bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and intensity ofSchistosoma mansoniinfection in pediatric populations on antiretroviral therapy in north-western Tanzania: a cross-sectional study
Authors: Mazigo Humphrey D , Kirway Laurence , Ambrose Emmanuela Ausebio
Published: July 2019

Background

In areas where HIV and intestinal schistosomiasis are highly endemic, co-infections of the two diseases in a single human host are frequent. Evidence in adult populations indicates that HIV and intestinal schistosomiasis are associated with negative health impacts. However, the topic of HIV and schistosomiasis in paediatric populations has received little attention. The present study determined the prevalence and intensity ofSchistosoma mansoniinfection in a paediatric population on antiretroviral therapy (ART) in north-western Tanzania.

Design, settings and participants

A cross-sectional study was conducted among HIV-infected children aged 1–16 years on ART attending a Care and Treatment Clinic at Ukerewe Designated District Hospital, north-western Tanzania.

Main outcome measures

Single stool and urine samples were collected and screened forS. mansonieggs and circulating cathodic antigen (CCA), using the Kato-Katz (KK) technique and point-of-care CCA (POC-CCA) rapid urine test, respectively.

Results

A total of 134 children with a median age of 10 years (IQR 7–12 years) participated in the study. Of these, 44.8% (60/134) and 55.2% (74/134) were female and male, respectively. The overall prevalence ofS. mansonibased on the KK technique and POC-CCA rapid test were 10.7% (95% CI 5.9% to 18.4%) and 33.8% (95% CI 26.2% to 42.4%), respectively. The overall geometrical mean eggs per gram of faeces was 293.9 GM-epg (95% CI 123.3 to 700.9). A small proportion of the children had moderate (4.9%, 5/103) and heavy (3.8%, 4/103) intensity of infection.

Conclusion

Paediatric populations on ART are co-infected withS. mansoniinfection. Screening and treatment of intestinal schistosomiasis at initiation of ART is recommended to reduce the risk of developing hepatosplenic disease, schistosomiasis-related immune reconstitution inflammatory syndrome and the possible adverse effect of schistosomiasis on outcome of ART.
Why is reporting quality improvement so hard? A qualitative study in perioperative care
Authors: Jones Emma Leanne , Dixon-Woods Mary , Martin Graham P
Published: July 2019

Objectives

Quality improvement (QI) may help to avert or mitigate the risks of suboptimal care, but it is often poorly reported in the healthcare literature. We aimed to identify the influences on reporting QI in the area of perioperative care, with a view to informing improvements in reporting QI across healthcare.

Design

Qualitative interview study.

Setting

Healthcare and academic organisations in Australia, Europe and North America.

Participants

Stakeholders involved in or influencing the publication, writing or consumption of reports of QI studies in perioperative care.

Results

Forty-two participants from six countries took part in the study. Participants included 15 authors (those who write QI reports), 12 consumers of QI reports (practitioners who apply QI research in practice), 11 journal editors and 4 authors of reporting guidelines. Participants identified three principal challenges in achieving high-quality QI reporting. First, the broad scope of QI reporting—ranging from small local projects to multisite research across different disciplines—causes uncertainty about where QI work should be published. Second, context is fundamental to the success of a QI intervention but is difficult to report in ways that support replication and development. Third, reporting is adversely affected by both proximal influences (such as lack of time to write up QI) and more distal, structural influences (such as norms about the format and content of biomedical research reporting), leading to incomplete reporting of QI findings.

Conclusions

Divergent terminology and understandings of QI, along with existing reporting norms and the challenges of capturing context adequately yet succinctly, make for challenges in reporting QI. We offer suggestions for improvement.
Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program
Authors: Sullivan Elizabeth , Ward Stephen , Zeki Reem , Wayland Sarah , Sherwood Juanita , Wang Alex , Worner Faye , Kendall Sacha , Brown James , Chang Sungwon
Published: July 2019

Introduction

The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described.

Methods and analysis

Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the ‘time-to’ health-related outcomes after adjusting for potential confounders.

Ethics and dissemination

Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Ethics Committee, the Corrective Services NSW Ethics Committee and the University of Technology Sydney Human Research Ethics Committee.
Protocol for the development and acceptability of a fertility-related decision aid for young women with breast cancer in Portugal
Authors: Gonçalves Vânia , Travado Luzia , Ferreira Pedro Lopes , Quinn Gwendolyn
Published: July 2019

Introduction

Young patients with breast cancer may face impaired fertility due to cancer treatments, which often leads to complex fertility decisions. To aid fertility decision-making, it is crucial that women have access to high-quality information; however, their fertility information needs are often unmet. Decision aids (DAs) are educational materials to assist with decision-making, by addressing individual values and preferences. In oncofertility, DAs may constitute a valuable resource to help patients obtain information and make better informed decisions. This paper reports on the protocol of the development and transcreation of a fertility-related DA booklet to support young Portuguese patients with breast cancer, originally developed and validated for an Australian audience.

