bluuebunny/crossref_metadata_2025 huggingface dataset:
Sales promotion in health and medicine: using incentives to stimulate patient interest and attention
Authors: Elrod James K. , Fortenberry John L.
Published: September 2020

Background

Sales promotion—the use of incentives to encourage patronage—is a staple of marketing communications in the health services industry. Sales promotion applications commonly used by health services organizations include free samples, free trials, coupons, contests, and loyalty programs. These avenues engender goodwill, appreciation, and attentiveness; they also serve as small, but powerful promotional mechanisms by reminding recipients of healthcare institutions, compelling particular actions, encouraging repeat business, or prompting some related desirable in an effort to hasten exchange and bolster loyalty.

Discussion

Sales promotion offers myriad opportunities for healthcare providers to connect with audiences. While limited in their power to attract broad audiences when used in isolation, sales promotion avenues used in tandem with other marketing communications create helpful engagement synergies which amplify conveyance initiatives. This article presents an overview of sales promotion and notably shares deployment insights and experiences from Willis-Knighton Health System, permitting peer healthcare establishments to view associated pathways, reflect on their own sales promotion efforts, and potentially bolster initiatives with the perspectives supplied herein.

Conclusions

Sales promotion offers healthcare providers a complementary communications avenue, helping to reinforce other elements of the marketing communications mix, affording opportunities to develop better connections with patients. In formulating associated communication plans, health and medical establishments should be reminded of the benefits offered by sales promotion and especially strive to effect creative applications that build interest and attention. By doing so, opportunities to bolster patient volume and increase all-important market share abound.
Assessment of health service delivery parameters in Kano and Zamfara States, Nigeria
Authors: Bala Usaini , Ajumobi Olufemi , Umar Amina , Adewole Adefisoye , Waziri Ndadilnasiya , Gidado Saheed , Mohammed Audu B. , Uhomoibhi Perpetua , Muhammad Basheer , Ismail Munira , Kachur Stephen Patrick , Cash Shelby , Asamoa Kwame
Published: September 2020

Background

In 2013, the Nigeria Federal Ministry of Health established a Master Health Facility List (MHFL) as recommended by WHO. Since then, some health facilities (HFs) have ceased functioning and new facilities were established. We updated the MHFL and assessed service delivery parameters in the Malaria Frontline Project implementing areas in Kano and Zamfara States.

Methods

We assessed all HFs in each of the 34 project local government areas (LGAs) between July and September 2017. Project staff administered a semi-structured questionnaire developed for this assessment to heads of HFs about the type of facility, category and number of staff working at the facility and to record geo-coordinates of facility.

Results

In the Kano State project area, 726 HFs were identified and geo-located: 31 were new facilities, 608 (84%), 116 (16%) and two (0.3%) were Primary Health Care (PHC), secondary and tertiary facilities respectively. Using the national definition, there were 710 (98%) functional facilities and 644 (91%) of these reported to the national health information platform, District Health Information System, version 2 (DHIS2).

The Zamfara project area had 739 HFs: eight were new, 715 (97%), 22 (3.0%) and two (0.2%) PHCs, secondary and tertiary facilities respectively. There were 695 (94%) functional facilities with 656 (94%) of these reporting to DHIS2. Using national criteria for primary health care designation, only 95 (9%) of all PHCs in the two States met the minimum human resource requirements.

Conclusion

Most HFs were functional and reported to DHIS2. A comprehensive MHFL having all the important parameters that should be established and updated regularly by authorities to make it more useful for health services administration and management. Most functional facilities are understaffed.
Case report: characterization of a persistent, treatment-resistant, novel Staphylococcus aureus infection causing chronic mastitis in a Holstein dairy cow
Authors: Putz Ellie J. , Palmer Mitchell V. , Ma Hao , Casas Eduardo , Reinhardt Timothy A. , Lippolis John D.
Published: September 2020

Background

Mastitis is the most common health concern plaguing the modern dairy cow and costs dairy producers estimates of two billion dollars annually. Staphylococcus aureus infections are prevalent, displaying varied disease presentation and markedly low cure rates. Neutrophils are considered the first line of defense against mastitis causing bacteria and are frequently targeted in the development of treatment and prevention technologies. We describe a case of naturally occurring, chronic mastitis in a Holstein cow (1428), caused by a novel strain of S. aureus that was not able to be cleared by antibiotic treatment.

