bluuebunny/crossref_metadata_2025 huggingface dataset:
Keeping profits at home: A study of firm ownership and the geographical concentration of capital gains in the United States
Authors: Mygrant Mark S
Published: June 2020

Approximately 39% of American wealth exists in the form of private ownership in firms. Surprisingly, the existing economic geography literature offers us little insight into where the owners of this vast wealth reside relative to the firms they own, nor of the potentially important economic implications of this unknown geographical proximity. This comparative case study utilizes a unique dataset to examine three mid-size American manufacturing firms with varied ownership structures. It finds that the employee-owned firm and family-owned firm concentrate firm-created wealth in local communities to a greater degree than the publicly traded firm. Building on this empirical evidence, the paper then uses both Endogenous and Keynesian growth theory to argue that this concentration can feasibly lead to local economic growth through subsequent local reinvestment of that wealth. This theoretical insight is important because it offers a new perspective on the multifaceted debate concerning which firms should receive incentives from local policymakers. Results imply that public policy requiring local ownership as a condition of incentives is in the long-term economic interest of local residents. This pilot work contributes to the existing academic literature by justifying subsequent studies on the economic geography of firm ownership and by establishing methodological precedent on the subject.
Can inspiratory muscle training benefit patients after stroke? A systematic review and meta-analysis of randomized controlled trials
Authors: Zhang Xintong , Zheng Yu , Dang Yini , Wang Lu , Cheng Yihui , Zhang Xiu , Mao Mao , Lu Xiao
Published: June 2020

Objectives:

The aim of this study was to investigate the effects of inspiratory muscle training in post-stroke patients and to explore the effective training protocol.

Data sources:

PubMed/Medline, Web of Science, Scopus, Embase, Cochrane database, China National Knowledge Infrastructure, and China Science Periodical Database were searched through April 2020.

Review methods:

Trials examining effects of inspiratory muscle training on pulmonary function, cardiopulmonary endurance, pulmonary infection incidence, and quality of life in post-stroke patients were included. Subgroup analysis was performed to compare different training programs. Mean differences and risk ratios with 95% confidence intervals were presented. Risk of bias was assessed with the Cochrane tool.

Results:

Thirteen randomized controlled trials involving a total of 373 participants were identified. Meta-analysis conducted in 8 out of 13 trials revealed evidence for beneficial effects of inspiratory muscle training on forced vital capacity (MD: 0.47, 95% CI: 0.28–0.66), forced expired volume in 1 second (MD: 0.26, 95% CI: 0.18–0.35), 6-minute walk test (MD: 52.61, 95% CI: 25.22–80.01), maximum inspiratory pressure (MD: 18.18, 95% CI: 5.58–30.78), inspiratory muscle endurance (MD: 19.99, 95% CI: 13.58–26.40), and pulmonary infection incidence (RR: 0.11, 95% CI: 0.03–0.40). Omitting individual trials from the meta-analysis did not significantly change the results. The effective inspiratory muscle training protocol was suggested by subgroup analysis with three repetitions per week and more than 20 minutes per day for three weeks.

Conclusion:

Inspiratory muscle training can be considered as an effective intervention for improving pulmonary function and cardiopulmonary endurance, and reducing pulmonary infection incidence in patients after stroke.
Periportal fields cause stronger cooling effects than veins in hepatic microwave ablation: an in vivo porcine study
Authors: Poch Franz GM , Geyer Beatrice , Neizert Christina A , Gemeinhardt Ole , Niehues Stefan M , Vahldiek Janis L , Frericks Bernd , Lehmann Kai S
Published: June 2020

Background

Vascular cooling effects are a well-known source for tumor recurrence in thermal in situ ablation techniques for hepatic malignancies. Microwave ablation (MWA) is an ablation technique to be considered in the treatment of malignant liver tumors. The impact of vascular cooling in MWA is still controversial.

Purpose

To evaluate the influence of different intrahepatic vessel types, vessel sizes, and vessel-to-antenna-distances on MWA geometry in vivo.

Material and Methods

Five MWAs (902–928 MHz) were performed with an energy input of 24.0 kJ in three porcine livers in vivo. MWA lesions were cut into 2-mm slices. The minimum and maximum radius of the ablation area was measured for each slice. Distances were measured from ablation center toward all adjacent hepatic vessels with a diameter of ≥1 mm and within a perimeter of 20 mm around the antenna. The respective vascular cooling effect relative to the maximum ablation radius was calculated.

Results

In total, 707 vessels (489 veins, 218 portal fields) were detected; 370 (76%) hepatic veins and 185 (85%) portal fields caused a cooling effect. Portal fields resulted in higher cooling effects (37%) than hepatic veins (26%, P < 0.01). No cooling effect could be observed in close proximity of vessels within the central ablation zone.

