bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Impact of a Cognitive-Behavioral Intervention for Women in Domestic Violence Situations in Brazil
Authors: Habigzang Luísa Fernanda , Schneider Jaluza Aimèe , Frizzo Rafaela Petroli , Freitas Clarissa Pinto Pizarro de
Published: September 2018

Domestic violence against women constitutes a serious public health problem, which requires effective interventions for its prevention and treatment. This study aimed to develop and evaluate an intervention protocol, based on cognitive-behavioral therapy, for women in situations of domestic violence. The sample was composed of 11 women that were victims of psychological, physical, and/or sexual violence perpetrated by their partners. Symptoms of anxiety, depression, stress and post-traumatic stress disorder (PTSD) and life satisfactions levels were evaluated before and after the 13 individual psychotherapy sessions. The intervention protocol consisted of psychoeducation techniques, cognitive restructuring, gradual exposure to traumatic memories, problem resolution and recurrence prevention. Results showed a significant reduction in depression, anxiety and stress symptoms. The life satisfaction levels also increased significantly after the intervention, however, PTSD symptoms remained stable. These results constitute initial evidence for the effectiveness of the intervention. In Brazil, there is a lack of evidence-based interventions for the treatment of this population, thus, this study contributes by presenting an evidence-based intervention that may be used to qualify the actions of the public mental health services.
Protocolo de observación de la función de explicación (PROFE): un instrumento para operacionalizar la transmisión de contenidos por parte del profesorado
Authors: Borges del Rosal María África , Falcón Muñoz de Bustillo Cristina
Published: September 2018

La calidad de la docencia universitaria es fundamental dentro del proceso educativo, lo que exige la evaluación del profesorado, prefiriéndose la metodología observacional cuando se evalúa la conducta de este. El objetivo de este estudio consistió en el análisis pormenorizado de la función docente de explicación, de especial relevancia dentro el escenario educativo, lo que hace importante su análisis. Para ello, se utilizó el instrumento observacional PROFE, para medir los recursos y estrategias utilizados durante la explicación. Se ha puesto a prueba la bondad psicométrica del instrumento mediante fiabilidad, homogeneidad y se ha optimizado el número de sesiones y el tiempo, para posteriormente analizar la conducta de cinco profesores de la Universidad de La Laguna.
Renovación contextual de la distribución temporal del responder
Authors: Moreno Zazueta José Natividad , Flores Aguirre Carlos Javier
Published: September 2018

Se ha reportado que en ciertos fenómenos (recuperación espontánea, readquisición, resurgencia y renovación contextual) es posible observar la recuperación de una respuesta previamente extinguida. La renovación contextual, se refiere a la reaparición de una respuesta extinguida que resulta de un cambio de contexto entre la fase de extinción y prueba. El propósito del presente trabajo consistió en evaluar la renovación contextual, atendiendo tanto a la distribución temporal del responder, como a la tasa de respuesta. Se encontró una recuperación de la tasa de respuesta, siendo un resultado consistente con los reportados en el área de renovación contextual. Además, se pudo identificar una renovación de la distribución temporal de respuesta. Los resultados se discuten reconociendo que la tasa y la distribución temporal constituyen dos dimensiones de la ejecución que son moduladas por los cambios de contexto.
Modulation spectrum-constrained trajectory error training for mixture density network-based speech synthesis
Authors: Park Sangjun , Hahn Minsoo
Published: September 2018

In statistical parametric speech synthesis, a mixture density network is employed to address the limitations of a linear output layer such as pre-computed fixed variances and the unimodal assumption. However, it also has a defect, i.e., it cannot deploy a static-dynamic constraint needed in the training phase for high-quality speech synthesis. To cope with this problem, this paper proposes a training algorithm based on the minimum trajectory error for a mixture density network. And a modulation spectrum-constrained loss function is also proposed to alleviate the over-smoothing effect. The experimental results confirm meaningful improvement both in objective and subjective performance measures.
Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study
Authors: Gong Xiao-Huan , Wu Huan-Yu , Li Jian , Xiao Wen-Jia , Zhang Xi , Chen Min , Teng Zheng , Pan Hao , Yuan Zheng-An
Published: September 2018

Objectives

This study aimed to identify the epidemiology, clinical characteristics, aetiology and seasonality of sporadic infectious diarrhoea in adults in Shanghai.

Setting

This study was based on a city-wide, active continuous hospital-based diarrhoea surveillance network established by Shanghai Municipal Center for Disease Control and Prevention. There were 22 sentinel hospitals in all 16 districts (9 primary-level hospitals, 6 secondary-level hospitals and 7 tertiary-level hospitals) which were selected using probability proportionate to size sampling method.

Participants

From 1 May 2012 to 31 May 2016, 90 713 patients were included in this study. Among 8797 patients whose stool samples were collected and detected, 4392 patients were male.

