bluuebunny/crossref_metadata_2025 huggingface dataset:
Lower extremity alignment due to patellofemoral syndrome and dynamic postural balance
Authors: Erdoganoglu Yildiz , Pepe Murad , Kaya Defne , Tagrikulu Bilgehan , Aksahin Ertugrul , Aktekin Cem Nuri
Published: February 2020

Study design:

This study is a prospective study.

Aim:

Lower extremity malalignment is an important etiologic factor in patellofemoral pain syndrome (PFPS). We hypothesized that lower limb malalignment may affect dynamic balance and physical function. This prospective study was conducted to investigate the relationship between the lower limb alignment and the dynamic balance and physical function in patients with PFPS.

Methods:

The study included 62 individuals with unilateral PFPS. Pain severity was assessed by the numerical pain scale and the pain duration was recorded. Lower extremity bone alignment was evaluated by the lateral distal femoral angle (LDFA) and the medial proximal tibia angle. Dynamic postural balance was assessed by the star excursion balance test. The functional status of the patients was evaluated by the 30-second chair stand test.

Results:

The mean duration of the pain was 24.2 ± 31.5 months and the mean pain severity was 8.1 ± 1.4. Although there was a significant difference found between the affected and unaffected LDFA values of lower extremities ( p < 0.05), there was no difference found with regard to the dynamic balance values of the lower extremities ( p > 0.05). However, significant changes of posterolateral balance were identified at a painful side without causing a postural dynamic imbalance ( p < 0.05).

Conclusion:

In our study, we found a valgus deformity as a deterioration in the lower limb alignment of patients with PFPS which may cause a deterioration of posterolateral balance only. However, no change in postural dynamic balance was observed in the comparison of affected side and unaffected side. Dynamic postural balance has been influenced by many kinematic changes related to lower extremities including pelvis, hip, and ankle. Thus, reciprocal mechanisms in the anatomical structures may compensate the postural balance dynamically.
Echocardiography in the Management of Cardiogenic Shock
Authors: Bansal Manish , Ranjan Shraddha
Published: February 2020

Cardiogenic shock is a highly common clinical entity and is characterized by high mortality. Its prompt recognition, identification of the underlying etiology, and assessment of the severity of hemodynamic dysfunction are crucial for accurate management of this condition. Echocardiography is the most useful diagnostic modality in this setting, due to its ability to provide comprehensive information about cardiac structure and function, promptly, safely, and at the patient’s bedside. This review discusses the role of echocardiography in the evaluation and management of cardiogenic shock.
May-Thurner Syndrome and Recurrent DVT: A Case Report
Authors: Tarannum Neha , K. H.V.V.S.S. Lakshman , Azam Mohammed Sadiq , Premchand Rajendra Kumar
Published: February 2020

May-Thurner syndrome/Cockets syndrome/ileocaval syndrome is a rarely diagnosed, anatomical and pathologically variable condition, causing venous flow obstruction in iliocaval territory. We report a case of 64 year old male patient who presented with unprovoked proximal deep venous thrombosis (DVT) of left lower limb. Evaluated for hypercoagulable state, which was negative, the patient underwent catheter guided thrombolysis and anticoagulation for 6 months. Two years later, he developed left lower limb swelling, and venous doppler revealed acute DVT; CT venogram was consistent with left common iliac vein compression by right common iliac artery suggestive of May-Thurner syndrome. Catheter-guided thrombolysis was done, and percutaneous transluminal peripheral angioplasty/stent was placed from inferior vena cava to left common iliac vein. This case highlights the importance of high index of suspicion in managing patients with DVT for possible ileocaval syndrome wherein anticoagulation alone is insufficient and needs more aggressive and definitive treatment to relieve the obstruction and to prevent recurrence.
Transcriptome profiles of Quercus rubra responding to increased O3 stress
Authors: Soltani Nourolah , Best Teo , Grace Dantria , Nelms Christen , Shumaker Ketia , Romero-Severson Jeanne , Moses Daniela , Schuster Stephan , Staton Margaret , Carlson John , Gwinn Kimberly
Published: February 2020

Background

Climate plays an essential role in forest health, and climate change may increase forest productivity losses due to abiotic and biotic stress. Increased temperature leads to the increased formation of ozone (O3). Ozone is formed by the interaction of sunlight, molecular oxygen and by the reactions of chemicals commonly found in industrial and automobile emissions such as nitrogen oxides and volatile organic compounds.

Although it is well known that productivity of Northern red oak (Quercus rubra) (NRO), an ecologically and economically important species in the forests of eastern North America, is reduced by exposure to O3, limited information is available on its responses to exogenous stimuli at the level of gene expression.

