bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of extracorporeal membrane oxygenation in HIV-positive patients with severe respiratory failure: a retrospective observational case series
Authors: Collett Luke W , Simpson Thomas , Camporota Luigi , Meadows Chris IS , Ioannou Nicholas , Glover Guy , Kulasegaram Ranjababu , Barrett Nicholas A
Published: November 2018

The objective is to describe the outcomes of patients with human immunodeficiency virus (HIV) infection who received extracorporeal membrane oxygenation (ECMO) for severe respiratory failure (SRF). The design and setting was a single centre retrospective observational case series, from January 2012 to June 2017, at a tertiary university hospital and regional referral centre for ECMO in the United Kingdom. The participants were all patients referred with SRF and HIV infection. The main outcome measure was patient 90-day survival. Twenty-four patients were referred, of whom nine received ECMO. Six out of nine (67%) of patients were alive at 90 days. Median duration of ECMO was 18 days. There were no identified differences between survivors and non-survivors. ECMO can be used successfully in selected patients with HIV and SRF, including those with poor HIV control and high illness severity. HIV status alone should not exclude patients from treatment with extracorporeal therapy.
Vision-based curved lane keeping control for intelligent vehicle highway system
Authors: Osman Kawther , Ghommam Jawhar , Mehrjerdi Hasan , Saad Maarouf
Published: November 2018

This article addresses the coordinated longitudinal and lateral motion control for an intelligent vehicle highway system. The strategy of this work consists of defining the edges of the traveled lane using a vision sensor. According to the detected boundaries, a constrained path-following method is proposed to drive the longitudinal and the lateral vehicle’s motion. Error constraints of the intelligent vehicle highway system position are manipulated by including the function of barrier Lyapunov in designing the guidance algorithm for the intelligent vehicle highway system. To calculate the necessary forces that would steer the vehicle to the desired path, a control design is proposed that integrates the sign of the error for the compensation of the uncertain vehicle’s parameters. The Lyapunov function is later used to minimize the path-following errors and to guarantee a stable system. The efficiency of the developed approach is proved by numerical simulations.
Historical Review: Opiate Addiction and Opioid Receptors
Authors: Wang Shaocheng
Published: November 2018

Substance use disorders (SUDs), defined as a collection of symptoms including tolerance and withdrawal, are chronic illnesses characterized by relapse and remission. In the United States, billions of dollars have been lost due to SUDs. In the past 30 years, effective medications and behavioral interventions have played a major role in preventing relapse and facilitating longer periods of abstinence. From the late 1990s to the present, the opioid epidemic or opioid crisis in the United States has raised public awareness of SUDs. Methadone, buprenorphine, and naloxone have proven their effectiveness in treating addicted individuals, and each of them has different effects on different opioid receptors. Methadone and buprenorphine target mu opioid receptors (MORs) in the brain to treat opioid dependence by reducing withdrawal and craving, whereas naloxone is an opioid antagonist used to treat opioid overdose. Mu, kappa, and delta are opioid receptor subtypes with common analgesic effects, and each also has unique effects and distribution in the brain. MORs in distinct brain regions, such as the nucleus accumbens and basolateral amygdala, trigger the euphoria and incentive properties of rewarding stimuli. Kappa opioid receptors can trigger anti-reward effects and produce dysphoric effects. Delta opioid receptors can induce anxiolytic effects. Though effective medications are available, relapse is still common due to neurobiological changes in brain pathways and tolerance of opioid receptors with repeated abuse of substances. In this article, I summarize the biological mechanisms of opioid dependence and opioid receptors and review previous articles about medications used to treat SUDs and their clinical effects.
Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016
Authors: Li Ming , Roder David , Whop Lisa J , Diaz Abbey , Baade Peter D , Brotherton Julia ML , Canfell Karen , Cunningham Joan , Garvey Gail , Moore Suzanne P , O’Connell Dianne L , Valery Patricia C , Condon John R
Published: November 2018

Objective

Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women.

Methods

Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women.

Results

Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher.

Conclusions

Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.
Rewriting Mazeppa: Meaning and communication in Liszt’s virtuoso and program music
Authors: Rodriguez Hugo
Published: November 2018

Musical virtuosity is often studied with an emphasis on the outstanding skills of the performer and their sensory and emotional effects on the listener. However, Franz Liszt, one of the main virtuosos in music history, was convinced that what matters in virtuosity is its specific function within the semantic and communicative processing of music. This article proposes a theoretical framework to further investigate Liszt’s intuitions in light of contemporary research on musical meaning and communication. First, we analyze philological data concerning Liszt’s creative process in the Mazeppa works, a set of works including both his virtuoso and program music. Second, we compare our results with recent research on music semantics based on inferential processes about the composer/performer’s intentions (Antović, Stamenković, & Figar, 2016; Schlenker, 2017). We criticize the associationist hypothesis (the idea that the composer’s intention is that the listener infers an association between the music and a real or fictional state of the world) and we defend a causalist hypothesis (the idea that the composer’s intention is that the listener recognizes the music as being an intentional “rewriting” of the states of the world, mental or physical, that are the causes of the music itself). Third, we suggest that what distinguishes Liszt’s virtuoso and program music rewritings are the visual and gestural components of two listening experiences: the virtuoso music “rewrites” its episodic causes (memories, personal experiences) whereas the program music “rewrites” its genetic causes (the work’s creative path and intertextual relations).
Sexual Assault Information Posted on College and University Websites: Size and Setting Matter
Authors: Simmons Catherine A. , Clay Joy A.
Published: November 2018