Results

The positive rate was 47.96%. Bacterial and viral infections accounted for 27.19% and 69.07% separately. Norovirus was the most common pathogen (43.10%), followed by rotavirus,Vibrio parahaemolyticus, diarrhoeagenicEscherichia coli(DEC) andSalmonellaspp. Patients between 30–44 and 45–59 years were more likely to have infectious diarrhoea and viral diarrhoea. Those aged 30–44 years were the most likely to get infected withV. parahaemolyticus(adjusted OR, aOR vs 60+ years: 2.04, 95% CI 1.47 to 2.78) and norovirus (aOR vs 60+ years: 1.32, 95% CI 1.12 to 1.56). Bacterial (exceptV. parahaemolyticus) diarrhoea was characterised by fever, abdominal pain and loose stool; while viral diarrhoea was characterised by nausea, vomiting and watery stool. A seasonal distribution of infectious diarrhoea was observed with larger peaks in winter and smaller peaks in summer. Winter peaks were mainly due to norovirus and rotavirus, and summer peaks were due to bacterial infections. An emerging spring peak of norovirus around March was observed in the past 3 years.

Conclusion

Viral infections were predominant, and norovirus played a leading role. A seasonal distribution was observed and an emerging spring peak of norovirus was noted. Our findings highlight the necessity for conducting an active, comprehensive surveillance in adults, to monitor changing dynamics in the epidemiology and aetiology of infectious diarrhoea.
Comparing resource use between paediatric emergency department visits by triage level
Authors: Samuels-Kalow Margaret E , Niedzwiecki Matthew , Friedman Ari B , Sokolove Peter E , Hsia Renee Y
Published: September 2018

Objective

The majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as ‘non-urgent’.

Study design

We examined US ED visits for children aged 0–17 years from 1 January 2009 to 31 December 2011 in the National Hospital Ambulatory Medical Care Survey. Visits triaged on arrival as ‘non-urgent’ (level 5) were compared with urgent visits (triage levels 1–4) for resource use and disposition. Sensitivity and specificity of triage for predicting resource use and disposition were assessed.

Results

Among 21 052 observations, representing 86 620 988 visits, 11.1% were triaged as ‘non-urgent’. Diagnostic services were provided during 37.6% (95% CI 33.9% to 41.4%) of non-urgent and 55.2% (95% CI 53.3% to 57.2%) of urgent visits. Procedures were performed in 23.9% (95% CI 20.4% to 27.3%) of non-urgent and 33.9% (95% CI 31.2% to 35.9%) of urgent visits. 1.7% (95% CI 0.09% to 2.6%) of the non-urgent visits resulted in admission, with 0.08% (95% CI 0% to 0.2%) to critical care units, compared with 4.4% (95% CI 3.6% to 5.2%) of the urgent visits, with 0.3% (95% CI 0.2% to 0.4%) to critical care. Despite some substantial differences in the rates of resource use, triage score had poor sensitivity for identifying patients who did not receive ED tests, procedures or admission.

Conclusion

A significant percentage of ED patients with non-urgent ED triage scores received ED testing and procedures. More work is needed to improve methods of prospectively identifying patients with low acuity complaints who do not need significant ED resources.
Integration of echocardiographic screening by non-physicians with remote reading in primary care
Authors: Nascimento Bruno R , Beaton Andrea Z , Nunes Maria Carmo Pereira , Tompsett Allison R , Oliveira Kaciane K B , Diamantino Adriana C , Barbosa Márcia M , Lourenço Tainá V , Teixeira Isabella M , Ruiz Gabriela Z L , Rios João Pedro P , Ribeiro Antonio Luiz P , Sable Craig
Published: September 2018

Introduction

Heart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence.

Methods

Over 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17–20, 35–40 and 60–65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease.

Results

Total 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p<0.001). Prevalence was higher in patients in the SC group aged >60 years (29.2%), compared with 35–40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, p<0.001 and aortic stenosis in 5.4% vs 4.3%, p=0.51.

Conclusions

Integration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral.
Does infection withChlamydia trachomatisinduce long-lasting partial immunity? Insights from mathematical modelling
Authors: Omori Ryosuke , Chemaitelly Hiam , Althaus Christian L , Abu-Raddad Laith J
Published: September 2018

Objectives

To explore whether existence of long-lasting partial immunity against reinfection withChlamydia trachomatisis necessary to explainC. trachomatisprevalence patterns by age and sexual risk, and to provide a plausible estimate for the effect size, defined here as a reduction in susceptibility to reinfection.

Methods

A population-based mathematical model was constructed to describeC. trachomatisnatural history and transmission dynamics by age and sexual risk. The model was parameterised using natural history, and epidemiological and sexual behaviour data, and applied for UK and US data. Sensitivity analyses were conducted to assess the robustness of predictions to variations in model structure and to examine the impact of alternative assumptions for the mechanism underlying partial immunity.

