bluuebunny/crossref_metadata_2025 huggingface dataset:
Can the Cost Affect the Choice of Various Methods of Postmastectomy Breast Reconstruction?
Authors: Franchelli Simonetta , Leone Maria Stella , Berrino Pietro , Passarelli Barbara , Cicchetti Silvia , Perniciaro Giuseppe , Delfino Eliano , Santi Pierluigi
Published: April 2018

Aim and background

A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal.

Methods

The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps.

Results

After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs.

Conclusions

There is no balance between price list and effective cost of the different surgical reconstructive procedures, which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regions and hospitals to improve the service, keeping it at a good level.
Malignant Mixed Müllerian Tumor of the Uterus. Features Favoring its Origin from a Common Cell Clone and an Epithelial-to-Mesenchymal Transformation Mechanism of Histogenesis
Authors: Guarino Marcello , Giordano Ferdinando , Pallotti Francesco , Polizzotti Giulio , Tricomi Paolo , Cristofori Enrico
Published: April 2018

Aims and background

Various histogenetic mechanisms have been postulated to explain the biphasic carcinomatous-sarcomatous appearance of malignant mixed müllerian tumors (MMMTs), but the nature of these uncommon neoplasms is still unclear. Some evidence would suggest that MMMT displays similarities with sarcomatoid carcinoma, a tumor arising in extragenital sites that also features a mixed appearance. To gain further insight into the histogenesis of this tumor, we have studied by immunohistochemistry a case of uterine MMMT showing an extensive rhabdomyosarcomatous component.

Methods

A panel of antibodies including reactivity for p53, cytokeratin, vimentin, desmin, muscle actin, epithelial membrane antigen (EMA), myoglobin, type IV collagen, laminin, and tenascin was applied to paraffin tumor sections by means of the avidin-biotin complex technique.

Results

p53 immunoreactivity was observed in approximately the same number of cells in carcinomatous and sarcomatous tissue. The former stained for vimentin, cytokeratin and EMA, while the latter, in addition to expressing vimentin, desmin, muscle actin and myoglobin, also exhibited immunoreactivity for epithelial markers such as cytokeratin and EMA. At the borders between carcinoma and sarcoma the basement membrane pattern, as seen by staining for type IV collagen and laminin, showed interruptions in correspondence with areas of transition between the two tissues. Antibody to tenascin strongly labeled the sarcomatous tissue immediately around carcinomatous elements.

Conclusions

A similar immunoreactivity for p53 in both carcinomatous and sarcomatous components, expression of epithelial markers in the sarcomatous cells, and disruption of the basement membrane profile in areas of transition between carcinomatous and sarcomatous tissue, would all suggest, as has been postulated for extragenital sarcomatoid carcinomas, an origin from a common epithelial clone and an epithelial-to-mesenchymal transformation-based mechanism of development for this MMMT. In addition, these findings provide further analogies between these categories of tumors, supporting a unifying nosological concept for MMMTs and sarcomatoid carcinomas of non-genital tract origin.
LA RICERCA DI ESITO: RAZIONALI ED OBIETTIVI
Authors: Olivieri Antonio , Recchia Giuseppe , Roila Fausto
Published: April 2018

Outcome research measures the clinical, economic and humanistic outcomes of pharmacological therapies on patients suffering from different diseases. Outcome research can be applied either to phase II and III clinical trials to assess new drugs for registration or to already marketed drugs to assess their real value when used in clinical practice in a large population of patients.

Oncology can be a major field of application because there is a large amount of new treatments put on the market, often without demonstration of significant improvement in survival or Quality of Life but with higher prices than the old molecules.

Patients and disease specific outcomes have been identified for cancer by a Working Group set up by the American Society of Clinical Oncology, with the former being defined as more critical to establish the value of new treatments. Survival, drug toxicity and impact on Quality of Life are the most important patient's outcomes to consider before recommending anti-cancer therapies for use in clinical practice.

The present paper will describe the outcomes in oncology and will deal with the transferability to clinical practice of the results of clinical trials.
Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center
Authors: Flannery Alexander H. , Thompson Bastin Melissa L. , Montgomery-Yates Ashley , Hook Corrine , Cassity Evan , Eaton Phillip M. , Morris Peter E.
Published: April 2018

Background:

Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization.

Methods:

This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes.

Results:

The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science.

