bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Loud’ and ‘quiet’ politics: Questioning the role of ‘the artist’ in street art projects after the 2011 Egyptian Revolution
Authors: Sprengel Darci
Published: September 2019

This article examines the grassroots artistic initiative al-Fann Midan (Art is a City Square) in Cairo and a contrasting approach to street art organizing in Alexandria to demonstrate how each enacted a different relationship to ‘the political’ in a revolutionary moment. Extending sociologist Asef Bayat’s concept ‘quiet encroachment’, it analyzes these contrasting approaches through the sonic metaphor of ‘loud’ and ‘quiet’ politics. As a spectrum, this framework highlights how the everyday, the gestural, and the affective on the one hand can exist simultaneously, and at times in tension with, larger, more representational political expressions on the other. It thus avoids fetishizing creative ‘resistance’ or ‘dissent’, while nonetheless analyzing art in a revolutionary moment, by grounding creative expression more historically and with analytical attention to how it reanimates long-standing debates among Arab intellectuals regarding the role of the ‘artist’.
Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery
Authors: Hernefalk B. , Eriksson N. , Larsson S. , Borg T.
Published: September 2019

Background and Aims:

Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures.

Patients and Methods:

Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models.

Results:

There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health ( p < 0.01) at 5 years. Recovery of physical function ( p < 0.01), mental health ( p = 0.04), and pain ( p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point ( p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years ( p = 0.02) and improved when compared to results at 2 years ( p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited.

Conclusion:

Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.
Rethinking the role of transitions between activities in early childhood settings: An examination of their linguistic characteristics in two preschool classrooms
Authors: Ryan Ève , Bailey Alison L , Grace Yiching H
Published: September 2019

This study points to ways in which the amount and complexity of teacher talk in two preschool classrooms during transitions between activities differed from instructional activity settings throughout the day. What emerged were language characteristics that suggest not all transitions are created equal. In fact, as shown by qualitative excerpts of teacher–student interactions, some transitions are quite substantive and provide opportunities for rich extended conversations. The findings of this study suggest that, despite the popular perception of transitions as lost instructional time, the informal setting of transitions can be used to reinforce concepts taught in more formal instructional settings such as circle time, as well as opportunities to introduce new concepts and vocabulary following children’s lead. Interviews with the teachers of these two classrooms, while revealing their acknowledgment of some challenges (e.g. children’s engagement), mostly emphasized the intentional and potentially instructional nature of transitions.
The ethics of care and justice in primary nursing of older patients
Authors: Juujärvi Soile , Ronkainen Kirsi , Silvennoinen Piia
Published: September 2019

While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is expected to be aligned with the ethic of care because it emphases the nurse–patient relationship and enables more independent role for nurses in decision-making. The aim of this study was to examine nurses’ ethical decision-making in the context of primary nursing. Participants were seven nurses, and one physiotherapist from a geriatric rehabilitation unit of a public hospital in Finland. Data were collected through focus group interviews and qualitatively analyzed through Lyons’ coding scheme for moral orientations. The results showed that primary nurses employ empathic understanding and particularistic thinking when building relationships with patients and their families, and when assessing their needs for coping at home after discharge. Most ethical conflicts were related to discharge and were solved through balancing the ethics of care and justice considerations. It is concluded that care and justice are integrated in nurses’ everyday ethical decision-making. The ethic of care nurtures good patient–nurse relationships, while the ethic of justice is needed to address the fair delivery of care in the context of an aging population and diminishing public resources. Both ethics should be acknowledged in clinical practices and included in ethics education.
The When and Who of Graduation and Dropout Predictors: A Moderated Hazard Analysis
Authors: Berzenski Sara R.
Published: September 2019

This study examined graduation and persistence among social and behavioral science students at a regional comprehensive university. Hazard analyses identified predictors of student trajectories, times at which predictors were more or less impactful, and interactions between predictors such that particular risk factors were more detrimental for certain groups. Results revealed that first-time freshmen and first-time transfer students operate under very different risk models. Total units enrolled and cumulative grade point average emerged as the most salient predictors across all models; however, numerous predictors varied in their salience across time and student subgroup. Differential predictors functioned as risks early versus late in student trajectories. Underrepresented minority status emerged as a risk factor in interaction with other predictors, such that it amplified other risks. These findings suggest that examinations of graduation and persistence must highlight the complex ways in which traditional risk factors interact with time and context to impact student success.
A National Scoping Study on Barriers to Conducting and Using Research Among Nurses in the United Arab Emirates
Authors: Al-Yateem Nabeel , Griffiths Jane , McCreaddie May , Robertson-Malt Suzanne , Kuzemski Dawn , Mathew Anthony Jincy , Fielding Mark , Al Khatib Fatima , Macaulay Sojka Elizabeth , Jean Williams Jennifer
Published: September 2019

