergoing elective clean hand surgery between 2012 and 2018 were retrospectively cross-referenced with patients who had previously undergone a TJA at the same urban academic medical center. Inclusion criteria were any patients who underwent clean hand surgery during the study period who were an adult between the ages of 30 and 90, had a previous TJA, and did not have a previous history of a PJI. All charts were reviewed to collect data on patient demographics, co-morbidities, the type of TJA and hand surgery performed, whether prophylactic antibiotics were used prior to the hand surgery, and whether a PJI occurred within 3 months of the hand surgery. Results: Total of 331 patients (181 females and 150 males) were identified over the 6-year period that met inclusion criteria. In total, 13% of the patients received prophylactic antibiotics prior to their hand surgery and 87% had not. Only 1 case of a PJI occurred within 3 months of a hand surgery. No relationship was identified between the PJI and the hand surgery, nor the need for preoperative antibiotic prophylaxis. Conclusions: Incidence of PJI after clean hand surgery is very low. We do not recommend the routine use of antibiotic prophylaxis in patients undergoing clean elective hand surgery with a history of prior TJA in order to prophylax against a PJI.
The Utility of Preoperative HbA1c as a Standardized Protocol in Elective Carpal Tunnel Release: A Retrospective Review of Clinical Outcomes
Authors: Collins Patrick S. , Apel Peter J. , Truong Albert Y. , Zarei Melika , Lozano Alicia J. , Capito Anthony E.
Published: May 2020

Background: In an effort to reduce surgical complications, some institutions have implemented universal hemoglobin A1c (HbA1c) screening for all preoperative patients. However, the value of HbA1c screening for predicting clinically meaningful complications after elective carpal tunnel release (CTR) remains unclear. The purpose of this study was to investigate the clinically meaningful predicative value of HbA1c screening on postoperative complications following elective CTR. Methods: A retrospective cohort study of 790 patients who underwent CTR was performed. All patients had an HbA1c screening performed, regardless of whether they underwent the diagnosis for diabetes or not. Primary outcomes were overall complication rate, rates of major complications (readmission or reoperation), and rates of minor complications (surgical site infection and wound dehiscence). Patients were stratified into 3 groups based on HbA1c: HbA1c <7, HbA1c 7-8, and HbA1c >8. Results: The overall complication rate for all groups was 4.8%. Rates of major complications were 0.4% for readmission and 0.1% for reoperation. For minor complications, the odds ratio (OR) for the HbA1c 7-8 group was 0.6 (95% confidence interval [CI], 0.14-1.77), and for the HbA1c >8 group, the OR was 1.6 (95% CI, 0.66-3.60). All minor complications resolved with outpatient treatment. There were no statistically significant differences between the groups for any comparisons. Conclusions: Elective CTR has a low complication rate. Routine preoperative screening of HbA1c is of little value in predicting clinically meaningful complications.
Transradial Woven EndoBridge device to treat a ruptured basilar tip aneurysm under conscious sedation
Authors: Bhogal P , Chan N , Makalanda HLD , Wong K , Noblet J
Published: May 2020

We present a patient with a ruptured basilar tip aneurysm treated under conscious sedation via a right radial approach using the Woven EndoBridge device. We discuss the technical aspects of the case as the well as the available literature on the treatment of ruptured aneurysms treated without general anaesthesia. We discuss the potential benefits of the Woven EndoBridge device in such situations.
Functional outcomes of trigger finger release in non-diabetic and diabetic patients
Authors: Stirling Paul H. C. , Jenkins Paul J. , Duckworth Andrew D. , Clement Nicholas D. , McEachan Jane E.
Published: May 2020

We compared the functional outcomes, health-related quality of life, and satisfaction in diabetic and non-diabetic patients undergoing A1 pulley release for trigger finger in 192 patients. Preoperative and postoperative Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick DASH), EuroQol-5 dimensions, and satisfaction scores were collected prospectively over a 6-year period. These patients had a mean follow-up of 14 months (range 11–40) after surgery. There were 143 patients (143 trigger fingers) without diabetes and 49 patients (49 trigger fingers) with diabetes. We found overall QuickDASH improvement was the same in both groups (–4.5 points). Patient satisfaction rates were comparable in both groups (90% versus 96%), and no significant difference in postoperative health-related quality of life was observed. No complications were reported in either group. We conclude from this study that A1 pulley release leads to similar functional improvement and high patient satisfaction at one year postoperatively in diabetic and non-diabetic patients.