Conclusions:

A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.
Activism in Bosnia-Herzegovina: Struggles against Dual Hegemony and the Emergence of “Local First”
Authors: Puljek-Shank Randall , Fritsch Felix
Published: April 2018

The 2014 protests and plenums in Bosnia-Herzegovina were widely noted for their insertion of economic and social justice topics into the stale public discourse of ethnocracy. They also signified a potential to break with an anemic civil society shaped by international intervention, technocratic “project logic” and apolitical service provision. This article argues for treating these struggles in reference to the dual nature of the hegemony created by both local ethnonationalists and international liberal intervenors. It applies a Gramscian perspective to the processes by which hegemony is created and (re)produced via consensus in civil society. The challenge to dual hegemony can be seen in the central focus of contestation on social justice in economic arrangements as well as in the alternative logics of engagement and organizational forms in society. We describe the tensions arising from this dual challenge in terms of the degree to which they contest or reproduce the predominant anti-politics, a stance of distancing from dialogue or even contact with political actors and institutions. We conclude that the events during and since 2014 have strengthened the means to build an alternative third bloc via a “local first” approach, containing heterogeneous forms of local-scale action with explicitly political strategies.
Lane marking detection and classification with combined deep neural network for driver assistance
Authors: Zhang Weiwei , Liu Hui , Wu Xuncheng , Xiao Lingyun , Qian Yubin , Fang Zhi
Published: April 2018

An efficient approach for lane marking detection and classification by the combination of convolution neural network and recurrent neural network is proposed in this paper. First, convolution neural network is trained for lane marking features extraction, and then these convolution neural network features of continuous frames are transferred to recurrent neural network model for lane boundary detection and classification in the time domain. At last, a lane boundary fitting method based on dynamic programming is proposed to improve the lane detection accuracy and robustness. The method presented generates satisfactory results of lane detection and type classification under various traffic conditions according to the experimental results, which show that the approach provided in this paper outperforms traditional methods and the total lane markings classification reached 95.21% accuracy.
Holocene hydrologic and vegetation developments in the Orange River catchment (South Africa) and their controls
Authors: Burdanowitz Nicole , Dupont Lydie , Zabel Matthias , Schefuß Enno
Published: April 2018

The summer rainfall zone (SRZ) in the South African interior experienced pronounced hydrological and vegetation changes during the Holocene inferred to be driven mainly by shifts in atmospheric and oceanic circulations systems. The exact mechanisms controlling these changes are still debated. To gain better insights into the Holocene environmental changes in the South African SRZ and their driving factors, we analysed compound-specific carbon and hydrogen isotopes of plant wax n-alkanes (δ13Cwax and δDwax) from a marine sediment core covering the last 9900 years. The core has been recovered offshore the mouth of the Orange River, predominantly draining the South African summer rainfall region. Our data indicate a dry early Holocene and a gradual increase of wetter conditions with a higher abundance of C4 vegetation towards the middle Holocene. Wettest conditions occurred around 3900 cal. yr BP. The last 3900 years were characterised by a gradual aridification overlain by variable wetter conditions. During the ‘Little Ice Age’ (LIA: ca. 640–310 cal. yr BP), relatively dry conditions with elevated C4 plant contributions occurred. This opposite behaviour, that is, more C4 plant contribution during drier conditions compared to the remainder of the Holocene, points towards an influence of winter rainfall in the lower Orange River catchment during the late-Holocene and a decline in summer rainfall. We emphasise the importance of changes in the latitudinal insolation gradient (LIG) as a potentially important controlling mechanism for hydrologic and vegetation changes in the SRZ.
The usefulness of science knowledge for parents of hearing-impaired children
Authors: Shauli Sophie , Baram-Tsabari Ayelet
Published: April 2018

Hearing-impaired children’s chances of integrating into hearing society largely depend on their parents, who need to learn vast amounts of science knowledge in the field of hearing. This study characterized the role played by science knowledge in the lives of nonscientists faced with science-related decisions by examining the interactions between general science knowledge, contextual science knowledge in the field of hearing, and parents’ advocacy knowledge and attitudes. Based on six semi-structured interviews and 115 questionnaires completed by parents of hearing-impaired children, contextual science knowledge emerged as the only predictor for having slightly better advocacy attitudes and knowledge (5.5% explained variance). Although general science knowledge was the best predictor of contextual knowledge (14% of explained variance), it was not a direct predictor of advocacy knowledge and attitudes. Science knowledge plays some role in the lives of hearing-impaired families, even if they do not list it as a resource for successful rehabilitation.
Impulsive energy conversion with magnetically coupled nonlinear energy harvesting systems
Authors: Dai Quanqi , Park Inhyuk , Harne Ryan L
Published: April 2018