It is important that nurses fully engage with the development and use of evidence-based practice so they can influence policy and improve patient care. There are significant challenges in developing nursing research and evidence-based practice in the United Arab Emirates (UAE). Therefore, the UAE Nursing and Midwifery Council formed a Scientific Research Subcommittee to lead the development of nursing research. Following a literature review to assess the status of nursing research in the UAE, the Subcommittee initiated a study to clarify UAE nurses’ perceptions of barriers to implementing research. The results were expected to enable comparisons with other countries and establish a baseline on which to build and prioritize initiatives to address identified barriers. A cross-sectional design with convenience sampling was used to survey 606 nurses from across the UAE. The survey included the BARRIERS questionnaire and was administered online and in paper-based formats. The top three nurse-perceived barriers that affected nurses’ use of research in the UAE (in descending order) were as follows: lack of authority to change patient care procedures, insufficient time to read research, and insufficient time on the job to implement new ideas. The highest ranked barriers to nurses conducting research in the UAE were lack of time and competing demands for time. The findings of this survey and a published literature review informed development of a strategy to address identified barriers to nurses in the UAE using and conducting research. This multifaceted strategy includes initiatives to reform policy and practice at local and national levels.
CNDP2 Acts as an Activator for Human Ovarian Cancer Growth and Metastasis via the PI3K/AKT Pathway
Authors: Zhang Li Q. , Yang Hua Q. , Yang Su Q. , Wang Ying , Chen Xian J. , Lu Hong S. , Zhao Ling P.
Published: September 2019

Introduction:

The mechanism of tumorigenesis and metastasis of ovarian cancer has not yet been elucidated. This study aimed to investigate the role and molecular mechanism of cytosolic nonspecific dipeptidase 2 in tumorigenesis and metastasis.

Methods:

Cytosolic nonspecific dipeptidase 2 expression in human ovarian cancer tissues and cell lines was assessed with methyl thiazolyl tetrazolium (MTT), clone formation, and transwell assays performed to evaluate the ability of ovarian cancer cells to proliferate and migrate. Nude mice tumor formation experiments were also performed by subcutaneously injecting cells with stable cytosolic nonspecific dipeptidase 2 knockdown and control SKOV3 cells into BALB/c female nude mice to detect changes in PI3K/AKT pathway-related proteins by Western blotting.

Results:

Cytosolic nonspecific dipeptidase 2 was highly expressed in human ovarian cancer tissues, with its expression associated with pathological data, including ovarian cancer metastasis. A cytosolic nonspecific dipeptidase 2 stable knockdown or ectopic expression ovarian cancer cell model was established and demonstrated that cytosolic nonspecific dipeptidase 2 could promote the proliferation of ovarian cancer cells. Transwell cell migration and invasion assays confirmed that cytosolic nonspecific dipeptidase 2 enhanced cell metastasis in ovarian cancer. Furthermore, in vivo xenograft experiments demonstrated that cytosolic nonspecific dipeptidase 2 can promote the development and progression of ovarian cancer, increasing the expression of phosphorylated PI3K and AKT.

Conclusions:

Cytosolic nonspecific dipeptidase 2 promotes the occurrence and development of ovarian cancer through the PI3K/AKT signaling pathway.
parallel: A command for parallel computing
Authors: Vega Yon George G. , Quistorff Brian
Published: September 2019

The parallel package allows parallel processing of tasks that are not interdependent. This allows all flavors of Stata to take advantage of multiprocessor machines. Even Stata/MP users can benefit because many community-contributed programs are not automatically parallelized but could be under our framework.
gidm: A command for generalized inflated discrete models
Authors: Xia Yiwei , Zhou Yisu , Cai Tianji
Published: September 2019

In this article, we describe the gidm command for fitting generalized inflated discrete models that deal with multiple inflated values in a distribution. Based on the work of Cai, Xia, and Zhou (Forthcoming, Sociological Methods & Research: Generalized inflated discrete models: A strategy to work with multimodal discrete distributions), generalized inflated discrete models are fit via maximum likelihood estimation. Specifically, the gidm command fits Poisson, negative binomial, multinomial, and ordered outcomes with more than one inflated value. We illustrate this command through examples for count and categorical outcomes.
Review of William Gould’s The Mata Book: A Book for Serious Programmers and Those Who Want to Be
Authors: Jann Ben
Published: September 2019

In this article, I review The Mata Book: A Book for Serious Programmers and Those Who Want to Be, by William Gould (2018, Stata Press).
Mexican American Parental Knowledge and Perceptions of Childhood Obesity: An Integrative Review
Authors: Confiac Nathalie , Turk Melanie T. , Zoucha Rick , McFarland Marilyn
Published: September 2019

Introduction:

For the past two decades, childhood obesity has remained a national public health concern, particularly among Hispanic populations. Multiple cross-sectoral obesity prevention strategies have been implemented yet remain unsuccessful in generating sustainable lifestyle changes.

Method:

The purpose of this integrative review, using the Whittemore and Knafl method, was to examine the literature from 2009 to 2018 regarding Mexican American parental knowledge and perceptions of childhood obesity. The CINAHL, PubMed, PsycINFO, and ERIC databases were used to search the literature, and 13 peer-reviewed articles met the inclusion criteria.

