bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Program Based on the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Model
Authors: Kaasalainen Sharon , Sussman Tamara , Thompson Genevieve , McCleary Lynn , Hunter Paulette , Wickson-Griffiths Abigail , Venturato Lorraine , Ploeg Jenny , Parker Deborah , Sinclair Shane , Haas Vanina Dal-Bello , Earl Marie , You John
Published: July 2019

Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that palliative approaches to care are currently suboptimal in these settings. The purpose of this study was to evaluate resident, family, and staff outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end-of-life discussions and planning.
Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents, families and staff of the LTC homes through chart reviews, surveys and interviews.
Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end-of-life and hospital deaths for those participating in SPA-LTC, an improvement in interdisciplinary communication between staff, support for both families and staff involved, and increased family involvement in the care of residents. However, there were no significant pre-post differences in staff collaboration or comfort in providing end of life care.
Conclusions: The benefits of SPA-LTC for families, residents and staff justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context.
Geographical distribution of family physicians in Japan: A nationwide cross-sectional study
Authors: Yoshida Shuhei , Matsumoto Masatoshi , Kashima Saori , Koike Soichi Soichi , Tazuma Susumu , Maeda Takahiro
Published: July 2019

Background

Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem.

Methods

We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists.

Results

519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001).

Conclusions

Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.
Preoperative prognostic nutritional index predicts both short and long-term outcomes after liver resection for hepatocellular carcinoma.
Authors: Saito Yu , Imura Satoru , Morine Yuji , Ikemoto Tetsuya , Yamada Shinichiro , Shimada Mitsuo
Published: July 2019

Background
The aim of this study was to investigate the prognostic significance of the prognostic nutritional index (PNI) for both short and long term outcomes after liver resection for hepatocellular carcinoma (HCC).
Methods
162 (without any previous treatment) of 229 surgically treated HCC patients were retrospectively analyzed. The cut off value of the preoperative PNI was 45.0. Patients were divided into two groups, PNI low (n=76) and high (n=86) group.
Results
Among some immune parameters such as PNI, neutrophil to lymphocyte ratio (NLR) and aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), PNI had most reliable parameters in terms with prediction of both short and long term outcomes. Preoperative PNI tended to correlate with low skeletal muscle mass (SMM). In short term outcomes, PNI low group were more likely to have postoperative complications. The disease-free survival rate in PNI low group was significantly worse than that in the PNI high group (20.5 vs. 48.7 %, 5 year SR, p=0.03). On multivariate analysis, Low PNI was an independent prognostic factor for disease free survival (HR 1.65, p= 0.04).
Conclusions
The preoperative PNI was the most significant prognostic factor for evaluating both short and long-term outcomes after liver resection for HCC.
Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective study from Kampala, Uganda
Authors: Nalwanga Damalie , Musiime Victor , Kizito Samuel , Kiggundu John Baptist , Musoke Philippa , Tumwine James K
Published: July 2019

Background:
Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM.
Methods:
This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14.
Results:
Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001).
Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
Common gastrointestinal symptoms and associated factors among under five children in Rural Dembiya, northwest Ethiopia: a community-based cross-sectional study
Authors: Gizaw Zemichael , Addisu Ayenew , Guadie Destaye
Published: July 2019

Background

Gastrointestinal (GI) symptoms such as abdominal discomfort, abdominal cramp, nausea, vomiting, gas in the GI tract, or changes in bowel habits (e.g., diarrhea) are common in the community. However, these symptoms may be misinterpreted and their impact and significance misunderstood, especially in the rural communities. This study was, therefore, conducted to assess common GI symptoms among children in rural Dembiya, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in May 2017 among 225 randomly selected under five children. The presence of GI symptoms among children was assessed by health professionals and mothers’ report. Direct stool examination technique was used to identify parasitic infections. Bacteriological analysis of drinking water was done to determine the quality of drinking water. Food safety, environmental sanitation and hygiene condition of children were assessed using standardized observation checklists. Multivariable binary logistic regression analysis was employed to identify factors associated with GI symptoms on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05.

Results

The current study depicted that 139 of 225(61.8%) of the children had GI symptoms. Abdominal discomfort [137 of 139(98.7%)], abdominal cramp [125 of 139(89.9%)] and diarrhea [118 of 139(84.9%)] were the highest GI symptoms reported. GI symptoms were significantly associated with childhood intestinal parasitic infections [AOR = 13.69, 95% CI = 3.31, 56.59)], unclipped and unclean finger nails [AOR = 2.28, 95% CI = (1.02, 5.10)], inadequate living environment sanitation [AOR = 2.37, 95% CI = (1.08, 5.18)], unclean living houses [AOR = 9.06, 95% CI = (2.60, 31.54)] and owning livestock [AOR = 4.68, 95% CI = (1.82, 12.03)].