Results

RNA sequencing yielded more than 323 million high-quality raw sequence reads. De novo assembly generated 52,662 unigenes, of which more than 42,000 sequences could be annotated through homology-based searches. A total of 4140 differential expressed genes (DEGs) were detected in response to O3stress, as compared to their respective controls. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of the O3-response DEGs revealed perturbation of several biological pathways including energy, lipid, amino acid, carbohydrate and terpenoid metabolism as well as plant-pathogen interaction.

Conclusion

This study provides the first reference transcriptome for NRO and initial insights into the genomic responses of NRO to O3. Gene expression profiling reveals altered primary and secondary metabolism of NRO seedlings, including known defense responses such as terpenoid biosynthesis.
Health-promoting factors in higher education for a sustainable working life – protocol for a multicenter longitudinal study
Authors:   Impact within the Swedish framework for “Health Research in Collaboration”, Lindmark U. , Ahlstrand I. , Ekman A. , Berg L. , Hedén L. , Källstrand J. , Larsson M. , Nunstedt H. , Oxelmark L. , Pennbrant S. , Sundler A. , Larsson I.
Published: February 2020

Background

The World Health Organization has highlighted the importance of health promotion for health service providers in order to ensure sustainable working life for individuals involved in providing health services. Such sustainability begins when students are preparing to manage their own future health and welfare in working life. It has been suggested that universities, employees and trainee health professionals should adopt or follow a salutogenic approach that not only complements the providing of information on known health risks but also favors health promotion strategies. This paper describes the study design and data collection methods in a planned study aiming to explore health-promoting factors for a sustainable working life among students in higher education within healthcare and social work.

Methods

This protocol describes a multicenter longitudinal study involving Swedish students on higher education programs in the healthcare and social work sectors. In 2018, the study invited students on seven education programs at six universities to participate. These programs were for qualification as: biomedical laboratory scientists (n = 121); dental hygienists (n = 87); nurses (n = 1411); occupational therapists (n = 111); physiotherapists (n = 48); radiographers (n = 60); and, social workers (n = 443). In total, 2283 students were invited to participate. Participants completed a baseline, a self-reported questionnaire including six validated instruments measuring health-promoting factors and processes. There are to be five follow-up questionnaires. Three while the students are studying, one a year after graduating, and one three years after graduating. Each questionnaire captures different health-promoting dimensions, namely: health-promoting resources (i.e. sense of coherence); occupational balance; emotional intelligence; health and welfare; social interaction; and work and workplace experiences/perceptions.

Discussion

This study focuses on the vastly important aspect of promoting a sustainable working life for healthcare and social work employees. In contrast to previous studies in this area, the present study uses different, validated instruments in health promotion, taking a salutogenic approach. It is hoped that, by stimulating the implementation of new strategies, the study’s findings will lead to education programs that prepare students better for a sustainable working life in healthcare and social work.
Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan
Authors: Chen Ping-Ling , Lin Hsiao-Yu , Ong Jiann Ruey , Ma Hon-Ping
Published: February 2020

Background

Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults.

Method

The data of survey participants aged > 65 years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to determine potential predictors associated with falls. The regression coefficients of the predictors in the final model were translated into scores (by multiplying by 5) and then summed to obtain a total risk-score for falls. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of the risk assessment profile.

Result

Self-reported falls within 1 year accounted for 19.1% of the total falls. The predictors that were included in the risk profile according to the logistic regression analysis results were as follows: female sex (adjusted odds ratio = 1.57; risk-score = 2), living alone (adjusted odds ratio = 1.56; risk-score = 2), urinary incontinence (adjusted odds ratio = 1.36; risk-score = 2), perceived unhealthiness (adjusted odds ratio = 1.32; risk-score = 1), perceived pain (adjusted odds ratio = 1.51; risk-score = 2), hospital admission in the past year (adjusted odds ratio = 2.42; risk-score = 4), low activity of daily living (ADL) scores (adjusted odds ratio = 1.29; risk-score = 1), and low mobility function scores (adjusted odds ratio = 1.68; risk-score = 3). At a total risk-score cutoff point of 6 (range 0–17), the model predicted falls with a sensitivity and specificity of 75.16 and 52.75%, respectively (area under the ROC curve = 0.70).

Conclusion

The fall-risk assessment profile comprising eight predictors—female sex, living alone, incontinence, perceived unhealthiness, perceived pain, hospital admission in the past year, low ADL scores, and low mobility function scores—may serve as an assessment tool for identification of older adults with a high risk of falling, and assessment results can be used to facilitate community-based intervention.
Impact of Endourological procedures with or without double-J stent on sexual function: a systematic review and meta-analysis
Authors: Lu Junlin , Lu Yinghong , Xun Yang , Chen Fan , Wang Shaogang , Cao Shiyi
Published: February 2020

Background

Endourological procedures are widely used to treat benign urinary disorders and the double-J stent is routinely used. However, its potential impact on sexual function remains unclear. Therefore, we performed a quantitative systematic review to determine the relationship between endourological procedures with or without double-J stent and post-operative sexual function.