Results:

Three main themes emerged from the literature synthesis: (1) parental misperception of child body weight and size, (2) influence of cultural health and growth beliefs on parental perception of child weight, and (3) parental perspectives of causes and consequences of childhood obesity and how to address it. However, cultural variations in parental perceptions were found; therefore, attempts to generalize Mexican Americans’ cultural practices should be avoided.

Conclusion:

Studies using qualitative approaches are needed to gain deeper insights about Mexican American culture regarding children’s health as it relates to body weight, the roles of different family members in the Mexican American childrearing tradition, and the impact of their associated health beliefs.
Mathieu Jaboulay (1860-1913) and His Innovations in Vascular and General Surgery
Authors: Laios Konstantinos , Bontinis Vangelis , Bontinis Alkis , Mavrommatis Evangelos , Lytsikas-Sarlis Pavlos , Tsoucalas Gregory , Androutsos George
Published: September 2019

Mathieu Jaboulay (1860-1913) was an inventor in vascular and general surgery. He fabricated many new surgical techniques and instruments such as Jaboulay method for vascular sutures, Jaboulay anastomotic button, and Jaboulay amputation, known also as hemipelvectomy. In addition, he was a pioneer in heterologous transplantation and sympathectomy. He found death suddenly in a terrible train crash. He was a reputable Professor of Surgery at Lyon Faculty of Medicine with prestigious students in vascular surgery.
Examining offending behaviour following receipt of a business crime reduction partnership’s place-based exclusion sanction
Authors: Stafford Andrew B
Published: September 2019

This article examines the post-sanction offending behaviour of individuals who received a warning or exclusion from a Business Crime Reduction Partnership in England. Noteworthy desistance occurred following the receipt of the warning (76%) and the exclusion (37%). Displacement of offending was observed, with most of those who continued to offend doing so only at business premises away from where they received their initial sanction. Variation in post-sanction offending behaviour was explored according to offender age and sex, offence time and whether the offence concerned theft, violence, abuse or alcohol. Higher rates of recidivism were observed among male offenders and those committing abuse offences, higher rates of displacement among those who committed theft offences, and the most varied and unpredictable offending among those who continued to offend post-exclusion. The findings presented here highlight the importance of holistic, multi-sector Business Crime Reduction Partnerships that make information on offenders easily accessible to their members.
Efficacy of inhaled ciprofloxacin agents for the treatment of bronchiectasis: a systematic review and meta-analysis of randomized controlled trials
Authors: Lim Jeong Uk , Hong Seung Wook , Ko Jae-Hoon
Published: September 2019

Background:

The efficacy of inhaled ciprofloxacin agents in the treatment of patients with bronchiectasis is controversial. The objective of the study was to review systematically the efficacy of inhaled ciprofloxacin agents in patients with bronchiectasis.

Methods:

We searched PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials (RCTs) evaluating inhaled ciprofloxacin agents among patients with bronchiectasis. Data were pooled using a meta-analysis technique.

Results:

Two phase II and four phase III RCTs were included with a total of 1685 patients. Treatment durations of phase III studies were 48 weeks, while those of phase II studies were shorter. Pooled analysis of overall studies exhibited a statistically significant benefit of inhaled ciprofloxacin agents in three exacerbation outcome measures, including time to first exacerbation (hazard ratio 0.74, 95% confidence interval [CI] 0.63–0.86, I2 23%), exacerbation frequency (risk ratio [RR] 0.73, 95% CI 0.61–0.86, I2 42%), and exacerbation proportion (RR 0.85, 95% CI 0.76–0.96, I2 25%) without significant heterogeneity. Outcomes evaluating pulmonary function, quality of life, and adverse events were not significantly different between the two groups. Although eradication of respiratory pathogens was more frequently observed, the emergence of ciprofloxacin resistance was also significantly higher in the ciprofloxacin group.

Conclusions:

A meta-analysis of RCTs of inhaled ciprofloxacin agents showed clinical benefit in terms of pulmonary exacerbations in patients with bronchiectasis. Since a significant increase of resistance was also noticed, clinical trials with a longer study period are required for a conclusive assessment. The reviews of this paper are available via the supplemental material section.
Exploring aerial perching and grasping with dual symmetric manipulators and compliant end-effectors
Authors: Yu Pengfei , Wang Zihao , Wong KC
Published: September 2019

Inspired by talon of a predator bird, this paper presents a quadrotor with two 2- Degree of Freedoms (DOFs) compliant manipulators which could mimic bird perching and grasping. The symmetric configuration of the manipulators causes minimum shift in center of gravity and a minimum disturbance to the angular momentum of the platform during grasping and perching maneuvers. Thus, the dynamics of the manipulator is independent to that of the platform. Moreover, a compliant end-effector is introduced to decouple the dynamics of the unmanned aerial vehicles from the force interaction with the environment or target objects. Therefore, aerial manipulation problem is significantly simplified due to the minimum amount of disturbance among components. In addition, the manipulators could function as the landing gear, which allows larger work envelope, weight saving and less landing impact. It also has the potential to achieve a bird-like “perch and watch” to increase the endurance of unmanned aerial vehicles in missions that involve extended endurance.
Glucocorticoid-induced osteoporosis: from clinical trials to clinical practice
Authors: Adami Giovanni , Rahn Elizabeth J , Saag Kenneth G
Published: September 2019

Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis. To date, six large randomized controlled clinical trials on the efficacy of pharmaceutical treatment in GIOP have been conducted. All of these studies have focused predominately on bone mineral density outcomes, and none of them have been statistically powered to address fracture endpoints. The purpose of this review is to highlight differences in the design and results within these large randomized GIOP clinical trials, and how these differences might affect clinical decisions. Differences between studies in trial design, populations studied, and variable efficacy impact the comparability and generalizability of these findings, and ultimately should affect practitioners’ behavior. We review the clinical trials that provide the best quality evidence on comparative efficacy and safety of GIOP treatments. We also propose suggestions on the design of future GIOP clinical trials with attention to improved generalizability, and, ideally, study designs that might achieve fracture outcomes.
Usage of Hydrocolloid-Based Plasters in Patients Who Have Developed Allergic Contact Dermatitis to Isobornyl Acrylate While Using Continuous Glucose Monitoring Systems
Authors: Kamann Stefanie , Heinemann Lutz , Oppel Eva
Published: September 2019

Background:

Continuous glucose monitoring (CGM) systems replace more and more capillary self-monitoring of blood glucose by patients with diabetes. However, at least a subset of patients experience adverse skin reactions such as severe allergic contact dermatitis (ACD) after prolonged usage of CGM systems. A major allergen isobornyl acrylate (IBOA) has been identified recently.

Objectives:

After developing an ACD, patients have difficulties in continuing the usage of their CGM system (and also of, eg, certain patch pumps). Most of such patients look for possibilities to continue the usage of, eg, a CGM system that requires intermittent scanning (iscCGM, Freestyle Libre).

Patients and Methods:

Eight patients with a known ACD were supplied with different hydrocolloid-based plasters ( n = 5 with Hansaplast blister plaster, n = 2 with Cutimed Hydro B from BSN, and n = 1 with Stomahesive baseplate from Convatec). They attached these plasters to their skin underneath their iscCGM system.

Results:

All patients were able to continue the usage of this iscCGM system when using such plasters.

Conclusion:

Patients with ACD benefit from the usage of such plasters; however, some limitations have to be acknowledged.
Fibular Plate Fixation and Correlated Short-term Complications
Authors: Bäcker Henrik Constantin , Greisberg Justin K. , Vosseller J. Turner
Published: September 2019

Background. The most common method of surgical stabilization of fibular fractures is plate osteosynthesis. Despite its ubiquity, there is a dearth of large series reporting implant-related outcomes and complications. The purpose of this study was to report on short-term complications and hardware removal after plate fixation of distal fibula fractures. Methods. A retrospective chart analysis and review of radiographic images was performed of 461 ankle fractures between 2011 and 2017. In 404 cases, a fibular fracture was treated surgically; 94.1% underwent tubular and 5.9% locking plate fixation. The primary outcome was radiographic union, with a mean follow-up of 11.6 months. Minor, intermediate, and major complications were recorded as well as the rate of hardware removal. Results. The union-rate with plate fixation was 99.5% (402/404). The overall complication rate was 19.3% (n = 78/404). Of these complications, 79.5% (62/78) were considered minor. These complications included erythema, heterotopic ossification, neurapraxia, delayed union, and deep-vein thrombosis; 20.5% (16/78) of the complications were considered intermediate (9/78, 11.5%) or major (7/78, 9.0%). Intermediate and major complications included deep infection, nonunion/malunion, and osteomyelitis. Subsequent surgery was needed in 7 cases (1.7%, 7/404). In another 93 patients, hardware-related symptoms were identified: 23 (5.7%) underwent syndesmosis screw removal and 54 (13.4%) hardware removal. No correlation to the fixation technique was identified. Conclusion. This study shows a relatively low rate of major complications and a high union rate of 99.5% for fibular plate osteosynthesis in a large cohort. Any other treatment, including other fixation techniques, will need to show an equivalent or better complication and reoperation profile.

Level of Evidence: Level III: Retrospective, comparative study
Treatment of Recalcitrant Maxillary Sinusitis With Endoscopic Modified Medial Maxillectomy: A Systematic Review of Safety and Efficacy
Authors: Loftus Catherine A. , Yoo Frederick , Desiato Vincent M. , Schlosser Rodney J. , Soler Zachary M.
Published: September 2019

Background

Endoscopic sinus surgery is an effective treatment option for patients with chronic rhinosinusitis (CRS), although approximately 20% of patients fail to improve with standard surgical procedures. Expanded procedures such as the endoscopic modified medial maxillectomy (EMMM) have been described in management of refractory maxillary sinusitis.

Objective

This study aims to review the current literature on the safety and efficacy of the EMMM for treatment of refractory maxillary sinusitis.

Methods

A literature search was performed of PubMed, Ovid, and Cochrane databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. English-language articles evaluating the EMMM procedure on patients with recalcitrant maxillary sinusitis were included. Full-text articles were obtained and evaluated by 2 reviewers independently, with a third reviewer for mediation of disagreements.

