bluuebunny/crossref_metadata_2025 huggingface dataset:
Time-Frequency Approach Applied to Finding Interaction Regions in Pathogenic Proteins
Authors: Arenas Ailan F , Arango-Plaza Nicolás , Arenas Juan Camilo , Salcedo Gladys E
Published: June 2019

Protein-protein interactions govern all molecular processes for living organisms, even those involved in pathogen infection. Pathogens such as virus, bacteria, and parasites contain proteins that help the pathogen to attach, penetrate, and settle inside the target cell. Thus, it is necessary to know the regions in pathogenic proteins that interact with host cell receptors. Currently, powerful pathogen databases are available and many pathogenic proteins have been recognized, but many pathogenic proteins have not been characterized. This work developed a program in MATLAB environment based on the time-frequency analysis to recognize important sites in proteins. Our program highlights the highest energy patches in proteins from their time-frequency distribution and matches the corresponding frequency. We sought to know if this approach is able to recognize stretches residues related to interaction. Our approach was applied to five study cases from pathogenic co-crystallized structures that have been well characterized. We searched the frequencies that characterize interaction regions in pathogenic proteins and with this information tried to identify new interaction patches in either paralogs or orthologs. We found that our program generates a well-interpretable graphic under several descriptors that can show important regions in proteins even those related to interaction. We propose that this MATLAB program could be used as a tool to explore outstanding regions in uncharacterized proteins.
‘Recognition of competition’ versus Will to App: rethinking digital engagement in Australian youth sexual health promotion policy and practice
Authors: Albury Kath
Published: June 2019

Recent Australian research has found that young people (broadly defined as 15–30-year-olds) express a strong preference for seeking out digital sexual health information that is produced by authoritative sources (e.g. government websites), but are more likely to share material that is funny and/or features intimate first-person narratives. This produces a tension for sexual health messaging that aims to flag credibility, but also ‘spreadability’ – and perhaps even ‘relatability’. This tension is not exclusive to health communication, but has much in common with challenges facing digital news publishers who have struggled in recent years to tread a line between authoritativeness and clickbait. Drawing on participant observation of Australian sexual health promotion policy and practice and studies of online news and activism, this article reflects on the challenges and opportunities facing Australian sexual health organisations seeking to work with young people in digital spaces. A range of brief case studies of models offered by successful digital publishers, such as Vice and Upworthy, are offered as alternatives to the ‘Will to App’.
Boundary element method for nonadhesive and adhesive contacts of a coated elastic half-space
Authors: Li Qiang , Pohrt Roman , Lyashenko Iakov A , Popov Valentin L
Published: June 2019

We present a new formulation of the boundary element method for simulating the nonadhesive and adhesive contact between an indenter of arbitrary shape and an elastic half-space coated with an elastic layer of different material. We use the Fast Fourier Transform-based formulation of boundary element method, while the fundamental solution is determined directly in the Fourier space. Numerical tests are validated by comparison with available asymptotic analytical solutions for axisymmetric flat and spherical indenter shapes.
Obesity worsens central inflammation and disability in multiple sclerosis
Authors: Stampanoni Bassi Mario , Iezzi Ennio , Buttari Fabio , Gilio Luana , Simonelli Ilaria , Carbone Fortunata , Micillo Teresa , De Rosa Veronica , Sica Francesco , Furlan Roberto , Finardi Annamaria , Fantozzi Roberta , Storto Marianna , Bellantonio Paolo , Pirollo Pamela , Di Lemme Sonia , Musella Alessandra , Mandolesi Georgia , Centonze Diego , Matarese Giuseppe
Published: June 2019

Background:

Previous studies evidenced a link between metabolic dysregulation, inflammation, and neurodegeneration in multiple sclerosis (MS).

Objectives:

To explore whether increased adipocyte mass expressed as body mass index (BMI) and increased serum lipids influence cerebrospinal fluid (CSF) inflammation and disease severity.

Methods:

In this cross-sectional study, 140 consecutive relapsing-remitting (RR)-MS patients underwent clinical assessment, BMI evaluation, magnetic resonance imaging scan, and blood and CSF collection before any specific drug treatment. The CSF levels of the following cytokines, adipocytokines, and inflammatory factors were measured: interleukin (IL)-6, IL-13, granulocyte macrophage colony-stimulating factor, leptin, ghrelin, osteoprotegerin, osteopontin, plasminogen activator inhibitor-1, resistin, and Annexin A1. Serum levels of triglycerides, total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were assessed.

Results:

A positive correlation emerged between BMI and Expanded Disability Status Scale score. Obese RR-MS patients showed higher clinical disability, increased CSF levels of the proinflammatory molecules IL-6 and leptin, and reduced concentrations of the anti-inflammatory cytokine IL-13. Moreover, both the serum levels of triglycerides and TC/HDL-C ratio showed a positive correlation with IL-6 CSF concentrations.