Results

Partial immunity against reinfection was found necessary to explain observedC. trachomatisprevalence patterns by age and sexual risk. The reduction in susceptibility to reinfection was estimated at 93% using UK data (95% uncertainty interval (UI)=88%–97%) and at 67% using US data (95% UI=24%–88%). The model-structure sensitivity analyses affirmed model predictions. The immunity-mechanism sensitivity analyses suggested a mechanism of susceptibility reduction against reinfection or a mechanism of infectious-period duration reduction upon reinfection.

Conclusions

A strong long-lasting partial immunity againstC. trachomatisreinfection should be present to explain observed prevalence patterns. The mechanism of immunity could be either a reduction in susceptibility to reinfection or a reduction in duration of infection on reinfection.C. trachomatisinfection appears to naturally elicit a strong long-lasting immune response, supporting the concept of vaccine development.
Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients
Authors: Chambers Laura C , Morgan Jennifer L , Lowens M Sylvan , Robinson Tashina S , Romano Sarah S , Leipertz Gina L , Hughes James P , Golden Matthew R , Khosropour Christine M , Fredricks David N , Manhart Lisa E
Published: September 2018

Objective

AlthoughChlamydia trachomatis(CT) andMycoplasma genitalium(MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired.

Methods

We enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes withoutNeisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW).

Results

Between 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU−) and 249 MSW (126 NGU+, 123 NGU−). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU.

Conclusions

Among MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.
Pricing and Service Quality Guarantee Decisions in Logistics Service Supply Chain with Fairness Concern
Authors: Du Ni , Han Qinglan
Published: September 2018

Although existing contributions that explore service quality guarantee problem of a logistic service supply chain (LSSC) consider fairness concern behavior of one member, little attention is paid to considering the combination of members’ fairness concern and the joint decision of pricing and service quality guarantee in LSSC. Therefore, it is necessary to research how different fairness concern affects the joint decision of pricing and service quality guarantee in an LSSC. First considering a price and quality-sensitive logistics service market, a basic model without fairness concern of a customized LSSC is established. Then, a new model with fairness concern of a decentralized LSSC is constructed based on the basic model. The optimal decision of the LSSC with fairness concern is investigated in three cases. In each case, we analyze the effect of fairness concern on the optimal decision, and the expected profits and utilities. Finally, some numerical studies are shown to verify our theoretical analyses and some managerial insights are given.
SIGIR Initiative to Implement ACM Artifact Review and Badging
Authors: Ferro Nicola , Kelly Diane
Published: September 2018

Recently, the ACM created a policy on Artifact Review and Badging, which presents a framework to help SIGs recognize repeatability, replicability and reproducibility in published research. While the ACM policy established a vocabulary and definitions, it did not prescribe procedures for implementation. Rather, the ACM has left this to each SIG to define given the variety of research traditions and approaches that exist with the ACM community. SIGs are not required to implement badging, but given the growing interest in this topic in the SIGIR community, a task force has been assembled to determine how badging might be implemented. This report describes the ACM policy on Artifact Review and Badging, introduces the task force, and presents survey data describing the SIGIR community's opinions about this initiative.
Natural Killer Cells in Liver Disease and Hepatocellular Carcinoma and the NK Cell-Based Immunotherapy
Authors: Liu Pingyi , Chen Lingling , Zhang Haiyan
Published: September 2018

Nature killer (NK) cells play a critical role in host innate and adaptive immune defense against viral infections and tumors. NK cells are enriched in liver hematopoietic cells with unique NK repertories and functions to safeguard liver cells against hepatitis virus infection or malignancy transformation. However, accumulating evidences were found that the NK cells were modulated by liver diseases and liver cancers including hepatocellular carcinoma (HCC) and showed impaired functions failing to activate the elimination of the viral-infected cells or tumor cells and were further involved in the pathogenesis of liver injury and inflammation. The full characterization of circulation and intrahepatic NK cell phenotype and function in liver disease and liver cancer has not only provided new insight into the disease pathogenesis but has also discovered new targets for developing new NK cell-based therapeutic strategies. This review will discuss and summarize the NK cell phenotypic and functional changes in liver disease and HCC, and the NK cell-based immunotherapy approaches and progresses for cancers including HCC will also be reviewed.
Analysis of User Content Retrieval Delay Based on the Matern Hard‐Core Point Process of Type II
Authors: Zhao Shuyuan , Zhao Jihong , Qu Hua , Ren Gongye
Published: September 2018

The content retrieval delay is an important performance metric for enhancing user experience in wireless networks. In this paper, by modeling the locations of the base stations (BSs) as the Matern hard‐core point process of type II (MHP), we analyze the content retrieval delay for a typical cache‐enabled device in wireless networks under the most popular content policy. Since it is intractable to get the size distribution of a Voronoi cell in the MHP model, we propose an approximate formula based on the empirical result in the Poisson point process and derive the cellular load which denotes the number of the user devices connected to a randomly chosen BS. Since the probability generating functional for MHP does not exist, we also propose approximate methods for the coverage probability of the MHP model. At last, we derive the cumulative distribution function of the content retrieval delay. Simulation results validate the accuracy of our analytical conclusions for user content retrieval delay.
A Peer‐to‐Peer Architecture for Distributed Data Monetization in Fog Computing Scenarios
Authors: de la Vega Francisco , Soriano Javier , Jimenez Miguel , Lizcano David
Published: September 2018

