bluuebunny/crossref_metadata_2025 huggingface dataset:
PredictNcool
Authors: Siddhu Lokesh , Panda Preeti Ranjan
Published: October 2019

Recent research on mitigating thermal problems in 3D memories has covered reactive strategies that reduce memory power consumption, and thereby, performance, when the memory temperature reaches the maximum operating limit. Such techniques could benefit from temperature prediction and avoid unnecessary invocations and state transitions of the thermal management strategy. We develop an accurate steady state temperature predictor for thermal management of 3D memories. We utilize the symmetries in the floorplan, along with other design insights, to reduce the predictor’s model parameters, making it lightweight and suitable for runtime thermal management. Using the temperature prediction, we introduce
PredictNcool
, a proactive thermal management strategy to reduce application runtime and memory energy. We compare
PredictNcool
with two recent thermal management strategies and our experiments show that the proposed optimization results in performance improvements of 28% and 5%, and memory subsystem energy reductions of 38% and 12% (on average).
Status, Institutions, and Prospects for Global Capture Fisheries
Authors: Costello Christopher , Ovando Daniel
Published: October 2019

We compile global data to examine the current status, trends, threats, and opportunities in the world's wild-capture fisheries. We find that global fisheries have largely diverged—well-managed, often industrial fisheries tend to be in reasonably good health, while coastal fisheries, often from low-governance regions, tend to be in poor health. Good governance seems to play a central role, and we summarize key findings from the literature on how effective fishery management can simultaneously increase food security, livelihoods, and conservation outcomes. Other solutions, such as marine protected areas and big data, can be useful but will not, by themselves, solve the main fishery challenges. We conclude by examining notorious threats, such as climate change and lack of governance on the high seas, and find that these can be largely neutralized with good fishery management, suggesting that overall, the future of wild fisheries can be bright with effective fishery management interventions.
Is a Universal Influenza Virus Vaccine Possible?
Authors: Nachbagauer Raffael , Palese Peter
Published: October 2019

Influenza viruses remain a severe burden to human health because of their contribution to overall morbidity and mortality. Current seasonal influenza virus vaccines do not provide sufficient protection to alleviate the annual impact of influenza and cannot confer protection against potentially pandemic influenza viruses. The lack of protection is due to rapid changes of the viral epitopes targeted by the vaccine and the often suboptimal immunogenicity of current immunization strategies. Major efforts to improve vaccination approaches are under way. The development of a universal influenza virus vaccine may be possible by combining the lessons learned from redirecting the immune response toward conserved viral epitopes, as well as the use of adjuvants and novel vaccination platforms.
Laboratory Simulation of Flow through Rough-Walled Microfractures under High Hydraulic Gradient
Authors: Zhang Shuai , Qiao Wei-Guo , Li Yan-Zhi , Song Wei-Jie , Qin Jun-Ling , Wang Ji-Yao
Published: October 2019

Laboratory experiments on fluid flow through fracture are important in solving the fluid-in-rush problems that happen during the tunnel excavation. In order to study the mechanism of fluid flow through a rough-walled microfracture, fluid flow experiments were carried out and the fiber Bragg grating (FBG) strain sensors were applied to monitor the deformation of the microfracture surface during the seepage process. Considering the difficulty of collection of undisturbed rock samples from the deep locations, a methodology to simulate fluid flow through a fractured rock mass using analog materials containing a single fracture was developed. This method is easy to simulate the fluid flow through a fracture of certain aperture. Experimental data showed that Forchheimer equation could provide an excellent description of the nonlinear relationship between hydraulic gradient and flow velocity, and the variations of Forchheimer coefficients with joint roughness coefficient (JRC) were studied. It was found that the deformation of the microfracture surface subjected to seepage could be accurately captured by the quasi-distributed FBG strain sensors. The test results also demonstrated that the surface strain is significantly affected by hydraulic pressure.
Integrated Multicriteria Decision-Making Methods to Solve Supplier Selection Problem: A Case Study in a Hospital
Authors: Akcan Serap , Güldeş Meral
Published: October 2019