Conclusion

The prevalence of GI symptoms among under five children in rural Dembiya, northwest Ethiopia was found to be high. GI symptoms were significantly associated with childhood intestinal parasitic infections, hand hygiene condition of children and sanitation condition of the living environment. Therefore, preventing intestinal parasitic infections, improving hand hygiene condition and promoting environmental sanitation will have overriding contributions to prevent symptoms among children in rural Dembiya.
Parents as carers on a neonatal unit: qualitative study of parental and staff perceptions in a low-income setting
Authors: Ndiaye Sokhna , Bosowski Johanna , Tuyisenge Lisine , Penn-Kekana Loveday , Moxon Sarah , Thorogood Nicki , Lissauer Thomas
Published: July 2019

Background. To determine parents’ experiences on a neonatal unit in a low-income country, how they and staff perceive the role of parents and if parent’s role as primary carers could be extended.
Methods. Qualitative analysis using semi-structured interviews with 12 parents and 16 staff.
Results. Parental themes were around their general impression, stress and discharge. They were satisfied with their baby’s care but feared their baby may die. Mothers were stressed from need to remain in the hospital throughout baby’s stay, to provide feeds day and night, comfort and clean their baby, and provide constant kangaroo mother care before discharge. They experienced loneliness from lack of visitors, difficulty finding food and somewhere to sleep, financial worries and concern about family and home. Mothers were desperate to be discharged. Staff were preoccupied with shortage of nurses limiting care provision and restricting their ability to educate parents as inpatients and after discharge and to provide follow-up, and their constant presence. Neither thought parent’s role could be extended.
Conclusion. Staff and parent perceptions on improving parent’s experience differed. Staff thought that the solution was increasing nurse numbers to improve care and educate parents, but is unlikely in near future. Parents were severely stressed by psychosocial concerns and practical issues around hospitalization. Our identification of parental concerns suggests greatest potential for improving their stay on the neonatal unit may be from psychosocial support, potentially from experienced mothers, mothers’ groups, allied health professionals and community health workers and from improved facilities, particularly providing food and accommodation.
The transfer of knowledge on integrated care between five European regions: a qualitative multi-method study
Authors: Grooten Liset , Vrijhoef Hubertus Johannes Maria , Alhambra-Borrás Tamara , Whitehouse Diane , Devroey Dirk
Published: July 2019

Background To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives.

Methods A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The frameworks of knowledge exchange and knowledge mobilisation were used for data analyses.

Results All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree.

Conclusions The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings.
Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study
Authors: Hashimoto Yoshitaka , Hamaguchi Masahide , Obora Akihiro , Kojima Takao , Fukui Michiaki
Published: July 2019

Background

Previous meta-analyses revealed that obesity confers a risk of gastric cancer. On the other hand, metabolically healthy obese (MHO) individuals, who are healthier than metabolically abnormal obese (MAO) individuals, have lower risks of colon cancer and breast cancer. However, the association between MHO and incident gastric cancer is unclear.

Methods

This historical cohort study included 19,685 Japanese individuals who participated in health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low high density lipoprotein-cholesterol). Obese (O) or non-obese (NO) was classified by a body mass index cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise.

Results

Over the median follow-up period of 5.5 years, 78 participants developed gastric cancer. Five-years cumulative incident rate of gastric cancer was 0.2% (case/n = 17/8,331) in MHNO, 0.2% (1/653) in MHO, 0.5% (35/7,276) in MANO and 0.7% (25/3,425) in MAO. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95%CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95%CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95%CI 1.10–3.97, p = 0.024) in MAO.