Results

Six studies met eligibility criteria and were included into the study, with follow-up ranging from 12 to 82.8 months. Two studies contained Level 2 evidence and 4 studies contained Level 4 evidence. EMMM was found to be effective in CRS and cystic fibrosis-related CRS (0% and 9.1% revision rate, respectively). Symptom resolution was noted 60% to 80% of patients. Four studies reported complications, with a total of 4 complications out of 211 patients.

Conclusions

There are no high-quality Level 1 studies evaluating the efficacy and safety of the EMMM procedure. Level 2 to Level 4 studies indicate that this procedure is relatively safe with a low complication rate and symptom resolution in up to 80% of patients with recalcitrant maxillary sinusitis.
Update on the synergistic effect of HSL and insulin in the treatment of metabolic disorders
Authors: Lan Yu-Long , Lou Jia-Cheng , Lyu Wen , Zhang Bo
Published: September 2019

Hormone-sensitive lipase (HSL) is one of the three lipases in adipose tissue present during periods of energy demand. HSL is tightly controlled by insulin regulation via the central and peripheral systems. The suppressive effects of insulin on HSL are also associated with complex crosstalk with other pathways in the metabolic network. Because impaired insulin action is the driving force behind the pathogenesis of diabetes and other metabolic complications, elucidation of the intricate relationships between HSL and insulin may provide an in-depth understanding of these pandemic diseases and potentially identify strategies to inhibit disease development. Insulin not only differentially regulates HSL isoform transcription but also post-transcriptionally affects HSL phosphorylation by stimulating PKA and endothelin (ET-1), and controls its expression indirectly via regulating the activity of growth hormone (GH). In addition, a rapid elevation of HSL levels was detected after insulin injection in patients, which suggests that the inhibitory effects of insulin on HSL can be overridden by insulin-induced hypoglycemia. Conversely, individuals with hereditary HSL deficiency, and animals with experimental HSL deletion, showed major disruptions in mRNA/protein expression in insulin signaling pathways, ultimately leading to insulin resistance, diabetes, and fatty liver. Notably, HSL inactivation could cause insulin-independent fatty liver, while insulin resistance induced by HSL deficiency may further aggravate disease progression. The common beliefs that HSL is the overall rate-limiting enzyme in lipolysis and that insulin is an inhibitor of HSL have been challenged by recent discoveries; therefore, a renewed examination of their relationships is required. In this review, by analyzing current data related to the role of, and mutual regulation between, HSL and insulin and discussing unanswered questions and disparities in different lines of studies, the authors intend to shed light on our understanding of lipid metabolism and provide a rational basis for future research in drug development.
Carcinoid tumor masquerading as testicular tumor
Authors: Garg Harshit , Kaushal Seema , Nayak Brusabhanu , Singh Prabhjot , Ramteke Prashant , Sarangi Jayati
Published: September 2019

Level of evidence: 3
Provincial Needs Assessment to Determine the Current State of Glomerulonephritis Care in Ontario
Authors: Pang Jocelyn , D’Antonio Christina , Heale Esti , Boll Philip , Blake Peter , Evans Jenna M. , Hladunewich Michelle
Published: September 2019

Background:

Despite its relative rarity, glomerulonephritis (GN) accounts for 20% of prevalent end-stage renal disease patients in Ontario. Early identification and appropriate management of GN to delay progression of disease can reduce patient morbidity and health system costs. As such, a provincial GN needs assessment was conducted to inform on the development of the provincial GN strategic framework in Ontario.

Objective:

To understand the current state of GN care in Ontario from nephrologist, hospital administrator, and patient and family perspectives.

Design:

Cross-sectional.

Settings:

26 regional renal programs in Ontario.

Patients:

23 patients and family members living with GN who do not require renal replacement therapy.

Measurements:

Patient and family member interviews as well as a survey of nephrologists.

Methods:

The study included 3 components: (1) interviews with patients and family members, (2) a survey of nephrologists, and (3) interviews with regional renal programs. The Ontario Renal Network provincial office developed the needs assessment questions and the physician survey questions after consultation with practicing nephrologists and hospital administrators. Thematic analysis was used to assess interview data and descriptive statistics to assess survey data.

Results:

Interviews with patients and family members (n = 23) identified gaps in care related to diagnosis and referral to nephrology care, education and decision-making, and psychosocial supports. The survey of nephrologists (n = 74) identified various issues that contribute to unstandardized GN care across Ontario, including a lack of provincial expertise in providing complex GN care, access to medication, multidisciplinary team support as well as patient education, and psychosocial supports. Interviews with regional renal programs aligned with interview and survey findings (n = 11).

Limitations:

Interviews with patients and family members were facilitated by 1 interviewer and limited to 20 interviews due to resource limitations. All nephrologists, patients, and family members who participated in the survey and interviews were volunteers and English-speaking, which may have resulted in self-selection bias.

Conclusions:

The provincial GN needs assessment emphasized the necessity to develop and implement a provincial GN strategy. The strategic framework includes 4 objectives: (1) ensure patients are supported to make informed decisions, (2) establish a provincial model of care, (3) leverage data to enable planning, decision-making, and monitoring of outcomes, and (4) ensure appropriate access to medication. This is the first Ontario strategy to address provincial gaps in GN care.
The Role of Peer Support in Managing Occupational Stress: A Qualitative Study of the Sustaining Resilience at Work Intervention
Authors: Agarwal Bhavya , Brooks Samantha K. , Greenberg Neil
Published: September 2019

Background: Peer support at work may support psychological resilience by enhancing coping skills and providing social support. The current study aimed to examine how a workplace peer support program, “Sustaining Resilience at Work” (StRaW), may support employee mental health from the perspective of the trained peer supporter. Method: Nine individuals from various public and private organizations who had completed StRaW peer supporter training participated in semi-structured interviews to explore their views on the StRaW program. Data were analyzed using inductive thematic analysis. Findings: Three main themes emerged: the impact of workplace stressors on employee mental health, the impact of StRaW, and feedback on StRaW. The results suggested positive effects of StRaW training on practitioners’ ability to support colleagues and maintain their own psychological well-being. Discussion/Application to Practice: Our results indicated that peer support programs in the workplace may improve employees’ well-being and relationships between employees. As such, occupational health professionals should recommend that their organizations invest in these types of programs to improve organizational resilience. They should encourage employees they consider to be capable of supporting their colleagues to undergo this training as evidence suggests this is beneficial to the trained employees’ own well-being, rather than making them feel burdened or under pressure. Occupational health professionals should also view such programs as useful ways of improving attitudes toward mental health within their organizations.
Pan-Jewish Solidarity and the Jewish Significance of Modern Israel: The 1958 “Who Is a Jew?” Affair Revisited
Authors: Shiff Ofer , Barak-Gorodetsky David
Published: September 2019

The focus of this article is the 1958 “Who is a Jew?” controversy and David Ben-Gurion’s inquiry into Jewishness leading intellectuals from Israel and the Diaspora regarding how to register a child born to a non-Jewish mother in the Israeli identity card. The article’s main claim is that this correspondence must be understood not only as reflecting a continuous struggle between diaspora and Israeli Jews or between Jews of various religious persuasions, but rather as reflecting a built-in tension between pan-Jewish solidarity and Israeli Jewish sovereignty. This built-in tension seems to prevail today as well, and thus our analysis of the 1958 event may enable a more complex understanding of the continuous and seemingly unresolved tensions within today’s Jewish world.
Geographies of politics and the police: Post-democratization, SYRIZA, and the politics of the “Greek debt crisis”
Authors: Karaliotas Lazaros
Published: September 2019

This paper explores the entangled dynamics of de-politicization and re-politicization in the midst of the “Greek debt crisis.” Critically revisiting Jacques Rancière’s political writings, it argues that, despite common criticisms to the contrary, his oeuvre foregrounds the impurity of democratic politics. Rancière, the paper contends, offers critical heuristic tools in understanding and engaging with how processes of post-democratization and democratic politics intersect, become entangled, and are mutually constituted. Simultaneously, however, it also challenges Rancière’s almost exclusive emphasis on political subjectification to argue for a plural understanding of the modalities and spatialities of democratic politics. Reading the politics of the “Greek debt crisis” through this lens, the paper unpacks how post-democratization has unfolded through an uneven and contested geography articulated at multiple scales. In parallel, it also maps the diverse and impure modalities of democratic politics in crisis-ridden Greece: from the staging of disagreement through the 2011 squares movement to the articulation of everyday commoning and solidarity movements to SYRIZA’s meteoric rise to power. In so doing, the paper demonstrates how post-democratization and democratic politics are being shaped in constant relationship and tension.
Microbial biosynthesis of lactate esters
Authors: Lee Jong-Won , Trinh Cong T.
Published: September 2019

Background

Green organic solvents such as lactate esters have broad industrial applications and favorable environmental profiles. Thus, manufacturing and use of these biodegradable solvents from renewable feedstocks help benefit the environment. However, to date, the direct microbial biosynthesis of lactate esters from fermentable sugars has not yet been demonstrated.

Results

In this study, we present a microbial conversion platform for direct biosynthesis of lactate esters from fermentable sugars. First, we designed a pyruvate-to-lactate ester module, consisting of a lactate dehydrogenase (ldhA) to convert pyruvate to lactate, a propionate CoA-transferase (pct) to convert lactate to lactyl-CoA, and an alcohol acyltransferase (AAT) to condense lactyl-CoA and alcohol(s) to make lactate ester(s). By generating a library of five pyruvate-to-lactate ester modules with divergent AATs, we screened for the best module(s) capable of producing a wide range of linear, branched, and aromatic lactate esters with an external alcohol supply. By co-introducing a pyruvate-to-lactate ester module and an alcohol (i.e., ethanol, isobutanol) module into a modularEscherichia coli(chassis) cell, we demonstrated for the first time the microbial biosynthesis of ethyl and isobutyl lactate esters directly from glucose. In an attempt to enhance ethyl lactate production as a proof-of-study, we re-modularized the pathway into (1) the upstream module to generate the ethanol and lactate precursors and (2) the downstream module to generate lactyl-CoA and condense it with ethanol to produce the target ethyl lactate. By manipulating the metabolic fluxes of the upstream and downstream modules through plasmid copy numbers, promoters, ribosome binding sites, and environmental perturbation, we were able to probe and alleviate the metabolic bottlenecks by improving ethyl lactate production by 4.96-fold. We found that AAT is the most rate-limiting step in biosynthesis of lactate esters likely due to its low activity and specificity toward the non-natural substrate lactyl-CoA and alcohols.