Methods

We conducted a search of PubMed, EMBASE, Web of Science, and Cochrane Library databases up to December 2018 for studies that compared sexual function before and after endourological procedures. The quality of the included studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). We performed subgroup analyses to explore heterogeneity. A random effects model was used to combine the results.

Results

Five prospective studies involving 485 sexually active participants were identified. Pooled results showed that, in patients without a double-J stent, the change in sexual function after endourological procedures was not significant in men (mean difference [MD]: − 0.61, 95% confidence interval [CI]: − 1.43 to 0.22, p = 0.148) or women (MD: 0.53, 95% CI: − 0.52 to 1.57, p = 0.322). However, in patients with indwelling double-J stent, sexual function scores significantly declined after the procedure in both men (MD: -4.25, 95% CI: − 6.20 to − 2.30, p < 0.001) and women (MD: -7.17, 95% CI: − 7.88 to − 6.47, p < 0.001).

Conclusions

Our meta-analysis suggests that indwelling double-J stent after endourological procedures could be a crucial factor causing temporary sexual dysfunction post-operatively. Our results may be used to provide evidence-based advice to patients.
Where is clinical research for radiotherapy going? Cross-sectional comparison of past and contemporary phase III clinical trials
Authors: Park Sunmin , Rim Chai Hong , Yoon Won Sup
Published: February 2020

Purpose

The features of past and contemporary phase III clinical trials for radiotherapy were reviewed to activate future clinical trials and to advise on actual clinical practice.

Methods and materials

The phase III clinical trials for radiotherapy were searched in the database of ‘ClinicalTrials.gov’ by the U.S. National Institute of Health. Using the staring date, the studies during each period of 4 years were collected for the past (from Jan 2000 to Dec 2003) and contemporary (July 2014 to June 2018) years. For the investigated subjects, the patterns of studies were classified as: Category A, the comparisons of rival radiotherapy protocols; Category B, the comparisons of multidisciplinary approaches; Category C, the investigation of supplementary agents; and Category D, the investigation of optimal partners for concurrent radiotherapy.

Results

The number of studies increased, from 96 past to 158 contemporary studies. The patterns of studies were similar with the mild increase of Category A in the contemporary years (22.9% vs. 29.1%). For the study locations and the funding sources, the Chinese studies (2.1% vs. 34.2%, P < 0.001) and the affiliated institutions of researchers (37.5% vs. 72.2%, P < 0.001) markedly increased in the contemporary years from the past Western studies and non-profit organization, respectively. The robust radiation techniques were more usual in the contemporary years (11.5% vs. 44.9%, P < 0.001). The fractionation schedule and delivery technique were the common issues in both past and contemporary years of Category A. In Category B, the indications of stereotactic radiotherapy was the rising concern, with eight ongoing studies. Except for the studies of palliative or prophylactic goals and stereotactic radiotherapy, the escape from conventional fraction size was 37.9% (36/95) in the contemporary years with the median fraction size of 2.5 Gy (range 2.05–6.6 Gy) in the comparison with 19.0% (15/79) in the past years (P = 0.006).

Conclusions

To activate the clinical trials for radiotherapy, the funding sources would be diversified, including industrial support. Hypofractionated schedules using robust techniques could be preemptively considered in actual clinical practice.
Diagnostically challenging human papillomavirus-associated primary squamous cell carcinoma of the rectum with metastasis in both ovaries: a case report
Authors: Tschann P. , Lechner D. , Feurstein B. , Abendstein B. , Dertinger S. , Bösl A. , Vitlarov N. , Offner F. , Königsrainer I.
Published: February 2020

Introduction

Squamous cell carcinomas of the rectum are extremely rare and their pathogenesis is still under debate. Their proper diagnosis and treatment may thus be challenging.

Case presentation

A 52-year-old Caucasian woman was transferred to our department with a history of pelvic pain. Colonoscopy revealed a small tumorous lesion of the upper rectum and an endoscopic biopsy showed infiltration of the rectal mucosa by a squamous cell carcinoma. Afterward, tumorous lesions were found on imaging in both her ovaries. A laparoscopy with adnexectomy and anal mapping was performed and revealed tumor masses of squamous cell carcinoma in both ovaries. Based on the large size of the ovarian tumors and the concurrence of extensive, partly ciliated, macrocystic epithelium in one of the ovaries, a diagnosis of ovarian squamous cell carcinoma arising from a mature teratoma was rendered. However, human papillomavirus genotyping analyses were positive for human papillomavirus-16 in both the rectal tumor and ovarian tumors leading to a final diagnosis of a human papillomavirus-associated rectal squamous cell carcinoma metastatic to both ovaries. Neoadjuvant chemoradiation therapy of her rectum, total mesorectal excision, and hysterectomy were performed followed by adjuvant chemotherapy.