Case presentation

The infection was identified in a single quarter, 2 months into the cow’s first lactation. The infection persisted for the following 20 months, including through dry off, and a second calving and lactation. This case of mastitis was associated with a consistently high somatic cell count, however presented with no other clinical signs. This cow was unsuccessfully treated with antibiotics commonly used to treat mastitis, consisting of two rounds of treatment during lactation and an additional round at the beginning of dry off. The chronic infection was also unchanged through an experimental mid-lactation treatment with pegylated granulocyte-colony stimulating factor (PEG-gCSF) and an additional periparturient treatment with PEG-gCSF. We isolated milk neutrophils from 1428 and compared them to two cows challenged with experimental S. aureus, strain Newbould 305. Neutrophils from 1428’s milk had higher surface expression of myeloperoxidase compared to experimental Newbould challenged animals, as well as increased presence of Neutrophil Extracellular Traps. This suggests a heightened activation state of neutrophils sourced from 1428’s naturally occurring infection. Upon postmortem examination, the affected quarter revealed multifocal abscesses separated by fibrous connective tissues. Abscesses were most common in the gland cistern and collecting duct region. Microscopically, the inflammatory reaction was pyogranulomatous to granulomatous and consistent with botryomycosis. Colonies of Gram-positive cocci were found within the eosinophilic matrix of the Splendore-Hoeppli reaction within granulomas and intracellularly within the acinar epithelium.

Conclusions

Collectively, we describe a unique case of chronic mastitis, the characterization of which provides valuable insight into the mechanics of S. aureus treatment resistance and immune escape.
A retrospective study on transabdominal ultrasound measurements of the rumen wall thickness to evaluate chronic rumen acidosis in beef cattle
Authors: Fiore Enrico , Faillace Vanessa , Morgante Massimo , Armato Leonardo , Gianesella Matteo
Published: September 2020

Background

Chronic and subacute rumen acidosis are economically important in the beef industry. The aim of this study was to evaluate the potential suitability of the transabdominal ultrasonographic examination of the ruminal wall to diagnose chronic rumen acidosis in beef cattle compared to direct measurement of ruminal pH, as a fast non-invasive tool to be used in field condition. Ultrasonographic examination of the rumen was conducted in 478 beef cattle before rumenocentesis (chronic rumen acidosis group = pH ≤ 5.8; healthy group = pH ≥ 5.9). Rumen wall ultrasound measurements included rumen wall thickness (RWT) and rumen mucosa and submucosa thickness (RMST).

Results

The Analysis of Variance showed the high significant effect of the pH class for RWT and RMST (P < 0.001). Spearman RANK correlation analysis showed interaction between rumen pH and RWT (− 0.71;P < 0.0001) and RMST (− 0.75; P < 0.0001). A significant Spearman’s correlations were found between volatile fatty acids (VFA) and RWT and RMST.

The differentiation efficiency of RWT between healthy and chronic rumen acidosis groups, as a result of the receiver operator curve (ROC) analysis, was quite good with an area under the receiver operator curve (AUROC) of 0.88:P < 0.0001; 95% CI: 0.83–0.98. Using a cut-off value of > 8.2 mm. The differentiation efficiency of RMST between healthy and chronic rumen acidosis groups, as a result of ROC curve analysis, was good with an AUROC of 0.90:p < 0.0001; 95% CI: 0.85–0.94. Using a cut-off value of > 5.3 mm.

Conclusions

In this study, the thickening of RWT and RMST is correlated with the changes of ruminal pH. Transabdominal rumen ultrasound has the potential to become a powerful diagnostic tool useful to identify fattening bulls affected by chronic rumen acidosis.
Multiple strategies to improve the yield of chitinase a from Bacillus licheniformis in Pichia pastoris to obtain plant growth enhancer and GlcNAc
Authors: Song Wen , Zhang Nuo , Yang Mo , Zhou Yuling , He Nisha , Zhang Guimin
Published: September 2020

Chitinase and chitin-oligosaccaride can be used in multiple field, so it is important to develop a high-yield chitinase producing strain. Here, a recombinant Pichia pastoris with 4 copies of ChiA gene from Bacillus licheniformis and co-expression of molecular chaperon HAC1 was constructed. The amount of recombinant ChiA in the supernatant of high-cell-density fermentation reaches a maximum of 12.7 mg/mL, which is 24-fold higher than that reported in the previous study. The recombinant ChiA can hydrolyze 30% collodidal chitin with 74% conversion ratio, and GlcNAc is the most abundant hydrolysis product, followed by N, N′-diacetylchitobiose. Combined with BsNagZ, the hydrolysate of ChiA can be further transformed into GlcNAc with 88% conversion ratio. Additionally, the hydrolysate of ChiA can obviously accelerate the germination growth of rice and wheat, increasing the seedling height and root length by at least 1.6 folds within 10 days.
CRISPR-Cas, a robust gene-editing technology in the era of modern cancer immunotherapy
Authors: Miri Seyed Mohammad , Tafsiri Elham , Cho William Chi Shing , Ghaemi Amir
Published: September 2020