Modern IoT deployments do require considerable investments that might only be justified if the data being gathered could be monetized, which leads to the need for a digital data marketplace. In many cases, the provider of the IoT data needs to process it locally for data curation, aggregation, stream processing, etc. At the same time, the consumer could be interested in nearby data. This scenario resembles a fog computing architecture where companies require being able, keeping data under their control, to securely make it available to other companies in a peer‐to‐peer fashion, without needing a cloud intermediary (like traditional marketplaces do), thus maximizing the locality of the processing and avoiding the existence of a bottleneck when the intermediary makes the data delivery for accounting purposes. Nevertheless, this imposes a hard requirement: by not having a central marketplace, the peers (seller and customer) need to trust each other, which, in turn, requires enforcing a nonrepudiation schema. In this paper, the authors propose a distributed peer‐to‐peer architecture for such a data marketplace that takes advantage of the architectural fundamentals of fog computing, in which data processing, filtering, and stream based event generation is done in a fog node along with the data, and where relationships, both commercial agreements and data delivery, are performed directly between producers and consumers without the need of mutual trust thanks to the usage of blockchain principles (e.g., distributed ledger, consensus mechanism). The proposed architecture is validated through a case study involving a set of key issues regarding nonrepudiation commonly identified when moving from a centralized marketplace to a distributed one. Moreover, it is shown that the proposed solution does not bring in any limitation with regard to a centralized marketplace solution, in terms of pricing models (subscriptions, pay‐per‐use, etc.) or usage conditions (contract duration, updates rate, etc.).
A Comparative Experimental Study on the Flexural Behavior of High‐Strength  Fiber‐Reinforced Concrete and High‐Strength Concrete Beams
Authors: Yang In-Hwan , Joh Changbin , Kim Kyoung-Chul
Published: September 2018

The flexural responses of high‐strength fiber‐reinforced concrete (HSFRC) beams and high‐strength concrete (HSC) beams are compared in this study. A series of HSFRC and HSC beams were tested under pure flexural loading. The effects of the type of concrete, compressive strength of the concrete, and tensile rebar ratio on the flexural behavior of the concrete beams were investigated. The flexural behavior of the HSFRC and HSC beams including the induced crack and failure patterns, load and deflection capacity, crack stiffness, ductility index, and flexural toughness was compared. The crack stiffness of the HSC and HSFRC beams increased with the rebar ratio. For the same rebar ratios, the crack stiffness of the HSFRC beams was much greater than that of the HSC beams. The ductility index of the HSC beams decreased sharply with an increase in the rebar ratio, but the ductility index of the HSFRC beams did not show a clear decrease with increasing rebar ratio. The flexural toughness of the HSFRC beams was greater than that of the HSC beams at higher rebar ratios of 1.47% and 1.97%, indicating that the energy absorption of the HSFRC beams was greater than that of the HSC beams. Test results also indicated that HSFRC developed better and more consistent ductility with higher rebar ratio. In addition, the tested bending strength and sectional analysis results were compared.
Nonlinear Dynamic Characteristic Analysis of a Landing String in Deepwater Riserless Drilling
Authors: Liu Jun , Zhao Hongliang , Yang Simon X. , Liu Qingyou , Wang Guorong
Published: September 2018

The landing string is an important component of deepwater riserless drilling systems. Determination of the dynamic characteristics of the landing string plays an essential role in its design for ensuring its safe operation. In this paper, a dynamic model is developed to investigate the dynamic response characteristics of a landing string, where a landing string in a marine environment is modeled as a flexible slender tube undergoing coupled transverse and axial motions. The heaving motion of the drilling platform is taken as the upper boundary condition and the motion of the drilling bit caused by the interaction between the rock and the bit as the lower boundary condition. A semiempirical Morison equation is used to simulate the effect of the load imposed by the marine environment. The dynamic model, which is nonlinearly coupled and multibody, is discretized by a finite element method and solved by the Newmark technique. Using the proposed model, the dynamic responses of the displacement, axial force, and moment in the landing string are investigated in detail to find out the influences of driving depth of surface catheter, platform motion, bit movement, and marine environment on the dynamical characteristics of the landing string.
Synergistic Interaction of HOXB13 and CIP2A Predisposes to Aggressive Prostate Cancer
Authors: Sipeky Csilla , Gao Ping , Zhang Qin , Wang Liang , Ettala Otto , Talala Kirsi M. , Tammela Teuvo L.J. , Auvinen Anssi , Wiklund Fredrik , Wei Gong-Hong , Schleutker Johanna
Published: September 2018

Purpose:

Distinguishing aggressive prostate cancer from indolent disease improves personalized treatment. Although only few genetic variants are known to predispose to aggressive prostate cancer, synergistic interactions of HOXB13 G84E high-risk prostate cancer susceptibility mutation with other genetic loci remain unknown. The purpose of this study was to examine the interplay of HOXB13 rs138213197 (G84E) and CIP2A rs2278911 (R229Q) germline variants on prostate cancer risk.

Experimental Design:

Genotyping was done in Finnish discovery cohort (n = 2,738) and validated in Swedish (n = 3,132) and independent Finnish (n = 1,155) prostate cancer cohorts. Expression pattern analysis was followed by functional studies in prostate cancer cell models.

Results:

Interplay of HOXB13 (G84E) and CIP2A (R229Q) variants results in highest observed inherited prostate cancer risk (OR, 21.1; P = 0.000024). In addition, this synergism indicates a significant association of HOXB13 T and CIP2A T dual carriers with elevated risk for high Gleason score (OR, 2.3; P = 0.025) and worse prostate cancer–specific life expectancy (HR, 3.9; P = 0.048), and it is linked with high PSA at diagnosis (OR, 3.30; P = 0.028). Furthermore, combined high expression of HOXB13-CIP2A correlates with earlier biochemical recurrence. Finally, functional experiments showed that ectopic expression of variants stimulates prostate cancer cell growth and migration. In addition, we observed strong chromatin binding of HOXB13 at CIP2A locus and revealed that HOXB13 functionally promotes CIP2A transcription. The study is limited to retrospective Nordic cohorts.

Conclusions:

Simultaneous presence of HOXB13 T and CIP2A T alleles confers for high prostate cancer risk and aggressiveness of disease, earlier biochemical relapse, and lower disease-specific life expectancy. HOXB13 protein binds to CIP2A gene and functionally promotes CIP2A transcription.
The Protease-Dependent Mesenchymal Migration of Tumor-Associated Macrophages as a Target in Cancer Immunotherapy
Authors: Gui Philippe , Ben-Neji Myriam , Belozertseva Ekaterina , Dalenc Florence , Franchet Camille , Gilhodes Julia , Labrousse Arnaud , Bellard Elisabeth , Golzio Muriel , Poincloux Renaud , Maridonneau-Parini Isabelle , Le Cabec Véronique
Published: September 2018

Macrophage recruitment is essential for tissue homeostasis but detrimental in most cancers. Tumor-associated macrophages (TAMs) play a key role in cancer progression. Controlling their migration is, thus, potentially therapeutic. It is assumed that macrophages use amoeboid motility in vivo like other leukocytes. However, it has not yet been explored. We examined TAM migration using intravital microscopy in mouse tumors and by monitoring ex vivo tissue infiltration in human surgical samples. We demonstrated that TAMs perform protease-dependent and ROCK-independent mesenchymal migration inside mouse fibrosarcoma and breast cancer explants using their own matrix metalloproteases (MMP). In contrast, macrophages use ROCK-dependent and protease-independent amoeboid migration inside inflamed ear derma and in connective tissue at the tumor periphery. We also showed that inhibition of mesenchymal migration correlates with decreased TAM recruitment and tumor growth. In conclusion, this study elucidates how macrophages migrate in vivo, and it reveals that the MMP-dependent migration mode of TAMs provides a rationale for a new strategy in cancer immunotherapy: to target TAMs specifically through their motility. Cancer Immunol Res; 6(11); 1337–51. ©2018 AACR.
Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study
Authors: Ohata Ken , Sakai Eiji , Nakao Tomomi , Kimoto Yoshiaki , Ishii Rindo , Konishi Takafumi , Ueno Sayaka , Takita Maiko , Negishi Ryoju , Morinushi Tatsuo , Muramoto Takashi , Matsuhashi Nobuyuki , Nakaya Teruo , Koba Ikuro , Nakaji Shigeyuki
Published: September 2018

Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated. Results: Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65–10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23–11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34–18.2, p < 0.001) were significant independent predictors of severe OSAS. Conclusion: A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS.
A Dementia Café as a Bridgehead for Community-Inclusive Care: Qualitative Analysis of Observations by On-the-Job Training Participants in a Dementia Café
Authors: Takechi Hajime , Sugihara Yuriko , Matsumoto Hitomi , Yamada Hiroko
Published: September 2018

Background/Aims: Dementia cafés are becoming widespread as a new approach to dementia care, but their operational procedures and significance have not been adequately studied. Methods: On-the-job training (OJT) for professionals planning to operate a dementia café in the future was conducted in a pioneering dementia café in Japan. The reports of OJT trainees’ observations and learning were analyzed qualitatively. Results: Reports could be summarized in up to 9 themes: 2 related to the atmosphere and significance of the café, 3 related to the guests, such as people with dementia and their families, and 4 related to the café staff. Discussion: The results of the present study identified the elements that make up dementia cafés and their significance and suggest that dementia cafés could be a new type of community resource for dementia care in the future.
Feasibility of International Proposed Standardized Enteral Connector for Semi-Solid Formula Feeding
Authors: Maruyama Michio , Iijima Shohei , Ishibashi Nobuya , Inukai Michio , Oriishi Tetsuharu , Kawasaki Naruo , Kurata Naomi , Suzuki Yutaka , Tabei Isao , Chiba Masahiro , Nakamura Etsuko , Higashiguchi Takashi
Published: September 2018