Conclusion

Colorectal squamous cell carcinoma is a rare disease. In cases of colorectal squamous cell carcinoma, metastatic disease at any other location has to be excluded. Human papillomavirus genotyping is essential in this context. Discussion of the treatment strategies should be interdisciplinary and include chemoradiation therapy and radical surgery.
Local monotonicity coefficients in Orlicz sequence spaces equipped with the p-Amemiya norm
Authors: He Xin , Cui Yunan , Hudzik Henryk
Published: February 2020

In this paper, the monotonicity is investigated with respect to Orlicz sequence space $l_{\varPhi , p}$

l

Φ
,
p

equipped with the p-Amemiya norm, and the necessary and sufficient condition is obtained to guarantee the uniform monotonicity, locally uniform monotonicity, and strict monotonicity for $l_{\varPhi , p}$

l

Φ
,
p

. This completes the results of the paper (Cui et al. in J. Math. Anal. Appl. 432:1095–1105, 2015) which were obtained for the non-atomic measure space. Local upper and lower coefficients of monotonicity at any point of the unit sphere are calculated, $l_{\varPhi , p}$

l

Φ
,
p

is calculated.
Effects of aging on foot pedal responses to visual stimuli
Authors: Yuda Emi , Yoshida Yutaka , Ueda Norihiro , Kaneko Itaru , Miura Yutaka , Hayano Junichiro
Published: February 2020

Background

Car accidents due to unexpected forward or backward runaway by older drivers are a serious social problem. Although the cause of these accidents is often attributed to stepping on the accelerator instead of the brake, it is difficult to induce such pedal application errors systematically with usual drive simulators. We developed a simple personal computer system that induces the pedal errors, and investigate the effects of age on the error behaviors.

Methods

The system consisted of a laptop computer and a three-pedal foot mouse. It measured response time, accuracy, and flexibility of pedal operation to visual stimuli. The system displayed two open circles on the computer display, lighting one of the circles in a random order and interval. Subjects were instructed to press the foot pedal with their right foot as quickly as possible when the circle was lit; the ipsilateral pedal to the lit circle in a parallel mode and the contralateral pedal in a cross mode. When the correct pedal was pressed, the light went off immediately, but when the wrong pedal was pressed, the buzzer sounded and the light remained on until the correct pedal was pressed. During a 6-min trial, the mode was switched between parallel and cross every 2 min. During the cross mode, a cross mark appears on the display. The pedal responses were evaluated in 52 subjects divided into young (20–29 years), middle-aged (30–64 years), and older (65–84 years) groups. Additionally, the repeatability of the pedal response characteristic indicators was examined in 14 subjects who performed this test twice.

Results

The mean response time was 95 ms (17%) longer in the older group than in the young group. More characteristically, however, the older group showed 2.1 times more frequent pedal errors, fell into long hesitations (response freezing > 3 s) 16 times more often, and took 1.8 times longer period to correct the wrong pedal than the young groups. The indicators of pedal response characteristics showed within-individual repeatability to the extent that can identify the age-dependent changes.

Conclusions

Hesitations and extended error correction time can be associated with increased crash risk due to unexpected runaway by older drivers. The system we have developed may help to uncover and evaluate physiological characteristics related to crash risk in the elderly population.
Factors Influencing Quality of Team Discussion: Discourse Analysis in an Undergraduate Team-Based Learning Biology Course
Authors: Leupen Sarah M. , Kephart Kerrie L. , Hodges Linda C.
Published: February 2020

Group activities as part of active-learning pedagogies are thought to be effective in promoting student learning in part because of the quality of discussion they engender in student teams. Not much is known, however, about which instructional factors are most important in achieving productive conversation or how these factors may differ among different collaborative pedagogies. We explored what provokes meaningful group discussions in a university physiology course taught using team-based learning (TBL). We were most interested in discussions that evoke explanations that go beyond statements of basic facts and into disciplinary reasoning. Using transcribed conversations of four randomly selected teams three times throughout the semester, we analyzed three distinct discursive phenomena—conceptual explanations, re-evaluations, and co-construction—that occurred in productive conversations. In this paper, we provide examples from student discussions showing the role of each of these elements in moving students toward conceptual understanding. These phenomena were more likely to occur in response to higher-order questions in Bloom’s taxonomy. Preclass preparation and student accountability as part of TBL may be important factors in this finding. We share implications for practice based on our results.
The role of schizotypal traits and the OXTR gene in theory of mind in schizophrenia: A family-based study
Authors: Giralt-López M. , Miret S. , Soler J. , Campanera S. , Parellada M. , Fañanás L. , Fatjó-Vilas M.
Published: February 2020

Background.

There is consistent evidence that theory of mind (ToM) is impaired in schizophrenia (SZ); however, it remains unclear whether such deficits are trait- or state-dependent. We evaluated ToM in patients with schizophrenia spectrum disorders (SSDs), their healthy first-degree relatives, and controls to test its suitability as an endophenotypic marker. We also studied the modifying effect of markers of clinical and genetic liability to SZ (schizotypy and genetic variability in the oxytocin receptor gene: OXTR) on ToM in healthy individuals.