To better understand what and how institutions of higher education (IHEs) communicate information about sexual assault (SA) on their websites, the current cross-sectional descriptive exploratory study analyzed a stratified sample representing 15% of the IHE websites in the United States. Findings show the availability, location, and type of SA information posted on IHE websites differ based on student population and residential character. Large and primarily residential schools are more likely to include SA information, across multiple pages, with a wider informational span than other categories. However, informational gaps are apparent across all websites. Implications for policy and practice are highlighted.
Encounters With Writing: Becoming-With Posthumanist Ethics
Authors: Zapata Angie , Kuby Candace R. , Thiel Jaye Johnson
Published: November 2018

In this article, the authors (re)think writing as an ethical endeavor to explore and to cultivate more inclusive orientations for writing research and teaching. Situated in posthumanist scholarship on intra-activity, trans-corporeality, and translingual assemblages, they provide data–theory encounters that resist the privileging of alphabetic print, standardized written English approaches to writing pedagogies that have detached writers from the contextual doing/being/feeling demanded of composing-with-all-bodies. Data in the article are drawn from three separate research projects. Diffractively reading data through posthumanist theoretical concepts, the authors highlight the tensions and insights produced from their analysis to provoke an ethico-onto-epistemological shift in writing studies and classroom pedagogies, and to enliven the ethical work of exploring and cultivating more inclusive orientations to writing research and teaching.
Engaging Destination Stakeholders in the Digital Era: The Best Practice of Italian Regional DMOs
Authors: Trunfio Mariapina , Della Lucia Maria
Published: November 2018

This article examines the underinvestigated topic of how destination marketing organizations (DMOs) engage stakeholders in destination management and marketing through leverage on off-line tools, official destination websites, and social media platforms. Building on a significant body of literature and advances in quantitative and qualitative research, we provide three methodological tools: two scales assessing DMO stakeholder engagement off-line and online and a social media index measuring tourist engagement. Our results confirm that in Italy regional DMOs are capitalizing on the digital platforms and off-line participatory tools to enhance stakeholder engagement in destinations’ decision making. Theoretical and managerial implications for destination management in the digital era are suggested.
Evaluation of Pro-re-Nata (PRN) and Treat and Extend Bevacizumab treatment protocols in Sorsby Fundus Dystrophy
Authors: Tsokolas Georgios , Almuhtaseb Hussein , Lotery Andrew
Published: November 2018

Purpose:

To describe long-term outcomes with intravitreal Bevacizumab for choroidal neovascularization secondary to Sorsby fundus dystrophy.

Materials/methods:

Observational case series.

Results:

Two sisters of the same family formally diagnosed with Sorsby fundus dystrophy were followed-up for 12 years. The elder sister (S1) presented with significant decline in vision due to choroidal neovascularization in her right eye (OD). She developed choroidal neovascularization 3 years later in her left eye (OS). She was treated with Bevacizumab intravitreal injections on a on a pro-re-nata (PRN) until April 2015, when a treat-and-extend (T&E) approach was adopted. Best corrected visual acuities at the time of switch to T&E were 1.09 OD and 0.85 LogMar OS. Best corrected visual acuities at the last follow-up were LogMar 1.1 OD and 0.82 OS. Her younger sister (S2) presented with best corrected visual acuities of LogMar 0.1 OD and 0.0 OS. She developed choroidal neovascularization 5 years later in both eyes. OS developed choroidal neovascularization 18 months after her right eye. She received Bevacizumab on a pro re nata basis until April 2015 when a switch to a T&E was performed. Best corrected visual acuity in the left eye at the switch to T&E was 0.34 LogMar. At the last follow-up, best corrected visual acuities were LogMar 1.2 OD and 0.29 OS.

Conclusion:

Bevacizumab is an effective therapy for choroidal neovascularization secondary to Sorsby fundus dystrophy. A T&E protocol appears more effective compared to pro re nata protocol in minimizing recurrence of choroidal neovascularization with potential secondary scar formation or atrophy.
Intrapelvic component retrieval via anterior inferior iliac spine osteotomy in revision total hip arthroplasty
Authors: Stickney William , Yoon Richard S , Patel Jay N , Klein David S , Haiduekwych George J , Liporace Frank A
Published: November 2018

Introduction:

In the revision setting, intrapelvic acetabular components provide a unique set of challenges for the treating surgeon. Retrieval is complicated by complex anatomical relationships within the pelvis and historically, surgeons have used multiple approaches to safely retrieve the cup.

