bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracic stomach syndrome after whole-stomach esophagectomy for esophageal cancer mimicking tension pneumothorax: a case report
Authors: Hasegawa Daisuke , Komura Hidefumi , Katsuta Ken , Kawaji Takahiro , Nishida Osamu
Published: November 2019

Background

Sudden onset of respiratory failure is one of the most fearful manifestations in intensive care units. Among the differential diagnoses of respiratory failure, tension pneumothorax is a life-threatening disease that requires immediate invasive intervention to drain the air from the thoracic cavity. However, other etiologies with manifestations similar to those of tension pneumothorax should also be considered after whole-stomach esophagectomy for esophageal cancer. We report a rare case of a patient with thoracic stomach syndrome mimicking tension pneumothorax after esophagectomy with whole-stomach reconstruction.

Case presentation

A 49-year-old Asian woman was admitted to our intensive care unit after esophagectomy for esophageal cancer with whole-stomach reconstruction while under sedation and intubated. Despite initial stable vital signs, the patient rapidly developed tachypnea, low blood pressure, and low oxygen saturation. Chest radiography revealed a mediastinal shift and led to a presumptive diagnosis of tension pneumothorax. Hence, an aspiration catheter was inserted into the right pleural space. However, her clinical symptoms did not improve. Chest computed tomography was performed, which revealed a significantly distended reconstructed stomach that was compressing the nearby lung parenchyma. Her respiration improved immediately after nasogastric tube placement. After the procedure, we successfully extubated the patient.

Conclusions

Similar to tension pneumothorax, thoracic stomach syndrome requires immediate drainage of air from the thoracic cavity. However, unlike tension pneumothorax, this condition requires nasogastric tube insertion, which is the only way to safely remove the accumulated air and avoid possible complications that could occur due to percutaneous drainage. For patient safety, it might be clinically important to place nasogastric tubes after esophagectomy with whole-stomach reconstruction, even if radiographic guidance is required. In addition, clinicians should consider thoracic stomach syndrome as one of the differential diagnoses of respiratory failure after whole-stomach esophagectomy.
Review of Tibetan Pastoralists and Development: Negotiating the Future of Grassland Livelihoods edited by Andreas Gruschke and Ingo Breuer
Authors: Nyima Yonten
Published: November 2019

Book details

Gruschke A and Breuer I (eds.)

Tibetan Pastoralists and Development: Negotiating the Future of Grassland Livelihoods

Wiesbaden, Germany

Reichert Verlag, 2017

240 pages, ISBN: 9783954902422
Factors that affect Israeli paramedics’ decision to quit the profession: a mixed methods study
Authors: Dopelt Keren , Wacht Oren , Strugo Refael , Miller Rami , Kushnir Talma
Published: November 2019

Background

The rate of Israeli paramedics leaving the profession has been increasing in recent years: 50% leave the profession in three years, for the most part before retirement. While approximately 2500 paramedics have been trained, only about a third of them are still active.

The number of paramedics per 100,000 in Israel is only 8, compared to around 66 in the US, and in light of the shortage of paramedics it is important to enhance retention rates. The purpose of the study was to examine the factors related to paramedics leaving the profession in Israel.

Methods

1. An online survey was sent to 1000 paramedics via Email. 533 were recruited of whom 200 have left the profession. Questions included demographics, job satisfaction, and reasons for leaving or remaining in the profession.

2. In-depth interviews with 15 paramedics who left the profession.

Results

Out of 1000 emails sent, 533 Paramedics responded, of which 200 paramedics who left the profession responded (73% left five years after completing training and 93% after 10 years). Among these former paramedics, choosing the paramedic profession was based mainly on an idealistic sense of mission and eagerness to help others, yet leaving the paramedic profession was related to extrinsic factors: lack of career options, extensive and strenuous physical demands accompanied by unrewarding salaries, unusually long work hours, and shift work that negatively affected family and personal life.

Conclusions

It seems that work conditions, including the lack of opportunities for promotion, lack of professional prospects, and inappropriate compensation for hard work are crucial factors in the decision to leave.

Recommendations

A joint committee of the Ministries of Health, Justice, and Finance and MDA (Magen David Adom, the national EMS in Israel) should be established for the purpose of improving the conditions and modalities of employment of paramedics and providing appropriate emotional support for paramedics who are exposed daily to work under extreme conditions of stress and human suffering. A joint effort could greatly reduce rates of leaving, training costs, and costs incidental to turnover, as well as increase job satisfaction. Moreover, regulating the profession and expanding the scope of practice to new fields like community paramedicine as part of the EMS service and expanding the scope of physician assistants as an academic profession can create opportunities for advancement and diversity at work that will help retain paramedics in the profession.
Research on the micromotion characteristics of a chaff cloud
Authors: Li Ran , Hao Xinhong , Li Ping
Published: November 2019

