bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vorspannkraftverluste in HV‐Schraubverbindungen
Authors: Friede Roland , Lange Jörg 
Published: December 2016

AbstractHerrn Univ.‐Prof. Dr.‐Ing. Gerhard Hanswille zur Vollendung seines 65. Lebensjahres gewidmetBei HV‐Verbindungen werden die Schrauben planmäßig vorgespannt. Hierbei führen die Effekte “Setzen” und “selbsttätiges Losdrehen” zu Vorspannkraftverlusten, die bei der Planung prinzipiell zu berücksichtigen sind. Am Institut für Stahlbau und Werkstoffmechanik der TU Darmstadt wurden Versuche zum Setzen und selbsttätigen Losdrehen durchgeführt. Ziel war es, die Effekte weiter zu erforschen und Konstruktionsregeln für die praktische Auslegung von HV‐Verbindungen abzuleiten. Im vorliegenden Beitrag werden Grundlagen zum Vorspannen zusammengefasst sowie die Versuche zum Setzen und selbsttätigen Losdrehen vorgestellt und die daraus resultierenden Ergebnisse und Konstruktionsempfehlungen präsentiert.Loss of preload in connections using high‐strength bolts. In high‐strength structural bolting connections (system HV) the bolts are usually preloaded. Embedding and self‐loosening lead to a loss of the preload that has to be considered in the structural design. At the Institut für Stahlbau und Werkstoffmechanik (Institute for Steel Structures and Materials Mechanics) of TU Darmstadt the embedding and self‐loosening was assessed experimentally. Aim of this was to gain further knowledge of these effects and to develop recommendations for the practical application of preloaded bolted connections. In this paper some basics of preloading are presented. Furthermore the test‐results are presented and some design recommendations are given.
Plastische Querschnittstragfähigkeit von kreisförmigen Hohlprofilen
Authors: Kindmann Rolf , Jonczyk Dominik , Knobloch Markus 
Published: December 2016

AbstractHerrn Univ.‐Prof. Dr.‐Ing. Gerhard Hanswille zur Vollendung seines 65. Lebensjahres gewidmetTraditionell wird die plastische Querschnittstragfähigkeit von kreisförmigen Hohlprofilen in der Regel mit einem Modell bestimmt, bei dem der Querschnitt auf eine Linie reduziert wird (Linienmodell). Damit ergeben sich Näherungen, deren Güte von den Durchmessern und Profildicken abhängt. In dem vorliegenden Beitrag werden dünn‐ und dickwandige Querschnitte untersucht und die plastische Querschnittstragfähigkeit für einzelne Schnittgrößen und ihre Kombinationen ermittelt. Darüber hinaus werden Näherungen für vereinfachte Berechnungen angegeben und Tragfähigkeitsbedingungen gemäß DIN EN 1993‐1‐1 hinsichtlich ihrer Genauigkeit bewertet. Plastic resistance of circular hollow sections. The plastic resistance of circular hollow sections is usually determined by reducing the cross‐section to a line. The use of this model leads to approximations, which accuracy depends on the diameters and the thicknesses. The present paper deals with the plastic resistance of thin and thick circular hollow sections for each stress resultant and for combinations. Precise solutions and approximations for simplified verifications are given. The accuracy of verifications given in DIN EN 1993‐1‐1 is evaluated.
Application of activity sensors for estimating behavioral patterns
Authors: Roberts Caleb P. , Cain James W. , Cox Robert D. 
Published: December 2016

ABSTRACTThe increasing use of Global Positioning System (GPS) collars in habitat selection studies provides large numbers of precise location data points with reduced field effort. However, inclusion of activity sensors in many GPS collars also grants the potential to remotely estimate behavioral state. Thus, only using GPS collars to collect location data belies their full capabilities. Coupling behavioral state with location data would allow researchers and managers to refine habitat selection models by using diel behavioral state changes to partition fine‐scale temporal shifts in habitat selection. We tested the capability of relatively unsophisticated GPS‐collar activity sensors to estimate behavior throughout diel periods using free‐ranging female elk (Cervus canadensis) in the Jemez Mountains of north‐central New Mexico, USA, 2013–2014. Collars recorded cumulative number of movements (hits) per 15‐min recording period immediately preceding GPS fixes at 0000, 0600, 1200, and 1800 hr. We measured diel behavioral patterns of focal elk, categorizing active (i.e., foraging, traveling, vigilant, grooming) and inactive (i.e., resting) states. Active behaviors (foraging, traveling) produced more average hits (0.87 ± 0.69 hits/min, 4.0 ± 2.2 hits/min, respectively; 95% CI) and inactive (resting) behavior fewer hits (−1.1 ± 0.61 95% CI). We differentiated active and inactive behavioral states with a bootstrapped threshold of 5.9 ± 3.9 hits/15‐min recording period. Mean cumulative activity‐sensor hits corresponded with observed diel behavioral patterns: hits increased during crepuscular (0600, 1800 hr) observations when elk were most active (0000–0600 hr: d = 0.19; 1200–1800 hr: d = 0.64) and decreased during midday and night (0000 hr, 1200 hr) when elk were least active (1800–0000 hr: d = −0.39; 0600–1200 hr: d = −0.43). Even using relatively unsophisticated GPS‐collar activity sensors, managers can remotely estimate behavioral states, approximate diel behavioral patterns, and potentially complement location data in developing habitat selection models. © 2016 The Wildlife Society.
Transoral Approach for Odontoidectomy Efficacy and Safety
Authors: Elbadrawi Ahmed Mohamed , Elkhateeb Tameem Mohamed 
Published: December 2016

