bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Calcium Hydroxide-containing Pulp-capping Agents on Pulp Cell Migration, Proliferation, and Differentiation
Authors: Schröder U.
Published: May 2016

The findings from the recent literature on pulpal cell responses to the application of calcium hydroxide to exposed pulps are described. The effect of calcium hydroxide on healthy and inflamed pulp is discussed. The effect of incorporation of calcium hydroxide in various pulp-capping agents is presented.

The initial effect of calcium hydroxide applied to exposed pulp is the development of a superficial three-layer necrosis. The beneficial effect of calcium hydroxide is regarded as the result of the chemical injury caused by the hydroxyl ions, limited by a zone of firm necrosis against the vital tissue, and the toleration of calcium ions by the tissue. The firm necrosis causes slight irritation and stimulates the pulp to defense and repair. The observed sequence of tissue reactions is that which is expected when connective tissue is wounded. It starts with vascular and inflammatory cell migration and proliferation, to control and elimination of the irritating agent. This is followed by the repair process, including migration and proliferation of mesenchymal and endothelial pulp cells and formation of collagen. When the pulp is protected from irritation, odontoblasts differentiate, and the tissue formed assumes the appearance of dentin, i.e., the function of the pulp is normalized.

The mineralization of the collagen starts with dystrophic calcification of both the zone of firm necrosis and the degenerated cells in the adjacent tissue, leading to deposition of mineral in the newly-formed collagen. The presence of calcium ions stimulates precipitation of calcium carbonate in the wound area and thereby contributes to the initiation of mineralization.

Hard tissue formation in contact with some hard-setting calcium hydroxide cements has been reported, indicating a less-extensive initial chemical injury than that produced by calcium hydroxide alone. The differences in tissue response to various calcium hydroxide-containing cements are related to such factors as differences in pH and rates of release of hydroxyl ions and calcium ions. Other components of the cements, leading to different chemical reactions, may inactivate calcium hydroxide or be noxious to the pulp and thereby interfere with healing. Decisive factors for healing of the inflamed pulp are the degree of inflammation, the time of irritation and infection, and the location of the exposure. The effect of calcium hydroxide is not a factor.

Internal dentin resorption, observed in pulpotomized primary teeth capped with calcium hydroxide, occurs when chronically inflamed pulp is present at the time of treatment and/or is induced by improper wound treatment, such as leaving a blood clot between the wound surface and the calcium hydroxide.

Concerning the addition of corticosteroids to calcium hydroxide-containing pulp-capping agents, no biologically acceptable histological results have been reported so far.
Dentin-Predentin Complex and Its Permeability: Pathology and Treatment Overview
Authors: Mjör P.A.
Published: May 2016

This review paper focuses attention on tissue changes which may lake place in dentin and on localized alterations in tissue formation in the predentin area. A number of reaction patterns has been described in dentin affecting both the inorganic and organic components.

Dentinal tubules may become partly or completely obturated by growth of the peritubular dentin. Precipitation of mineral salts within the tubules, which may be a reprecipitation of minerals from adjacent demineralized dentin, represents a fundamentally different mode of obturation of dentinal tubules. Initially, demineralization selectively affects the peritubular dentin. If dentin is exposed to the oral environment, the surface layer may become hypermineralized. The surface layer of dentin, exposed by grinding, becomes covered by a smear layer.

Displacement of the contents of the tubules or of the odontoblasts is a characteristic change in the organic components. Odontoblast destruction or degeneration will lead to a lack of, or reduced, predentin formation. Changes in the protein components which lead to alterations in dentin permeability have also been reported.

The structure of the interface between dentin and localized formations of irregular secondary dentin varies considerably. If there is no tubular communication between primary and secondary dentin, the interface will act as an impermeable barrier.

Changes in dentin, including irregular secondary dentin formation, affect the permeability of the tissue. Such changes are clinically important for the outcome of all types of restorative work performed on vital teeth.
Left Ventricular Function and Physiological Performance in Female Ironman Athletes and Female Police Officers
Authors: Leischik Roman , Foshag Peter , Strauss Markus , Spelsberg Norman
Published: May 2016

Data about physiological performance of female ironman triathletes are rare. However, some studies have reported this endurance sport may cause damage to the right or left ventricles, even in females. The goal of this study was to assess prospectively the right/left ventricular function and physiological performance in female athletes (middle- and long ironman distance) and to compare the findings to female federal police officers. A total of 33 female triathletes and 37 female police officers were examined using spiro-ergometry and echocardiography. Female triathletes achieved VO2max 52.8 ± 5.7 ml/kg−1·min−1, and police officers 35.3 ± 6.5 ml/kg−1·min−1. In athletes, left ventricular end-diastolic diameter was 4.4 ± 0.3 cm and in police officers 4.5 ± 0.4 cm, and the left ventricular muscle mass index was 85.8 g/m2 ± 18.7 in athletes and in police officers 72.0 g/m2 ± 9.1. Right ventricular area change among athletes was 49.4 ± 8.5%, and in police officers 46.0 ± 6.9%. The performance date of female triathletes can be used as training prescription for leisure female triathletes, when middle or long distances in triathlon competitions are planned. No right or left ventricular dysfunction was found despite long training and finishing of long distance competitions: non-elite athletes, 5.4 ± 2.8 years of triathlon competitions; elite athletes, 7.6 ± 5.8 years.
Teaching Statistics in APA-Accredited Doctoral Programs in Clinical and Counseling Psychology
Authors: Ord Anna S. , Ripley Jennifer S. , Hook Joshua , Erspamer Tiffany
Published: May 2016