Conclusion:

Obesity and altered lipid profile are associated with exacerbated central inflammation and higher clinical disability in RR-MS at the time of diagnosis. Increased adipocytokines and lipids can mediate the negative impact of high adiposity on RR-MS course.
A student-centred digital technology approach: The relationship between intrinsic motivation, learning climate and academic achievement of physical education pre-service teachers
Authors: Calderón Antonio , Meroño Lourdes , MacPhail Ann
Published: June 2019

There is a lack of research on the use of digital technology in physical education teacher education (PETE) and its relationship with the learning and engagement of pre-service teachers. Furthermore, research reports low engagement of pre-service teachers in digital approaches that do not promote active learning and are mostly teacher-centred. This paper aims to: (a) explore the relationship between a student-centred digital technology approach and the pre-service teachers’ intrinsic motivation, learning climate and academic achievement; and (b) test the relationship between learning climate and intrinsic motivation as possible predictors of academic achievement. The student-centred digital technology approach was designed following an adaptation of the five-phase pedagogical guidelines for teaching with emerging technologies. Two intact classes ( n = 110 students) and one teacher educator were involved in the study. Following a mixed-method approach, quantitative data was collected on pre-service teachers’ intrinsic motivation, learning climate and academic achievement. Qualitative data explored pre-service teachers’ tweets and learning blogs. Choice and novelty were two central tenets that conditioned high levels of intrinsic motivation and academic achievement. The study provides support for the use of active learning environments where pre-service teachers are involved in creative content production using digital technology in PETE programmes. Given the growing role of digital technology for learning in educational policies and new physical education curricula, we advocate for the publication of more research-based experiences on the integration of digital technology in PETE programmes. The transferability of such teaching and learning experiences to pre-service teachers’ and physical education teachers’ practice would be especially worthwhile.
Achenbach syndrome (paroxysmal finger hematoma)
Authors: Godoy Alejandro , Tabares Aldo Hugo
Published: June 2019

Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.
Because words matter: Investigating vocabulary development across contexts and modalities
Authors: Zaytseva Victoria , Miralpeix Imma , Pérez-Vidal Carmen
Published: June 2019

The present study investigates the effects of two subsequent learning contexts, formal instruction (FI) at home and a 3-month stay abroad (SA), on vocabulary acquisition in English as a foreign language (EFL) writing and speaking. Data were collected from 30 Catalan/Spanish learners of English before and after each learning period using a written composition and an oral interview. These samples were examined in terms of quantitative measures of lexical proficiency in the domains of diversity, sophistication, density and accuracy. Native-speaker baseline data were also obtained through the same tasks for comparison purposes. Results reveal that SA is particularly beneficial for written productive vocabulary, and less so for oral, and that progress occurs especially in lexical diversity. FI, however, shows a modest effect on the improvement of oral productive vocabulary and affects namely lexical sophistication.
Cognitive, emotional, and behavioral contributors to early childhood weight status
Authors: Gross Amy C , Kaizer Alexander M , Vock David M , Siddiqui Sana , Fox Claudia K
Published: June 2019

Pediatric obesity is a serious public health concern affecting almost 16% of two- to five-year-olds. Prior research has not sufficiently addressed how various factors combine to contribute to the heterogeneous condition of obesity. The goal of this study was to assess multiple individual factors to determine how they collectively contribute to weight status in young children, as this information could lead to tailored interventions. This was a cross-sectional, population-based study of three- to five-year-olds. Child height and weight were measured. Parents completed a demographic survey and validated questionnaires regarding these child characteristics: internalizing and externalizing behaviors, sleep problems, executive functions, and food approach and food avoid behaviors. Data for 154 participants (mean age: 4.4 ± 0.8 years; mean body mass index- z: .28 ± 1.0; 50% male) were analyzed using linear and logistic regression and a stepwise regression procedure. In the stepwise selection procedure for the binary outcome of obese/overweight versus normal weight, food avoid ( p = .151), food approach ( p = .017), and the White demographic variable ( p = .117) were identified as important predictors. In conclusion, when considering various cognitive, emotional, and behavioral factors, only food approach and food avoid eating behaviors predicted weight status in young children, suggesting prevention and intervention efforts should specifically address these aspects in young children.
Social inequalities in unintentional childhood injury incidence suggest subgroup identification and differentiation in the municipal planning of preventive efforts
Authors: Andersen Iben Kryger , Lauritsen Jens
Published: June 2019