This paper reports the investigation on the micromotion characteristics of chaff dipoles and a chaff cloud. Micromotion models of chaff dipoles and steady-state chaff clouds are discussed. Fourier transform method and time-frequency method are used to study the micromotion features of chaff dipoles, in the energy domain and time-frequency domain, respectively. Based on the characteristic parameters in these two domains, the simulation results show that there are micro-Doppler frequency components in the echo signals from chaff dipoles, and these frequency components vary periodically. Then, the micro-Doppler frequencies of chaff cloud are obtained based on the method of multipoint synthesis. Finally, the experimental results of chaff dipoles dispersion verify the micromotion characteristics of chaff dipoles and chaff cloud obtained by using the empirical mode decomposition method and the short-time Fourier transform method.
How to overcome political and legal barriers to the implementation of a drug consumption room: an application of the policy agenda framework to the Belgian situation
Authors: Smith Pierre , Favril Louis , Delhauteur Dominique , Vander Laenen Freya , Nicaise Pablo
Published: November 2019

Background

For more than 30 years, drug consumption rooms (DCRs) have been implemented in Western countries. DCRs are supported by a large body of evidence about public safety and public health effectiveness. However, a political consensus has never been achieved in Belgium on amending the existing law that explicitly penalises the supply of a room for facilitating drug use. Despite this adverse legal and policy framework, a DCR opened in the city of Liège in 2018. In this case report, we applied the theoretical framework proposed by Shiffman and Smith for policy agenda setting, in order to describe and assess how political and legal barriers were overcome in the process of opening the DCR.

Case presentation

For some years, fieldworkers and some city policymakers argued for DCR implementation in Belgium, but without gaining the support of the national authorities, mainly for ideological reasons. In order to address this debate, a feasibility study of DCR implementation in Belgian cities was commissioned. At the national level, an institutional debate took place about the political responsibility for DCRs as a public health intervention, as health care is mainly a matter of regional policy. The lack of consensus led to a situation of political deadlock. Meanwhile, the publication of the study report and the context of local elections offered an opportunity for Liège authorities to reignite the local debate on DCRs. At the local level, law enforcement, care professionals, residents, users, and the press were all involved in the implementation process. Therefore, a local consensus was formed and despite the absence of any national legal change, the DCR opened 1 month before the local elections. It has been working without major medical or legal incident since then. Incidentally, the mayor of Liège was re-elected.

Conclusions

Although the lack of a legal framework may engender instability and affect longer-term effectiveness, the DCR implementation in Liège was successful and was based on a local consensus and effective communication rather than on an appropriate legal framework. The experience provides lessons for other cities that are considering opening a DCR despite an adverse legal and political context.
Magnitude and causes of first-line antiretroviral therapy regimen changes among HIV patients in Ethiopia: a systematic review and meta-analysis
Authors: Ataro Zerihun , Motbaynor Birhanu , Weldegebreal Fitsum , Sisay Mekonnen , Tesfa Tewodros , Mitiku Habtamu , Marami Dadi , Teklemariam Zelalem , Shewamene Zewdneh
Published: November 2019

Background

Antiretroviral therapy (ART) has markedly decreased the morbidity and mortality due to HIV/AIDS. ART regimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. This is found to be a major concern among HIV/AIDS patients in a resource-limited setting, where treatment options are limited.

Objectives

The aim of this review is to generate the best available evidence regarding the magnitude of first-line antiretroviral therapy regimen change and the causes for regimen change among HIV patients on ART in Ethiopia.

Methods

The reviewed studies were accessed through electronic web-based search strategy from PubMed Medline, EMBASE, Hinari, Springer link and Google Scholar. Data were extracted using Microsoft Excel and exported to Stata software version 13 for analyses. The overall pooled estimation of outcomes was calculated using a random-effect model of DerSimonian–Laird method at 95% confidence level. Heterogeneity of studies was determined using I2statistics. For the magnitude of regimen change, the presence of publication bias was evaluated using the Begg’s and Egger’s tests. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42018099742. The published methodology is available from:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=99742.

Results

A total of 22 studies published between the years 2012 and 2018 were included. Out of 22 articles, 14 articles reported the magnitude of regimen change and consisted of 13,668 HIV patients. The estimated national pooled magnitude of regimen change was 37% (95% CI: 34, 44%; Range: 15.1–63.8%) with degree of heterogeneity (I2), 98.7%;p-value < 0.001. Seventeen articles were used to identify the causes for first-line antiretroviral therapy regimen change. The major causes identified were toxicity, 58% (95% CI: 46, 69%; Range: 14.4–88.5%); TB co-morbidity, 12% (95% CI: 8, 16%; Range: 0.8–31.7%); treatment failure, 7% (95% CI: 5, 9%; Range: 0.4–24.4%); and pregnancy, 5% (95% CI: 4, 7%; Range: 0.6–11.9%).