Conclusions

This study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer.
Bacterial Urinary Tract Infection among Adult Renal Transplant Recipients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Authors: kiros Teklehaimanot , Asrat Daniel , Ayenew Zeleke , Tsige Estifanos
Published: July 2019

Abstract
Background: Despite significant advances in surgical techniques, immunosuppression protocols follow up periods and antimicrobial stewardship in modern medicine; post-renal transplantation urinary tract infection remained a major public health problem globally. This multiple serious squeal includes asymptomatic bacteriuria, cystitis and pyelonephritis. Among these, the bacterial origin of infection complications accounts for the most significant clinical, socio-economic impacts in many countries of the world. Therefore, the aim of the study was to investigate the prevalence of bacterial isolates that cause urinary tract infections, assess antibiotic susceptibility pattern among symptomatic and asymptomatic renal transplant recipients attending at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Methods: A hospital-based cross-sectional study was conducted from December 2017 to August 2018 among 74 renal transplant recipients St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. A first morning voided clean-catch mid-stream urine specimens were collected and 0.001ml inoculated onto blood and MacConkey agar plates following the standard bacteriological protocols. It was incubated aerobically at 35–37°C for 24–48 hours. Cultural characteristics and series of biochemical tests were used for the identification of isolates to species level.
Results: Significant bacteriuria was found in 11/74 (14.9%, 95% CI =8.2-24.7) patients. The prevalence among females 6/32 (18.75%) was higher among males 5/42 (11.9%) without significant association (COR=2.09, 95% CI=1.04-8.45, P=0.253). Urinary tract infection was higher in the age group of 35–49 years old (19.3%). Age was statistically significant and stronger independent associated risk factor with crude odds ratio=3.67, 95% CI=2.89-20.07 and P= 0.003, respectively. The most prevalent bacteria isolates were Escherichia coli 2(18.2%), Staphylococcus aureus 2(18.2%), Acinetobacter spp. 2(18.2%), Enterococcus spp. 2(18.2%), Coagulase-negative Staphylococci 2(18.2%) followed by Portus mirabilis 1(9.1%). The majority (80%) of Gram-negative bacteria were resistant to ciprofloxacin, chloramphenicol, and trimethoprim/sulfamethoxazole.
Conclusions: In conclusion, the overall prevalence of urinary tract infection in the study participants was relatively low with a prevalence of 14.9%. Majority of the study participants were asymptomatic. The multidrug-resistant bacterial isolates in the present study account for 82%.
Keywords: Kidney Transplantation, Urinary Tract Infection, Antimicrobial Susceptibility Testing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
A 2/1 sunitinib dosing schedule provides superior antitumor effectiveness and less toxicity than a 4/2 schedule for metastatic renal cell carcinoma: A systematic review and meta-analysis
Authors: Deng Huan , Zeng Lianli , Wu Qian , Wang Li , Hong Zhengdong , Yi Fengming , Wei Yiping , Zhang Wenxiong
Published: July 2019

Background

The standard sunitinib schedule to treat metastatic renal cell carcinoma (mRCC) is 4 weeks on/2 weeks off (4/2). However, some studies revealed intolerable adverse events (AEs) in patients on this schedule. An alternative schedule, 2 weeks on/1 week off (2/1), may overcome this issue. This meta-analysis was performed to compare the effectiveness and toxicity between the 2/1 and 4/2 sunitinib dosing schedules.

Methods

We acquired relevant studies by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar. Our main endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and AEs.

Results

We identified 9 medium- and high-quality studies. Both schedules were effective for mRCC, with comparable OS and similar ORR. However, the 2/1 schedule had better PFS (hazard ratio (HR) = 0.81, 95% confidence interval [CI]: 0.66-0.99, P= 0.04), higher DCR (risk rate (RR) = 1.22, 95% CI: 1.01-1.47, P= 0.04) and fewer dosage interruptions (RR= 0.60, 95% CI: 0.43-0.84, P= 0.003). Additionally, the 2/1 schedule elicited fewer specific severe AEs, including thrombocytopenia/platelet disorder, hand-foot syndrome, hypertension and fatigue. In our subanalysis, PFS was better among East Asians using the 2/1 schedule than among other populations (HR= 0.75, 95% CI: 0.58-0.98, P= 0.03), and patients administered an initial dosage of 50 mg/d on the 2/1 schedule had superior PFS (HR= 0.76, 95% CI: 0.59-0.97, P= 0.03) than those others.

Conclusions

These findings suggest that the 2/1 schedule is more suitable for mRCC than 4/2, due to superior PFS, better DCR and fewer AEs. Nevertheless, more large-scale studies with good quality are needed.
The association between fecal enterotoxigenic B. fragilis with colorectal cancer
Authors: Haghi Fakhri , Goli Elshan , Mirzaei Bahman , Zeighami Habib
Published: July 2019

Background

Enterotoxigenic Bacteroides fragilis (ETBF) is an enterotoxin-producing bacterium that possibily has a role in the occurrence and progression of colorectal cancer (CRC) by modulating the mucosal immune response and inducing epithelial cell changes. The aim of this study was to investigate the frequency of ETBF in stool samples of CRC patients and healthy volunteers.

