bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of extended urine protein monitoring frequency in patients receiving bevacizumab
Authors: Schiffer Molly , Zukovic Lejla , Hall Sophia , Merl Man Yee
Published: July 2020

Purpose

Proteinuria monitoring is required for patients receiving bevacizumab. Nonetheless, the frequency of monitoring is not specified in the package insert. A 2014 quality improvement study performed at Yale New Haven Health System (YNHHS) found that proteinuria occurred in 15% (all grade) of the 162 patients evaluated. These results led to decreasing the frequency of proteinuria monitoring from every treatment to every other treatment. The objective of this study is to assess the safety of the extended interval for urine protein (UP) monitoring.

Methods

Patients receiving at least four bevacizumab treatments at YNHHS from January to June 2017 were randomly selected and retrospectively reviewed. The following data were collected: baseline patient characteristics, comorbidities, medication history, and proteinuria monitoring. The grade, prevalence and management of proteinuria were evaluated. The minimum necessary sample size was determined to be 384 treatments to achieve a 95% confidence interval.

Results

Fifty-five patients and 388 bevacizumab treatments were evaluated. Urine protein was assessed in 52.5% of treatments. The incidence of proteinuria among patients was 7.2% (grade 2) and 0% (grade 3). Cumulative dose and the number of total bevacizumab doses did not affect the timing for onset or severity of proteinuria. Two patients with UP ≥ 2+ were further monitored using a 24-h urine collection test with negative results. No treatments were held due to proteinuria.

Conclusion

Monitoring proteinuria every other treatment does not increase the frequency of adverse events. Urine protein is now monitored prior to every third bevacizumab treatment, reducing unnecessary labs and chair time.
Prognostic factors and proposed grading system for cutaneous and subcutaneous soft tissue sarcomas in cats, based on a retrospective study
Authors: Dobromylskyj Melanie J , Richards Victoria , Smith Ken C
Published: July 2020

Objectives

The objectives of this study included utilising a large database from a diagnostic laboratory to identify any breed, sex or age predilections for cutaneous and subcutaneous soft tissue sarcomas (STSs), and the most common anatomical locations. The second aim was to obtain clinical outcomes and to assess histological features of those tumours to identify any potentially useful prognostic indicators and propose a grading system.

Methods

Records from the laboratory were searched for feline submissions received from January 2012 to December 2013 diagnosed with STSs; the breed, age, sex and neuter status of the cat and anatomical location of the tumour were recorded. Clinical outcomes were acquired using a questionnaire to submitting practices, and histological features of tumours from patients with known outcomes were assessed.

Results

No sex, neuter status or breed predispositions were found. Most STSs arise in middle-aged and older cats, and the most common anatomical location was the trunk. Forty-seven cases had a known clinical outcome and archived tissues allowing for histological assessment of the tumour. Significant differences in median survival time (MST), mitotic index and histological score were detected between those cats that died of tumour-related disease and those that did not. A novel grading system applied to these tumours produced significant differences in MST between cats with low (MST = 900.5 days), intermediate (MST = 514 days) and high grade tumours (MST = 283 days).

Conclusions and relevance

This is the first study applying a histological grading system to these common tumours. Local recurrence is often the cause of a poor outcome, with metastatic disease apparently rare. The proposed grading system incorporates features that can be assessed on routine haematoxylin and eosin-stained sections; in this small study, the histological grade of the tumour appears to be associated with survival time.
Optical coherence tomography angiography in Tuberous sclerosis complicated with macular choroidal neovascularization
Authors: Fortunato Michele , Turtoro Angela , Cennamo Gilda , Nardella Chiara
Published: July 2020

This study describe the optical coherence tomography angiography (OCTA) features of a young patient with Tuberous sclerosis complicated with CNV unilateral macular choroidal neovascularization during the ranibizumab therapy. OCTA scans of macular region of right eye, revealed a dense microvascular network confirming the diagnosis of CNV. After four monthly intravitreal injections, OCTA revealed a decrease of size and activity of CNV. OCTA is a valid, non-invasive, dyeless, and reliable method that could improve the diagnosis and management of CNV in child with Tuberous sclerosis.
Exploiting Homoplasy in Genome-Wide Association Studies to Enhance Identification of Antibiotic-Resistance Mutations in Bacterial Genomes
Authors: Lai Yi-Pin , Ioerger Thomas R
Published: July 2020