Magnets have received broad attention for vibration energy harvesting due to noncontact, nonlinear forces that may be leveraged among harvesting system elements. Yet, opportunities to integrate multi-directional coupling among a nonlinear energy harvesting system subjected to impulsive excitations have not been scrutinized, despite widespread prevalence of such excitations. To characterize these potentials, this research investigates an energy harvesting system with magnetically induced nonlinearities and coupling effects under impulsive excitations. A system model is formulated and validated with experimental efforts to reconstruct static and dynamic properties of the system via simulations. Then, the model is harnessed to scrutinize dynamic response of the system when subjected to impulse conditions. This research reveals the clear impulse strength dependence and influence of asymmetries on total electrical energy capture and energy conversion efficiency that are tailored by magnetic force coupling. Asymmetry is found to promote greater impulse-to-electrical energy conversion when compared to the symmetric counterpart system and a benchmark nonlinear energy harvester. The roles of initial conditions exemplify how stored energy in an asymmetric energy harvesting system may be released during nonlinear impulsive response. These results provide insights about opportunities and challenges to incorporate magnetic coupling effects in nonlinear energy harvesting systems subjected to impulses.
Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care
Authors: Abu Al Hamayel Nebras. , Isenberg Sarina R. , Hannum Susan M. , Sixon Joshua , Smith Katherine Clegg. , Dy Sydney M.
Published: April 2018

Background:

Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective.

Objective:

To explore older patients’ perspectives on the quality of serious illness care in primary care.

Design:

Qualitative interview study.

Participants:

Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative.

Methods:

We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method.

Results:

We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care.

Conclusions:

Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.
Research and development techniques for early-warning satellite systems using concurrent engineering
Authors: Sun Fuyu , Wang Hua , Zhou Jianping
Published: April 2018

An early-warning satellite system is a complex project that requires the participation of many aerospace academies and scientific institutions. In terms of software programming, this study proposes a new simulation integrated management platform for the analysis of parallel and distributed systems. The platform facilitates the design and testing of both applications and architectures. To improve the efficiency of project development, new early-warning satellite systems are designed based on the simulation integrated management platform. In terms of project management, this study applies concurrent engineering theory to aerospace engineering and presents a method of collaborative project management. Finally, through a series of experiments, this study validates the simulation integrated management platform, models, and project management method. Furthermore, the causes of deviation and prevention methods are explained in detail. The proposed simulation platform, models, and project management method provide a foundation for further validations of autonomous technology in space attack–defense architecture research.
Association Between Adherence to Statins, Illness Perception, Treatment Satisfaction, and Quality of Life among Lebanese patients
Authors: Haddad Christine , Hallit Souheil , Salhab Mohammad , Hajj Aline , Sarkis Antoine , Ayoub Eliane Nasser , Jabbour Hicham , Khabbaz Lydia Rabbaa
Published: April 2018

Objectives:

The main objective of this study was to evaluate treatment adherence to statin and health-related quality of life (QOL) in Lebanese patients with dyslipidemia. Secondary objectives were to examine associations between treatment adherence, QOL, treatment satisfaction, and illness perception.

Methods:

This cross-sectional study, conducted in 20 community pharmacies from all districts of Lebanon between August 2016 and April 2017, enrolled 247 adult patients taking any statin.

Results:

The mean age of the participants was 52.63 ± 11.92 years (57.5% males); the mean duration of treatment with a statin was 59.72 months. A significant association was found between adherence and marital status ( P < .0001), educational level ( P = .001), cigarette smoking ( P < .0001), and alcohol drinking ( P < .0001). A negative but significant correlation was found between the adherence score and the duration of dyslipidemia ( r = −0.199). A significant but negative correlation was also found between the side effect score and age ( r = −0.137). The monthly salary, the marital status, the educational level, smoking cigarettes or waterpipes, and drinking alcohol were all associated with the Illness Perception Questionnaire scores ( P < 0.0001 for all variables). Secondary level of education (β = 13.43), smoking more than 3 waterpipes per week (β = 14.06), global satisfaction score (β = 0.32), convenience score (β = 0.29), and effectiveness score (β = 0.27) would significantly increase the adherence score. Smoking more than 15 cigarettes per day (β = −11.15) and a divorced status (β = −14.81) would however significantly decrease the adherence score. Significant associations were found between the illness perception score, the QOL domains, and the satisfaction domains ( P < .05 for all variables).