Conclusions

The original first-line regimen was changed in one-third of HIV patients on ART in Ethiopia. Toxicity of the drugs, TB co-morbidity, treatment failure, and pregnancy were the main causes for the change of the first-line regimen among HIV patients on antiretroviral therapy.
Sympatric Atlantic puffins and razorbills show contrasting responses to adverse marine conditions during winter foraging within the North Sea
Authors: St. John Glew Katie , Wanless Sarah , Harris Michael P. , Daunt Francis , Erikstad Kjell Einar , Strøm Hallvard , Speakman John R. , Kürten Benjamin , Trueman Clive N.
Published: November 2019

Background

Natural environments are dynamic systems with conditions varying across years. Higher trophic level consumers may respond to changes in the distribution and quality of available prey by moving to locate new resources or by switching diets. In order to persist, sympatric species with similar ecological niches may show contrasting foraging responses to changes in environmental conditions. However, in marine environments this assertion remains largely untested for highly mobile predators outside the breeding season because of the challenges of quantifying foraging location and trophic position under contrasting conditions.

Method

Differences in overwinter survival rates of two populations of North Sea seabirds (Atlantic puffins (Fratercula arctica) and razorbills (Alca torda)) indicated that environmental conditions differed between 2007/08 (low survival and thus poor conditions) and 2014/15 (higher survival, favourable conditions). We used a combination of bird-borne data loggers and stable isotope analyses to test 1) whether these sympatric species showed consistent responses with respect to foraging location and trophic position to these contrasting winter conditions during periods when body and cheek feathers were being grown (moult) and 2) whether any observed changes in moult locations and diet could be related to the abundance and distribution of potential prey species of differing energetic quality.

Results

Puffins and razorbills showed divergent foraging responses to contrasting winter conditions. Puffins foraging in the North Sea used broadly similar foraging locations during moult in both winters. However, puffin diet significantly differed, with a lower average trophic position in the winter characterised by lower survival rates. By contrast, razorbills’ trophic position increased in the poor survival winter and the population foraged in more distant southerly waters of the North Sea.

Conclusions

Populations of North Sea puffins and razorbills showed contrasting foraging responses when environmental conditions, as indicated by overwinter survival differed. Conservation of mobile predators, many of which are in sharp decline, may benefit from dynamic spatial based management approaches focusing on behavioural changes in response to changing environmental conditions, particularly during life history stages associated with increased mortality.
Looking beyond appearances: a multi-analytical approach on the prehistoric clay weights
Authors: Manea Bogdan , Lechintan Mircea , Popescu Gabriel , Ignat Theodor , Opriş Vasile , Constantin Florin , Dimache Mădălina , Parnic Valentin , Bugoi Roxana , Lazăr Cătălin
Published: November 2019

In this paper we analyzed a batch of 64 clay weights from three archaeological sites located in Romania (Gumelniţa, Măgura-Jilava, and Sultana) that belong to Kodjadermen-Gumelniţa-Karanovo VI cultural complex (4600–3900 cal. BC). Our approach includes an interdisciplinary investigation based on technological analysis, experimental archaeology, and X-ray CT scans coupled with statistical analysis. This investigation has a high potential to reveal relevant information regarding the technological background (e.g., inclusion, voids, temper, etc.), manufacturing stages (e.g., modeling, shaping, kneading, etc.), or transformation processes (e.g., drying and firing vs. weight and size modification) in order to identify, explain and understand the chaîne operatoire for this type of artefacts. Moreover, correlation of the results with the experimental archaeology could offer an integrative interpretation about the material culture of past humans and its multiple meanings, but also critical information about the multiple dimensions of manufacture for these objects (e.g., time, effort, physical–chemical processes, etc.). The multi-analytical approach proposed here also includes a comparative study of technological aspects of these clay weights across the three archaeological sites investigated, as well as the experimental replicas.
Fluorescent fullerene nanoparticle-based lateral flow immunochromatographic assay for rapid quantitative detection of C-reactive protein
Authors: Park Kyung Mi , Chung Da Jung , Choi Mijin , Kang Taejoon , Jeong Jinyoung
Published: November 2019

A fluorescent fullerene nanoparticle (NP)-based lateral flow immunochromatographic assay (LFIA) was developed for the rapid and quantitative detection of C-reactive protein (CRP) in serum. The polyclonal CRP-antibody-conjugated fullerene NPs were simply prepared by 1-ethyl-3-(3-dimethyllaminopropyl)-carbodiimide hydrochloride coupling after carboxylation of fluorescent fullerene NPs. By applying the CRP-antibody-conjugated fullerene NPs to a lateral flow test strip, quantitative analysis of CRP in serum was possible at a concentration range of 0.1–10 ng/ml within 15 min. We anticipate that this novel fluorescent fullerene NP-based LFIA can be useful for the rapid and accurate sensing of biological and chemical species, contributing to the disease diagnosis and prognosis, environmental monitoring, and food safety.
Use of Agaricus bisporus mushroom in beef burgers: antioxidant, flavor enhancer and fat replacing potential
Authors: Patinho Iliani , Saldaña Erick , Selani Miriam Mabel , de Camargo Adriano Costa , Merlo Thais Cardoso , Menegali Beatriz Schmidt , de Souza Silva Anna Paula , Contreras-Castillo Carmen J.
Published: November 2019

