bluuebunny/crossref_metadata_2025 huggingface dataset:
INCENTIVO À BOA-FÉ OBJETIVA POR DECISÕES JUDICIAIS o problema da aplicação de indenizações punitivas em caso de abuso em alteração unilateral de contrato de transporte aéreo
Authors: Magalhães Marcus Abreu de
Published: November 2019

O presente artigo busca reﬂexão acerca da discricionariedade inerente à atividade jurisdicional e de possíveis mecanismos para mitigar consequências indesejáveis da variação de entendimentos do julgador. Analisa a técnica de respeito aos precedentes e busca pontos em comum com o modelo continental de subsunção à lei. Partindo da análise de casos concretos vinculados a hipótese corriqueira e repetitiva – a fxação de reparação quando de descumprimento de contrato de transporte aéreo – o trabalho analisa efeitos do modelo de análise individual das demandas propostas. O exemplo abordado é a alteração ou cancelamentos de voos de maneira unilateral de modo a propiciar à empresa aérea fornecedora do serviço de transporte maiores oportunidades de lucro em detrimento do contrato frmado com o consumidor. A hipótese proposta revela tanto vantagens da uniformização, eis que julgados estabelecem a necessidade de indenização por cancelamento de voo e indicam valores da reparação, quanto o problema da ausência de repressão ao comportamento das empresas sucumbentes ante os valores insufcientes da indenização para estimular modifcação da conduta.
MEDIAÇÃO ESCOLAR E JUSTIÇA RESTAURATIVA
Authors: Fernandes Glaucia Guisso , Lopes Maria Paula Daltro
Published: November 2019

O presente artigo analisa a importância da mediação, como meio adequado de resolução de conﬂito, no âmbito escolar, resguardando o acesso à justiça na educação, com base na Constituição Federal e demais diplomas legais, especialmente o Estatuto da Criança e do Adolescente. Será demonstrado que o procedimento de mediação é o meio mais efcaz para a resolução de conﬂitos no âmbito escolar, viabilizando os preceitos da justiça restaurativa e não punitiva.
A comunicação da ciência: o caso do programa televisivo da Maratona da Saúde = Science Communication: The Case of Maratona da Saúde TV program
Authors: Souza Mariana Adeodato Alves de , Oliveira Andrea
Published: November 2019

Resumo: Introdução: A comunicação científica e a maior aproximação da ciência com a sociedade são estratégias de angariação de fundos para a investigação científica. Objetivo: o presente artigo tem como objetivo examinar as narrativas utilizadas no programa televisivo da Maratona da Saúde como ferramenta comunicativa para a eficácia da captação de recursos. Metodologia: realizou-se uma análise de conteúdo do Programa Televisivo das cinco edições da Maratona da Saúde, a partir do trabalho de Luís Mauro Sá Martino (2016). Resultados: a Maratona da Saúde é um projeto inovador, cujo êxito encontra-se na mescla de várias formas de narrativas sobre a saúde e a ciência, com uso de linguagem acessível, conseguindo envolver progressivamente o espectador - o que contribui para que ele se torne um possível doador. Conclusão: o Programa contribui para educação e aprendizado da sociedade portuguesa sobre a ciência, a saúde e a importância do seu fomento.Palavras-chave: comunicação de ciência; entretenimento; angariação de fundos; narrativa; Maratona da Saúde; Portugal.Abstract: Introduction: Scientific communication and a great approximation of science with society are strategies for raising funds for scientific research. Objective: The goal of the study is to examine the narratives used in the television program of Maratona da Saúde as a communicative tool for the effectiveness of fundraising. Methodology: a content analysis of the Television Program of the five editions of Maratona da Saúde was carried out, based on the work of Luís Mauro Sá Martino (2016). Results: the results obtained indicate that the Maratona da Saúde is, in fact, an innovative Project, whose success lies in the mixture of various forms of health and science narratives, using accessible language, managing to gradually involve the viewer, which contributes to make him a potential donor. Conclusion: the studied TV show contributes to the education and learning of Portuguese society about science, health and the importance of its promotion.Keywords: science communication; entertainment; fundraising; narrative; Maratona da Saúde; Portugal.
Nadir e o círculo vermelho
Authors: Afonso Laura
Published: November 2019