Many antibacterial drugs have multiple mechanisms of resistance, which are often represented simultaneously by a mixture of resistance mutations (some more frequent than others) in a clinical population. This presents a challenge for Genome-Wide Association Studies (GWAS) methods, making it difficult to detect less prevalent resistance mechanisms purely through (weak) statistical associations. Homoplasy, or the occurrence of multiple independent mutations at the same site, is often observed with drug resistance mutations and can be a strong indicator of positive selection. However, traditional GWAS methods, such as those based on allele counting or linear regression, are not designed to take homoplasy into account. In this article, we present a new method, called ECAT (for Evolutionary Cluster-based Association Test), that extends traditional regression-based GWAS methods with the ability to take advantage of homoplasy. This is achieved through a preprocessing step which identifies hypervariable regions in the genome exhibiting statistically significant clusters of distinct evolutionary changes, to which association testing by a linear mixed model (LMM) is applied using GEMMA (a well-established LMM-based GWAS tool). Thus, the approach can be viewed as extending GEMMA from the usual site- or gene-level analysis to focusing on clustered regions of mutations. This approach was evaluated on a large collection of more than 600 clinical isolates of multidrug-resistant (MDR) Mycobacterium tuberculosis from Lima, Peru. We show that ECAT does a better job of detecting known resistance mutations for several antitubercular drugs (including less prevalent mutations with weaker associations), compared with (site- or gene-based) GEMMA, as representative of existing GWAS methods. The power of the multiphase approach in ECAT comes from focusing association testing on the hypervariable regions of the genome, which reduces complexity in the model and increases statistical power.
Dimethyl fumarate treatment shifts the immune environment toward an anti-inflammatory cell profile while maintaining protective humoral immunity
Authors: Longbrake Erin E , Mao-Draayer Yang , Cascione Mark , Zielinski Tomasz , Bame Eris , Brassat David , Chen Chongshu , Kapadia Shivani , Mendoza Jason P , Miller Catherine , Parks Becky , Xing Diana , Robertson Derrick
Published: July 2020

Background:

Delayed-release dimethyl fumarate (DMF) demonstrates sustained efficacy and safety for relapsing forms of MS. Absolute lymphocyte count (ALC) is reduced initially, then stabilizes on treatment.

Objective:

PROCLAIM, a 96-week, prospective, open-label, phase 3b study, assessed lymphocyte subsets and immunoglobulin (Ig) levels during 48 and 96 weeks (W) of DMF treatment.

Methods:

Patients received 240 mg DMF BID. Endpoints: lymphocyte subset count changes (primary); Ig isotypes and ALC changes (secondary); adverse events and relationship between ALC changes and ARR/EDSS (exploratory); and neurofilament assessment (ad hoc).

Results:

Of 218 patients enrolled, 158 (72%) completed the study. Median ALC decreased 39% from baseline to W96 (BL–W96), stabilizing above the lower limit of normal (baseline: 1.82 × 109/L; W48: 1.06 × 109/L; W96: 1.05 × 109/L). CD4 + and CD8 + T cells correlated highly with ALC from BL–W96 ( p < 0.001). Relative to total T cells, naive CD4 + and CD8 + T cells increased, whereas CD4 + and CD8 + central and effector memory T cells decreased. Total IgA, IgG, IgM, and IgG1–4 subclass levels remained stable. Adverse event rates were similar across ALC subgroups. ARR, EDSS, and neurofilament were not correlated with ALCs.

Conclusion:

Lymphocyte decreases with DMF were maintained over treatment, yet immunoglobulins remained stable. No increase in infection incidence was observed in patients with or without lymphopenia.

Support:

Biogen
Probabilistic analysis models to determine capsule dosage for healing of cracks in concrete
Authors: Wang Miaomiao , Hu Xiangming , Zhao Yanyun
Published: July 2020

In order to analyze the optimal dosage of capsule pre-embedded in concrete materials, this article simplified the irregular cracks generated in concrete materials into linear regular hexagonal cracks in two-dimensional plane and planar cracks in three-dimensional space. Then, the probability model describing the interaction between the cracks and capsules was established using the probability theory of integral geometry. The theoretical solutions for the required capsule dosage for the two- and three-dimensional cases were derived. Finally, the calculated results for the theoretical model were compared with those provided by the computer simulation software. The results indicated that the model is suitable for analyzing and optimizing the capsule dosage required to repair cracks in concrete materials. It can provide a theoretical basis for the design of self-healing materials.
Seismic behavior of exteriorbeam–column joints with high-performance steel rebar: Experimental and numerical investigations
Authors: Gao Fei , Tang Zhiqiang , Mei Shilong , Hu Biao , Huang Shitao , Chen Junbo
Published: July 2020

Three full-scale exterior beam–column joints with anti-seismic steel reinforcement were tested under quasi-static cyclic loading and column axial compressive loading. The test variables were column axial load ratio and joint core hoop reinforcement ratio. Experimental results, including failure mode, hysteretic curve, ductility, energy dissipation, stiffness degradation, and decoupling of deformations, were presented and analyzed. The tests revealed that the anti-seismic rebar resulted in good joint seismic performance and that column axial load ratio and joint core hoop reinforcement ratio impose limited influence of joint performance when the joint failed in beam flexural failure. The calibrated finite element models developed based on OpenSees were then used to simulate the behavior of joint specimens. Parametric studies via finite element modeling were performed to study the influence of various parameters on the performance of beam–column joints.
Durability of seawater and sea sand concrete and seawater and sea sand concrete–filled fibre-reinforced polymer/stainless steel tubular stub columns
Authors: Li Ying-Lei , Zhao Xiao-Ling , Raman RK Singh
Published: July 2020