Conclusions

We have successfully established the biosynthesis pathway of lactate esters from fermentable sugars and demonstrated for the first time the direct fermentative production of lactate esters from glucose using anE. colimodular cell. This study defines a cornerstone for the microbial production of lactate esters as green solvents from renewable resources with novel industrial applications.
Study of Unilateral Retinoblastoma With and Without Histopathologic High-Risk Features and the Role of Adjuvant Chemotherapy: A Children’s Oncology Group Study
Authors: Chévez-Barrios Patricia , Eagle Ralph C. , Krailo Mark , Piao Jin , Albert Daniel M. , Gao Yun , Vemuganti Geeta , Ali Mohammad Javed , Khetan Vikas , Honavar Santosh G. , O’Brien Joan , Leahey Ann-Marie , Matthay Katherine , Meadows Anna , Chintagumpala Murali
Published: September 2019

PURPOSE

To prospectively determine the prevalence of high-risk histopathologic features (HRFs) in patients with unilateral retinoblastoma who undergo enucleation and to evaluate the role of chemotherapy in preventing recurrences.

PATIENTS AND METHODS

Children newly diagnosed with enucleated unilateral retinoblastoma were enrolled prospectively. After central histopathology review, patients with specific HRFs received chemotherapy; others were observed. Primary end points were event-free survivals (EFS).

RESULTS

Of the 331 patients enrolled during 2005 to 2010, 321 eligible patients had central histopathologic review. Discordance between central review and contributing institutions occurred in 23% of patients with HRFs and in 17% of patients without HRFs. Postlaminar optic nerve involvement was present in 53 patients; 42 had massive posterior uveal invasion (≥ 3 mm); 15 had concomitant peripapillary 3 mm or greater choroid and postlaminar optic nerve involvement; and 15 had focal (< 3 mm) choroidal concomitant with lamina or prelamina optic nerve involvement. Two-year EFS for patients with HRFs requiring adjuvant chemotherapy was 0.96 (95% CI, 0.89 to 0.98), and 2-year EFS for patients without HRFs for which observation was indicated was 0.99 (95% CI, 0.96 to 1.0). The 2-year EFS for all patients was 0.98 (95% CI, 0.96 to 0.99).

CONCLUSION

Adequate handling and interpretation of histopathology of eyes with retinoblastoma is necessary to assign metastatic risk. Concomitant less than 3 mm choroidal and any prelaminar/laminar optic nerve invasion show no recurrence and may warrant no adjuvant chemotherapy. In contrast, concomitant greater than 3 mm peripapillary choroidal invasion and 1.5 mm or greater of postlaminar optic nerve invasion have the poorest outcomes, supporting the need for a more intensive adjuvant chemotherapy regimen for this subgroup. Strict criteria for adjuvant therapy may improve outcomes of children who undergo enucleation at diagnosis and may avoid unnecessary adjuvant chemotherapy for those who are not at risk for recurrence.
Genomic Biomarkers to Predict Resistance to Hypomethylating Agents in Patients With Myelodysplastic Syndromes Using Artificial Intelligence
Authors: Nazha Aziz , Sekeres Mikkael A. , Bejar Rafael , Rauh Michael J. , Othus Megan , Komrokji Rami S. , Barnard John , Hilton Cameron B. , Kerr Cassandra M. , Steensma David P. , DeZern Amy , Roboz Gail , Garcia-Manero Guillermo , Erba Harry , Ebert Benjamin L. , Maciejewski Jaroslaw P.
Published: September 2019

PURPOSE

We developed an unbiased framework to study the association of several mutations in predicting resistance to hypomethylating agents (HMAs) in patients with myelodysplastic syndromes (MDS), analogous to consumer and commercial recommender systems in which customers who bought products A and B are likely to buy C: patients who have a mutation in gene A and gene B are likely to respond or not respond to HMAs.

METHODS

We screened a cohort of 433 patients with MDS who received HMAs for the presence of common myeloid mutations in 29 genes that were obtained before the patients started therapy. The association between mutations and response was evaluated by the Apriori market basket analysis algorithm. Rules with the highest confidence (confidence that the association exists) and the highest lift (strength of the association) were chosen. We validated our biomarkers in samples from patients enrolled in the S1117 trial.

RESULTS

Among 433 patients, 193 (45%) received azacitidine, 176 (40%) received decitabine, and 64 (15%) received HMA alone or in combination. The median age was 70 years (range, 31 to 100 years), and 28% were female. The median number of mutations per sample was three (range, zero to nine), and 176 patients (41%) had three or more mutations per sample. Association rules identified several genomic combinations as being highly associated with no response. These molecular signatures were present in 30% of patients with three or more mutations/sample with an accuracy rate of 87% in the training cohort and 93% in the validation cohort.