Case presentation:

We present the case of a 53-year-old female with intrapelvic migration of the acetabular components of her total hip arthroplasty. Patient was treated through a novel, single incision approach with utilisation of an anterior inferior iliac spine (AIIS) osteotomy.

Results:

An AIIS osteotomy allows for improved visualisation within the pelvis and safe retrieval through a single exposure without compromising the ability to perform definitive, revision reconstruction. At 1-year follow-up, the patient has had no complications related to infection or failure of the implants. Ambulation is performed with the aid of a cane in the community with mild, occasional pain.
Feedforward control of double-panel casing for active reduction of device noise
Authors: Wrona Stanislaw , Pawelczyk Marek
Published: November 2018

The active casing approach is a technique to reduce noise emission of devices and machinery by controlling vibrations of their casings. This method was successfully validated by the authors for a single-panel casing in previous publications. However, if even higher noise reduction is required, a dedicated double-panel structure can be employed. In this paper, the sound insulation efficiency of a double-panel active casing is evaluated and compared with a single-panel structure by performing a series of laboratory experiments. The least mean squares algorithm is used to adaptively update control filter parameters. A low-frequency noise in the range up to 500 Hz is considered. Advantages and limits of the proposed approach are pointed out and discussed, and conclusions for future research are given.
Research excellence across clinical healthcare: a novel research capacity building programme for nurses and midwives in a large Irish region
Authors: Fullam James , Cusack Eithne , Nugent Linda E
Published: November 2018

Background: A lack of support and research skills development has contributed to low research output by clinically based nurses and midwives in Ireland, including those in specialised and advanced roles. A novel research capacity building (RCB) programme was developed to address existing barriers. The programme was developed and implemented using Cooke’s principles of RCB. Nurses and midwives participated from acute hospital, community, public health, mental health, older adult, intellectual disability, addiction and palliative care settings. Aims: This paper provides an evaluation of the Research Excellence Across Clinical Healthcare (REACH) programme from 2013–2016. Methods: Document analysis was used to evaluate RCB activities and outputs. Data were extracted from programme reports, conference proceedings, paper references, and workshop and conference sign-in/evaluation forms. Results: Individuals ( n = 17) and small research groups ( n = 4) were supported. Increased research capacity was demonstrated through dissemination of research in peer-reviewed journals, posters and oral presentations at national and international conferences. Sustainability was demonstrated by progression of participants to PhD ( n = 3) and research projects that remain ongoing ( n = 5). Skills development was facilitated by the organisation of workshops and conferences. Conclusions: A programme that provides academic support and mentorship in the clinical environment along with skills development can build research capacity. Future research should involve follow-up to determine any long-term effects.
‘Rival visions of reality’: An analysis of the framing of Boko Haram in Nigerian newspapers and Twitter
Authors: Ette Mercy , Joe Sarah
Published: November 2018

This article focuses on the framing of Boko Haram, a transnational terrorist group, in legacy and social media platforms. The discussion is predicated on the understanding that in spite of its popularity as a research tool, the concept of framing is still problematic. One area of contention has been the reliability and validity of framing analysis. Drawing on Robert Entman’s seminal definition, this study investigates the viability of two innovative framing approaches and explores the intersection of the framing of Boko Haram in four Nigerian newspapers and Twitter. The authors argue that, while newspapers continue to dominate the media space, it is important to acknowledge the growing relevance of social media in shaping and influencing the opinion of their users. The study’s findings support the viability of these approaches and come to the conclusion that exploring the differences between the platforms can unearth different versions of reality.
Framing conflicts in digital and transnational media environments
Authors: Knüpfer Curd B , Entman Robert M
Published: November 2018

This article provides an overview of established and emerging approaches to frame analysis as a tool for analysing dynamics of political conflicts. It first surveys the approaches taken by contributors to this special issue and notes some implications for further research. The second part of the article then outlines four ways in which digital platforms and transnational information flows might influence the way framing contests play out in current and future media environments. These include: (1) fragmentation within media systems; (2) increasing transnational information flows that potentially create transnational publics; (3) altered framing processes and effects in the more complex networked environments; and (4) architectures and emerging logics of digital platforms. The authors believe these four factors will become crucial for understanding the connections between frame competition and political conflicts.
Comparing leukocyte-rich platelet-rich plasma injection with surgical intervention for the management of refractory tennis elbow. A prospective randomised trial
Authors: Watts AC , Morgan BW , Birch A , Nuttall D , Trail IA
Published: November 2018

Background

Patients with ongoing symptoms after non-operative treatment of lateral epicondylosis are usually treated with surgical release. Platelet-rich plasma injection is an alternative treatment option. This study aims to determine whether there is a difference in outcome from platelet-rich plasma injection or surgical release for refractory tennis elbow.