This article presents an experimental investigation on the durability behaviour of seawater sea sand concrete and seawater sea sand concrete–filled fibre-reinforced polymer/stainless steel tubular stub columns. Effects of NaCl of seawater on the strength of seawater sea sand concrete and on the deterioration of fibre-reinforced polymer were studied. Accelerated degradation tests were conducted on fibre-reinforced polymer rings exposed to a combined environment of 3.5% NaCl solution and seawater sea sand concrete. Obvious hoop strength reductions were observed in glass fibre-reinforced polymer and basalt fibre-reinforced polymer rings after 6-month exposure at 60°C. Seawater sea sand concrete–filled glass fibre-reinforced polymer tubular stub columns were exposed to an indoor environment (i.e. aged in air at room temperature) for a maximum duration of 2.5 years and no degradation was found by comparing the axial compressive test results from unexposed and exposed specimens. Seawater sea sand concrete–filled stainless steel tubes did not show any deterioration in strength after a 2.5-year exposure to an indoor environment or a 1.5-year immersion in NaCl solution. This study indicated that a hydrothermal environment (e.g. full immersion in solution) is much more aggressive to fibre-reinforced polymer than a dry environment. The reliability of using accelerated degradation test data to estimate the long-term performance of fibre-reinforced polymer–related structures in a real environment may need further research.
Nostalgia and pastiche in the post-postmodern zeitgeist: The ‘postcar’ from Italy
Authors: Cantone Luigi , Cova Bernard , Testa Pierpaolo
Published: July 2020

The transition towards a post-postmodern zeitgeist has attracted much scholarly attention over the last decade, highlighting the major traits of the coming post-postmodern condition, such as sincerity challenging irony, reconstruction despite paradoxes, hope despite difficult circumstances and structure counterbalancing anti-structure in lived experience. Nevertheless, we know little about what is happening with regard to nostalgia, a key characteristic of postmodernity, especially in terms of one of its major components, pastiche. From the start of the 1990s, marketing research on postmodern nostalgia and pastiche has largely focused on different models of cars. Through an interpretive analysis focusing on the dual comeback of an Italian car, the Giulia, this article aims to investigate the existence and forms that nostalgia and pastiche take under the new zeitgeist. It highlights a mutation of nostalgia that is becoming regenerative. The major consequence of this is the changing nature of pastiche, from stylistic to essentialist. Our understanding of the coming zeitgeist has also improved: in addition to confirming the major features of post-postmodernity already established in the literature, this study argues that the possibility of a (mini)miracle is another key feature of our times.
An inverse elastic method of crack identification based on sparse strain sensing sheet
Authors: Xiong Zeyu , Glisic Branko
Published: July 2020

Reliable damage detection over large areas of structures can be achieved by spatially quasi-continuous structural health monitoring enabled by two-dimensional sensing sheets. They contain dense arrays of short-gauge sensors, which increases the probability to have sensors in direct contact with damage (e.g. crack opening) and thus identify (i.e. detect, localize, and quantify) it at an early stage. This approach in damage identification is called direct sensing. Although the sensing sheet is a reliable and low-cost technology, the overall structural health monitoring system that is using it might become complex due to large number of sensors. Hence, intentional reduction in number of sensors might be desirable. In addition, malfunction of sensors can occur in real-life settings, which results in unintentional reduction in the number of functioning sensors. In both cases, reduction in the number of (functioning) sensors may lead to lack of performance of sensing sheet. Therefore, it is important to explore the performance of sparse arrays of sensors, in the cases where sensors are not necessarily in direct contact with damage (indirect sensing). The aim of this research is to create a method for optimizing the design of arrays of sensors, that is, to find the smallest number of sensors while maintaining a satisfactory reliability of crack detection and accuracy of damage localization and quantification. To achieve that goal, we first built a phase field finite element model of cracked structure verified by the analytical model to determine the crack existence (detection), and then we used the algorithm of inverse elastostatic problem combined with phase field finite element model to determine the crack length (quantification) and location (localization) by minimizing the difference between the sensor measurements and the phase field finite element model results. In addition, we experimentally validated the method by means of a reduced-scale laboratory test and assessed the accuracy and reliability of indirect sensing.
Cable tension identification via nonlinear static inverse problem
Authors: Pacitti Arnaud , Peigney Michaël , Bourquin Frédéric , Lacarbonara Walter
Published: July 2020