Methods and analysis

Recent literature on clinical guidelines will be reviewed. A summary of these guidelines will be created and will inform the first round of DAs revisions. A forward translation process will translate the DA from Australian English to Portuguese. A multidisciplinary Portuguese experts panel will revise and give feedback on the scientific and cultural aspects of the DA content for Portuguese audience. Next, a backward translation process will assess content equivalence between the original and the final adapted version. Finally, Learner Verification (LV) will be used in a qualitative study of young patients with breast cancer and their partners. Two focus groups with 6–10 participants each will be conducted with: (1) recently diagnosed young patients with breast cancer; (2) breast cancer survivors and (3) their partners. Results from the DA acceptability assessment will inform its final version. Data will be analysed using content analysis and constant comparison method to identify key themes/textual units related to LV.

Ethics and dissemination

Ethical approval was granted by the Portuguese Institute of Oncology Porto. Results will be disseminated through peer-reviewed journals and presented at scientific meetings for academic and health professionals audiences.
Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018
Authors: Burrell Sam , Vodstrcil Lenka A , Fairley Christopher K , Kilner Alex , Bradshaw Catriona S , Chen Marcus Y , Chow Eric P F
Published: July 2019

Objectives

In 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne.

Methods

All MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine.

Results

Of the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28; 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A.

Conclusion

The critical vaccination threshold for hepatitis A has been estimated at >70%. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.
The role of dispersal, selection, and timing of sampling on the false discovery rate of loci under selection during geographic range expansion
Authors: Mayrand Paul , Filotas Élise , Wittische Julian , James Patrick M.A.
Published: July 2019

Identifying adaptive loci is important to understand the evolutionary potential of species undergoing range expansion. However, in expanding populations, spatial demographic processes such as allele surfing can create spatial patterns of neutral genetic variation that appear similar to those generated through adaptive processes. As a result, the false discovery rate of adaptive loci may be inflated in landscape genomic analyses. Here, we take a simulation modelling approach to investigate how range expansion affects our ability to correctly distinguish between neutral and adaptive genetic variation, using the mountain pine beetle outbreak system as a motivating example. We simulated the demographic and population genetic dynamics of populations undergoing range expansion using an individual-based genetic model CDMetaPOP. We investigated how the false discovery rate of adaptive loci is affected by (i) dispersal capacity, (ii) timing of sampling, and (iii) the strength of selection on an adaptive reference locus. We found that a combination of weak dispersal, weak selection, and early sampling presents the greatest risk of misidentifying loci under selection. Expanding populations present unique challenges to the reliable identification of adaptive loci. We demonstrate that there is a need for further methodological development to account for directional demographic processes in landscape genomics.
MARKET ORIENTATION AND NEW PRODUCT SUPERIORITY AMONG SMALL AND MEDIUM-SIZED ENTERPRISES (SMEs): THE MODERATING ROLE OF INNOVATION CAPABILITY
Authors: DOGBE COURAGE SIMON KOFI , TIAN HONG-YUN , POMEGBE WISDOM WISE KWABLA , SARSAH SAMPSON ATO , OTOO CHARLES ODURO ACHEAMPONG
Published: July 2019

The study explored the effects of the individual dimensions of market orientation on the superiority of new products introduced unto the market by SMEs, as well as the moderating role of innovation capability on these relationships. Analysis was based on 373 SMEs whose respondents were either employee-managers or owner-managers. Confirmatory Factor Analysis was conducted to check for validity and reliability of the observed items. A hierarchical regression model was estimated to test the various hypotheses set for the study. Findings revealed that customer orientation and inter-functional coordination had a positive and significant effect on new product superiority; however, competitor orientation had no significant effect. Innovation capability positively moderated the effects of customer orientation, competitor orientation and inter-functional coordination on new product superiority. This indicates the crucial role of SMEs’ innovative capability in leveraging the effect of competitor orientation on new product superiority.
Automated segmentation of intraretinal cystoid macular edema based on Gaussian mixture model
Authors: Wu Jinghong , Niu Sijie , Chen Qiang , Fan Wen , Yuan Songtao , Li Dengwang
Published: July 2019

We introduce a method based on Gaussian mixture model (GMM) clustering and level-set to automatically detect intraretina fluid on diabetic retinopathy (DR) from spectral domain optical coherence tomography (SD-OCT) images in this paper. First, each B-scan is segmented using GMM clustering. The original clustering results are refined using location and thickness information. Then, the spatial information among every consecutive five B-scans is used to search potential fluid. Finally, the improved level-set method is used to obtain the accurate boundaries. The high sensitivity and accuracy demonstrated here show its potential for detection of fluid.
Environmental Pollution, Income Inequality, and Household Energy Consumption: Evidence from the United Kingdom
Authors: Ghosh Sudeshna
Published: July 2019