Cancer immunotherapy has been emerged as a promising strategy for treatment of a broad spectrum of malignancies ranging from hematological to solid tumors. One of the principal approaches of cancer immunotherapy is transfer of natural or engineered tumor-specific T-cells into patients, a so called “adoptive cell transfer”, or ACT, process. Construction of allogeneic T-cells is dependent on the employment of a gene-editing tool to modify donor-extracted T-cells and prepare them to specifically act against tumor cells with enhanced function and durability and least side-effects. In this context, CRISPR technology can be used to produce universal T-cells, equipped with recombinant T cell receptor (TCR) or chimeric antigen receptor (CAR), through multiplex genome engineering using Cas nucleases. The robust potential of CRISPR-Cas in preparing the building blocks of ACT immunotherapy has broaden the application of such therapies and some of them have gotten FDA approvals. Here, we have collected the last investigations in the field of immuno-oncology conducted in partnership with CRISPR technology. In addition, studies that have addressed the challenges in the path of CRISPR-mediated cancer immunotherapy, as well as pre-treatment applications of CRISPR-Cas have been mentioned in detail.
RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture
Authors: Huang Zhangheng , Tong Yuexin , Fan Zhiyi , Hu Chuan , Zhao Chengliang
Published: September 2020

Background

The objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF).

Methods

From August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments.

Results

The average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001).

Conclusions

Our results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.
Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report
Authors: Khalifa Rami , Craft Madison R. , Wey Aaron J. , Thabet Ahmed M. , Abdelgawad Amr
Published: September 2020

Background

Gluteal compartment syndrome is an uncommon condition and can be difficult to diagnose. It has been diagnosed after trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication. The diagnosis is based on clinical findings and, in most cases, recognizing these symptoms and making a diagnosis early is critical to a complete recovery.

Case presentation

A 53-year-old male who underwent left foot surgery had severe pain to his contralateral hip and posterior gluteal compartment radiating to the right lower extremity immediately postoperative. He was positioned supine with a “bump” placed under his right hip to externally rotate his operative leg during the surgery. Due to the patient’s complex past medical history, a presumptive diagnosis of a herniated disc and/or compression of the sciatic nerve was made as a cause for the patient’s pain. This resulted in a misdiagnosis period of 36 h until the patient was diagnosed with unilateral gluteal compartment syndrome. Performing a fasciotomy was decided against due to the increased risk of complications. The patient was treated with administration of IV fluids and closely monitored. On post-op day 6, the patient was discharged. At three months post-op, the patient was walking without a limp and he had no changes in his peripheral neurologic examination compared to his preoperative baseline.

Conclusion

Gluteal compartment syndrome is a surgical emergency that must be considered postoperatively especially in obese patients with prolonged operation times who experience acute buttock pain. The use of positional bars or “bumps” in the gluteal area should be used with caution and raise awareness of this complication after orthopedic surgeries.
Effect of animal-sourced bioactive peptides on the in vitro development of mouse preantral follicles
Authors: Liu Gang , Li Shubin , Ren Jinyu , Wang Chunyu , Zhang Yaxuan , Su Xiulan , Dai Yanfeng
Published: September 2020

The aim of this study was to investigate the effect of bioactive peptides (BAPT) from animal sources on the development of mouse preantral follicles in vitro. Preantral follicles were isolated and randomly divided into the following groups: an untreated group (control) and three groups supplemented with 20, 40 and 60 μg/mL BAPT, respectively. After establishing the in vitro follicle culture, the gene expression levels and hormone levels were quantified. After in vitro maturation, the developmental rates, reactive oxygen species (ROS) production levels and mitochondrial distributions of MII oocytes were investigated, followed by the analyses of embryonic developmental rates after in vitro fertilization.

