bluuebunny/crossref_metadata_2025 huggingface dataset:
A Coordinated Population Health Approach to Diabetes Education in Primary Care
Authors: Zupa Margaret F. , Arena Vincent C. , Johnson Patricia A. , Thearle Margaret B. , Siminerio Linda M.
Published: October 2019

Purpose

The purpose of this feasibility study was to determine the effectiveness of an insurer-based diabetes educator (DE)–driven intervention that relies on systematic restructuring of primary care (PC) linking DE services through population health, practice redesign, and coordinated care for patients with diabetes mellitus (DM) identified as high risk.

Methods

Two DEs were introduced as members of PC teams and worked with practice-based care managers (PBCMs) to identify and refer DM patients considered at high risk, A1C >9%, DM-related emergency room visit or hospitalization, or reported barriers to care. Elements shown to ensure quality, including population management, diabetes self-management education and support (DSMES), and coordinated patient-centered team-based PC, were central to intervention. A1C, low-density lipoprotein (LDL), and body mass index (BMI) were collected at baseline and outcomes were followed at 3, 6, 9, and 12 months after intervention.

Results

For patients who received intervention, A1C decreased on average 1.2% (95% confidence interval [CI], 0.8-1.5) from 9.6% (81 mmol/mol) to 8.4% (68 mmol/mol) over 6 months and by 1.1% (95% CI, 0.7-1.5) from 9.2% (77 mmol/mol) to 8.1% (65 mmol/mol) over 12 months, indicating durable improvement in glycemic control. There was no significant change in BMI, and LDL improvement observed at 9 months was lost by 12-month follow-up.

Conclusion

Findings support the feasibility of a DE-driven intervention for patients with DM at high risk through a coordinated PC approach that improves glycemic control. The feasibility and clinical outcome of this model warrant consideration of a fresh role for DEs in the complex environment of value-based care.
Parenting Changes of Mothers of a Child with Cancer
Authors: Kim Min Ah , Yi Jaehee , Wilford Aurene , Kim Soo Hyun
Published: October 2019

Having a child with cancer affects the dyadic relationship between caregivers and the child. This study focused on changes in parenting and discipline among mothers after their child was diagnosed with cancer. We used semistructured interviews to explore 20 mothers’ experiences of parenting a child who had been diagnosed with cancer during the prior 5 years and before the age of 19 years in South Korea. Thematic analysis yielded five themes related to parenting changes: parental overprotection, increased parental permissiveness, use of threats to ensure compliance, concern for the child’s stress levels, and mothers’ confusion about optimal parenting. All mothers reported uncertainty and concern regarding how best to parent their sick child to ensure optimal health outcomes. The findings inform best practices for integrating medical and mental health care to support optimal maternal parenting and encourage optimal health outcomes for children with cancer.
Impact Evaluation Using Analysis of Covariance With Error-Prone Covariates That Violate Surrogacy
Authors: Lockwood J. R. , McCaffrey Daniel F.
Published: October 2019

Background:

Analysis of covariance (ANCOVA) is commonly used to adjust for potential confounders in observational studies of intervention effects. Measurement error in the covariates used in ANCOVA models can lead to inconsistent estimators of intervention effects. While errors-in-variables (EIV) regression can restore consistency, it requires surrogacy assumptions for the error-prone covariates that may be violated in practical settings.

Objectives:

The objectives of this article are (1) to derive asymptotic results for ANCOVA using EIV regression when measurement errors may not satisfy the standard surrogacy assumptions and (2) to demonstrate how these results can be used to explore the potential bias from ANCOVA models that either ignore measurement error by using ordinary least squares (OLS) regression or use EIV regression when its required assumptions do not hold.

Results:

The article derives asymptotic results for ANCOVA with error-prone covariates that cover a variety of cases relevant to applications. It then uses the results in a case study of choosing among ANCOVA model specifications for estimating teacher effects using longitudinal data from a large urban school system. It finds evidence that estimates of teacher effects computed using EIV regression may have smaller bias than estimates computed using OLS regression when the data available for adjusting for students’ prior achievement are limited.
The mGluR2/3 agonist LY379268 reverses NMDA receptor antagonist effects on cortical gamma oscillations and phase coherence, but not working memory impairments, in mice
Authors: Sokolenko Elysia , Hudson Matthew R , Nithianantharajah Jess , Jones Nigel C
Published: October 2019

Background:

Abnormalities in neural oscillations that occur in the gamma frequency range (30–80 Hz) may underlie cognitive deficits in schizophrenia. Both cognitive impairments and gamma oscillatory disturbances can be induced in healthy people and rodents by administration of N-methyl-D-aspartate receptor (NMDAr) antagonists.