This study aimed to evaluate the potential use of Agaricus bisporus mushroom as a natural antioxidant, fat/salt substitute and flavor enhancer in beef burger. Ten treatments were considered using a fractional factorial design (salt [0.5, 1.25 and 2.0%], fat [10, 15 and 20%] and mushroom content [0, 15 and 30%]). Treatments were characterized by instrumental and sensory measurements. The statistical design indicated that fat content had little influence on the results. The principal component analysis showed that the incorporation of mushrooms and salt modified the texture, moisture and water activity. Oxidative stability decreased as the salt content increased, at a low-fat content. Finally, the sensory profile was affected by the mushroom and salt contents, with the fat content exerting the least influence. Therefore, mushroom incorporation in beef burger may be a feasible strategy to reduce the fat content of beef burgers.

Graphical abstract
High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study
Authors: Kim Sang-Gyun , Kim Soo-Hyun , Baek Jung-Heum , Kim Jae-Gyoon , Jang Ki-Mo , Lim Hong-Chul , Bae Ji-Hoon
Published: November 2019

Background

The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries.

Methods

We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus.

Results

There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025).

Conclusions

There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears.

Level of study

Level IV, retrospective case series.
Oct4 expression in gastric carcinoma: association with tumor proliferation, angiogenesis and survival
Authors: El-Guindy Dina M. , Wasfy Rania E. , Abdel Ghafar Muhammad T. , Ali Dina A. , Elkady Asmaa M.
Published: November 2019

Background

Octamer-binding transcription factor 4 (Oct4) is a transcription factor that has an important role in stem cell differentiation and self-renewal. Oct4 has also been implicated in tumorigenicity of different cancers. This study aimed to analyze Oct4 expression in gastric carcinoma (GC) and to evaluate the relation between Oct4 expression and clinicopathologic parameters, tumor proliferation, and angiogenesis in addition to patient survival.

Results

Oct4 mRNA was detected by quantitative reverse transcription PCR (qRT-PCR) in 45 GC specimens and adjacent non-cancerous tissues. We found a significant difference in Oct4 mRNA relative expression levels in GC tissue compared with adjacent non-cancerous tissues (p < 0.001). Furthermore, immunohistochemistry (IHC) was performed to study the Oct4 expression in GC cases. High Oct4 immunostaining was detected in 62.2% of GC specimens. High Oct4 expression both by mRNA relative quantitation and IHC were significantly related to poorly differentiated tumors, nodal metastasis, and stage III tumors. Moreover, high Oct4 IHC expression was also associated with cases positive for Ki-67 and VEGF expressions (p < 0.001 and 0.021, respectively). Oct4 expression identified by both mRNA relative quantitation and IHC was significantly related (p < 0.001). As regards patient survival, high Oct4 expression was significantly related to poor overall survival (OS) and disease-free survival (DFS) (p = 0.029 and 0.031, respectively).

Conclusion

Oct4 plays a valuable role in the progression and prognosis of GC. High Oct4 expression is associated with high tumor grade, nodal metastasis, stage III tumors, and poor OS and DFS. High Oct4 is also significantly associated with Ki-67 and VGEF expression, thus enhancing tumor proliferation and angiogenesis.
Student Satisfaction and Learning Outcomes in Asynchronous Online Lecture Videos
Authors: Choe Ronny C. , Scuric Zorica , Eshkol Ethan , Cruser Sean , Arndt Ava , Cox Robert , Toma Shannon P. , Shapiro Casey , Levis-Fitzgerald Marc , Barnes Greg , Crosbie Rachelle H.
Published: November 2019

Our study identified online lecture video styles that improved student engagement and satisfaction, while maintaining high learning outcomes in online education. We presented different lecture video styles with standardized material to students and then measured learning outcomes and satisfaction with a survey and summative assessment. We created an iterative qualitative coding scheme, “coding online asynchronous lectures” (COAL), to analyze open-ended student survey responses. Our results reveal that multimedia learning can be satisfying and effective. Students have strong preferences for certain video styles despite their equal learning outcomes, with the Learning Glass style receiving the highest satisfaction ratings. Video styles that were described as impersonal and unfamiliar were rated poorly, while those that were described as personal and engaging and evoked positive affective responses were rated highly. The students in our study rated lecture video styles that aligned with Mayer’s multimedia learning principles as highly satisfying, indicating that student feedback can be a valuable resource for course designers to consider as they design their own online courses. Finally, we provide guidelines for creating engaging, effective, and satisfying asynchronous lecture videos to support establishment of best practices in online instruction.
Azimuthal anisotropy analysis of wide-azimuth P-wave seismic data for fracture orientation and density characterization in a tight gas reservoir
Authors: Xie Wanxue , He Guangming , Li Le , Jin Degang , Chen Dan , Zhang Hua , Zhao Yao
Published: November 2019