Aims: This registry-based study examined differences according to socio-economic factors in the incidence of unintentional childhood injuries involving main injury types. Methods: All children aged 0–15 years living in the municipality of Odense were followed from January 1 2006 to December 31 2010 ( n=176,585). Injury outcome ( n=27,745) was defined as visits to the local emergency department. Cohort data were transferred to Statistics Denmark and linked with socio-economic registry data based on unique personal identification numbers. Results: Children aged 10–15 years were at the highest risk for any injury (incidence rate ratio (IRR)=1.14), traffic injury (IRR=5.89) and sports injury (IRR=49.58) compared to children aged 0–4 years. Girls were at lower risk for any injury (IRR=0.85) and higher risk for sports injury (IRR=1.11) and home injuries (IRR=1.12) compared to boys. Children of parents with the lowest household income were at the highest risk for any injury (IRR=1.19) and traffic injury (IRR=2.16) compared to children of parents with the highest group. Children of parents with primary education were at the highest risk of any injury (IRR=1.22) and the lowest risk of traffic injury (IRR=0.80) and sports injury (IRR=0.75) compared to children of parents with tertiary education. Immigrants and descendants were at lower risk for any injury (IRR=0.75 and 0.79, respectively) and sports injury (IRR=0.81 and 0.68, respectively) compared to Danish children. Conclusions: Injury risk varied with socio-economic factors in a Danish municipal setting. The effect varied between specific injury types. Social and ethnic background is important in establishing targeted preventive efforts, but some aspects of selection bias may occur.
Class in Australian higher education: The university as a site of social reproduction
Authors: Bunn Matthew , Threadgold Steven , Burke Penny Jane
Published: June 2019

Explanations of inequality in higher education primarily use the dominant language of institutional equity discourses, such as low socio-economic status (LSES), ‘under-represented’ or ‘non-traditional’ backgrounds. We argue that analysis that relies on a static series of objective categories regularly fails to account for the symbolic-historical conditions that have produced class boundaries. In acknowledging this, one of the challenges in higher education research is to illuminate how working-class understanding of education systems is brought into universities, and how it relates to, and is contested by, the dominant middle-class culture of the university. We propose a Bourdieusian-inspired class analysis be adopted for Australian higher education that focuses more closely on the way in which symbolic power is distributed through the misrecognition of species of capital as symbolic capital. Using this approach we argue that universities, rather than ameliorating class difference, are a poorly understood site of its generation.
An exploration of U.S. adults’ information processing skills and political efficacy
Authors: Saal Leah Katherine , Yamashita Takashi , Shaw Donita M , Perry Kristen H
Published: June 2019

As recent debates about the role of social media in election outcomes suggest, understanding the association between information processing skills and political efficacy in the U.S. is a significant inquiry for adult and continuing education. Data from the Programme for the International Assessment of Adult Competencies were used to explore relationships between U.S. participants’ information processing skills and political efficacy. Given the impact of certain demographic characteristics on political efficacy, the study also analyzed whether the relationship between information processing skills and self-reported political efficacy varied across levels of cultural engagement, formal educational attainment, or immigrant status. The results illustrate that higher levels of literacy, numeracy, and problem solving in technology-rich environments are associated with higher political efficacy for U.S. participants. Our research is framed in both cognitive and critical lenses, and we provide implications for practice in adult and continuing education settings.
Implementing the Icelandic Model for Preventing Adolescent Substance Use
Authors: Kristjansson Alfgeir L. , Mann Michael J. , Sigfusson Jon , Thorisdottir Ingibjorg E. , Allegrante John P. , Sigfusdottir Inga Dora
Published: June 2019

This is the second in a two-part series of articles about the Icelandic Model for Primary Prevention of Substance Use (IPM) in this volume of Health Promotion Practice. IPM is a community collaborative approach that has demonstrated remarkable effectiveness in reducing substance use initiation among youth in Iceland over the past 20 years. While the first article focused attention on the background context, theoretical orientation, evaluation and evidence of effectiveness, and the five guiding principles of the model, this second article describes the 10 core steps to practical implementation. Steps 1 to 3 focus on building and maintaining community capacity for model implementation. Steps 4 to 6 focus on implementing a rigorous system of data collection, processing, dissemination, and translation of findings. Steps 7 to 9 are designed to focus community attention and to maximize community engagement in creating and sustaining a social environment in which young people become progressively less likely to engage in substance use, including demonstrative examples from Iceland. And Step 10 focuses on the iterative, repetitive, and long-term nature of the IPM and describes a predictable arc of implementation-related opportunities and challenges. The article is concluded with a brief discussion about potential variation in community factors for implementation.
Curcumin release from blended polycaprolactone/polylactic acid electrospun nanofibrous meshes
Authors: Jahanmardi Yasaman , Tavanaie Mohammad A , Tehrani-Bagha Ali R
Published: June 2019