Methods

A total of 60 stool samples from confirmed CRC patients and 60 stool samples from healthy volunteers with no personal or familial history or diagnosis of colorectal disease were collected. Stool samples were screened for direct detection of B. fragilis using PCR targeting the marker genes of neu and bft. Enterotoxin isotypes bft-1, bft-2 and bft-3 were also detected in B. fragilis positive samples.

Results

The frequency of B. fragilis among CRC and control cases was 58.3% and 26.6%, respectively (P<0.05). The rate of bft gene in CRC cases was significantly higher than in controls (P<0.05). Also, the presence of bft gene in CRC patients stage III was significantly higher than stages I and II (P< 0.05). Enterotoxin isotype bft-2 was detected with higher frequency among CRC patients than healthy control (P<0.05).

Conclusion

Our results show the association between fecal ETBF and CRC, and we suggest that detection of ETBF may be a potential marker for colorectal cancer diagnosis. However, additional investigations on tumor and paired normal tissue samples are required to substantiate this possible correlation.
Radiomics of apparent diffusion coefficient maps to predict histologic grade in squamous cell carcinoma of the tongue and mouth floor: A preliminary study
Authors: Ren Jiliang , Yuan Ying , Qi Meng , Shi Yiqian , Tao Xiaofeng
Published: July 2019

Background

The assessment of histologic grade plays an important part in prognosis evaluation of squamous cell carcinoma (SCC) of the tongue and mouth floor (MF). This study was performed to ascertain if apparent diffusion coefficient (ADC)-based radiomics can predict histologic grade in SCC of the tongue and MF.

Methods

This study involved 95 patients (training cohort: n = 63; testing cohort: n = 32), who were categorized as low- and high-grade SCCs according to the pathologic findings. A total of 526 radiomics features were extracted from ADC maps. Radiomics signature was constructed with least absolute shrinkage and selection operator (LASSO) logistic regression. Receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the performance of the radiomic signature in the training and testing cohorts.

Results

Six features were selected to construct the radiomics signature for predicting histologic grade. The ADC-based radiomics signature performed well in discriminating between low- and high-grade tumors, with AUCs of 0.82 and 0.78 in the training and testing cohorts, respectively. Based on the cutoff value of the training cohort, the radiomics signature achieved accuracies of 0.75 and 0.78, sensitivities of 0.71 and 0.86, and specificities of 0.83 and 0.64 in the training and testing cohorts, respectively.

Conclusions

The ADC-based radiomics signature could identify histologic grade in SCC of the tongue and MF.
CHALLENGES IN CHOICE OF THE TREATMENT STRATEGY FOR PATIENTS WITH RECURRENT PSEUDOMYXOMA PERITONEI
Authors: Abdullaev A. G. , Davydov М. M. , Коzlov N. A.
Published: July 2019

Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis accompanied by accumulation of mucus and high recurrence rate and in some cases complicated with intestinal obstruction. In the last 10–15 years, there has been observed a significant improvement in overall survival of patients with recurrent pseudomyxoma, who underwent cytoreductive surgery in combination with intraperitoneal chemotherapy. However, the frequency of recurrences of peritoneal pseudomyxoma after optimal cytoreduction can reach 80–90 % in the first 2 years.

The purpose of the study was to analyze the results of combined therapy (cytoreductive surgery and hypothermic intraperitoneal chemoperfusion) in patients with recurrent pseudomyxoma peritonei, who previously underwent cytoreductive surgery.

Material and Methods. The study included 43 patients previously undergoing cytoreductive surgery for pseudomyxoma peritonei in the Thoracic Oncology Department of the N.N. Blokhin National Medical Research Center of Oncology.

Results. Re-operations were performed in 11 of the 43 patients with recurrent pseudomixoma peritonei after previously performed cytoreductive surgery. Repeated intraperitoneal chemoperfusion with hyperthermia was performed in 6 patients. Of the 11 reoperated patients, 7 had a complete cytoreduction (CC-0), recurrence was detected within 22 to 47 months; 2 patients had CC-1 and recurrence was observed within 12 and 15 months. Optimal cytoreduction (CC0-1) was achieved in 7 of the 11 patients. The maximum follow-up period was 44 months. Recurrence was noted in 9 patients, while the majority of patients had a satisfactory quality of life. Two patients showed signs of partial intestinal obstruction. None of the patients died during the follow-up period. In two patients with optimal (CC-0) cytoreduction, there were no signs of disease progression 9 and 15 months after re-surgery. One-year disease-free survival rate was 51 %.