The role of anisotropy in fracture detection has dramatically increased with the advent of wide-azimuth (WAZ) and high-density seismic acquisition. Fracture prediction using horizontal transverse isotropy (HTI) anisotropic theory is a useful tool for identifying reservoir characteristics. We have developed an approach for fracture density and orientation estimation based on the combination of a velocity variation with azimuth (VVAZ) and an amplitude variation with azimuth (AVAZ) analysis workflow. First, we sort the prestack WAZ data into offset vector tile (OVT) sectors and perform VVAZ inversion by elliptical velocity fitting of measured azimuth-differential traveltimes. In this step, we can predict the fast P-wave velocity, slow P-wave velocity, and fracture orientation. Second, we apply AVAZ inversion to extract more accurate predictions of the anisotropic gradient and fracture orientation. We implement the method with 3D prestack WAZ seismic data acquired in the Sichuan Basin, from the southwest part of China. The field data example indicates that the inversion results agree with geologic information and well-log imaging data, which confirm the effectiveness of this technology.
Advances in active acoustic ranging
Authors: Johansen Asbj⊘rn L. , Allen William T. , Goobie Roger , Bennett Nicholas , Poedjono Benny , Calvez Joël Le
Published: November 2019

Recent advances in the processing and interpretation of sonic imaging surveys warrant a fresh look at the performance of active acoustic ranging for locating wellbores. The interpretation of results from sonic imaging surveys typically has been done in workflows similar to classic seismic interpretation, where the data are projected into a 2D plane and reflective features are picked. These sonic imaging workflows require significant time and expertise to execute. The reflected arrival events typically are obscured by higher amplitude borehole modes, and the migration workflow needs numerous critical parameter choices that require interpreting the raypath type and azimuth of the reflected arrivals. When used for acoustic ranging, additional challenges are present, particularly in situations where the logging tool rotates and the relative position of the target well changes with depth. This may occur when the logging or target well trajectories have a curved shape, since determining the direction and distance to the target well then requires careful interpretation of migration image amplitudes. We demonstrate how a newly developed automated approach to the interpretation of sonic imaging data helps improve accuracy and removes interpreter bias while simplifying the processing chain and reducing turnaround time. We compare our results to what has been obtained previously by using the same data set. We achieve a marked improvement in accuracy and consistency using this new technique.
Deep learning-driven velocity model building workflow
Authors: Araya-Polo Mauricio , Farris Stuart , Florez Manuel
Published: November 2019

Exploration seismic data are heavily manipulated before human interpreters are able to extract meaningful information regarding subsurface structures. This manipulation adds modeling and human biases and is limited by methodological shortcomings. Alternatively, using seismic data directly is becoming possible thanks to deep learning (DL) techniques. A DL-based workflow is introduced that uses analog velocity models and realistic raw seismic waveforms as input and produces subsurface velocity models as output. When insufficient data are used for training, DL algorithms tend to overfit or fail. Gathering large amounts of labeled and standardized seismic data sets is not straightforward. This shortage of quality data is addressed by building a generative adversarial network (GAN) to augment the original training data set, which is then used by DL-driven seismic tomography as input. The DL tomographic operator predicts velocity models with high statistical and structural accuracy after being trained with GAN-generated velocity models. Beyond the field of exploration geophysics, the use of machine learning in earth science is challenged by the lack of labeled data or properly interpreted ground truth, since we seldom know what truly exists beneath the earth's surface. The unsupervised approach (using GANs to generate labeled data)illustrates a way to mitigate this problem and opens geology, geophysics, and planetary sciences to more DL applications.
Amino Acid Polymorphisms in Hla Class II Differentiate Between Thyroid and Polyglandular Autoimmunity
Authors: Frommer Lara , Flesch Brigitte K , König Jochem , Kahaly George J
Published: November 2019

Context

The structure of the human leucocyte antigen (HLA) peptide-binding clefts strongly contributes to monoglandular and polyglandular autoimmunity (AP).

Objective

To investigate the impact of amino acid polymorphisms on the peptide-binding interactions within HLA class II and its association with AP.

Design

Immunogenetic study.

Setting

Tertiary referral center for autoimmune endocrine diseases.

Subjects

587 subjects with AP, autoimmune thyroid disease (AITD), type 1 diabetes (T1D), and healthy unrelated controls were typed for HLA class II.