Aims:

We studied relationships between cognitive impairment and gamma abnormalities following NMDAr antagonism, and attempted to reverse deficits with the metabotropic glutamate receptor type 2/3 (mGluR2/3) agonist LY379268.

Methods:

C57/Bl6 mice were trained to perform the Trial-Unique Nonmatching to Location (TUNL) touchscreen test for working memory. They were then implanted with local field potential (LFP) recording electrodes in prefrontal cortex and dorsal hippocampus. Mice were administered either LY379268 (3 mg/kg) or vehicle followed by the NMDAr antagonist MK-801 (0.3 or 1 mg/kg) or vehicle prior to testing on the TUNL task, or recording LFPs during the presentation of an auditory stimulus.

Results:

MK-801 impaired working memory and increased perseveration, but these behaviours were not improved by LY379268 treatment. MK-81 increased the power of ongoing gamma and high gamma (130–180 Hz) oscillations in both brain regions and regional coherence between regions, and these signatures were augmented by LY379268. However, auditory-evoked gamma oscillation deficits caused by MK-801 were not affected by LY379268 pretreatment.

Conclusions:

NMDA receptor antagonism impairs working memory in mice, but this is not reversed by stimulation of mGluR2/3. Since elevations in ongoing gamma power and regional coherence caused by MK-801 were improved by LY379268, it appears unlikely that these specific oscillatory abnormalities underlie the working memory impairment caused by NMDAr antagonism.
Synbiotics for prevention of ventilator-associated pneumonia: a probiotics strain-specific network meta-analysis
Authors: Fan Qiong-Li , Yu Xiu-Mei , Liu Quan-Xing , Yang Wang , Chang Qin , Zhang Yu-Ping
Published: October 2019

Objective

Probiotics may be efficacious in preventing ventilator-associated pneumonia (VAP). The aim of this network meta-analysis (NMA) was to clarify the efficacy of different types of probiotics for preventing VAP.

Methods

This systematic review and NMA was conducted according to the updated preferred reporting items for systematic review and meta-analysis. A systematic literature search of public databases from inception to 17 June 2018 was performed.

Results

NMA showed that “ Bifidobacterium longum +  Lactobacillus bulgaricus +  Streptococcus thermophiles” was more efficacious than “ Ergyphilus” in preventing VAP (odds ratio: 0.15, 95% confidence interval: 0.03–0.94). According to pairwise meta-analysis, “ B. longum + L. bulgaricus +  S. thermophiles” and “ Lactobacillus rhamnosus” were superior to placebo in preventing VAP. Treatment rank based on surface under the cumulative ranking curves revealed that the most efficacious treatment for preventing VAP was “ B. longum +  L. bulgaricus +  S. thermophiles” (66%). In terms of reducing hospital mortality and ICU mortality, the most efficacious treatment was Synbiotic 2000FORTE (34% and 46%, respectively).

Conclusions

Based on efficacy ranking, “ B. longum +  L. bulgaricus +  S. thermophiles” should be the first choice for prevention of VAP, while Synbiotic 2000FORTE has the potential to reduce in-hospital mortality and ICU mortality.
A study of Holocene Asian summer and winter monsoon change by an analog of climate factors between millennial and modern interannual scales
Authors: Li Yu , Li Yichan , Ye Wangting , Peng Simin
Published: October 2019

The East Asian monsoon exerts a profound influence on environmental change in the East Asian region. Various factors have been hypothesized as the dominant Asian monsoon forcings, however, the forcings can change from interannual to millennial timescales. The linkages between monsoon forcings at different timescales remain unclear. To better understand the connection of the variabilities and mechanisms of the East Asian monsoon at various timescales, we present a modern analog. Various climatic data, monsoon indices, and circulation factor calculations were used to identify the variabilities and controlling factors of the modern East Asian summer and winter monsoons. Paleo-climatic proxies from a region sensitive to both summer and winter monsoons were used in concert with monsoon simulation data to reconstruct and analyze paleo-monsoon variations and mechanisms. Results showed that the weakening of the Holocene Asian summer and winter monsoons is closely linked to low-latitude summer insolation and mid-latitude winter insolation, while modern summer and winter monsoons are related to global circulation, sea surface temperature, and sea ice change. We confirm that the driving mechanism of the monsoon was dependent on timescale.
The impact of partisanship in the era of retrenchment: Insights from quantitative welfare state research
Authors: Bandau Frank , Ahrens Leo
Published: October 2019