Conclusion. Repeated surgeries for recurrent pseudomyxoma present a great challenge for surgeons due to the difficulty in achieving optimal cytoreduction. Optimal cytoreduction in initial surgery should be considered as the main condition for repeated surgery. Moreover, additional criterion for a favorable prognosis is the time to progression of disease.
METHOD OF TREATMENT FOR ANAL CANCER AFFECTING THE SKIN
Authors: Kit O. I. , Rozenko L. Ya. , Frantsiyants E. M. , Gusareva M. A. , Kosheleva N. G. , Solntseva A. A. , Krokhmal Yu. N.
Published: July 2019

The extent of surgery for anal rectal cancer (ARC) is determined by the clinical efficacy of neoadjuvant chemoradiotherapy (CRT). An approach using medium intensity ultrasound combined with chemotherapy was developed. Advantages of sonodynamic chemotherapy (SD CT) were evaluated to improve the CRT efficacy and the quality of life of patients with ARC affecting the skin.

Material and methods.34 patients with morphologically verified сТ2–3N0–1M0 ARC received 2 cycles of polychemotherapy (PCT): intravenous bolus of mitomycin C 10 mg/m2 on days 1 and 29 + continuous infusion of 5-fluorouracil 1000 mg/m2 daily on days 1–4 and 29–32. Patients received CRT 3 weeks after the second PCT cycle. Prior to each session of standard external and intracavitary irradiation, 18 patients of the main group received a 2-hour extemporaneous mixture to the primary tumor site: 5 mg of the Coletex SP-1 hydrogel material with propolis based on sodium alginate plus 100 mg of gemcitabine-medac together with mid-frequency ultrasound (0.88 MHz, I =1.0 Вm/cm2, Patent No. 2638616). 16 controls received capecitabine 825 mg/m2 orally twice a day with 12-hour intervals during the radiation course.

Results.Controlled general clinical effect after external irradiation + SD CT in the main group was 25.7 % (p<0.05) higher than in controls, and complete regression was 1.4 times more frequent (77.8 % vs. 56.2 %). Radical surgery after CRT was necessary only in 11.1 % cases in the main group vs. 43.8 % in controls (p<0.05). No local recurrences were observed during 612 months in 16 patients of the main group without surgery, while 22.2 % (p<0.05) of controls showed local recurrence. The rates of pelvic relapses and distant metastases were similar in both groups.

Conclusion.The positive effect of the proposed method for ARC treatment is determined by the combination of therapeutic factors including the action of a radiosensitizing agent introduced into tumor tissues.
Two Uses of Gender in Conversation: A Membership Categorization Analysis
Authors: Bouhout Najib
Published: July 2019

Discourse analysts have for a long time focused on the study of gender differences in language. Recent approaches, however, eschew that concern in favor of studying the performative aspects of gender. In line with this, Membership Categorization analysis offers the additional advantage of studying societal members’ gender categorization in conversation, the way it shapes the course of conversation, and its import, and consequences, for the conduct of participants in interaction. Membership Categorization Analysis is used here to spot some practical uses of gender by interactants in mundane talk among friends. More specifically, the article analyses two conversational instances where interactants deploy the categories ‘men’ and ‘manly practices’ to realize particular actions in conversation (suggestion and blame attribution). One finding is that gender categorization does pragmatic actions in interaction. In addition, the article argues that the relevance of gender, as one textual given among many, must be analytically demonstrated empirically in the conduct of interactants rather than invoked for the theoretical concerns of the discourse analyst.
Mechanical Characterization of Nanomaterial Reinforced Aluminum-based Hybrid Nanocomposites
Authors: L Girisha , Deshpande Malteshkumar , Naik Gururaja Lakshman , M R Mahanthesh
Published: July 2019