Aos 4 anos de idade Nadir pintou um círculo vermelho na parede da sala de sua casa, e, este facto foi como que um prenuncio, de que a matemática sempre orientaria a sua vida. Bem cedo, Nadir enunciou que a arte é um reflexo das leis da natureza, que a essência da obra de arte é a geometria, A Arte, para Nadir, era a chama que lhe dava sentido à vida, era o ar que respirava. Já enquanto aluno das Belas-Artes Dórdio Gomes lhe notara a «paixão irresistível pela pintura», Nadir dedicou-se inteiro à Arte e à compreensão do fenómeno artístico com uma lucidez e independência de espírito invulgares. A arte, qual corrente caudalosa, ninguém a pode suster e pintou sempre desde que aos quatro anos pinta um círculo vermelho na parede da sala de sua casa.
Nadir Afonso, o artista e a sua circunstância
Authors: Afonso Artur
Published: November 2019

Poderemos dissociar o homem da sua obra (e é justo que o façamos) mas quase inevitavelmente a nossa análise processa-se por meio de uma observação contaminada entre as características do criador (a personalidade, o temperamento, as crenças, as circunstâncias da vida e da sorte – e, de uma forma mais abrangente, a cultura e o meio onde se insere,) e a obra efectivamente criada.
The Impact of cotton textile sector trends in Cameroon
Authors: Elvis Nguepi Tsafack
Published: November 2019

This study attempts to clarify and evaluate the factors that impact on cotton sector production in Cameroon and differentiate producers `behavior. A description of producers ‘behaviour is made in order to identify their main characteristics, which should shed light on the relationships between cotton textile production , the main producers` characteristics price and non-price variables. An inventory of ongoing sectoral agricultural policies is presented and suggestions are made for formulating alternative policies. The next section presents both a review of agricultural policies and the cotton sector in Cameroon. The third and fourth sections are literature review and cotton belt while the fifth presents the methodology. Discussion and interpretation of the empirical findings is followed by the conclusion and policy recommendations.
Aggregation of Fuzzy Expert Judgments
Authors: Posadsky Alexey Igorevich , Sivakova Tatiana Vladimirovna , Sudakov Vladimir Anatolievich
Published: November 2019

Two methods of aggregating fuzzy judgments of experts are proposed in the work: a fuzzy weighted sum based on a generalization operation and an average fuzzy ranking. Fuzzy object scores are used to calculate ranks based on the eigenvector of the fuzzy ratio matrix. The problem of determining the optimal fuzzy ranking is reduced to the linear programming problem.
Extendable Endoprostheses in Skeletally Immature Patients
Authors: Tsuda Yusuke , Tsoi Kim , Stevenson Jonathan D. , Fujiwara Tomohiro , Tillman Roger , Abudu Adesegun
Published: November 2019

Background:

Extendable endoprostheses are used to reconstruct segmental defects following resection of bone sarcomas in skeletally immature patients. However, there remains a paucity of studies with regard to long-term outcomes.

Methods:

We retrospectively reviewed 124 skeletally immature children who underwent an extendable endoprosthetic replacement and survived more than 10 years after the surgical procedures. Anatomical sites included the distal part of the femur (n = 66), the proximal part of the femur (n = 13), the proximal part of the tibia (n = 29), and the proximal part of the humerus (n = 16). Complications and implant survival were classified according to the modified Henderson criteria.

Results:

The mean follow-up was 24 years (range, 10 to 36 years). The mean age at the time of the extendable endoprosthetic replacement was 9 years (range, 2 to 16 years). All patients had reached skeletal maturity at the last follow-up. The 10-year endoprosthetic failure-free survival rate was 28%. A total of 243 complications occurred in 90% of patients; these complications were most frequently related to soft-tissue problems (27% of complications). The incidence of and cumulative survival with respect to each failure mode varied between anatomical sites. Soft-tissue failures occurred most frequently in the proximal part of the femur (77%; p = 0.003), and the distal part of the femur was the most frequent site of aseptic loosening (52%; p = 0.014) and structural failure (55%; p = 0.001). Excluding lengthening procedures, 105 patients (85%) underwent an additional surgical procedure, with a mean of 2.7 surgical procedures per patient (range, 0 to 7 surgical procedures per patient). The mean limb-length discrepancy at the final follow-up was 1 cm (range, 0 to 9 cm). Limb salvage was achieved in 113 patients (91%). The mean Musculoskeletal Tumor Society functional score (the percentage of a total score of 30 points) was 82% (range, 40% to 100%) in 115 patients with available data at the last follow-up.