Conclusion:

This study showed that global satisfaction with treatment, convenience, and effectiveness are important factors that increase treatment adherence. Patient adherence results in patient satisfaction and improved QOL and is an important criterion for achieving desired therapeutic outcomes.
Is Peripherally Inserted Central Catheter–Related Thrombosis Associated With ABO Blood Group? A Case–Control Pilot Study
Authors: Haddad Raad A. , Alnimer Yanal , Abdalla Ahmed , Ríos-Bedoya Carlos F. , Bachuwa Ghassan
Published: April 2018

Peripherally inserted central catheter (PICC) use is associated with many complications including line-related thrombosis. Several studies and meta-analyses confirmed the increased risk to develop venous thromboembolism in non-O blood group individuals. Our pilot study aimed to examine whether PICC-related thrombosis is influenced by ABO blood group. We identified patients admitted to Hurley Medical Center between March 2012 and March 2016 who had PICC placed during their admission, had their ABO blood group identified in their medical record, and had upper extremity venous Doppler ultrasound performed on the same side of PICC. We excluded pregnant women, patients on anticoagulation initiated before PICC insertion, and patients with active cancer. Data of 227 patients who met our criteria were analyzed. Of these patients, 140 (61.7%) patients had PICC-related thrombosis (cases) and 86 (37.9%) patients had O blood group. Controls were patients who had PICC and did not develop PICC-related thrombosis. Multivariate logistic regression revealed no association between PICC-related thrombosis and ABO blood group (adjusted odds ratio: 1.1; 95% confidence interval: 0.6-2.0; P = .733). Therefore, our data suggest that non-O blood group does not increase the odds of having PICC-related thrombosis.
On-Top-Plasty for Atypical Thumb Duplication: A Case Report With 10 Year Follow-up
Authors: Pons-Riverola Albert , Camprubi-Garcia Eric , Barrera-Ochoa Sergi , Bergua-Domingo Josep M. , Knorr Jorge , Soldado Francisco
Published: April 2018

Background: A very uncommon pattern of thumb duplication consists of an ulnar-side floating thumb and a radial-side distally hypoplastic thumb. Methods: We report the case of a 15-month-old child with this type of thumb duplication on his right hand treated with an on-top-plasty technique. The ulnar-side segment was pedicled and transferred to the lateral thumb, which was distally resected. Results: A well-aligned and widely mobile thumb with a wide first web and an excellent cosmetic appearance was exhibited 10 years after surgery. Conclusions: On-top-plasty technique might be amenable to reconstruct certain atypical thumb duplications.
Design and simulation of inner and outer cylinder–type steam catapult
Authors: Shi Yan , Shi Tiancheng , Ma Weihua , Gao Chang
Published: April 2018

In order to solve the problem of sealing the cylinder of the steam catapult, a nested structure of inner and outer cylinders is developed. The openings of the inner and the outer cylinders are staggered after the installation. The materials of inner and outer cylinders are the same. The thermal deformations of the two types of cylinders are consistent at high temperature, so that the radial sealing can be guaranteed. Based on the basic working principle of this steam catapult, a dynamic mathematical simulation model is developed with some assumptions; relevant researches are carried out by simulating the dynamics and thermodynamics process of the steam launch system. The result indicates that the radius of cylinder and the initial steam pressure have significant effects on the takeoff speed and the takeoff acceleration. With a constant load, the radius of cylinder is inversely proportional to the initial steam pressure, and it is considered that the optimal choice should be 0.4 m/2 MPa. The headwind helps takeoff and reduces the dependence on the thrust force in the launch process. The simulation result could provide a reference for the design of the inner and outer nested cylinder–type steam catapult.
Investigation of friction power consumption and performance of a water turbine seal based on the imbalanced rotation of nano-magnetic fluids
Authors: Li Zhenggui , Zhang Jiarong , Li Deyou , Chai Xin , Li Bo , Yang Fengyu
Published: April 2018

The calculation of friction power consumption and the performance of nano-magnetic fluids in sealed water turbines have proved to be hurdles in studies on nano-magnetic fluidic device designs and applications. In this article, we investigate the imbalanced rotation Ω ≠ 1/2 ( rot υ) of a nano-magnetic fluid suspended in a paramagnetic carrier liquid. Through Langevin and Navier–Stokes equations, the formula for the theoretical friction power consumption can be calculated for the magnetic particles in the nano-magnetic fluid. The calculated value shows a well agreement with the test result. Further simulation indicates that the magnetic field gradient Δ Bsum between the tooth space (wave trough) and the pole tooth (wave crest) has the most influence on the imbalanced rotation in a sealed nano-magnetic fluid device in a water turbine. Specifically, the larger the Δ Bsum, the more obviously imbalanced the nano-magnetic fluid rotation will be at that location; and the imbalanced torque will be larger, so the seal differential pressure will be as well. As a result, the sealing capacity will be better and the frictional power consumption will be larger; and the reverse is also true. This study result can serve as a reference for designs for sealed nano-magnetic fluidic devices for water turbines, which is significant, especially given the heat from friction power consumption in the water turbine and its cooling equipment.
Polymorphisms in the TOX3/LOC643714 and risk of breast cancer in south China
Authors: Liao Jinling , Chen Yang , Zhu Jia , Wang Qiuyan , Mo Zengnan
Published: April 2018