There is a great interest in developing drug delivery systems that are biocompatible and release the drug in a controlled way. In this study, the release of curcumin from electrospun meshes made from polycaprolactone, polylactic acid, or their blends was studied and compared. The polymers and curcumin were dissolved in a mixture of chloroform and dimethylformamide. The beadless electrospun meshes were obtained under the following conditions: the applied voltage of 22 kV, the tip to collector distance of 13 cm, and the polymer feed rate of 0.2 ml/h. The viscosity of the polymer solution increased by increasing the percentage of polylactic acid in the mixture. As a result, the average fiber diameter of the meshes was increased. The fabricated polycaprolactone mesh showed the minimum average fiber diameter (∼120 nm) and the maximum porosity (∼71%). The hybrid nanofibrous meshes were also fabricated using two counter nozzles on both sides of the collector. The tensile strengths of the polylactic acid and polycaprolactone electrospun meshes loaded with curcumin were 19.86 and 12.64 MPa, respectively. The tensile strain of the meshes increased from 43 to 116% by increasing the polycaprolactone weight percentage in the mixture. The results showed that the physical–mechanical properties of the fabricated electrospun meshes could be tuned by polymer blending. The release of curcumin from these electrospun meshes was monitored in a buffer solution using an UV-Vis spectrophotometer. The critical parameters on the release of curcumin were found to be the type of polymers, the average diameter of nanofibers, porosity, and hydrophilicity of the meshes.
Setup Error Assessment and Correction in Planar kV Image- Versus Cone Beam CT Image-Guided Radiation Therapy: A Clinical Study of Early Breast Cancer Treated With External Beam Partial Breast Irradiation
Authors: Wang Wei , Yu Ting , Xu Min , Shao Qian , Zhang Yingjie , Li Jianbin
Published: June 2019

Objective:

To compare differences in setup error assessment and correction between planar kilovolt images and cone beam computed tomography images for external beam partial breast irradiation during free breathing.

Methods:

Nineteen patients who received external beam partial breast irradiation after breast-conserving surgery were recruited. Interfraction setup error was acquired using planar kilovolt images and cone beam computed tomography. After online setup correction, the residual error was calculated, and the setup error was compared. The residual error and setup margin were quantified for planar kilovolt and cone beam computed tomography images.

Results:

The largest setup error was observed in the anteroposterior direction for both cone beam computed tomography and planar kilovolt imaging (−1.45 mm, 1.74 mm). The cone beam computed tomography–based setup error (systematic error [Σ]) was less than the planar kilovolt images based on Σ in the anteroposterior direction (–1.2 mm vs 2.00 mm; P = .005), and no significant differences were observed for random error (σ) in 3 dimensions ( P = .948, .376, .314). After online setup correction, cone beam computed tomography significantly reduced the residual setup error compared with planar kilovolt images in the anteroposterior direction (Σ: −0.20 mm vs 0.50 mm, P = .008; σ: 0.45 mm vs 1.34 mm, P = .002). The cone beam computed tomography–based setup margin was smaller than the planar kilovolt image-based setup margin in the anteroposterior direction (−1.39 mm vs 5.57 mm, P = .003; 0.00 mm vs 3.20 mm, P = .003).

Conclusions:

Discrepancy between the setup errors observed with planar kilovolt and cone beam computed tomography was obvious in the anteroposterior direction. Compared to cone beam computed tomography, the elapsed treatment time was smaller when the initial alignment used kilovolt planar imaging. Whether using planar kilovolt or cone beam computed tomography, residual errors can be reduced to 1.5 mm for external beam partial breast irradiation procedures.
Vincristine-induced anemia in hereditary spherocytosis
Authors: Michlitsch Jennifer , Larkin Sandra , Vichinsky Elliott , Kuypers Frans A
Published: June 2019

Vincristine, a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Vincristine-induced anemia has been observed, but its mechanism is not well understood. We describe a case involving serious vincristine-induced anemia in a patient with congenital spherocytosis and provide the explanation to the underlying mechanism. This report demonstrates that vincristine administration to patients with a red cell disorder may require additional clinical interventions to compensate for the vincristine-induced anemia.