Does government partisanship still matter in the era of welfare retrenchment? The comprehensive quantitative research on this question offers contradicting answers. Our meta-analysis demonstrates that the results of published empirical studies depend on a number of the studies’ characteristics. Focusing on studies on retrenchment-prone ‘old social policies’, we show that the single most important factor affecting the results on partisanship is the choice of the dependent variable. In general, studies using entitlements are four times more likely to find partisan effects than studies based on social spending. Furthermore, partisan effects are more pronounced in class-related programmes like unemployment benefits and sick pay than in lifecourse-related welfare programmes such as pensions. Finally, we show a clear decline of partisanship over time. Some recent studies, however, indicate that innovations in terms of operationalisation and measurement of the independent variable may bring new life to the debate on the persistence of partisanship.
Clinical characteristics of exposures to liquid laundry detergent packets
Authors: Banner W , Yin S , Burns MM , Lucas R , Reynolds KM , Green JL
Published: October 2019

Introduction:

Our objective was to describe the characteristics of liquid laundry detergent packet (LDP) exposures and to develop referral and treatment recommendations.

Methods:

This retrospective cohort study investigated LDP exposures reported to the National Poison Data System from January 1, 2013 through June 30, 2014. Three medical toxicologists reviewed the most significant exposures ( n = 450).

Results:

Of 17,857 reported LDP exposures, 13,307 involved only an LDP (no other substance) and were followed to a known medical outcome. The median age was 2 years (range 12 days to 100 years). Approximately 10% of exposures reported a major or moderate effect. The most common symptom was vomiting (51.7%; n = 6875), but stridor or aspiration pneumonia and respiratory depression secondary to central nervous system effects also occurred. Two pediatric and two adult deaths occurred, but no causal mechanism leading to death could be identified in any of the deaths.

Conclusions:

LDPs occasionally produce a toxidrome of vomiting, stridor, hypoxia, and sedation with metabolic acidosis and respiratory failure. These symptoms and the availability of LDPs highlight the need for referral and treatment recommendations and efforts to minimize unintentional exposures. Review of data from US poison centers may provide referral and treatment recommendations that improve patient outcomes.
Individual Differences in Learning Efficiency
Authors: McDermott Kathleen B. , Zerr Christopher L.
Published: October 2019

Most research on long-term memory uses an experimental approach whereby participants are assigned to different conditions, and condition means are the measures of interest. This approach has demonstrated repeatedly that conditions that slow the rate of learning tend to improve later retention. A neglected question is whether aggregate findings at the level of the group (i.e., slower learning tends to improve retention) translate to the level of individual people. We identify a discrepancy whereby—across people—slower learning tends to coincide with poorer memory. The positive relation between learning rate (speed of learning) and retention (amount remembered after a delay) across people is referred to as learning efficiency. A more efficient learner can acquire information faster and remember more of it over time. We discuss potential characteristics of efficient learners and consider future directions for research.
Making the World of Difference: a service user-led education programme reshaping the learning environment in psychiatry
Authors: Newton-Howes Giles , Gordon Sarah , Fedchuk Dasha
Published: October 2019

Objective:

To describe the implementation of a service user-led learning programme implemented within the education of undergraduate medical students and psychiatric registrars.

Conclusion:

This programme has the potential to impact on the learning of those early in their medical career and future consultant psychiatrists. Ongoing research will help to explain the reach and depth of the programme and the elements of greatest benefit.
Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria
Authors: Degge Hannah M. , Laurenson Mary , Dumbili Emeka W. , Hayter Mark
Published: October 2019

Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the “leaking” identity, “masu yoyon fitsari” (leakers of urine) identity, and the “spoiled” identity, causing stigmatization and psychological trauma. The “masu yoyon fitsari” identity, however, built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon, and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women’s identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women’s role.
Stories of Change: Comparative Time-Framed Experience Telling in Health Promotion Group Discussions
Authors: Logren Aija , Ruusuvuori Johanna , Laitinen Jaana
Published: October 2019

In this article, we examine comparative time-framed experience telling: episodes of interaction in health promotion group discussions in which one of the participants tells their experience and, in response, another participant tells their own experiences from separate moments or periods of their life and compares them. In so doing, group members reinforce and encourage the previous speaker’s positive stance or challenge the negative stance toward contextually relevant objects: behavior change and suggested solutions. This practice allows group members to demonstrate their independent access to experiences that are similar to those of the other, present evidence of similarities and differences between the experiences, and show their epistemic independence regarding their claims. By recontextualizing the experience of the other in this way, it becomes possible for the group members to interpret and even oppose it while maintaining a level of understanding of the differences between the experiences in question and respecting them.
The Experience of Pediatric Palliative Caregiving: A Qualitative Analysis From the Photographs of Meaning Program
Authors: Levy Kathryn , Grant Pei C. , Tenzek Kelly E. , Depner Rachel M. , Pailler Megan E. , Beaupin Lynda K.
Published: October 2019