Nanostructures are viewed as definitive fiber materials as a reinforcement for matrices because of their impressive properties. Because of their phenomenal mechanical properties Carbon nanotubes (CNTs), graphene (GR), and nanodiamond (ND) have made an enormous proportion of intensity in research over the world. Multiwalled carbon nanotubes (MWCNTs), Graphene, and Nano Diamond were utilized as reinforcements for the current work. Nanostructures with their extraordinary strength, minute size, and high aspect ratio were used as reinforcements in commercial-purity Al matrix. These nanocomposites were manufactured by various different routes such as casting and powder metallurgy techniques. Both of these methods are helpful for the preparation of MWCNTs/Al nanocomposites. These nanocomposites were manufactured with various weight fractions of reinforcements and characterized for their mechanical properties and indicated improved properties in contrast with the base Al matrix. Al/MWCNT nanocomposites, Al/MWCNT/GR hybrid nanocomposites and Al/MWCNT/GR/ND hybrid nanocomposites samples were tested for their mechanical properties such as Young’s modulus, percentage elongation yield strength, and ultimate Strength. Mechanical characterization of these prepared composite samples demonstrated improved strength when compared with the casted samples.
Factors Influencing Midwifery Clinical Decision-making
Authors: Sakala Betty Kambeja
Published: July 2019

Clinical decision-making is an important element in midwifery practice. Midwives are required to have a sound knowledge to manage complications during childbirth. Any misjudgement by a midwife may lead to adverse birth outcomes. The aim of this paper is to review factors that contribute to clinical decision-making of midwives. This was achieved by reviewing published research articles. Studies have shown that shortage of human and material resources, poor skill mix, absence of mentors and lack of autonomy are some of the contributing factors that may affect midwives’ decision-making.
Global organization, home care: the internal structure of the migrant care sector
Authors: Turai Tünde
Published: July 2019

Globalization consists of various interactions between structural and individual level factors. It is a process that determines social structures, and thus the framework of individual level decisions and action, while some of the actors are actively engaged in shaping them. There is a demand for migrant care work in health and elderly care services and is formed at the intersection of multiple spheres of actions (of the state, private sphere, families). The cheap and flexible human resource capacities, providing partly professional and partly familial-type care with long working hours (even around the clock) on a long run, can be recruited among women coming from abroad. The reproduction sector that has been integrated into the global labor market, and has become a notable section itself, raises several new questions, compelling us to examine the interference of three aspects: gender, migration and care. In my paper I aim at demonstrating how women from Eastern and Central Europe got involved in the global care sector, how they contribute to its functioning, and what work regimes have been established within the sectors covered by them.
Uso y funcionalidad didáctica de Twitter desde la perspectiva del estudiante universitario. Un estudio de caso en la UNED
Authors: Vázquez-Cano Esteban , Sevillano M.ª Luisa
Published: July 2019

Este artículo analiza el uso que realizan los estudiantes universitarios de Twitter y su percepción como recurso didáctico en la Educación Superior en el contexto de los estudios de Grado y Máster en la Facultad de Educación de la UNED. A través de una metodología mixta cuantitativa y cualitativa se analiza la percepción del alumnado sobre la funcionalidad didáctica en la Educación Superior. Los resultados muestran que lo estudiantes perciben el potencial educativo de Twitter en tres dimensiones: 1) “Síntesis, opinión y divulgación de la información”. 2) “Trabajo colaborativo en red” y 3) “Investigación y desarrollo curricular”. Asimismo, destacan especialmente actividades como el seguimiento de palabras o hashtags (60%), las reflexiones sobre tendencias en la red (63%) y la conformación de comunidades o grupos virtuales para realización de proyectos colaborativos (53%). Una amplia mayoría de los estudiantes consideran Twitter una herramienta beneficiosa para su desarrollo académico y social.
Performance analysis of flexible intelligent hand prosthesis
Authors: Qin Yanan
Published: July 2019

The study of flexible intelligent hand prosthesis has important practical significance for handicapped people. Aiming at the grasping force control of flexible hand prosthesis, this paper draws lessons from the anatomical structure design of human hand, and proposes a fingertip grasping force control method based on linear tension feedback. The control strategy can realize the stable control of fingertip grasping force. The static mechanical model of finger is established, and the mathematical relationship of fingertip contact force calculation in static state is obtained. Then a friction compensation method is proposed. The experimental results show that the fitting value of the friction moment of the lasso matches well with the test value, and the error after friction compensation is obviously reduced.
Experimental diagnosis of multiple faults on a rotor-stator system by fast Fourier transform and wavelet scalogram
Authors: Tchomeni Bernard Xavier , Alugongo Alfayo
Published: July 2019