Method

Eighty-one patients with a diagnosis of tennis elbow for a minimum of six months, treated with previous steroid injection and a minimum visual analogue scale pain score of 50/100 were randomised to open surgery release (41 patients) or leucocyte rich platelet-rich plasma (L-PRP) (40 patients). Patients completed the Patient-Rated Tennis Elbow Evaluation and Disability of the Arm Shoulder and Hand at baseline, 1.5, 3, 6 and 12 months post-intervention. The primary endpoint was change in Patient-Rated Tennis Elbow Evaluation pain score at 12 months.

Results

Fifty-two patients completed final follow-up. Functional and pain scores improved in both groups. No differences in functional improvements were found but greater improvements in Patient-Rated Tennis Elbow Evaluation pain scores were seen after surgery. Thirteen patients crossed over from platelet-rich plasma to surgery within 12 months, and one surgical patient underwent a platelet-rich plasma injection.

Conclusion

L-PRP and surgery produce equivalent functional outcome but surgery may result in lower pain scores at 12 months. Seventy per cent of patients treated with platelet-rich plasma avoided surgical intervention.
T Cell Assessment in Allergic Drug Reactions during the Acute Phase According to the Time of Occurrence
Authors: Torres M.J. , Mayorga C. , Fernández T.D. , Cornejo-García J.A. , Antúnez C. , Valenzuela M. , Prado M.F. Del , Rodriguez-Pena R. , Blanca M.
Published: November 2018

Allergic drug reactions can be classified as immediate, accelerated or delayed. This classification usually correlates with the mechanism involved: immediate reactions are IgE mediated and delayed reactions are T cell dependent. We analyzed lymphocyte involvement in patients with these reactions by determining cell subpopulations, activation state and skin homing receptor expression (CLA) in blood and skin. Patients with immediate, accelerated and delayed reactions were evaluated during the acute phase and after resolution. Controls taking drugs were included. Phenotypic immunofluorescence analysis was done by flow cytometry in peripheral blood, and by immunohistochemistry in skin for delayed reactions. Forty-six patients were included, 17 with immediate reactions, 10 accelerated and 19 delayed. At the acute phase CLA was significantly increased in delayed reactions and HLA-DR in all three types of reaction. In the severest delayed reactions, Steven-Johnson/Lyell syndromes, the CD4 subsets were increased in peripheral blood and skin compared to maculopapular exanthemas and urticaria and HLA-DR when compared with urticaria. In maculopapular exanthemas CLA was significantly increased in peripheral blood and skin compared to urticaria and the severe reactions. We found that T-cells are implicated, besides delayed reactions, in immediate and accelerated reactions. In delayed reactions there is a parallelism between results found in skin and peripheral blood with a higher participation of CD4+ cells the more severe the reaction.
Cytokines in the Nasal Washes of Children with Respiratory Syncytial Virus Bronchiolitis
Authors: Midulla F. , Tromba V. , Russo L. LO , Mileto F. , Sabatino G. , Sgarrella M. , Panuska J.R. , Manganozzi L. , Korn D. , Moretti C.
Published: November 2018

Although respiratory syncytial (RS) virus is the major cause of bronchiolitis and pneumonia in young children, the factors that regulate the associated lung inflammation have not been defined. The levels of interleukin (IL)10, IL-12, and interferon (IFN) were determined in the nasal wash samples from 20 infants with a clinical diagnosis of bronchiolitis, seven with confirmed RS virus infections and 9 control children without respiratory illnesses. IL-10 levels were significantly higher in acute nasal wash samples (1–4 d post-hospitalization) from RS virus- infected infants than in convalescent samples from these children (14–21 d post-hospitalization), from children with other forms of bronchiolitis and from control children. In contrast, only one RS virus-infected infant had detectable IL-12 in an acute nasal wash sample. IFN activity was not detected in any samples from RS virus-infected children. RS virus infection stimulates IL-10 expression but not IL-12 and IFN, possibly contributing to an ineffective cell-mediated immune response.
Genetic and Environmental Associations Among Executive Functions, Trait Anxiety, and Depression Symptoms in Middle Age
Authors: Gustavson Daniel E. , Franz Carol E. , Panizzon Matthew S. , Reynolds Chandra A. , Xian Hong , Jacobson Kristen C. , Toomey Rosemary , Lyons Michael J. , Kremen William S.
Published: November 2018