Impact statement

Therapy with vincristine (VCR), a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Our paper indicates that treatment of patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia. Careful evaluation of other hematologic disorders is important in using a well-known oncology treatment. Whereas extreme concentrations of VCR were shown to alter red cell viability, data did not show negative effects in patients treated. Our data show that under conditions of increased hematopoiesis, hemoglobin in the circulation drops rapidly requiring transfusion. VCR administration to patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia.
Pediatric Hand Injuries Requiring Closed Reduction at a Tertiary Pediatric Care Center
Authors: Market Marisa , Bhatt Maala , Agarwal Amisha , Cheung Kevin
Published: June 2019

Background: Hand fractures and dislocations are common injuries in the pediatric population. This study aims to characterize the pediatric hand injuries that required closed reduction and identify those that required multiple reduction attempts. Methods: A retrospective cohort study was carried out in patients younger than 18 years of age with hand fractures or dislocations who underwent closed reduction in the emergency department (ED). Patients who ultimately required surgical reduction and fixation were not included. Results: Of the 310 hand injuries identified, 148 (114 fractures and 34 dislocations) underwent closed reduction in the ED; 7.4% of those required repeat reduction. Hand injuries that most often required repeat reduction included metacarpophalangeal joint dislocations (20.0%) and proximal phalanx neck (16.7%), metacarpal shaft (15.4%), metacarpal neck (6.2%), and proximal phalanx base (5.6%) fractures. No modifiable risk factors predicting the need for repeat reduction were identified. Conclusions: Some pediatric hand injuries are more likely to require repeat closed reduction by a hand surgeon. This retrospective study is the first step toward quality improvement as it provides opportunities for further research into the factors contributing to reductions that are unsuccessful at the first attempt. Identification of these factors and implementation of quality improvement measures are necessary to ensure the effective treatment of all pediatric hand injuries.
Radon Therapy Is Very Promising as a Primary or an Adjuvant Treatment for Different Types of Cancers: 4 Case Reports
Authors: Kojima Shuji , Cuttler Jerry M. , Inoguchi Kiyomi , Yorozu Kenshou , Horii Takashisa , Shimura Noriko , Koga Hironobu , Murata Akihisa
Published: June 2019

We report on the application of radon inhalation therapy to patients with 4 types of cancer: colon, uterine, lung, and liver cell. The radon treatments were given to improve the efficacy of chemotherapy and were potent in all 4 cases. Marker values decreased and disease symptoms were alleviated. We include a lengthy discussion on the mechanism that may be responsible for the observed results. While employing the radon generator to treat the patient with hepatocellular carcinoma, we discovered that a concentration of 6 MBq/m3 was very effective, while 1 MBq/m3 was marginal. This implies different, and rather high, radon concentration thresholds for the treatment of different types of cancer. The evidence from these 4 cases suggests that radon inhalation may be beneficial against various cancer types as an important adjuvant therapy to conventional chemotherapy and for local high-dose radiotherapy, which would address the problem of distant metastasis. A previous case report on 2 patients with advanced breast cancer, who refused chemotherapy or radiotherapy, indicates that radon may be effective as a primary therapy for cancer. Clinical trials should be carried out to determine the best radon concentrations for treatment of other types of cancer, at different stages of progression.
Narratives of death: Systemic determinants of the coverage of a Public Health Emergency of International Concern
Authors: Duru Adaobi Vivian
Published: June 2019

This study used the 2014 Ebola outbreak as a case study to compare news coverage of a Public Health Emergency of International Concern (PHEIC) between the Polarized Pluralist media system and the Liberal media system. This investigation revealed that partisan frames, emphasis on local and international efforts and use of health expert sources all differed across the two media systems. These differences suggest that social, political and economic attributes of media systems affect how news is shaped. When an event of international significance occurs, such as a disease outbreak, the characteristics that make up a media system will influence how issues are covered and presented to the public. Giving the current globalized nature of news, the findings in this study has implications for international news flow.
Involvement of inflammasome activation via elevation of uric acid level in nociception in a mouse model of muscle pain
Authors: Yoshida Shinichirou , Hagiwara Yoshihiro , Tsuchiya Masahiro , Shinoda Masamichi , Koide Masashi , Hatakeyama Hiroyasu , Chaweewannakorn Chayanit , Suzuki Kazuaki , Yano Toshihisa , Sogi Yasuhito , Itaya Nobuyuki , Sekiguchi Takuya , Yabe Yutaka , Sasaki Keiichi , Kanzaki Makoto , Itoi Eiji
Published: June 2019