Methods

Amino acids within the peptide binding cleft that are encoded by HLA class II exon 2 were listed for all codon positions in all subjects. Overall comparisons between disease and control groups with respect to allele distribution at a given locus were performed by assembling rare alleles applying an exact Freeman Halton contingency table test with Monte-Carlo P values based on 150 000 samples.

Results

The Monte Carlo exact Fisher test demonstrated marked differences in all 3 loci, DQA1, DQB1, and DRB1 (P < .0001) between AP and both AITD and controls, as well as between AP type II (Addison’s disease as a major endocrine component) and AP type III (T1D + AITD). Differences were also noted between AP and T1D pertaining to the DRB1 allele (P < .041). Seven amino acid positions, DRB1-13, DRB1-26, DRB1-71, DRB1-74, DQA1-47, DQA1-56, and DQB1-57, significantly contributed to AP. Five positions in DQA1 (11, 47, 50, 56, and 69) completely correlated (P < .0001).

Conclusion

Amino acid polymorphisms within HLA class II exon 2 mediate the AP risk and differentiate between thyroid and polyglandular autoimmunity.
Fibrous Dysplasia/McCune-Albright Syndrome: A Rare, Mosaic Disease of Gα s Activation
Authors: Boyce Alison M , Collins Michael T
Published: November 2019

Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a rare disorder of striking complexity. It arises from somatic, gain-of-function mutations in GNAS, leading to mosaic Gα s activation and inappropriate production of intracellular cyclic adenosine monophosphate (cAMP). The clinical phenotype is largely determined by the location and extent of affected tissues, and the pathophysiological effects of Gα s activation within these tissues. In bone, Gα s activation results in impaired differentiation of skeletal stem cells, leading to discrete skeletal lesions prone to fracture, deformity, and pain. Extraskeletal manifestations include a variable combination of hyperpigmented macules and hyperfunctioning endocrinopathies. Distinctive age-related changes in disease development has key effects on histologic, radiographic, and clinical features. FD/MAS thus presents along a uniquely broad clinical spectrum, and the resulting challenges in diagnosis and management can be difficult for clinicians. This review presents FD/MAS in the context of a mosaic disorder of Gα s activation, providing an intellectual framework within which to understand, evaluate, and treat this interesting disease. It includes a comprehensive summary of current understanding of FD/MAS pathogenesis, and a detailed discussion of clinical presentation and management. Critical areas of unmet need are highlighted, including discussion of key challenges and potential solutions to advance research and clinical care in FD/MAS.
Alternatives to Periodization: Literary History, Modernism, and the “New” Temporalities
Authors: Friedman Susan Stanford
Published: November 2019

Can literary history be done without the conventional reliance on linear periodization? What might a literary history of modernism look like without the usual periodization of roughly 1890–1940? This essay reviews the arguments for and against periodization and then argues that the new time studies—based in nonlinear concepts of time for the study of the contemporary—offers alternatives to the Eurocentric periodization of modernism. These new temporalities were anticipated by early twentieth-century Euro-American modernism, presented in the essay with an account of the dramatic debate between Albert Einstein and Henri Bergson in 1922 and a discussion of Virginia Woolf’s experiments with the relationality of space and time in her fiction. Multidimensional, layered, and disjunctive concepts of time are better suited for the study of planetary modernisms that incorporate the colonial and postcolonial modernities. Kabe Wilson’s multimedia installation based on a remix of A Room of One’s Own and selected criticism on modernism are used to illustrate alternatives to linear periodization.
World Poetry: Commonplaces of an Idea
Authors: Feinsod Harris
Published: November 2019

This essay offers a philological career of the term world poetry as poets and scholars employed it and close cognates across the twentieth century (the century in which it first appeared). This career emphasizes trajectories in three of the West’s imperial language formations—poésie mondiale in French, poesía mundial in Spanish, and world poetry in English—but also highlights kindred trajectories in non-Western languages, such as sheʿr-e jahān in Persian and shiʿr fi al-ʿalam in Arabic. Corroborating Édouard Glissant’s claim that “the amassing of commonplaces is, perhaps, the right approach to my real subject—the entanglements of worldwide relation,” the essay argues for an understanding of world poetry as the accumulated philological history of poetic folkways, habits of use, sociological institutions, formations, and conjunctures that group around the term itself.
Macroeconomic Feedback Effects of Medicaid Expansion: Evidence from Michigan
Authors: Levy Helen , Ayanian John Z. , Buchmueller Thomas C. , Grimes Donald R. , Ehrlich Gabriel
Published: November 2019

Context: Medicaid expansion has costs and benefits for states. The net impact on a state's budget is a central concern for policy makers debating implementing this provision of the Affordable Care Act. How large is the state-level fiscal impact of expanding Medicaid, and how should it be estimated?

Methods: We use Michigan as a case study for evaluating the state-level fiscal impact of Medicaid expansion, with particular attention to the importance of macroeconomic feedback effects relative to the more straightforward fiscal effects typically estimated by state budget agencies. We combine projections from the state of Michigan's House Fiscal Agency with estimates from a proprietary macroeconomic model to project the state fiscal impact of Michigan's Medicaid expansion through 2021.