The Photographs of Meaning Program for pediatric palliative caregivers (POM-PPCG) is an innovative, meaning-based intervention utilizing photovoice and social media components. In 2017, 9 pediatric palliative caregivers participated in this intervention. During the social media portion of the POM-PPCG, participants were presented with weekly themes based on a meaning-making curriculum. In response, they took photographs, applied either audio or typed narratives, and shared them via social media. Ninety-five photographs with narratives were produced during the intervention. Through thematic qualitative analysis with consensual qualitative research components, 5 themes were identified: Love, Challenges, Loss, Coping, and The New Normal. This study adds to existing literature by shedding light on the experiences of caregivers of children with palliative care needs. Findings from this research contribute not only to the innovative use of qualitative methods but also to the clinical knowledge and practice regarding the pediatric palliative caregiver experience.
Outcomes Associated With Standardized Ideal Body Weight Dosing of Intravenous Immune Globulin in Hospitalized Patients: A Multicenter Study
Authors: Grindeland Jeremy W. , Grindeland Carlina J. , Moen Cassandra , Leedahl Nathan D. , Leedahl David D.
Published: October 2019

Background: There are limited outcomes data for ideal body weight (IBW)-based dosing of intravenous immune globulin (human, IVIG) in hospitalized patients. Objective: To investigate clinical outcomes associated with a standardized change from total body weight to IBW-based dosing of IVIG. Methods: This was a retrospective, multicenter, pre-post sequential period analysis. Data from pre-implementation and post-implementation of an IBW-based dosing strategy for IVIG were collected in 2-year periods (October 1, 2012, to August 31, 2014, and October 2, 2014, to October 1, 2016, respectively). The primary outcome was incidence of 30-day hospital readmission. Length of stay (LOS) was analyzed as a secondary outcome. Results: For the 2 study periods, 297 patients were included for analysis. Both groups had similar demographics, IVIG indications, and body weight measurements, but the post-implementation period had a lower median grams per dose as compared with the pre-implementation period (40 vs 30 g, P ≤ 0.01). 30-Day hospital readmission rates were not significantly different (4% vs 9%, P = 0.07). In-hospital all-cause mortality was also not statistically significant (7.7% vs 3.4%, P = 0.11). The 2 study groups had a similar median hospital LOS (8 vs 7.6 days, P = 0.27). Conclusion and Relevance: The implementation of a standardized IBW IVIG dosing strategy was not associated with a statistically significant increase in 30-day hospital readmission or LOS but was associated with significantly fewer grams per dose given. Application of these data may aid in decreasing institutional drug spend without affecting patient outcomes. However, the study was underpowered, and further investigation is necessary to validate these findings.
The Fall Risk with Alpha blockers Given InitiaL dose or Elderly status (FRAGILE) Study
Authors: McDonnell Chelsea C. , Rogers Kelly C. , Regen Sloan M. , Finks Shannon W.
Published: October 2019

Background: α-1 adrenergic antagonists are commonly prescribed, but there is question regarding their safety in patients at increased fall risk. Objective: The purpose of the FRAGILE study was to determine the risk for developing adverse drug events (ADEs) in veterans prescribed α-1 blockers. Methods: A single-center, retrospective, observational cohort analysis was conducted of veterans newly initiated on α-1 antagonists. Veterans were categorized into at-risk (patients who met at least 1 of 2 criteria: age 65 or older or high initial dose of α blockade) or control (veterans without either risk factor) groups. The primary outcome was the composite all-cause ADEs, including hospitalizations or emergency department (ED) visits. Secondary outcomes included number of fall-related ADEs and medication discontinuation rates with follow-up for 12 months. Results: A total of 300 veterans were evaluated. There was no significant difference in the composite outcome of all-cause ED visits between at-risk (n = 169) versus control (n = 131) groups (0.81 vs 1.17, P = 0.09) or all-cause hospitalizations (0.28 vs 0.39, P = 0.25). Seventy-three veterans in the at-risk group experienced an all-cause ADE versus 64 in the control group ( P = 0.36). No significant differences in secondary outcomes were found. Fall-related side effects occurred in 8% of the total cohort. Conclusion and Relevance: Rates of all-cause or fall-related ADEs were not significantly different. An 8% discontinuation rate resulting from fall-related ADEs and high rates of coadministered medications that could increase fall risk. Pharmacists can play a key role in optimizing α-1 blocker administration.
Cancer Screening in Behavioral Health Care Programs
Authors: Rockson Lois , Swarbrick Margaret , Pratt Carlos
Published: October 2019

OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.
Ocular complications of Garcinia cambogia extract diet pills: Case report
Authors: Cho Hyun-kyung , Han Yong Seop , Park Jong Moon
Published: October 2019

Background:

Garcinia cambogia contains hydroxycitric acid. Hydroxycitric acid is a potent competitive inhibitor of adenosine triphosphate citrate lyase which is a key enzyme in the synthesis of fatty acids. Hydroxycitric acid also regulates the level of serotonin. In these regards, hydroxycitric acid has been reported to exhibit weight loss activity. Adverse reactions of G. cambogia from numerous clinical studies demonstrated relatively mild reactions. However, there are some complications of G. cambogia reported in the past: acute liver injury, acute hepatitis, and hepatic failure. However, ocular complications of G. cambogia have not been reported yet.

Case presentation:

A 35-year-old female visited our clinic with decreased vision in the left eye and ocular pain in both eyes for the last 6 days. She also complained of headache, dizziness, and nausea. She had taken G. cambogia extract more than the recommended dose. There was myopic shift with anterior chamber shallowing in both eyes, especially in the left eye. Moreover, swelling and retinal folds of peripapillary retinal nerve fiber layer and macula were observed in both eyes. These ocular complications of G. cambogia extract resolved after discontinuation of the extract and topical and oral steroid treatment. Herein, we report the first case of ocular complications of G. cambogia extract diet pill assessed with optical coherence tomography of optic disk and macula along with dual Scheimpflug analyzer.

Conclusion:

It is necessary that physicians dealing with obesity advice patients about possible visual disturbance of this extract when taken in overdose so that they can see an ophthalmologist immediately.
Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility
Authors: Mallick Arijit , Jehan Shah , Omonbude Daniel
Published: October 2019

Background:

Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously.

Methods:

We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality.

Results:

Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively.

Conclusion:

Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.
A comparative study of the impact of focused vs. comprehensive corrective feedback and revision on ESL learners’ writing accuracy and quality
Authors: Rahimi Mohammad
Published: October 2019

The impetus for the present study came from Ferris’ (2010) article discussing the gap between theory, research, and practice in written corrective feedback (WCF). To address this gap, the present study aimed at comparing the impact of focused vs. comprehensive WCF and revision on the improvement of written accuracy of learners of English as a second language (ESL), with a focus on their global linguistic errors (sentence and word); the study also examined how this improvement contributed to the students’ writing quality, defined in terms of clarity of expression and text comprehensibility. Data was collected from 78 intermediate French ESL learners randomly assigned to four different treatment groups: two groups received focused WCF and two groups comprehensive WCF; one of the focused and one of the comprehensive groups were required to revise their writing and the other two groups did no revision after WCF. A comparison was made between the error means of the four groups on three out of seven essays they wrote during a 15-week writing course: week one (T1), week eight (T2) and week 14 (T3). The results revealed that the focused groups were more successful than the comprehensive ones in reducing their words errors at T2; no significant effect was observed for revision. Also, the focused-revision group outperformed the other groups at both T2 and T3 in reducing their sentence errors. The comprehensive-revision, however, group was more successful than the other groups in improving their overall written accuracy. The results also showed that the focused-revision group made more improvement than the other three groups in their writing quality at T3.
Narratives of rebellion
Authors: Joosse Paul
Published: October 2019

Working from a narrative criminological framework, this article distinguishes and describes the ‘narrative of rebellion’ as a generic form that can be encountered widely in situations of asymmetrical struggle. Because narratives of rebellion furnish their tellers with agentic potential across various stages of the ‘rebellious career’ (from contemplation, to participation, to capture, and ultimately to peril), they are desirable cultural accoutrements for bringing into seditious struggle. Rebellion stories typically (a) subsume individuals within collective avatars that are represented as existing somehow ‘outside of life’ – often through legendary martyrdom, (b) advance plots that draw causal connections between failure/death and regenerative proliferation ‘from below,’ and (c) promulgate of a sense of solidarity with many as-yet unseen fellow travelers. These features offer protective resources for rebels engaging in criminal resistance, while also providing a framework for sense-making that, rather than obfuscating danger (a prominent feature of existing theories of rebellious participation), offers interpretive resources for contending with the likelihood of a perilous fate.
Social inclusion of refugees into higher education in Norway: A critical analysis of Norwegian higher education and integration policies
Authors: Abamosa Juhar Yasin , Hilt Line Torbjørnsen , Westrheim Kariane
Published: October 2019

In numerous countries, the widening participation of underrepresented groups in higher education has become an official part of education policies. However, inequalities continue in some areas, including refugees’ participation. Norway hosts many refugees, but little is known about the social inclusion of refugees into higher education in the country. In this paper, three documents representing Norwegian higher education and integration policies are analysed using an integrated analytical framework constructed from social inclusion and its three main dimensions (access, participation and empowerment) and from a critical discourse analysis. The analysis is conducted to address how social inclusion into higher education is conceptualized, which major discourses underpin the conceptualization and what implications these have for the social inclusion of refugees into higher education in Norway. The article argues that social inclusion is conceptualized from an access dimension signifying the dominance of neoliberal principles in the policy documents. On the contrary, social justice discourses are marginalized and human potential principles are absent from the documents signalling the disempowerment of refugees in relation to higher education. Future policies should incorporate conscious and clear strategies informed by social justice and empowerment principles to ensure the social inclusion of refugees into higher education.
The Silencing of SFRP2 Expression in ESCC Is Due to Methylation of the Gene Promoter
Authors: Liu Qian , Zhou Ya-Xing , Hui-Wang  , Li Qiao-Xin , Wu Miao , Ma Yu-Qing
Published: October 2019

Objective:

Our aim of the study was to investigate the expression level and methylation status of the secreted frizzled-related protein 2 in esophageal squamous cell carcinoma and to evaluate the clinical utility of the marker.

Material and Methods:

We first used Immunohistochemistry (ICH) to explore the expression level of secreted frizzled-related protein 2 protein in esophageal squamous cell carcinoma tissues and adjacent normal tissues and then used methylation-specific polymerase chain reaction and bisulfite sequencing polymerase chain reaction to detect methylation status of secreted frizzled-related protein 2.

Results:

Secreted frizzled-related protein 2 expression was notably reduced in patients with esophageal squamous cell carcinoma, whereas methylation of secreted frizzled-related protein 2 was increased in the majority of esophageal squamous cell carcinoma specimens.

Conclusion:

Sum up, we have demonstrated the abnormal DNA hypermethylation, causing reduced or absent gene expression. Methylation testing of secreted frizzled-related protein 2 using epigenetic marker may be a significative screening method for patients with esophageal squamous cell carcinoma.
Guilty by Association: KCTD16 and GABABR Antibodies in Paraneoplastic Limbic Encephalitis
Authors: Gaspard Nicolas
Published: October 2019

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On biodiplomacy: Negotiating life and plural modes of existence
Authors: Constantinou Costas M , Opondo Sam Okoth
Published: October 2019

This article examines the intersection of biopolitics with diplomacy and engages its dynamic re-envisioning as biodiplomacy. It revisits Michel Foucault’s peripheral attention to diplomacy and his framing of the concept in his writings on raison d’état and the government of the living. The article suggests that biodiplomacy can help us understand better the complexity of global biopolitical projects, moving us beyond governmentality and sensitizing us about the continuous negotiation of the meaning and materiality of particular ways of living vis-à-vis other ways of being. Specifically, the article addresses modes of existence peculiar to the postcolony or encompassing antithetical value systems and argues that biodiplomacy opens up a wider field of ethical and cosmopolitical possibilities by making visible the interconnected plurality of human and non-human forces.
Intravesical Lactobacillus rhamnosus GG is safe and well tolerated in adults and children with neurogenic lower urinary tract dysfunction: first-in-human trial
Authors: Groah Suzanne L. , Rounds Amanda K. , Ljungberg Inger H. , Sprague Bruce M. , Frost Jamie K. , Tractenberg Rochelle E.
Published: October 2019

Background:

Urinary symptoms are common for people with neurogenic lower urinary tract dysfunction (NLUTD). No nonprescription approach has been proven safe and effective for self-management of urinary symptoms. Our objective was to describe the safety and tolerability of Lactobacillus rhamnosus GG ( LGG®) instilled intravesically for self-management of inflammatory urinary symptoms in adults and children with NLUTD due to spinal cord injury or disease (SCI/D) and who use intermittent catheterization (IC).

Methods:

A total of 103 individuals with SCI/D enrolled in an 18-month study consisting of three 6-month stages: baseline (weekly observation of urinary symptoms); intervention (self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine); and washout (weekly observation of urinary symptoms). Urinary symptoms were assessed using the Urinary Symptom Questionnaire for people with neurogenic bladder using intermittent catheters (USQNB-IC). Safety was based on serious adverse events and adverse events (S/AEs) and trends in symptoms. Tolerability was defined as the independence of AE experience and willingness to use/pay for this intervention.

Results:

A total of 74 (77%) adults and 6 (86%) of children completed the study, of whom 64 instilled LGG® for a total of 357 instillations (range 1–41 per person). There were 59 S/AEs, 44% (26/59) of which were categorized as infectious genitourinary. There was no statistical relationship between S/AEs and use or dose of the intervention.