Muscle pain is a common condition in many diseases and is induced by muscle overuse. Muscle overuse induces an increase in uric acid, which stimulates the nucleotide-binding oligomerization domain-like receptor (NLR). This receptor contains the pyrin domain NLRP-3 inflammasome which when activated, results in the secretion of potent pro-inflammatory cytokines such as interleukin-1β (IL-1β). The aim of this study was to investigate the involvement of inflammasome activation via the elevation of uric acid level in nociception in a mouse model of muscle pain. The right hind leg muscles of BALB/c mice were stimulated electrically to induce excessive muscle contraction. The left hind leg muscles were not stimulated as a control. Mechanical withdrawal thresholds, levels of uric acid, IL-1β, and NLRP3, caspase-1 activity, and the number of macrophages were investigated. Furthermore, the effects of xanthine oxidase inhibitors, such as Brilliant Blue G, caspase-1 inhibitor, and clodronate liposome, on pain were investigated. In the stimulated muscles, mechanical withdrawal thresholds decreased, and the levels of uric acid, NLRP3, and IL-1β, caspase-1 activity, and the number of macrophages increased compared to that in the non-stimulated muscles. Administration of the inhibitors attenuated hyperalgesia caused by excessive muscle contraction. These results suggested that IL-1β secretion and NLRP3 inflammasome activation in macrophages produced mechanical hyperalgesia by elevating uric acid level, and xanthine oxidase inhibitors may potentially reduce over-exercised muscle pain.
US prisms and prejudice through mediating the Middle East
Authors: Wilkins Karin G
Published: June 2019

Mediating the Middle East engages social and political constructions that articulate sentiment within the United States, with consequences not only to foreign policies and relationships, but also to experiences of Arab and Muslim citizens. Engagement with media narratives is expected to become particularly relevant when people do not share a resonating identity or direct experience with the community being projected. I position this research as an entry into how we might understand the primacy of dominant media narratives in shaping norms that contribute to discriminatory practices. Through this analysis, I focus on the concerns of Arab and Muslim Americans, considering the consequences of negative media characterizations of Islam, of Arab communities, and of the Middle East. This study builds on a national survey of adult United States citizens (n = 1416), with a targeted proportion of Arab American residents. These attitudes toward fellow citizens as well as foreign countries are considered in relation to extent of engagement with popular culture, specifically action-adventure given its role in Hollywood narratives featuring the Middle East. Attitudes toward Arab and Muslim communities within the United States as well as in the Middle East are demonstrated to be related to this form of media engagement.
Sustainability and climate change: All you need to know?
Authors: Kemple Terry
Published: June 2019

Climate change with its new risks to human health and life on earth is coming. The current hope is to reduce its impact by limiting global warming to 1.5℃ by 2100. Achieving this goal will need effective international collaboration and action, the development of new and alternative technologies, and the ability and willingness of people to change their daily habits. GPs and their practices can lead and be role models by improving their own sustainability. This article summarises what you need to know and signposts easy-to-use resources to improve your sustainability and respond to the challenges of climate change.
Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review
Authors: Gamalathge Pushpa Udayangani , Kularatna Sanjeewa , Carter Hannah E , Senanayake Sameera , Graves Nicholous
Published: June 2019

Background:

Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings.

Aim:

To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence.

Methods:

A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted.

Results:

Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies.

Conclusions:

The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.
Patterns of treatment and outcome with 500-mg fulvestrant in postmenopausal women with hormone receptor-positive/HER2-negative metastatic breast cancer: a real-life multicenter Italian experience
Authors: Palumbo Raffaella , Sottotetti Federico , Quaquarini Erica , Gambaro Anna , Ferzi Antonella , Tagliaferri Barbara , Teragni Cristina , Licata Luca , Serra Francesco , Lapidari Pietro , Bernardo Antonio
Published: June 2019

Background:

Fulvestrant 500 mg (F500) is the most active endocrine single agent in hormone receptor-positive (HR+)/HER2-negative metastatic breast cancer (MBC). Few data are available regarding the effectiveness of the drug in a real-world setting.

Patients and methods:

This prospective, multicenter cohort study aimed to describe the patterns of treatment and performance of F500 in a large population of unselected women with MBC, focusing on potential prognostic or predictive factors for disease outcome and response. The primary endpoints were progression-free survival (PFS) and clinical benefit rate.

Results:

From January 2011 to December 2015, 490 consecutive patients treated with F500 were enrolled. Overall, three different cohorts were identified and analyzed: the first received F500 after progression from previous chemotherapy (CT) or endocrine therapy; the second received the drug for de novo metastatic disease; and the third was treated as maintenance following disease stabilization or a response from a previous CT line. Median overall survival (OS) in the whole population was 26.8 months, ranging from 32.4 in first line to 22.0 and 13.7 months in second line and subsequent lines, respectively. Both the presence of liver metastasis and the treatment line were significantly associated with a worse PFS, while only the presence of liver metastasis maintained its predictive role for OS in multivariate analysis.

