bluuebunny/crossref_metadata_2025 huggingface dataset:
New species of Neocorynura Schrottky from Brazil (Hymenoptera: Apoidea)
Authors: GONÇALVES RODRIGO BARBOSA
Published: January 2019

Neocorynura Schrottky is one of the most speciose genera in the Augochlorini with about 80 species. Neocorynura is primarily distributed in the Neotropical region, from Argentina to Mexico. New species have been described recently, but the Brazilian fauna has not been studied at the same rate. Thus, the objective of this study is to provide a revision of Neocorynura species from Brazil. More than 2,500 specimens were studied along with the examination of primary type specimens and/or high resolution photographs of type material. A total of 44 species were recognized, 24 new species are added to the fauna and figured as N. acuta sp.nov., N. aethra sp.nov., N. amabilis sp.nov., N. arethusa sp.nov., N. aurantia sp.nov., N. carmenta sp.nov., N. dictyata sp.nov., N. eliasi sp.nov., N. hebe sp.nov., N. hyalina sp.nov., N. insolita sp.nov., N. laevistriata sp.nov., N. lamellata sp.nov., N. meloi sp.nov., N. nambikwara sp.nov., N nicolle sp.nov., N. olivacea sp.nov., N perfida sp.nov., N. pilosifacies sp.nov., N. proserpina sp.nov., N. rubicunda sp.nov., N. surrufa sp.nov., N. truncata sp.nov., and N. veneta sp.nov. I designate the lectotype for Corynura oiospermi Schrottky and consider this name as a junior synonym of Halictus codion Vachal. Augochloropsis celaeno Schrottky is considered a junior synonym of Corynura pseudobaccha Cockerell. Casosoma semimarginata Cockerell is resurrected from synonymy with Cacosoma aenigma Gribodo. Neocorynura aenigma (Gribodo) and Neocorynura caligans (Vachal) are removed from the faunal list for Brazil. Half of species recognized here are known only for the female. The males of N. atromarginata (Cockerell), N. cuprifrons (Smith), N. dilutipes (Vachal), N. erinnys (Schrottky), N. melamptera (Moure), N. roxane (Schrottky) and N. semimarginata (Cockerell) and females of N. iopodion (Vachal) and N. jucunda (Smith) are described for the first time. Identification keys to females and males are presented.
The Development of the North Pacific Jet Phase Diagram as an Objective Tool to Monitor the State and Forecast Skill of the Upper-Tropospheric Flow Pattern
Authors: Winters Andrew C. , Keyser Daniel , Bosart Lance F.
Published: January 2019

Previous studies employing empirical orthogonal function (EOF) analyses of upper-tropospheric zonal wind anomalies have identified the leading modes of North Pacific jet (NPJ) variability that prevail on synoptic time scales. The first mode corresponds to a zonal extension or retraction of the exit region of the climatological NPJ, while the second mode corresponds to a poleward or equatorward shift of the exit region of the climatological NPJ. These NPJ regimes can strongly influence the character of the large-scale flow pattern over North America. Consequently, knowledge of the prevailing NPJ regime and the forecast skill associated with each NPJ regime can add considerable value to operational medium-range (6–10-day) forecasts over North America. This study documents the development of an NPJ phase diagram, which is constructed from the two leading EOFs of 250-hPa zonal wind anomalies during 1979–2014 excluding the summer months (June–August). The projection of 250-hPa zonal wind anomalies at one or multiple times onto the NPJ phase diagram provides an objective characterization of the state or evolution of the upper-tropospheric flow pattern over the North Pacific with respect to the two leading EOFs. A 30-yr analysis of GEFS reforecasts with respect to the NPJ phase diagram demonstrates that forecasts verified during jet retraction and equatorward shift regimes are associated with significantly larger average errors than jet extension and poleward shift regimes. An examination of the best and worst forecasts further suggests that periods characterized by rapid NPJ regime transition and the development and maintenance of North Pacific blocking events exhibit reduced forecast skill.
A Model of Competitive Impression Management: Edison versus Westinghouse in the War of the Currents
Authors: Cole Benjamin M. , Chandler David
Published: January 2019

Organizational impression management theory traditionally explains how firms manage threats from specific events or from campaigns orchestrated by non-competitors, such as activists or regulators, but has not attempted to explain the complex dynamics of impression management campaigns orchestrated by a firm’s competitor. To address this oversight, we analyze one of the bitterest rivalries in corporate history—the war of the currents between Thomas Edison and George Westinghouse, which ended in the triumph of Westinghouse’s alternating current over Edison’s direct current for electric power transmission. We define competitive impression management as activity by a firm or its employees that is intended to alter the perceptions of a competing firm or its offerings in the eyes of a common audience. By combining historical case study and grounded theory methods, our findings reveal that the war of the currents unfolded across distinct chronological stages dependent on the actions and reactions of others that were shaped by audiences’ information filters. We explore the implications of our theory of campaigns and their consequences, expanding the scope of impression management theory, deepening our understanding of how organizations compete, and providing fertile ground for future research on market-based campaigns.
Estimating the Relationship Between the Current Account, the Capital Account and Investment for India
Authors: Goyal Ashima , Sharma Vaishnavi
Published: January 2019