Background Odontoid process pathologies can cause upper motor neuron lesions. These pathologies can be approached through either a high retropharyngeal approach or a transoral approach. The introduction of the surgical microscope, proper instrumentations, and proper antibiotics has increased utilization of the transoral approach. Questions/Purposes Our approach to anterior odontoid resection through transoral approach for different pathologies resulting in compression the cervical cord or causing craniocervical instability is described here. We aim to explore the safety and efficacy of this approach. Methods Twenty cases of different odontoid pathologies were managed by transoral surgery. Patients were assessed clinically for axial neck pain and radicular symptoms using visual analog scale. The Nurick score was used to get an overall functional evaluation of the difficulty of ambulation and walking. Radiological evaluation of the patients included plain radiographs, CT scans, and MRI of the cervical spine. Posterior surgery was done as a first stage for restoring the sagittal profile of the cervical spine. Transoral surgery was done as a second stage for odontoid resection and anterior decompression of the cord. Results Average follow-up was 29.4 ± 3.8 months. Mean preoperative Nurick scale was 1.3 ± 1.2. Mean postoperative Nurcik scale was 0.5 ± 0.61. Patients with axial neck pain were improved after surgery except the 6 patients; mean VAS preoperative 8.2 ± 2.3 SD, mean postoperative VAS 3.7 ± 0.8SD, and radicular symptoms were not significantly changed after surgery; gait changes were improved in all patients with preoperative gait disturbance. Conclusion The transoral approach is a safe and effective surgical method for the direct decompression of ventral midline extradural compressive disease of the craniovertebral junction.
Safety and Efficacy of Natalizumab in Japanese Patients with Relapsing-Remitting Multiple Sclerosis: Open-Label Extension Study of a Phase 2 Trial
Authors: Saida Takahiko , Kira Jun-Ichi , Kishida Shuji , Yamamura Takashi , Ohtsuka Nobuhisa , Ling Yan , Torii Shinichi , Lucas Nisha , Kuesters Geoffrey , Steiner Deb , Tibung J. T. ,   on behalf of the Natalizumab Trial Principal Investigators
Published: December 2016

Abstract
Introduction
The efficacy of natalizumab was evaluated in Japanese patients with relapsing-remitting multiple sclerosis (RRMS) in a 24-week, phase 2 bridging study. An open-label, 2-year extension study from this trial was conducted to assess the safety and efficacy of natalizumab treatment in Japanese patients.

Methods
A total of 97 patients (43 previously on placebo; 54 previously on natalizumab) who had completed the bridging study were treated with 300 mg natalizumab every 4 weeks. Multiple sclerosis relapses, changes in Expanded Disability Status Scale (EDSS) scores, and adverse events were assessed at regular intervals. Anti-natalizumab and anti-JC virus (JCV) antibodies were measured.

Results
After 2 years of natalizumab treatment, the mean adjusted annualized relapse rate was 0.30 (95% confidence interval [CI]: 0.18–0.52) among previously-on-placebo patients and 0.13 (95% CI: 0.05–0.29) among previously-on-natalizumab patients. The mean change in EDSS score from baseline to week 120 was −0.03 among previously-on-placebo patients and −0.18 among previously-on-natalizumab patients. In both groups, >90% of patients experienced ≥1 adverse event. Two previously-on-placebo patients developed persistently positive anti-natalizumab antibodies. Approximately 65% of all patients tested positive for anti-JCV antibodies at open-label treatment initiation. No deaths or progressive multifocal leukoencephalopathy cases were reported.