Methods.

The sample included 38 stable SSD patients, 80 unaffected first-degree relatives, and 81 controls. ToM was assessed using the Hinting Task (HT) and schizotypy via the Schizotypal Personality Questionnaire-Brief (SPQ-B), which generates interpersonal (SPQ-IP), cognitive-perceptual (SPQ-CP), and disorganization (SPQ-D) scores. The polymorphism rs53576 of OXTR was genotyped.

Results.

Patients presented poorer HT performance than relatives and controls (p = 0.003 and p < 0.001). High SPQ-IP and SPQ-CP scores correlated with poorer ToM performance in relatives (p = 0.010 and p = 0.030), but not in controls. OXTR was not associated with HT scores, but it showed a modifying effect within controls; high SPQ-CP was related to HT poorer performance conditional to GG genotype (p = 0.007).

Conclusions.

ToM deficits were present in patients but not in unaffected relatives or controls. However, our data indicate the usefulness of clinical and genetic liability markers to characterize differences in ToM abilities within healthy individuals. Then, the observed link between ToM and SZ liability suggests the putative role of ToM as an endophenotypic marker. Nevertheless, new analyses in larger samples are needed.
The impact of mental vulnerability on the relationship between cardiovascular disease and depression
Authors: Jørgensen Terese Sara Høj , Wium-Andersen Marie Kim , Jørgensen Martin Balslev , Osler Merete
Published: February 2020

Background.

The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression.

Methods.

A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983–2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression.

Results.

During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability.

Conclusions.

Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.
Integrating the “Immunome” in the Stratification of Myelodysplastic Syndromes and Future Clinical Trial Design
Authors: Winter Susann , Shoaie Saeed , Kordasti Shahram , Platzbecker Uwe
Published: February 2020

Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis and often include a dysregulation and dysfunction of the immune system. In the context of population aging, MDS incidence is set to increase substantially, with exponential increases in health care costs, given the limited and expensive treatment options for these patients. Treatment selection is mainly based on calculated risk categories according to a Revised International Prognostic Scoring System (IPSS-R). However, although IPSS-R is an excellent predictor of disease progression, it is an ineffective predictor of response to disease-modifying therapies. Redressing these unmet needs, the “immunome” is a key, multifaceted component in the initiation and overall response against malignant cells in MDS, and the current omission of immune status monitoring may in part explain the insufficiencies of current prognostic stratification methods. Nevertheless, integrating these and other recent molecular advances into clinical practice proves difficult. This review highlights the complexity of immune dysregulation in MDS pathophysiology and the fine balance between smoldering inflammation, adaptive immunity, and somatic mutations in promoting or suppressing malignant clones. We review the existing knowledge and discuss how state-of-the-art immune monitoring strategies could potentially permit novel patient substratification, thereby empowering practical predictions of response to treatment in MDS. We propose novel multicenter studies, which are needed to achieve this goal.
Understanding the Role of Comparative Clinical Studies in the Development of Oncology Biosimilars
Authors: Stebbing Justin , Mainwaring Paul N. , Curigliano Giuseppe , Pegram Mark , Latymer Mark , Bair Angel H. , Rugo Hope S.
Published: February 2020

Biosimilars have the potential to broaden patient access to biologics and provide cost savings for health care systems. During the development of a biosimilar, data that directly compare the proposed biosimilar with the reference product are required. Such comparative data are generated in a stepwise hierarchical process that begins with extensive laboratory-based structural analyses and functional assays. This initial analytical phase serves as the foundation for the demonstration of biosimilarity and is followed by nonclinical in vivo testing (if required) and then clinical evaluation, including a comparative pharmacokinetics/pharmacodynamics study that is usually conducted in healthy volunteers. The development program typically culminates with a comparative clinical efficacy study. The aim of this study is to confirm clinical equivalence of the potential biosimilar and reference product on the basis of prespecified margins, using a study population and efficacy end point that are sufficiently sensitive for detecting potential product-related differences. Such studies also include detailed analyses of safety as well as evaluation of immunogenicity. As biosimilars become more widely available in oncology, especially with recent regulatory approvals of rituximab, trastuzumab, and bevacizumab biosimilars, it is critically important that clinicians understand how the comparative clinical study differs from a traditional phase III efficacy and safety study in the development of a novel biologic originator product. Here, we review the role of comparative clinical studies in biosimilar development, with a focus on trials conducted to support approved trastuzumab biosimilars. We discuss the study populations and end points used, extrapolation of indications, and the confirmatory nature of these studies within the totality of evidence supporting biosimilarity.
Risk of Postdural Puncture Headache in Adolescents and Adults
Authors: DelPizzo Kate , Luu Thuyvan , Fields Kara G. , Sideris Alexandra , Dong Naomi , Edmonds Chris , Zayas Victor M.
Published: February 2020

BACKGROUND:

Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption; however, postdural puncture headache (PDPH) remains a significant risk associated with this technique. The literature specifically examining this complication in adolescents is scarce. Our primary objective was therefore (1) to estimate the incidence of PDPH with a 27G pencil-point needle in patients between the ages of 12 and 19 undergoing ambulatory lower extremity procedures and (2) to compare it to the incidence in adults aged 20–45 years.