Background/Aims: The current study was undertaken to assess if the semi-solid formulas could be used with a new ENFit connector with similar force to current percutaneous endoscopic gastrostomy (PEG) tubes. Methods: Experiment 1: We measured the applied pressure (force) needed to compress the syringe containing 7 viscous semi-solid formulas with a 20 Fr PEG tube and low-profile tube through the ENFit connector or the current connector. Experiment 2: This experiment was conducted to evaluate the compression force through 2 connectors in 3 infusion velocity, 7 PEG tube types with 2 semi-solid formulas. Results: Experiment 1: The force needed to compress the syringe through the ENFit connector was higher in 3 semi-solid formulas with a 20 Fr low-profile tube; otherwise, there were no significant differences. Experiment 2: Each formula required a higher force in the ENFit connector in 6 settings out of 21. Conclusions: The ENFit connector will likely not show any remarkable change in the force to administer the semi-solid formula. However, a higher force was required under some conditions in the prototype ENFit connector. Further investigation of sensory test is needed to confirm the feasibility of the ENFit connector for using the semi-solid formulas.
ЛІКАРСЬКА ПОМИЛКА: СУЧАСНИЙ ПОГЛЯД НА ПРОБЛЕМУ З ПОЗИЦІЇ СУДОВО-МЕДИЧНОЇ ЕКСПЕРТНОЇ ПРАКТИКИ
Authors: Franchuk V. V.
Published: September 2018

Випадки судових позовів, пов’язаних із неналежним наданням медичної допомоги, стали помітною проблемою сучасної України. Разом з тим, особливості невдалого виконання медичними працівниками різних фахів власних професійних обов’язків залишаються сьогодні в країні практично не дослідженими.Мета – з’ясування медико-правових особливостей лікарських помилок в Україні.Матеріал і методи. Досліджено матеріали судово-слідчих справ, порушених проти медичних працівників різних регіонів України, і виконаних відповідно до цих справ комісійних експертиз в Тернопільському, Чернівець­кому та Житомирському обласних бюро судово-медичної експертизи за 2007–2016 рр. (загалом вивчено 350 таких справ).Результати. Вивчені поширеність, особливості, причини та наслідки лікарських помилок. Недоліки у наданні медичної допомоги виявлені в 72,0 % експертиз за «лікарськими справами». Неналежне виконання професійних обов’язків допускали зазвичай лікарі стаціонарних відділень районних і міських лікарень. Найчастіше медичні працівники припускались діагностичних помилок, питома вага яких серед інших дефектів медичної допомоги склала 29,7 %, лікувально-тактичні помилки мали місце у 27,9 % випадків, помилки у веденні медичної документації – у 21,3 %, організаційні – у 14,6 %, деонтологічні – 7,5 %. Помилкові дії лікарів рідко були одиничними, зазвичай асоціюючись між собою. Структура лікарських помилок за якісною характеристикою була наступною: недос­татній обсяг медичної допомоги (54,3 %), несвоєчасність медичної допомоги (27,0 %), неправильність її надання (14,4 %), ненадання (4,3 %). Дефекти якості медичної допомоги зустрічались як поодиноко, так і комбіновано. Недоліки у наданні медичної допомоги майже завжди (97,0 %) супроводжувались тяжкими наслідками – смертю пацієнтів. Неналежні дії медичних працівників, які мали причинно-наслідковий зв’язок із несприятливими наслідками, констатовані в 12,9 % випадків експертиз.Висновки. Різноманітні дефекти у наданні медичної допомоги констатовані судово-медичними експертними комісіями серед 3/4 «лікарських справ». Медичні працівники найчастіше припускались діагностичних та лікувально-тактичних помилок. Майже кожен п’ятий випадок неналежної медичної допомоги був викликаний некваліфікованими діями лікарів.
Collateral Clock Is More Important Than Time Clock for Tissue Fate
Authors: Vagal Achala , Aviv Richard , Sucharew Heidi , Reddy Mahati , Hou Qinghua , Michel Patrik , Jovin Tudor , Tomsick Thomas , Wintermark Max , Khatri Pooja
Published: September 2018

Background and Purpose—

Although perfusion abnormality is an increasingly important therapeutic target, the natural history of tissue at risk without reperfusion treatment is understudied. Our objective was to determine how time affects penumbral salvage and infarct growth in untreated acute ischemic stroke patients and whether collateral status affects this relationship.