Multiple executive functions (EFs) are associated with trait anxiety and depression symptoms, but it is unclear how genetic and/or environmental factors account for these associations and whether they are explained by general variance underlying multiple EFs (i.e., common EF). In this study, 1,207 male twins completed seven EF tasks and measures of trait anxiety and depression symptoms at an average age of 62 years. The common EF factor was associated with both anxiety ( r = −.24) and depression ( r = −.32) symptoms. Anxiety and depression had a near-complete genetic overlap ( rg = .96). Genetic influences shared with depression accounted for 83% of the phenotypic correlation between anxiety and common EF. For depression, the phenotypic correlation with common EF was explained by genetic influences shared with anxiety (69%) but also nonshared environmental influences distinct from anxiety (20%). These results suggest that genetic influences on common EF play a role in the observed genetic overlap between anxiety and depression.
The Effect of Adherence to Screening Guidelines on the Risk of Alzheimer’s Disease in Elderly Individuals Newly Diagnosed With Type 2 Diabetes Mellitus
Authors: Yashkin Arseniy P. , Akushevich Igor , Ukraintseva Svetlana , Yashin Anatoliy
Published: November 2018

Objective: The aim of this study was to examine the possibility that type 2 diabetes and Alzheimer’s disease may share common behavioral protective factors such as adherence to type 2 diabetes treatment guidelines given that these two diseases have both epidemiological and metabolic similarities. Method: The method used in this study is a retrospective cohort study of 3,797 U.S. Medicare fee-for-service beneficiaries aged 66+ newly diagnosed with type 2 diabetes and without a prior record of Alzheimer’s disease based on the Health and Retirement Study. Results: Results of a left-truncated Cox model showed that adherence reduces the risk of Alzheimer’s disease by 20% to 24%. Other significant effects were college education (hazard ratio [HR]: 0.65; p value: .023), stroke (HR: 1.40; p value: .013), and 4+ limitations in physical functioning (HR: 1.33; p value: .008). Discussion: Risk of Alzheimer’s disease can be reduced by behavioral factors. Possible mechanisms may include earlier start of interventions to reduce blood glucose levels and improve insulin sensitivity.
Lesions of retrosplenial cortex spare immediate-early gene activity in related limbic regions in the rat
Authors: Powell Anna L , Hindley Emma , Nelson Andrew JD , Davies Moira , Amin Eman , Aggleton John P , Vann Seralynne D
Published: November 2018

The retrosplenial cortex forms part of a network of cortical and subcortical structures that have particular importance for spatial learning and navigation in rodents. This study examined how retrosplenial lesions affect activity in this network by visualising the expression of the immediate-early genes c- fos and zif268 after exposure to a novel location. Groups of rats with extensive cytotoxic lesions (areas 29 and 30) and rats with lesions largely confined to area 30 (dysgranular cortex) were compared with their respective control animals for levels of c- fos expression measured by immunohistochemistry. These cortical lesions had very limited effects on distal c- fos activity. Evidence of a restricted reduction in c-fos activity was seen in the septal dentate gyrus (superior blade) but not in other hippocampal and parahippocampal subareas, nor in the anterior cingulate and prelimbic cortices. Related studies examined zif268 activity in those cases with combined area 29 and 30 lesions. The only clear evidence for reduced zif268 activity following retrosplenial cell loss came from the septal CA3 area. The confined impact of retrosplenial tissue loss is notable as, by the same immediate-early gene measures, retrosplenial cortex is itself highly sensitive to damage in related limbic areas, showing a marked c- fos and zif268 hypoactivity across all of its subareas. This asymmetry in covert pathology may help to explain the apparent disparity between the severity of learning deficits after retrosplenial cortex lesions and after lesions in either the hippocampus or the anterior thalamic nuclei.
Detritic Synovitis With Osteolysis Leading to Pathologic Fracture and Deltoid Avulsion Following Total Shoulder Arthroplasty
Authors: Guild Theodore , Onsen Leonard T , Rivers Marie , Cheski Rebecca , Bear Brian , Izquierdo Rolando
Published: November 2018

Purpose

To report a unique case of detritic synovitis with associated lytic lesion leading to pathologic fracture of the acromion and deltoid avulsion following total shoulder arthroplasty (TSA).

Methods

An institutional review board-approved retrospective case analysis was performed using Electronic Medical Records (EMR) sourced pathology and radiology results, clinic notes, and surgical reports. Case Description: We present the case of a 79-year-old woman with a surgical history significant for TSA who presented with new onset of shoulder pain. The patient was found to have a lytic lesion in the acromion secondary to an inflammatory reaction to polyethylene wear debris. The lytic lesion led to fracture of the acromion and avulsion of the deltoid muscle. The patient was treated with an open biopsy, culture, and repair of the deltoid avulsion.

Discussion

This is a previously unreported complication of TSA resulting from detritic synovitis, a destructive inflammatory reaction to polyethylene wear debris within an artificial joint. The differential diagnosis includes periprosthetic infection with osteomyelitis and metastatic disease. This patient presented with extensive osteolysis, pathologic fracture of the acromion and deltoid avulsion that was successfully treated with debridement and surgical repair of the deltoid.