Conclusions:

One or two doses of self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine was safe and well tolerated among this sample of adults and children with SCI/D who have NLUTD and use IC.
Accurate position control of a flapping-wing robot enabling free-flight flow visualisation in a wind tunnel
Authors: Karásek Matěj , Percin Mustafa , Cunis Torbjørn , van Oudheusden Bas W , De Wagter Christophe , Remes Bart DW , de Croon Guido CHE
Published: October 2019

Flow visualisations are essential to better understand the unsteady aerodynamics of flapping wing flight. The issues inherent to animal experiments, such as poor controllability and unnatural flapping when tethered, can be avoided by using robotic flyers that promise for a more systematic and repeatable methodology. Here, we present a new flapping-wing micro air vehicle (FWMAV)-specific control approach that, by employing an external motion tracking system, achieved autonomous wind tunnel flight with a maximum root-mean-square position error of 28 mm at low speeds (0.8–1.2 m/s) and 75 mm at high speeds (2–2.4 m/s). This allowed the first free-flight flow visualisation experiments to be conducted with an FWMAV. Time-resolved stereoscopic particle image velocimetry was used to reconstruct the three-dimensional flow patterns of the FWMAV wake. A good qualitative match was found in comparison to a tethered configuration at similar conditions, suggesting that the obtained free-flight measurements are reliable and meaningful.
Assessing equity in the distribution of hospital beds: evidence from northern Iran
Authors: Ebrahimzadeh Javad , Merati Zahra , Hedayati Zafarghandi Mahsa , Rajabi Ghasem , Ezati Asar Mohamad , Sahranavard Veshareh Zahra , Sotodeh Manesh Sam , Delpasand Mansoor
Published: October 2019

Objective:

To assess equity in the distribution of hospital beds in northern Iran.

Methods:

In this cross-sectional study, we investigated the degree of equity by using 2016 census data from 16 cities in Guilan province. The hospital beds include burns, intensive care unit, coronary care unit and neonatal intensive care unit beds. We analysed the general status and explored its distribution equity by using the Theil index.

Findings:

We found that Rezvanshahr and Masal had no hospital beds. The utilisation gap was positive only in Rasht, as capital of the province. Neonatal intensive care unit beds were only found in Rasht and Lahijan. Rasht was shown to have a positive gap in using burns, intensive care unit and coronary care unit beds, with a negative gap of 14.68 in coronary care unit beds. The other 15 cities did not have such hospital beds. For intensive care unit, coronary care unit and neonatal intensive care unit beds, nearly 8%, 2% and 14% of cities were deprived of being equipped with these hospital beds, respectively. The highest positive gap and the lowest negative gap were attributed to coronary care unit beds. In the province, there were 0.057 burns beds, 0.137 intensive care unit beds, 0.381 coronary care unit beds and 0.72 neonatal intensive care unit beds per 10,000 population (neonatal intensive care unit beds, per 1000 neonates). In 11 out of 16 cities, the number of coronary care unit beds per 10,000 population was higher than the provincial average. The highest inequality in distribution was shown to be for burns beds (0.8), neonatal intensive care unit beds (0.75), intensive care unit beds (0.55) and coronary care unit beds (0.21), respectively.

Conclusion:

This study revealed high inequalities in the distribution of hospital beds in northern Iran. The local and national policy-makers should design and implement a comprehensive monitoring and evaluation system for tracking and allocating healthcare resources, both qualitatively and quantitatively, which appears to be very necessary to increase the equity in access to healthcare services.
Safety evaluation of intravenous immunoglobulin in pediatric patients: a retrospective, 1-year observational study
Authors: Elajez Reem , Ezzeldin Asmaa , Gaber Hossamaldein
Published: October 2019

Background:

Intravenous immunoglobulin (IVIG) is a pooled human plasma protein that has shown efficacy in treating a variety of disorders. IVIG is generally well tolerated and has a good safety profile. There are various IVIG products available on the market, which results in differences in efficacy and safety profile. The aim of this study was to assess the safety profile of IVIG use in pediatric patients and its association with other predicted factors.

Methods:

Retrospective chart review study of all pediatric patients who received IVIG as an inpatient at Hamad General Hospital in Qatar during 2014. The occurrence of adverse drug reactions (ADR) was tested for any association with other predicted factors, such as patient age, IVIG dose, brand, and adherence to infusion protocol.

Results:

A total of 345 IVIG prescriptions were received by pediatric patients during the study period. Most common documented side effects were: fever (5.8%), chills (2.6%), and headache (2%). Renal insufficiency was observed only in six cases, with five of those in ‘Risk’ category according to RIFLE criteria. A hypersensitivity reaction was documented in seven patients, despite being premedicated with paracetamol and/or diphenhydramine and following the infusion protocol. None of the predicted factors were found to be significantly associated with ADR incidence except IVIG brand.