A new identification technique is proposed to evaluate the tension of a cable using a static inverse approach that couples a universal cable model with displacement sensors, strain gauges and added masses that should preserve operational affordability. An inverse problem is formulated as the minimization of a data misfit functional based on the differences in terms of vertical displacements and axial strains between two equilibrium configurations of the cable, namely, one loaded and the other free. The inverse problem formulation echoes the parametric study of a non-conventional functional suggesting a way to identify the cable parameters, namely, its length, its axial stiffness, and its mass per unit length. The computational resolution of the inverse problem is implemented as a two-step identification procedure. First, the axial stiffness and mass per unit length are kept constant and the length of the cable is approximately found via a simple line search algorithm using finite differences to estimate the functional derivatives. Second, the other physical parameters are assessed using an adjoint method for which the direct problem, the adjoint problem, and the parameter sensitivities are defined as derivatives of a Lagrangian functional with respect to dual variables, primal variables, and parameters, respectively. Due to the ill-conditioning of the problem, the proposed method does not enable an exact parameter identification but yields a good tension assessment. An experimental test campaign conducted on a multilayered 21-m long stranded cable subject to several tension levels confirms the relevance of the proposed inverse method. A field test campaign of the method on three 120-m long cables of Bonny-sur-Loire (France) suspension bridge is also presented. It proves the reliability and affordability of the overall tension identification process.
Results of Iliac Branch Devices in Octogenarians Within the pELVIS Registry
Authors: Fargion Aaron Thomas , Masciello Fabrizio , Pratesi Giovanni , Torsello Giovanni , Donas Konstantinos P. , Pratesi Carlo , Austermann Martin , Inchingolo Mirjam , Bisdas Theodosios , Pitoulias Georgios A. , Taneva Gergana T. , Dorigo Walter , Ippoliti Arnaldo , Barbante Matteo , Cao Piergiorgio , Ferrer Ciro , Verzini Fabio , Parlani Gianbattista , Simonte Gioele , Kölbel Tilo , Tsilimparis Nikolaos , Haulon Stephan , Branzan Daniela , Schmidt Andrej , Scheinert Dirk
Published: July 2020

Purpose: To evaluate if the elderly could benefit from the implantation of iliac branch devices (IBDs) to preserve the patency of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation. Materials and Methods: From January 2005 to April 2017, 804 patients enrolled in the pELVIS registry underwent endovascular aneurysm repair with 910 IBDs due to aneurysmal involvement of the iliac bifurcation. Among the 804 patients, 157 (19.5%) were octogenarians (mean age 82.9±2.5 years; 157 men) with 171 target IIAs for preservation. Outcomes at 30 days included technical success, death, conversion to open surgery, and major complications. Outcomes evaluated in follow-up were patency of the IBD and target vessels, type I and type III endoleaks, aneurysm-related reinterventions, aneurysm-related death, and overall patient survival. Kaplan-Meier analyses were employed to evaluate the late outcome measures; the estimates are presented with the 95% confidence interval (CI). Results: Technical success was 99.4% with no intraoperative conversions or deaths (1 bridging stent could not be implanted, and the IIA was sacrificed). Perioperative mortality was 1.9%. The overall perioperative aneurysm-related complication rate was 8.9% (14/157), with an early reintervention rate of 5.1% (8/157). Median postoperative radiological and clinical follow-up were 21.8 months (range 1–127) and 29.3 months (range 1–127), respectively. Estimated rates of freedom from occlusion of the IBD, the IIA, and the external iliac artery at 60 months were 97.7% (95% CI 96.1% to 99.3%), 97.3% (95% CI 95.7% to 98.9%), and 98.6% (95% CI 97% to 99.9%), respectively. Estimated rates of freedom from type I and type III endoleaks and device migration at 60 months were 90.9% (95% CI 87% to 94.3%), 98.7% (95% CI 97.5% to 99.8%), and 98% (95% CI 96.4% to 99.6%), respectively. Freedom from all cause reintervention at 60 months was 87.4% (95% CI 82.6% to 92.2%). The estimated overall survival rate at 60 months was 59% (95% CI 52.4% to 65.6%). Conclusion: IBD implantation in octogenarians provided acceptable perioperative mortality and morbidity rates, with satisfying long-term freedom from IBD-related complications and should be considered a feasible repair option for selected elderly patients affected by aneurysms involving the iliac bifurcation.
Manufacturing Hate 4.0: Can Media Studies Rise to the Challenge?
Authors: Lim Sun Sun
Published: July 2020