Conclusion

As the prevalence of TSA rises, orthopedic surgeons should be aware of the possibility of detritic synovitis in patients who present with pain after shoulder arthroplasty with imaging studies demonstrating periarticular osteolysis.
Timing of treatment of smoldering myeloma: delay until progression
Authors: Kumar Shaji K.
Published: November 2018

This article has a companion Point by Mateos and González-Calle.
LLIN Evaluation in Uganda Project (LLINEUP): factors associated with ownership and use of long-lasting insecticidal nets in Uganda: a cross-sectional survey of 48 districts
Authors: Gonahasa Samuel , Maiteki-Sebuguzi Catherine , Rugnao Sheila , Dorsey Grant , Opigo Jimmy , Yeka Adoke , Katureebe Agaba , Kyohere Mary , Lynd Amy , Hemingway Janet , Donnelly Martin , Kamya Moses R. , Staedke Sarah G.
Published: November 2018

Background

Long-lasting insecticidal nets (LLINs) are a key malaria control intervention. To investigate factors associated with ownership and use of LLINs in Uganda, a cross-sectional community survey was conducted in March–June 2017, approximately 3 years after a national Universal Coverage Campaign (UCC).

Methods

Households from 104 clusters (health sub-districts) in 48 districts were randomly selected using two-staged cluster sampling; 50 households were enrolled per cluster. Outcomes were household ownership of LLINs (at least one LLIN), adequate LLIN coverage (at least one LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Associations between variables of interest and outcomes were made using multivariate logistic regression.

Results

In total, 5196 households, with 29,627 residents and 6980 bed-nets, were included in the analysis. Overall, 65.0% of households owned at least one LLIN (down from 94% in 2014). In the adjusted analysis, factors most strongly associated with LLIN ownership were living in a wealthier household (highest tercile vs lowest; adjusted odds ratio [aOR] 1.94, 95% CI 1.66–2.28, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 1.91, 95% CI 1.60–2.28, p < 0.001). Only 17.9% of households had adequate LLIN coverage (down from 65% in 2014). Factors most strongly associated with adequate coverage were fewer residents (2–4 vs ≥ 7; aOR 6.52, 95% CI 5.13–8.29, p < 0.001), living in a wealthier household (highest tercile vs lowest; aOR: 2,32, 95% CI 1.88–2.85, p < 0.001) and time since the last UCC (29–37 vs 42–53 months; aOR 2.13, 95% CI 1.61–2.81, p < 0.001). Only 39.5% of residents used a LLIN the previous night. Age was strongly associated with LLIN use, as were household wealth and time since the last UCC. Children < 5 years (44.7%) and residents > 15 years (44.1%) were more likely to use nets than children aged 5–15 years (30.7%; < 5 years: aOR 1.71, 95% CI 1.62–1.81, p < 0.001; > 15 years: aOR 1.37, 95% CI 1.29–1.45, p < 0.001).

Conclusions

Long-lasting insecticidal net ownership and coverage have reduced markedly in Uganda since the last net distribution campaign in 2013/14. Houses with many residents, poorer households, and school-aged children should be targeted to improve LLIN coverage and use.

Trial registration This study is registered with ISRCTN (17516395)
Neuropsychiatric profile and psychotropic medication use in adults with autism spectrum disorder: results from the Australian Longitudinal Study of Adults with Autism
Authors: Cvejic Rachael C. , Arnold Samuel R. C. , Foley Kitty-Rose , Trollor Julian N.
Published: November 2018

Background

Children and adolescents with autism spectrum disorder (ASD) are a highly medicated group. Few studies have examined the neuropsychiatric profile and patterns of psychotropic medication use among adults with ASD.

Aims

To describe and compare the neuropsychiatric profile and psychotropic medication use in a cohort of adults with ASD and non-autistic controls.

Method

Baseline data from a survey-based, longitudinal study of adults with ASD in Australia. Participants were 188 adults with ASD and 115 controls aged 25–80 years.

Results

ASD was associated with increased odds of psychotropic medication use even when controlling for the presence of any neurological or psychiatric disorder. There were no corresponding indications for 14.4% of psychotropic medications prescribed to adults with ASD.

Conclusions

This study found substantial psychotropic prescribing for adults with ASD. Patterns of psychotropic medication use may reflect prescribing for behavioural indications despite limited evidence to support this practice.

Declaration of interest

None.
Approach to the Diagnosis and Treatment of Adult Burkitt's Lymphoma
Authors: Dunleavy Kieron
Published: November 2018

Burkitt's lymphoma is a rarely encountered, aggressive B-cell lymphoma that is highly curable in children and young adults. In middle-aged and older adults, however, administering curative therapy may be challenging because standard Burkitt's lymphoma platforms are associated with high treatment-related toxicity in these age groups. Because of its high curability, the testing of alternative, less toxic approaches in Burkitt's lymphoma has been challenging. Although the critical role of MYC in Burkitt's lymphoma has been well described, recent biologic insights have identified several new mutations that cooperate with MYC in driving lymphomagenesis, paving the way for novel drug testing in this disease. Recently, intermediate-intensity approaches have been tested in Burkitt's lymphoma. Early multicenter results demonstrate good tolerability while maintaining high cure rates in all patient and age groups.
Plasma Acylcarnitines and Risk of Type 2 Diabetes in a Mediterranean Population at High Cardiovascular Risk
Authors: Guasch-Ferré Marta , Ruiz-Canela Miguel , Li Jun , Zheng Yan , Bulló Mònica , Wang Dong D , Toledo Estefanía , Clish Clary , Corella Dolores , Estruch Ramon , Ros Emilio , Fitó Montserrat , Arós Fernando , Fiol Miquel , Lapetra José , Serra-Majem Lluís , Liang Liming , Papandreou Christopher , Dennis Courtney , Martínez-González Miguel A , Hu Frank B , Salas-Salvadó Jordi
Published: November 2018

Context

The potential associations between acylcarnitine profiles and incidence of type 2 diabetes (T2D) and whether acylcarnitines can be used to improve diabetes prediction remain unclear.

Objective

To evaluate the associations between baseline and 1-year changes in acylcarnitines and their diabetes predictive ability beyond traditional risk factors.

Design, Setting, and Participants

We designed a case-cohort study within the PREDIMED Study including all incident cases of T2D (n = 251) and 694 randomly selected participants at baseline (follow-up, 3.8 years). Plasma acylcarnitines were measured using a targeted approach by liquid chromatography–tandem mass spectrometry. We tested the associations between baseline and 1-year changes in individual acylcarnitines and T2D risk using weighted Cox regression models. We used elastic net regressions to select acylcarnitines for T2D prediction and compute a weighted score using a cross-validation approach.

Results

An acylcarnitine profile, especially including short- and long-chain acylcarnitines, was significantly associated with a higher risk of T2D independent of traditional risk factors. The relative risks of T2D per SD increment of the predictive model scores were 4.03 (95% CI, 3.00 to 5.42; P < 0.001) for the conventional model and 4.85 (95% CI, 3.65 to 6.45; P < 0.001) for the model including acylcarnitines, with a hazard ratio of 1.33 (95% CI, 1.08 to 1.63; P < 0.001) attributed to the acylcarnitines. Including the acylcarnitines into the model did not significantly improve the area under the receiver operator characteristic curve (0.86 to 0.88, P = 0.61). A 1-year increase in C4OH-carnitine was associated with higher risk of T2D [per SD increment, 1.44 (1.03 to 2.01)].

Conclusions

An acylcarnitine profile, mainly including short- and long-chain acylcarnitines, was significantly associated with higher T2D risk in participants at high cardiovascular risk. The inclusion of acylcarnitines into the model did not significantly improve the T2D prediction C-statistics beyond traditional risk factors, including fasting glucose.
Functional Analysis of Genetic Variation in the SECIS Element of Thyroid Hormone Activating Type 2 Deiodinase
Authors: Zevenbergen Chantal , Groeneweg Stefan , Swagemakers Sigrid M A , de Jong Arthur , Medici-Van den Herik Evita , Rispens Madzy , Klootwijk Wim , Medici Marco , de Rijke Yolanda B , Meima Marcel E , Larsen P Reed , Chavatte Laurent , Venter Deon , Peeters Robin P , Van der Spek Peter J , Visser W Edward
Published: November 2018

Context

Thyroid hormone is important for normal brain development. The type 2 deiodinase (D2) controls thyroid hormone action in the brain by activating T4 to T3. The enzymatic activity of D2 depends on the incorporation of selenocysteine for which the selenocysteine-insertion sequence (SECIS) element located in the 3′ untranslated region is indispensable. We hypothesized that mutations in the SECIS element could affect D2 function, resulting in a neurocognitive phenotype.

Objective

To identify mutations in the SECIS element of DIO2 in patients with intellectual disability and to test their functional consequences.

Design, Setting, and Patients

The SECIS element of DIO2 was sequenced in 387 patients with unexplained intellectual disability using a predefined pattern of thyroid function tests. SECIS element read-through in wild-type or mutant D2 was quantified by a luciferase reporter system in transfected cells. Functional consequences were assessed by quantifying D2 activity in cell lysate or intact cell metabolism studies.

Results

Sequence analysis revealed 2 heterozygous mutations: c.5703C>T and c.5730A>T, which were also present in the unaffected family members. The functional evaluation showed that both mutations did not affect D2 enzyme activity in cell lysates or intact cells, although the 5730A>T mutation decreased SECIS element read-through by 75%. In the patient harboring the c.5730A>T variant, whole genome sequencing revealed a pathogenic deletion of the STXBP1 gene.

Conclusions

We report on two families with mutations in the SECIS element of D2. Although functional analysis showed that nucleotide 5730 is important for normal SECIS element read-through, the two variants did not segregate with a distinct phenotype.
Relapse following use of Ponseti method in idiopathic clubfoot
Authors: Chand S. , Mehtani A. , Sud A. , Prakash J. , Sinha A. , Agnihotri A.
Published: November 2018

Purpose

We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well.