METHODS:

After institutional review board (IRB) approval, patients aged 12–45 years undergoing ambulatory lower extremity surgery were approached. Patients undergoing the procedure under combined spinal-epidural (CSE) or spinal anesthesia with a 27G pencil-point needle were eligible for enrollment. Patients were consented before surgery and received a survey via e-mail on postoperative day (POD) 4 inquiring about the presence of a headache. Each headache was described by the participant and assessed for severity, time of onset, duration, location, and whether it was of a postural nature. All patients reporting a postural headache were contacted by a physician author to confirm a diagnosis of PDPH using the International Headache Society diagnostic criteria.

RESULTS:

A total of 656 patients were included in the analysis. Overall, 3.4% of patients developed PDPH. The percentage developing PDPH was 4.9% (3.0–7.8) among those aged 12–19 years and 1.8% (0.8–3.9) in the 20- to 45-year-old group. After adjusting for covariates, the age group between 12 and 19 years was associated with an almost 3-fold increase in the odds (2.8 [95% confidence interval {CI}, 1.1–7.3]) for the development of PDPH compared to that in the 20–45 age group. One patient in the adult group required an epidural blood patch.

CONCLUSIONS:

The overall incidence for the development of PDPH in ambulatory patients <45 years of age is low. However, the odds for developing PDPH is significantly higher in teenagers compared to those aged 20–45 years. This increase was not associated with an increase in the need for an epidural blood patch. Providers may incorporate these data in their consent process and have a higher index of suspicion for PDPH in teenagers who report headaches after neuraxial anesthesia.
Turkish Communication and Media Policies as Reflected in Government Programs: A Historical Analysis between 1923 and 2014
Authors: Atabek Ümit , Atabek Gülseren Şendur
Published: February 2020

The main aim of this paper is to explore Turkish communication and media policies through governmental programs. Governmental programs are valuable sources for tracing the historical development and change of public policies on communication and media. Our research examines 60 governmental programs. We used content analysis methodology in order to examine the communication and media policies in these programs. As unstructured data, the texts of 60 governmental programs (a corpus of 892 pages) are pre-processed (tokenized, stemmed, tagged and cleaned) by KNIME, an open source software for text analysis and data mining. Additionally, we developed a term dictionary for searching communication and media policies. These dictionary terms helped us exploring the themes of governmental policies. Finally, we graphed the data suitably for the historical analysis of themes in order to trace the policy changes. Our research findings helped us to monitor the changes in Turkish communication and media eco-system with regard to specific technologies such as newspaper, radio, television and internet. We also explored certain policy concepts on communication and media freedoms and rights. The analysis revealed that almost all governments included communication and media related issues in their programs, and the amount of references to communication and media policies increased historically. It is also found that the political differences of governments did not cause much difference in their quantitative references to communication and media issues.
Suggestions on how to use Europeana for pedagogical purposes in order to promote Europe’s cultural heritage
Authors: Anagnostou Giannis , Chatziefstratiou Afroditi , Peristeri Theodora , Theofanellis Timoleon
Published: February 2020

The purpose of this paper is to examine how educators can use Europeana to promote Europe’s cultural heritage. At first we present Europeana and the basic elements regarding media literacy that teachers and students need to know to make a web based project. We then continue by presenting Europeana as an educational tool. Since it is difficult to introduce a new tool to teachers, we offer a general purpose scenario that can be utilized in any subject. This scenario has been tested in class and the students found it interesting. The idea is that the teacher selects the project area and this must involve European history, especially parts of cultural heritage that are included in the Europeana collection. A rough idea about the project is accomplished by students using the English version of Wikipedia. Those two are blended together to make a story using primary material. Students use other sources to support their case. In the process they learn to cite and to create the sources of the material they use, to respect the work of others, to appreciate primary sources and to share material with others.
Non-Governmental Organizations as a Place for Cultural Rituals: Cyprus Turkish French Cultural Association
Authors: ÇİFTÇİ Dilan , ÇİFTÇİ Heran , SOYER Filiz
Published: February 2020