Conclusions:

Extendable endoprostheses are associated with a high complication rate and a need for additional surgical procedures over time. Despite this, successful limb salvage with reasonable function and small limb-length discrepancy is achievable in the long term. Our study provides benchmark data for individual anatomical sites for further improvements of outcomes.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Reconstruction of the Suprascapular Nerve in Brachial Plexus Birth Injury
Authors: Manske M. Claire , Kalish Leslie A. , Cornwall Roger , Peljovich Allan E. , Bauer Andrea S. ,   on behalf of the TOBI Study Group
Published: November 2019

Background:

Shoulder external rotation recovery in brachial plexus birth injury is often limited. Nerve grafting to the suprascapular nerve and transfer of the spinal accessory nerve to the suprascapular nerve are commonly performed to restore shoulder external rotation, but the optimal surgical technique has not been clearly demonstrated. We investigated whether there was a difference between nerve grafting and nerve transfer in terms of shoulder external rotation recovery or secondary shoulder procedures.

Methods:

This is a multicenter, retrospective cohort study of 145 infants with brachial plexus birth injury who underwent reconstruction with nerve grafting to the suprascapular nerve (n = 59) or spinal accessory nerve to suprascapular nerve transfer (n = 86) with a minimum follow-up of 18 months (median, 25.7 months [interquartile range, 22.0, 31.2 months]). The primary outcome was the Active Movement Scale (AMS) score for shoulder external rotation at 18 to 36 months. The secondary outcome was secondary shoulder surgery. Two-sample Wilcoxon and t tests were used to analyze continuous variables, and the Fisher exact test was used to analyze categorical variables. The Kaplan-Meier method was used to estimate the cumulative risk of subsequent shoulder procedures, and the proportional hazards model was used to estimate hazard ratios (HRs).

Results:

The grafting and transfer groups were similar in Narakas type, preoperative AMS scores, and shoulder subluxation. The mean postoperative shoulder external rotation AMS scores were 2.70 in the grafting group and 3.21 in the transfer group, with no difference in shoulder external rotation recovery between the groups (difference, 0.51 [95% confidence interval (CI), −0.31 to 1.33]). A greater proportion of the transfer group (24%) achieved an AMS score of >5 for shoulder external rotation compared with the grafting group (5%) (odds ratio, 5.9 [95% CI, 1.3 to 27.4]). Forty percent of the transfer group underwent a secondary shoulder surgical procedure compared with 53% of the grafting group; this was a significantly lower subsequent surgery rate (HR, 0.58 [95% CI, 0.35 to 0.95]).

Conclusions:

Shoulder external rotation recovery in brachial plexus birth injury remains disappointing regardless of surgical technique, with a mean postoperative AMS score of 3, 17% of infants achieving an AMS score of >5, and a high frequency of secondary shoulder procedures in this study. Spinal accessory nerve to suprascapular nerve transfers were associated with a higher proportion of infants achieving functional shoulder external rotation (AMS score of >5) and fewer secondary shoulder procedures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
DROPS Survey and Reporting Based on Asset Inspection Management System a Reliable Inspection Tool to Manage DROPS in Offshore & Onshore Drilling Rigs, Empowering the Work Site Supervisor to Enhance Overall Efficiency of the System to Performance
Authors: John Shibu
Published: November 2019

Dropped Objects pose the number-one risk of serious injuries, fatalities, and equipment damage in several industries across the globe and is more prominent in Off shore drilling condition, where more personnel perform their duties within a confined space. Dropped Object Prevention Scheme [DROPS] is intended to be applied to operations in which Dropped Objects could cause harm to people, equipment, and/or the environment. Though Companies develop documented DROPS at relevant levels/departments within the organization as per objectives and targets developed as part of their company's existing Health, Safety, and Environment and/or operational goal-setting processes. Third Party DROPS Survey and Reporting is a catalyst to integrate & guide the scheme to meet its objectives.

This paper emphasizes the importance of a robust DROPS, reinforced by repeatable and reliable DROPS Survey & Reporting, in compliance with present industry standard and at the end extend its SMARTER possibilities of expansion with use of RFID Tags and Artificial Intelligence. Our cloud-based Asset Inspection Management System "SOSINSPECTIONEERING" through which (1)Each individually identified DROPS Item shall have a Unique Asset ID,(2)Generate individual DROPS Report for each DROPS Asset, (3)Generate a DROPS Master Asset Register capturing the main features of DROPS Reports and linking it to the latest DROPS Report, (4)Option for Client to download a excel picture book with all 3 levels of Securing and a detailed item specific checklist, (5)The Check list downloaded to ‘Tab’ or any equivalent device provides the work site supervisor to use it in his/her regular verification inspection and report compliance/non-compliance report for further analysis.

We are also developing the system to next level of application such as, (a)Tagging each DROPS Asset with RFID Tags, (b) RFID Tag to load with latest DROPS Report for that Asset ID, (c)Each DROPS Reports of the Asset to linked to its other documentation like (i)Manufacture Certificate; (ii)OEM/Other DATA Sheets; (iii)Latest Lifting Certificate &NDT Inspection, (d)RFID scanner with the Work Site Supervisor to Download the DROPS Report or ‘Drone’ to scan the RFID Tag to Down load the latest DROPS Report to the Remote System for verification, (e)Work Site Supervisor of Third Party DROPS Surveyor with Camera can take real time Photos to edit the DROPS Report and modify the ‘Photo Book’ in real time, (f)similarly Camera fitted in a ‘Drone’ can go one step beyond the checklist to use artificial intelligence to recognize patterns and takes a probabilistic approach to verify the compliance by using more historical data.
Effective Reservoir Management with Flow Control Devices for SAGD Producer Wells in Mackay River
Authors: Rosi Giuseppe , Zhu Da , O'Hagan Dermot
Published: November 2019

Inflow Control Devices (ICDs) have been adopted for commercial steam-assisted gravity drainage (SAGD) production for nearly ten years and yet the function they serve is not well understood, and field data evaluating their performance remains scant. Thus, the purpose of the current study is twofold: Firstly, the study derives a simplified analytical model demonstrating how increasing the dP across ICDs acts to improve conformance along a producing lateral. The resulting equation of the analysis acts as a simple rule of thumb for determining an appropriate pressure drop across ICDs to achieve conformance. Secondly, the study evaluates the performance of ICDs that had been installed in four wells, two of which had ICDs installed prior to circulation and two that adopted ICDs later in their lifecycle. The field data shows that ICDs increase production rates and improve conformance along the lateral. These improvements are achieved by an increased drawdown facilitated by the ICDs. This part of the study highlights how early-life results may differ between ICD bearing wells compared to their conventionally completed (slotted liner) offsets: ICD bearing wells exhibit improved conformance and an ability to develop more challenging reservoir resulting in different oil production profiles and composite SORs.
Evaluation, Implementation, and Operations of an FCD for SAGD Producer Wells
Authors: Neeteson Nathan , Heukelman Herman , Zhu Da , Thompson Scott
Published: November 2019

The goal of this paper is to present the philosophies for the qualification and flow loop testing of FCD nozzles as well as the macroscopic implementation and operations of FCDs in SAGD producer wells. A quantitative methodology to evaluate FCD nozzles to choke back steam will be presented. Flow loop testing data will be shown to illustrate the qualification process. We will also discuss if sand control screens should be put on the tubing deployed inflow control devices. Some modeling and field examples will be shown. In the end, field data of the SAGD producer wells installed with the FCDs will be presented. Experience to manage and operate the wells will be shared.
Silicate-Activated Geopolymer Alternatives to Portland Cement for Thermal Well Integrity
Authors: van Oort Eric , Juenger Maria , Liu Xiangyu , McDonald Michael
Published: November 2019

Ordinary Portland cement (OPC) has been the material of choice for oil & gas well cementing and abandonment for many decades now. However, there are drawbacks to the use of OPC for cementing and abandonment purposes, particularly in wells with higher temperatures. OPC is brittle and does not re-heal when cracked. It is easily contaminated by mud and spacer fluids. Furthermore, it has relatively low tensile strength and low strength when bonding to rock formations and casing. Moreover, the production of OPC is the 2nd largest source of CO2 emissions in the world. At the CODA industry-affiliate consortium at the University of Texas at Austin dedicated to well construction, decommissioning and abandonment, work is ongoing to find technically superior alternatives to OPC. Particularly promising materials are so-called geopolymers, formed by activating an alumino-silicate material such as fly ash (a waste material that is often discarded) with an alkali. It was found that these geopolymer materials offer more ductile strength and failure behavior, considerable resistance to contamination, higher tensile strength and bond strength, and an ability to re-heal when damaged. The results obtained for geopolymers formed by activating flyash with potassium and sodium silicates indicate that these may be well-suited for achieving long-term thermal well integrity.
An operon consisting of a P-type ATPase gene and a transcriptional regulator gene responsible for cadmium resistances in Bacillus vietamensis 151-6 and Bacillus marisflavi 151-25
Authors: Yu Xiaoxia , Ding Zundan , Ji Yangyang , Zhao Jintong , Liu Xiaoqing , Tian Jian , Wu Ningfeng , Fan Yunliu
Published: November 2019