Conclusion

Hepatic vessels influenced MWA zones and caused a distinct cooling effect. Portal fields resulted in more pronounced cooling effect than hepatic veins. No cooling effect was observed around vessels situated within the central white zone.
A case of unplanned pregnancy at 2 months after uterine curettage in a patient with a hydatidiform mole
Authors: Cao Jie-Qiong , Zhao Ye , Ma Ying , Wang Qiu-Man , Niu Li-Na , Qiao Si
Published: June 2020

Whether an unplanned pregnancy should be terminated during follow-up of a hydatidiform mole is controversial. We report a patient who had an unplanned pregnancy with a hydatidiform mole at 2 months after uterine curettage when the human chorionic gonadotropin level had decreased to a negative value. Hydatidiform mole was confirmed by histopathology. Uterine curettage was performed twice and regular follow-ups were performed after surgery. The patient achieved a full-term pregnancy. The Apgar score of the newborn was 10 at 1, 5, and 10 minutes, and the newborn had no malformations. We conclude that the pregnancy outcome might be good in an unplanned pregnancy when the human chorionic gonadotropin level is negative.
Multiple-dose versus single-dose gonadotropin-releasing hormone agonist after first in vitro fertilization failure associated with luteal phase deficiency: A randomized controlled trial
Authors: Qu Danni , Li Yuan
Published: June 2020

Objective

To evaluate the efficacy and safety of multiple- versus single-dose gonadotropin-releasing hormone agonist (GnRH-a) addition to luteal phase support (LPS), in patients with a first in vitro fertilization (IVF) failure associated with luteal phase deficiency (LPD).

Methods

Eighty patients with a first IVF failure associated with LPD were randomly assigned into single-dose and multiple-dose GnRH-a groups. In the second IVF attempt, patients in the single-dose group were given standard LPS plus a single dose of GnRH-a 6 days after oocyte retrieval. Patients in the multiple-dose group received standard LPS plus 14 daily injections of GnRH-a. Children conceived were followed up for 2 years.

Results

Pregnancy (67.5% vs. 42.5%), clinical pregnancy (50.0% vs. 22.5%), and live birth rates (42.5% vs. 20.0%) were significantly higher in the multiple-dose versus single-dose GnRH-a group. Patients in the multiple-dose GnRH-a group had significantly higher progesterone levels 14 days after oocyte recovery (35.9 vs. 21.4 ng/mL). No significant difference existed in the status at birth or developmental and behavior assessments of 2-year-old children conceived in both groups.

Conclusions

Daily addition of GnRH-a to standard LPS can achieve better pregnancy outcomes with a sustained safety profile in patients with a first IVF failure associated with LPD.
Three-dimensional finite element modeling for evaluation of laryngomalacia severity in infants and children
Authors: Xu Hongming , Chen Jiali , Pu Shilei , Li Xiaoyan
Published: June 2020

This study was performed to investigate the feasibility of using a three-dimensional (3D) finite element model for laryngomalacia severity assessment. We analyzed laryngeal computed tomography images of seven children with laryngomalacia using Mimics software. The gray threshold of different tissues was distinguishable, and a 3D visualization model and finite element model were constructed. The laryngeal structure parameters were defined. The peak von Mises stress (PVMS) value was obtained through laryngeal mechanical analysis. The PVMS values of the laryngeal soft tissue and cartilage scaffolds were independently correlated with disease severity. After stress loading the model, the relationship between laryngomalacia severity and the PVMS value was apparent. However, the PVMS value of laryngeal soft tissue was not correlated with laryngomalacia severity. This study established the efficacy of a finite element model to illustrate the morphological features of the laryngeal cavity in infants with laryngomalacia. However, further study is required before widespread application of 3D finite element modeling of laryngomalacia. PVMS values of the laryngeal cartilage scaffold might be useful for assessment of laryngomalacia severity. These findings support the notion that structural abnormalities of the laryngeal cartilage may manifest as quantifiable changes in stress variants of the supraglottic larynx.
Clinical practice in the management of postoperative delirium by Chinese anesthesiologists: a cross-sectional survey designed by the European Society of Anaesthesiology
Authors: Delp Simon , Mei Wei , Spies Claudia D. , Neuner Bruno , Aldecoa César , Bettelli Gabriella , Bilotta Federico , Sanders Robert D. , Kramer Sylvia , Weiss Bjoern
Published: June 2020

Objective

In this survey, we assessed the current clinical management of postoperative delirium (POD) among Chinese anesthesiologists, after publishing the European POD guideline.

Methods

We administered an electronic survey, designed according to the European POD guideline. The survey was completed using mobile devices.

Results

In total, 1,514 respondents from China participated in the survey. Overall, 74.4% of participants reported that delirium is very important. More than 95% of participants stated that they routinely assessed POD. In total, 61.4% screened for POD using clinical observation and 37.6% used a delirium screening tool. Although the depth of anesthesia (a POD risk factor) was monitored, electroencephalogram monitoring was unavailable to 30.6% of respondents. Regarding treatment, only 24.1% of respondents used a standard algorithm; 58.5% used individualized treatment.