Objective:

Breast cancer is the most widespread cancer in women, with a high mortality rate. This study aims to assess the association between single nucleotide polymorphisms (SNPs) of LOC643714 (rs12922061) and TOX3 (rs3803662) and breast cancer, as well as the clinical characteristics of tumors.

Materials and methods:

In total, 104 breast cancer patients and 118 healthy controls were recruited to our study. The genotyping was performed by the SNP scan method. General characteristics, the clinical characteristics of tumors and reproductive factors were included in the analysis. Statistical tests included the Student t-test, the Chi-square test (X2) or Fisher’s exact test, and unconditional logistic regression analysis. The receiver operating characteristic curves were used to evaluate the predictive role of rs12922061 in breast cancer.

Results:

The LOC643714 polymorphism was a risk factor for breast cancer under a dominant model (TT+TC vs. CC: OR 1.801; 95% CI 1.048, 3.095; statistical power=60%), recessive model (TT vs. TC + CC: OR 4.297; 95% CI 1.164, 15.867; statistical power=64%) and log-additive (TT vs. CC: OR 5.163; 95% CI 1.368, 19.485; statistical power= 73%). Furthermore, the rs12922061 polymorphism was associated with menopause status in patients ( P=0.005). No statistically significant association was found between the rs3803662 polymorphism and breast cancer in patients or healthy controls.

Conclusions:

Our study found that rs12922061 of LOC643714 was related to breast cancer risk. With a limited sample size and statistical power, further multi-center studies are needed to confirm the influence of the LOC643714 polymorphisms on breast cancer based on larger populations.
Prognostic value of platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: A systematic review and meta-analysis
Authors: Zhang Xiangwei , Wang Yang , Zhao Linping , Sang Shaowei , Zhang Lin
Published: April 2018

The platelet-to-lymphocyte ratio (PLR) is a useful prognostic factor in several cancers. However, the prognostic role of PLR in esophageal cancer remains controversial. The aim of this study is to evaluate the association between PLR and the oncologic outcome of esophageal cancer patients through a meta-analysis. Relevant articles were researched from Embase, PubMed, and Web of Science databases. The meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. Finally, 19 articles with 6134 patients were included in our study. The summary results indicated that the elevated PLR was negatively related to overall survival (HR= 1.263; 95% CI 1.094, 1.458). The subgroup analysis revealed that increased PLR was associated with poor overall survival in esophageal cancer patients for Asians (HR=1.252; 95% CI 1.141, 1.373) but not for Caucasians (HR=1.463; 95% CI 0.611, 3.502). When the patients were segregated by pathological type, sample size, and HR estimate method, high PLR was also significantly correlated with poor overall survival. In contrast, elevated PLR was not statistically associated with disease-free survival or cancer-specific survival. High PLR is associated with poor overall survival in patients with esophageal cancer. PLR may be a significant predictive biomarker in patients with esophageal cancer. Further large-cohort studies are needed to confirm these findings.
Wind turbine planetary gearbox feature extraction and fault diagnosis using a deep-learning-based approach
Authors: He Miao , He David , Yoon Jae , Nostrand Thomas J , Zhu Junda , Bechhoefer Eric
Published: April 2018

