bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastropharyngeal Anastomotic Leak in Medullary Thyroid Carcinoma Following Initiation of a Tyrosine Kinase Inhibitor: A Case Report of an Unusual Side Effect of Cabozantinib
Authors: Ackerman Jaeger , Kent Sean , Walker Paul 
Published: February 2020

Background: Medullary thyroid carcinoma (MTC) accounts for 1% to 2% of thyroid cancers in the United States. When identified early, total thyroidectomy is most often curative. However, in advanced disease, more aggressive treatment such as laryngectomy and esophagectomy may be indicated. Postsurgical fistula formation and leak is a potential complication in such cases. These fistulas are most likely to occur at the anastomotic site in cases of laryngectomy or esophagectomy. Concomitant chemotherapy and radiation increase this risk. Tyrosine kinase inhibitors (TKI) such as Cabozantinib are used as therapy for metastatic MTC. These drugs have previously been associated with dehiscence of anastomotic sites in the gastrointestinal tract. While previously identified in the bowel, this report represents the first documented case of gastropharyngeal anastomosis leak described in the context of TKI use for head and neck cancer. Case Presentation: We present the case of a 72-year-old male previously diagnosed with MTC. His gastropharyngeal anastomosis status-post laryngopharyngectomy and gastric pull up had been stable for 23 years. Over the past year, he developed back pain and was found to have spinal metastases of MTC. He was subsequently started on Cabozantinib to slow the progression of the disease. Within months of starting this TKI, a bleeding pharyngocutaneous fistula developed at the anastomosis site of the gastric pull up and pharynx. Upon discontinuation of Cabozantinib, the fistula healed with no further complications. Conclusions: To our knowledge, this is the first documented case of gastropharyngeal anastomotic leak related to TKI use. A causal relationship is highly plausible given the previously stable anastomosis and the suspicious advent of complications within months of initiation of this new drug. While previously limited to cases of intraabdominal bowel dehiscence, this report now suggests that wound dehiscence must be considered a known side effect of TKIs throughout the gastrointestinal tract, including the gastropharynx. As such, the risk of anastomotic dehiscence should be discussed with the patient prior to starting a TKI.
Designing for Adaptation in Workers’ Individual Behaviors and Collective Structures With Cognitive Work Analysis: Case Study of the Diagram of Work Organization Possibilities
Authors: Elix Ben , Naikar Neelam 
Published: February 2020

Objective We demonstrate that the diagram of work organization possibilities, a recent addition to cognitive work analysis, can be used to develop designs that promote adaptation in the workplace. Background Workers in sociotechnical systems adapt not just their individual behaviors but also their collective structures in dealing with instability, uncertainty, and unpredictability in their tasks. However, conventional design approaches are limited in supporting adaptations in both workers’ behaviors and structures, especially during unforeseen situations. The work organization possibilities diagram has the potential to meet these requirements, but its value for design has not been established. Method We present a case study of a future system for maritime surveillance that provides an analytical demonstration of the utility of the diagram for design and empirical validation of the impact, uniqueness, and feasibility of this approach in an industrial setting. Results This application results in a team design that is integrated with the career and training progression pathway of the crew in a way that maximizes the system’s behavioral and structural possibilities for adaptation. Further, the approach has impact on practice, makes a distinct contribution to design relative to other techniques, and is implemented feasibly in an industrial setting. Conclusion The work organization possibilities diagram can contribute to the development of an integrated system design that supports actors’ possibilities for behavioral and structural adaptation in a unified fashion. Application This research provides a basis for designing interfaces, teams, training, and automation that preserve a system’s inherent capacity for adaptation.
Integrating internet of things in electrical engineering education
Authors: Alharbi Fahd 
Published: February 2020

The Saudi Vision 2030 plan is based on three pillars: the Kingdom’s statues as a center for Arab and Islamic countries, stimulating the economy by diversifying revenues and taking advantage of the strategic location that makes the country a center of trade and gateway to the world. The initiative to establish the city of Neom emerges to achieve the objective of reducing the country’s dependence on oil, diversifying its economy, and developing public services sectors. NEOM project focuses on several sectors such as energy and water, mobility, biotech, advanced manufacturing, and digital sciences. One of the main sustainability factors for a smart city as NEOM project is the human factor. It is important to qualify engineers to be able to operate and maintain digital technology such as internet of things applications and devices. In this article, we propose integrating the internet of things technology and applications into the electrical engineering education to introduce students to the future skills and enable them to participate in the sustainability of Saudi Vision 2030.
Tensile properties of ply splice fiber reinforced composite laminates
Authors: Zhu Meng , Chen Dingding , Xing Suli , Hu Qigao , Wang Rui 
Published: February 2020

To fabricate large-scale or unusually shaped composite structures, pieces of reinforcement plies can be spliced to match specific size and shape requirements, forming ply splice structures. The junction of different plies can be considered a defect in the final material, affecting the mechanical properties. In this paper, ply splice carbon fiber reinforced plastics were studied to analyze the fracture mechanism caused by the ply splice, including the effects of the junction geometry and the ply angle. Tensile tests were performed, assisted with digital image correlation for strain distribution analysis and acoustic emission for break mode analysis. The finite element method was also performed using ABAQUS software to study the fracture mechanism. In order to analyze the interlaminar fracture, the interface was simulated with cohesive elements. The results showed that, for a unidirectional carbon fiber reinforced plastics with ply splice, fracturing occurred first at the junction location and then at the interfaces between the splicing layers and the continuous layers. The final strength was determined by the number of continuous layers. The ply-angle had evident effects on the properties of carbon fiber reinforced plastics with ply splices. For a stacking sequence of [± 30°]5S, the effects of the ply splice on the strength and the fracture mode were similar to the effect with unidirectional plates. For a stacking sequence of [± 45°]5S, the ply splice had no effect on the fracture mode, but it did decrease the strength slightly. For a stacking sequence of [± 60°]5S, almost no effect of the ply splice structure could be observed. PACS (optional, as per journal): 75.40.-s; 71.20.LP
ICD-10-CM–Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study
Authors: Slavova Svetla , Quesinberry Dana , Costich Julia F. , Pasalic Emilia , Martinez Pedro , Martin Julia , Eustice Sarah , Akpunonu Peter , Bunn Terry L. 
Published: February 2020

Objectives: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Methods: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). Results: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. Conclusions: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.
Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor
Authors: Chen Yuzhou , Jiang Fangyi , Li Hong , Chen Shiyi , Qiao Yang , Li Yunxia , Hua Yinghui , Chen Jiwu , Ge Yunshen 
Published: February 2020

Background:Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear.Purpose/Hypothesis:The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients.Study Design:Cohort study; Level of evidence, 3.Methods:A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared.Results:A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears.Conclusion:Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.
Stronger State School Nutrition Laws Are Associated With Healthier Eating Behaviors and Optimal Weight Status in US Adolescents
Authors: Sanjeevi Namrata , Lipsky Leah M. , Nansel Tonja R. , Haynie Denise , Liu Aiyi , Simons-Morton Bruce 
Published: February 2020

Purpose: To investigate relationships of farm-to-school, school meal, and competitive food state laws with eating behaviors and weight status and to examine interaction between different types of state laws. Design: Observational cohort study. Settings: US adolescents. Participants: The NEXT study is a nationally representative sample of adolescents assessed annually for 7 years. Data (N = 2751) from students attending public schools from the first (W1) and third (W3) assessment waves (2010 and 2012), occurring during grades 10 and 12, respectively, of the NEXT study were included. Measures: Eating behaviors and weight status of adolescents were linked with Classification of Laws Associated with School Students scoring for state laws. Analysis: Regression analyses examined associations of laws with intake and weight status, accounting for complex survey design and school-level clustering. Results: Adolescents in states with strong farm-to-school laws had greater W1 whole fruit, lower soda, and snack intakes versus those in states with no laws. Strong school meal laws were associated with lower W1 soda intake. Adolescents in states with strong competitive food laws had lower soda intake and overweight/obesity odds than those in states with no laws in W3. Strong farm-to-school laws were inversely associated with W3 overweight/obesity odds only in states with strong competitive food laws. Conclusions: Stronger laws governing school nutrition were related to healthier eating behaviors and optimal weight status in this nationally representative sample of adolescents. Further, farm-to-school laws may be more effective in reducing obesity when combined with strong competitive food legislation.
Race/Ethnic Variations in Predictors of Health Consciousness Within the Cancer Prevention Context
Authors: Nevarez Lucinda , Hovick Shelly R. , Enard Kimberly R. , Lloyd Stacy M. , Kahlor Lee Ann 
Published: February 2020

Purpose: Although the literature establishes a link between health consciousness (HC) and prevention behavior, less explored are the individual, social, and health characteristics that are associated with increased HC. Similarly, underexamined is the influence of race and ethnicity on the relationship of these characteristics to higher levels of HC. Design: This cross-sectional study aims to identify and assess the relative importance of factors associated with higher levels of HC, highlighting the role of race and ethnicity. Participants: Participants came from a national research panel survey (N = 1007). Measures: Participants completed a 4-item scale capturing key concepts of HC as well as questionnaires capturing demographic profiles, social support, social networking activities, and health status. Analysis: A stepwise multiple regression was used to identify significant predictors of HC. Results: Female and more educated participants report higher levels of HC. African American and Hispanic participants report higher levels of HC compared to white participants. Findings indicate social support, social network participation, education, cancer survivorship, and health status were positively associated with higher HC for the collective sample. However, results revealed variations in factors associated with higher HC when stratified by race/ethnicity. Conclusion: Findings suggest that interventions aiming to motivate cancer prevention behaviors within at-risk communities may find more success by incorporating factors that are aligned with increased HC among culturally diverse populations.
Sustained virologic suppression with abacavir, emtricitabine, and crushed dolutegravir and tenofovir alafenamide in a patient with HIV and eosinophilic esophagitis
Authors: Moore Sarah E , Huesgen Emily , Howe Zachary 
Published: February 2020

We report the use of crushed dolutegravir (DTG) and tenofovir alafenamide (TAF) tablets in a 27-year-old man with progressive dysphagia due to eosinophilic esophagitis, which severely limited compliance, leading to viral resistance. Based on his drug resistance history, allergies, and inability to swallow tablets intact, he was transitioned to DTG 50 mg (crushed), TAF 25 mg (crushed), liquid abacavir (20 mg/ml) 30 ml, and liquid emtricitabine (10 mg/ml) 24 ml orally daily. After receiving this regimen for five months, the patient’s HIV viral load decreased from 9910 to 59 copies/ml and after ten total months became suppressed at <20 copies/ml. Our case report suggests administration of crushed DTG and TAF tablets may be a viable option for patients with dysphagia and limited treatment options.
Exploration of Two Different Structures for Debriefing in Simulation: The Influence of the Structure on the Facilitator Role
Authors: Tosterud Randi , Kjølberg Kristin , Kongshaug Arnhild Vestnes , Haugom Jon Viktor 
Published: February 2020

Background. In the use of simulation as a learning approach, a structured debriefing is important for students to achieve learning. The facilitator’s feedback style and abilities in facilitating are crucial, and have a great impact on the learning environment. The facilitators should facilitate for student active learning, and provide helpful feedback to empower students as self-regulated learners. The aim of the study was to explore the Steinwachs structure and the Critical Response Process structure when used in debriefing in medical simulation, and how each of them affected the facilitator’s role. Method. A multi-method, comparative quasi-experimental design was used. Results. Structuring debriefing in accordance with the Critical Response Process facilitated a facilitator role that coincided with factors highlighted in theory on how to facilitate student active learning and the development self-regulating learners. Structuring debriefing in accordance with the Steinwachs structure revealed that debriefing seemed to be based more on the facilitator’s frames and dominance than the students’ frames and involvement. Conclusion. The results of this study showed that Critical Response Process (CRP) can be an appropriate structure to use in debriefing in medical simulation. It reduced the facilitator’s dominance and frames, coincident with what is empathized in collaborative, active and learner-centered learning.
Genetic association study of SOX2 gene polymorphisms with high myopia in a Chinese population
Authors: Li Lan , Cui Ying Juan , Zou Yunchun , Yang Liyuan , Yin Ximin , Li Bo , Yan Liying 
Published: February 2020