CONCLUSION

Genomic biomarkers can identify, with high accuracy, approximately one third of patients with MDS who will not respond to HMAs. This study highlights the importance of machine learning technologies such as the recommender system algorithm in translating genomic data into useful clinical tools.
Intrathecal Drug Delivery Systems for Cancer Pain: An Analysis of a Prospective, Multicenter Product Surveillance Registry
Authors: Stearns Lisa M. , Abd-Elsayed Alaa , Perruchoud Christophe , Spencer Robert , Hammond Krisstin , Stromberg Katherine , Weaver Todd
Published: September 2019

BACKGROUND:

The safety and efficacy of intrathecal drug delivery systems (IDDSs) for the treatment of cancer-related pain have been demonstrated in randomized controlled clinical trials (RCTs). Despite positive evidence for this therapy, IDDS remains underutilized to treat cancer pain. Real-world registry data augment existing safety and effectiveness data and are presented here to broaden awareness of this therapeutic option, needed for adequate cancer-related pain treatment, and as a viable tool addressing concerns with systemic opioid use.

METHODS:

This prospective, long-term, multicenter (United States, Western Europe, and Latin America) registry started in 2003 to monitor the performance of SynchroMed Infusion Systems. Patient-reported outcomes were added in 2013. Before data acquisition, all sites obtained Ethics Committee/Institutional Review Board approval and written patient consent. The study was registered (NCT01524276 at clinicaltrials.gov) before patients were enrolled. Patients who provided informed consent were enrolled in the registry at initial IDDS implant or replacement.

RESULTS:

Through July 2017, 1403 patients with cancer pain were enrolled and implanted. The average (minimum/maximum) age of patients was 59 years (13/93 years), with 56.6% female. The most frequent cancer types were lung, breast, colon/rectal, pancreatic, and prostate. The majority of patients whose registry follow-up ended (87%; 1141/1311) were followed through death, with 4.3% (n = 57) exiting due to device explant or therapy discontinuation; the remaining 113 (8.6%) discontinued for reasons such as transfer of care, lost to follow-up, and site closure. Pain scores within the cohort of patients providing baseline and follow-up data improved significantly at 6 (P = .0007; n = 103) and 12 (P = .0026; n = 55) months compared to baseline, with EuroQol with 5 dimensions (EuroQol-5D) scores showing significant improvement at 6 months (P = .0016; n = 41). Infection requiring surgical intervention (IDDS explant, replacement, pocket revision, irrigation and debridement, etc) was reported in 3.2% of patients.

CONCLUSIONS:

Adequate and improved pain control in patients with cancer, even in advanced stages, with concurrent quality of life maintenance is attainable. Results from this large-scale, multicenter, single-group cohort supplement existing RCT data that support IDDS as a safe and effective therapeutic option with a positive benefit–risk ratio in the treatment of cancer pain.
Fibrosing mediastinitis mimicking as chronic pulmonary thromboembolism
Authors: Sinha Dimpi , Kundaragi Nischal G , Kale Sudhir Kumar , Sharma Sukrity
Published: September 2019

Fibrosing mediastinitis is an uncommon, benign, progressive disorder caused by proliferation of fibrous tissue within mediastinum resulting in encasement of vital mediastinal broncho-vascular structures. Due to its rarity and variable clinical presentation, it is often misdiagnosed. We are presenting a case of fibrosing mediastinitis in an Ethiopian origin young male presenting with pulmonary hypertension due to simultaneous occlusion of pulmonary vein and arteries, clinically misdiagnosed as chronic pulmonary thromboembolism.
Paraumbilical vein aneurysm: case report
Authors: Gardiner Natasha , Voigt Stephan
Published: September 2019

A 48-year-old female patient was found to have a paraumbilical vein saccular aneurysm, which is a rare consequence of portal hypertension. She presented with right upper quadrant pain and had a known diagnosis of alcoholic liver disease. This had progressed since her last admission. We discuss the multimodality images obtained, diagnosis and complications associated with this pathology.
Psoriatic arthritis
Authors: Ocampo D Vanessa , Gladman Dafna
Published: September 2019

Psoriasis is a multisystemic, inflammatory skin condition that can affect many areas of the body, but most commonly the extensor surfaces of the elbows and knees, and sometimes the intergluteal and umbilical area. It has a prevalence of 2–4% in western adults, and 20­–30% of psoriasis patients will develop psoriatic arthritis (PsA). PsA is an inflammatory musculoskeletal disease associated with cutaneous psoriasis. It affects men and women almost equally with a peak age at onset of 40 and 50 years. It is a diverse disease that affects multiple organ systems includes peripheral and axial joints, entheses, skin, and nails. PsA is associated with comorbidities such as osteoporosis, uveitis, subclinical bowel inflammation, and cardiovascular disease. Given this heterogeneity, its diagnosis has been difficult. Here we present an updated review of its classification criteria CASPAR (classification criteria for PsA), use of screening tools to aid in early diagnosis, recent findings on pathogenesis, and new therapeutic approaches including new biologic medications.