Planetary gearboxes are widely used in the drivetrain of wind turbines. Planetary gearbox fault diagnosis is very important for reducing the downtime and maintenance cost and improving the safety, reliability, and life span of the wind turbines. The wind energy industry is currently using condition monitoring systems to collect massive real-time data and conventional vibratory analysis as a standard method for planetary gearbox condition monitoring. As an attractive option to process big data for fault diagnosis, deep learning can automatically learn features that otherwise require much skill, time, and experience. This article presents a new deep-learning-based method for wind turbine planetary gearbox fault diagnosis developed by a large memory storage and retrieval neural network with dictionary learning. The developed approach can automatically extract self-learned fault features from raw vibration monitoring data and perform planetary gearbox fault diagnosis without supervised fine-tuning process. From the raw vibration monitoring data, a dictionary is first learned by a large memory storage and retrieval with dictionary learning network. Based on the learned dictionary, a sparse representation of the raw vibration signals is generated by shift-invariant sparse coding and input to a large memory storage and retrieval network classifier to obtain fault diagnosis results. The structure of the large memory storage and retrieval with dictionary learning is determined by optimal selection of the sliding box size to generate sub-patterns from the vibration data. The effectiveness of the presented method is tested and validated with a set of seeded fault vibration data collected at a planetary gearbox test rig in laboratory. The validation results have shown a promising planetary gearbox fault diagnosis performance with the presented method.
Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis
Authors: Zhu Jia , Qi Xingshun , Yu Haonan , Yoshida Eric M , Mendez-Sanchez Nahum , Zhang Xintong , Wang Ran , Deng Han , Li Jing , Han Dan , Guo Xiaozhong
Published: April 2018

Background

Hepatic encephalopathy is associated with altered gut microbiota. Proton pump inhibitors increase the risk of small bowel bacterial overgrowth.

Objectives

This was a case‐control study aimed at exploring the relationship of proton pump inhibitor use with the risk of hepatic encephalopathy during hospitalization in liver cirrhosis.

Methods

Case and control groups were defined as cirrhotic patients who developed hepatic encephalopathy during hospitalization and those without hepatic encephalopathy at admission or during hospitalization, respectively. Age, gender, and Child‐Pugh score were matched between the groups. Odds ratios with 95% confidence intervals were calculated to express the association of proton pump inhibitors with the risk of hepatic encephalopathy. Four subgroup analyses were performed after excluding patients with acute upper gastrointestinal bleeding, infections, and in‐hospital death, and after matching model for end‐stage liver disease score.

Results

In the overall analysis, 128 patients were included in each group of cases and controls. The proportion of proton pump inhibitor use was significantly higher in the case group than the control group (79.7% vs 43%, p < 0.001). Proton pump inhibitor use (odds ratio = 3.481, 95% confidence interval: 1.651–7.340, p = 0.001) was independently associated with the development of hepatic encephalopathy in the multivariate analysis. In the four subgroup analyses, proton pump inhibitor use remained independently associated with the risk of hepatic encephalopathy.

Conclusion

Proton pump inhibitor use might increase the risk of hepatic encephalopathy during hospitalization.
Demographic Study of Hip Fractures in the Maltese Islands
Authors: Bugeja Mark , Aquilina Simon , Farrugia Charles , Esposito Ivan
Published: April 2018

Introduction:

Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting.

Objective:

To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands.

Method:

All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association.

Results:

A moderate negative correlation ( r = −0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days.

Conclusion:

Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.
Postracism Mythology: NBA Commissioner Adam Silver’s “Heroic” Banishment of Racism From the NBA
Authors: Cramer Linsay M.
Published: April 2018

On April 29, 2014, National Basketball Association (NBA) Commissioner Adam Silver delivered a press conference in which he fined the then-owner of the Los Angeles (L.A.) Clippers, Donald Sterling, 2.5 million dollars and banned him for life from any affiliation with the NBA due to racist comments that Sterling made to his then-girlfriend in a recorded phone conversation that was released to the public. This article examines how Silver, through his leadership performance and the global news and sports media reactions to his performance, rhetorically advanced postracism logics and hegemonic masculine ideals through mythological constructions of White masculinity. This rhetorical analysis and critique revealed that Silver’s press conference and the global news and sports media’s response to it obviate the racial and gender structures of NBA administrative positions that favor White masculinity while simultaneously advancing hegemonic ideals that function to marginalized those who do not occupy White masculine positionality.
The dynamics of disordered dialogue: Prefrontal, hippocampal and thalamic miscommunication underlying working memory deficits in schizophrenia
Authors: Kupferschmidt David A , Gordon Joshua A
Published: April 2018