This study explored the impact of income inequality, household energy consumption, government expenditure, and investment on carbon dioxide emissions at the household level over the period 1970–2015 in the United Kingdom. The study applied Clemente–Montanes–Reyes unit root test to identify structural break in the time series. Further, the cointegrating relationship of the time series observations was explored by applying the autoregressive distributed lag model (ARDL) (linear) bounds test approach along with the nonlinear ARDL for making fruitful comparisons in the long-run relationship among the variables. The paper used Bayer–Hanck combined cointegration method for robustness test in the cointegrating methods. In addition, the causality analysis was explored using the Toda–Yamato (1995) method of Granger causality. The results confirmed the existence of cointegration among the variables.The estimated NARDL results show that in the long run the negative asymmetric impact of the income inequality is stronger than the positive impact. The paper concludes that there is an urgent need to reduce income inequality in the United Kingdom to improve equitable consumption of energy at the household level. Last the causality test shows that there exists unidirectional causality from inequality transmission to carbon emissions.
Matching Graph, a Method for Extracting Parallel Information from Comparable Corpora
Authors: Bakhshaei Somayeh , Safabakhsh Reza , Khadivi Shahram
Published: July 2019

Comparable corpora are valuable alternatives for the expensive parallel corpora. They comprise informative parallel fragments that are useful resources for different natural language processing tasks. In this work, a generative model is proposed for efficient extraction of parallel fragments from a pair of comparable documents. The core of the proposed model is a graph called the Matching Graph. The ability of the Matching Graph to be trained on a small initial seed makes it a proper model for language pairs suffering from the scarce resource problem. Experiments show that the Matching Graph performs significantly better than other recently published models. According to the experiments on English-Persian and Arabic-Persian language pairs, the extracted parallel fragments can be used instead of parallel data for training statistical machine translation systems. Results reveal that the extracted fragments in the best case are able to retrieve about 90% of the information of a statistical machine translation system that is trained on a parallel corpus. Moreover, it is shown that using the extracted fragments as additional information for training statistical machine translation systems leads to an improvement of about 2% for English-Persian and about 1% for Arabic-Persian translation on BLEU score.
Embedded EthiCS
Authors: Grosz Barbara J. , Grant David Gray , Vredenburgh Kate , Behrends Jeff , Hu Lily , Simmons Alison , Waldo Jim
Published: July 2019

A Harvard-based pilot program integrates class sessions on ethical reasoning into courses throughout its computer science curriculum.
Overly attached
Authors: Matsudaira Kate
Published: July 2019

Know when to let go of emotional attachment to your work.
Industry-scale knowledge graphs
Authors: Noy Natasha , Gao Yuqing , Jain Anshu , Narayanan Anant , Patterson Alan , Taylor Jamie
Published: July 2019

Five diverse technology companies show how it's done.
Spatio-temporal Adaptive Pricing for Balancing Mobility-on-Demand Networks
Authors: He Suining , Shin Kang G.
Published: July 2019

Pricing in mobility-on-demand (MOD) networks, such as Uber, Lyft, and connected taxicabs, is done adaptively by leveraging the price responsiveness of drivers (supplies) and passengers (demands) to achieve such goals as maximizing drivers’ incomes, improving riders’ experience, and sustaining platform operation. Existing pricing policies only respond to short-term demand fluctuations without accurate trip forecast and spatial demand-supply balancing, thus mismatching drivers to riders and resulting in loss of profit.

We propose CAPrice, a novel adaptive pricing scheme for urban MOD networks. It uses a new spatio-temporal deep capsule network (STCapsNet) that accurately predicts ride demands and driver supplies with vectorized neuron capsules while accounting for comprehensive spatio-temporal and external factors. Given accurate perception of zone-to-zone traffic flows in a city, CAPrice formulates a joint optimization problem by considering spatial equilibrium to balance the platform, providing drivers and riders/passengers with proactive pricing “signals.” We have conducted an extensive experimental evaluation upon over 4.0× 10
8
MOD trips (Uber, Didi Chuxing, and connected taxicabs) in New York City, Beijing, and Chengdu, validating the accuracy, effectiveness, and profitability (often 20% ride prediction accuracy and 30% profit improvements over the state-of-the-arts) of CAPrice in managing urban MOD networks.
Mitigating Tail Response Time of n-Tier Applications
Authors: Wang Qingyang , Zhang Shungeng , Kanemasa Yasuhiko , Pu Calton
Published: July 2019