Conclusion

Our survey showed that there are high awareness levels among Chinese anesthesiologists regarding the importance of POD. However, routine assessment and monitoring of all patients, including perioperative anesthesia depth monitoring, and a treatment algorithm need to be implemented on a larger scale. According to the results, efforts should be made to improve the knowledge of POD among Chinese anesthesiologists.
Successful treatment of a patient with NSCLC carrying uncommon compound EGFR G719X and S768I mutations using osimertinib: A case report
Authors: Cai Yangyang , Wang Yizhuo , Sun Jingnan , Wang Xu , Xu Yinghui , Sun Chao , Guo Ye , Sun Mengyao , Ma Kewei
Published: June 2020

The discovery of epidermal growth factor receptor ( EGFR) somatic mutations and the availability of tyrosine kinase inhibitors (TKIs) as targeted therapies have altered the therapeutic prospects of advanced non-small-cell lung cancer (NSCLC). G719X and S768I are uncommon mutations, and they often exist as compound mutations. A few reports have described the efficacy of first- and second-generation EGFR-TKIs. However, the efficacy of osimertinib in patients with these uncommon compound mutations is unknown. In this study, we reported the postoperative outcome of a patient with NSCLC and uncommon compound EGFR G719X and S768I mutations. After postoperative recurrence, the patient was treated with osimertinib, and an excellent and long-lasting clinical response was achieved. The patient has taken osimertinib for 31.0 months and exhibited a partial response, and her follow-up is ongoing.
Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience
Authors: Simforoosh Nasser , Dadpour Mehdi , Mousapour Pouria , Honarkar Ramezani Mehdi
Published: June 2020

Background:

There is a growing concern about postsurgical outcomes of radical prostatectomy, especially in the younger population and patients with earlier tumor stages. Here, we present our 17 years’ experience of sutureless vesico-urethral alignment after radical prostatectomy with a focus on postoperative functional urinary outcomes.

Methods:

Data of 784 patients who underwent radical prostatectomy during 2001–2017 were evaluated retrospectively. Before surgery, patients’ demographic information, pathologic stage, margin of surgery, prostate-specific antigen, and Gleason score were obtained. Then, serum prostate-specific antigen level, urinary continence, potency, and other functional outcomes of surgery were recorded after each postoperative visit.

Results:

The mean age (±standard deviation) of patients was 61.3 (±6.30) years. The median (IQ25–75) duration of follow-up was 30 (12–72) months. Full continence was achieved in 90% and 95.9% of patients at 3 and 6 months post surgery and 96.4% of the patients were continent at the last follow-up visit. Bladder neck stricture occurred in 167 patients (21.3%). During the follow-up period, none of the patients complained of total incontinence and at the last visit, 36.6% of patients reported potency. The frequency of grade 2 continence was significantly higher in patients with high-stage tumors (T3/T4), high Gleason score (⩾8), high preoperative serum prostate-specific antigen (>20 ng/dL), and positive margin of surgery. Potency had a significant relationship with age, stage of the disease, and preoperative prostate-specific antigen.

Conclusion:

Maximal sparing of intrapelvic urethral length through sutureless vesico-urethral alignment technique results in excellent early urinary continence recovery after radical prostatectomy. A more advanced tumor stage (T1/T2), a higher Gleason score, high preoperative prostate-specific antigen, as well as positive surgical margin are risk factors of postoperative incontinence in patients who undergo radical prostatectomy.
High Rates of Genetic Diagnosis in Psychiatric Patients with and without Neurodevelopmental Disorders: Toward Improved Genetic Diagnosis in Psychiatric Populations
Authors: So Joyce , Sriretnakumar Venuja , Suddaby Jessica , Barsanti-Innes Brianna , Faghfoury Hanna , Gofine Timothy
Published: June 2020

Objective:

There is a paucity of literature on genetic diagnosis in psychiatric populations, particularly the vulnerable population of patients with concomitant neurodevelopmental disorder (NDD). In this cross-sectional study, we investigated the genetic diagnostic rate in 151 adult psychiatric patients from two centers in Ontario, Canada, including a large subset (73.5%) with concurrent NDD, and performed phenotypic analysis to determine the strongest predictors for the presence of a genetic diagnosis.

Method:

Patients 16 years of age or older and affected with a psychiatric disorder plus at least one of NDD, neurological disorder, congenital anomaly, dysmorphic features, or family history of NDD were recruited through the genetics clinics between 2012 and 2016. Patients underwent genetic assessment and testing according to clinical standards. Chi-squared test was used for phenotypic comparisons. Multivariate logistic regression analysis was performed to determine which phenotypic features were predictive of genetic diagnosis types.