The results showed that BAPT promoted the growth of mouse preantral follicles. Notably, after 14 d of in vitro culture, the levels of 17 β-estradiol and progesterone were up-regulated with BAPT treatments. Moreover, the expression levels of Oct4, Bmp15, GDF9, FOXO3, Zp3, FOXL2, Inhibin alpha, SOD2, Catalase, GPx and Bcl-2 in the developing follicles were significantly up-regulated after BAPT treatments (P < 0.05), while BAPT significantly inhibited the expression levels of BAX (P < 0.05). Following BAPT treatments, the ROS production levels of MII oocytes were decreased while the mitochondrial distributions were significantly enhanced. Furthermore, increased maturation rates, fertilization and embryonic developmental rates were found in these BAPT-treated groups (P < 0.05).

These results demonstrated that BAPT significantly improved the development of preantral follicles in vitro by reducing ROS-dependent cellular damages and by enhancing mitochondrial distributions, thereby promoting the further applications of animal-derived BAPT in biomedical research.
Identification and characterization a novel polar tube protein (NbPTP6) from the microsporidian Nosema bombycis
Authors: Lv Qing , Wang Lijun , Fan Youpeng , Meng Xianzhi , Liu Keke , Zhou Bingqian , Chen Jie , Pan Guoqing , Long Mengxian , Zhou Zeyang
Published: September 2020

Background

Microsporidians are opportunistic pathogens with a wide range of hosts, including invertebrates, vertebrates and even humans. Microsporidians possess a highly specialized invasion structure, the polar tube. When spores encounter an appropriate environmental stimulation, the polar tube rapidly everts out of the spore, forming a 50–500 µm hollow tube that serves as a conduit for sporoplasm passage into host cells. The polar tube is mainly composed of polar tube proteins (PTPs). So far, five major polar tube proteins have been isolated from microsporidians. Nosema bombycis, the first identified microsporidian, infects the economically important insect silkworm and causes heavy financial loss to the sericulture industry annually.

Results

A novel polar tube protein of N. bombycis (NbPTP6) was identified. NbPTP6 was rich in histidine (H) and serine (S), which contained a signal peptide of 16 amino acids at the N-terminus. NbPTP6 also had 6 potential O-glycosylation sites and 1 potential N-glycosylation site. The sequence alignment analysis revealed that NbPTP6 was homologous with uncharacterized proteins from other microsporidians (Encephalitozoon cuniculi, E. hellem and N. ceranae). Additionally, the NbPTP6 gene was expressed in mature N. bombycis spores. Indirect immunofluorescence analysis (IFA) result showed that NbPTP6 is localized on the whole polar tube of the germinated spores. Moreover, IFA, enzyme-linked immunosorbent (ELISA) and fluorescence-activated cell sorting (FACS) assays results revealed that NbPTP6 had cell-binding ability.

Conclusions

Based on our results, we have confirmed that NbPTP6 is a novel microsporidian polar tube protein. This protein could adhere with the host cell surface, so we speculated it might play an important role in the process of microsporidian infection.
Analysis of drug sensitivity of human high-grade osteosarcoma in a chick chorioallantoic membrane (CAM) model: a proof of principle study
Authors: Guder Wiebke K. , Hartmann Wolfgang , Trautmann Marcel , Hardes Jendrik , Wardelmann Eva , Balke Maurice , Streitbürger Arne
Published: September 2020

Objective

Multi-agent chemotherapy is an important pillar in treatment of high-grade osteosarcoma. In an effort to improve patient survival, it is imperative to determine the effectiveness of new substances. The objective of this study was to investigate whether the chick chorioallantoic membrane (CAM) model can be used to analyze drug sensitivity in high-grade osteosarcoma.

Results

Spare biopsy tissue from five patients diagnosed with high-grade osteosarcoma was transferred into non-immortalized primary cell culture. After a pre-incubation period of 10 days, fertilized chick eggs were inoculated with primary tumor cells suspended in extracellular matrix gel. On day 16, treatment with 20 µmol/l doxorubicin (n = 4) or 25 µl of culture medium (n = 6) was performed for 24 h. CAM membranes were documented macroscopically, harvested and examined histologically. Transfer of biopsy specimens into primary cell culture was successful in all cases. 50% (n = 10) of eggs died after inoculation with tumor cells and before application of doxorubicin. No deaths occurred after application of doxorubicin. Histological examination found a response to doxorubicin in all four specimens. Based upon these results, the CAM model represents a promising preclinical alternative to animal experiments to determine drug sensitivity of osteosarcoma cells. Further research with regard to other substances and dosages appear justified.
Voluntary exercise in mesothelioma: effects on tumour growth and treatment response in a murine model
Authors: Fisher Scott A. , Peddle-McIntyre Carolyn J. , Burton Kimberley ,  Newton Robert U. , Marcq Elly , Lake Richard A. , Nowak Anna K.
Published: September 2020