This article reflects on the growing scourge of hate speech and its propagation via digital social media networks. It discusses how media studies has drawn attention to salient aspects of online hate speech including technological affordances, communication tactics, representational tropes, and audience response. It argues that insights from media studies are vital for unpacking the societal impact of the media and indeed for tackling a destructive force such as online hate speech. It further encourages media studies scholars to engage vigorously with colleagues in and across other disciplines to forge interdisciplinary research collaborations to address pressing societal issues. It urges media studies scholars to connect with the realms of industry, policy making, and civic society to ensure that the public discourse on the challenges of digitalization and mediatization is academically informed, evidence-based, and finely balanced.
No Grand Pronouncements Here...: Reflections on Cancel Culture and Digital Media Participation
Authors: Ng Eve
Published: July 2020

Although there are numerous prominent examples of social media misuse, these cases should not disproportionately characterize the scope or potential of digital media participation as a whole. Using cancel culture as an entry point, this essay discusses how digital practices often follow a trajectory of being initially embraced as empowering to being denounced as emblematic of digital ills. However, while platforms such as Twitter do have characteristics that militate against nuanced debate, scholars can productively direct attention to interactions in other digital spaces, particularly using methods that yield more qualitatively informative data. These spaces include message boards and comment threads, which foster more long-form engagement. It is also important to look beyond the major English-language platforms, both to account for platform-specific features and so that conditions of online discourse routine in many global contexts, such as negotiating censorship, are centrally theorized in digital media studies.
Three Challenges for Media Studies in the Age of Platforms
Authors: Poell Thomas
Published: July 2020

Digital platforms, from Instagram to Spotify, have become central to the production, distribution, and monetization of cultural content. This essay discusses how this process of platformization poses three interrelated challenges for the research on and governance of contemporary cultural industries. First, platformization complicates the question of media concentration, as platform corporations integrate highly diverse businesses, not only hosting and curating media content, but also functioning as advertising networks, data intermediaries, and so on. Second, it thwarts the regulation of media content, as platforms channel vast amounts of heterogeneous materials, shared by a broad range of users, making it extremely difficult to maintain oversight. Third, the growing dominance of platform corporations over the cultural domain makes it vital, but also difficult, to develop and sustain online public service media and alternative noncommercial platforms. The essay closes by discussing how these challenges can and should be addressed from the perspective of media studies.
Mobilizing Media Studies in an Age of Datafication
Authors: Dencik Lina
Published: July 2020

We are at a pivotal moment for understanding and deciding what is actually at stake with datafication. In this contribution, I argue for the increasingly important and politicized role of media scholarship to privilege lived experiences and situated practices as a counter to the active neutralization of data-driven systems and their implications. In particular, I argue for the relevance of media studies to emphasize the uses to which technology is put and explore how data practices relate to other social practices and historical contexts as a way to broaden the parameters of response, moving data politics beyond the confines of the technology itself, and contending instead with the premise and terms of the debate.
What Roseanne Barr Meant to Media Studies
Authors: Leonard Suzanne
Published: July 2020

After a series of vile tweets, in 2018 comedienne Roseanne Barr was summarily dismissed from her eponymous sitcom Roseanne, a self-styled reboot of the original U.S. television show (running from 1988 to 1997). While Barr’s firing may seem like a rarified event, my concern is with the vexed position of the unruly comedienne in a paradoxical cultural moment in which feminist activism has impacted the media industries, yet misogyny and xenophobia are blatantly incarnated in U.S. political leadership. Barr’s brand of unapologetic comedy served as a foundational heuristic for the development of feminist television studies, yet her politics have been increasingly revealed as abhorrent. This article examines this puzzling disconnect between progressive political gains around gender, class, body size, and sexuality in the realm of media personalities, products, and theories, and the seemingly intractable position of regressive racism, a conflation that Barr’s brand of toxic provocation both articulates and underscores.
Field Mapping: What Is the “Media” of Media Studies?
Authors: Parks Lisa
Published: July 2020

This short article explores the changing meanings of “media” in media studies in relation to emerging technologies and critical paradigms in the field. After brief discussion of various media studies approaches, including media ecologies and algorighmic cultures, the article discusses the institutional rise of data sciences and compares this field to media studies. The author argues that while the foundational assumptions, methodological frameworks, and mindsets of data sciences and media studies differ, curious co-existences can morph into lively collaborations rather than turf battles, and concludes by pointing to research that explemplies a productive synthesis.
Using Interactive E-Book User Log Variables to Track Reading Processes and Predict Digital Learning Outcomes
Authors: Yang Dandan , Zargar Elham , Adams Ashley Marie , Day Stephanie L. , Connor Carol McDonald
Published: July 2020