Results:

Overall, 45.7% of patients in the total cohort were diagnosed with genetic disorders with the vast majority of diagnoses (89.9%) comprising single gene and chromosomal disorders. There were management and treatment implications for almost two-thirds (63.8%) of diagnosed patients. Presence of a single gene disorder or chromosomal diagnosis was predicted by differing combinations of neurological, NDD, and psychiatric phenotypes.

Conclusion:

The results of this study highlight the frequency and impact of genetic diagnosis in psychiatric populations, particularly those with concomitant NDD. Genetic assessment should be considered in psychiatric patients, particularly those with multiple brain phenotypes (psychiatric, neurodevelopmental, neurological).
Adopting a Cloak of Incompetence: Impression Management Techniques for Feigning Lesser Selves
Authors: McLuhan Arthur
Published: June 2020

The “cloak of competence” concept captures attempts to disguise limitations and exaggerate abilities. The author examines the conceptual converse: the “cloak of incompetence,” or the various ways people deliberately disregard, disguise, downplay, or diminish their personal abilities. Drawing on a comparative analysis of manifold empirical cases, the author identifies three generic competence-concealing techniques—avoidance, performance, and neutralization—and considers some of the interactional contingencies that can enhance or reduce their effectiveness. Avoidance and performance techniques are used to manage creditable competence. Neutralization techniques are used to manage credited competence. Each strategy obstructs the appearance and attribution of competence in a particular way: avoidance techniques prevent the dramatic realization of competence, performance techniques dramatically realize incompetence, and neutralization techniques discount, downplay, distance, or otherwise explain away evident but undesirable competent performances. The author concludes by discussing some implications for sociologies of persons, culture, and structure.
Endocrine disruption: Molecular interactions of environmental bisphenol contaminants with thyroid hormone receptor and thyroxine-binding globulin
Authors: Beg Mohd A , Sheikh Ishfaq A
Published: June 2020

Many bisphenol A (BPA) analogs have been commercially used recently, such as 2,2-bis(4-hydroxyphenyl)butane (BPB), 4,4′-ethylidenebisphenol, 4,4′-methylenediphenol (BPF), 4,4′-(1,4-phenylenediisopropylidene)bisphenol (BPP), 4,4′-dihydroxydiphenyl sulfone (BPS), 4,4′-cyclohexylidenebisphenol (BPZ), 4,4′-(hexafluoroisopropylidene)diphenol (BPAF), 4,4′-(1-phenylethylidene)bisphenol (BPAP), and 2,2-bis(4-hydroxy-3,5-dimethylphenyl)propane (TMBPA), to circumvent adverse effects of BPA. However, their increasing use is also contaminating the environment, which is a potential cause of concern for human health. Thyroid hormone transport and signaling are potential targets for endocrine-disrupting activity of BPA analogs. Thyroxine-binding globulin (TBG) is the major carrier protein for thyroxine (T4) and triiodothyronine (T3) in blood. Thyroid hormones exert their action through thyroid hormone receptors (TRα and TRβ). This report presents the thyroid-disrupting potential of indicated nine BPA analogs from structure-based studies with TBG and TRα. Each BPA analog formed important polar and hydrophobic interactions with a number of residues of TBG and TRα. Majority of TBG residues (77–100%) and TRα residues (70–91%) interacting with BPA analogs were common with those of native ligands T4 and T3, respectively. Majority of BPA analogs interacted with TBG forming a salt bridge interaction at Lys-270. The hydrogen-bonding interaction of T3 with TRα at His-381 was also shared by majority of analogs. The binding energy for BPP, BPB, BPZ, BPAP, and TMBPA with both proteins was closer to binding energy of respective native ligands. The similarity in structural binding characteristics suggested potential disrupting activity of thyroid hormone signaling and transport.
Presentation and Outcome of Acute Necrotizing Encephalopathy of Childhood: A 10-Year Single-Center Retrospective Study From Hong Kong
Authors: Chow Chit Kwong , Ma Che Kwan Louis
Published: June 2020

Acute necrotizing encephalopathy (ANE) is a rare disease in childhood. We reviewed the 10-year data from a local pediatric department, reported the clinical characteristics, laboratory tests, neuroimaging findings, and outcome of the acute necrotizing encephalopathy cases and identified the potential factors affecting the outcome. Eight episodes of acute necrotizing encephalopathy among 7 patients were recorded, in which all of them had an initial presentation of fever and seizure. We identified that acute necrotizing encephalopathy patients with a severe score of Glasgow Coma Scale (GCS) on presentation, brainstem involvement in magnetic resonance imaging (MRI) of the brain, and higher MR imaging scores were associated with worse outcome. Association of outcome with acute necrotizing encephalopathy severity score, platelet count, and serum alanine aminotransferase level did not reach a statistically significant level. These results highlight the importance of combined clinical, laboratory, and neuroimaging findings in determining the prognostic outcome of acute necrotizing encephalopathy patients.
A Longitudinal Test of the Mediational Role of Delinquent Peer Association on the Link Between Psychopathy and Offending
Authors: Bryson Sara L. , Brady Caitlin M. , Ray James V.
Published: June 2020