Background: Cadmium (Cd) is a severely toxic heavy metal to most microorganisms. Many bacteria have developed Cd 2+ resistance. Results: In this study, we isolated two different Cd 2+ resistance Bacillus sp . strains, Bacillus vietamensis 151-6 and Bacillus marisflavi 151-25 , which could be grown in the presence of Cd 2+ at concentration up to 0.3 mM and 0.8 mM, respectively. According to the genomic sequencing, transcriptome analysis under cadmium stress, and other related experiments, a gene cluster in plasmid p25 was found to be a major contributor to Cd 2+ resistance in B. marisflavi 151-25. The cluster in p25 contained orf4802 and orf4803 which encodes an ATPase transporter and a transcriptional regulator protein, respectively. Although 151-6 has much lower Cd 2+ resistance than 151-25, they contained similar gene cluster, but in different locations. A gene cluster on the chromosome containing orf4111 , orf4112 and orf4113 , which encodes an ATPase transporter, a cadmium efflux system accessory protein and a cadmium resistance protein, respectively, was found to play a major role on the Cd 2+ resistance for B. vietamensis 151-6. Conclusions: This work described cadmium resistance mechanisms in newly isolated Bacillus vietamensis 151-6 and Bacillus marisflavi 151-25. Based on homologies to the cad system (CadA-CadC) in Staphylococcus aureus and analysis of transcriptome under Cd 2+ induction, we inferred that the mechanisms of cadmium resistance in B. marisflavi 151-25 was as same as the cad system in S. aureus . Although Bacillus vietamensis 151-6 also had the similar gene cluster to B. marisflavi 151-25 and S. aureus , its transcriptional regulatory mechanism of cadmium resistance was not same. This study explored the cadmium resistance mechanism for B. vietamensis 151-6 and B. marisflavi 151-25 and has expanded our understanding of the biological effects of cadmium.
Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy
Authors: Zhang Guodong , Li Jijun , Tang Jun , Zhang Lei , Wang Dechao , Sun zengtao
Published: November 2019

The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). Methods: A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. Results: Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain. Conclusions: During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.
Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients
Authors: Hough Judith , Levan Daniel , Steele Michael , Kelly Kristine , Dalton Megan
Published: November 2019

The Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy. Three interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session. For the 164 participants included in this study, self-efficacy survey response rate varied from 77-96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p<0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified ‘experience’ as the primary theme.
Conclusion: SBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.
Trends in prevalence and correlates of intimate partner violence against women in Zimbabwe, 2005-2015
Authors: Mukamana Jeanette Iman'ishimwe , Machakanja Pamela , Adjei Nicholas Kofi
Published: November 2019

Background: Intimate partner violence (IPV) is a widespread problem affecting all cultures and socioeconomic groups. This study explored the trends in prevalence and risk factors associated with IPV among Zimbabwean women of reproductive age (15-49 years) from 2005-2015. Methods: Data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) on 13,409 women (survey year: 2005/2006; n=4,081), (survey year: 2010/2011; n=4,411) and (survey year: 2015; n=4,917) were analyzed. Multiple logistic regressions and hierarchical modelling techniques were applied to examine the associations between demographic characteristics, socioeconomic status, media exposure and IPV against women. We further estimated IPV prevalence by type (physical, sexual and emotional) over time. Results: The prevalence of IPV decreased from 45.2% in 2005 to 40.9% in 2010, and then increased to 43.1% in 2015. Some of the risk factors associated with IPV were younger age, low economic status, cohabitation and rural residence. Educational attainment of women was however not significantly associated with IPV. Conclusions: The findings indicate that women of reproductive age are at high and increasing risk of physical and emotional violence. There is thus an urgent need for an integrated policy approach to address the rise of IPV related physical and emotional violence against women in Zimbabwe. Keywords: Intimate Partner Violence (IPV); Trends; Risk factors; Demographic and Health Surveys (DHS); Zimbabwe
Assessment of infection in newly diagnosed multiple myeloma patients: Risk factors and main characteristics
Authors: Lin Chenyao , Shen Hui , Zhou Shuimei , Liu Minghui , Xu Anjie , Huang Shuang , Shen Changxin , Zhou Fuling
Published: November 2019