In supply chain literature, supplier evaluation and selection problem is one of the most studied subjects because of the significant roles of suppliers in terms of the chain’s sustainability and profitability. Therefore, it is important for organizations to adopt a systematic way to evaluate and select the best supplier according to their respective criteria in today’s competitive environment. Multicriteria decision-making methods provide for this need of organizations because determination of an appropriate supplier selection is a multicriteria decision-making (MCDM) problem essentially. Although a lot of applications of these methods for supplier evaluation and selection can be seen in the literature, studies in the health-care sector are insufficient. Hospitals in the health-care sector also have to consider their supplier-related decisions to decrease risks and threads which affect their effectiveness. The aim of this study was to fill this gap by providing different hybrid models for selecting the best supplier for hospitals. Supplier evaluation and selection process start with recognizing the related criteria according to the studies in the literature. Analytic hierarchy process (AHP) method is deployed to weight the criteria, and suppliers are listed via technique for order preference by similarity to ideal solution (TOPSIS), elimination and choice translating reality English (ELECTRE), grey relational analysis (GRA), and simple additive weighting (SAW) methods. The main aim of this study was to present different hybrid MCDM methods and show their efficiency and consistency with each other. In this study, hybrid multicriteria decision-making models (AHP-TOPSIS, AHP-ELECTRE, AHP-GRA, and AHP-SAW) are presented and compared. The results show that the presented hybrid methods in this study are consistent with each other and give the same ranking for the selection of the best supplier. It can be considered as a useful guideline for hospitals.
Workshop Report
Authors: Pang Li , Sager Philip , Yang Xi , Shi Hong , Sannajust Frederick , Brock Mathew , Wu Joseph C. , Abi-Gerges Najah , Lyn-Cook Beverly , Berridge Brian R. , Stockbridge Norman
Published: October 2019

Given that cardiovascular safety concerns remain the leading cause of drug attrition at the preclinical drug development stage, the National Center for Toxicological Research of the US Food and Drug Administration hosted a workshop to discuss current gaps and challenges in translating preclinical cardiovascular safety data to humans. This white paper summarizes the topics presented by speakers from academia, industry, and government intended to address the theme of improving cardiotoxicity assessment in drug development. The main conclusion is that to reduce cardiovascular safety liabilities of new therapeutic agents, there is an urgent need to integrate human-relevant platforms/approaches into drug development. Potential regulatory applications of human-derived cardiomyocytes and future directions in employing human-relevant platforms to fill the gaps and overcome barriers and challenges in preclinical cardiovascular safety assessment were discussed. This paper is intended to serve as an initial step in a public-private collaborative development program for human-relevant cardiotoxicity tools, particularly for cardiotoxicities characterized by contractile dysfunction or structural injury.
Thrombus Migration Paradox in Patients With Acute Ischemic Stroke
Authors: Alves Heitor C. , Treurniet Kilian M. , Jansen Ivo G.H. , Yoo Albert J. , Dutra Bruna G. , Zhang Guang , Yo Lonneke , van Es Adriaan C.G.M. , Emmer Bart J. , van den Berg René , van den Wijngaard Ido R. , Lycklama à Nijeholt Geert J. , Vos Jan-Albert , Roos Yvo B.W.E.M. , Schonewille Wouter , Marquering Henk A. , Majoie Charles B.L.M. ,   on behalf of the MR CLEAN Registry Investigators‡
Published: October 2019

Background and Purpose—

The location of the thrombus as observed on first digital subtraction angiography during endovascular treatment may differ from the initial observation on initial noninvasive imaging. We studied the incidence of thrombus dynamics, its impact on patient outcomes, and its association with intravenous thrombolytics.

Methods—

We included patients from the MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) with an initial target occlusion on computed tomography angiography located in the intracranial internal carotid artery, M1, or M2. The conventional angiography target occlusion was defined during endovascular treatment. Thrombus dynamics were classified as growth, stability, migration, and resolution. The primary outcome was functional outcome at 90 days (modified Rankin Scale). The secondary outcomes were successful and complete reperfusion (extended treatment in cerebral infarction scores of 2b-3 and 3, respectively).

Results—

The analysis included 1349 patients. Thrombus migration occurred in 302 (22%) patients, thrombus growth in 87 (6%), and thrombus resolution in 39 (3%). Intravenous treatment with alteplase was associated with more thrombus migration (adjusted odds ratio, 2.01; CI, 1.29–3.11) and thrombus resolution (adjusted odds ratio, 1.85; CI, 1.22–2.80). Thrombus migration was associated with a lower chance of complete reperfusion (adjusted odds ratio, 0.57; CI, 0.42–0.78) and successful reperfusion (adjusted odds ratio, 0.74; CI, 0.55–0.99). In the subgroup of patients with M1 initial target occlusion, thrombus migration was associated with better functional outcome (adjusted common odds ratio, 1.49; CI, 1.02–2.17), and there was a trend towards better functional outcome in patients with thrombus resolution (adjusted common odds ratio, 2.23; CI, 0.93–5.37).

Conclusions—

In patients with acute ischemic stroke, thrombus location regularly changes between computed tomography angiography and digital subtraction angiography. Administration of intravenous alteplase increases the chance of thrombus migration and resolution. Thrombus migration is associated with better functional outcome but reduces the rate of complete reperfusion.
The barratry of the shipmaster in early modern law: the approach of Italian and English law courts
Authors: Rossi Guido
Published: October 2019