Although prior research has found that psychopathy and delinquent peer association are predictors of delinquency, less research has assessed the dynamic role of peers in the relationship between psychopathic traits and offending. Using 10 waves of data from the Pathways to Desistance longitudinal study ( n = 1,354), the current exploratory study investigates the impact of changes in delinquent peer association on the relationship between psychopathy and self-reported offending. Although the effects are small, results indicate that youth with higher Psychopathy Checklist Youth Version (PCL:YV; Forth et al.) scores report higher initial levels of delinquent peer association, which results in increases in offending over the study period. Initial levels (intercept) and change (slope) in delinquent peer association are positively associated with offending. Findings also demonstrate that initial levels and changes in delinquent peer association mediate the relationship between psychopathy and changes in offending. The findings have implications for delinquency prevention and intervention efforts for all adolescents and particularly serious offenders.
The East of the West, or the West of the East? Attitudes toward the European Union and European Integration in Poland after 2008
Authors: Konieczna-Sałamatin Joanna , Sawicka Maja
Published: June 2020

Through the lens of modernization theories, the process of European integration can be perceived as Poland’s second modernization, following the systemic transformation in the nineties. In this article, we analyze the divergent perceptions of the European Union, and attitudes toward European integration, as they coexist within contemporary Polish society. We introduce the notion of European integration as a triple modernization, encompassing economic, institutional, and cultural changes. Using a mixed methods approach based on qualitative and quantitative data from the European Values Study 2017, we demonstrate that Poles generally accept the peripheral status of Poland in the economic context and expect financial support from the core of the EU. Simultaneously, within the cultural context, there exists a marginal but salient attitude that is based on opposition toward cultural pressures and on a claim to an active role in the shaping of the European axiological agenda. Distinguishing the three aspects of this general process of European integration allows for the identification of the source of tensions that are described in literature as cross-European populist tendencies to question the very idea of European integration in member societies of the EU.
“Church Is Important to Our Clients”: Autonomy, Community, and Religious Expression within a Long-term Care Organization
Authors: Trotter LaTonya
Published: June 2020

Autonomy and selfhood are primary concerns for scholars of long-term care. Previous work has shown how organizational routines threaten client autonomy and disrupt access to the material and symbolic resources that ground the biography of the self. In this article, I examine how a group of African-American older adults within an adult day service center ameliorated these threats through religious expression. In most health care settings, religion is delivered as an individual, clinical resource. At this site, religion and recreation became intertwined such that religion became a participatory resource that affirmed client membership to a community beyond the walls of the organization. However, as an institutionally provided resource, religion was delivered through work routines that constrained which versions of community to which clients could belong. I conclude by considering the implications for the expanding universe of long-term care organizations tasked with the maintenance of the body as well as the continuity of the self.
School Board Sensemaking of Federal and State Accountability Policies
Authors: Sutherland Daniella Hall
Published: June 2020

This qualitative case study examines how board members make sense of federal accountability policies and how their sensemaking shapes their use of assessment data as a policy instrument. Deviating from previous work on practitioner sensemaking, the participants’ interpretations of assessments did not align with their ensuing use of the data. Furthermore, board members’ use of assessment data diverged from both federal and state messaging, illustrating board members’ synthesis and adaptation of external messaging into a locally driven narrative. As the nation has shifted to state accountability systems under Every Student Succeeds Act (ESSA), the findings provide insights to policymakers and practitioners to support local implementation.
Equity and State Immigrant Inclusivity: English Learner Education in ESSA
Authors: Callahan Rebecca , Gautsch Leslie , Hopkins Megan , Carmen Unda Maria Del
Published: June 2020

With the 2015 passage of the Every Student Succeeds Act (ESSA), the oversight of language policy in U.S. schools shifted from federal to state governance. Although the education of students officially designated as English learners (ELs) has historically been grounded in federal law, we argue that ELs’ educational experiences are also largely influenced by societal attitudes toward immigrants and immigration. Using a critical policy analysis (CPA) approach, we examine how 12 states’ immigrant policy contexts are associated with the EL educational policies articulated in their ESSA implementation plans. We find that states’ demographic and immigrant policy contexts combine to produce four distinct approaches toward EL education, from departing to approaching equity.
Noise, vibration and harshness during dry clutch engagement oscillations
Authors: Minas I , Morris N , Theodossiades S , O’Mahony M
Published: June 2020