Level of evidence: III
Increased Vascularity in the Neonatal versus Adult Meniscus: Evaluation with Magnetic Resonance Imaging
Authors: Lin Kenneth M. , Gadinsky Naomi E. , Klinger Craig E. , Dyke Jonathan P. , Rodeo Scott A. , Green Daniel W. , Fabricant Peter D. , Helfet David L. , Shea Kevin G. , Lazaro Lionel E.
Published: May 2020

Objective. Quantification of meniscus vascularity has been limited with previous techniques, and minimal data exist describing differential vascular zones in the skeletally immature meniscus. The objective of this study is to use quantitative contrast-enhanced magnetic resonance imaging (MRI) to compare meniscal vascularity in neonatal specimens with adults. We hypothesized that the developing meniscus has greater and more uniform vascularity throughout all zones. Design. Ten fresh-frozen human cadaveric knees (5 neonatal, age 0-6 months; 5 adult, 34-67 years) underwent gadolinium-enhanced MRI using an established vascularity quantification protocol. Regions of interest corresponding to peripheral and central zones of the meniscus were identified on pre-contrast coronal images, and signal enhancement within the same regions (normalized against background tissue) was compared between pre- and post-contrast images. Results. The medial and lateral menisci had similar distribution of perfusion (45.8% ± 8.1% medial vs. 54.2% ± 8.1% lateral in neonatal knees; 50.6% ± 11.3% medial vs. 49.4% ± 11.3% lateral in adult knees, P = 0.47). Increased perfusion was demonstrated in the periphery compared with the central zone (2.3:1 in neonatal knees and 3.25:1 in adult knees, P = 0.31). Neonatal specimens demonstrated 6.0-fold greater overall post-contrast meniscal signal enhancement compared with adults ( P < 0.0001), with the 0-month specimen demonstrating the greatest proportional signal enhancement. Conclusions. While blood flow to the periphery is greater than to central zones in all menisci, younger menisci receive proportionally greater overall blood flow compared to adults, including to the central zone, suggesting that the immature meniscus is a more biologically active tissue than its adult counterpart.
Impact of an On-Site Versus Remote Patient Navigator on Pediatricians’ Referrals and Families’ Receipt of Resources for Unmet Social Needs
Authors: Messmer Emily , Brochier Annelise , Joseph Marie , Tripodis Yorghos , Garg Arvin
Published: May 2020

Background: Patient navigation is increasingly being used by pediatric health care delivery systems to address patients’ unmet social needs. However, it is not known whether navigators working remotely can be as effective at linking families to community resources as on-site navigators. The aim of this study was to assess whether a patient navigator located on-site versus remotely is more likely to receive referrals from clinicians, successfully follow-up with patients, and assist families with enrollment in social needs resources. Methods: A patient navigator worked on-site and remotely as she divided her time between 4 federally qualified health centers (FQHCs) from May 2015 to June 2019. We conducted a 1-sample test of proportion comparing the proportion of on-site referrals made with the proportion of the week spent in each FQHC. To assess the impact of on-site versus remote referrals on number of contacts with a family, we conducted a 2-sample t test. We used chi-square testing to assess the effect of on-site versus remote status on resource enrollment. Results: Of the referrals (N = 414) made to the patient navigator, the majority were made through the electronic health record (83%) versus in person (17%) ( P < .0001). When the navigator was on-site, significantly more referrals were made than expected (45% vs 29%, P < .0001). Between remote and on-site referral groups, there was no significant difference in number of contact points (1.0 vs 1.1 points, P = .32) or in the proportion of families who received a resource (4.6% vs 5.1%, P = .31). Conclusion: Our results indicate that clinicians were significantly more likely to refer families to patient navigation if the navigator was on-site. The likelihood of having contact with the navigator and enrolling in a resource, however, did not differ between families referred when the patient navigator was on-site compared with remote.
Future Aspirations of Young Women With Disabilities: An Examination of Social Cognitive Career Theory
Authors: Pham Yen K. , Hirano Kara A. , Lindstrom Lauren , DeGarmo David S.
Published: May 2020

Young women with disabilities face multiple barriers that limit their career pathways. Little research has been conducted to examine how cognitive constructs of career self-efficacy and outcome expectations contribute to their future aspirations. This study examined direct relationships between career self-efficacy and outcome expectations on future aspirations, mediating effects of autonomy and self-realization on these relationships, and moderating effects of mental health on these links for young women with disabilities. Although existing research on social cognitive career theory has focused on career self-efficacy, results from this study indicated that outcome expectations might have an even stronger influence on future aspirations. Mental health barriers negatively impact future aspirations of the study’s sample. Limitations and implications for research and practice were discussed.