For a long time, the concept of barratry (at least in its maritime meaning) was one and the same on both sides of the Channel. The barratry of the shipmaster was part of the mercantile usages, and it identified the intentionally blameworthy conduct of the master. When law courts began to decide on insurance litigation they were confronted with a notion quite alien to them. Broadly speaking, the shipmaster’s barratry could well be considered a fraud of sort. But in order to decide on its occurrence in a specific case, law courts had to analyse it in legal terms, and so according to the specific legal categories of their own system. The point ceases to be trivially obvious if we think that the different legal framework of civil and common law courts progressively led to very different interpretations of the same thing. Thus, with the shift of insurance litigation from mercantile justice to law courts maritime barratry began to acquire increasingly different features in the two legal systems. Very often, the very same conduct of the shipmaster was considered as negligent by civil law courts and barratrous by common law courts. The difference was of great practical importance, for many policies excluded barratry from the risks insured against. So, depending on the kind of law court, an insurer could be charged with full liability for the mishap or walk away without paying anything. If the beginning of the story was the same, its end could not have been more different.
The United States and the Paris Agreement on Climate Change
Authors: Khubchandani Mohit
Published: October 2019

In June 2017, US President Donald Trump announced that the US ‘will withdraw from the Paris Accord’. This paper argues that the US is still a party to the Paris Agreement and that its current domestic policies, such as revocation of the Clean Power Plan and lifting the Coal Moratorium, constitute an internationally wrongful act.
On the Governance of International Judicial Institutions: The Development of Performance Indicators for the International Criminal Court
Authors: Carcano Andrea
Published: October 2019

This article reviews the recent effort of the Assembly of States Parties to the Rome Statute (ASP) to measure the performance of the International Criminal Court (ICC) through the identification of goals and performance indicators. Upon an analysis of the various performance indicators reports prepared by the ICC and pertinent scholarly contributions, it offers a critical review of the ASP’s endeavour. While appreciating the usefulness of the large amount of information collected by the ICC in the said reports, it argues that the turn to managerialism brought about by the ASP’s endeavour, while laudable in many respects, may constitute an encroachment on the exercise of the judicial function if not properly handled through a closer coordination with the goals set in the ICC Statute. It may, in fact, amount to ‘micromanagement’ with the consequence of diverting the ASP’s attention from the more pressing task of developing—20 years after the signing of the Rome Statute—an innovative vision of the ICC’s role for the next (20) years.
Sustainable Development Goal 16 at a Cross-Roads
Authors: Lachenmann Frauke
Published: October 2019

The negotiation process of the Sustainable Development Goals (SDGS) process was extremely ambitious. It sought to remedy all the shortcomings of the Millennium Development Goals (MDGS) by ensuring transparency, ownership of the countries of the Global South, strong involvement of civil society groups and stakeholders, and creating a truly transformative set of sustainable development goals. Yet, it did not manage to avoid all the mistakes that were characteristic of the formulation of the MDGS. In addition, it struggled with its very own problems.

The article traces the developments and debates that led to the formulation of Goal 16 on the rule of law. It shows that the success of this ambitious goal largely depends on the refinement of the indicator framework and the review mechanism.
Peliosanthes revoluta (Asparagaceae), a new species from limestone areas in southwestern Guangxi, China

Authors: NONG DONG-XIN , XIE YUE-YING , KE FANG , YU LI-YING
Published: October 2019

The genus Peliosanthes Andrews (1810: 605) belonging to the family Asparagaceae is represented by more than 70 species in tropical and subtropical Asia (IPNI 2019). In the past 15 years many species have been discovered and described from China, Cambodia, Laos and Vietnam (Tanaka 2004, Tamura et al. 2008, Averyanov & Tanaka 2012, Averyanov et al. 2013, 2015a, 2015b, 2017, Nguyen et al. 2017, Roy et al. 2017, Vislobokov 2016, Vislobokov et al. 2018). In September 2015, we collected plants of Peliosanthes growing in shadow, primary broad-leaved evergreen forests on rocky limestone mountains in southwestern Guangxi, China. They had fasciculate flowers in the axils and hence appears to be closely allied to P. teta Andrews (1810: 605), but after a close study, we found them differ clearly from the former in many significant diagnostic characters. We therefore consider the plants to represent an undescribed species and name them here.
Nomenclatural correction in Leobordea (Crotalarieae, Fabaceae)

Authors: BOATWRIGHT JAMES S.
Published: October 2019

N/A
“I’m not alone”: Women’s experiences of recovery oriented occupational therapy groups following depression
Authors: Woolley Hannah , Levy Esther , Spector Samantha , Geneau Naomie , Castro Aileen , Rouleau Suzanne , Roy Laurence
Published: October 2019

Background.

Occupational therapy groups have been carried out as interventions in mental health settings across a variety of populations. Limited research explores the lived experience of individuals with depression following participation in recovery oriented occupational therapy groups.

Purpose.

To better understand how recovery oriented occupational therapy groups shape participants’ personal experience of daily life, including recovery.

Method.

Five individuals who had previously completed at least one recovery oriented occupational therapy group each participated in two in-depth semi-structured interviews. Analyses of the transcripts were completed using interpretative phenomenological analysis (IPA).

Findings.