Determining the root causes of various noise, vibration and harshness phenomena in modern automotive drivetrains is a critical task for industry, since noise, vibration and harshness issues often result in worsened driving experience. The aim of the current research is to investigate the dynamics during dry clutch engagement and the associated – often problematic – oscillations. This paper reports the development and partial validation of numerical models to study dry clutch behaviour. The models are used to investigate the influence of clutch and throttle actuation on the occurrence of unwanted clutch oscillations. The dynamic coefficient of friction between the clutch interacting surfaces was measured using a pin-on-disc rig under different slip speeds and contact pressure conditions, which are representative of a typical clutch engagement manoeuvre. The paper highlights the occurrence of instability issues in clutch dynamics (disc radial mode) as potential generators of aggressive noise, vibration and harshness, particularly during two different clutch pedal actuations. Such analysis has not hitherto been reported in the open literature.
Recommendations for treating life-threatening Kaposi sarcoma during pregnancy in HIV-positive women in low income countries
Authors: Bacha Jason M , El-Mallawany Nader K , Slone Jeremy S , Wilkinson Jeffrey P , Mehta Parth S , Campbell Liane R
Published: June 2020

In areas of high HIV and human herpes virus 8 prevalence, life-threatening forms of Kaposi sarcoma (KS) can occur in HIV-positive women during pregnancy. Treating KS in pregnancy must balance both the well-being of the mother with the health of the fetus, yet data and recommendations on the best treatment approach for KS during pregnancy are limited. Without effective treatment, which can be difficult to obtain in low income countries (LICs), the mother and infant are at risk for poor outcomes. A successful case report is used as teaching example, followed by a detailed review of the literature that culminates in recommendations for treating KS during pregnancy among HIV-positive women in LICs. A 31-year-old HIV-positive woman presented for care in April 2016 at 28 weeks gestation with extensive KS skin lesions, KS lymphadenopathy, and a large oropharynx KS lesion causing partial airway obstruction. She had initiated antiretroviral therapy (ART) months prior and was virally suppressed, suggesting KS-immune reconstitution inflammatory syndrome. Due to the severity of KS and her third trimester status, combination chemotherapy was initiated using bleomycin, vincristine, and doxorubicin followed by maintenance therapy with paclitaxel. She showed remarkable response to the chemotherapy and had a normal vaginal delivery of a healthy baby at full term. Full clinical remission was achieved, and her baby was HIV-negative with no negative health effects of the KS or the chemotherapy. Review of the sparse existing literature demonstrates the importance, safety, and effectiveness of treating KS during pregnancy. We offer simple adaptable treatment recommendations for use in treating HIV-positive women with KS during pregnancy in LICs. Life-threatening KS can be treated using chemotherapy and ART in resource-limited settings, allowing for good outcomes in mother and infant. While monotherapy with liposomal doxorubicin or paclitaxel is preferred, these are often not available in LICs. As alternatives, bleomycin, vincristine, and doxorubicin can be safely used during the second and/or third trimesters for treating KS. Following a simple treatment approach can be an effective way to treat KS in pregnancy for pregnant women living with HIV in an LIC setting.
A Limited Sampling Strategy for Therapeutic Drug Monitoring of Mycophenolate Mofetil for Prophylaxis of Acute Graft-Versus-Host Disease in Allogeneic Stem Cell Transplantation
Authors: Gota Vikram , Purohit Vaitashi , Gurjar Murari , Nayak Lingaraj , Punatar Sachin , Gokarn Anant , Bonda Avinash , Bagal Bhausaheb , Vora Chakor Sunil , Patil Anand , Nookala Manjunath , Khattry Navin
Published: June 2020

A universally accepted strategy for therapeutic drug monitoring (TDM) of mycophenolate mofetil (MMF) in the prevention of acute graft-versus-host disease (aGVHD) in allogenic hematopoietic stem cell transplantation (alloHSCT) does not exist. We explored the feasibility of developing a limited sampling strategy (LSS) for TDM of MMF in this setting. Patients undergoing alloHSCT received standard MMF-cyclosporine prophylaxis, with MMF administered twice daily (BD) for matched transplant recipients or thrice daily (TID) in haploidentical transplantation. Intensive blood sampling was carried out on day 7 and area under the concentration–time curve (AUC) of mycophenolic acid (MPA), the active metabolite, was estimated using noncompartmental analysis. The ability of MPA exposure defined by AUC0-12 to discriminate between responders (patients who did not develop GVHD) and nonresponders (patients who developed GVHD) was determined by receiver operating characteristic curve analysis. Patients were divided into training and validation sets within BD and TID groups. Mathematical equations were developed from the training set to predict AUC0-12 from an abbreviated AUC involving a limited number of sampling points. The equations were validated in the validation set by comparing the MPA AUC0-12 predicted from LSS with the observed AUC0-12. It was observed that patients with AUC0-12 ≤18.99 mg*h/L had a higher risk of developing aGVHD [odds ratio (OR) = 2.63 (1.17 to 5.87), P = 0.06]. The benefit was more in matched transplant recipients [OR = 3.5 (1.30 to 9.49), P = 0.05] as compared to haploindentical transplant [OR = 2.8 (0.49 to 15.91), P = NS]. Using the mathematical equations, the observed AUC0-12 was predicted with 92.31% accuracy in the BD subset and 100% accuracy in the TID subset for a combined accuracy of 94.76%. A set of just three samples that constituted the abbreviated AUC1-4 was used to develop the predictive models. The LSS could be employed for the therapeutic monitoring of MMF particularly in patients undergoing matched hematopoietic stem cell transplantation.
Ganoderma lucidum Polysaccharide Enzymatic Hydrolysate Suppresses the Growth of Human Colon Cancer Cells via Inducing Apoptosis
Authors: Bai Jing hui , Xu Jian , Zhao Jian , Zhang Rui
Published: June 2020