Objective

There is substantial evidence that exercise can safely reduce the risk of cancer and improve survival in different human cancer populations. Long latency periods associated with carcinogen–induced cancers like asbestos induced mesothelioma provide an opportunity to implement exercise as an intervention to delay or prevent disease development. However, there are limited studies investigating the ability of exercise to prevent or delay cancer, and exercise as a preventive strategy has never been assessed in models with a known carcinogen. We investigated the potential of voluntary exercise (VE) to delay development of asbestos related disease (ARD) in our well-characterised, asbestos induced MexTAg model of mesothelioma.

Results

Asbestos exposed MexTAg mice were given continuous or delayed access to VE and ARD assessed over time. We found that the addition of VE did not affect ARD development in asbestos exposed MexTAg mice. However, non–asbestos exposed, aged matched control mice participated in significantly more VE behaviours, suggesting subclinical development of ARD after asbestos exposure had a greater impact on VE participation than age alone. These data highlight the importance of model choice and the potential limitation that some pre–clinical studies may not accurately represent the clinical paradigm, particularly in the context of prevention studies.
Asymptotic behavior of a stochastic HIV model with Beddington–DeAngelis functional response
Authors: Wang Suxia , Zhao Juan , Zhu Junxing , Ren Xiaoli
Published: September 2020

In this paper, we study the dynamics property of a stochastic HIV model with Beddington–DeAngelis functional response. It has a unique uninfected steady state. We prove that the model has a unique global positive solution. Furthermore, if the basic reproductive number is not larger than 1, the asymptotic behavior of the solution is stochastically stable. Otherwise, it fluctuates randomly around the infected steady state of the corresponding deterministic HIV model. Finally, some numerical simulations are carried out to verify our results.
Magnitude and trends in socio-economic and geographic inequality in access to birth by cesarean section in Tanzania: evidence from five rounds of Tanzania demographic and health surveys (1996–2015)
Authors: Shibre Gebretsadik , Zegeye Betregiorgis , Ahinkorah Bright Opoku , Keetile Mpho , Yaya Sanni
Published: September 2020

Background

Majority of maternal deaths are avoidable through quality obstetric care such as Cesarean Section (CS). However, in low-and middle-income countries, many women are still dying due to lack of obstetric services. Tanzania is one of the African countries where maternal mortality is high. However, there is paucity of evidence related to the magnitude and trends of disparities in CS utilization in the country. This study examined both the magnitude and trends in socio-economic and geographic inequalities in access to birth by CS.

Methods

Data were extracted from the Tanzania Demographic and Health Surveys (TDHSs) (1996–2015) and analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. First, access to birth by CS was disaggregated by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Ratio (R), Slope Index of Inequality (SII) and Relative Index of Inequality (RII). A 95% confidence interval was constructed for point estimates to measure statistical significance.

Results

The results showed variations in access to birth by CS across socioeconomic, urban-rural and regional subgroups in Tanzania from 1996 to 2015. Among the poorest subgroups, there was a 1.38 percentage points increase in CS coverage between 1996 and 2015 whereas approximately 11 percentage points increase was found among the richest subgroups within same period of time. The coverage of CS increased by nearly 1 percentage point, 3 percentage points and 9 percentage points among non-educated, those who had primary education and secondary or higher education, respectively over the last 19 years. The increase in coverage among rural residents was 2 percentage points and nearly 8 percentage points among urban residents over the last 19 years. Substantial disparity in CS coverage was recorded in all the studied surveys. For instance, in the most recent survey, pro-rich (RII = 15.55, 95% UI; 10.44, 20.66, SII = 15.8, 95% UI; 13.70, 17.91), pro-educated (RII = 13.71, 95% UI; 9.04, 18.38, SII = 16.04, 95% UI; 13.58, 18.49), pro-urban (R = 3.18, 95% UI; 2.36, 3.99), and subnational (D = 16.25, 95% UI; 10.02, 22.48) absolute and relative inequalities were observed.