Conclusions
The efficacy and safety findings from this 2-year open-label extension study are comparable to and confirm the results of other clinical trials of natalizumab conducted in non-Asian patient populations, and provide longer-term evidence of efficacy and safety in Japanese patients.

Trial registration
ClinicalTrials.gov identifier NCT01416155.

Funding
Biogen.
Acute pain in the emergency department: Effect of an educational intervention
Authors: Friesgaard Kristian Dahl , Paltved Charlotte , Nikolajsen Lone 
Published: December 2016

Abstract

Background and aims
Pain management is often inadequate in emergency departments (ED) despite the availability of effective analgesics. Interventions to change professional behavior may therefore help to improve the management of pain within the ED. We hypothesized that a 2-h educational intervention combining e-learning and simulation would result in improved pain treatment of ED patients with pain.

Methods
Data were collected at the ED of Horsens Regional Hospital during a 3-week study period in March 2015. Pain intensity (NRS, 0–10) and analgesic administration were recorded 24 h a day for all patients who were admitted to the ED during the first and third study weeks. Fifty-three ED nurses and 14 ED residents participated in the educational intervention, which took place in the second study week.

Results
In total, 247 of 796 patients had pain >3 on the NRS at the admission to the ED and were included in the data analysis. The theoretical knowledge of pain management among nurses and residents increased as assessed by a multiple choice test performed before and after the educational intervention (P = 0.001), but no change in clinical practice could be observed: The administration for analgesics [OR: 1.79 (0.97–3.33)] and for opioids [2.02 (0.79–5.18)] were similar before and after the educational intervention, as was the rate of clinically meaningful pain reduction (NRS >2) during the ED stay [OR: 0.81 (CI 0.45–1.44)].

Conclusions
Conduction of a 2-h educational intervention combining interactive case-based e-learning with simulation-based training in an ED setting was feasible with a high participation rate of nurses and residents. Their knowledge of pain management increased after completion of the program, but transfer of the new knowledge into clinical practice could not be found. Future research should explore the effects of repeated education of healthcare providers on pain management.

Implications
It is essential for nurses and residents in emergency departments to have the basic theoretical and practical skills to treat acute pain properly. A modern approach including e-learning and simulation lead to increased knowledge of acute pain management. Further studies are needed to show how this increased knowledge is transferred into clinical practice.
Transmastoid resurfacing versus middle fossa plugging for repair of superior canal dehiscence: Comparison of techniques from a retrospective cohort
Authors: Rodgers Brian , Lin Jim , Staecker Hinrich 
Published: December 2016

AbstractObjectiveTo compare and contrast our experience with middle cranial fossa approach (MFR) and transmastoid approach with capping of the dehiscence (TMR) of superior semicircular canal dehiscence and to determine guidelines to help guide management of these patients.MethodsAll patients from 2005 to 2014 with symptomatic superior semicircular canal dehiscence syndrome with dehiscence demonstrated on CT scan of the temporal bone who underwent surgical repair and had a minimum 3 months of follow up. Surgical repair via the MFR or TMR, preoperative CT temporal bone, preoperative, and postoperative cervical vestibular evoked myogenic potential (cVEMP) testing and anterior canal video head thrust testing (vHIT). Success of repair was stratified as complete success, moderate success, mild success, or failure based on resolution of all symptoms, the chief complaint, some symptoms, or no improvement, respectively.ResultsA total of 29 ears in 27 patients underwent surgical repair of canal dehiscence. Complete or moderate success was seen in 71% of the MFR group compared to 80% of the TMR group. There were zero failures with the MFR group and no major intracranial complications. There were 2 failures out of 15 ears that underwent the TMR. Residual symptoms were most commonly vertigo or disequilibrium in the MFR and aural fullness or autophony in the TMR groups, respectively. MFR hospital stay was approximately 2 days longer. Average cVEMP threshold shifted 18 dB with surgical correction in the MFR group. A 29 dB average shift was seen in the TMR group. The MFR group had a significant reduction in their anterior canal gain compared to the TMR group.ConclusionsTMR is a less invasive alternative to MFR. However, in our series, we have not seen any intracranial complications (aphasia, stroke, seizures, etc.) in our MFR patients. Interestingly, vestibular symptoms were better addressed than audiological symptoms by the TMR suggesting its usefulness as a less invasive option for patients with primarily vestibular complaints. Residual auditory symptoms in TMR patients may be due to the flow of acoustic energy from the superior canal to the mastoid cavity through an incompletely sealed third window.
A wandering tube
Authors: Dubin Ina , Gelber Moshe , Schattner Ami 
Published: December 2016