Ganoderma lucidum is a popular traditional Chinese medicine used in China to improve health. Previous researches have revealed that the polysaccharide from G. lucidum could exert diversity activities, including immunomodulation, antioxidant, and antitumor effects. However, the effect of enzymatically hydrolyzed G. lucidum polysaccharide (EGLP) in colorectal cancer (CRC) progression remains unknown. The present research aimed to investigate the antitumor mechanism of EGLP in human colon cancer cells. For this purpose, the cytotoxic effects of EGLP were measured by the (3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT) method. The apoptosis was evoked upon EGLP treatment, which was assayed using flow cytometry. The results indicated that EGLP may induce apoptosis in human colon cancer cell (HCT-116) cells via the upregulation of BCL-2 associated X protein (Bax), phospho-extracellular regulated protein kinases (P-ERK), and cleaved caspase-3 expression and downregulation of B-cell lymphoma-2 (Bcl-2), phospho-serine/threonine kinase 1 (p-Akt1), and cyclo-oxygen-ase (COX-2) expression. The obtained findings indicated EGLP as a new therapeutic agent in fighting CRC.
Psychological Mechanisms Forged by Cultural Evolution
Authors: Heyes Cecilia
Published: June 2020

The adaptive features of cognitive mechanisms, the features that make them fit for purpose, have traditionally been explained by nature and nurture. In the last decade, evidence has emerged that distinctively human cognitive mechanisms are also, and predominantly, shaped by culture. Like physical technology, human cognitive mechanisms are inherited via social interaction and made fit for purpose by culture evolution. This article surveys evidence from developmental psychology, comparative psychology, and cognitive neuroscience indicating that imitation, mentalizing, and language are “cognitive gadgets” shaped predominantly by cultural evolution. This evidence does not imply that the minds of newborn babies are blank slates. Rather, it implies that genetic evolution has made subtle changes to the human mind, allowing us to construct cognitive gadgets in the course of childhood through cultural learning.
Of Changing Needs and Mismatched Expectations: Teaching Business Communication in Indian Business Schools
Authors: Shrivastava Madhusri
Published: June 2020

The exploratory research uses the framework of Communication Studies and Sociology to demonstrate how restructuring of social hierarchies impacts language use in the Business Communication class of an Indian management institute. The study examines how dominant communication practices are being subverted by issues of identity, power, privilege, sociopolitical forces and technological transformation. It suggests that instructors teaching Business Communication may benefit by aligning their pedagogy to the sensibilities of the present generation of management students. The paper is premised on the interpretivist belief that meanings and identities are socially constructed through respondents’ engagement with everyday realities. Twenty-two in-depth personal interviews were conducted with participants of the postgraduate programme in management and instructors of Business Communication. Further, a questionnaire was administered to 51 participants of an executive management programme to understand attitudes towards language use at the workplace. The responses indicate that a variant of indigenised English appears to be acquiring legitimacy amongst young professionals, while instructors continue to emphasise grammatical accuracy, blindsided by their training in language and literature. Therefore, to cater to the next generation of managers, instructors may have to shed their bias against non-formal expressions in English, and consider focusing on the functional aspects more important for intra-national purposes.
Conversations on Cancer Chemotherapy Cessation in Patients With Advanced Cancer: Qualitative Findings From a Multi-Institutional Study
Authors: Stout Jeremiah , Kumbamu Ashok , Tilburt Jon , Fernandez Cara , Geller Gail , Koenig Barbara , Lenz Heinz-Josep , Jatoi Aminah
Published: June 2020

Purpose:

As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer.

Methods:

This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively.

Results:

Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: “…You know this is…always really tough…But I—I think that you may need more help…I think we’re close to stopping chemotherapy…And hospice is really helpful to have in place…” In contrast, the second conversation element was more convoluted: “…transplant is not an option and surgery is not an option…The options…are taking a pill…It doesn’t shrink the tumor…It may help you live a little longer. But I’m worried if [you] had the pill, it’s still a therapy and it still has side effects. I [am] worried if I give it to you now, that you’re so weak, it will make you worse.” No relationship seemed apparent between conversation elements and chemotherapy cessation.