Conclusion

The findings showed that over the last 19 years, women who were uneducated, poorest/poor, living in rural settings and from regions such as Zanzibar South, appeared to utilize CS services less in Tanzania. Therefore, such subpopulations need to be the central focus of policies and programmes implemmentation to improve CS services coverage and enhance equity-based CS services utilization.
The effect of acute and chronic food shortage on human population equilibrium in a subsistence setting
Authors: Tomiyama Joshua-Michael , Takagi Daisuke , Kantar Michael B.
Published: September 2020

Background 

World population is projected to reach 9–11 billion by 2050, raising concerns about food system security and sustainability. Modeling food systems are often a way to understand current and future dynamics. The most common model, first articulated by Malthus (Malthusian), shows population growth as an exponential function and food production as a linear function, concluding that human carrying capacity will be reached leading to mass starvation. Another prominent model was introduced by Boserup (Boserupian), which explains increases in food production as a function of population growth.

Methodology 

Here, we explore which food systems dynamics exist at equilibrium and after perturbation. The model introduced explores food availability in an isolated village and then in a line of villages. The isolated village model includes three key parameters: maximum calorie production (a), food production resilience (b), and minimum calorie requirement per person (c). The multiple village model adds an additional parameter for trade.

Results 

Isolated village populations are more resilient to famine than Malthusian theory predicts, suggesting that Malthus’ premise may be inaccurate. Predictably, across multiple villages increasing access and production reduce famine. However, under certain conditions large amounts of transport can lead to antagonist relationships leading to rapid changes in population.

Conclusion 

Food systems under both production and access scenarios proved to be resilient to small perturbations, requiring a large catastrophe to induce mortality; this appeared to discount the Malthusian model. This model can create dynamics where different modes of famine relief apply, but here we see that a balanced approach of both access and production appears to be the most resilient to famine.
Expression of p52, a non-canonical NF-kappaB transcription factor, is associated with poor ovarian cancer prognosis
Authors: Hufnagel Demetra H. , Wilson Andrew J. , Saxon Jamie , Blackwell Timothy S. , Watkins Jaclyn , Khabele Dineo , Crispens Marta A. , Yull Fiona E. , Beeghly-Fadiel Alicia
Published: September 2020

Background

The canonical and non-canonical nuclear factor-kappaB (NF-κB) signaling pathways have key roles in cancer, but studies have previously evaluated only the association of canonical transcription factors and ovarian cancer survival. Although a number of in vitro and in vivo studies have demonstrated mechanisms by which non-canonical NF-κB signaling potentially contributes to ovarian cancer progression, a prognostic association has yet to be shown in the clinical context.

Methods

We assayed p65 and p52 (major components of the canonical and non-canonical NF-κB pathways) by immunohistochemistry in epithelial ovarian tumor samples; nuclear and cytoplasmic staining were semi-quantified by H-scores and dichotomized at median values. Associations of p65 and p52 with progression-free survival (PFS) and overall survival (OS) were quantified by Hazard Ratios (HR) from proportional-hazards regression.

Results

Among 196 cases, median p52 and p65 H-scores were higher in high-grade serous cancers. Multivariable regression models indicated that higher p52 was associated with higher hazards of disease progression (cytoplasmic HR: 1.54; nuclear HR: 1.67) and death (cytoplasmic HR: 1.53; nuclear HR: 1.49), while higher nuclear p65 was associated with only a higher hazard of disease progression (HR: 1.40) in unadjusted models. When cytoplasmic and nuclear staining were combined, p52 remained significantly associated with increased hazards of disease progression (HR: 1.91, p = 0.004) and death (HR: 1.70, p = 0.021), even after adjustment for p65 and in analyses among only high-grade serous tumors.

Conclusions

This is the first study to demonstrate that p52, a major component of non-canonical NF-κB signaling, may be an independent prognostic factor for epithelial ovarian cancer, particularly high-grade serous ovarian cancer. Approaches to inhibit non-canonical NF-κB signaling should be explored as novel ovarian cancer therapies are needed.
Smart multimedia learning of ICT: role and impact on language learners’ writing fluency— YouTube online English learning resources as an example
Authors: Alobaid Azzam
Published: September 2020

This work seeks to determine if and how much the smart learning environment of Information and Communications Technology (ICT) tools like YouTube can help improve learners’ fluency of language use and expression in their daily written communication. This research highlights and takes advantage of the potential role and features of multimedia brought to the language learner by the ICT tools, taking YouTube online English learning resources as an example of this smart learning environment. This work hypothesizes that learners who engage with, expose themselves more to and leverage such online language materials could develop their fluency of daily language use and expression in writing over time. The findings of this research show that there is a statistically significant difference in some but not all aspects of the learners’ writing fluency; basically, the accuracy and organization of ideas as qualitative dimensions of fluency improved after the actual exposure to YouTube over five months as long as factors like engagement, enhancement and intelligibility are provided by its multi-mediated input. However, other aspects of fluency in writing could develop slightly but with no statistically significant difference. Also, compared to other sources of language learning in the learners’ environment, multimedia educational tools developed by ICT like the widely known platform YouTube can be more effective and thus strongly recommended equally for language learners and teachers where optimization of writing fluency is the target of learning. This paper is a work-in-progress that investigates the role and impact of smart learning environment of ICT multi-media on English language learners’ fluency and accuracy of use and expression in speaking and writing.
Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression
Authors: Wang Xingwen , Ma Longbing , Liu Zhenlei , Chen Zan , Wu Hao , Jian Fengzeng
Published: September 2020

Background

Although the single-stage posterior realignment craniovertebral junction (CVJ) surgery could treat most of the basilar invagination (BI) and atlantoaxial dislocation (AAD), there are still some cases with incomplete decompression of the spinal cord, which remains a technique challenging situation.

Methods

Eleven patients were included with remained myelopathic symptoms after posterior correction due to incomplete decompression of the spinal cord. Transoral odontoidectomy assisted by image-guided navigation and intraoperative CT was performed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up.

Results

Eleven patients were followed up for an average of 47 months. Symptoms were alleviated in 10 of 11 patients (90.9%). One patient died of an unknown reason 1 week after the transoral approach. The clinical and radiological parameters pre- and postoperatively were reported.

Conclusion

Transoral odontoidectomy as a salvage surgery is safe and effective for properly selected BI and AAD patients after inadequate indirect decompression from posterior distraction and fixation. Image-guided navigation and intraoperative CT can provide precise information and accurate localization during operation, thus enabling complete resection of the odontoid process and decompression of the spinal cord.
Abbreviated Breast Magnetic Resonance Imaging for Supplemental Screening of Women With Dense Breasts and Average Risk
Authors: Weinstein Susan P. , Korhonen Katrina , Cirelli Claire , Schnall Mitchell D. , McDonald Elizabeth S. , Pantel Austin R. , Zuckerman Samantha , Borthakur Ari , Conant Emily F.
Published: September 2020

PURPOSE

Although mammography is the standard of care for breast cancer screening, dense breast tissue decreases mammographic sensitivity. We report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts.

METHODS

The study was approved by the institutional review board and is Health Insurance Portability and Accountability Act complaint. This retrospective review includes women who were imaged between January 1, 2016 and February 28, 2019. On a 1.5 Tesla magnet, the imaging protocol consisted of three sequences: Short-TI Inversion Recovery (STIR), precontrast, and postcontrast. A subtraction sequence and a maximum intensity projection were generated. We report the patient-level CDR and the positive predictive value of AB-MR examinations after negative/benign digital breast tomosynthesis (DBT).

RESULTS

Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up.

CONCLUSION

Preliminary results from clinical implementation of screening AB-MR resulted in a CDR of 27.4/1,000 at the patient level after DBT in women with dense breasts. Additional evaluation is warranted.
Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient
Authors: Sperduto Paul W. , Mesko Shane , Li Jing , Cagney Daniel , Aizer Ayal , Lin Nancy U. , Nesbit Eric , Kruser Tim J. , Chan Jason , Braunstein Steve , Lee Jessica , Kirkpatrick John P. , Breen Will , Brown Paul D. , Shi Diana , Shih Helen A. , Soliman Hany , Sahgal Arjun , Shanley Ryan , Sperduto William A. , Lou Emil , Everett Ashlyn , Boggs Drexell H. , Masucci Laura , Roberge David , Remick Jill , Plichta Kristin , Buatti John M. , Jain Supriya , Gaspar Laurie E. , Wu Cheng-Chia , Wang Tony J.C. , Bryant John , Chuong Michael , An Yi , Chiang Veronica , Nakano Toshimichi , Aoyama Hidefumi , Mehta Minesh P.
Published: September 2020

PURPOSE

Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility.

METHODS

A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively.

RESULTS

Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation ( P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non–small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively.