Participants’ experiences of the recovery oriented occupational therapy groups ranged from positive to negative, with variable impacts on their lived experiences. Two major themes emerged: (a) participants’ perception of “normal” and (b) navigation of meaningful participation.

Implications.

Increased understanding of what aspects of recovery oriented occupational therapy groups are meaningful to individuals with depression can help support their personal recovery process.
Neural network modeling and single-neuron proportional–integral–derivative control for hysteresis in piezoelectric actuators
Authors: Liang Yuen , Xu Suan , Hong Kaixing , Wang Guirong , Zeng Tao
Published: October 2019

A new polynomial fitting model based on a neural network is presented to characterize the hysteresis in piezoelectric actuators. As hysteresis is multi-valued mapping, and traditional neural networks can only solve one-to-one mapping, a hysteresis mathematical model is proposed to expand the input of the neural network by converting the multi-valued into one-to-one mapping. Experiments were performed under designed excitation with different driven voltage amplitudes to obtain the parameters of the model using the polynomial fitting method. The simulation results were in good accordance with the measured data and demonstrate the precision with which the model can predict the hysteresis. Based on the proposed model, a single-neuron adaptive proportional–integral–derivative controller combined with a feedforward loop is designed to correct the errors induced by the hysteresis in the piezoelectric actuator. The results demonstrate superior tracking performance, which validates the practicability and effectiveness of the presented approach.
De-Criminalising Adolescent to Parent Violence Under s 76 Serious Crime Act 2015 (c.9)
Authors: Bettinson Vanessa , Quinlan Christina
Published: October 2019

This article questions the appropriateness of including adolescent to parent violence (APV) within the elements of a criminal offence designed to criminalise domestic violence and abuse. The offence, s 76 Serious Crime Act 2015, prohibits controlling and coercive behaviours towards a person personally connected to the defendant. This spans ongoing intimate relationships and a wide range of family relationships. The authors conducted a small-scale research study that looked at practitioners’ understandings of APV and found that many cases of APV could satisfy the s 76 offence. The article examines the correlation between the concepts of coercive control and APV, noting that there are significant differences that justify treating adolescent-perpetrators of APV differently to adult-perpetrators of intimate partner coercive control in the criminal law. These factors concern the unique vulnerabilities of both the parent-victim and the adolescent-perpetrator in APV, and human rights law requires the equal protection of both parties on the basis of their vulnerability.
Qualitative methods II: On the presentation of ‘geographical ethnography’
Authors: Hitchings Russell , Latham Alan
Published: October 2019

This review examines how ethnographic methods currently feature in the work of human geographers. The ethnographic approach continues to be a popular choice amongst those hoping to learn from how social life unfolds in particular places and settings. But what visions of ethnography do geographers draw on to attain authorial authority? What are the implications of how they present their field experiences? How, linking back to our last review, is their ethnographic work connected to the interview? And what are some of the downsides to how the term is deployed in the discipline?
Protestors, terrorists or something else? How to think about dissident groups
Authors: Young Joseph K , Shellman Steve
Published: October 2019

Many scholars of contentious politics claim there is no such thing as a group that uses only one tactic, yet scholars, pundits, and the public routinely use single-minded terms like protestors, dissidents, and terrorists. Other scholars and research programs suggest that some groups are specialists who tend to stick to a single tactic to achieve their goals, such as non-violence, violence, or specific kinds of violence, like terror. We make the claim that both sides of the debate are empirically valid and that both types of group exist. That is, some groups tend to specialize in a single tactic while others use a variety of tactics. This paper examines the empirical distribution of group types by examining the mix of tactics that groups employ. The analysis helps resolve part of the debate and pushes scholarly thinking in new directions about how often, why, and when groups operate across this spectrum.
Prevalence of Depression and Anxiety in Parkinson Disease and Impact on Quality of Life: A Community-Based Study in Spain
Authors: Chuquilín-Arista Fany , Álvarez-Avellón Tania , Menéndez-González Manuel
Published: October 2019

Background:

Identifying neuropsychiatric disorders is essential for prompt treatment to reduce morbidity. Among these disorders, anxiety and depression have been frequently associated with Parkinson disease (PD), particularly among elderly population.

Objective:

The objective of this study is to determine the prevalence of anxiety and depression in a series of community-based PD cases in Spain, their relationship with different clinical and sociodemographic characteristics, and quality of life.

Methods:

This is an observational, descriptive, survey-based study with 95 community-based patients with PD diagnosis at different disease stages. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and the Beck Depression Inventory II, respectively. Quality of life was assessed using the Parkinson’s Disease Questionnaire 39.

Results:

The prevalence of depression and anxiety was 32.63% and 68.42%, respectively. Concomitant depression and anxiety were observed in 31.58% of patients. Patients with longer than 10 years’ PD duration had an increased risk of depression. We found a relationship between the presence of anxiety, depression, and the patient’s quality of life.

Conclusions:

Depression is present in one-third and anxiety in two-thirds of PD cases in community settings in Spain. Depression and anxiety have a very negative impact on quality of life in PD. Both anxiety and depression are independent from sociodemographic characteristics, patient’s comorbidities, or antiparkinsonian treatments; presenting as intrinsic symptoms in PD.
Group Work Assessment: Assessing Social Skills at Group Level
Authors: Forsell Johan , Forslund Frykedal Karin , Hammar Chiriac Eva
Published: October 2019

Group work assessment is often described by teachers as complex and challenging, with individual assessment and fair assessment emerging as dilemmas. The aim of this literature review is to explore and systematize research about group work assessment in educational settings. This is an integrated research area consisting of research combining group work and classroom assessment. A database search was conducted, inspired by the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The analysis and categorization evolved into a typology consisting of five themes: (a) purpose of group work assessment, (b) what is assessed in group work, (c) methods for group work assessment, (d) effects and consequences of group work assessment, and (e) quality in group work assessment. The findings reveal that research in the field of group work assessment notably focuses on social skills and group processes. Peer assessment plays a prominent role and teachers as assessors are surprising absences in the reviewed research.
Evaluating a Web-Based Health-Promoting Dialogue Tool in School Health Services: Feasibility and User Experiences
Authors: Sagatun Åse , Kvarme Lisbeth Gravdal , Misvær Nina , Myhre Mia , Valla Lisbeth , Holen Solveig
Published: October 2019

Adolescence is a sensitive period in life and a time to redefine and learn new skills. In Norway, school health services provide individual health-promoting consultations with all eighth-grade students. As an aid to support these consultations, a dialogue tool called SchoolHealth was developed using a co-creation approach. SchoolHealth consists of a web-based health information form designed to be completed by the students and generates individual feedback reports to help the school nurses to prepare for the consultation and tailor it to the individual student’s need. Our aims were to evaluate the feasibility and user experiences of SchoolHealth among students and school nurses using a mixed methods approach. A total of 79 eighth-grade students (69% of those invited) and four school nurses from three schools participated. Analyses indicated that SchoolHealth was feasible, promoted reflection among students, and helped prepare students and school nurses for the consultation.
Effectiveness of demographic characteristics in understanding Malaysian customers’ perceived value of the integrated resort sector
Authors: Ahn Jiseon
Published: October 2019

Incorporating demographic variables in brand management provides many practical benefits for service providers. Although the impact of customers’ perceived values on their attitude and behavior has been extensively examined in the past, studies connecting customers’ demographic characteristics and their tourism behavior remain scarce. Thus, this study aims to empirically investigate the role of demographic variables (e.g. gender, age, income, and marital status) in the relationship between perceived value and brand-related behavior. Specifically, the research conducts several multigroup analyses to examine how demographic factors link Malaysian customers’ behavior toward integrated resort brands. Demographic factors are found to associate with customers’ perceived spiritual, status, efficiency, and aesthetic values. Findings reveal that customers’ individual characteristics and perceived values produce different results in their future behavioral intention toward integrated resort brands. In addition, the impact of spiritual and aesthetic values on brand loyalty is stronger among male customers than among female customers. Moreover, personal satisfaction is highly influential among low-income and married customers. On the basis of these findings, this study provides implications not only for integrated resort service providers but also for destination marketers to develop micromarketing strategies.
Understanding the wine tourism experience: The roles of facilitators, constraints, and involvement
Authors: Gu Qiushi , Qiu Hanqin , King Brian EM , Huang Songshan (Sam)
Published: October 2019

Understanding the wine tourism experience is indispensable to the development of a wine tourism destination. This study tested an integrated model to obtain a better understanding of the wine tourism experience. The proposed model included both perceived wine tourism facilitators and constraints to examine their effects on wine tourism experience and tested the moderating role of involvement in these effects. Using Chinese outbound wine tourists in Australia as the study sample, this study identified that winery fame, interpersonal facilitators, and local attractions are three facilitating factors, while personal language and transportation barriers and time and information barriers were the perceived constraining factors. Both interpersonal facilitators and local attractions positively affected wine tourism experience; however, winery fame negatively influenced wine tourism experience. The study found that involvement moderated the effects of facilitators/constraints on wine tourism experience. For high-involvement wine tourists, the effect of local attractions is pronounced, while interpersonal facilitator negatively influences their wine tourism experience. Theoretical and practical implications are discussed.
Novel technologies open new frontiers in structural engineering
Authors: Mufti Aftab , Bakht Baidar , Khalid Huma
Published: October 2019

Civil infrastructures, being essential for modern and advanced societies, are the foundation of the dynamic economy and improvement of the quality of people’s lives. The design and construction of such infrastructures involve a significant cost to a country, but the proper use of the scientific methods to monitor and maintain these structures can improve their cost-effectiveness. Civil engineers strive to design and construct structures meeting the highest standards of engineering in order to enhance the durability and functionality of such infrastructures. However, civil engineers have been rather slow in adopting civionics engineering to improve the useful life of infrastructures. It is noted that the new term ‘civionics’ was coined recently to denote structural health monitoring of civil structures with the help of electronic sensors. This article will discuss several lessons learned during the implementation of health monitoring systems for civil structures.
Heterogeneous catalysts in the aldol condensation of heptanal with cyclopentanone
Authors: Vrbková Eva , Kovářová Tereza , Vyskočilová Eliška , Červený Libor
Published: October 2019

A large number of heterogeneous catalysts were tested in the aldol condensation of heptanal with cyclopentanone. There are many possible products from this aldol condensation, among which the most desired is 2-heptylidenecyclopentanone. As heterogeneous catalysts, the following were tested: caesium modified zeolites, functionalized MCM-41, and single (MgO, CaO, ZnO) and double (Mo–Si, Mg–Al, Zn–Al) metal oxides. The activity of modified zeolites and functionalized zeolites in this aldol condensation was low, whereas single and double metal oxides possessed high activity. The highest selectivity to the desired 2-heptylidenecyclopentanone (52%) was obtained using magnesium oxide as catalyst.
Delayed Presentation of Seymour Fractures: A Single Institution Experience and Management Recommendations
Authors: Samade Richard , Lin James S. , Popp James E. , Samora Julie Balch
Published: October 2019

Background: Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. Methods: A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher’s exact test, with results reported as P-values ( P), odds ratios (ORs), and 95% confidence intervals (CIs). Results: There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, P = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, P = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, P = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin ( P = .039). Conclusions: Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.
Nocturnal hypoxia in patients with idiopathic pulmonary arterial hypertension
Authors: Yan Lu , Luo Qin , Zhao Zhihui , Zhao Qing , Jin Qi , Zhang Yi , Liu Zhihong
Published: October 2019

Background

Sleep‐disordered breathing causes a variety of cardiovascular complications and increases the risk of a poor prognosis in patients. There is still some controversy regarding the clinical diagnosis and treatment of sleep‐disordered breathing in patients with pulmonary hypertension. The aim of this study was to determine the incidence of desaturation in idiopathic pulmonary arterial hypertension (IPAH) patients, evaluate the effect of desaturation on the clinical status of patients with IPAH, and identify possible influencing factors.

Methods

Patients with IPAH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from January 2018 to July 2019 were enrolled. Nocturnal hypoxic time was defined as the time that oxygen saturation remained below 90%. Desaturation was defined as a nocturnal oxygen saturation level less than 90% for more than 10% of the total recording time. Baseline clinical characteristics and parameters were collected to compare IPAH patients with and without desaturation. In addition, logistic regression was performed to identify possible factors associated with desaturation in IPAH patients.

Results

Fifty patients with IPAH were included. Among them, 17 patients presented desaturation. Patients with desaturation were older, had a shorter six‐min walking distance (6MWD), had a higher mean right atrial pressure, and had a lower daytime arterial oxygen partial pressure than patients without desaturation, and there were significant differences in the VE/VCO2 and VE/VCO2 slope (P < 0.05). The multivariate logistic regression analysis indicated that the 6 MWD (OR = 0.971, 95% CI: 0.948–0.994, P = 0.013) and; VE/VCO2 slope (OR = 1.095, 95% CI: 1.010–1.307, P = 0.032) were independently associated with desaturation after adjusting for age, sex, and body mass index.

Conclusion

Nocturnal hypoxia is common in IPAH patients. Desaturation may aggravate the clinical situation of patients with IPAH. In IPAH patients, a poor exercise capacity (6 MWD) and the VE/VCO2 slope can predict desaturation after adjusting for age, sex, and body mass index.
Deconstructing Individual Differences in Long-Term Personality Disorder and Trait Change
Authors: Woods William C. , Wright Aidan G. C. , Skodol Andrew E. , Morey Leslie C. , Hopwood Christopher J.
Published: October 2019

Converging lines of evidence suggest that personality pathology comprises shared and unique impairments. We leveraged a large clinical sample ( N = 505) and a person-centered statistical approach, ipsative change analysis, to decompose individuals’ multidimensional profiles at two time points into a metric that captures change in the elevation of the profile (i.e., impairment severity) and change in configuration of the dimensions in the profile (i.e., stylistic symptom presentation). Results demonstrated that both severity and style change were associated with overall pathology change, although the relative importance of these metrics was influenced by assessment method. Specifically, structured interview showed strong effects of severity change relative to style change, whereas self-report was less definitive. In addition, severity change was more strongly associated with change in psychosocial functioning. Results support earlier evidence of shared and unique factors in personality pathology while highlighting the influence of assessment method on models of pathology structure.
ASH evidence-based guidelines: statins in the prevention of venous thromboembolism
Authors: Evans Natalie S. , Green David
Published: October 2019

A 42-year-old woman under your care for the management of obesity calls you because she has a sister who had a pulmonary embolism. The patient recently read that statin medications are associated with a lower risk of venous thromboembolism (VTE) and wonders whether she should take a statin drug to prevent the development of pulmonary emboli.
The incidence, natural history, biology, and treatment of transformed lymphomas
Authors: Bernstein Steven H. , Burack W. Richard
Published: October 2019

Treatment of patients with transformed lymphoma presents a significant challenge to the practicing physician. Indeed, the transformation of follicular lymphoma to a more aggressive histology is inherent to the biology of this disease and is often associated with an aggressive clinical course, resulting in a poor prognosis. Recent population-based studies have better defined the incidence of this event, and recent laboratory studies have defined the molecular and immunological processes associated with transformation. These studies will be discussed in this review, as will the treatment options for these patients.
The Clinical Relevance of Response Variability to Antiplatelet Therapy
Authors: Cattaneo Marco
Published: October 2019

Interindividual variability in the pharmacological response to antiplatelet drugs has been reported in some studies. Suboptimal response to aspirin, as determined by specific tests (serum thromboxane B2), appears to be rare and in most cases is caused by poor compliance. In contrast, studies using specific tests to measure the pharmacological effect of clopidogrel showed a wide variability of responses, with a significant number of subjects (approximately one-third) who were very poor responders. Interindividual differences in the extent of metabolism of clopidogrel to its active metabolite is the most plausible mechanism for the observed interindividual variability in platelet inhibition. Tailored treatment based on laboratory monitoring of platelet function has been proposed as a solution to poor responsiveness to clopidogrel. However, we still need to identify the ideal laboratory test and to answer basic questions on its clinical utility and cost-effectiveness before monitoring clopidogrel therapy can be recommended in clinical practice.
How do novel molecular genetic markers influence treatment decisions in acute myeloid leukemia?
Authors: Patel Jay P. , Levine Ross L.
Published: October 2019

Acute myeloid leukemia (AML) is the most common acute leukemia diagnosed in adults, and the majority of patients with AML die from relapsed disease. Although many studies over the past 4 decades have identified disease alleles in AML, recent genome-wide and candidate gene studies have identified additional recurrent somatic mutations in AML patients with biologic, clinical, and therapeutic importance. Herein we review our current understanding of the molecular pathogenesis of AML and discuss how mutational profiling can be used to refine prognostication in AML and to inform therapeutic approaches. We also review the current challenges in translating genomic studies to the clinical setting, which remains a significant challenge and an urgent priority.
Is there a role for “watch and wait” in follicular lymphoma in the rituximab era?
Authors: Kahl Brad
Published: October 2019

The paradigm of “watch and wait” for low-tumor-burden follicular lymphoma (LTB-FL) was established in an era when the treatment options were more limited. With the introduction of rituximab, it appears that the natural history of this incurable disease has changed. However, most of the contemporary treatment data have been generated in patients with high tumor burden, and it is unclear whether the improvements in outcome also apply to the LTB population. There are no published trials evaluating rituximab-chemotherapy combinations and just a few studies evaluating single-agent rituximab in this population. As a result, there are many unknowns in the management of LTB-FL. Would the application of rituximab-chemotherapy combination cure a fraction of patients? Would the application of rituximab-chemotherapy combination improve the overall survival of the population? Would treatment with single-agent rituximab improve the psychologic quality of life by avoiding a watch and wait interval or by delaying the time to first chemotherapy? This review, a mixture of data and opinion, will discuss goals of therapy for an LTB-FL patient, summarize existing data, and propose a management algorithm.
Emerging role of kinase-targeted strategies in chronic lymphocytic leukemia
Authors: Wiestner Adrian
Published: October 2019

Chronic lymphocytic leukemia (CLL) is a malignancy of mature B cells that depend on host factors in the tissue microenvironment for survival and proliferation. In vitro, CLL cells rapidly undergo apoptosis unless microenvironmental factors are provided that support their survival. Signaling pathways activated in the microenvironment in vivo include the B-cell receptor (BCR) and NF-κB pathways. Thus, CLL is a disease “addicted to the host” and is dependent on pathways that promote normal B-cell development, expansion, and survival; this is particularly true in the case of the BCR signaling cascade. Small-molecule inhibitors of kinases that are essential for BCR signal transduction abrogate the stimulating effects of the microenvironment on CLL cells. The orally administered tyrosine kinase inhibitors fostamatinib and ibrutinib and the phosphatidylinositol 3-kinase inhibitor GS-1101 have induced impressive responses in relapsed and refractory CLL patients, mostly with moderate side effects. Reductions in lymphadenopathy and splenomegaly are seen within weeks and are frequently accompanied by a transient rise in absolute lymphocyte count that is asymptomatic and probably the result of changes in CLL cell trafficking. This review discusses the biologic basis for kinase inhibitors as targeted therapy of CLL and summarizes the exciting early clinical experience with these agents.
Complement in hemolytic anemia
Authors: Brodsky Robert A.
Published: October 2019