Conclusions:

The effectiveness of F500 was detected in patients treated both upon disease progression and as maintenance. The relevant endocrine sensitivity of 80% of patients included in the study could probably explain the good results observed in terms of outcome.
Major innovations and clinical applications of disodium-levofolinate: a review of available preclinical and clinical data
Authors: Ratti Margherita , Hahne Jens Claus , Toppo Laura , Castelli Emanuela , Petrelli Fausto , Passalacqua Rodolfo , Barni Sandro , Tomasello Gianluca , Ghidini Michele
Published: June 2019

The association of folinate salts with 5-fluorouracil (5-FU) represents a gold standard in the treatment of many cancers. In several clinical trials, the simultaneous administration of calcium–folinic acid (Ca-FA) and the prolonged infusion of 5-FU resulted in a better clinical response compared with fluoropyrimidine alone and 5-FU bolus. However, the simultaneous infusion of 5-FU and Ca-FA mixed in the same infusion pump is hindered by the crystallization of calcium salts, which eventually leads to catheter obstruction and damage. The sodium salt of leucovorin-disodium levofolinate (Na-Lv) is a novel molecule with a pharmacological profile similar to Ca-FA. Owing to its higher solubility, it can be safely mixed with 5-FU in a single pump without the risk of precipitation and catheter occlusion. The efficacy and safety of Na-Lv have been widely examined in preclinical and clinical phase II studies in combination with various schedules of 5-FU and in several cancer types. PubMed, EMBASE, SCOPUS and Web of Science databases were searched from inception to November 2018 to retrieve available published phase I and II series, including Western patients. Compared with Ca-FA, Na-Lv shows a more favourable efficacy and toxicity profile in terms of overall response rate, progression-free survival, time to progression and occurrence of severe adverse events. Moreover, it allows treatment time to be shortened, decreasing the number of required human resources for drug administration and limiting the occurrence of catheter damage.
Spinal subarachnoid space tapering in patients with syringomyelia
Authors: Rutan Emily , Madan Neel , Zea Ryan , Haughton Victor
Published: June 2019

Background and purpose

Cervical spine tapering affects cerebrospinal fluid dynamics. Cervical spine taper ratios derived from anteroposterior diameters reportedly differ between patients with syringomyelia and controls. We attempted to verify the differences in diameter and to show differences in cross-sectional area between syringomyelia and controls.

Methods

Cervical spine magnetic resonance images in syringomyelia patients (idiopathic or Chiari I related) and control patients were examined. In each subject, the anteroposterior diameter of the spinal canal was measured at each cervical level, and C1–C4, C4–C7, and C1–C7 taper ratios were calculated. Differences in taper ratio between groups were tested for statistical significance with the t-test. Cross-sectional areas of the spinal canal were measured at each cervical spinal level, and tapering was calculated.

Results

Eighteen patients with idiopathic syringomyelia, 28 with Chiari I, and 29 controls were studied. Chiari and syringomyelia patients had significantly steeper diameter-based taper ratios than controls. The dural sac areas tapered proportionally with the diameter-based taper ratio in all groups.

Conclusions

Cervical spine anteroposterior diameter tapering and dural sac cross-sectional areas tapering differ between syringomyelia patients and controls.
Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population
Authors: Ueda Yusuke , Sugaya Hiroyuki , Takahashi Norimasa , Matsuki Keisuke , Tokai Morihito , Hoshika Shota , Onishi Kazutomo , Hamada Hiroshige
Published: June 2019

Background:

Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability.

Purpose:

To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined.

Results:

RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 53 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs.

Conclusion:

The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.
The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial
Authors: Ponce Silvia , Pastor Esther , Orosa Belen , Oscullo Grace , Catalán Pablo , Martinez Alfonso , Hernández Luis , Muriel Alfonso , Chiner Eusebi , Martínez-García Miguel Ángel
Published: June 2019

The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with nonsevere obstructive sleep apnoea (OSA) is controversial. The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA in terms of clinical, quality-of-life and neurocognitive measures.

This was an open-label, randomised, multicentre clinical trial in 145 elderly patients (≥70 years old) with confirmed moderate OSA (apnoea–hypopnoea index 15–29.9 events·h−1) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary end-point was the Epworth Sleepiness Scale (ESS) score, and the secondary end-points included quality of life (Quebec Sleep Questionnaire (QSQ) domain scores), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests. The analysis was performed according to the intention-to-treat principle.

Mean±sdage was 74.9±4.6 years. The CPAP group achieved a greater improvement in the ESS score (adjusted difference of 2.6 (95% CI 3.6–1.6) points; effect size 1) in some sleep-related symptoms and in some dimensions of the QSQ questionnaire (nocturnal symptoms: −0.7 (95% CI −0.3–−1.0) points; p<0.0001 and emotions: −0.4 (95% CI −0.1–−0.7) points; p=0.023). However, CPAP did not demonstrate any effect on either neurocognitive tests (including anxiety and depression) or blood pressure levels. There was a positive correlation between the effect of CPAP and the improvement in ESS scores and quality of life domains.