ABSTRACTThe predominant causes of acute mechanical small bowel obstruction in geriatric patients are adhesions and hernias, which is not much different than in other adult age groups. Unusual etiologies may be encountered, such as volvulus or gallstone ileus, but a displaced feeding gastrostomy tube is a distinctly rare cause of intestinal obstruction which needs to be considered by emergency physicians as it may be increasingly encountered.
Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis
Authors: Chartier Lucas B. , Bosco Laura , Lapointe-Shaw Lauren , Chenkin Jordan 
Published: December 2016

AbstractObjectivesLong bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.Data sourceMEDLINE and EMBASE databases were searched through July 19, 2015.Study selectionWe included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.Data extractionThirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%–100%, specificity 79.2%–100%, positive likelihood ratio (LR) 3.11–infinity, and negative LR zero–0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%–100% and 56%–100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%–96.4%) and specificity of 92.9% (95% CI, 86.6%–96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%–95.6%) and specificity of 94.2% (95% CI, 86.1%–97.7%).ConclusionPoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.
A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations
Authors: Betz Martin , Stempien James , Trevidi Sachin , Bryce Rhonda 
Published: December 2016

ABSTRACTObjectivesEmergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS).MethodsThis observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged. Participants’ CTAS scores were collected from the electronic record. Patients arriving to the ED by ambulance were excluded.ResultsA total of 536 participants were timed over 13 separate intervals. Of these, 11 left without being triaged. Participants who scored either CTAS 1 or 2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1) minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6, 24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, and CTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patients subsequently categorized as CTAS 1 or 2, 20.8% waited longer than the recommended time-to-physician of 15 minutes to be triaged.ConclusionsAll urban EDs closely follow patients’ wait times, often stratified according to triage category, which are assumed to be time-stamped upon a patient’s arrival in the ED. We note that pre-triage times exceed the CTAS recommended time-to-physician in a possibly significant proportion of patients. EDs should consider documenting times to treatment from the moment of patient arrival rather than registration.
NATO and the Ukraine crisis: Collective securitisation
Authors: Sperling James , Webber Mark 
Published: December 2016

AbstractIn securitisation theory (ST) little attention has been paid to how actors undertake securitisation collectively. The empirical focus of that theory has also, paradoxically, neglected the military-strategic sector and with it regional security organisations like NATO. Such an oversight is worth correcting for three reasons. First, NATO is constantly engaged in securitisation across a range of issues, a process that reflects an underappreciated recursive interaction between the Alliance and its member states. Second, the Ukraine crisis has resulted in Russia being explicitly identified as a source of threat and so has triggered a successful collective (re)securitisation by the Alliance. Third, a framework that demonstrates NATO’s standing as a securitising actor has potential relevance to other regional security organisations. This article discusses and amends ST in service of an approach that permits securitisation by actors other than the state, in this case NATO. A model of collective securitisation is presented and then applied empirically to the post-Cold War desecuritisation of Russia and its subsequent resecuritisation following the annexation of Crimea. The implications of resecuritisation for the emergence of a self-reinforcing security dilemma in NATO-Russia relations are also considered.
A Pediatric Approach to Ventilator-Associated Events Surveillance
Authors: Cocoros Noelle M. , Priebe Gregory P. , Logan Latania K. , Coffin Susan , Larsen Gitte , Toltzis Philip , Sandora Thomas J. , Harper Marvin , Sammons Julia S. , Gray James E. , Goldmann Donald , Horan Kelly , Burton Michael , Checchia Paul A. , Lakoma Matthew , Sims Shannon , Klompas Michael , Lee Grace M. 
Published: December 2016

OBJECTIVEAdult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.DESIGNRetrospective cohortSETTINGPediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitalsPATIENTSPatients ≤18 years old ventilated for ≥1 dayMETHODSWe identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.RESULTSIn total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.CONCLUSIONSWe propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.Infect Control Hosp Epidemiol 2017;38:327–333
Quantifying Antimicrobial Exposure: Hazards in Populations With End-Stage Renal Disease
Authors: Snyder Graham M. , McCoy Christopher , D’Agata Erika M. C. 
Published: December 2016

Using a rigorously collected data set of antimicrobial use among patients receiving chronic hemodialysis, antimicrobial use was calculated using 3 different methodologies: daily defined dose, days of therapy, and start–stop days. Estimates of antimicrobial use varied by as much as 10-fold, depending on the type of antimicrobial.Infect Control Hosp Epidemiol 2017;38:360–363