The prefrontal cortex is central to the orchestrated brain network communication that gives rise to working memory and other cognitive functions. Accordingly, working memory deficits in schizophrenia are increasingly thought to derive from prefrontal cortex dysfunction coupled with broader network disconnectivity. How the prefrontal cortex dynamically communicates with its distal network partners to support working memory and how this communication is disrupted in individuals with schizophrenia remain unclear. Here we review recent evidence that prefrontal cortex communication with the hippocampus and thalamus is essential for normal spatial working memory, and that miscommunication between these structures underlies spatial working memory deficits in schizophrenia. We focus on studies using normal rodents and rodent models designed to probe schizophrenia-related pathology to assess the dynamics of neural interaction between these brain regions. We also highlight recent preclinical work parsing roles for long-range prefrontal cortex connections with the hippocampus and thalamus in normal and disordered spatial working memory. Finally, we discuss how emerging rodent endophenotypes of hippocampal- and thalamo-prefrontal cortex dynamics in spatial working memory could translate into richer understanding of the neural bases of cognitive function and dysfunction in humans.
Hypomethylating agents in relapsed and refractory AML: outcomes and their predictors in a large international patient cohort
Authors: Stahl Maximilian , DeVeaux Michelle , Montesinos Pau , Itzykson Raphael , Ritchie Ellen K. , Sekeres Mikkael A. , Barnard John D. , Podoltsev Nikolai A. , Brunner Andrew M. , Komrokji Rami S. , Bhatt Vijaya R. , Al-Kali Aref , Cluzeau Thomas , Santini Valeria , Fathi Amir T. , Roboz Gail J. , Fenaux Pierre , Litzow Mark R. , Perreault Sarah , Kim Tae Kon , Prebet Thomas , Vey Norbert , Verma Vivek , Germing Ulrich , Bergua Juan Miguel , Serrano Josefina , Gore Steven D. , Zeidan Amer M.
Published: April 2018

Key Points

In the largest study of HMAs in RR-AML to date, 16% of patients achieved CR/CRi and experienced a median OS of 21 months. Low proliferative disease (peripheral blood blasts <5%) was associated with improved response and OS.
Changing wage structure in India in the post-reform era: 1993–2011
Authors: Jacoby Hanan G. , Dasgupta Basab
Published: April 2018

This paper documents the changing structure of wages in India over the post-reform era, the roughly two-decade period since 1993. To investigate the factors underlying these changes, a supply-demand framework is applied at the level of the Indian state. While real wages have risen across India over the past two decades, the increase has been greater in rural areas and, especially, for unskilled workers. The analysis finds that, in rural areas, the changing wage structure has been driven largely by relative supply factors, such as increased overall education levels and falling female labor force participation. Relative wage changes between rural and urban areas have been driven largely by shifts in employment, notably into unskilled-intensive sectors like construction.

JEL Classification:J21, J23, J24, J31
A property of the determinant of a 2 × 2 tensor relevant to magnetotellurics
Authors: Lilley Frederick E. M. , Phillips Christopher J. E.
Published: April 2018

Where a [Formula: see text] tensor relates two geophysical quantities that are measured in the field as time-varying vectors, its determinant is shown to be positive when, for two different events occurring at different times, a step clockwise in the direction of one vector from the first event to the second is accompanied by a step clockwise in the direction of the other vector from the first event to the second. The determinant would be negative were the azimuths of the two field vectors to “counter step,” i.e., change in opposite directions. In magnetotellurics (MT), the technique known as phase-tensor analysis brings a focus on the determinant signs of MT impedance tensors and telluric distortion tensors, and the azimuth-stepping rules should apply to both categories. Any determinants which may be negative are then seen in the light that they imply a counter stepping of the azimuths of the two relevant field vectors.
The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model – RETRACTED
Authors: Atilola O. , Abiri G. , Ola B.
Published: April 2018

Mental health services for youths within the juvenile justice system remain a contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important, multi-systemic steps needed to adapt the system for modern mental health promotion and services are highlighted.
Pearls & Oy-sters: The critical role of histopathology in diagnosing cancer-associated necrotizing CNS vasculitis
Authors: Sheehan Joshua , Tate Jessica , Mott Ryan , Geer Carol , Wolfe Rachel , Strowd Roy E. , Guzik Amy
Published: April 2018

Objective

To highlight the importance of a broad differential and histopathologic confirmation in patients with newly diagnosed cancer with brain lesions atypical for CNS metastasis.

Methods

We report 2 cases of biopsy-proven CNS vasculitis in patients undergoing treatment for a newly diagnosed nonmetastatic cancer. Comprehensive medical record review was performed to identify the clinical presentation, representative neuroimaging, histopathologic features, and response to treatment.

Results

Patient 1 presented 1 month into induction therapy of malignant vaginal squamous cell carcinoma (stage 3, T2N1M0) with acute episodic left-sided hemiparesis due to seizure activity progressing to severe encephalopathy. Imaging revealed a right frontoparietal lesion while systemic workup was unrevealing. Biopsy demonstrated necrotizing vasculitis. Patient 2 presented 6 months after diagnosis of right breast invasive ductal carcinoma (stage IIa, T2N0M0, estrogen receptor–positive, progesterone receptor–positive, human epidermal growth factor receptor–2 positive) with subacute bifrontal headaches with associated phonophobia. Imaging showed hyperintense lesions involving the right temporoparietal region and systemic workup was unrevealing. Brain biopsy showed a necrotizing vasculitis. Patient 1 was treated with methyprednisolone and plasmapheresis and patient 2 was treated with prednisone. Both patients showed complete resolution of symptoms shortly after treatment and improvement on imaging.