Methods

We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol.

Results

Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%.

Conclusion

We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol.

Level of evidence

IV
Is it always necessary to perform an axillary lymph node dissection after neoadjuvant chemotherapy for breast cancer?
Authors: Osorio-Silla I , Gómez Valdazo A , Sánchez Méndez J I , York E , Díaz-Almirón M , Gómez Ramírez J , Rivas Fidalgo S , Oliver JM , Álvarez CM , Hardisson D , Díaz Miguel M , Lobo F , Díaz Domínguez J
Published: November 2018

Introduction

Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy.

Materials and methods

A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. A predictive model was generated by a multivariate logistic regression analysis for pathological complete response-dependent variable.

Results

The response of the primary lesion to neoadjuvant chemotherapy according to post-treatment magnetic resonance imaging, Her2/neu overexpression and a low estrogen receptor expression are associated with a higher rate of nodal pathologically complete response. The multivariant model generated a receiver operating characteristic curve with an area under the curve of 0.79 and a confidence interval of 0.72–0.87 at a 95% level of significance.

Conclusions

This model could be a helpful tool for the surgeon to help in predicting which cases have a higher likelihood of achieving a pathologically complete response and therefore selecting those who may benefit from a post-neoadjuvant chemotherapy sentinel lymph node biopsy and avoid unnecessary axillary lymphadenectomy.
Caracterização dos resíduos sólidos gerados em laticínios
Authors: Leite Antonio Iranaldo Nunes , Alves Rayane Campos , Soares Fernanda Damasceno , Otenio Marcelo Henrique , Paula Vanessa Romário de
Published: November 2018

A conscientização ambiental está cada vez mais inserida nas escolhas do consumidor. A preocupação em atender essa demanda tem impulsionado as empresas a buscarem adequação dos seus processos e rotinas. Este estudo tem como objetivo realizar um levantamento dos resíduos sólidos gerados nos laticínios e os respectivos tratamentos e a disposição final. Foram convidados a participar vinte e duas (22) indústrias de diversas regiões do Brasil, classificados quanto ao porte e potencial poluidor. Participaram 7 (sete) laticínios localizados na região Sudeste, 3 (três) na região Sul, 3 (três) na região Centro-Oeste, 3 (três) na região Norte, 7 (sete) na região Nordeste. Foi elaborado um questionário eletrônico estruturado de acordo com a divisão de classe dos resíduos: comuns, químicos e biológicos, e enviado aos laticínios. As respostas demonstraram que as indústrias de laticínios, independente do volume de leite processado com características intrínsecas, frequência e volume gerado não possuem em suas rotinas o gerenciamento dos resíduos. Este estudo demonstra a situação atual de como os laticínios tratam este tema e destaca a necessidade dessas indústrias sem se adaptar às questões ambientais. Baseado na legislação vigente, de resíduos sólidos, a indústria de laticínio deve buscar adequação e inserção de tecnologias sustentáveis em seus processos e rotinas. A adoção dessas práticas tem influência direta e positiva no marketing e comercialização da empresa.
Gold, Slaves, and Trading Routes in Southern Blue Nile (Abbay) Societies, Ethiopia, 13th–16th Centuries
Authors: Bouanga Ayda
Published: November 2018

In the thirteenth century, the territories of Damot, Ǝnnarya, Ǝndägäbṭän, and Wäräb, located south of the Blue Nile, west of Awash, and northeast of the Gibe watershed, belonged to the realm of Damot. At that time, the motälämi dynasty ruled the kingdom and sought to assert authority over the Muslim states of eastern Ethiopia, šäwa, and Ifat. Following the accession of the Solomonic dynasty and its territorial conquests in the fourteenth century, the Kingdom of Damot gradually disappeared. It gave way to two different entities: the eastern part is known as medieval Damot—protectorate of the Christian kingdom—whereas the western part became the southern region of the Christian province of šäwa. South of this geopolitical entity were the kingdoms of Gamo and Janjero, which were famous for trading gold and slaves, particularly eunuchs, throughout the medieval period. Inhabited by agro-pastoralists settled in different areas of southern Blue Nile, Damot, Gamo, and Janjero were at the crossroads of an important trade in luxury goods. Slaves and gold originated from there and were then integrated into a long-distance commercial network. After passing through the Muslim states of eastern Ethiopia, the goods arrived in the ports of the Red Sea (Massawa and Zeyla) before reaching the Arabian Peninsula and Asia. This article analyzes the economic history of the region, draws the contours of the production of gold and slaves, and traces their routes to the Red Sea. It shows a relatively stable localization of the “production” of gold and slaves in Ethiopia during the medieval period. At the local level, this phenomenon raises questions about various aspects of the Ethiopian slave trade, such as the methods of slave acquisition (raids, wars, punitive expeditions), and the role of physical and cultural otherness (stigmatization and legitimization based on cultural denigration), and their impact on the transformation of political structures.