Complement is increasingly being recognized as an important driver of human disease, including many hemolytic anemias. Paroxysmal nocturnal hemoglobinuria (PNH) cells are susceptible to hemolysis because of a loss of the complement regulatory proteins CD59 and CD55. Patients with atypical hemolytic uremic syndrome (aHUS) develop a thrombotic microangiopathy (TMA) that in most cases is attributable to mutations that lead to activation of the alternative pathway of complement. For optimal therapy, it is critical, but often difficult, to distinguish aHUS from other TMAs, such as thrombotic thrombocytopenic purpura; however, novel bioassays are being developed. In cold agglutinin disease (CAD), immunoglobulin M autoantibodies fix complement on the surface of red cells, resulting in extravascular hemolysis by the reticuloendothelial system. Drugs that inhibit complement activation are increasingly being used to treat these diseases. This article discusses the pathophysiology, diagnosis, and therapy for PNH, aHUS, and CAD.
Treatment-free remission in CML: who, how, and why?
Authors: Mahon Francois-Xavier
Published: October 2019

Chronic myeloid leukemia (CML) is the best example of successful targeted therapy. Today, the overall survival of patients with CML treated by using tyrosine kinase inhibitors (TKIs) is very close to that of the healthy population. The current question is: how can we further ameliorate the clinical outcome of patients with CML? Clinical trials have shown that some patients with CML in the chronic phase who achieve sustained deep molecular responses on TKI therapy can safely suspend therapy with no evidence of relapse. The long follow-up studies and the number of eligible patients have now validated the concept of treatment-free remission (ie, the ability to maintain a molecular response after stopping therapy). It should be considered as the future criterion to evaluate the success of clinical trials, especially if we want to take into account the quality of life of patients in addition to the economic aspect. Because post-TKI discontinuation follow-ups have been increasing over time with no evidence of relapse in some patients, the next step for the coming decade will be to address the topic of CML cure.
HEMATOLOGIC EFFECTS OF SPLENECTOMY IN STILL-CHAUFFARD-FELTY SYNDROME
Authors: HIRSCHBOECK JOHN S.
Published: October 2019

Two cases of Still-Chauffard-Felty syndrome treated by splenectomy are presented. One case has survived five years with complete hematologic restitution and definite improvement in the arthritis. The second case expired six weeks after splenectomy. Autopsy revealed portal vein thrombosis (pylephlebitis). Both cases exhibited the blood manifestations associated with "hypersplenism." In both cases splenectomy resulted in a return of the peripheral blood picture to relative normality.
TREATMENT OF LIVER EXTRACT SENSITIVITY
Authors: SCHWARTZ STEVEN O. , LEGERE HELEN
Published: October 2019

Sensitivity reactions to the parenteral administration of liver extract are not uncommon. They were present in 68 of 396 patients (17 per cent) receiving liver therapy.

The symptoms of sensitivity to liver extract are those of any foreign protein reaction.

Various technics can be used to circumvent reactions and still maintain patients on adequate doses of liver extract.

These methods are:

A. Changing the "brand" or type of liver extract.

B. Reducing the dose of liver extract.

C. Desensitization with liver extract.

D. Utilizing a histamine-protein complex as an antigen to produce histamine antibodies.

The latter method was successful in 10 of 11 cases in which other methods had been without effect.
RUPTURE OF THE SPLEEN IN INFECTIOUS MONONUCLEOSIS
Authors: SMITH E. B. , CUSTER R. P.
Published: October 2019

1. Seven cases of ruptured spleen as a complication of infectious mononucleosis are described and reference made to the 3 cases previously recorded in the literature.

2. It proved possible to make an objective histologic diagnosis of infectious mononucleosis from well prepared sections of the spleens. The diagnosis was based on: (a) a blurred architectural pattern due chiefly to large numbers of atypical lymphocytes diffused throughout the pulp and clumped in the blood sinuses; (b) small, poorly defined follicles, usually without germinal centers, in less than usual numbers per unit area; (c) cellular "infiltrates," composed largely of normal and atypical lymphocytes, in the capsule and trabeculae, in the adventitia of small intratrabecular arteries, and in the subintimal zone of collecting venous sinuses and intratrabecular veins; (d) swelling of the lining or attached cells of the blood sinuses.

3. "Infiltration" of the capsule and trabeculae reached considerable proportions, occasionally to the point of complete dissolution of these structures, and served as a predisposing cause of rupture. The same changes were noted in intact spleens from fatal cases of infectious mononucleosis.

4. The spleen in infectious mononucleosis was 3 to 4 times normal size and ruptured during the third or fourth week of the disease.

5. The importance of trivial injury as the exciting cause of so-called "spontaneous" rupture of the spleen has been emphasized. It is recommended that extreme caution be employed during attempted palpation of the spleen in a suspected case of the disease. When the diagnosis is obvious, splenic palpation may well be omitted.