Conclusions

These cases highlight the importance of comprehensive evaluation of new brain lesions in patients with nonmetastatic solid tumors. Characteristics of new brain lesions in patients with cancer that should raise suspicion of diagnoses other than brain metastasis include (1) primary malignancy without regional or distant metastasis, (2) imaging without discrete mass-like enhancement, and (3) cortically based location of lesions not at the gray–white matter junction.
The VLDL receptor regulates membrane progesterone receptor trafficking and non-genomic signaling
Authors: Nader Nancy , Dib Maya , Courjaret Raphael , Hodeify Rawad , Machaca Raya , Graumann Johannes , Machaca Khaled
Published: April 2018

Progesterone mediates its physiological functions through activation of both transcription-coupled nuclear receptors and seven-pass-transmembrane progesterone receptors (mPRs), which transduce the rapid non-genomic actions of progesterone by coupling to various signaling modules. However, the immediate mechanisms of action downstream of mPRs remain in question. Herein, we use an untargeted quantitative proteomics approach to identify mPR interactors to better define progesterone non-genomic signaling. Surprisingly, we identify the very-low-density lipoprotein receptor (VLDLR) as an mPRβ (PAQR8) partner that is required for mPRβ plasma membrane localization. Knocking down VLDLR abolishes non-genomic progesterone signaling, which is rescued by overexpressing VLDLR. Mechanistically, we show that VLDLR is required for mPR trafficking from the endoplasmic reticulum to the Golgi. Taken together, our data define a novel function for the VLDLR as a trafficking chaperone required for the mPR subcellular localization and, as such, non-genomic progesterone-dependent signaling.

This article has an associated First Person interview with the first author of the paper.
New records of Ephemeroptera (Insecta) from Roraima State, Northern Brazil
Authors: Gama Neto Jaime de Liege , Passos Mahedy Araujo Bastos , Cruz Jenisson Araujo , Souza Nazareno Trajano de
Published: April 2018

Abstract. The aim of this work is to present new records and distributional notes of Ephemeroptera species on Roraima states. Farrodes maculatus Domínguez, Molineri & Peters, 1996, Hermanellopsis incertans (Spieth, 1943) and Thraulodes marreroi Chacón, Segnini & Domínguez, 1999 are recorded for the first time in Brazil. Family Coryphoridae,  Callibaetis cruentus Cruz, Salles & Hamada, 2014, Callibaetis gelidus Cruz, Salles & Hamada, 2014, Campylocia demoulini Gonçalves & Salles, 2017, Coryphorus aquilus Peters, 1981, Fittkaulus cururuensis Savage, 1986, Fittkaulus maculatus Savage & Peters, 1978, Miroculis fittkaui Savage & Peters, 1983, and Simothraulopsis sabalo Kluge, 2007 are recorded for the first time in Roraima. The number of known species of Ephemeroptera in Roraima, after our study, has increased from 64 to 75. Novos registros de Ephemeroptera (Insecta) do Estado de Roraima, norte do BrasilResumo. O objetivo deste trabalho é apresentar novos registros de espécies e notas sobre a distribuição geográfica de Ephemeroptera no Estado de Roraima. As espécies Farrodes maculatus Domínguez, Molineri & Peters, 1996, Hermanellopsis incertans (Spieth, 1943) e Thraulodes marreroi Chacón, Segnini & Domínguez, 1999 são registradas pela primeira vez no Brasil. A família Coryphoridae e as espécies Callibaetis cruentus Cruz, Salles & Hamada, 2014, Callibaetis gelidus Cruz, Salles & Hamada, 2014, Campylocia demoulini Gonçalves & Salles, 2017, Coryphorus aquilus Peters, 1981, Fittkaulus cururuensis Savage, 1986, Fittkaulus maculatus Savage & Peters, 1978, Miroculis fittkaui Savage & Peters, 1983 and Simothraulopsis sabalo Kluge, 2007 são registradas pela primeira vez no estado de Roraima. O número de espécies de Ephemeroptera com registros de ocorrência em Roraima é elevado de 64 a 75.
Research Roundup
Authors: Costello John
Published: April 2018

John Costello provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.