Causality from the capital account (KA) to the current account (CA) of the balance of payments indicates disruption from capital flows while the reverse can indicate smooth financing of the CA that allows investment to exceed domestic savings. A three-variable vector autoregression tests for Granger causality between the Indian CA, KA, KA components, and gross fixed capital formation (GFCF) over 2000–01Q1 to 2015–16Q3. Since a CA deficit indicates an excess of investment over savings it is useful to estimate which type of capital flows affect investment. No causality is found to exist in any direction between the KA and the CA. There is only indirect causality through some components. Of the capital flow components, only FDI affects GFCF. The latter consistently affects the CA. The CA affects debt portfolio flows and non-resident deposits, suggesting these were used to finance the CA, but they were not causal for GFCF. Volatile flows, therefore, did not deteriorate the CA, but they also did not contribute to GFCF. India’s gradual KA convertibility may have mitigated shocks from the KA. Long-term sustainability, however, requires FDI to increase as compared to other types of flows.

JEL Codes: F21, F32
Conducting critical ethnography: Personal reflections on the role of the researcher
Authors: Hagues Rachel
Published: January 2019

Critical ethnography is conducted to uncover areas of oppression with a desire to listen to the voices of the oppressed in an effort to empower. This method can highlight strengths to build upon to help overcome aspects of society that participants consider unjust. It is appealing for social workers because the motives are to bring helpful change to participants’ lives. I reflect on the role of the researcher when doing such research internationally, such as wrestling through positionality, power, representing participants well, and checking biases through trusted local relationships.
Street Gangs, Gun Violence, and Focused Deterrence: Comparing Place-based and Group-based Evaluation Methods to Estimate Direct and Spillover Deterrent Effects
Authors: Braga Anthony A. , Zimmerman Greg , Barao Lisa , Farrell Chelsea , Brunson Rod K. , Papachristos Andrew V.
Published: January 2019

Objectives:

Focused deterrence seeks to change the violent behavior of gangs not directly targeted by the intervention by leveraging network ties between groups. This study appraises group-based and place-based methodologies in detecting direct and spillover crime reduction impacts of a focused deterrence strategy implemented in Oakland, California.

Method:

Quasi-experimental designs and panel regression models were used to compare shooting trends for directly treated gangs and census block groups to shooting trends for comparison gangs and block groups that did not directly receive the treatment. The design further analyzed whether vicariously treated gangs and untreated block groups immediately surrounding treated block groups experienced spillover shooting reductions.

Results:

The focused deterrence program generated statistically significant direct reductions in shootings in treated block group areas and by treated gangs relative to shootings in untreated block group areas and by untreated gangs, respectively. Spillover deterrent effects of varying magnitudes were found when shooting trends by vicariously treated gangs and in surrounding block groups were compared to shootings trends in comparison units.

Conclusions:

Group-based evaluation methodologies were better positioned to detect changes in violent gang behaviors after treatment and to shed light on deterrence mechanisms supporting program efficacy. Future focused deterrence studies should be theory driven rather than black box evaluations.
Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review
Authors: Puri Pooja , Shukla SK , Haque I
Published: January 2019

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology – incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli’s cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.
Brain death in low-income countries: a report from Malawi
Authors: Prin Meghan , Quinsey Caroline , Kadyaudzu Clement , Hadar Eldad , Charles Anthony
Published: January 2019

Most low-income nations have no practice guidelines for brain death; data describing brain death in these regions is absent. Our retrospective study describes the prevalence of brain death among patients treated in an intensive care unit (ICU) at a referral hospital in Malawi. The primary outcome was designation of brain death in the medical chart. Of 449 ICU patients included for analysis between September 2016 and May 2018, 43 (9.6%) were diagnosed with brain death during the ICU admission. The most common diagnostic reasons for admission among these patients were trauma (49%), malaria (16%) and postoperative monitoring after general abdominal surgery (19%). All patients diagnosed with brain death were declared dead in the hospital, after cardiac death. In conclusion, the incidence of brain death in a Malawi ICU is substantially higher than that seen in high-income ICU settings. Brain death is not treated as clinical death in Malawi.
Depressive Symptoms Among Adult Children Aged 55 Years or Older: The Effects of Support Provided to Their Older Parents
Authors: Gao Xiang , Guo Qiuju , Sun Fei , Hodge David R.
Published: January 2019

Objectives

This study examines the effects of frequency of visits, monetary, and in-kind support provided to older parents on the depressive symptoms of adult children.

Method

This study drew secondary data from the China Health and Retirement Longitudinal Study Follow-up Questionnaire. A total of 629 older children aged 55 years and older ( M = 59.80, standard deviation = 3.90) met the inclusion criteria. The dependent variable—depressive symptoms—was measured with the Center for Epidemiological Studies Depression scale.

Results

Approximately 22% of participants reported clinically significant levels of depressive symptoms. Hierarchical regression analyses found that more frequent visits and monetary support to older parents were related to lower levels of depressive symptoms in older children.

Conclusion

Providing monetary support to parents may help mitigate a major concern of parents: health-care costs. Older children’s altruistic behaviors meet legal and cultural expectations in Chinese society, contributing to family intimacy and thereby their own mental health outcomes.
Tire tread rubber compounds with ternary system filler based on carbon black, silica, and metakaolin: Contribution of silica/metakaolin content on the final properties
Authors: Gabriel Cléverson Fernandes Senra , Gabino Alessandra de Alencar Padua , de Sousa Ana Maria Furtado , Furtado Cristina Russi Guimarães , Nunes Regina Célia Reis
Published: January 2019

Carbon black and high performance silica have been widely employed as binary system filler in tire tread formulations. This study evaluated the total and partial substitution of silica by metakaolin (MK) on the properties of tread rubber composites. Dynamic mechanical thermal analysis and abrasion tests were conducted as typical assessments of tire tread performance: rolling resistance (fuel consumption), wet traction (safety), and abrasion (durability). Further the energy spent by the equipment during the processing of formulations was also analyzed, as well as rheological and mechanical properties. A significant reduction of rolling resistance was obtained with 75% and 100% of silica substitution by MK, which could lead to lower heat buildup in tire tread applications, without showing negative effects on wet traction, although abrasion showed undesired results. The substitution of silica by MK also lowered energy demanded for processing. No major changes were observed in vulcanization parameters and mechanical properties, which is interesting considering the fact that MK is nonreinforce filler.
Do Institutional Investors Know Banks Better? Evidence From Institutional Trading Surrounding the 2008 Financial Crisis
Authors: Song Wei-Ling , Wang Hui (Hillary)
Published: January 2019

The catastrophic economic damage caused by the 2008 financial crisis was unprecedented and caught many market participants by surprise. It raises the question: To what extent do institutional investors play a monitoring role in the banking industry? In this article, we investigate this underresearched area and provide evidence that gray institutions (i.e., banks and insurance companies) have more information about banks’ risk exposure to securitization than independent institutions do (e.g., investment companies and public pension funds) as gray institutions shied away from banks holding more private-label mortgage-backed securities or issuing riskier securitization deals before the crisis. We also find that the trading of gray institutions before the crisis can predict high-exposure banks’ abnormal returns around the Lehman Bankruptcy and subsequent 1-year stock performance. The trades of gray institutions are also significant and positively related to such banks’ operating performance during the crisis period.
The Journey of Justice: Recounting Milestones over the Past Six Decades
Authors: Pattnaik Subhra , Tripathy Santosh Kumar
Published: January 2019

Organizational justice has come a long way in the last six decades. Through the 1950s until the 2000s, it diverged from being a single-dimensional construct (distributive justice) to a four-dimensional construct (distributive, procedural, interpersonal and informational justice). However, by the mid-1980s, it again started moving towards convergence in the form of integrative and overall justice. This article provides a comprehensive timeline review of major historical milestones in this interesting journey of justice. It chronicles the relevant theories, evolution of various forms of justice, debates, discussions and disagreements related to the construct and the various measurement approaches used to operationalize it at different points of time. It ends by discussing the questions raised by researchers on the validity of the construct in the present era and what new paths lay ahead in the journey of justice.
Burden, Social Support, and Life Satisfaction Among Caregivers of Children With Intellectual Disability: The Case of Felege Abay and Shembt Primary Schools, Bahir Dar, Ethiopia
Authors: Gebeyehu Fentanesh , Sahile Amare , Ayalew Meseret
Published: January 2019

This study was conducted to examine the burden, social support, and life satisfaction among caregivers of children with intellectual disability. The level of burden, social support, and life satisfaction of caregivers; the relationship among burden level, social support, and life satisfaction; and burden level difference across sociodemographic characteristics of the participants were the objectives of this study. With inclusion criteria of availability, willingness, and pertinent priority of being parents, grandparents, and siblings of the child, 74 caregivers were selected using comprehensive sampling technique. Descriptive statistics, one sample t test, Pearson correlation coefficient, independent sample t test, and one-way analysis of variance, were used for data analysis. The findings revealed that caregivers are experiencing much level of burden with inadequate social support and have pitiable satisfaction in their life. Burden is negatively correlated with social support and life satisfaction, but social support is positively correlated with satisfaction in life. Some of the sociodemographic variables, such as sex and school, were showing significant differences in the experiences of burden level, while all other sociodemographic variables used in this study were not having significant difference. The result implied that caregivers are in need of social support so as to outweigh the level of burden and enhance their satisfaction in life.
Cost and availability optimization of wind energy with distributed energy resources of a microgrid
Authors: Ramabhotla Sundari , Bayne Stephen B
Published: January 2019

A microgrid, an emerging technology in the electric power systems, has various benefits due to the implementation of distributed energy sources along with the loads. A microgrid utilizing the wind energy, solar energy, combined heat and power, natural gas generator, diesel generator, and battery storage is considered in an islanded mode of operation. The economic dispatch optimization is implemented using a reduced gradient algorithm to optimize the Operation and Maintenance cost in the islanded mode of the microgrid. The cost of each energy source is evaluated for every hour of the day using MATLAB code. Then, the availability of each energy source in the microgrid is evaluated. The results obtained are validated by comparing the Operation and Maintenance cost and the availability of each energy source in the microgrid. The optimal solution is achieved by considering the change in wind forecast and battery energy storage profiles.
Immigrant Workers’ Organizational Temporality: Association With Cultural Time Orientation, Acculturation, and Mobile Technology Use
Authors: Lee Sun Kyong , Flores Marisa L.
Published: January 2019

Based on a meso-level model of organizational temporality, this study examined U.S. immigrant workers’ workplace temporal enactment and construal regarding cultural time orientation (monochronic vs. polychronic), acculturation type (assimilation, integration, segregation), and mobile technology use. Analyses revealed that cultural time orientation and acculturation type interacted to influence separated enactment of organizational temporality, and immigrant workers’ acculturation type and mobile use for work had significant interaction effects on their future- and present-time perspective. Participants with integrated and assimilated acculturation were more likely to experience time in ways consistent with the Western, industrialized organizations’ temporality, whereas those with the segregated acculturation reported a distinct pattern of temporal enactment and construal in relation to mobile phone use for work.
Pressure characteristics of a novel double rotor hydraulic transformer
Authors: Jiang Jihai , Liu Zhongxun
Published: January 2019

The hydraulic transformer is the core component when it works with the common pressure rail system, which integrates the functions of the pump and the motor, and thus possesses sensitive pressure characteristics. The rotating speed has significant influence on the pressure characteristics of a hydraulic transformer while it has not been considered previously. In this study, aimed at improving the working performance, a novel double rotor hydraulic transformer is proposed and a comprehensive mathematical model considering the dynamic characteristics of the cylinder block is established. At the same time, a prototype is made and the experiment is conducted. The test results show that the robust rotor structure enables a larger pressure range, and the numerical results exhibit a good match with the test results. The parameter sensitivity study shows that the delivery pressure is mainly subject to the valve plate control angle δ and, under the effects of the resistance torques, pressure loss will occur especially under a large control angle and a high rotating speed. The magnitude of the instantaneous angular velocity fluctuation increases sharply when the speed is lower than 400 r/min, which is the main reason for the serious pressure pulsation at a low speed. As a result of the improved low-speed stability and output flow uniformity, the pressure pulsation rate of the double rotor hydraulic transformer is greatly reduced. However, the pulsation rate is still high at an extremely low speed. In addition, when the rotating speed exceeds the capability of the damping grooves, the pressure undershoot becomes serious at the A-T transition region around the control angle of −30°. Consequently, from the perspective of pressure characteristics, the limitation on the rotating speed under small control angles is suggested for the design of the double rotor hydraulic transformer controller.
Androgen Mediation—and Antiandrogens Mitigation—of the Epidermal Growth Factor Receptor (EGFR) Inhibitor–Induced Rash: Results From a Pilot Randomized Trial and Small Translational Case Series
Authors: Le-Rademacher Jennifer G. , Rowland Kendrith , Atherton Pamela J. , Dakhil Christopher , Sun Zhifu , Tan Angelina , Schmidt Lucy , Nguyen Phuong L. , Radecki Breitkopf Carmen , Pittelkow Mark , Tindall Donald , Menon Smitha , Jatoi Aminah
Published: January 2019

Background:

Although 50% to 90% of patients who receive epidermal growth factor receptor (EGFR) inhibitors develop a rash, options for rash prevention or palliation remain limited. This issue is particularly important from a palliative care standpoint because these agents are prescribed only to patients with incurable cancer. Here, we report (1) gene expression profiling of skin biopsies from patients with an EGFR inhibitor–induced rash and (2) a randomized, placebo-controlled feasibility trial with the antiandrogen, spironolactone. Both investigations were undertaken to begin to explore the hypothesis that androgens mediate EGFR inhibitor–induced rash and that antiandrogens palliate it.

Methods/Results:

First, 4 skin biopsies from patients with EGFR inhibitor–induced rash (3 men and 1 woman) were subject to gene expression microarray profiling. A public data set of normal skin gene expression (Gene Expression Omnibus, GSE22998) served as a reference. Sixty percent of commonly interrogated androgen receptor genes (207 of 308 between the 2 data sets) were differentially expressed ( P < .05) in the rash samples. Second, in a 17-patient double-blinded, placebo-controlled trial with topical spironolactone applied to the face, although the primary feasibility end point was not achieved, patients in the spironolactone arm received more doses of EGFR inhibitor, and anecdotal photographic evidence suggested salutatory effects of spironolactone on rash.

Conclusions:

Epidermal growth factor receptor inhibitor–induced rash appears to be androgen-mediated; antiandrogen therapy merits further study for rash prevention/palliation.
An elastoplastic micro-mechanical damage model for quasi-brittle materials under uniaxial loading
Authors: Guo Yadong , Kuang Yachuan
Published: January 2019

A new stochastic micro-mechanical damage model for quasi-brittle materials subjected to monotonic and cyclic uniaxial loading is proposed in this paper. The model uses a series of microelements endowed with simple material properties, in which plastic elements are adopted to consider and record plastic deformation, to represent the overall response of the material. The elastoplastic coupling and plastic-damage coupling, as well as the heterogeneity of the material are considered in the model. Furthermore, the model can exhibit the non-linear performance and stochastic properties of the material, and the model predictions match the experimental data well.
Differences of transverse impact damages in 3D angle-interlock woven composites between warp and weft directions
Authors: Ren Chunlei , Siddique Amna , Sun Baozhong , Gu Bohong
Published: January 2019

Transverse impact damages of 3D angle-interlock woven composites have been tested at split Hopkinson pressure bar along warp and weft directions respectively. The impact deformation and damages were photographed with a high-speed camera. A finite element analyses model was established at mesostructure level to unveil the inner yarn, resin damages, and stress distributions. There are significant differences of yarn breakages and interface damage between the two directions. From finite element analysis simulations and scanning electron microscope photographs, we found the warp yarns were in kink band deformation and shear damage, while the weft yarns were in compressive failure and had smooth fractography. The warp yarns which run through-thickness directions impede transverse impact crack propagations in resins and lead to high delamination resistances. The straight weft yarns impart high stiffness and strength to in-plane directions.
Be(com)ing “In-Resonance-With” Research: Improvising a Postintentional Phenomenology Through Sound and Sonic Composition
Authors: Wargo Jon M.
Published: January 2019

Scholarship in postqualitative research has long examined the constructs of orientation and experimentation. How do we come to know and name experience? How do we value its matter as a form of mattering. Combining perspectives from phenomenology, feminist new materialisms, and sound studies, this article traces the intra-active encounters of the Museum of Contemporary Art–Detroit’s (MoCAD) performance of John Cage’s “How to Get Started.” Reading postphenomenological inquiry as improvisation, the article underscores that phenomenological ontologies are always already a be(com)ing, and that qualitative research more broadly is inherently an act of being “in-resonance-with.”
Book Review: Watson, B. and Clarke, M. 2014: Child Sponsorship: Exploring Pathways to a Brighter Future
Authors: Bhattacharyya Rituparna
Published: January 2019

Watson, B. and Clarke, M. 2014: Child Sponsorship: Exploring Pathways to a Brighter Future. London: Palgrave Macmillan. 347 pp. Ä90.47 (Hardcover), Ä72.99 (eBook), Ä83.19 (Softcover). ISBN: 978-1-137-30959-4 (Hardcover), 978-1-137-30960-0 (eBook), 978-1-349-45640-6 (Softcover).
Manufacturing and Services Growth in Developing Economies: ‘Too Little’ Finance?
Authors: Daway-Ducanes Sarah Lynne Salvador , Gochoco-Bautista Maria Socorro
Published: January 2019

This article explores the relationship between financial development and growth in manufacturing and service sectors in 77 developing economies over the period 1984–2013. Specifically, we examine whether the size of the financial sector matters and if it does, whether the size of the financial sector in these countries is of a sufficient scale for credit and liquidity expansion to benefit the economy. Using the two-step system generalized method of moments, we find a u-shaped relationship between either manufacturing or services growth and financial size, indicating that a critical level of financial scale has to be achieved for financial expansion to positively affect the growth. For some 50%–90 per cent of the economies in the sample, there is a robustly long-run adverse effect of financial expansion on both manufacturing and services growth, indicating a case of ‘too little’ finance, likely explained by a combination of weak institutions, market failures and the existence of large and lumpy investments that require sufficient financial scale.
The Shape of Things to Come and what to do about Tom and Mia: Interrogating the OECD’s International Early Learning and Child Well-Being Study from an anti-colonialist perspective
Authors: Urban Mathias
Published: January 2019

In this article, I discuss the International Early Learning and Child Well-being Study (IELS), which is currently being rolled out by the Organisation for Economic Co-operation and Development. I summarise the development of IELS and the critique that has been voiced by early childhood scholars, professionals and advocates. I then move to an aspect of IELS that has so far been absent from the discussion: the actual conduct of the test, using the two stylised child characters Tom and Mia. I provide a provisional reading of the Tom and Mia imaginary through the lens of post-colonial and neo-colonial analysis. Applying the concept of colonisation as a frame of reference opens a space for introducing resistance and anti-colonial practices as productive forces to challenge the global hegemony. I draw on Pedro Sotolongo’s concept of the power of marginal notions to argue that experiences made on the margins of society, both geographically and socially, offer very practical alternatives to reconceptualising early childhood education, and services for young children, families and communities.
Renal Cancer is Not Radioresistant: Slowly but Continuing Shrinkage of the Tumor After Stereotactic Body Radiation Therapy
Authors: Funayama Satoshi , Onishi Hiroshi , Kuriyama Kengo , Komiyama Takafumi , Marino Kan , Araya Masayuki , Saito Ryo , Aoki Shinichi , Maehata Yoshiyasu , Nonaka Hotaka , Tominaga Licht , Muramatsu Juria , Nakagomi Hiroshi , Kamiyama Manabu , Takeda Masayuki
Published: January 2019

Purpose:

To evaluate the safety and efficacy of stereotactic body radiation therapy for primary lesion of renal cell carcinoma with long-term and regular follow-up of tumor size and renal function.

Methods:

This prospective study included 13 patients treated with stereotactic body radiation therapy for primary lesion of stage I renal cell carcinoma between August 2007 and June 2016 in our institution. Diagnosis of renal cell carcinoma was made by 2 radiologists using computed tomography or magnetic resonance imaging. A dosage of 60 Gy in 10 fractions or 70 Gy in 10 fractions was prescribed. The higher dose was selected if dose constraints were satisfied. Tumor response on imaging examination, local progression-free rate, overall survival, and toxicity were assessed.

Results:

The mean follow-up period was 48.3 months (range: 11-108 months). The tumors showed very slow but continuous response during long-term follow-up. Three cases (23.1%) showed transient progression during the short follow-up. The mean duration until the day on which partial response was confirmed among the partial or complete response cases was 22.6 months (95% confidence interval, 15.3-30.0 months). Local progression-free rate was 92.3% for 3 years and overall survival rate 91.7% for 2 years and 71.3% for 3 years. Twelve cases (92.3%) had impaired renal function at baseline. Renal function decreased slowly and mildly in most of the cases, but 2 cases of solitary kidney showed grade 4 or 5 renal dysfunction.

Conclusion:

All renal tumors decreased in size slowly but continuously for years after stereotactic body radiation therapy. Renal cancer can be treated radically with stereotactic body radiation therapy as a radiosensitive tumor, but careful attention should be given in cases with solitary kidney.
Assessing the cognitive complexity of cyber range environments
Authors: Roque Antonio , Stetson Douglas , Hannon Daniel J
Published: January 2019

We present a conceptual foundation and empirical framework for modeling cognitive complexity in cyber range event operating environments. Definitions of key concepts, such as cognitive complexity, task difficulty, and Blue Team cognitive workload, are informed by the literature of human factor engineering. This is followed by an approach to assessing cognitive complexity as experienced by a Blue Team in a given cyber range event operating environment, and a validation of that assessment method.
The New Era of Cardiac Surgery Hybrid Therapy for Cardiovascular Disease
Authors: Solenkova Natalia V. , Umakanthan Ramanan , Leacche Marzia , Zhao David X. , Byrne John G.
Published: January 2019

Surgical therapy for cardiovascular disease carries excellent long-term outcomes but it is relatively invasive. With the development of new devices and techniques, modern cardiovascular surgery is trending toward less invasive approaches, especially for patients at high risk for traditional open heart surgery. A hybrid strategy combines traditional surgical treatments performed in the operating room with treatments traditionally available only in the catheterization laboratory with the goal of offering patients the best available therapy for any set of cardiovascular diseases. Examples of hybrid procedures include hybrid coronary artery bypass grafting, hybrid valve surgery and percutaneous coronary intervention, hybrid endocardial and epicardial atrial fibrillation procedures, and hybrid coronary artery bypass grafting/carotid artery stenting. This multi-disciplinary approach requires strong collaboration between cardiac surgeons, vascular surgeons, and interventional cardiologists to obtain optimal patient outcomes.
Transaortic Endoclamp for Mitral Valve Operation through Right Minithoracotomy in 369 Patients
Authors: Glower Donald D. , Desai Bhargavi
Published: January 2019

Objective

The effects and benefits of a transaortic endoclamp for mitral valve operation through right minithoracotomy have not been established.

Methods

The records were examined in 671 patients undergoing mitral valve operation using aortic cannulation through a 6-cm right minithoracotomy in the fourth intercostal space. The ascending aorta was cannulated with a 24-Fr cannula through a 12-mm port in the first intercostal space. The experience from 1998 to 2006 with aortic endoclamping (group A, N = 436) was compared with the experience from 2006 to 2009 with external aortic clamping (group B, N = 235). Aortic endoclamping was achieved with a 30 mL endoclamp introduced through the aortic cannula into the ascending aorta to provide aortic endoclamping, anterograde cardioplegia, and root venting. Percutaneous femoral venous cannulation was used.

Results

Group A and group B had similar demographics. Endoclamp availability (group A) resulted in significantly less fibrillatory arrest (no clamping) in 67 of 436 (15%) versus 104 of 235 (44%) patients in group B (P = 0.001). In patients with aortic clamping, endoclamp (group A) versus external clamp (group B) was not a determinant of clamp time or pump time. Hospital and late outcomes were not different between groups. No patient complications could be attributed to the endoclamp.

Conclusions

Aortic endoclamping requires no more clamp or pump time than external clamping and can provide a more bloodless field than ventricular fibrillation without obstructing hardware. Aortic endoclamping is a safe alternative for mitral surgery through right minithoracotomy.
Long-Term Survival after Minimal Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery in Patients with Low Ejection Fraction
Authors: Gorki Hagen , Patel Nirav C. , Balacumaraswami Lognathen , Jennings Joan , Goksedef Deniz , Subramanian Valavanur A.
Published: January 2019

Objective

The long-term survival after minimal invasive direct coronary artery bypass (MIDCAB) surgery to any coronary territory in patients with ejection fraction of ≤30% was investigated for the first time in literature.

Methods

Seventy-three patients with primary MIDCAB and 89 patients with reoperative MIDCAB were studied including preoperative risk factors, operative details, early postoperative complications, and survival up to 10 years postoperatively.

Results

Despite the high-risk profile of the patients, the MIDCAB approach for targeted revascularization resulted in excellent short-term results. Ventricular arrhythmia contributed to four of six early deaths. Survival at 5 years postoperatively was 62.5% for primary MIDCAB and 43.2% for reoperative MIDCAB and at 10 years was 36.9% and 29.5%, respectively. Functionally complete vascularization correlates with significantly better long-term survival particularly in primary MIDCAB procedures.

Conclusions

MIDCAB is a valuable option for targeted revascularization in high-risk patients with low ejection fraction and reoperation.
Performance of Four Risk Algorithms in Predicting Intermediate Survival in Patients Undergoing Aortic Valve Replacement
Authors: Tran Henry A. , Roy Sion K. , Hebsur Shrinivas , Barnett Scott D. , Schlauch Karen A. , Hunt Sharon L. , Holmes Sari D. , Ad Niv
Published: January 2019

Objective

Several risk models exist to predict operative outcomes after cardiac surgery and are used in selecting patients for alternative procedures such as transcatheter valve implantation. We sought to evaluate the performance of the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) model in accurately identifying patients at high risk for aortic valve replacement (AVR).

Methods

Three hundred and ninety four consecutive patients who underwent isolated AVR from January 1, 2001, to July 1, 2007, at a tertiary care center were analyzed using the STS database. Patients were stratified into tertiles according to operative surgical risk calculated by the four models [STS-PROM, European system for cardiac operative risk evaluation (EuroSCORE), Ambler, and Providence]. Vital status at 1 year was determined using the National Death Index and Social Security Death Index.

Results

There were 310 low-risk patients, 56 intermediate-risk patients, and 28 high-risk patients with respect to the STS-PROM. The predicted risk of death for the low-risk, intermediate-risk, and high-risk groups were 2.4% ± 1.1%, 6.9% ± 1.4%, 15.8% ± 7.6% (P < 0.001) with respect to the STS-PROM model. Actual operative mortality for each respective group was 1.94%, 5.36%, 14.29% (P < 0.001) and 1-year mortality was 3.23%, 12.50%, 21.43% (P < 0.001), respectively.

Conclusions

High-risk patients have significantly high mortality after AVR. The STS-PROM accurately predicts operative mortality and can be used to predict 1-year survival as well. This risk model may be preferentially used instead of the EuroSCORE.
Video-Assisted Minimally Invasive Mitral Valve Surgery External Aortic Clamp versus Endoclamp Techniques
Authors: Loforte Antonio , Luzi Giampaolo , Montalto Andrea , Ranocchi Federico , Polizzi Vincenzo , Sbaraglia Fabio , Della Monica Paola Lilla , Menichetti Antonio , Musumeci Francesco
Published: January 2019

Objective

Video-assisted minimally invasive mitral valve surgery can be performed through different approaches. The aim of the study was to report our early results and compare the external transthoracic aortic clamping with the endoaortic balloon occlusion techniques according to our experience.

Methods

Between January 2000 and March 2010, 138 patients (103 women, aged 58.4 ± 10.2 years) underwent video-assisted mitral valve surgery through a right thoracotomy. Cardiopulmonary bypass was instituted by femoral arterial and bicaval cannulation with active venous drainage and normothermia; cardioplegic arrest achieved with intermittent blood cardioplegia. In group A (93 patients, 68 women, aged 58.8 ± 7.8 years, 72 MV replacement, 21 MV repair), aortic clamping was achieved using the external transthoracic aortic clamp. In group B (45 patients, 35 women, aged 58.1 ± 11.4 years, 33 MV replacement, 12 MV repair), aortic clamping was achieved with endoaortic balloon occlusion.