Although statistical methods and research design are crucial areas of competency for psychologists, few studies explore how statistics are taught across doctoral programs in psychology in the United States. The present study examined 153 American Psychological Association–accredited doctoral programs in clinical and counseling psychology and aimed at identifying specific aspects of statistics instruction within these programs. We conducted a comprehensive review of statistics syllabi to clarify how much emphasis and time were spent on each topic, and whether different types of programs differed significantly in their approach to statistics instruction. We detected relative consistency of the material covered in statistics classes across the various doctoral programs.
Nasal Tumorigenesis in B6C3F1 Mice Following Intraperitoneal Diethylnitrosamine
Authors: Chen Yung-Ju , Wallig Matthew A. , Jeffery Elizabeth H.
Published: May 2016

Diethylnitrosamine (DEN) is a chemical broadly used in animal models as a hepatocarcinogen, reported to also cause pulmonary neoplasms in mice. The original objective was to evaluate the impact of a Western diet with or without 10% broccoli on DEN-induced on liver cancer. We administered DEN (45 mg/kg) intraperitoneally to young adult male B6C3F1 mice by 6 weekly injections and evaluated liver cancer 6 months after the DEN treatments. Here, we report unexpected primary tumorigenesis in nasal epithelium, independent of dietary treatment. More than 50% of DEN-treated B6C3F1 mice developed nasal neoplasm-related lesions, not reported previously in the literature. Only one of these neoplasms was visible externally prior to postmortem examination. Intraperitoneal DEN treatment used as a model for liver cancer can have a carcinogenic effect on the nasal epithelium in B6C3F1 mice, which should be carefully monitored in future liver cancer studies.
Regulation in practice: Power, resources and context at the local scale in UK food retailing
Authors: Wood Steve , Alexander Andrew
Published: May 2016

This article uses a relational lens to explore the conflict between the regulatory state and a leading food retailer seeking store expansion within one catchment in south-east England over an eight-year period. The research highlights the relational power geometries which play out in context between regulators and a regulated corporate firm to emphasise the role of power, resources, and scale. The research teases out how the power of the state to uphold an interpretation of market rules is compromised by a lack of responsiveness compared to both the proactive and reactive tactics of the well-resourced corporate retailer. It recognises how multiple regulatory agents of the state with divergent goals, sometimes situated across different spatial scales of governance, can produce markedly different judgements resulting in outcomes that are not in the public interest. Such situations require swift and coherent regulatory responses and can reveal the need for changes to the organisation of the regulatory infrastructure itself.
Prevention of stress- or nitric oxide donor-induced medication overuse headache by a calcitonin gene-related peptide antibody in rodents
Authors: Kopruszinski Caroline Machado , Xie Jennifer Yanhua , Eyde Nathan Mackenzie , Remeniuk Bethany , Walter Sarah , Stratton Jennifer , Bigal Marcelo , Chichorro Juliana Geremias , Dodick David , Porreca Frank
Published: May 2016

Objective

The objective of this study was the determination of the role of calcitonin gene-related peptide (CGRP) in the induction of medication overuse headache (MOH)-related migraine in an injury-free preclinical model.

Methods

Rats were primed by a 7-day period of exposure to acute migraine therapies including sumatriptan and morphine. After an additional 14-day drug-free period, rats were exposed to putative migraine triggers including bright light stress (BLS) or nitric oxide (NO) donor in the presence or absence of TEV48125, a fully humanized CGRP antibody. Cutaneous allodynia (CA) was used as an outcome measure and CGRP blood and cerebrospinal fluid (CSF) levels were measured.

Results

BLS and NO donor challenge evoked delayed, long-lasting CA selectively in rats that were previously treated with sumatriptan or morphine. BLS produced a significant increase in CGRP in the plasma, but not CSF, in animals that were previously exposed to sumatriptan compared to saline controls. TEV48125 did not modify baseline tactile thresholds or produce behavioral side effects, but significantly inhibited both BLS- and NO donor-induced CA in animals that were previously primed with sumatriptan or morphine; an isotype control protein that does not bind CGRP had no effect.

Interpretation

These data suggest that acute migraine medications may promote MOH in susceptible individuals through CGRP-dependent mechanisms and that anti-CGRP antibodies may be a useful clinical strategy for the treatment of MOH.
Cerebral vasomotor reactivity in reversible cerebral vasoconstriction syndrome
Authors: Topcuoglu Mehmet Akif , Chan Suk-tak , Silva Gisele Sampaio , Smith Eric Edward , Kwong Kenneth K , Singhal Aneesh Bhim
Published: May 2016

Background

Altered cerebrovascular tone is implicated in reversible cerebral vasoconstriction syndrome (RCVS). We evaluated vasomotor reactivity using bedside transcranial Doppler in RCVS patients.