Purpose: The aim of this study is to investigate whether SOX2 gene variants were associated with high myopia in a Chinese population. Methods: This study is conducted using case-control association analysis. This study recruited 83 healthy controls (with binocular spherical equivalent between –0.50 and +0.50 D) and 117 high myopia cases (spherical equivalent > –6.00 D in both eyes). Three single-nucleotide polymorphisms were selected from HapMap database for genotyping by direct sequencing. Statistical software (SPSS 22.0) was used for statistical analysis. The chi-square test was used to examine the difference in the frequency between cases and controls. Results: Genotype distributions in the three single-nucleotide polymorphisms were all in accordance with the Hardy–Weinberg equilibrium. The differences of rs4575941 locus genotype frequency and allele frequency between the case group and the control group were statistically significant (p = .043 and p = .029, respectively). The rs4575941 allele G frequency in the high myopia group was significantly higher than that in the control group with an odds ratio value of 1.579. However, the value of a chi-square test for the trend was 0.029, and after Bonferroni test, the p value was .087. Conclusion: In Chinese population, rs4575941 in SOX2 gene was likely to play some roles in the genetic susceptibility to high myopia; the rs4575941 allele G might be a risk gene for high myopia.
Anatomy of Non-tariff Barriers in India–Sri Lanka Free Trade Agreement: An Empirical Investigation
Authors: Pal Barun Deb , Pohit Sanjib 
Published: February 2020

This article attempts to answer one crucial research question: why the utilization of India–Sri Lanka Free Trade Agreement (ISFTA) route for trade is very poor by the Indian exporters (13%) as compared to their Sri Lankan counterpart (65%) even after one decade of its implementation? The available studies have blamed the non-tariff barriers (NTBs) which are hamstringing the growth of trade between these partners development of international trade. However, these have considered NTBs as subset of non-tariff measures (NTMs) which are quite narrow sense of finding the hidden barriers within the International trade process. Therefore, this article has analysed in detail the logistic process involved in international trade between India and Sri Lanka to understand various NTBs sheltered within this logistic process. Further, the article has identified issues which are not directly beyond the logistic process which are affecting the international trade between these two countries. JEL: F0, F1
Prospective Outcomes of Cryopreserved Osteochondral Allograft for Patellofemoral Cartilage Defects at Minimum 2-Year Follow-up
Authors: Melugin Heath P. , Ridley Taylor J. , Bernard Christopher D. , Wischmeier Dillen , Farr Jack , Stuart Michael J. , Macalena Jeffrey A. , Krych Aaron J. 
Published: February 2020

Objective To analyze the clinical outcomes, knee function, and activity level of patients after treatment of full-thickness cartilage defects involving the patellofemoral compartment of the knee with cryopreserved osteochondral allograft. Design Nineteen patients with cartilage defects involving the patellofemoral compartment were treated. The average age was 31 years (range 15-45 years), including 12 females and 7 males. Patients were prospectively followed using validated clinical outcome measures including Veterans RAND 12-item Health Survey (VR-12), International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. Graft incorporation was evaluated by magnetic resonance imaging (MRI) or second-look arthroscopy. Results The cartilage defects included the patella ( n = 16) and the femoral trochlea ( n = 3). Mean VR-12 scores increased from 31.6 to 46.3 ( P < 0.01), mean IKDC increased from 40.0 to 69.7 ( P < 0.01), mean KOOS increased from 53.9 to 80.2 ( P < 0.01), and mean Tegner scores increased from 3.0 to 4.9 ( P < 0.01), at average follow-up of 41.9 months (range 24-62 months). Of the 3 patients who underwent second-look arthroscopy, all demonstrated a well-incorporated graft. Mean MOCART score for the 6 patients with follow-up MRI was 62.5 (range 25-85). The reoperation rate was 21.1% and 2 patients (12.5%) experienced progressive patellofemoral osteoarthritis requiring conversion to patellofemoral arthroplasty. Conclusion Patients with unipolar cartilage defects involving the patellofemoral compartment of the knee can have positive outcomes at minimum 2-year follow-up after surgical treatment with a cryopreserved osteochondral allograft when concomitant pathology is also addressed, but the reoperation rate is high and bipolar cartilage lesions may increase the failure rate.