Conclusions:

Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.
After Janus: Teachers’ Unions, Walkouts, and Social Justice Unionism
Authors: Strassfeld Natasha M. , Strassfeld Robert N.
Published: June 2020

Recent union-supported teachers’ walkouts and strikes across several U.S. states and cities highlighted union-led and grassroots efforts to amplify teachers’ voices. Yet, the recent U.S. Supreme Court decision, Janus v. AFSCME, Council 31, provides a strength test for teachers’ unions and members engaging in social justice/equity work within a post- Janus landscape. This article first explores traditional functions of teachers’ unions. Next, it examines Janus and potential consequences for union participation, teachers’ advocacy, and civil rights. Using a social justice lens, the article discusses how and why unions may need to consider strengthening “social justice unionism” by building on walkouts and strikes.
Flying Blind: Education Reform in Latin America in the 1990s
Authors: Vargas Thomas R.
Published: June 2020

Conventional wisdom suggests that Latin American countries reformed public education in the 1990s in response to a crisis of coverage and quality. Yet, in terms of access, Latin American countries had achieved relatively high enrollment and completion rates by 1990. With regard to quality, there was simply no high-quality evidence showing weak or lowering standards. In short, by the early 1990s, there was very little scientific evidence of a generalized crisis of public education in Latin America. By uncovering these patterns, this article argues that political scientists should revisit the origins of education reform efforts in the 1990s.
Dual– Versus Mono–Bronchodilator Therapy in Moderate to Severe COPD: A Meta-analysis
Authors: Lipari Melissa , Kale-Pradhan Pramodini B. , Wilhelm Sheila M.
Published: June 2020

Background:

Chronic obstructive pulmonary disease (COPD) guidelines recommend both long-acting and dual bronchodilator therapy. It is unclear if there are differences in efficacy and safety.

Objective:

This meta-analysis evaluates the efficacy of dual therapy with long-acting β-agonist (LABA) + long acting muscarinic antagonist (LAMA) compared with monotherapy with LAMA for COPD.

Methods:

We searched PubMed, CINAHL, and Web of Science databases from inception through March 2020 to identify English-language, prospective randomized controlled trials (RCTs) that compared dual therapy with monotherapy in adult patients with COPD. Risk of bias was assessed using the Jadad score. Overall analysis was performed using Review Manager 5.3. Treatment effect was determined with the random-effects model using the Mantel-Haenszel method and was reported as mean difference (MD) with 95% CI.

Results:

A total of 18 RCTs were included (n = 6086; median Jadad score 5/5) that compared LAMA + LABA with LAMA. There was a greater improvement in forced expiratory volume at 1 s (FEV1) with dual therapy compared with LAMA: MD = 0.08; 95% CI = [0.05, 0.11]. There was no difference in St George Respiratory Questionnaire (SGRQ) scores between groups: OR = −0.85; 95% CI = [−1.83, 0.13]. There were no differences in overall adverse events (OR = 1.00; 95% CI = 0.92, 1.09), serious adverse events (OR = 1.01; 95% CI = 0.86, 1.18), or cardiovascular events (OR = 0.88; 95% CI = 0.58, 1.34).

Conclusion and Relevance:

Dual therapy improves FEV1 and is as safe as LAMA. Dual therapy does not improve SGRQ scores more than LAMA.
Xanthogranulomatous Ureteritis Mimicking Ureteral Involvement by Cancer in a Radical Cystectomy Specimen
Authors: Rodgers Shannon A. , Williamson Sean R.
Published: June 2020

Xanthogranulomatous pyelonephritis is well established as a renal mass-forming inflammatory process. However, a ureteral counterpart is minimally recognized. In this article, we present a case of xanthogranulomatous ureteritis in an 81-year-old woman, mimicking ureteral involvement by cancer in a radical cystectomy specimen for invasive urothelial carcinoma. Similar to the pathogenesis of xanthogranulomatous pyelonephritis, the patient was noted to have ureteral obstruction by calculus and had urine culture positive for Klebsiella pneumoniae. To our knowledge, this is the first report of xanthogranulomatous ureteritis associated with this pathogen and the only report associated with concurrent bladder cancer. Increased pathologist and urologist awareness of xanthogranulomatous ureteritis expands the spectrum of pseudotumoral processes of the ureter.
Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity
Authors: MacDonald Ashlee , Ciufo David , Vess Eric , Knapp Emma , Awad Hani A. , Ketz John P. , Flemister Adolph S. , Oh Irvin
Published: June 2020

Background:

Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model.

Methods:

Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA).

Results:

Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees ( P = .031) and 5.8 ± 2.7 degrees ( P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees ( P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity ( P = .04 and P = .02, respectively).

Conclusion:

The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model.

Clinical Relevance:

The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV.