bluuebunny/crossref_metadata_2025 huggingface dataset:
Erenumab: A First-in-Class Monoclonal Antibody for Migraine Prevention
Authors: Garland Scott G. , Smith Steven M. , Gums John G.
Published: February 2019

Objective: To review the pharmacology, efficacy, and safety of the calcitonin gene-related peptide (CGRP) inhibitor erenumab for migraine preventive therapy. Data Sources: A MEDLINE/PubMed search (January 2000 to January 2019) was conducted using the keywords erenumab-aooe, erenumab, migraine, migraine prophylaxis, migraine prevention, and chronic migraine. Additional articles were identified by hand from references. Study Selection and Data Extraction: We included English-language articles (excluding poster presentations) evaluating erenumab pharmacology, efficacy, or safety in humans for migraine prevention. Data Synthesis: Erenumab is a CGRP inhibitor that inhibits vasodilation in response to acute migraines, which decreases pain perception during the migraine. Erenumab efficacy and safety has only been compared with placebo, but its reduction in monthly migraine days (MMDs) and medication response (≥50% reduction in MMDs) are comparable to current recommended off-label therapies for migraine prevention in short-term treatment studies. Additionally, erenumab is associated with low adverse event burden with no difference found compared with placebo per published clinical trials. Relevance to Patient Care and Clinical Practice: Erenumab is the first medication approved in the United States for the prevention of migraines in adults. No head-to-head data are available, but existing data suggest that erenumab is at least as effective as current off-label products and with reduced adverse effects. Conclusion: Erenumab is an effective once-monthly injectable agent for migraine prevention in patients with chronic or episodic migraine. It is also effective for patients who have previously failed migraine preventive therapy. Erenumab has a favorable adverse effect profile, which may improve patient adherence.
Celebrity Cancer on Twitter: Mapping a Novel Opportunity for Cancer Prevention
Authors: Vos Sarah C. , Sutton Jeannette , Gibson C. Ben , Butts Carter T.
Published: February 2019

Social media platforms have the potential to facilitate the dissemination of cancer prevention and control messages following celebrity cancer diagnoses. However, cancer communicators have yet to systematically leverage these naturally occurring interventions on social media as these events are difficult to identify as they are unfolding and little research has analyzed their effect on social media conversations. In this study, we add to the research by analyzing how a celebrity cancer announcement influenced Twitter conversations in terms of the volume of social media messages and the type of content. Over a 9-day period, during which actor Ben Stiller announced that he had been treated for prostate cancer, we collected 1.2 million Twitter messages about cancer. We conducted automated content analyses to identify how often common cancer sites (prostate, breast, colon, or lung) were discussed. Then, we used manual content analysis on a sample of messages to identify cancer continuum content (awareness, prevention, early detection, diagnosis, treatment, survivorship, and end of life). Chi-square analyses were implemented to evaluate changes in cancer site and cancer continuum content before and after the announcement. We found that messages related to prostate cancer increased significantly more than expected for 2 days following Stiller’s announcement. However, the number of cancer messages that described other cancer locations either did not increase or did not increase by the same magnitude. In terms of message content, results showed larger than expected increases in diagnosis messages. These results suggest opportunities to shape social media conversations following celebrity cancer announcements and increase prevention and early detection messages.
News Use as Amplification: Norwegian National, Regional, and Hyperpartisan Media on Facebook
Authors: Larsson Anders Olof
Published: February 2019

This study details the influence of hyperpartisan media actors in comparison to regional and national news media competitors by gauging audience engagement in relation to news on Facebook in Norway. Adopting the perspective of news use as a way of understanding such engagement, the study finds that followers of hyperpartisan Facebook Pages are more active than those following mainstream media Pages. The study also looks closer into what kinds of news are engaged with to higher degrees than others, building on these results in suggesting opportunities for future research into news production and consumption on Facebook.
The “cancer–cold” hypothesis and possible extensions for the Nordic populations
Authors: Voskarides Konstantinos
Published: February 2019

Cancer incidence is inexplicably high in cold countries. This has been revealed by recent genetic and epidemiological studies. These studies used data from the GLOBOCAN-2012 database, for 186 populations and for a variety of cancer types. Cancer incidence in Nordic people is particularly high for the frequent cancer forms, like breast, prostate and colon cancer. A relationship of cancer with cold is suspected since Inuit and Alaska Indians that live in even more extreme low temperatures have the higher cancer rates in the world. In this article, possible reasons for this phenomenon are discussed. These explanations are related with: evolutionary adaptation to extreme cold, the genetic background of Nordic people, the experimentally proven fast growth and metastasis of tumors at low temperatures, high concentration of certain air pollutants at cold environments, low levels of serum Vitamin D, overdiagnosis by the medical doctors and high quality of the health system in Nordic countries. Lifestyle parameters are not discussed in detail, although these may be equally crucial for cancer risk in cold countries. In conclusion, more studies are needed to elucidate the real causes of this epidemiological pattern.
The selective mineralocorticoid receptor modulator AZD9977 reveals differences in mineralocorticoid effects of aldosterone and fludrocortisone
Authors: Bamberg Krister , William-Olsson Lena , Johansson Ulrika , Jansson-Löfmark Rasmus , Hartleib-Geschwindner Judith
Published: February 2019

Introduction:

AZD9977 is a novel mineralocorticoid receptor (MR) modulator, which in preclinical studies demonstrated organ protection without affecting aldosterone-regulated urinary electrolyte excretion. However, when tested in humans, using fludrocortisone as an MR agonist, AZD9977 exhibited similar effects on urinary Na+/K+ ratio as eplerenone. The aim of this study is to understand whether the contradictory results seen in rats and humans are due to the mineralocorticoid used.

Materials and methods:

Rats were treated with single doses of AZD9977 or eplerenone in combination with either aldosterone or fludrocortisone. Urine was collected for five to six hours and total amounts excreted Na+ and K+ were assessed.

Results:

AZD9977 dose-dependently increased urinary Na+/K+ ratio in rats when tested against fludrocortisone, but not when tested against aldosterone. Eplerenone dose-dependently increased urinary Na+/K+ ratio when tested against fludrocortisone as well as aldosterone.

Conclusions:

The data suggest that the contrasting effects of AZD9977 on urinary electrolyte excretion observed in rats and humans are due to the use of the synthetic mineralocorticoid fludrocortisone. Future clinical studies are required to confirm the reduced electrolyte effects of AZD9977 and the subsequent lower predicted hyperkalemia risk.
Experimental investigation of a small-scaled model for overflow section of a high gravity dam on shaking table
Authors: Wang Mingming , Chen Jianyun , Wei Hai , Song Bingyue
Published: February 2019

A 203 m-high concrete gravity dam is a huge structure for which the dynamic responses, damage mechanism, and safety evaluation under an intense earthquake need to be investigated carefully and in detail. This article presents the results of the dynamic failure model test on the overflow section of the aforementioned dam. It presents the seismic characteristics, failure mode, and safety evaluation for the overflow section during a strong earthquake. Two models of the dam section have been tested on the shaking table to simulate earthquake effects in a laboratory. The first model considers the Chinese code seismic wave, while the second model considers the Wenchuan seismic wave, a natural wave. The peak ground acceleration (PGA) of the first crack during testing determines the seismic safety level of the dam, and the locations and forms of cracks at the end of testing indicate the vulnerable areas of the dam under two kinds of earthquake inputting. After the final analysis, the results of the experimental works for the overflow during an earthquake offer an important reference for engineering designers working on anti-seismic design.
Fuzzy optimization of energy management for power split hybrid electric vehicle based on particle swarm optimization algorithm
Authors: Yin Chunfang , Wang Shaohua , Yu Chengquan , Li Jiaxin , Zhang Sheng
Published: February 2019

A dual planetary gear hybrid electric vehicle is introduced in the paper. The speed and torque relations between different components of the power split hybrid system are systematically established using the lever analogy. Based on the electric power balance, the influence of the ratio between the engine speed and output speed of the power coupling system on the hybrid electric vehicle powertrain transmission efficiency is revealed, and the transmission efficiency optimization strategy is further proposed. Since some engine operation points are distributed in the low-efficiency region, the engine torque control strategy is designed using fuzzy control algorithm. The fuzzy membership function and fuzzy rules are optimized by particle swarm optimization to reduce the bad influence of expert experience and knowledge on the derivation of optimal engine torque. The vehicle powertrain and the control strategy models are established based on AVL/Cruise and MATLAB/Simulink platforms, and the joint simulation is conducted. Simulation results show that the proposed optimal energy management strategy can optimize the operation points of the engine. The final value of the battery state of charge is kept within a reasonable range, and the equivalent fuel consumption of the whole vehicle is reduced by 10.26% compared with that the transmission efficiency optimization control strategy.
Community pharmacists’ experiences with the Saskatchewan Medication Assessment Program
Authors: Currie Krysta , Evans Charity , Mansell Kerry , Perepelkin Jason , Jorgenson Derek
Published: February 2019

Background:

The Saskatchewan Medication Assessment Program (SMAP) is a publicly funded community pharmacy–based medication assessment service with limited previous evaluation. The purpose of this study was to explore community pharmacists’ experiences with the SMAP.

Methods:

Online, self-administered questionnaire that consisted of a combination of 53 Likert scale and free-text questions. All licensed pharmacists who were practising in a community pharmacy setting in Saskatchewan were eligible to participate.

Results:

Response rate was 20.3% ( n = 228/1124). Most respondents agreed that the SMAP is achieving all of its intended purposes. For example, 89.7% agreed that the SMAP improved medication safety for patients who receive the service. Most pharmacists enjoyed performing the assessments (84.6%) and were confident in their ability to identify drug-related problems (88.3%). Pharmacists reported lack of time, patients having difficulty coming to the pharmacy and restrictive eligibility criteria as the top barriers to the SMAP. Good teamwork, employer support and personal professional commitment were the top recognized facilitators. Respondents made several suggestions to improve the SMAP in the free-text areas of the questionnaire.

Conclusions:

Community pharmacists in Saskatchewan were positive and confident about performing medication assessments, and most agreed that the SMAP is achieving all of the intended purposes. Respondents also identified several barriers to providing SMAP services, which have resulted in specific recommendations that should be addressed to improve the program.
Improving 21st-century teaching skills: The key to effective 21st-century learners
Authors: Kim Sharon , Raza Mahjabeen , Seidman Edward
Published: February 2019

The development of competencies known as 21st-century skills are garnering increasing attention as a means of improving teacher instructional quality. However, a key challenge in bringing about desired improvements lies in the lack of context-specific understanding of teaching practices and meaningful ways of supporting teacher professional development. This paper focuses on the need to measure the social quality of teaching processes in a contextualized manner. We do so by highlighting the efforts made to develop and measure teacher practices and classroom processes using the Teacher Instructional Practices and Processes System© (TIPPS) in three different contexts: Uganda (secondary), India (primary), and Ghana (pre-school). By examining how such a tool can be used for teacher feedback, reflective practice, and continuous improvement, the hope is to pave the way toward enhanced 21st-century teacher skills and, in turn, 21st-century learners.
Sex Categorization of Faces: The Effects of Age and Experience
Authors: Hillairet de Boisferon Anne , Dupierrix Eve , Uttley Lesley , DeBruine Lisa M. , Jones Benedict C. , Pascalis Olivier
Published: February 2019

The face own-age bias effect refers to the better ability to recognize the face from one's own age compared with other age groups. Here we examined whether an own-age advantage occurs for faces sex categorization. We examined 7- and 9-year-olds' and adults' ability to correctly categorize the sex of 7- and 9-year-olds and adult faces without external cues, such as hair. Results indicated that all ages easily classify the sex of adult faces. They succeeded in classifying the sex of child faces, but their performance was poorer than for adult faces. In adults, processing time increased, and a response bias ( male response) was elicited for child faces. In children, response times remained constant, and no bias was observed. Experience with specific category of faces seems to offer some advantage in speed of processing. Overall, sex categorization is more challenging for child than for adult faces due to their reduced sexual dimorphic facial characteristics.
Impact of in-hospital cardiac rehabilitation on mortality and readmissions in heart failure: A population study in Lombardy, Italy, from 2005 to 2012
Authors: Scalvini Simonetta , Grossetti Francesco , Paganoni Anna Maria , Teresa La Rovere Maria , Pedretti Roberto FE , Frigerio Maria
Published: February 2019

Aims

The 2016 European guidelines for the diagnosis and treatment of heart failure classified cardiac rehabilitation as a mandatory class I intervention. We aimed to analyse in heart failure patients the impact of an in-hospital cardiac rehabilitation programme on all-cause mortality and readmissions.

Methods

From the Lombardy healthcare administrative database, we analysed in patients with incident heart failure, from 2005 to 2012, the number of all hospitalisations, cardiac rehabilitation admissions, post-discharge deaths, outpatient drug prescriptions and visits. We divided patients into hospitalised for heart failure in acute care only (group A) versus patients with one or more admission to cardiac rehabilitation for an in-hospital cardiac rehabilitation programme (group B).

Results

Of 140,552 incident cases, 100,843 (71%) were in group A and 39,709 (29%) in group B. Patients in group B had 3.26 ± 1.78 admissions to acute care before referral to an in-hospital cardiac rehabilitation programme. Male gender, age in women and comorbidities (more than two) were higher in group B ( P < 0.0001). Patients in group B had a higher number of interventional procedures ( P < 0.0001), drug prescription and outpatient visit rate ( P < 0.0001). Total mortality was 30% in group A versus 29% in group B. At Cox and logistic regression analyses, after adjustment for covariates, group B had a significantly lower risk of mortality (hazard ratio 0.5768, 95% confidence interval 0.5650–0.5888, P < 0.0001) and readmissions (0.7997, 0.7758–0.8244, P < 0.0001) than group A.

Conclusion

This study showed in a large population of heart failure patients that in-hospital cardiac rehabilitation is associated with a reduction of all-cause mortality and rehospitalisations in heart failure. Given its potential significant benefit, referral of heart failure patients to an in-hospital cardiac rehabilitation programme should be promoted.
A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic
Authors: Sastre Lauren R , Matson Stephanie , Gruber Kenneth J , Haldeman Lauren
Published: February 2019

Objective:

To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population.

Methods:

Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers.

Results:

Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported.

Conclusion:

Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.
Computer-aided assessment of the extra-cellular matrix during pancreatic carcinogenesis: a pilot study
Authors: Grizzi Fabio , Fiorino Sirio , Qehajaj Dorina , Fornelli Adele , Russo Carlo , de Biase Dario , Masetti Michele , Mastrangelo Laura , Zanello Matteo , Lombardi Raffaele , Domanico Andrea , Accogli Esterita , Tura Andrea , Mirandola Leonardo , Chiriva-Internati Maurizio , Bresalier Robert S. , Jovine Elio , Leandri Paolo , Di Tommaso Luca
Published: February 2019

Background

A hallmark of pancreatic ductal adenocarcinoma is the desmoplastic reaction, but its impact on the tumor behavior remains controversial. Our aim was to introduce a computer -aided method to precisely quantify the amount of pancreatic collagenic extra-cellular matrix, its spatial distribution pattern, and the degradation process.

Methods

A series of normal, inflammatory and neoplastic pancreatic ductal adenocarcinoma formalin-fixed and paraffin-embedded Sirius red stained sections were automatically digitized and analyzed using a computer-aided method.

Results

We found a progressive increase of pancreatic collagenic extra-cellular matrix from normal to the inflammatory and pancreatic ductal adenocarcinoma. The two-dimensional fractal dimension showed a significant difference in the collagenic extra-cellular matrix spatial complexity between normal versus inflammatory and pancreatic ductal adenocarcinoma. A significant difference when comparing the number of cycles necessary to degrade the pancreatic collagenic extra-cellular matrix in normal versus inflammatory and pancreatic ductal adenocarcinoma was also found. The difference between inflammatory and pancreatic ductal adenocarcinoma was also significant. Furthermore, the mean velocity of collagenic extra-cellular matrix degradation was found to be faster in inflammatory and pancreatic ductal adenocarcinoma than in normal.

Conclusion

These findings demonstrate that inflammatory and pancreatic ductal adenocarcinomas are characterized by an increased amount of pancreatic collagenic extra-cellular matrix and by changes in their spatial complexity and degradation. Our study defines new features about the pancreatic collagenic extra-cellular matrix, and represents a basis for further investigations into the clinical behavior of pancreatic ductal adenocarcinoma and the development of therapeutic strategies.
Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland
Authors: Lyall Laura M. , Penades Nagore , Smith Daniel J.
Published: February 2019

Background

People with bipolar disorder typically require long-term pharmacological treatment to prevent episodes of depression or mania. However, evidence-based guidelines are often not followed by prescribers and, in some countries, prescribing of lithium is in decline. Polypharmacy is also common in bipolar disorder.

Aims

To employ a data linkage approach to describe and evaluate prescribing patterns in bipolar disorder in Scotland between 2009 and 2016.

Method

By linking prescribing data to the electronic Scottish Morbidity Records, we identified a cohort of 23 135 patients with bipolar disorder who were prescribed psychotropic medication between 2009 and 2016. We examined trends in proportions of patients prescribed each of six drug categories. Random effects logistic models examined change in prescribing over years of interest.

Results

The most common form of treatment was antidepressant monotherapy (24.96%), with only 5.90% of patients receiving lithium monotherapy. Prescribing of antipsychotics and anti-epileptics increased from 2009 to 2016 (antipsychotics: odds ratio 1.16, 95% CI 1.15–1.18; anti-epileptics: odds ratio 1.34, 95% CI 1.32–1.36), whereas prescribing of lithium decreased (odds ratio 0.83, 95% CI 0.82–0.85). Prescribing of valproate decreased from 2009–2016 in women, but increased in men (women: odds ratio 0.93, 95% CI 0.90–0.97; men: odds ratio 1.11, 95% CI 1.04–1.18).

Conclusions

Antidepressant monotherapy was the most common form of treatment for bipolar disorder in Scotland and prescribing of lithium has declined between 2009 and 2016. The findings are concerning and represent a gap between treatment guidelines and clinical practice.

Declaration of interest

None.
The effectiveness of psychoanalytic/psychodynamic psychotherapy for reducing suicide attempts and self-harm: systematic review and meta-analysis
Authors: Briggs Stephen , Netuveli Gopalakrishnan , Gould Nick , Gkaravella Antigone , Gluckman Nicole S. , Kangogyere Patricia , Farr Ruby , Goldblatt Mark J. , Lindner Reinhard
Published: February 2019

Background

Preventing suicide and self-harm is a global health priority. Although there is a growing evidence base for the effectiveness of psychoanalytic and psychodynamic psychotherapies for a range of disorders, to date there has been no systematic review of its effectiveness in reducing suicidal and self-harming behaviours.

Aims

To systematically review randomised controlled trials of psychoanalytic and psychodynamic psychotherapies for suicidal attempts and self-harm.

Method

We searched PubMed, PsycINFO, Psycharticles, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials for randomise controlled trials of psychoanalytic and psychodynamic psychotherapies for reducing suicide attempts and self-harm.

Results

Twelve trials (17 articles) were included in the meta-analyses. Psychoanalytic and psychodynamic therapies were effective in reducing the number of patients attempting suicide (pooled odds ratio, 0.469; 95% CI 0.274–0.804). We found some evidence for significantly reduced repetition of self-harm at 6-month but not 12-month follow-up. Significant treatment effects were also found for improvements in psychosocial functioning and reduction in number of hospital admissions.

Conclusions

Psychoanalytic and psychodynamic psychotherapies are indicated to be effective in reducing suicidal behaviour and to have short-term effectiveness in reducing self-harm. They can also be beneficial in improving psychosocial well-being. However, the small number of trials and moderate quality of the evidence means further high-quality trials are needed to confirm our findings and to identity which specific components of the psychotherapies are effective.

Declaration of interest

None.
Insight Into Molecular Determinants of T3 vs T4 Recognition From Mutations in Thyroid Hormone Receptor α and β
Authors: Wejaphikul Karn , Groeneweg Stefan , Hilhorst-Hofstee Yvonne , Chatterjee V Krishna , Peeters Robin P , Meima Marcel E , Visser W Edward
Published: February 2019

Context

The two major forms of circulating thyroid hormones (THs) are T3 and T4. T3 is regarded as the biologically active hormone because it binds to TH receptors (TRs) with greater affinity than T4. However, it is currently unclear what structural mechanisms underlie this difference in affinity.

Objective

Prompted by the identification of a novel M256T mutation in a resistance to TH (RTH)α patient, we investigated Met256 in TRα1 and the corresponding residue (Met310) in TRβ1, residues previously predicted by crystallographic studies in discrimination of T3 vs T4.

Methods

Clinical characterization of the RTHα patient and molecular studies (in silico protein modeling, radioligand binding, transactivation, and receptor–cofactor studies) were performed.

Results

Structural modeling of the TRα1-M256T mutant showed that distortion of the hydrophobic niche to accommodate the outer ring of ligand was more pronounced for T3 than T4, suggesting that this substitution has little impact on the affinity for T4. In agreement with the model, TRα1-M256T selectively reduced the affinity for T3. Also, unlike other naturally occurring TRα mutations, TRα1-M256T had a differential impact on T3- vs T4-dependent transcriptional activation. TRα1-M256A and TRβ1-M310T mutants exhibited similar discordance for T3 vs T4.

Conclusions

Met256-TRα1/Met310-TRβ1 strongly potentiates the affinity of TRs for T3, thereby largely determining that T3 is the bioactive hormone rather than T4. These observations provide insight into the molecular basis for underlying the different affinity of TRs for T3 vs T4, delineating a fundamental principle of TH signaling.
Exercise and the Gut Microbiome: A Review of the Evidence, Potential Mechanisms, and Implications for Human Health
Authors: Mailing Lucy J. , Allen Jacob M. , Buford Thomas W. , Fields Christopher J. , Woods Jeffrey A.
Published: February 2019

The gastrointestinal tract contains trillions of microbes (collectively known as the gut microbiota) that play essential roles in host physiology and health. Studies from our group and others have demonstrated that exercise independently alters the composition and functional capacity of the gut microbiota. Here, we review what is known about the gut microbiota, how it is studied, and how it is influenced by exercise training and discuss the potential mechanisms and implications for human health and disease.
Persuasion: The Art of Changing Worldviews
Authors: Galperti Simone
Published: February 2019

Persuaders often face the task of changing their listeners’ world-view, which may involve conveying evidence that disconfirms that view. It has been shown, however, that people are often reluctant to change their worldviews. These aspects of persuasion cannot be captured in the standard Bayesian framework. The paper identifies the constraints, opportunities, and trade-offs of persuading people to change worldview. It finds necessary and sufficient conditions under which it is optimal for persuaders to do so. It also shows when and how they conceal disconfirming evidence and take advantage of their listener’s existing worldview. (JEL D82, D83, D91)
Beliefs about Gender
Authors: Bordalo Pedro , Coffman Katherine , Gennaioli Nicola , Shleifer Andrei
Published: February 2019

We conduct laboratory experiments that explore how gender stereotypes shape beliefs about ability of oneself and others in different categories of knowledge. The data reveal two patterns. First, men’s and women’s beliefs about both oneself and others exceed observed ability on average, particularly in difficult tasks. Second, overestimation of ability by both men and women varies across categories. To understand these patterns, we develop a model that separates gender stereotypes from misestimation of ability related to the difficulty of the task. We find that stereotypes contribute to gender gaps in self-confidence, assessments of others, and behavior in a cooperative game. (JEL C92, D83, D91, J16)
How Do Individuals Repay Their Debt? The Balance-Matching Heuristic
Authors: Gathergood John , Mahoney Neale , Stewart Neil , Weber Jörg
Published: February 2019

We study how individuals repay their debt using linked data on multiple credit cards. Repayments are not allocated to the higher interest rate card, which would minimize the cost of borrowing. Moreover, the degree of misallocation is invariant to the economic stakes, which is inconsistent with optimization frictions. Instead, we show that repayments are consistent with a balance-matching heuristic under which the share of repayments on each card is matched to the share of balances on each card. Balance matching captures more than half of the predictable variation in repayments and is highly persistent within individuals over time. (JEL D14, D15, D91, G41)
The evolution of pre-operative spine tumour embolization
Authors: Omid-Fard Nima , Fisher Charles G , Heran Manraj KS
Published: February 2019

Pre-operative spine tumour embolization is a useful adjunct to minimize operative complications and blood loss during complex resections. While the efficacy of this procedure has been well studied, relatively little is documented regarding how to optimize technical parameters for tumour characteristics. This pictorial case series seeks to review our centre’s experience over the last decade in using a range of embolization techniques. As experience with this procedure has matured, we propose an approach based on the patient’s vascular anatomy and tumour angioarchitecture. This includes the use of coils as protective barriers rather than primary embolics; particle embolization to permeate fine capillary networks; consideration for liquid embolic agents in the presence of large caliber tumour vessels with associated arteriovenous shunting; and percutaneous intralesional embolization when endovascular access is insufficient to achieve the desired outcome. In many cases, a combination of these methods is needed, and close communication with the surgeon ensures the best outcome. Despite these advances, continued work is needed to determine how to optimize complete devascularization, and thus surgical benefit, while safely sparing critical neuroanatomical structures.
Um negócio saudável?
Authors: Espino Gilmara , Aidar Marcelo
Published: February 2019

As plataformas virtuais para agendamento de consultas médicas trazem vantagens para prestadores de serviço e para pacientes, mas problemas regulatórios e uso reduzido colocam seu futuro em xeque.
Torre de Babel
Authors: Andrade Neto Jorge Aguiar de , Escrivão Junior Álvaro
Published: February 2019

Atualmente, os diferentes elos na área de saúde não estão integrados. Como mudar esse cenário?
E-commerce com resultado
Authors: Guissoni Leandro Angotti , Farinha Rodrigo Lourenço
Published: February 2019

Empresas com vendas on-line precisam balancear seus modelos de negócios e entender as mudanças no comportamento do consumidor para competir e lucrar em tempos de disrupção digital.
Unir o país pelo fortalecimento da democracia
Authors: Teixeira Marco Antonio Carvalho
Published: February 2019

É no debate democrático das ideias que se podem descobrir valores comuns, mesmo com a permanência do conflito político.
Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir
Authors: Javaeed Arslaan , Zafar Maria Bint , Iqbal Madiha , Ghauri Sanniya  Khan
Published: February 2019

Objective: To find out the correlation between internet addiction and depression, anxiety and stress among undergraduate medical students in Azad Kashmir.

Methods: A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

Results: A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <0.001) and similar type of correlation was observed between internet addiction and stress (p 0.003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Conclusion: Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

How to cite this:Javaeed A, Zafar MB, Iqbal M, Ghauri SK. Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir. Pak J Med Sci. 2019;35(2):506-509. doi: https://doi.org/10.12669/pjms.35.2.169

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Non-specific impairment of Lung Function on Spirometery in Patients with Chronic Hepatitis-C
Authors: Zuberi Faisal Faiyaz , Zuberi Bader Faiyaz , Rasheed Tazeen , Nawaz Zunaira
Published: February 2019

Objectives: To document frequency of non-specific impairment of lung functions (NILF) in patients of HCV and to compare according to gender, genotype, liver fibrosis score and smoking status.

Methods: Patients of chronic hepatitis C were included after informed consent. Demographic data was recorded, and they underwent baseline investigations, fibroscan, abdominal ultrasound and PFT. Patients were segregated on basis of gender, fibroscan stages and smoking status. NILF was labelled if any two of three criteria are fulfilled (a) FVC <80% of Predicted, (b) FEV1 <80% Predicted, (c) FEV1/FVC ≥70.

Results: Two hundred thirty four patients were of chronic HCV who fulfilled the selection criteria were inducted in study. These included 49.6% males and 50.4% females. There were 15.0% smokers, 16.2% were ex-smokers while 68.8% were never smokers. NILF was present in 130 (55.6%) out of which 61.5% were female and 38.5% were male (p <0.001), its presence in smokers was 56.2% and in never smokers was 55.3% (p=0.507). Presence of NILF increased with Fibroscan stages from F1 to F4 (p <0.001).

Conclusions: NILF pattern on spirometry with normal chest radiograph is common among HCV patients. It was found more common in females and frequency increased progressively with fibro scan stages.

How to cite this:Zuberi FF, Zuberi BF, Rasheed T, Nawaz Z. Non-specific impairment of Lung Function on Spirometery in patients with Chronic Hepatitis-C. Pak J Med Sci. 2019;35(2):360-364. doi: https://doi.org/10.12669/pjms.35.2.73

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
40 years of the human T-cell leukemia virus: past, present, and future
Authors: Tagaya Yutaka , Matsuoka Masao , Gallo Robert
Published: February 2019

It has been nearly 40 years since human T-cell leukemia virus-1 (HTLV-1), the first oncogenic retrovirus in humans and the first demonstrable cause of cancer by an infectious agent, was discovered. Studies indicate that HTLV-1 is arguably one of the most carcinogenic agents to humans. In addition, HTLV-1 causes a diverse array of diseases, including myelopathy and immunodeficiency, which cause morbidity and mortality to many people in the world, including the indigenous population in Australia, a fact that was emphasized only recently. HTLV-1 can be transmitted by infected lymphocytes, from mother to child via breast feeding, by sex, by blood transfusion, and by organ transplant. Therefore, the prevention of HTLV-1 infection is possible but such action has been taken in only a limited part of the world. However, until now it has not been listed by the World Health Organization as a sexually transmitted organism nor, oddly, recognized as an oncogenic virus by the recent list of the National Cancer Institute/National Institutes of Health. Such underestimation of HTLV-1 by health agencies has led to a remarkable lack of funding supporting research and development of treatments and vaccines, causing HTLV-1 to remain a global threat. Nonetheless, there are emerging novel therapeutic and prevention strategies which will help people who have diseases caused by HTLV-1. In this review, we present a brief historic overview of the key events in HTLV-1 research, including its pivotal role in generating ideas of a retrovirus cause of AIDS and in several essential technologies applicable to the discovery of HIV and the unraveling of its genes and their function. This is followed by the status of HTLV-1 research and the preventive and therapeutic developments of today. We also discuss pending issues and remaining challenges to enable the eradication of HTLV-1 in the future.
Management of diabetic foot ulcers in the community: an update
Authors: Levy Natasha , Gillibrand Warren
Published: February 2019

Diabetic foot ulceration is costly, both in terms of NHS expenditure and quality of life for the patient. This article reviews the guidelines for assessment and management of the diabetic foot ulcer and provides instruction on undertaking vascular and neurological assessments of the diabetic foot. Wound assessment, with an overview of the TEXAS and SINBAD wound classification systems, is also explored, as is the importance of the 1 working day referral for expert assessment for any new diabetic foot ulcer in order to reduce wound complications, length of hospital stay and, ultimately, amputation.
Turning black or yellow wounds red using a hydroresponsive dressing
Authors: Hampton Sylvie
Published: February 2019

Wounds can be found anywhere on the wound healing continuum, which can be used to select appropriate dressings. With the exception of black toes or arterial heels, some simple rules of thumb to use for dressing selection would be as follows: a wet dressing for a dry wound; a dry dressing for a wet wound; an antibacterial dressing for one that is odorous; a superabsorbent dressing for high exudate loss; and a foam dressing to cover as a secondary dressing or as a primary dressing when the wound is healing. This article seeks to outline a method for changing black or yellow wounds on the healing continuum into a red and then pink wound. It also describes a case in which this method was successfully used to treat recalcitrant wounds.
Deepening trochleoplasty and medial patellofemoral ligament reconstruction normalize patellotrochlear congruence in severe trochlear dysplasia
Authors: Balcarek P. , Zimmermann F.
Published: February 2019

Aims

The aim of this study was to evaluate cartilaginous patellotrochlear congruence and patellofemoral alignment parameters after deepening trochleoplasty in severe trochlear dysplasia.

Patients and Methods

The study group comprised 20 patients (two male, 18 female; mean age 24 years (16 to 39)) who underwent deepening trochleoplasty and medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent lateral patellar dislocation due to severe trochlear dysplasia (Dejour type B to D). Pre- and postoperative MRI investigations of the study group were compared with MRI data of 20 age- and gender-matched control patients (two male, 18 female; mean age 27 years (18 to 44)) regarding the patellotrochlear contact ratio, patellotrochlear contact area, posterior patellar edge-trochlear groove ratio, and patellar tilt.

Results

Preoperatively, all parameters in the study group indicated significant patellar malalignment, including a reduced patellotrochlear contact ratio (mean 0.38 (0.13 to 0.59) vs mean 0.67 (0.48 to 0.88); p < 0.001), reduced contact area (mean 128 mm2(87 to 190) vs mean 183 mm2(155 to 227); p < 0.001), increased patellar lateralization (mean 0.82 (0.55 to 1.0) vs mean 0.99 (0.93 to 1.1); p < 0.001) and increased patellar tilt (mean 25.8° (8.1° to 43.0°) vs mean 9.1° (0.5° to 16.8°); p < 0.001). Postoperatively, all parameters in the study group improved significantly and reached normal values compared with the control group. The patellotrochlear contact ratio increased to a mean of 0.63 (0.38 to 0.85) (p < 0.001), the contact area increased to a mean of 187 mm2(101 to 255) (p < 0.001), the posterior patellar edge-trochlear groove ratio improved to a mean of 0.96 (0.83 to 0.91) (p < 0.001), and the patellar tilt decreased to a mean of 13.9° (8.1° to 22.1°) (p < 0.001) postoperatively.

Conclusion

Deepening trochleoplasty and MPFL reconstruction normalized the patellotrochlear congruence and patellofemoral alignment parameters. Modifying the dysplastic trochlea involves approximating the trochlear morphology to the shape of the patella rather than inducing a patella and trochlea mismatch. Cite this article: Bone Joint J 2019;101-B:325–330.
Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients
Authors: Lee S. H. , Han S. S. , Yoo B. M. , Kim J. W.
Published: February 2019

Aims

The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients.

Patients and Methods

We undertook a retrospective comparison of two methods of fixation, using a locking plate without an associated fibular strut allograft (LP group) and with a fibular allograft (FA group) for the treatment of these fractures. The outcome was assessed for 52 patients in the LP group and 45 in the FA group, with a mean age of 74.3 years (52 to 89), at a mean follow-up of 14.2 months (12 to 19). The clinical results were evaluated using a visual analogue scale (VAS) score for pain, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the range of movement. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH).

Results

The mean forward elevation in the LP and FA groups was 125.3° (sd 21.4) and 148.9° (sd 19.8), respectively (p = 0.042), while other clinical factors showed no statistically significant differences between the groups. The changes in NSA and HHH immediately after the operation and at final follow-up were significantly better in the FA group than in the LP group (p = 0.015 and p = 0.021, respectively).

Conclusion

For comminuted proximal humeral fractures in osteoporotic patients, locking plate fixation with a fibular strut allograft shows satisfactory short-term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a locking plate alone. Cite this article: Bone Joint J 2019;101-B:260–265.
Performance of automated multiplex polymerase chain reaction (mPCR) using synovial fluid in the diagnosis of native joint septic arthritis in adults
Authors: Sigmund I. K. , Holinka J. , Sevelda F. , Staats K. , Heisinger S. , Kubista B. , McNally M. A. , Windhager R.
Published: February 2019

Aims

This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis

Patients and Methods

Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study.

Results

Of 72 patients, 42 (58%) were deemed to have septic joints. The sensitivity of mPCR and synovial fluid culture was 38% and 29%, respectively. No significant differences were found between the AUCs of both techniques (p = 0.138). A strong concordance of 89% (Cohen’s kappa: 0.65) was shown. The mPCR failed to detect Staphylococcus aureus (n = 1) and Streptococcus pneumoniae (n = 1; no primer included in the mPCR), whereas the synovial fluid culture missed six microorganisms (positive mPCR: S. aureus (n = 2), Cutibacterium acnes (n = 3), coagulase-negative staphylococci (n = 2)).

Conclusion

The automated mPCR showed at least a similar performance to the synovial fluid culture (the current benchmark) in diagnosing septic arthritis, having the great advantage of a shorter turnaround time (within five hours). Cite this article: Bone Joint J 2019;101-B:288–296.
Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up
Authors: Löchel J. , Janz V. , Hipfl C. , Perka C. , Wassilew G. I.
Published: February 2019

Aims

The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique.

Patients and Methods

Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity.

Results

The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001).

Conclusion

The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316.