Methods

In this retrospective case-control study, middle cerebral artery (MCA) blood flow velocities were compared at rest and in response to breath-hold in RCVS ( n = 8), Migraineurs ( n = 10), and non-headache Controls ( n = 10). Hyperventilation response was measured in RCVS.

Results

In RCVS, Breath Holding Index (BHI) was severely reduced in seven of eight patients and 14/16 MCAs; seven of 16 MCAs showed exhausted (BHI < 0.1) or inverted (BHI < 0) vasomotor reactivity. Mean BHI in RCVS (0.23 ± 0.5) was significantly lower than Migraine (1.52 ± 0.57) and Controls (1.51 ± 0.32), p < 0.001. Triphasic velocity responses were seen in all groups. The maximum Vmeandecline during the middle negative phase was −15.5 ± 9.2% in RCVS, −15.4 ± 7% in Migraine, and −10.3 ± 5% in Controls ( p = 0.04). In the late positive phase, average Vmeanincrease was 6.2 ± 14% in RCVS, which was significantly lower ( p < 0.001) than Migraine (30.5 ± 11%) and Controls (30.2 ± 6%). With hyperventilation, RCVS patients showed 23% decrease in Vmean.

Conclusion

Cerebral arterial tone is abnormal in RCVS, with proximal vasoconstriction and abnormally reduced capacity for vasodilation. Further studies are needed to determine the utility of BHI to diagnose RCVS before angiographic reversibility is established, and to estimate prognosis.
Comparing the Effectiveness of Virtual and Concrete Manipulatives to Teach Algebra to Secondary Students With Learning Disabilities
Authors: Satsangi Rajiv , Bouck Emily C. , Taber-Doughty Teresa , Bofferding Laura , Roberts Carly A.
Published: May 2016

A sizable body of literature exists studying various technologies and pedagogical practices for teaching secondary mathematics curriculum to students with a learning disability in mathematics. However, with the growing footprint of computer-based technologies in today’s classrooms, some areas of study, such as the use of virtual manipulatives, lack sufficient exploration. Although concrete manipulatives were studied for many decades for students with a learning disability and are considered a best practice, the research base for virtual manipulatives is notably less. With a specific focus on algebraic instruction, this study sought to compare the benefits of both forms of manipulatives to assist secondary students with a learning disability in mathematics to solve single-variable linear equations using a single-subject alternating treatment design. Over the course of 30 sessions of intervention, three students exhibited over 90% average accuracy solving problems using both virtual and concrete manipulatives, while the concrete manipulative earned higher scores for two of the three students.
Costs of Policing
Authors: Wong Ivan , Bishopp Stephen A. , Schlager Melinda
Published: May 2016

A primary responsibility of organizational leaders in large metropolitan areas is to find the right balance between becoming more efficient while remaining highly effective, and these aspects of municipal governance are no less true in the City of Dallas, Texas. Among responsibility for law enforcement, an important job component of its police officers is to arrest and transport prisoners to jail. However, book-in procedures are unnecessarily time consuming due in part to the medical screening process. To examine this process, data were collected over a 90-day period from the Dallas County (Texas) jail. Findings from the current study indicate that adjustments to prisoner transfer times and changes to the staffing of medical personnel could significantly reduce jail wait times for officers. The current study utilizes organizational process theory and general systems theory to explain various relationships found within the Dallas County jail’s medical evaluation system. Finally, several policy recommendations are suggested.
Mini-review of the geotechnical parameters of municipal solid waste: Mechanical and biological pre-treated versus raw untreated waste
Authors: Petrovic Igor
Published: May 2016

The most viable option for biostabilisation of old sanitary landfills, filled with raw municipal solid waste, is the so-called bioreactor landfill. Even today, bioreactor landfills are viable options in many economically developing countries. However, in order to reduce the biodegradable component of landfilled waste, mechanical and biological treatment has become a widely accepted waste treatment technology, especially in more prosperous countries. Given that mechanical and biological treatment alters the geotechnical properties of raw waste material, the design of sanitary landfills which accepts mechanically and biologically treated waste, should be carried out with a distinct set of geotechnical parameters. However, under the assumption that ‘waste is waste’, some design engineers might be tempted to use geotechnical parameters of untreated raw municipal solid waste and mechanical and biological pre-treated municipal solid waste interchangeably. Therefore, to provide guidelines for use and to provide an aggregated source of this information, this mini-review provides comparisons of geotechnical parameters of mechanical and biological pre-treated waste and raw untreated waste at various decomposition stages. This comparison reveals reasonable correlations between the hydraulic conductivity values of untreated and mechanical and biological pre-treated municipal solid waste. It is recognised that particle size might have a significant influence on the hydraulic conductivity of both municipal solid waste types. However, the compression ratios and shear strengths of untreated and pre-treated municipal solid waste do not show such strong correlations. Furthermore, another emerging topic that requires appropriate attention is the recovery of resources that are embedded in old landfills. Therefore, the presented results provide a valuable tool for engineers designing landfills for mechanical and biological pre-treated waste or bioreactor landfills for untreated raw waste as well as planning landfill mining projects.
Shock environment design for space equipment testing
Authors: Morais OMF , Vasques CMA
Published: May 2016

The main specification in the verification by testing of space hardware vulnerability to shock excitations is the shock response spectrum. Although it compiles the most relevant information needed to describe the overall shock environment characteristics, shock testing still poses various difficulties and uncertainties concerning the suitability and operation of the shock test system used, and the adequate definition of the underlying test parameters. The approach followed from the interpretation of typical shock testing specifications to the development, validation, and characterization of the developed shock test system, including the definition and design of the relevant parameters influencing the attained shock environment, is described in this paper. The shock testing method here presented consists of a pendular in-plane resonant mono-plate shock test apparatus where the structural response of the ringing plate depends upon well-defined controllable parameters (e.g. impact velocity, striker shape, mass, and contact stiffness), which are parametrically determined to achieve the target shock environment specification. The concept and analytical model of two impacting bodies are used in a preliminary analysis to perform a rigid body motion analysis and contact assessment. A detailed finite element model is developed for the definition of the ringing plate dimensions, analysis of the plate dynamics and virtual shock testing. The assembled experimental apparatus is described and a test campaign is undertaken in order to properly characterize and assess the design and test parameters of the system. The developed shock test apparatus and corresponding finite element model are experimentally verified and validated. As a result of this study, a reliable finite element modeling methodology available for future shock test simulation and prediction of the experimental results was created, being an important tool for the adjustment of the shock test input parameters for future works. The developed shock test system was well characterized and is readily available to be used for shock testing of space equipment with varying specifications.
Temporal patterns of scientific information-seeking on Google and Wikipedia
Authors: Segev Elad , Sharon Aviv J.
Published: May 2016

In response to the news coverage of scientific events and to science education, people increasingly go online to get more information. This study investigates how patterns of science and technology information-seeking on Google and Wikipedia change over time, in ways that differ between “ad hoc” terms that correspond to news coverage and “cyclic” terms that correspond to the academic period. Findings show that the science and technology activity in Google and Wikipedia was significantly associated with ad hoc and cyclic patterns. While the peak activity in Google and Wikipedia largely overlapped for ad hoc terms, it mismatched for cyclic terms. The findings indicate the importance of external cues such as news media and education, and also of the online engagement process, and particularly the crucial but different role played by Google and Wikipedia in gaining science and technology knowledge. Educators and policy makers could benefit from taking into account those different patterns.
Impact of invitation schemes on breast cancer screening coverage: A cohort study from Copenhagen, Denmark
Authors: Jacobsen Katja Kemp , von Euler Chelpin My , Vejborg Ilse , Lynge Elsebeth
Published: May 2016

Background

The purpose of mammography screening is to decrease breast cancer mortality. To achieve this a high coverage by examination is needed. Within an organized screening programme, we examined the impact of changes in the invitation schedule on the interplay between coverage and participation.

Method

We studied nine cohorts aged 50–51 when first targeted by mammography screening in Copenhagen, Denmark. Population data were retrieved from the Danish Civil Registration System; invitation and attendance data from the screening programme database. Data were linked using unique personal identification numbers. Coverage by invitation was defined as (number of invited women/number of targeted women), coverage by examination as (number of screened women/number of targeted women), and participation rate as (number of screened women/number of invited women).

Results

Coverage by invitation was close to or above 95% for all newly recruited cohorts. In subsequent invitation rounds, both technical errors and changes in the invitation scheme affected the coverage by invitation. Coverage by examination at first invitation was 72.5% for the first cohort, but dropped to 64.2% for the latest cohort. Furthermore, coverage by examination dropped by increasing invitation number and with omission of re-invitation of previous non-attenders. Participation rate closely reflected changes in the invitation scheme.

Conclusion

Changes in the invitation schemes influenced coverage by invitation, coverage by examination, and participation rate. We observed a considerable gap between coverage by examination and participation rate, strongly indicating that the latter cannot without reservations, be taken as an indicator of the first.
The Changing Nature of Guilt in Family Caregivers: Living Through Care Transitions of Parents at the End of Life
Authors: Martz Kim , Morse Janice M.
Published: May 2016

Older adults cared for at home by family members at the end of life are at risk for care transitions to residential and institutional care settings. These transitions are emotionally distressing and fraught with suffering for both families and the older adult. A theoretical model titled “The Changing Nature of Guilt in Family Caregivers: Living Through Care Transitions of Parents at the End of Life” was developed using the method of grounded theory. When a dying parent cannot remain at home to die, family members experience guilt throughout the transition process. Findings indicated that guilt surrounding transfers escalated during the initial stages of the transfer but was mitigated by achieving what family members deemed as a “good” death when relatives were receiving hospice care. The findings of this interpretative approach provide new insights into family-focused perspectives in care transfers of the dying.
Initial strain energy-based thermo-elastoviscoplastic two-parameter damage self-healing model for bituminous composites—Part II: Computational aspects
Authors: Hong S , Yuan KY , Ju JW
Published: May 2016

This paper describes the implementation of the initial strain energy-based thermo-elastoviscoplastic two-parameter damage self-healing models for bituminous materials to compare the model predictions with experimental measurements. Computational algorithms based on the two-step operator splitting methodology are proposed and employed for numerical results. The elastic two-parameter damage self-healing predictor and the viscoplastic corrector are coupled with the Arrhenius-type temperature term via the net stress concept in conjunction with the hypothesis of strain equivalence and then systematically used for numerical implementation of the models. Four numerical examples of three-dimensional problems are first demonstrated for the effect of temperature and rest period for healing phenomenon. Second, experimental validation of the proposed model against monotonic constant-strain test at different temperatures and controlled-strain cyclic tension test is presented. It is observed that numerical simulations by the two-parameter model agree well with experimental results. In particular, the softening responses of the bituminous composites are well predicted for monotonic constant-strain rate test and the viscous damage behavior can be reasonably predicted by the proposed two-parameter damage models. It is noted that the two-parameter model can better predict the thermo-mechanical behavior of asphalt and is more versatile than the one-parameter isotropic damage self-healing model.
Dehydration as a Possible Cause of Monthly Variation in the Incidence of Venous Thromboembolism
Authors: Elias Saad , Hoffman Ron , Saharov Gleb , Brenner Benjamin , Nadir Yona
Published: May 2016

Background:

Monthly or seasonal changes in the incidence of venous thromboembolism (VTE) were previously reported; however, the mechanism of such variability is not completely understood.

Methods:

In the present retrospective single-center analysis, consecutive patients with proximal deep vein thrombosis and/or pulmonary embolism (PE) diagnosed between January 2009 and December 2013 were evaluated.

Results:

The study population included 1496 patients, 48% men, mean age 63 ± 18 years. Most (82%) cases with VTE were provoked and 39% of patients had active cancer. Four months of peak incidence (3, 7, 10 and 11) were compared with 4 months of the lowest incidence (4, 5, 6, and 12), showing a significant difference in VTE numbers (597 vs 405 cases/year, P = 0.001). In all subgroup analyses, including gender, provoked or unprovoked event and presence or absence of cancer, significant differences between the months of peak and lowest incidence remained. Blood urea nitrogen (BUN)–creatinine ratio was significantly higher in all cases in the peak incidence group compared to the lowest incidence group (24 ± 1.5 vs 21 ± 1.6, P = 0.03). In patients with unprovoked VTE (n = 269), levels of BUN and hematocrit were significantly increased in the peak incidence group compared to lowest incidence group (19.5 ± 0.8 mg/dL vs 16 ± 1.1 mg/dL, P = 0.03; 39.2 ± 0.3% vs 37.4 ± 0.5%, P = 0.01, respectively).

Conclusions:

The current study demonstrates that occurrence of VTE exhibits monthly variation also existing in patients with provoked events and even in those with cancer. Dehydration is suggested as a potential explanation to the month-related variation in incidence of VTE.
Resolving the Meat-Paradox: A Motivational Account of Morally Troublesome Behavior and Its Maintenance
Authors: Bastian Brock , Loughnan Steve
Published: May 2016

A majority of people the world over eat meat, yet many of these same people experience discomfort when the meat on their plate is linked to the death of animals. We draw on this common form of moral conflict—the meat-paradox—to develop insights into the ways in which morally troublesome behaviors vanish into the commonplace and every day. Drawing on a motivational analysis, we show how societies may be shaped by attempts to resolve dissonance, in turn protecting their citizens from discomfort associated with their own moral conflicts. To achieve this, we build links between dissonance reduction, habit formation, social influence, and the emergence of social norms and detail how our analysis has implications for understanding immoral behavior and motivations underpinning dehumanization and objectification. Finally, we draw from our motivational analysis to advance new insights into the origins of prejudice and pathways through which prejudice can be maintained and resolved.
Near-Infrared Spectroscopy
Authors: Green Michael Stuart , Sehgal Sankalp , Tariq Rayhan
Published: May 2016

Standard hemodynamic monitoring such as blood pressure and pulse oximetry may only provide a crude estimation of organ perfusion in the critical care setting. Near-infrared spectroscopy (NIRS) is based on the same principle as a pulse oximeter and allows continuous noninvasive monitoring of hemoglobin oxygenation and deoxygenation and thus tissue saturation “StO2.” This review aims to provide an overview of NIRS technology principles and discuss its current clinical use in the critical care setting. The study selection was performed using the PubMed database to find studies that investigated the use of NIRS in both the critical care setting and in the intensive care unit. Currently, NIRS in the critical care setting is predominantly being used for infants and neonates. A number of studies in the past decade have shown promising results for the use of NIRS in surgical/trauma intensive care units during shock management as a prognostic tool and in guiding resuscitation. It is evident that over the past 2 decades, NIRS has gone from being a laboratory fascination to an actively employed clinical tool. Even though the benefit of routine use of this technology to achieve better outcomes is still questionable, the fact that NIRS is a low-cost, noninvasive monitoring modality improves the attractiveness of the technology. However, more research may be warranted before recommending its routine use in the critical care setting.
Cost-Effectiveness of the Hepatitis C Self-Management Program
Authors: Groessl Erik J. , Sklar Marisa , Laurent Diana D. , Lorig Kate , Ganiats Theodore G. , Ho Samuel B.
Published: May 2016

Background. Despite the emergence of new hepatitis C virus (HCV) antiviral medications, many people with chronic HCV know little about their disease, are at risk for transmitting HCV to others, and/or are not considered good treatment candidates. Self-management interventions can educate HCV-infected persons, improve their quality of life, and prepare them for treatment. Purpose. A cost-effectiveness analysis of the HCV Self-Management Program is presented. Method. Effectiveness data in quality-adjusted life years (QALYs) were derived from the previously published prospective, randomized controlled trial ( n = 134). Health care utilization was abstracted from medical records in 2011 for the 12 months before and after study enrollment. Intervention costs were tracked from the payer’s perspective and combined with health care costs. Sensitivity analyses were used to examine assumptions. Data were analyzed in 2014. Results. Estimated intervention costs including organizational overhead were $1,760 per 6-week workshop, or $229/person. Health care costs were $815 lower/person for self-management participants, resulting in a cost savings of $586/person. Self-management participants had an average net gain of 0.02975 QALYs after 1 year. When removing inpatient substance use treatment days from analyses, costs were similar between groups, producing an incremental cost-effectiveness ratio of $6,218/QALY. Sensitivity analyses showed that the results and conclusions change little when assumptions were varied. Conclusions. When compared to information-only, the HCV Self-Management Program led to more QALYs and cost savings in the randomized controlled trial. Independent of health care costs, the intervention is low-cost and educates HCV-infected individuals about antiviral treatment and avoiding viral transmission. Low-cost interventions that can enhance the outcomes derived from expensive antiviral treatments should be studied further.
Advancing Understanding of the Characteristics and Capacity of African American Women Who Serve as Lay Health Advisors in Community-Based Settings
Authors: Shelton Rachel C. , Dunston Sheba King , Leoce Nicole , Jandorf Lina , Thompson Hayley S. , Erwin Deborah O.
Published: May 2016

Lay Health Advisor (LHA) programs hold tremendous promise for reducing health disparities and addressing social determinants of health in medically underserved communities, including African American populations. Very little is understood about the capacity of LHAs in these roles and the broader contributions they make to their communities. This article seeks to address this gap by describing the characteristics and capacity of a sample of 76 female African American LHAs from a nationally disseminated evidence-based LHA program for breast and cervical cancer screening (The National Witness Project), as well as potential differences between cancer survivors and nonsurvivors who serve as LHAs. A conceptual model for understanding LHA capacity and contributions in underserved communities at the individual, social, and organizational levels is presented. We describe LHA experiences and characteristics (e.g., experiences of mistrust and discrimination, racial pride, sociodemographics), capacity at the individual level (e.g., psychological and physical health, health behaviors), capacity at the social level (e.g., social networks, social support), and capacity at the organizational level (e.g., role-related competencies, self-efficacy, leadership, role benefits/challenges). Data were obtained through interview-administered telephone surveys between 2010 and 2011. Findings highlight the critical capacity that LHAs bring to their communities and the importance of supporting LHAs to sustain these programs and to address racial/ethnic health disparities.
Damage evaluation in high-rise buildings using one modal eigenpair
Authors: Jekikj Goran , Garevski Mihail
Published: May 2016

A development of the ‘first-order storey pseudo-stiffness-based damage index’ of high-rise buildings is presented in this article. The proposed damage index is based on identification of an input set of one modal eigenpair, consisting of one modal frequency and the corresponding mode shape, overcoming the need and the difficulties of identifying multiple sets of eigenpairs in operational modal analyses of multistorey buildings. The calculation of first-order storey pseudo-stiffness-based damage index is expressed as a simple numerical procedure for comparison between the dynamic parameters of undamaged and damaged structures. The accuracy of the proposed damage assessment approach has been verified in two different tests – numerical and experimental. The numerical tests are based on the calculation of first-order storey pseudo-stiffness-based damage index in numerical models in which the structural damage is simulated with previously defined storey stiffness degradation. The experimental test consists of first-order storey pseudo-stiffness-based damage index accuracy test on the structure of the Urban Disaster Prevention Research Center, located in Tsukuba, Japan, and comparison to the results obtained by previously proven accurate damage detection method. The test results have shown that the proposed first-order storey pseudo-stiffness-based damage index index, based on the first modal eigenpair, can be applied as an instant damage detection method in structural health monitoring of multistorey buildings, providing the location and severity of structural damage.
Tests of carbon fibre–reinforced polymer strengthened cold-formed stainless steel tubular sections subjected to web crippling
Authors: Zhou Feng , Ling Yunhao , Huang Pei
Published: May 2016

A total of 67 web crippling tests were conducted on carbon fibre–reinforced polymer strengthened cold-formed stainless steel square and rectangular hollow sections in this article. Several carbon fibre–reinforced polymer strengthening schemes were adopted, such as strengthened with carbon fibre–reinforced polymer sheets, strengthened with carbon fibre–reinforced polymer plates and strengthened with anchored carbon fibre–reinforced polymer plates. Two loading conditions of end-two-flange and interior-two-flange have been considered. The tests were performed on five different tubular section sizes which covered a slightly wide range of measured web slenderness ratios from 18.70 to 68.41. The effects of carbon fibre–reinforced polymer length, number of carbon fibre–reinforced polymer layers and carbon fibre–reinforced polymer strengthening schemes on the strength enhancement have been discussed based on the test results obtained from this study. It was found that the web crippling capacity of stainless steel tubular sections can be obviously increased by carbon fibre–reinforced polymer strengthening, especially for those sections with large values of web slenderness under end-two-flange loading condition. However, the strengthening enhancement of carbon fibre–reinforced polymer sheets and carbon fibre–reinforced polymer plates is quite limited due to the debonding between stainless steel tube and carbon fibre–reinforced polymer. The anchored carbon fibre–reinforced polymer plates can effectively delay or totally prevent the debonding failure. The web crippling behaviour of cold-formed stainless steel square and rectangular hollow sections strengthened with anchored carbon fibre–reinforced polymer plates has been significantly improved. Finally, the web crippling test results obtained from this study are compared with the current design strengths.
Effects of salt solution on mechanical behaviors of aramid fiber–reinforced polymer (AFRP) sheets and AFRP-to-concrete joints
Authors: Wu Bo , Zhang Shuo , Liu Fentao , Gan Ting
Published: May 2016

In this article, the mechanical behaviors of four kinds of specimens (i.e. aramid fiber–reinforced polymer sheets, steel-epoxy adhesive joints, concrete cubes, and aramid fiber–reinforced polymer-to-concrete joints) were evaluated, respectively, after the specimens were immersed in 35 g/L NaCl solution for up to 360 days. Test results show that (a) except for the tensile strength of the aramid fiber–reinforced polymer sheet related to an immersion time of 45 days being 5.0% higher than that of the control sheet, the change in the sheet’s tensile strength with the immersion time is not obvious, and the tensile strength of the sheet related to an immersion time of 360 days is almost the same as that of the control sheet; (b) the effect of the salt solution on the modulus of elasticity of the aramid fiber–reinforced polymer sheet is more significant than that on the tensile strength of the sheet, and the elastic modulus of the sheet related to an immersion time of 360 days is 11.1% lower than that of the control sheet; (c) the shear strength of the steel-epoxy adhesive joint experiences severe degradation after being immersed in the salt solution, but the compressive strength of the aged concrete cube is generally larger than that of the control cube; and (d) the maximum local shear stress in the aramid fiber–reinforced polymer-to-concrete joint generally shows a fluctuating increase with the increase in the immersion time, meanwhile the fracture energy of the joint generally increases with the increase in the immersion time, but the failure pattern of the joint with shorter immersion time is different from that with longer immersion time.
Experimental and numerical study on post-fire behavior of high-strength Q460 steel columns
Authors: Wang Weiyong , Liu Tianzi
Published: May 2016

Experimental study and finite element modeling on the structural behavior of high-strength Q460 steel columns after being exposed to ISO-834 standard fire are presented. Two section shapes were considered, namely welded H-shaped section and welded box-section. The experiment composes of two stages: heating and cooling stage of the specimens and compressive test on the specimen after fire exposure. The temperatures experienced in the specimens were recorded during both the heating and cooling phases, as well as the load–deflection curves, load–axial displacement curves, load–rotation curves, load–strain curves, and failure modes in the steel columns were measured during the compressive tests. Three-dimensional finite element models were also established by employing the program ANSYS to study the post-fire behavior of high-strength Q460 steel columns. The finite element models were used to investigate the effects of key parameters on the residual load-bearing capacity of high-strength Q460 steel columns, following exposure to the ISO-834 standard fire. The investigated parameters included heating time, cooling methods, and slenderness ratio. Finally, a simplified design approach was proposed for predicting the residual load-bearing capacity of high-strength Q460 steel columns after being exposed to ISO-834 standard fire.
Gamekeeper’s thumb
Authors: Kukadia Jogisha , Ashwood Neil
Published: May 2016

Gamekeeper’s thumb is a condition resulting from low-grade repeated force through the ulnar collateral ligament of the thumb metacarpophalangeal joint. In its acute form, it is sometimes known as Skier’s thumb and can be associated with tears, ruptures and fractures. Prompt assessment of the thumb’s structural integrity is therefore important in preventing long-term morbidity of metacarpophalangeal joint instability. Diagnosis is usually made clinically, although radiological imaging can act as a helpful adjunct. Unstable injuries tend to have a better functional outcome if repaired surgically. This article will outline relevant clinical anatomy, injury mechanism, clinical assessment and management of ulnar collateral injuries including Gamekeeper’s thumb.
Analysis of pre-hospital rescue times on mortality in trauma patients in a Scandinavian urban setting
Authors: Bagher A , Todorova L , Andersson L , Wingren CJ , Ottosson A , Wangefjord S , Acosta S
Published: May 2016

Objective

To analyze if pre-hospital rescue times were associated with mortality in a trauma cohort arriving by ambulance to hospital in a Scandinavian urban setting.

Methods

Between 2011 and 2013, individuals and pre-hospital rescue times were identified in Emergency Medical Dispatcher Centre, hospital, and forensic records in red alarm trauma. Major trauma was defined as a New Injury Severity Score (NISS)>15.

Results

Overall, 89% of 378 trauma patients received hospital care within 60 min; 51% had a response time of ≤8 min, and 95% had response time within ≤20 min. The on-scene time (p < 0.05) and total pre-hospital time (p < 0.05) were longer for patients ≥65 years, in comparison with patients <65 years. The patients with penetrating trauma had shorter on-scene time (p < 0.01), total pre-hospital time (p < 0.01), and shorter transport distance from trauma scene to hospital (p = 0.004), compared to those with blunt trauma. Patients with NISS > 15 were found to have the same pre-hospital rescue times as those with NISS ≤ 15. There was a trend that the occurrence of gunshots was associated with increased mortality (p = 0.074). When entering age, NISS, penetrating versus blunt injury, response time, and on-scene time in a multivariate regression analysis, age (p < 0.001), NISS (p < 0.001), and penetrating injury (p = 0.009) remained as independent factors associated with mortality and a trend for shorter on-scene time (p = 0.093).

Conclusions

Pre-hospital rescue times had less impact on mortality than injury severity, age, and penetrating trauma. Even though penetrating traumas were associated with shorter on-scene time and shorter transport distance to hospital, mortality was increased in this Scandinavian urban setting.
Journey Through Transformation
Authors: Duckworth Vicky , Ade-Ojo Gordon O.
Published: May 2016

The study draws on life history, literacy studies, and ethnographic approaches to exploring social practices as a frame to explore the narratives of two UK adult literacy learners who provide a description of their engagement with a transformative curriculum and pedagogical approach. One of the learners reveals his frustration at the lack of transformative opportunities in his learning programme. The other offers an illustration of how transformative learning can be encouraged and how it can actually transform the life of its beneficiaries. In essence, both case studies highlight some of the characteristics of transformative learning. Bourdieu’s concepts of field, capitals, and habitus are applied. The critical elements of these concepts include tools for consciousness raising and increasing the flow of capital, and linguistic capital. The notion of spoilt identities based on neoliberal individual accountability, that fails to address the structures and hierarchies of power, is challenged.
Intravenous zoledronate for osteoporosis: less might be more
Authors: Grey Andrew
Published: May 2016

Annual administration of 5 mg intravenous zoledronate is moderately effective in reducing fracture risk in older adults, decreasing the relative risk of clinical fracture by 33%. However, almost 10 years after its approval for use in clinical practice there remain very substantial uncertainties about the optimal treatment regimen, that is, the lowest dose and/or longest dosing interval that is efficacious. Several pieces of clinical research suggest that the current recommendation for annual administration of 5 mg zoledronate might represent overtreatment. Clinical trials to clarify the optimal use of zoledronate for reduction of fracture risk should be undertaken.
Efficacy of an Overnight Predictive Low-Glucose Suspend System in Relation to Hypoglycemia Risk Factors in Youth and Adults With Type 1 Diabetes
Authors: Calhoun Peter M. , Buckingham Bruce A. , Maahs David M. , Hramiak Irene , Wilson Darrell M. , Aye Tandy , Clinton Paula , Chase Peter , Messer Laurel , Kollman Craig , Beck Roy W. , Lum John ,   for the In Home Closed Loop Study Group
Published: May 2016

Background:

We developed a system to suspend insulin pump delivery overnight when the glucose trend predicts hypoglycemia. This predictive low-glucose suspend (PLGS) system substantially reduces nocturnal hypoglycemia without an increase in morning ketosis. Evaluation of hypoglycemia risk factors that could potentially influence the efficacy of the system remains critical for understanding possible problems with the system and identifying patients that may have the greatest benefit when using the system.

Methods:

The at-home randomized trial consisted of 127 study participants with hemoglobin A1c (A1C) of ≤8.5% (mmol/mol) for patients aged 4-14 years and ≤8.0% for patient aged 15-45 years. Factors assessed included age, gender, A1C, diabetes duration, daily percentage basal insulin, total daily dose of insulin (units/kg-day), bedtime BG, bedtime snack, insulin on board, continuous glucose monitor (CGM) rate of change (ROC), day of the week, time system activated, daytime exercise intensity, and daytime CGM-measured hypoglycemia.

Results:

The PLGS system was effective in preventing hypoglycemia for each factor subgroup. There was no evidence that the PLGS system was more or less effective in preventing hypoglycemia in any one subgroup compared with the other subgroups based on that factor. In addition, the effect of the system on overnight hyperglycemia did not differ in subgroups.

Conclusions:

The PLGS system tested in this study effectively reduced hypoglycemia without a meaningful increase in hyperglycemia across a variety of factors.