Conclusions:

IVIG generally has a good safety profile in pediatric patients, with low risk of severe ADR. More studies are needed to evaluate the correlation between ADR and IVIG formulation, taking into account other factors that may affect results.
DNA methylation identifies genetically and prognostically distinct subtypes of myelodysplastic syndromes
Authors: Reilly Brian , Tanaka Tiffany N. , Diep Dinh , Yeerna Huwate , Tamayo Pablo , Zhang Kun , Bejar Rafael
Published: October 2019

Key Points

Targeted DNAm profiling of MDS patient bone marrow mononuclear cells identifies several distinct DNAm clusters. Clusters enrich for specific genetic lesions and show differences in survival independent of clinical prognostic scoring systems..
Myeloablative vs reduced intensity T-cell–replete haploidentical transplantation for hematologic malignancy
Authors: Solomon Scott R. , St. Martin Andrew , Shah Nirav N. , Fatobene Giancarlo , Al Malki Monzr M. , Ballen Karen K. , Bashey Asad , Bejanyan Nelli , Bolaños Meade Javier , Brunstein Claudio G. , DeFilipp Zachariah , Champlin Richard E. , Fuchs Ephraim J. , Hamadani Mehdi , Hematti Peiman , Kanakry Christopher G. , McGuirk Joseph P. , McNiece Ian K. , Ciurea Stefan O. , Pasquini Marcelo C. , Rocha Vanderson , Romee Rizwan , Patel Sagar S. , Vasu Sumithira , Waller Edmund K. , Wingard John R. , Zhang Mei-Jie , Eapen Mary
Published: October 2019

Key Points

Disease-free survival is higher with myeloablative regimens for patients in their third to fifth decade. Beyond the fifth decade, low-dose total body irradiation regimens offset mortality associated with transplant procedure.
A simple, step-by-step guide to interpreting decision curve analysis
Authors: Vickers Andrew J. , van Calster Ben , Steyerberg Ewout W.
Published: October 2019

Background

Decision curve analysis is a method to evaluate prediction models and diagnostic tests that was introduced in a 2006 publication. Decision curves are now commonly reported in the literature, but there remains widespread misunderstanding of and confusion about what they mean.

Summary of commentary

In this paper, we present a didactic, step-by-step introduction to interpreting a decision curve analysis and answer some common questions about the method. We argue that many of the difficulties with interpreting decision curves can be solved by relabeling the y-axis as “benefit” and the x-axis as “preference.” A model or test can be recommended for clinical use if it has the highest level of benefit across a range of clinically reasonable preferences.

Conclusion

Decision curves are readily interpretable if readers and authors follow a few simple guidelines.
The demographic data and the high frequency of chromosome/chromatid breaks as biomarkers for genome integrity have a role in predicting the susceptibility to have Down syndrome in a cohort of Egyptian young-aged mothers
Authors: El-Attar Lama M. , Issa Noha M. , Mahrous Hanan Salah Eldin
Published: October 2019

Background

Down syndrome (DS) is a common numerical chromosome disorder that has its burden on both family and community. The well-known risk factor for chromosome 21 nondisjunction is advanced maternal age which failed to explain the occurrence of Down syndrome born to mothers less than 35 years. This study aimed to assess the effect of demographic data (consanguinity, residency area, and socioeconomic state) and chromosome/chromatid breaks as biomarkers for genome integrity on the susceptibility of young mothers to have a child with Down syndrome.

Results

Fifty mothers with a history of at least one DS pregnancy before the age of 35 were compared to 50 control mothers. There was a significant increase in DS births in consanguineous parents (46%) compared to 20% in non-consanguineous ones (OR = 3.40; 95% CI = 1.4–8.20, P = 0.006). Young mothers with DS children were more likely to be from rural areas (60%) than urban areas (40%) (OR = 2.66; 95%, CI = 1.18–5.98, P = 0.017) and of a low socioeconomic status (62%) rather than a high socioeconomic status (38%) (OR = 3.80; 95%, CI = 1.65–8.74, P = 0.001).

Chromosome/chromatid breaks were detected in 76% of DS young mothers and 32% of control mothers (P < 0.001). There was an odds ratio of chromatid breaks of 8.50 (3.411–21.17) and chromosome breaks of 3.93 (1.40–11.05) with significant difference between the studied groups (P < 0.001 and P = 0.009 respectively).

Conclusion

In addition to advanced maternal age, consanguinity, residency in rural areas, and low socioeconomic status could be considered as possible risk factors for Down syndrome. The high frequency of chromosome/chromatid breaks in young mothers with a previous history of DS children highlights the impact of genome integrity on the tendency to chromosome 21 nondisjunction. These findings are valuable in predicting having a Down syndrome baby and providing proper genetic counseling for high-risk families.