Stealth assessment has been successfully embedded in educational games to measure students’ learning in an unobtrusive and supportive way. This study explored the possibility of applying stealth assessment in a digital reading platform and sought to identify potential in-system indicators of students’ digital learning outcomes. Utilizing the user log data from third- to fifth-grade students ( n = 573) who read an interactive Word Knowledge E-Book, we examined various user log variables and their associations with word knowledge and strategic reading outcomes. Descriptive analysis provided a depiction of the real-time reading processes and behaviors in which students engaged while digitally reading. Multiple regression analysis with classroom fixed effects demonstrated that user log variables relevant to answering questions and making decisions (i.e., percentage of embedded questions answered correctly; number of attempts to answer the questions; and making implausible decisions) were significantly associated with students’ word knowledge and strategic reading outcomes. Variables indicating reading time and frequency, however, were not significantly associated with these outcomes. This study highlights the potential of interactive e-books as another digital learning environment to establish stealth assessment, which may allow researchers and educators to track students’ reading processes and predict reading outcomes while supporting digital learning.
NRF2 mediates γ-globin gene regulation through epigenetic modifications in a β-YAC transgenic mouse model
Authors: Zhu Xingguo , Xi Caixia , Ward Alexander , Takezaki Mayuko , Shi Huidong , Peterson Kenneth R , Pace Betty S
Published: July 2020

NRF2 is the master regulator for the cellular oxidative stress response and regulates γ-globin gene expression in human erythroid progenitors and sickle cell disease mice. To explore NRF2 function, we established a human β-globin locus yeast artificial chromosome transgenic/NRF2 knockout (β-YAC/NRF2−/−) mouse model. NRF2 loss reduced γ-globin gene expression during erythropoiesis and abolished the ability of dimethyl fumarate, an NRF2 activator, to enhance γ-globin transcription. We observed decreased H3K4Me1 and H3K4Me3 chromatin marks and association of TATA-binding protein and RNA polymerase II at the β-locus control region (LCR) and γ-globin gene promoters in β-YAC/NRF2−/− mice. As a result, long-range chromatin interaction between the LCR DNase I hypersensitive sites and γ-globin gene was decreased, while interaction with the β-globin was not affected. Further, NRF2 loss silenced the expression of DNA methylcytosine dioxygenases TET1, TET2, and TET3 and inhibited γ-globin gene DNA hydroxymethylation. Subsequently, protein-protein interaction between NRF2 and TET3 was demonstrated. These data support the ability of NRF2 to mediate γ-globin gene regulation through epigenetic DNA and histone modifications.

Impact statement

Sickle cell disease is an inherited hemoglobin disorder that affects over 100,000 people in the United States causing high morbidity and early mortality. Although new treatments were recently approved by the FDA, only one drug Hydroxyurea induces fetal hemoglobin expression to inhibit sickle hemoglobin polymerization in red blood cells. Our laboratory previously demonstrated the ability of the NRF2 activator, dimethyl fumarate to induce fetal hemoglobin in the sickle cell mouse model. In this study, we investigated molecular mechanisms of γ-globin gene activation by NRF2. We observed the ability of NRF2 to modulate chromatin structure in the human β-like globin gene locus of β-YAC transgenic mice during development. Furthermore, an NRF2/TET3 interaction regulates γ-globin gene DNA methylation. These findings provide potential new molecular targets for small molecule drug developed for treating sickle cell disease.
Education Collections: Case Study in Their Use to Replace Permanent Collection Objects
Authors: Hughes Elaine
Published: July 2020

The use of an education collection in nontraditional museum settings is presented as a case study based on work at the Museum of Northern Arizona (MNA) between 2004 and 2020. MNA sought to resolve the use of permanent collections in nontraditional museums settings, specifically as decoration in an historic homestead complex and display in an assisted living facility, through the use, instead, of education objects. Historically, there was no distinction between education and permanent collections at MNA, but with the founding of an Education Division in 1975, a separate education collection began to grow. Recognizing the need to manage these assets, MNA staff developed a system to document and track these holdings and worked to sync policy with process. MNA updated its Collections Management Policy section on its education collection with a major shift in responsibility for documenting these holdings from the Education Department to the Collections Department. With a documented procedure and formal policy, MNA is set to complete the final project in 2020. MNA’s experience illustrates that an education collection can be used for more than hands-on experience. When used as decorative or display pieces, an education collection can serve to enrich our lives.
Assisting patients experiencing family violence: A survey of training levels, perceived knowledge, and confidence of clinical staff in a large metropolitan hospital
Authors: Fisher Caroline A. , Rudkin Nadine , Withiel Toni D , May Amanda , Barson Elizabeth , Allen Beverley , O’Brien Emma , Willis Karen
Published: July 2020

Objectives:

Family violence is a public health issue. It occurs in many forms, is most commonly directed at woman and children, and contributes significantly to death, disability, and illness. This study was conducted in the clinical staff in a large metropolitan hospital and aimed to determine levels of family violence training, self-perceived knowledge and confidence, specific clinical skills, and barriers to working effectively in the area.

Methods:

A short, targeted online survey was designed to capture the required information. Descriptive statistics were calculated, and free-text responses were analyzed using qualitative content analysis.

Results:

Survey responses were received from 534 staff (242 nurses, 225 allied health, 67 medical). Sixty-five percent had received some form of family violence training, mostly of short duration (1–3 h); 72% reported having little or no confidence working in the area, while 76% indicated that they had little or no knowledge in the area. Longer duration training was associated with an increase in knowledge and confidence ratings. Family violence screening rates and knowledge of several specific family violence clinical skills (how to appropriately ask clients about family violence and family violence risk factors) were also low. Thirty-four percent indicated that they did not know what to do, when a patient disclosed experiencing family violence. The most commonly indicated barriers to working effectively in this area were suspected perpetrators being present, perceived reluctance of patients/clients to disclose when asked, and time limitations.

Conclusion:

This research provides a useful snapshot of clinical staff perceptions of their family violence skill levels in a large metropolitan Australian tertiary hospital. It highlights the need for further in-depth training in clinical health professionals in family violence. The research will allow for family violence training to be tailored to the needs of the professional discipline and clinical area.
Synthesis, crystal structure, and thermal properties of Ni(NH3)4(AFT)2
Authors: Wei Shu-han , Ma Xiao , Ding Zi-mei , Xu Kang-zhen , Gao Hong-xu , Huang Jie , Zhao Feng-qi
Published: July 2020

Ni(NH3)4(AFT)2 [NiC6H16N18O2, AFT = 4-amino-3-(5-tetrazolate)furazan] is synthesized and characterized by elemental analysis and Fourier-transform infrared spectroscopy for the first time. X-ray diffraction measurements are used to determine the crystal structure of compound 1. The results demonstrate that compound 1 crystallized in the orthorhombic crystal system. The nickel(II) ion is six-coordinated by N atoms from two AFT-ligands and four NH3 molecules. Its thermal properties are investigated by differential scanning calorimetry and thermogravimetry-derivative thermogravimetry methods, with the results demonstrating that the differential scanning calorimetry curve exhibits two endothermic and one exothermic processes. The endothermic processes are in the range of 130–510 °C with a peak temperature of 188 °C. The temperature from 230 to 400 °C is the exothermic process in which the peak temperature is 314.58 °C. In addition, Kissinger’s and Ozawa-Doyle’s methods are used for calculating the non-isothermal kinetics parameters. Moreover, the apparent activation energy ( E), safety, and thermal stability parameters ( TSADT, TTIT, Tb) for Ni(NH3)4(AFT)2 are calculated. In addition, the calculated thermodynamic functions ( ∆S≠, ∆H≠, and ∆G≠) for the exothermic decomposition process of Ni(NH3)4(AFT)2 are 55.07 J mol−1 K−1, 196.18 kJ mol−1, and 164.90 kJ mol−1, respectively.
The influence of skin tears following collagenase treatment of Dupuytren’s disease on treatment outcomes
Authors: Phan Robert , Rozen Warren M. , Dela Cruz Giselle , Tobin Vicky , Hunter-Smith David J.
Published: July 2020

This study investigated influence of skin tears on patient-reported outcomes of injection of collagenase clostridium histolyticum for Dupuytren’s disease and association between extension deficit of digits before injection and skin tear after the injection. From 2016 to 2018, 391 Dupuytren’s cords were treated in 184 patients in a prospective cohort study and the patients were evaluated before injection and six months after injection. Skin tears occurred in 50% of these patients. We found no significant differences in the patient-reported outcomes between patients with or without skin tears. A higher extension deficit before treatment was associated with significantly increased frequency of skin tears. We conclude that the incidence of skin tears after injection does not affect patient reported outcomes six months after collagenase injection, but the incidence of skin tears is significantly associated with the severity of pre-treatment finger extension deficits.

Level of evidence: II
A bibliometric analysis of 23,492 publications on rectal cancer by machine learning: basic medical research is needed
Authors: Wang Kangtao , Feng Chenzhe , Li Ming , Pei Qian , Li Yuqiang , Zhu Hong , Song Xiangping , Pei Haiping , Tan Fengbo
Published: July 2020

Background and Aims:

The aim of this study was to analyse the landscape of publications on rectal cancer (RC) over the past 25 years by machine learning and semantic analysis.

Methods:

Publications indexed in PubMed under the Medical Subject Headings (MeSH) term ‘Rectal Neoplasms’ from 1994 to 2018 were downloaded in September 2019. R and Python were used to extract publication date, MeSH terms and abstract from the metadata of each publication for bibliometric assessment. Latent Dirichlet allocation was applied to analyse the text from the articles’ abstracts to identify more specific research topics. Louvain algorithm was used to establish a topic network resulting in identifying the relationship between the topics.

Results:

A total of 23,492 papers published were identified and analysed in this study. The changes of research focus were analysed by the changing of MeSH terms. Studied contents extracted from the publications were divided into five areas, including surgical intervention, radiotherapy and chemotherapy intervention, clinical case management, epidemiology and cancer risk as well as prognosis studies.

Conclusions:

The number of publications indexed on RC has expanded rapidly over the past 25 years. Studies on RC have mainly focused on five areas. However, studies on basic research, postoperative quality of life and cost-effective research were relatively lacking. It is predicted that basic research, inflammation and some other research fields might become the potential hotspots in the future.
A Paramedic’s Christmas Story
Authors: De La Garza John
Published: July 2020

I identify my experience as a professional paramedic as one of chaos and personal rupture. My story is one of survival. My quest is to have the experience count for something more than just having done the job. Through an insider’s perspective I have traced the time that I spent in the Emergency Medical Services (EMS) of the San Antonio Fire Department by reflecting, interpreting, and analyzing a collection of dramatic events that significantly impacted my life both personally and professionally. I describe my time in EMS as one of chaos and personal rupture. Although this account is a representation of one twenty-four-hour shift, it is the prelude to a much deeper story that remained untold for 30 years.
Concussion Epidemiology in Youth Sports: Sports Study of a Statewide High School Sports Program
Authors: Chun Benjamin J. , Furutani Troy , Oshiro Ross , Young Casey , Prentiss Gale , Murata Nathan
Published: July 2020

Background:

Current research on concussion incidence in youth athletes (age <18 years) is small and limited by variability in injury reporting and diagnostic methodology.

Hypothesis:

Concussion injuries commonly occur in high school sports programs. The likelihood of concussion among student-athletes (aged 13-18 years) depends on the sport they are participating in as well as the sex of the athlete.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 4.

Methods:

A retrospective analysis of all Hawaii high school athletes aged 13 to 18 years participating in 14 sports from 2011 through 2017 was performed as part of a statewide standardized concussion assessment and management program.

Results:

A total of 5993 concussions were identified among 92,966 athletes. The overall concussion rate was 0.96 (95% CI, 0.94-0.99). Girls’ judo had the highest concussion rate (1.92; 95% CI, 1.68-2.17) followed by football (1.60; 95% CI, 1.53-1.66). The concussion rate for boys (1.0; 95% CI, 0.97-1.03) was higher than that for girls (0.91; 95% CI, 0.87-0.95); however, in 4 of the 5 sports in which both girls and boys participated, girls had a higher rate of concussion injury.

Conclusion:

The likelihood of concussion among student-athletes aged 13 to 18 years may be higher than previously thought and varies depending on sport and sex.

Clinical Relevance:

Epidemiologic data on concussion injury in children and adolescents are useful in accurately determining the relative risks of high school sports participation and may be valuable in determining the appropriate allocation of health care and scholastic resources for student-athletes, as well as the impact of rule and training modifications designed to improve participant safety.
When to Abandon the Arthroscopic Bankart Repair: A Systematic Review
Authors: Levy Benjamin J. , Grimm Nathan L. , Arciero Robert A.
Published: July 2020

Context:

Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed.

Objective:

To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature.

Data Sources:

An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE).

Study Selection:

Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair.

Study Design:

Systematic review.

Level of Evidence:

Level 4.

Data Extraction:

Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar).

Results:

A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking.

Conclusion:

It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.
Supply-and-demand projections for the health workforce at a provincial level from 2015 to 2025 in Ilam, Iran
Authors: Bazyar Mohammad , Noori Hekmat Somayeh , Rafiei Sima , Mirzaei Amin , Otaghi Masoomeh , Khorshidi Ali , Mohammadnejad Sara , Tahmasebi Samane , Amarloei Ali , Jalilian Mohsen
Published: July 2020

Background:

Human resources are the key component of health systems. It is critical to have the right number of human resources at anytime and anywhere in the health system. This article aims to help local health decision makers to identify potential gaps between the future supply and demand of human resources and to make necessary changes in medical training processes to fill the gap.

Methods:

An eight-stage process was applied to project the supply and demand of health workers in Ilam province in 2025 for the following fields: public health, environmental health, general medicine, dentistry, pharmacy, nursing and midwifery. To estimate the demand for human resources, a mainly population-based model (manpower-to-population ratio) was applied. A modified version of the Australian dynamic stock and flow model was used to predict the supply of new recruits in 2025. The potential surplus or shortfall in the health workforce was calculated by comparing the supply and demand in 2025.

Results:

The demand and supply projections for the chosen fields were estimated respectively as: general medicine 457, 709; pharmacy 131, 86; dentistry 86, 251; nursing 949, 1657; midwifery 24, 247; public health 182, 211; and environmental health 92, 225.

Conclusions:

The current trend of medical graduates will meet the need for human resources in 2025, and there is no need to increase medical student admission. The Education Deputy of Ilam Medical University should take into account the health needs of its catchment area in medical educational processes and training new health-care staff.