CPAP treatment resulted in a significant improvement in diurnal hypersomnia and some sleep-related symptoms and quality of life domains in elderly patients with moderate OSA.
Donor human leukocyte antigen-G single nucleotide polymorphisms are associated with post-lung transplant mortality
Authors: Lazarte Julieta , Ma Jin , Martinu Tereza , Levy Liran , Klement William , White Matthew , Pelling Jacob , Guan Zehong , Azad Sassan , Tikkanen Jussi , Rao Vivek , Tomlinson George , Delgado Diego , Keshavjee Shaf , Juvet Stephen C.
Published: June 2019

Human leukocyte antigen (HLA)-G is a non-classical HLA that inhibits immune responses. Its expression is modified by single nucleotide polymorphisms (SNPs), which are associated with transplant outcomes. Our aim was to investigate the association of donor and recipient HLA-G SNPs with chronic lung allograft dysfunction (CLAD) and mortality after lung transplantation.

In this single-centre study, we examined 11 HLA-G SNPs in 345 consecutive recipients and 297 donors of a first bilateral lung transplant. A multivariable Cox proportional hazards model assessed associations of SNPs with death and CLAD. Transbronchial biopsies (TBBx) and bronchoalveolar lavage (BAL) samples were examined using quantitative PCR, ELISA and immunofluorescence.

Over a median of 4.75 years, 142 patients (41%) developed CLAD; 170 (49%) died. Multivariable analysis revealed donor SNP +3142 (GG+CGversusCC) was associated with increased mortality (hazard ratio 1.78, 95% CI 1.12–2.84; p=0.015). In contrast, five donor SNPs, -201(CC), -716(TT), -56(CC), G*01:03(AA) and 14 bp INDEL, conferred reduced mortality risk. Specific donor–recipient SNP pairings reduced CLAD risk. Predominantly epithelial HLA-G expression was observed on TBBx without rejection. Soluble HLA-G was present in higher concentrations in the BAL samples of patients who later developed CLAD.

Specific donor SNPs were associated with mortality risk after lung transplantation, while certain donor–recipient SNP pairings modulated CLAD risk. TBBx demonstrated predominantly epithelial, and therefore presumably donor-derived, HLA-G expression in keeping with these observations. This study is the first to demonstrate an effect of donor HLA-G SNPs on lung transplantation outcome.
Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network
Authors: Zhou Fei , Wang Yimin , Liu Yingmei , Liu Xuedong , Gu Li , Zhang Xiaoju , Pu Zenghui , Yang Guoru , Liu Bo , Nie Qingrong , Xue Bing , Feng Jing , Guo Qiang , Liu Jianhua , Fan Hong , Chen Jin , Zhang Yongxiang , Xu Zhenyang , Pang Min , Chen Yu , Nie Xiuhong , Cai Zhigang , Xu Jinfu , Peng Kun , Li Xiangxin , Xiang Pingchao , Zhang Zuoqing , Jiang Shujuan , Su Xin , Zhang Jie , Li Yanming , Jin Xiuhong , Jiang Rongmeng , Dong Jianping , Song Yuanlin , Zhou Hong , Wang Chen , Cao Bin
Published: June 2019

Although broad knowledge of influenza viral pneumonia has been established, the significance of non-influenza respiratory viruses in community-acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in the non-immunocompromised adult population.

Hospitalised immunocompetent patients with CAP were prospectively recruited from 34 hospitals in mainland China. Respiratory viruses were detected by molecular methods. Comparisons were conducted between influenza and non-influenza viral infection groups.

In total, 915 out of 2336 adult patients with viral infection were enrolled in the analysis, with influenza virus (28.4%) the most frequently detected virus, followed by respiratory syncytial virus (3.6%), adenovirus (3.3%), human coronavirus (3.0%), parainfluenza virus (2.2%), human rhinovirus (1.8%) and human metapneumovirus (1.5%). Non-influenza viral infections accounted for 27.4% of viral pneumonia. Consolidation was more frequently observed in patients with adenovirus infection. The occurrence of complications such as sepsis (40.1%versus39.6%; p=0.890) and hypoxaemia (40.1%versus37.2%; p=0.449) during hospitalisation in the influenza viral infection group did not differ from that of the non-influenza viral infection group. Compared with influenza virus infection, the multivariable adjusted odds ratios of CURB-65 (confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years) ≥3, arterial oxygen tension/inspiratory oxygen fraction <200 mmHg, and occurrence of sepsis and hypoxaemia for non-influenza respiratory virus infection were 0.87 (95% CI 0.26–2.84), 0.72 (95% CI 0.26–1.98), 1.00 (95% CI 0.63–1.58) and 1.05 (95% CI 0.66–1.65), respectively. The hazard ratio of 90-day mortality was 0.51 (95% CI 0.13–1.91).

The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza respiratory viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza respiratory viruses.