Background: Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time. Methods: Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis. Results: Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P =0.040), more severe anaemia (Hb<90 g/L, P =0.044) and elevated CRP (>10 mg/L, P =0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM ( P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis ( P = 0.011), especially ISS stage III ( P =0.008) and lower haemoglobin level ( P =0.039). Conclusions: Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.
Scaling Up Quality Improvement for Surgical Teams (QIST) - avoiding surgical site infection and anaemia at the time of surgery: protocol for a cluster randomised controlled trial
Authors: Scrimshire Ashley B , Booth Alison , Fairhurst Caroline , Tadd Win , Laverty Annie , Corbacho Belen , Torgerson David , McDaid Catriona , Reed Mike
Published: November 2019

Background: Measures shown to improve outcomes for patients often fail to be adopted into routine practice in the NHS. The Institute for Health Improvement Breakthrough Series Collaborative (BSC) model is designed to support implementation at scale. This trial aims to assess the effectiveness and cost-effectivenessof quality improvement collaboratives based on the BSC method for introducing service improvements at scale in the NHS. Methods: Forty Trusts will be randomised (1:1) to introduce one of two protocols already shown to improve outcomes in patients undergoing elective total hip and knee replacement surgery. The intervention is improvement collaboratives based on the BSC model, a learning system that brings together a large number of teams to seek improvement focused on a proven intervention. Collaboratives aim to deliver at scale, maximise local engagement and leadership and are designed to build capacity, enable learning and prepare for sustainability. Collaboratives involve learning sessions, action periods, and a summative congress. Trusts will be supported to introduce either: decolonisation for MSSA to reduce post-operative infection (QIST:Infection), or an anaemia optimisation programme to reduce peri-operative blood transfusions (QIST:Anaemia). Trusts will continue with their usual practice for whichever protocol they are not introducing. Anonymised data related to both infection and anaemia outcomes for patients undergoing hip or knee arthroplasty at all sites will mean the two groups act as controls for each other. The primary outcome for the QIST: Infection collaborative is deep MSSA surgical site infection within 90 days of surgery, and for the QIST: Anaemia collaborative is blood transfusion within 7 days of surgery. Patient-level secondary outcomes include length of hospital stay and re-admission, which will also inform the economic costings. Qualitative interviews will evaluate the support provided to teams. Discussion: The scale of this trial brings considerable challenges and potential barriers to delivery. Anticipated challenges relate to recruiting and sustaining up to 40 organisations, each with their own culture and context. This complex project with multiple stakeholders across a large geography will be managed by experienced senior-level project leaders with a proven track record in advanced project management. The team will ensure effective project governance and communications.
Glioma SOX2 expression decreased after adjuvant therapy
Authors: Yu Wei , Ren Xiaoqiu , Hu Chunxiu , Tan Yinuo , Shui Yongjie , Chen Zexin , Zhang Lili , Peng Jiaping , Wei Qichun
Published: November 2019

SOX2 is regarded as an important marker in stem cell. The change of SOX2 expression after adjuvant therapy in high grade glioma (HGG) remains unknown so far. Few patients with recurrent glioma have opportunity to undergo operation once again, so the recurrent glioma samples are scarce. This study tries to analyze SOX2 expression in paired primary and recurrent HGG, aims to better understand the transformation law of SOX2 after adjuvant therapy in HGG.Methods Twenty-four recurrent HGG patients who undergone a second resection were included. 16 patients received adjuvant therapy, the remaining 8 patients didn’t receive any adjuvant therapy at all. The protein expression of SOX2 in paired primary and recurrent HGG was tested by immunohistochemistry. The statistical analysis was conducted by IBM SPSS Statistics 19.0.Results In primary HGG, SOX2 expression of 3+,2+,1+ and 0+ were seen in 20 (83.3%), 1 (4.2%), 1 (4.2%) and 2 cases (8.3%), respectively. The expression of SOX2 was decreased in recurrent HGG compared to the paired primary sample (p=0.001). The decrease of SOX2 was often seen in patients received chemotherapy, radiotherapy or both (p=0.003). Patients with SOX2 high expression in primary glioma had a longer median PFS than those with SOX2 low expression with marginal statistic significance (12.7 vs. 5.4 months, p=0.083). For cases with SOX2 high expression in the primary glioma, those had SOX2 low expression after recurrence seemed to have worse prognosis as compared to patients with stable SOX2 high expression (PFS: 10.4 vs. 14.9 months, p=0.036; OS: 27.0 vs 49.5 months, p=0.005).Conclusions This is the first study comparing the protein expression of SOX2 in recurrent HGG and its paired primary tumor. SOX2 high expression is common in brain HGG, a tendency of decreased SOX2 expression in recurrent gliomas was evidenced. Lower SOX2 expression was seen in those patients who received adjuvant chemotherapy and/or radiotherapy. Patients with low SOX2 expression in primary HGG usually have poorer prognosis, those with SOX2 expression decreased in recurrent HGG had worse outcome.
Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study
Authors: Mpinganjira Samuel Lawrent , Tchereni Timothy , Gunda Andrews , Mwapasa Victor
Published: November 2019

Background
In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs.
Methods
We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews with them and also with 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis.
Results
The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options.
Conclusion
Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of mother-infant pairs in HIV care.
Key words
PRIME, PMTCT, EMTCT, loss to follow up, mother-infant pairs, Option B+
Characterization of genome-wide genetic variations between two varieties of tea plant (Camellia sinensis) and development of InDel markers for genetic research
Authors: Liu Shengrui , An Yanlin , Tong Wei , Qin Xiuju , Samarina Lidia , Guo Rui , Xia Xiaobo , Wei Chaoling
Published: November 2019

Single nucleotide polymorphisms (SNPs) and insertions/deletions (InDels) are the major genetic variations and are distributed extensively across the whole plant genome. However, few studies of these variations have been conducted in the long-lived perennial tea plant. In this study, we investigated the genome-wide genetic variation between Camellia sinensis var. sinensis ‘Shuchazao’ and Camellia sinensis var. assamica ‘Yunkang 10’, identified 7,511,731 SNPs and 255,218 InDels based on their whole genome sequences, and we subsequently analyzed their distinct types and distribution patterns. A total of 48 InDel markers that yielded polymorphic and unambiguous fragments were developed when screening six tea cultivars. These markers were further deployed on forty-six tea cultivars for transferability and genetic diversity analysis, exhibiting information with an average 4.02 of the number of alleles (Na) and 0.457 of polymorphism information content (PIC). The dendrogram showed that the phylogenetic relationships among these tea cultivars are highly consistent with their genetic backgrounds or original places. Interestingly, we observed that the catechin/caffeine contents between ‘Shuchazao’ and ‘Yunkang 10’ were significantly different, and a large number of SNPs/InDels were identified within catechin/caffeine biosynthesis-related genes. The identified genome-wide genetic variation and newly-developed InDel markers will provide a valuable resource for tea plant genetic and genomic studies, especially the SNPs/InDels within catechin/caffeine biosynthesis-related genes, which may serve as pivotal candidates for elucidating the molecular mechanism governing catechin/caffeine biosynthesis.
Suprapatellar versus infrapatellar approaches in the treatment of tibia intramedullary nailing ： A retrospective cohort study
Authors: Cui Yiliang , Hua Xingyi , Schmidutz Florian , Zhou Jian , Yin Zongsheng , Yan Shuang G
Published: November 2019

Background: Tibial shaft fractures are routinely managed with intramedullary nailing (IMN). An increasingly accepted technique is the suprapatellar (SP) approach. The purpose of this study was to compare the clinical and functional outcomes of knee joint after tibia IMN through an suprapatellar (SP) or traditional infrapatellar (IP) approach.
Methods: Retrospective analysis was performed in patients with tibial shaft fractures that were treated with IMN through a SP or IP approach between 01/01/2014 and 31/12/2016. The clinical and functional outcomes of the knee were assessed with the Hospital for Special Surgery (HSS) Knee Score. Secondary outcomes included the operation time and intraoperative blood loss.
Results: A total of 50 patients/fractures (26 IP and 24 SP) with a minimum follow-up of 15 months were evaluated. All fractures were OTA 42. No significant differences were found between the two groups in age, gender, side of fractures, operation time, intra-operative blood loss, and follow-up time. No significant difference was seen in HSS score ( P = 0.62) between them. Sub analysis of all the HSS components scores revealed no significant differences between pain ( P = 0.57), the stand and walk ( P = 0.54), the need for walking stick ( P = 0.60) and extension lag ( P = 0.60). The other HSS components showed full scores (IP 10 vs. SP 10) in both approaches, including muscle force, flexion deformity and stability components. The range of motion (ROM) component score was superior in the IP group ( P = 0.04) suggesting a higher ROM.
Conclusions: Both SP and IP approach results in equivalent overall HSS knee scores. However, for the HSS component, the IP approach was superior to SP approach regarding the ROM.
Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders?
Authors: Lu Tao , Pu Hong , Li Kuide , Mei Jie , Huang Meng-wei , Wang Shao-yu
Published: November 2019

The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. IVIM MRI was performed on a 1.5T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and standard diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p=0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P=0.018 and 0.033 respectively), but was not lower than in patients with increta(p=1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.
Effectiveness of root caries preventive and arresting agents in middle age and older adults: a systematic review
Authors: Castelo Raisa , ATTIK Nina , Gasqui Marie-Agnès , Catirse Alma , Pradelle-Plasse Nelly , Grosgogeat Brigitte
Published: November 2019

Background: Root caries among adults is a concern and requires special attention. This systematic review aimed to assess the findings on the effectiveness of different agents to treat root caries in middle age and older adults. Methods: PubMed, Scopus, and Web of Science databases were searched systematically, following PRISMA guidelines. Clinical trials that evaluate the effectiveness of preventive and/or arresting agents for root caries in patients over 50 years old, published from 2011 to 2019 (June). This review has been registered at PROSPERO database (CRD42018104399). Results: Twelve of 277 studies fully encountered the inclusion criteria and were selected for this review. Eight agents were identified in the studies and their efficacy were assessed by different methods. The agents that presented valuable results on arresting or preventing root caries were 38% SDF, arginine-containing toothpaste and high-fluoride toothpastes. Conclusion: Based on the selected studies’ findings, annual applications of 38% SDF could be the most effective treatment for root caries in older adults. In addition, the daily use of a 1,5% arginine toothpaste or a high fluoride toothpastes could also be recommended. More research on root-caries-specific diagnose methods, especially at very early stages, are necessary.
Outcomes of HIV Exposed Infants and Predictors of Positivity after Option B+ Guideline Implementation in Amhara Regional State’s Referral Hospitals, Ethiopia
Authors: Kassaw Mesfin Wudu , Abebe Ayele Mamo , Tilaye Kenean Getaneh , Diress Gedefaw , Getu Mikiyas Amare , Zemariam Alemu Birara
Published: November 2019

Background: Elimination of MTCT of HIV was a global public health priority. In 2013, the World Health Organization recommended antiretroviral therapy administration to all HIV positive pregnant, and breastfeeding women regardless of CD4 cell count or clinical stage, which is called “Option B+”. Ethiopia have had a high rate of MTCT of HIV. The rate of transmission on breastfeeding mothers was 24% in 2012. But the rate had been increased to more than 30% in 2015.Objective: This study aimed to determine outcomes of HIV exposed infants, explore the contributors of mortality and loss to follow up, and identify factors of HIV transmission among infants born from HIV positive mothers in Amhara regional state referral hospitals, Ethiopia, 2018/19. Methods: The study was done in five Amhara regional state referral hospitals’ PMTCT departments. A simple random sampling technique with proportional allocation was used to assess the outcomes of 217 exposed infants. A retrospective quantitative cohort design and qualitative exploratory design were used in all referral hospitals of the Amhara region. The data were collected from each hospital exposed infant medical record, which was documented between January 01/2014 and May 30/2017 . An in-depth interview was also taken place from health professionals working in the PMTCT department, zonal HIV officers, and mothers who are enrolled in the PMTCT department. A cumulative incidence rate was used to present mortality, transmission, and loss to follow- up.Results: The incidence rate of HIV transmission at enrollment to PMTCT program in Amhara regional state referral hospitals was 2.3% (95% CI, 0.5-4.6%), and 3.7 (95% CI, 1.4-6.5) at the time of completing PMTCT program using antibody or DNA-PCR test. Whereas the incidence rate of LTFU in Amhara regional state referral hospitals was 8.8% (95% CI, 5.4-12.4%). But the rate of mortality after enrollment to the program was zero. The interviewees’ opinions on mortality, and loss to follow up were categorized into themes.Conclusions: Irrespective of the WHO guideline expected outcome of option B+, the outcome of the PMTCT program in this study was high, particularly HIV transmission and LTFU.