This paper presents the recent application of the scalogram of Continuous Wavelet Transform (CWT) as a vibration monitoring and signal processing tool for a rotor dynamic response under parametric excitation. The experimental test data of coupled lateral-torsional vibrations of a rotor-stator system with transverse crack was obtained through a data acquisition set-up interfaced with Rotor-Kit-4 (RK-4). Analysis was executed on rotor deflection, orbit, frequency and time-frequency spectrum of the RK-4 experimental data. The scalograms of CWT were used experimentally to represent the aperiodic occurrence of rub between the rotor-stator and crack features. Variation in 3-D scalogram peaks in the presence of rub and crack were unique and were used to distinguish quasi-periodic motion from other types of motion. An unbalanced cracked rotor gave a higher frequency amplitude response compared to an unbalanced rotor with rub under the same conditions. Irregularities in orbit orientation near sub-harmonic resonances were observed in the test data. Multiple rebounds inside the orbit loop were unique rub indicators. Conspicuous horizontal components of the higher harmonics were observed near the critical speed when a crack existed. CWT established inherent feature patterns that discriminated unbalance, rub and a crack.
Safety assessment of upper buried gas pipeline under blasting vibration of subway tunnel: a case study in Beijing subway line
Authors: Jiang Nan , Gao Tan , Zhou Chuanbo , Luo Xuedong
Published: July 2019

As the buried gas pipelines are not easily field monitored, its status under the influence of tunnel blasting vibration is often difficult to obtain. In order to assess the safety of an upper buried gas pipeline under blasting vibration in the Beijing subway line 16, we established the 3D numerical model of the real field engineering to calculate and analyze the distribution of peak particle velocity (PPV) on the surface soil, proved its reliability by using the field monitoring data and discussed the dynamic response of the pipeline. Based on the analysis, we further assessed the safety of pipeline subjected to tunnel blasting vibration and concluded that the pipeline is only subjected to limited effect of tunnel blasting vibration and thus is safe.
Experimental study on failure characteristics of jointed rock mass under staged unloading conditions
Authors: Cao Ping , He Liwen , Tang Guodong
Published: July 2019

Strength and deformability characteristics of rock with pre-existing fissure are governed by cracking behavior. To further research the effects of pre-existing fissures on the mechanical properties and crack coalescence process under staged unloading conditions, a series of uniaxial compression tests were carried out. In this study, cement, fine sand, and water were used to fabricate a kind of brittle rock-like material rectangular model specimen. The mechanical properties of rock-like material specimen used in this research were all in good agreement with the brittle rock materials. The pre-existing fissure was created by mica sheets and the unloading zone was created by pre-filling Polylactic acid (PLA) resin material during the molding processes the model specimen. And the staged unloading test was conducted based on polylactic acid’s hot-melt characteristics. In order to investigate the crack initiation, propagation and coalescence process, inclination angle of pre-existing fissure was set to change from 0° to 90°. The mechanism of crack propagation and coalescence under photographic monitoring was discussed. And these experimental results indicate that the failure modes in the zone above unloading zone mainly consist of four modes: separation failure, shear-slip failure, mixed shear-separation failure and compression-shear failure. The experimental results are also expected to increase the understanding of the strength failure behavior and the cracking mechanism of rock under staged unloading.
Study on the optimum penetration depth by two TBM cutters under different cutter spacings
Authors: Wang Zhu , Cao Ping , Chen Yu
Published: July 2019

This paper investigates the optimum penetration depth and the synergistic effect of TBM (Tunnel Boring Machine) rock breaking under the different cutter spacings. Indentation tests, using two TBM cutters, were conducted on sandstone specimens based on an improved uniaxial testing. Afterwards, morphological measurement was performed to analyze the change of the groove volume, using a surface profilometer. Based on the evaluations of typical chips and cracks propagation, the fragmentation modes of the rock between two cutters under different penetration depths were proposed. In addition, the TBM rock breaking efficiency was studied. As the increase of the penetration depth, when the cutter spacing was constant, the results show that: (1) The rock fragmentation modes gradually changed from shear failure and shear-tensile failure to tensile failure. (2) Though penetration energy gradually increased, the groove volumes also increased, thus, the TBM rock breaking efficiency rises. (3) Specific energy decreased first and then gradually increased. It indicates that the optimum penetration depth was existent for different preset penetration depths. With the increase in cutter spacing, the optimum penetration depth also rised. According to the derivation and verification of the analytical formula, the internal relationship between the penetration depth and the fracture toughness was obtained, which was in line with the linear relationship between penetration depth and penetration energy. From a microscopic point of view, the sharp increase of penetration energy with increase of penetration depth can be explained.
Train induced pore water pressure generation model: numerical comparison
Authors: Mekonnen Aynalem
Published: July 2019

In recent decades, the provisions of new challenges to railway track demanded for a better understanding of the track dynamic, especially to track geotechnical dynamics. For geotechnical problems the presence of water in the void of soils has influence on the behavior of the soil effects such as temporarily development of excess pore water pressure of the soil or even liquefaction and mud pumping can occur. To account these effects considering the soil as two-phase material would be helpful to better understand the saturated railway line failures. Hence, this paper describes the pore fluid analysis of fully saturated railway embankment response subjected to train induced vibrations using three-dimensional finite element package ABAQUS. The modelized 3D track consists of train loads, rail, pads, sleeper, sub-ballast, ballast, saturated sub-grade, saturated subsoil layer and semi-infinite bedrock. The water-saturated soil layers modeled as poroelastic and the infinite bed rock as elastic medium. To this end, the influence of relative density, hydraulic conductivity, un-drained Young’s modulus and depth of embankment on excess pore water pressure development are compressively studied. The predicated results show that hydraulic conductivity, un-drained Young’s modulus and depth of embankment have quite significant effect on the induced excess pore water pressure; while the influence of relative density is very small. The result also shows that positive excess pore water pressure mainly distributes on the soil and this will permit fine grain soils to flow out from interior to exterior region of the model. Hence, mud pumping and liquefaction is developed not in specific type of soil instead can be developed in any type of soil with low hydraulic conductivity, high depth of embankment and low un-drained Young’s modulus.
The double Burgers model of fractured rock masses considering creep fracture damage
Authors: Zhao Yanlin , Liu Qiang , Tang Liming , Xie Senlin
Published: July 2019

Creep fracture of rock cracks is responsible for the creep failure of fractured rock masses. To capture creep fracture behaviors of fractured rock, we investigated the time-dependent characteristics of the rock crack propagation. The theoretical analysis shows that, similar to the rock creep process, the creep fracture of rock cracks includes the attenuation and steady creep stages. In addition, we established an equivalent Burgers model for creep fracture of rock cracks by introducing the equivalent stress and proposed a double Burgers model to study creep behaviors of fractured rock masses. Moreover, the proposed double Burgers model was embedding into FLAC3D, using FISH function. The numerical simulations on the specimens, containing ordered and random cracks, show that the creep fracture is responsible for the creep damage of fractured rock masses; moreover, the lateral creep damage is larger than the axial creep damage.
Ultimate bearing capacity of circular shallow foundations in frozen clay
Authors: Liu Shuang , Yao Zhaoming , Shang Yujiao
Published: July 2019

This paper presents a study on the ultimate bearing capacity of circular shallow foundation in frozen clay. The bearing capacity were determined by model test, numerical simulation and analytical solution. In numerical simulation, the temperature field considering the phase transition was transformed into a temperature load and applied to a three-dimensional solid model. The generalized Kelvin model was used to describe the creep of frozen clay, and step loading was used. Based on the tests results that frozen soil fails because of local shear, we proposed an analytical model to estimate the ultimate bearing capacity of circular shallow foundation with local shear failure mechanisms. Based on the limit equilibrium theory, it was assumed that the fracture plane of the model only develops to the boundary between the transition zone and the passive zone. The results from present study and some other method are presented and compared, which has shown and verified the feasibility of our method. And the analytical solution is in good consistent with the results of the model test and numerical simulation.
Dynamic simulation analysis of elastic overpressure fluctuation on silo wall for the arch action
Authors: Feng Yong , Liu Jie
Published: July 2019

In this research, the concept of elastic overpressure fluctuation is introduced on the basis of the overpressure theory in the arch action, the formation of overpressure in the arch action is investigated with the elastic fluctuation on the silo wall. The formation and elastic fluctuation of overpressure in arch action is analyzed systematically with the laboratory experiment and the PFC simulation which were established on the basic of a project example, the models achieve the arch action by changing factors such as the physical parameters of grain and cone half angle of the silo hopper. The results obtained indicate that the increment of pressure and the overpressure coefficient all decrease with height. And the overpressure started from the arch feet, propagated upward in the form of fluctuation on the silo wall. In addition, the overpressure fluctuations propagate uniformly which is illustrated by observing the time step of when the pressure fluctuations amplitude occur at each monitoring points. The results reveal the formation mechanism of the overpressure in arching, and the relevant research conclusions would be of great reference significance for the design of silo.