Results

Intraoperative procedure-associated problems were experienced in one patient (0.7%) in group A (one conversion to sternotomy for pleural adhesions and bad exposure). At a mean follow-up of 36 ± 18 months, 135 patients (97.8%) were in New York Heart Association class I to II, with satisfactory echocardiographic follow-up. In group A, two patients had noncardiac-related deaths. No perioperative deaths were observed in both groups. There were four (2.8%) transient ischemic attacks and one (0.7%) peripheral ischemic event (group A) during the early postoperative period. Mitral valve repair patients had a 5-year freedom from reoperation of 100% in both groups. There was no significant difference between the two groups regarding preoperative variables, such as age, sex, New York Heart Association class, and left ventricular ejection fraction (P ≥ 0.05). Postoperative levels of myocardial cytonecrosis enzymes (MB fraction, creatine kinase, and troponine I) as well as operative time, extracorporeal circulation, and aortic cross-clamping times or ventilation and intensive care unit times were not significantly different between the two groups (P ≥ 0.05). More microembolic events were observed in group A than in group B (total 143.4 ± 30.6 per patient vs 78.9 ± 28.6 per patient) by means of continuous automated intraoperative transcranial Doppler evaluations (P < 0.05) applied to part of population.

Conclusions

Both techniques proved safe and comparable with low risk of morbidity and mortality. Patients undergoing endoclamp technique resulted to be less subject to embolism.
Thromboembolic Events in Patients on Extracorporeal Membrane Oxygenation without Anticoagulation
Authors: Lamarche Yoan , Chow Bryan , Bédard Annie , Johal Navreet , Kaan Annemarie , Humphries Karin H. , Cheung Anson
Published: January 2019

Objective

Heparinization is thought to be mandatory to avoid thromboembolic complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, bleeding complications are common. We report our experience of VA-ECMO without systemic anticoagulation.

Methods

A prospectively assembled database describing all ECMO cases from 2000 to 2008 was analyzed. A heparin coated circuit (Medtronic, Inc., Minneapolis, MN USA) and membrane oxygenator (Quadrox D Bioline oxygenator; MAQUET, Rastatt, Germany) were used in all cases. After the initiation of VA-ECMO support, all coagulation parameters were corrected. No further systemic maintenance anticoagulant was given, except at the time of weaning.

Results

Thirty-two patients received VA-ECMO support; 20 patients (62.5%) were males with a median age of 52.5 years (interquartile range, 40.4–61.1 years). Central and peripheral cannulations were 53% and 47%, respectively. Etiologies of cardiogenic shock were postcardiotomy (75%, n = 24) and as a support to cardiopulmonary resuscitation in 25% of cases (n = 8). Thirty-day mortality was 43.8%. Median duration of ECMO support was 46.3 hours (interquartile range, 26.8–87.8 hours). The median number of packed red blood cell transfusions was 18 ± 25. Complications include five patients (16%) with limb ischemia requiring intervention, 15 patients (46.9%) had acute renal failure, two patients had deep vein thrombosis, and two patients had intracardiac clots detected on echocardiograms. No patient had a cerebrovascular event. Incidence of membrane oxygenator failure was low, requiring replacement in three patients; no adverse event occurred during replacement. Fourteen patients (43.8%) were re-explored for bleeding. Fourteen patients (44%) were discharged home and were long-term survivors.

Conclusions

VA-ECMO support without systemic anticoagulation may reduce bleeding complications and transfusion requirement, without increasing the risk of thromboembolism.
Augmented Reality Image Guidance during Off-Pump Mitral Valve Replacement through the Guiraudon Universal Cardiac Introducer
Authors: Guiraudon Gerard M. , Jones Douglas L. , Bainbridge Daniel , Linte Cristian , Pace Danielle , Moore John , Wedlake Christopher , Lang Pencilla , Peters Terry M.
Published: January 2019

Objective

We report our experience with ultrasound augmented reality (US-AR) guidance for mitral valve prosthesis (MVP) implantation in the pig using off-pump, closed, beating intracardiac access through the Guiraudon Universal Cardiac Introducer attached to the left atrial appendage.

Methods

Before testing US-AR guidance, a feasibility pilot study on nine pigs was performed using US alone. US-AR guidance, tested on a heart phantom, was subsequently used in three pigs (~65 kg) using a tracked transesophageal echocardiography probe, augmented with registration of a 3D computed tomography scan, and virtual representation of the MVP and clip-delivering tool (Clipper); three pigs were used to test feature-based registration.

Results

Navigation of the MVP was facilitated by the 3D anatomic display. AR displayed the MVP and the Clipper within the Atamai Viewer, with excellent accuracy for tool placement. Positioning the Clipper was hampered by the design of the MVP holder and Clipper. These limitations were well displayed by AR, which provided guidance for improved design of tools.

Conclusions

US-AR provided informative image guidance. It documented the flaws of the current implantation technology. This information could not be obtained by any other method of evaluation. These evaluations provided guidance for designing an integrated tool: combining an unobtrusive valve holder that allows the MVP to function properly as soon as positioned, and an anchoring system, with clips that can be released one at a time, and retracted if necessary, for optimal results. The portability of Real-time US-AR may prove to be the ideal practical image guidance system for all closed intracardiac interventions.