This study reveals the strength non-governmental organizations as a place for recalling cultural memory and cultural rituals. In this study, the theories about the tightness of cultural memory to its cultural environment, and the non-governmental organizations through the cross-border travel and the possibility of blending with the existing cultural symbols are described. The Turkish Cypriot French Cultural Association, which has been active in Northern Cyprus for 34 years, has been presented with a historical view, but the symbolic cultural rituals of the living legacies of French culture have been addressed through civil society organizations. While the subjects of cultural memory and collective memory are often referred to politics, non-governmental organizations with contributions to culture are often ignored. In the light of these conceptual debates a wide range of cultural memory and symbolic cultural rituals have been discussed. As a concrete assessment of all these information and discussions, the Turkish Cypriot French Cultural Association's French symbolic cultural rituals are the main objective of the study. In this context, the analysis of French cultural symbolic rituals in Northern Cyprus has been demonstrated by using visual text analysis technique and content-analysis technique. As the information and documents are obtained, the Turkish Cypriot French Cultural Association as a well-established non-governmental organization in Northern Cyprus has demonstrated its importance as a cultural memory venue.
Neutrino masses and interactions from Super-Kamiokande
Authors: Lola S.
Published: February 2020

We discuss topics on neutrino masses and interactions, in the light of the Super- Kamiokande data. The experimental observations can be explained either by several patterns of neutrino masses, or byflavour-changingneutrino matter-interactions. In the latter case, the coupling constants of the relevant operators are large enough to give interesting signals in ultra-high energy neutrino scattering to matter.
A new application of the quantum mechanical hypervirial theorems technique
Authors: Grypeos M. E. , Liolios Th. E.
Published: February 2020

A new approach is proposed on the basis of the quantum mechanical hypervirial theorems technique for the approximate analytic (or semi-analytic) determination of bound state energy eigenfunctions for quite a wide class of central potentials. The accuracy of the method is tested for the Gaussian potential and is best for the ground state.
The variation of the Ηωwith the particle number and the appearance of "kinks" for atomic clusters
Authors: Kotsos B. A. , Grypeos M. E.
Published: February 2020

The dependence of the harmonic oscillator (HO) energy level spacing Ηω on the particle number Ν is studied analytically for atomic clusters on the basis of their electronic densities, parametrizing Ekardt's results (for sodium clusters) by means of a Fermi distribution. An interesting feature of such an approach is that it leads, under the assumptions made, to "kinks", that is to "marked discontinuities in the slope" of Ηω at the closed shells. These discontinuities diminish as Ν increases.
On a single particle potential for atomic clusters
Authors: Kotsos B. A. , Liolios Th. E. , Grypeos M. E. , Koutroulos C. G. , Massen S. E.
Published: February 2020

The single-particle potential V(r) = -Vo[1+(r/K)^β)^-1, which has been proposed in the recent years for atomic (metal) clusters, is studied analytically in the case β = 2. By using perturbation-type techniques, approximate analytic expressions are obtained for the energy eigenvalues and other physically interesting quantities showing the variation of these quantities with the number of valence electrons. The accuracy is tested for Al clusters and is usually very good.
Description of the generalized momentum distribution in finite nuclei within t h e independent-particle shell model
Authors: Papakonstantinou P. , Mavrommatis E. , Kosmas T. S.
Published: February 2020

A method for calculating the generalized momentum distribution in finite nuclear systems is presented and discussed within the context of the independent particle shell model. Application to the light closed-shell nuclei 16O and 40Ca is included.
Strontium-90 in human bones and teeth in Greece: Measurements and predictions using an age-dependent model
Authors: Stamoulis K. C. , Assimakopoulos P. A. , Ioannides K. G.
Published: February 2020

Strontium-90 concentration in human bones and teeth, collected in Greece during the period 1992-1996, was measured. One hundred and five bone samples, mainly cancelous (spongy) bone, and 108 samples, involving a total of 896 individual teeth, were processed. Samples were classified according to age and sex of the donors. Radiostrontium concentration in bone samples showed small variations with regard to age or sex, yielding an average value of 30 mBq concentration measurements in teeth evinced a pronounced structure, which clearly reflects contamination from the 1960s atmospheric nuclear weapons tests and the more recent Chernobyl accident. This difference is attributed to the different bone texture of skeletal bones and teeth, the later consisting mainly of compact bone.An age-dependent model for radiostrontium concentration in human bones and teeth was developed, which was able to successfully reproduce the experimental data. Through a fitting process, the model also yielded calcium turnover rates for compact bone as a function of age, as well as an estimate of radiostrontium con- tamination of foodstaffs in Greece for the past four decades.
Patient education for preventing recurrence of venous leg ulcers: a systematic review
Authors: Shanley Emer , Moore Zena , Patton Declan , O’Connor Tom , Nugent Linda , Budri Aglecia MV , Avsar Pinar
Published: February 2020

Objective:

To investigate the impact of patient education interventions on preventing the recurrence of venous leg ulcers (VLU).