Findings: We find that Medicaid expansion in Michigan yields clear fiscal benefits for the state, in the form of savings on other non-Medicaid health programs and increases in revenue from provider taxes and broad-based sales and income taxes through at least 2021. These benefits exceed the state's costs in every year.

Conclusions: While these results are specific to Michigan's budget and economy, our methods could in principle be applied in any state where policy makers seek rigorous evidence on the fiscal impact of Medicaid expansion.
The Grassroots of Grass: Cannabis Legalization Ballot Initiative Campaign Contributions and Outcomes, 2004–2016
Authors: Orenstein Daniel G. , Glantz Stanton A.
Published: November 2019

Context: As of November 2018, medical cannabis was legal in 33 US states and recreational cannabis in 10, mostly enacted via ballot initiative.

Methods: We identified 32 cannabis legalization initiatives from 2004 to 2016 and obtained campaign contribution and state political and demographic data. After exploratory analyses of 15 potential independent variables, we quantified effects of 4 factors (initiative year, voter turnout, population born before 1946, advocate funding advantage) on voter support and likelihood of passage.

Findings: A small number of campaign contributors dominated both sides of the issue, with little involvement by health advocates. Time and turnout, not money, were the factors most associated with electoral outcomes, consistent with increases in public opinion favoring cannabis legalization over time. Year, turnout, and population age were associated with voter support, while year, turnout, and advocate funding advantage were associated with likelihood of passage. When adjusting for an anomalous result, initiative year was the only variable that remained significantly associated with odds of passage, with a 1-year increase in initiative date associated with 2.02 times higher odds of passage (p < .01).

Conclusion: These results underscore the importance of health advocate participation in developing cannabis legalization frameworks.
Three-dimensional live imaging of Atoh1 reveals the dynamics of hair cell induction and organization in the developing cochlea
Authors: Tateya Tomoko , Sakamoto Susumu , Ishidate Fumiyoshi , Hirashima Tsuyoshi , Imayoshi Itaru , Kageyama Ryoichiro
Published: November 2019

During cochlear development, hair cells (HCs) and supporting cells differentiate in the prosensory domain to form the organ of Corti, but how one row of inner HCs (IHCs) and three rows of outer HCs (OHCs) are organized is not well understood. Here, we investigated the process of HC induction by monitoring Atoh1 expression in cochlear explants of Atoh1-EGFP knock-in mouse embryos and showed that only the cells that express Atoh1 over a certain threshold are selected for HC fate determination. HC induction initially occurs at the medial edge of the prosensory domain to form IHCs and subsequently at the lateral edge to form OHCs, while Hedgehog signaling maintains a space between IHCs and OHCs, leading to formation of the tunnel of Corti. These results reveal dynamic Atoh1 expression in HC fate control and suggest that multi-directional signals regulate OHC induction, thereby organizing the prototype of the organ of Corti.
Who Is Screened Out? Application Costs and the Targeting of Disability Programs
Authors: Deshpande Manasi , Li Yue
Published: November 2019

We study the effect of application costs on the targeting of disability programs. We identify these effects using the closings of Social Security Administration field offices, which provide assistance with filing disability applications. Closings lead to a persistent 16 percent decline in the number of disability recipients in surrounding areas, with the largest effects for applicants with moderately severe conditions and low education levels. Disability applications fall by only 10 percent, implying that the closings reduce targeting efficiency based on current eligibility standards. Increased congestion at neighboring offices appears more important as a channel than higher travel or information costs. (JEL H55, I13, I18, J14)
Long-Term Orientation and Educational Performance
Authors: Figlio David , Giuliano Paola , Özek Umut , Sapienza Paola
Published: November 2019

We study the role of Long-Term Orientation on the educational attainment of immigrant students. Controlling for the quality of schools and socioeconomic characteristics, students from long-term oriented cultures perform better in third grade reading and math, have larger test score gains over time, fewer absences and disciplinary incidents, are less likely to repeat grades, more likely to enroll in advanced high school courses, and are more likely to graduate from high school in four years. Evidence on mechanisms suggests that both parents’ educational choices for their children and social learning from peers are important mechanisms. (JEL H75, I21, I26, J15, Z13)
A case series analysing patients with dental anxiety: a patient-centred model based on psychological profiling
Authors: Tizzoni Riccardo , Veneroni Laura , D'Aloia Alfonso , Tizzoni Marta , Clerici Carlo Alfredo
Published: November 2019

Anxiety and distress can jeopardize dental care experience of patients and may affect the clinical result. Although a wide range of sedation and analgesia techniques are currently available to relieve distress and pain during dental procedures, operative models to choose the most effective sedation-analgesic strategies are lacking.