Methods—

We used a prospectively collected, multicenter acute stroke registry to assess acute stroke patients who were not treated with intravenous thrombolysis or endovascular treatment. We analyzed baseline computed tomography angiogram and computed tomography perfusion within 24 hours of stroke onset along with follow-up imaging and assessed time from stroke onset to baseline imaging, ASPECTS (Alberta Stroke Program Early CT Score), vessel occlusion, collaterals, ischemic core, and penumbra. Penumbral salvage and infarct growth were calculated. Correlations between time and penumbral salvage and infarct growth were evaluated with Spearman correlation. Penumbral salvage and infarct growth were compared between subjects with good versus poor collateral status using the Wilcoxon rank-sum test. Clinical and imaging factors affecting penumbral salvage and infarct growth were evaluated by linear regression.

Results—

Among 94 untreated stroke patients eligible for this analysis, the mean age was 65 years, median National Institutes of Health Stroke Scale score was 13, and median (range) time from stroke onset to baseline imaging was 2.9 (0.4–23) hours. There was no correlation between time and salvaged penumbra (
r
=0.06;
P
=0.56) or infarct growth (
r
=−0.05;
P
=0.61). Infarct growth was higher among those with poor collaterals versus those with good collaterals (median, 52.3 versus 0.9 cm
3
;
P
<0.01). Penumbral salvage was lower among those with poor collaterals compared with those with good collaterals (poor, 0 [0–0]; good, 5.9 cm
3
[0–29.4];
P
<0.01). Multivariable linear regression demonstrated that collaterals, but not time, were significantly associated with infarct growth and penumbral salvage.

Conclusions—

In this natural history study, penumbral salvage and infarct growth were less time dependent and more a measure of collateral flow.
Angioedema and Hemorrhage After 4.5-Hour tPA (Tissue-Type Plasminogen Activator) Thrombolysis Ameliorated by T541 via Restoring Brain Microvascular Integrity
Authors: Chen Qing-Fang , Liu Yu-Ying , Pan Chun-Shui , Fan Jing-Yu , Yan Li , Hu Bai-He , Chang Xin , Li Quan , Han Jing-Yan
Published: September 2018

Background and Purpose—

tPA (tissue-type plasminogen activator) is the only recommended intravenous thrombolytic agent for ischemic stroke. However, its application is limited because of increased risk of hemorrhagic transformation beyond the time window. T541 is a Chinese compound medicine with potential to attenuate ischemia and reperfusion injury. This study was to explore whether T541-benefited subjects underwent tPA thrombolysis extending the time window.

Methods—

Male C57BL/6 N mice were subjected to carotid artery thrombosis by stimulation with 10% FeCl
3
followed by 10 mg/kg tPA with/without 20 mg/kg T541 intervention at 4.5 hours. Thrombolysis and cerebral blood flow were observed dynamically until 24 hours after drug treatment. Neurological deficit scores, brain edema and hemorrhage, cerebral microvascular junctions and basement membrane proteins, and energy metabolism in cortex were assessed then. An in vitro hypoxia/reoxygenation model using human cerebral microvascular endothelial cells was used to evaluate effect of T541 on tight junctions and F-actin in the presence of tPA.

Results—

tPA administered at 4.5 hours after carotid thrombosis resulted in a decrease in thrombus area and survival rate, whereas no benefit on cerebral blood flow. Study at 24 hours after tPA administration revealed a significant angioedema and hemorrhage in the ischemia hemisphere, a decreased expression of junction proteins claudin-5, zonula occludens-1, occludin, junctional adhesion molecule-1 and vascular endothelial cadherin, and collagen IV and laminin. Meanwhile, ADP/ATP, AMP/ATP, and ATP5D (ATP synthase subunit) expression and activities of mitochondria complex I, II, and IV declined, whereas malondialdehyde and 8-Oxo-2′-deoxyguanosine increased and F-actin arrangement disordered. All the insults after tPA treatment were attenuated by addition of T541 dose dependently.

Conclusions—

The results suggest T541 as a potential remedy to attenuate delayed tPA-related angioedema and hemorrhage and extend time window for tPA treatment. The potential of T541 to upregulate energy metabolism and protect blood-brain barrier is likely attributable to its effects observed.
Thrombus Volume as a Predictor of Nonrecanalization After Intravenous Thrombolysis in Acute Stroke
Authors: Yoo Joonsang , Baek Jang-Hyun , Park Hyungjong , Song Dongbeom , Kim Kyoungsub , Hwang In Gun , Kim Young Dae , Kim Seo Hyun , Lee Hye Sun , Ahn Seong Hwan , Cho Han-Jin , Kim Gyu Sik , Kim Jinkwon , Lee Kyung-Yul , Song Tae-Jin , Choi Hye-Yeon , Nam Hyo Suk , Heo Ji Hoe
Published: September 2018

Background and Purpose—

We investigated whether measuring the volume and density of a thrombus could predict nonrecanalization after intravenous thrombolysis.