Method:

A systematic review was undertaken using the following databases: Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library); Ovid; Ovid (In-process and Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL. Trial registries and reference lists of relevant publications for published and ongoing trials were also searched. There were no language or publication date restrictions. Randomised controlled trials (RCTs) and cluster RCTs of patient educational interventions for preventing VLU recurrence were included. Review authors working independently assessed trials for their appropriateness for inclusion and for their risk of bias, using pre-determined inclusion and quality criteria.

Results:

A total of four studies met the inclusion criteria (274 participants). Each trial explored different interventions as follows: the Lively legs programme; education delivered via a video compared with education delivered via a pamphlet; the Leg Ulcer Prevention Programme and the Lindsay Leg Club. Only one study reported the primary outcome of incidence of VLU recurrence. All studies reported at least one of the secondary outcomes: patient behaviours, patient knowledge and patient quality of life (QoL). It is uncertain whether patient education programmes make any difference to VLU recurrence at 18 months (risk ratio [RR]: 0.82; 95% confidence interval: [CI] 0.59 to 1.14) or to patient behaviours (walked at least 10 minutes/five days a week RR: 1.48; 95%CI: 0.99 to 2.21; walked at least 30 minutes/five days a week: RR 1.14; 95%CI: 0.66 to 1.98; performed leg exercises: RR: 1.47; 95%CI: 1.04 to 2.09); to knowledge scores (MD (mean difference) 5.12, 95% CI –1.54 to 11.78); or to QoL (MD: 0.85, 95% CI –0.13 to 1.83), as the certainty of evidence has been assessed as very low. It is also uncertain whether different types of education delivery make any difference to knowledge scores (MD: 12.40; 95%CI: –5.68 to 30.48). Overall, GRADE assessments of the evidence resulted predominantly in judgments of very low certainty. The studies were at high risk of bias and outcome measures were imprecise due to wide CIs and small sample sizes.

Conclusion:

It is uncertain whether education makes any difference to the prevention of VLU recurrence. Therefore, further well-designed trials, addressing important clinical, QoL and economic outcomes are justified, based on the incidence of the problem and the high costs associated with VLU management.
The subepidermal moisture scanner: the technology explained
Authors: Gefen Amit , Ross Graham
Published: February 2020

The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the ‘SEM scanner’. We also describe the mode of operation of the SEM scanner in monitoring tissue health and detecting subtle abnormal changes in tissue physiology in patients and anatomical sites at a risk of a pressure ulcer (PU: also known as a pressure injury). The technology of the SEM scanner was approved last year for sales in the US by the Food and Drug Administration (FDA). The SEM scanner detects changes in fluid contents of human skin and subdermal tissues, to a tissue depth of several millimetres, by measuring ‘capacitance’, an electrical property of the locally examined tissue site to store electric charge. The capacitance of tissues, called ‘biocapacitance’, is strongly affected by the amount of fluid (water) in the tissue. When the first cells die in a forming PU, inflammatory signalling causes the permeability of blood vessel walls to increase and oedema to develop. Simply, the scanner detects the early appearance of oedema, which is called ‘micro-oedema.’ Calculation of a ‘SEM-delta’ value, which compares biocapacitance measurements, acquired across several tissue sites, some of which are healthy and others where the PU may evolve, eliminates potential effects of systemic changes in tissue fluid contents and provides a consistent quantitative measure of the tissue health conditions at the monitored anatomical site. Here, we describe SEM scanner technology, how it operates and has been laboratory tested (in computer simulations, in silico) before commercial launch. We explain why targeting the physical biomarker of oedema leads to the documented success of the SEM scanner in the multiple published clinical trials, proving its ability to early detect PUs that form under intact skin.
Strategizing Kashmiri Freedom Struggle Through Nonviolent Means
Authors: Abbas Khurram
Published: February 2020

Since 1947, Kashmiris are demanding freedom from Indian occupation. They have adopted numerous approaches to gain independence from Indian subjugation, including nonviolent resistance, election boycotts and international arbitration. Various new trends in the Kashmiri freedom struggle have been observed since 2008 including a signature campaign ‘Safr-e-Azadi’ (journey for freedom) in 2008, ‘Muzaffarabad Chalo’ (Got to Muzaffarabad) march of 2008 and sit-ins of 2010 which have significantly changed the nature of Kashmir struggle. This paper explores emerging trends of strategic nonviolent Kashmiri struggle and practical future options to strategize the former through the prism of Gene Sharp's Theory of Nonviolence. This study assumes that strategic nonviolent movement in IOJ&K has highlighted the Kashmir cause across the world. It has challenged the Indian occupation through staging mass protests and employing new forms of strategic methods, which will likely put India under pressure in the future. If organized, well-coordinated and strategically planned, this struggle can be successful. In the wake of the Indian government's abrogation of Articles 370 and 35A and illegal annexation of IOJ&K on August 5, 2019, the need for devising a well-calibrated, inclusive and comprehensive strategy and employing all viable options for peaceful resolution of the Kashmir dispute further increases.