This case series proposes a patient-centred model to optimize patients’ cooperation during dental care delivery. We describe how to achieve correct anaesthesia by using the least sedative procedure, accounting for the dental procedure needed and patient’s psychological profile.

Five patients were considered as paradigmatic to show the balance between patients’ subjective experiences and the clinical procedures: a patient with low stress, good compliance (case 1); moderate stress and reduction in compliance (case 2); anxious patient (case 3); patient with acute anxiety and emotional distress (case 4); anguished patient (case 5).

A multimodal treatment of emotional and behavioural condition and a patient-centred model approach contributed to achieve the best patient satisfaction in the five cases detailed here.
The effectiveness of online parenting programmes in promoting parents’ and adolescents’ mental wellbeing: a systematic review protocol
Authors: Al Falahi Amna , Glazebrook Cris , Shokraneh Farhad
Published: November 2019

Introduction: Emotional difficulties among young people are debilitating and increasing in prevalence. Parent focused interventions delivered online offer a convenient and potentially effective way to increase young people’s access to support. A systematic review offers the opportunity to assess their effectiveness and to identify characteristic of interventions which are particularly effective.

Objective: To assess the existing online interventions for parents of young people that are designed to improve young people’s mental health and wellbeing.

Methods: We will conduct a systematic review of randomised controlled trials identified through searching CENTRAL, Embase, MEDLINE, PsycINFO, and PubMed. We will follow Cochrane Handbook and involve at least two people in screening and data extraction. Risk of bias will be assessed using Cochrane risk of bias tool. We will use EndNote, Excel, and Review Manager for managing the studies and data. We will also apply TIDieR checklist to extract and summarise the specific characteristics of interventions.

Protocol registration: PROSPERO CRD42018114921; registered on 31 October 2018.
Truthful Mechanisms for Medical Surplus Product Allocation
Authors: Zhang Can , Atasu Atalay , Ayer Turgay , Toktay L. Beril
Published: November 2019

Problem definition: We analyze a resource allocation problem faced by medical surplus recovery organizations (MSROs) that recover medical surplus products to fulfill the needs of underserved healthcare facilities in developing countries. The objective of this study is to identify implementable strategies to support recipient selection decisions to improve MSROs’ value provision capability. Academic/practical relevance: MSRO supply chains face several challenges that differ from those in traditional for-profit settings, and there is a lack of both academic and practical understanding of how to better match supply with demand in this setting where recipient needs are typically private information. Methodology: We propose a mechanism design approach to determine which recipient to serve at each shipping opportunity based on recipients’ reported preference rankings of different products. Results: We find that when MSRO inventory information is shared with recipients, the only truthful mechanism is random selection among recipients, which defeats the purpose of eliciting information. Subsequently, we show that (1) eliminating inventory information provision enlarges the set of truthful mechanisms, thereby increasing the total value provision; and (2) further withholding information regarding other recipients leads to an additional increase in total value provision. Finally, we show that under a class of implementable mechanisms, eliciting recipient valuations has no value added beyond eliciting preference rankings. Managerial implications: (1) MSROs with large recipient bases and low inventory levels can significantly improve their value provision by appropriately determining the recipients to serve through a simple scoring mechanism; (2) to truthfully elicit recipient needs information to support the recipient selection decisions, MSROs should withhold inventory and recipient-base information; and (3) under a set of easy-to-implement scoring mechanisms, it is sufficient for MSROs to elicit recipients’ preference ranking information. Our findings have already led to a change in the practice of an award-winning MSRO.
Clinical implications of self-neglect among patients in community settings
Authors: Noblett Karen
Published: November 2019

The consequences of self-neglect can be wide-reaching and devastating, not only for patients themselves but also for their wider community, including assisting health practitioners and social care staff. Supporting patients in the context of self-neglect requires extensive multi-agency collaboration in order to gain a full understanding and a workable management strategy for the individual. Because community nurses see patients in their own homes, they are well placed to identify and address self-neglect. This article explores the definition, signs and causes of self-neglect, with issues of particular relevance for community nursing staff. The understanding and assessment of mental capacity, which is often complex and challenging, is also discussed, as well as the involvement of the safeguarding team where necessary.
Implementing an adapted Buurtzorg model in an inner city NHS trust
Authors: Hamm Cepta , Glyn-Jones Julie
Published: November 2019

District nursing in inner city areas faces many challenges, particularly with regard to sustaining the nursing workforce, and ensuring nurses gain satisfaction and enjoyment from their work. The Dutch Buurtzorg model of self-managing teams offers a potential solution to address these problems. In this article, the authors, as nurse leaders, reflect on their experience of implementing a ‘test and learn’ pilot of such a model in the NHS in London, and then on a further scaling up of the model. This paper offers insights related to such issues as governance and assurance as well pragmatism in supporting a process of change. It is hoped that these reflections will guide other nurse leaders in setting up and sustaining this excellent model of team management and care.