Consistent low response time is essential for e-commerce due to intense competitive pressure. However, practitioners of web applications have often encountered the long-tail response time problem in cloud data centers as the system utilization reaches moderate levels (e.g., 50%). Our fine-grained measurements of an open source n-tier benchmark application (RUBBoS) show such long response times are often caused by Cross-tier Queue Overflow (CTQO). Our experiments reveal the CTQO is primarily created by the synchronous nature of RPC-style call/response inter-tier communications, which create strong inter-tier dependencies due to the request processing chain of classic n-tier applications composed of synchronous RPC/thread-based servers. We remove gradually the dependencies in n-tier applications by replacing the classic synchronous servers (e.g., Apache, Tomcat, and MySQL) with their corresponding event-driven asynchronous version (e.g., Nginx, XTomcat, and XMySQL) one-by-one. Our measurements with two application scenarios (virtual machine co-location and background monitoring interference) show that replacing a subset of asynchronous servers will shift the CTQO, without significant improvements in long-tail response time. Only when all the servers become asynchronous the CTQO is resolved. In synchronous n-tier applications, long-tail response times resulting from CTQO arise at utilization as low as 43%. On the other hand, the completely asynchronous n-tier system can disrupt CTQO and remove the long tail latency at utilization as high as 83%.
Block-based programming in computer science education
Authors: Weintrop David
Published: July 2019

Considering how block-based programming environments and tools might be used at the introductory level and beyond.
You Can't Teach a New Phone Old Tricks
Authors: Klugman Noah , Clark Meghan , Podolsky Matthew , Pannuto Pat , Taneja Jay , Dutta Prabal
Published: July 2019

The smartphone is an incredible computing platform. Loaded with powerful processing, vast data storage, near-global connectivity, built-in batteries, and a rich array of sensors, these devices reliably service the needs of billions of users every day. However, when tasked to run just a single application continuously without any human interaction, the smartphone platform becomes surprisingly unreliable. Over the course of a four-month deployment of Android-phone-based cellular gateways in Zanzibar, Tanzania, all 16 deployed phones failed despite significant engineering efforts, and six phones became physically damaged. This article examines what went wrong and how mobile computing platforms could adapt to support more traditional embedded computing roles and workloads.
Technical Report Column
Authors: Kelley Dean
Published: July 2019

Welcome to the Technical Reports Column. If your institution publishes technical reports that you'd like to have included here, please contact me at the email address above.
Guest Column
Authors: Gasarch William , Huddleston Scott , Metz Erik , Prinz Jacob
Published: July 2019

You have m muffins and s students. You want to divide the muffins into pieces and give the shares to students such that every student has m s muffins and the minimum piece is maximized. Let f(m; s) be the minimum piece in the optimal protocol. We present, by examples, several methods to obtain upper and lower bounds on f(m; s).
Survey of Reconfigurable Data Center Networks
Authors: Foerster Klaus-Tycho , Schmid Stefan
Published: July 2019

Emerging optical technologies introduce opportunities to recon gure network topologies at runtime. The resulting topological exibilities can be exploited to design novel demand-aware and self-adjusting networks. This paper provides an overview of the algorithmic problems introduced by this technology, and surveys rst solutions.
Upper Airway Changes following Functional Treatment with the Headgear Herbst or Headgear Twin Block Appliance Assessed on Lateral Cephalograms and Magnetic Resonance Imaging
Authors: Gu Min , Savoldi Fabio , Hägg Urban , McGrath Colman P. J. , Wong Ricky W. K. , Yang Yanqi
Published: July 2019

Objective. The present study compared the changes in the upper airway dimensions and sleep-related breathing disorder (SRBD) condition between functional treatment with the headgear Herbst (HG-Herbst) and headgear Twin Block (HG-TB) appliance. Soft tissues were assessed on lateral cephalometric X-ray and magnetic resonance imaging (MRI). Materials and Methods. Consecutive patients who sought orthodontic treatment at the Faculty of Dentistry of The University of Hong Kong were screened. Adolescents (12-17 year sold for boys and 10-15 years old for girls), with class II molar relationship and overjet >5 mm, with no severe transverse maxillary deficiency, were recruited. Patients were assigned either to the HG-Herbst or to the HG-TB treatment by stratified block randomisation, with sex as the stratification factor. Lateral cephalograms, magnetic resonance imaging (MRI), and the Paediatric Sleep Questionnaire (PSQ) were obtained at baseline and after treatment. Results. 28 patients were enrolled, and 26 patients (13 in each group) completed the treatment. Following 1 year of functional appliance treatment, a significantly lower increase of the lower anterior facial height was observed in the HG-Herbst group compared to the HG-TB group (p = 0.024). However, no significant differences were observed in the upper airway structures or SRBD between the two groups. Conclusion. The changes in upper airway dimensions and SRBD condition were not significantly different between the HG-Herbst and the HG-TB appliance treatment. Additional studies with larger sample size are warranted.
Evaluation of Knowledge and Practice of Pharmacy Professionals regarding the Risk of Medication Use during Pregnancy in Dessie Town, Northeast Ethiopia: A Cross-Sectional Study
Authors: Tuha Abdu , Gurbie Yilak , Hailu Haftom Gebregergs
Published: July 2019