Methods—

This study included a retrospective cohort to develop a computed tomography marker of thrombus for predicting nonrecanalization after intravenous thrombolysis and a prospective multicenter cohort for validation of this marker. The volume and density of thrombus were measured semiautomatically using 3-dimensional software on a baseline thin-section noncontrast computed tomography (1 or 1.25 mm). Recanalization was assessed on computed tomography angiography or magnetic resonance angiography immediately after intravenous thrombolysis or conventional angiography in patients who underwent further intra-arterial treatment. Nonrecanalization was defined as a modified Thrombolysis in Cerebral Infarction grade 0, 1, 2a.

Results—

In the retrospective cohort, 162 of 214 patients (76.7%) failed to achieve recanalization. The thrombus volume was significantly larger in patients with nonrecanalization than in those with successful recanalization (149.5±127.6 versus 65.3±58.3 mm
3
;
P
<0.001). In the multivariate analysis, thrombus volume was independently associated with nonrecanalization (
P
<0.001). The cutoff for predicting nonrecanalization was calculated as 200 mm
3
. In the prospective multicenter validation study, none of the patients with a thrombus volume ≥200 mm
3
among 78 enrolled patients achieved successful recanalization. The positive and negative predictive values were 95.5 and 29.4 in the retrospective cohort 100 and 23.3 in the prospective validation cohort, respectively. The thrombus density was not associated with nonrecanalization.

Conclusions—

Thrombus volume was predictive of nonrecanalization after intravenous thrombolysis. Measurement of thrombus volume may help in determining the recanalization strategy and perhaps identify patients suitable for direct endovascular thrombectomy.
Elevated International Normalized Ratio Is Associated With Ruptured Aneurysms
Authors: Can Anil , Castro Victor M. , Dligach Dmitriy , Finan Sean , Yu Sheng , Gainer Vivian , Shadick Nancy A. , Savova Guergana , Murphy Shawn , Cai Tianxi , Weiss Scott T. , Du Rose
Published: September 2018

Background and Purpose—

The effects of anticoagulation therapy and elevated international normalized ratio (INR) values on the risk of aneurysmal subarachnoid hemorrhage are unknown. We aimed to investigate the association between anticoagulation therapy, elevated INR values, and rupture of intracranial aneurysms.

Methods—

We conducted a case-control study of 4696 patients with 6403 intracranial aneurysms, including 1198 prospective patients, diagnosed at the Massachusetts General Hospital and the Brigham and Women’s Hospital between 1990 and 2016 who were on no anticoagulant therapy or on warfarin for anticoagulation. Patients were divided into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to evaluate the association of anticoagulation therapy, INR values, and presentation with a ruptured intracranial aneurysm, taking into account the interaction between anticoagulant use and INR. Inverse probability weighting using propensity scores was used to minimize differences in baseline demographics characteristics. The marginal effects of anticoagulant use on rupture risk stratified by INR values were calculated.

Results—

In unweighted and weighted multivariable analyses, elevated INR values were significantly associated with rupture status among patients who were not anticoagulated (unweighted odds ratio, 22.78; 95% CI, 10.85–47.81 and weighted odds ratio, 28.16; 95% CI, 12.44–63.77). In anticoagulated patients, warfarin use interacts significantly with INR when INR ≥1.2 by decreasing the effects of INR on rupture risk.

Conclusions—

INR elevation is associated with intracranial aneurysm rupture, but the effects may be moderated by warfarin. INR values should, therefore, be taken into consideration when counseling patients with intracranial aneurysms.
State Election Commission: Unravelled
Authors: Jain Anita Bhatnagar
Published: September 2018

India, the biggest democracy, is over 70 years old. Besides other regulatory authorities, election commissions have played a pivotal role in its formation. State election commissions (SECs) got the constitutional footing via the 73rd and 74th Amendments in 1993. Articles 243K and 243ZA provided for the elections to panchayats and municipalities, respectively. The panchayats comprise of district, block and village levels, while the municipalities include three levels based on the slab of urban population. The present study focuses on the SEC of Uttar Pradesh on various variables, including service conditions of commissioner, organisational structure, increasing responsibility, budget, use of technology and electronic voting machines (EVMs), measures to ensure transparency and objectivity and so on. The study surmises the challenge of evolving complexion of SECs in the changing environment. However, the role of various political parties and citizens and the sensitive issues of electoral reforms have to be simultaneously addressed for ensuring real democracy.
Unraveling Secessions
Authors: Hentschel Friedhelm
Published: September 2018

In many ethnically segregated countries, policy is directly linked to ethnicity, and thus, nonruling ethnic groups may suffer from the implemented policy. For these groups, a secession is one instrument to eliminate ethnic heterogeneity costs by implementing their own policy. However, leaving the country reduces economies of scale in the public good provision. Therefore, separatist ethnic groups face a trade-off between eliminating ethnic heterogeneity costs and losing economies of scale in the provision of public goods. I present a model for unraveling secessions in an ethnically segregated country. I use this model to derive conditions for the breakup of countries and to compare equilibrium behavior with and without the possibility of a consecutive secession. Among others, I find that a secessionist conflict will be more likely if there is a previous secession. Furthermore, aggregated conflict spending is larger in secessions with the possibility of a consecutive conflict.