Background. The developing organism is unique in its responsiveness to drugs and predictability of therapeutic effectiveness based on the adult which can lead to grave consequences in the neonate and child. Moreover, uncertainty about the risks of drug use in pregnancy could result in restrictive attitudes towards prescribing and dispensing medicines and their use. Pharmacists have huge duties to improve medication use, especially among pregnant women. The objective of this study is, hence, to assess the knowledge and practice of pharmacy professionals (PPs) towards the risk of medication use during pregnancy. Methodology. A questionnaire-based cross-sectional study was carried out over practicing community and hospital pharmacy professionals in Dessie town. They were asked about the safety of common drugs during pregnancy. It involves both prescription-only medications (POM) and over-the-counter (OTC) medications. Secondly, they were asked about their practice towards the risk of medication use during pregnancy. Both descriptive and analytical statistics were utilized. For descriptive analysis, results were expressed as numbers, percentages, and mean (± SD and 95% CI). Result. Seventy-six pharmacy professionals in Dessie, Northeast Ethiopia, took part in the study. Most of the respondents (64.5%) believed that amoxicillin is safe in all trimesters. 26 (34.2%) of participants knew that isotretinoin is unsafe for use by pregnant women. About dietary supplements, 32.9% of PPs reported that Vitamin A supplements are safe in all trimesters. There was a significant difference observed for study college and years of experience of the PPs in their score of knowledge test (p=0.020 and p=0.024, respectively). Additionally, there was a difference seen for gender (p=0.030), study college (p=0.036), and working institution (p=0.013) in their advice to pregnant women. Conclusion and Recommendation. Overall, PPs exhibited very low knowledge about drug safety during pregnancy. The absence of obligatory continuing pharmacy education for pharmacists is expected to have negatively affected the level of medication knowledge and consequently the pharmaceutical care services delivered in community and hospital pharmacies. As medication knowledge of PPs is poor, a multitude of strategies (educational, economic, managerial, and regulatory) should be designed by the government, universities, and pharmaceutical associations to improve the pharmacy professionals’ role in the healthcare system by providing them with continuous and up-to-date medication knowledge.
Altered Spontaneous Brain Activity of Children with Unilateral Amblyopia: A Resting State fMRI Study
Authors: Dai Peishan , Zhang Jinlong , Wu Jing , Chen Zailiang , Zou Beiji , Wu Ying , Wei Xin , Xiao Manyi
Published: July 2019

Objective. This study is aimed at investigating differences in local brain activity and functional connectivity (FC) between children with unilateral amblyopia and healthy controls (HCs) by using resting state functional magnetic resonance imaging (rs-fMRI). Methods. Local activity and FC analysis methods were used to explore the altered spontaneous brain activity of children with unilateral amblyopia. Local brain function analysis methods included the amplitude of low-frequency fluctuation (ALFF). FC analysis methods consisted of the FC between the primary visual cortex (PVC-FC) and other brain regions and the FC network between regions of interest (ROIs-FC) selected by independent component analysis. Results. The ALFF in the bilateral frontal, temporal, and occipital lobes in the amblyopia group was lower than that in the HCs. The weakened PVC-FC was mainly concentrated in the frontal lobe and the angular gyrus. The ROIs-FC between the default mode network, salience network, and primary visual cortex network (PVCN) were significantly reduced, whereas the ROIs-FC between the PVCN and the high-level visual cortex network were significantly increased in amblyopia. Conclusions. Unilateral amblyopia may reduce local brain activity and FC in the dorsal and ventral visual pathways and affect the top-down attentional control. Amblyopia may also alter FC between brain functional networks. These findings may help understand the pathological mechanisms of children with amblyopia.
Prediction of the Shear Failure of Opened Rock Fractures and Implications for Rock Slope Stability Evaluation
Authors: Li Yingchun
Published: July 2019

Rock slope commonly fails due to the shear failure of rock fractures. Shear strength of rock fractures are reduced substantially once the fracture surfaces are mismatched or opened. We propose a new criterion to predict the shear strength of rock fractures in different opening states. The degree of interlocking representing the true asperity contact area is incorporated into the modified model of Saeb and Amadei. The effect of fracture opening on asperity dilation and degradation is separately considered. The transitional stress that is a critical parameter involved in the model is analytically determined based on energy consideration. The new model is validated with experimental results from direct shear tests on synthetic fractures with regular‐shaped asperities. Good agreement between the analytical solution and the experimental data confirms the capacity of the proposed model. Therefore, the model has great potential for assessing the stability of rock slopes where fractures are often opened due to stress relief and engineering disturbances.
Safety and Feasibility of Repeated Intrathecal Allogeneic Bone Marrow-Derived Mesenchymal Stromal Cells in Patients with Neurological Diseases
Authors: Pan Kuang , Deng Lingna , Chen Peiying , Peng Qingxia , Pan Jingrui , Wu Yanfeng , Wang Yidong
Published: July 2019

Mesenchymal stromal cells (MSCs) have become the most commonly used adult stem cells in regenerative medicine. Preclinical studies have shown that MSCs-based therapy is a potential new treatment approach for neurological diseases. Intrathecal injection has unique feature which allows stem cells to directly migrate to the lesion site in patients with central nervous system (CNS) diseases. In this study, we evaluate the safety and feasibility of intrathecal allogeneic bone marrow-derived MSCs (BM-MSCs) in patients with neurological diseases. This open-label clinical study included 37 patients (14 diseases). Eligible patients underwent a baseline assessment and were intrathecally injected with allogeneic BM-MSCs (1×106 cells/kg, 4 consecutive treatments at 1-week intervals). After four infusions, the patients were followed up for at least 6 months. Adverse events, cerebrospinal fluid (CSF) test results, clinical symptoms, physical examination, and haematological and imaging examinations were used to assess the safety and feasibility of the treatment. Also, we performed a systematic review of the safety of all types of intrathecal stem cells and compared our result to previous studies. In our study, the highest adverse event was a slight ache at the injection site (4.11%), followed by fever (3.42%) and mild headache (2.05%). No severe adverse events were reported. After the intrathecal injections, the white blood cell (WBC) counts in the CSF increased in 30 patients and the protein concentration in the CSF exceeded the normal range in 26 patients, while other CSF indicators remained normal. Moreover, these patients had no suspected manifestations of CNS infection. Haematological and imaging examinations showed no abnormal changes after BM-MSCs infusion. Compared with previous studies, the incidence of adverse events was nearly consistent or even lower for headache, fever, nausea, and neck pain. In conclusion, repeated intrathecal allogeneic BM-MSCs are safe, feasible, and promising for the treatment of patients with neurological diseases.
Effect of Health Education Programme on the Knowledge of and Attitude about Sickle Cell Anaemia among Male Secondary School Students in the Jazan Region of Saudi Arabia: Health Policy Implications
Authors: Kotb Mohammed Mahmoud , Almalki Mohammed J. , Hassan Yasser , Al Sharif Anwar , Khan Maseer , Sheikh Kamaludin
Published: July 2019

This study was conducted to develop an instructional programme on sickle cell anaemia (SCA) and test the effect of the programme on the secondary school students’ knowledge of and attitude towards sickle cell anaemia in the Jazan region of Saudi Arabia. A pretest/posttest one-arm interventional study was conducted at the Faculty of Public Health and Tropical Medicine, Jazan University, with a convenience sample of 120 male students. The intervention consisted of two interactive sessions about sickle cell anaemia and premarital screening. The mean student knowledge score was 6.04 ± 3.02 on the pretest, which improved to 10.73 ± 3.47 on the posttest, with a statistically significant difference (t = 15.2, p < 0.001). There was no significant difference in the responses pertaining to attitude before and after the health education intervention. The policy implications of these findings are discussed to improve the performance of the Saudi healthcare system in dealing with this costly inherited disease.
Subject Retention in Prehospital Stroke Research Using a Telephone-Based Physician-Investigator Driven Enrollment Method
Authors: Rosell Bryant J. , Shkirkova Kristina , Saver Jeffrey L. , Liebeskind David S. , Starkman Sidney , Kim-Tenser May , Eckstein Marc , Sharma Latisha , Conwit Robin , Hamilton Scott , Sanossian Nerses
Published: July 2019

Background and Purpose: Subject retention into clinical trials is vital, and prehospital enrollment may be associated with higher rates of subject withdrawal than more traditional methods of enrollment. We describe rates of subject retention in a prehospital trial of acute stroke therapy. Methods: All subjects were enrolled into the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial. Paramedics screened eligible subjects and contacted the physician-investigator using a dedicated in-ambulance cellular phone. Physician-investigators obtained explicit informed consent from the subject or on-scene legally authorized representative (LAR) who reviewed and signed a consent form. Exception from informed consent (EFIC) was utilized in later stages of the study. Results: There were 1,700 subjects enrolled; 1,017 provided consent (60%), 662 were enrolled via LAR (39%), and 21 were enrolled via EFIC (1%). Of the 1,700 patients, 1,413 (83%) completed the 90-day visit, 265 (16%) died prior to the 90-day visit, and 22 (1.3%) withdrew from the study before completion. There were no differences in rates of withdrawal by method of study enrolment, i.e., self-consent (n = 14), 1.4%; LAR (n = 8), 1.2%; EFIC (n = 0) 0%. Conclusion: There was a high rate of retention when subjects were enrolled into prehospital stroke research using a phone-based method to obtain explicit consent.
EVA-Scalp: Evaluation of Patient Satisfaction with a Scalp Cooling Device to Prevent Chemotherapy-Induced Alopecia in Breast Cancer Patients
Authors: Bitto Franz-Ferdinand , König Alexander , Phan-Brehm Thuy  , Vallbracht Thomas , Koch Julian Gregor , Schinköthe Timo , Wolfgarten Matthias , Mahner Sven , Harbeck Nadia , Würstlein Rachel
Published: July 2019

Purpose: Scalp cooling (SC) offers a chance to reduce hair loss (HL), but patient satisfaction, the effect on well-being, as well as patient selection criteria have not been sufficiently assessed yet. Methods: In the EVAScalp trial, SC was offered to 70 breast cancer patients who received chemotherapy between November 2015 and September 2018. For SC, the Paxman-Orbis-II System was used. Satisfaction was measured by a questionnaire evaluating the level of depression with the WHO-5 well-being index (WHO-5) plus questions addressing the patient’s experiences and side effects using the SC device. To evaluate efficacy, documentation by photo, by a physician, and by an HL-diary was conducted. Results: Regarding efficacy, a significant difference between chemotherapy regimens is seen. Anthracycline-based therapies led to a stop of SC in 71% of the patients, whereas taxane-based therapies without anthracyclines were associated with a high acceptance of SC, and 88% of patients with paclitaxel-based therapies continued SC throughout their chemotherapy. Overall, only 7.69% of the patients stopped because of side effects. As an indicator for quality of life, WHO-5 was higher (65.8%) in patients with successful SC compared to in patients who stopped SC because of HL or side effects (only 53.0%). The majority of patients (82.22%) with successful SC would recommend SC to other patients. Conclusions: Patients tolerated SC as long as HL was successfully prevented. The well-being of patients with successful SC was significantly higher than that of patients who stopped SC prematurely. In general, SC is a promising approach and improves patient well-being, but there are still limitations to its utility depending on the chemotherapy regimen used.
Cervical Cancer with Intermediate Risk Factors: Is there a Role for Adjuvant Radiotherapy? A Systematic Review and a Meta-Analysis
Authors: Sagi-Dain Lena , Abol-Fol Sereen , Lavie Ofer , Sagi Shlomi , Ben Arie Alon , Segev Yakir
Published: July 2019

Background: The yield of adjuvant radiotherapy in cervical cancer patients with intermediate risk factors is controversial. The objective of our meta-analysis was to shed light on this important issue. Material and Methods: Search was conducted in several databases. By independent screening of titles and abstracts, 2 investigators selected original researches examining the effect of adjuvant radiation treatment on overall survival and progression-free survival in cervical cancer patients with intermediate risk factors. Results: Of the 5 articles included, a total of 591 patients with intermediate risk factors were encompassed. Statistical significance was noted in favor of radiation therapy in a subgroup of patients with 2 or more intermediate factors in terms of recurrence (OR 0.46 [95% CI 0.28–0.74, p = 0.001]) and overall survival (OR 1.86 [95% CI 1.03–3.36, p = 0.04]). After adding patients with one risk factor, radiation exerted a non-significant effect on recurrence rate, overall survival, disease-free survival, and 5-year cancer-specific survival, while increasing the rate of gastrointestinal side effects (2.4 vs. 0%, p = 0.0156). Conclusions: Adjuvant radiation therapy decreases the risk for recurrence and increases the overall survival in patients with 2 intermediate risk factors. These benefits were not shown after adding patients with one risk factor.
Treatment Lines in Hepatocellular Carcinoma
Authors: Wege Henning , Li Jun , Ittrich Harald
Published: July 2019

Background: Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and the second most lethal malignancy worldwide. In the Western world, HCC predominantly develops in patients with liver cirrhosis. Therefore, application of locoregional interventions and systemic agents should be based on an interdisciplinary evaluation, most importantly, taking the functional liver reserve into account. This review summarizes current treatment lines and novel strategies in the management of HCC. For the most part, randomized controlled trials and large meta-analyses are reported, with an emphasis on systemic therapies. Summary: In patients with limited hepatic disease and sufficient liver function, resection and local ablation are the most frequently employed curative locoregional therapies. Due to recurrence rates of up to 70% within 5 years and in patients with compromised liver function not amenable to these local modalities, liver transplantation remains superior in terms of tumor control and long-term survival. However, its applicability is limited because of the increasing gap between available donor organs and patients on the waiting list. Transarterial chemoembolization is commonly employed to bridge patients to transplantation and also serves as standard of care for patients not suitable for other local therapies. Recently, various phase 3 trials have reported a clinical benefit for the tyrosine kinase inhibitors lenvatinib, regorafenib, and cabozantinib in HCC. In addition, ramucirumab, an angiostatic antibody, also improves survival in second-line systemic therapy. This opens new avenues in the sequential application of treatment lines, and thus early response assessment is necessary to fully utilize the clinical impact of locoregional therapies and systemic therapies and to shift patients to further treatment lines before hepatic deterioration. Key Messages: Clinical decision-making in hepatocellular carcinoma is based on an interdisciplinary evaluation. Liver transplantation should always be considered as long-term curative treatment option, especially in T2 patients. In palliative treatment, early response assessment is required to advance patients to the next treatment line before decompensation.
New Insights into Weather and Stroke: Influences of Specific Air Masses and Temperature Changes on Stroke Incidence
Authors: Ertl Michael , Beck Christoph , Kühlbach Benjamin , Hartmann Jasmin , Hammel Gertrud , Straub Annette , Giemsa Esther , Seubert Stefanie , Philipp Andreas , Traidl-Hoffmann Claudia , Soentgen Jens , Jacobeit Jucundus , Naumann Markus
Published: July 2019

Background/Objectives: Meteorological factors seem to influence stroke incidence, however, the complex association between weather and stroke remains unclear. Possible explanations from the literature do not categorize into subdivisions of ischemic strokes, only have small patient numbers, or refer to a selection of isolated weather elements without investigating weather changes and more. Method: In this exploratory trial, almost 18,000 stroke cases from a single stroke center in Southern Germany were analyzed from 2006 to 2015 and classified into the main subgroups of strokes and subdivisions of ischemic stroke etiologies applying the Trial of Org 10172 in Acute Stroke Treatment classification. For each stroke event, the air mass classification was determined from a subset of 7 air mass categories. Relative excess morbidities were derived for the 7 different air mass categories, taking into account the day of the event and up to 2 and 5 days preceding the stroke event. Results: Statistically significant findings (α ≤0.1) reveal that dry tropical air masses were associated with a lower/higher risk for hemorrhagic (HEM)/macroangiopathic strokes (MAS), respectively. Dry polar air masses were associated with a higher risk for intracerebral bleedings and lower risk for ischemic stroke subtypes. Moist air masses were associated with a reduced incidence of MAS. A strong temperature increase 5 days prior to the event was associated with a lower risk of HEM strokes. Temperature increases were associated with lower risks for MAS and cardio-embolic strokes. Significant temperature decreases were associated with a higher risk of MAS. Conclusions: Temperature effects were dependent on both air masses and temperature changes within 5 days prior to the event and were associated with statistically relevant changes in stroke incidence. Decisive factors such as etiology, age, sex, and risk factors were also taken into account.
Bilateral Ear Swelling and Erythema after Chemotherapy: A Case Report of Ara-C Ears
Authors: Jaruvijitrattana Pitchaya , Chanprapaph Kumutnart
Published: July 2019

Cytarabine is an antimetabolite commonly used to treat hematological malignancies, especially acute myeloid leukemia (AML), acute lymphoblastic leukemia, and non-Hodgkin’s lymphoma. Cytarabine-induced cutaneous adverse effects are common, usually manifesting as morbilliform eruptions predominantly on the acral site, intertriginous zone, and to a lesser extent on the elbows, knees, neck, and ears. The presentation on ears is usually called “Ara-C ears,” which is considered as a rare subtype of acral erythema. We report a 53-year-old Thai woman with AML who developed cytarabine-induced rashes. The lesions began on symmetrical bilateral ears, posterior auricular areas, and forehead followed by expansion to the trunk and extremities. The clinical presentations and histopathological findings were compatible with toxic erythema of chemotherapy. After giving cetirizine 10 mg orally twice daily and 0.1% triamcinolone acetonide cream twice daily, the lesions gradually improved over 10 days. Notably, two additional courses of high-dose cytarabine were administered without any recurrence.
Endoscopic Upper GI Screening
Authors: Ebigbo Alanna , Messmann Helmut , Römmele Christoph
Published: July 2019

The rationale behind endoscopic screening of the upper gastrointestinal tract (GIT) in the West is different from Asian countries with a high prevalence of gastric cancer. If epidemiological data on upper GIT cancer in the Western world is considered, then endoscopic screening of the upper GIT must target premalignant conditions as well and, furthermore, lay emphasis on the assessment of the entire upper GIT in high-risk individuals from the mouth till the duodenum. Although data on the incidence, prevalence, and further development of premalignant conditions in the upper GIT is lacking, a risk-based approach to endoscopic screening will be more cost-effective than a general screening approach. Finally, endoscopists need to be educated and trained in the assessment of the upper GIT during screening endoscopy.
Screening and Prevention of Barrett’s Esophagus
Authors: Pech Oliver
Published: July 2019

Barrett’s esophagus (BO) is a risk factor for esophageal adenocarcinoma. However, screening for BO is difficult since it is not yet clear who should be screened and which screening method is cost-effective. Screening methods could be upper endoscopy at the time of the first screening colonoscopy, transnasal endoscopy, esophageal capsule endoscopy, or cytosponge. In order to prevent the development of BO or its neoplastic progression, there are modifiable risk factors like obesity or smoking that can be influenced. In addition, several drugs like proton pump inhibitors, aspirin, nonsteroidal anti-inflammatory drugs and statins have shown promising effects in mostly observational studies. However, data from prospective randomized trials are scarce in order to draw final conclusions.