CONCLUSION

Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
Association Between Behavioral and Learning Outcomes and Single Exposures to Procedures Requiring General Anesthesia Before Age 3: Secondary Analysis of Data From Olmsted County, MN
Authors: Warner David O. , Hu Danqing , Zaccariello Michael J. , Schroeder Darrell R. , Hanson Andrew C. , Wilder Robert T. , Sprung Juraj , Flick Randall P.
Published: September 2020

BACKGROUND:

Two prior population-based (children born in Olmsted County, MN), retrospective cohort studies both found that multiple exposures to anesthesia before age 3 were associated with a significant increase in the frequency of attention-deficit hyperactivity disorder (ADHD) and learning disabilities (LD) later in life. The primary purpose of this secondary analysis of these data was to test the hypothesis that a single exposure to anesthesia before age 3 was associated with an increased risk of ADHD. We also examined the association of single exposures with LD and the need for individualized educational plans as secondary outcomes.

METHODS:

This analysis includes 5339 children who were unexposed to general anesthesia before age 3 (4876 born from 1976 to 1982 and 463 born from 1996 to 2000), and 1054 children who had a single exposure to anesthesia before age 3 (481 born from 1976 to 1982 and 573 born from 1996 to 2000). The primary outcome of interest was ADHD. Secondary outcomes included LD (reading, mathematics, and written language) and the need for individualized educational programs (speech/language and emotion/behavior). To compare the incidence of each outcome between those who were unexposed and singly exposed to anesthesia before the age of 3 years, an inverse probability of treatment weighted proportional hazards model was used.

RESULTS:

For children not exposed to anesthesia, the estimated cumulative frequency (95% confidence interval [CI]) of ADHD at age 18 was 7.3% (95% CI, 6.5–8.1) and 13.0% (95% CI, 10.1–16.8) for the 1976–1982 and 1996–2000 cohorts, respectively. For children exposed to a single anesthetic before age 3, the cumulative frequency of ADHD was 8.1% (95% CI, 5.3–12.4) and 17.6% (95% CI, 14.0–21.9) for the 1976–1982 and 1996–2000 cohorts, respectively. In weighted analyses, single exposures were not significantly associated with an increased frequency of ADHD (hazard ratio [HR], 1.21; 95% CI, 0.91–1.60; P = .184). Single exposures were also not associated with an increased frequency of any LD (HR, 0.98; 95% CI, 0.78–1.23), or the need for individualized education plans.

CONCLUSIONS:

This analysis did not find evidence that single exposures to procedures requiring general anesthesia, before age 3, are associated with an increased risk of developing ADHD, LD, or the need for individualized educational plans in later life.
β-lactamases (bla TEM, bla SHV, bla CTXM-1, bla VEB, bla OXA-1) and class C β-lactamases gene frequency in Pseudomonas aeruginosa isolated from various clinical specimens in Khartoum State, Sudan: a cross sectional study
Authors: Abdelrahman Dina N. , Taha Aya A. , Dafaallah Mazar M. , Mohammed Alaa Abdelgafoor , El Hussein Abdel Rahim M. , Hashim Ahmed I. , Hamedelnil Yousif F. , Altayb Hisham N.
Published: September 2020

Background: Pseudomonas aeruginosa is a pathogenic bacterium, causing nosocomial infections with intrinsic and acquired resistance mechanisms to a large group of antibiotics, including β-lactams. This study aimed to determine the susceptibility pattern to selected antibiotics and to index the first reported β-lactamases gene (extended spectrum β-lactamases (ESBLs) genes and class C β-lactamases genes) frequency in Ps. aeruginosa in Khartoum State, Sudan.

Methods: 121 Ps. aeruginosa clinical isolates from various clinical specimens were used in this cross-sectional study conducted in Khartoum State. A total of 80 isolates were confirmed as Ps. aeruginosa through conventional identification methods and species-specific primers (the remaining 40 isolates were other bacterial species). The susceptibility pattern of the confirmed isolates to selected antibiotics was done following the Kirby Bauer disk diffusion method. Multiplex PCR was used for detection of seven β-lactamase genes (blaTEM, blaSHV, blaCTXM-1, blaVEB, blaOXA-1, blaAmpC and blaDHA).

Results: Of the 80 confirmed Ps. aeruginosa isolates, 8 (10%) were resistant to Imipenem while all isolates were resistant to Amoxicillin and Amoxyclav (100%). A total of 43 (54%) Ps. aeruginosa isolates were positive for ESBLs genes, while 27 (34%) were positive for class C β-lactamases, and 20 (25%) were positive for both classes. Frequency of ESBLs genes was as follows: blaTEM, 19 (44.2%); blaSHV, 16 (37.2%); blaCTX-M1, 10 (23.3%); blaVEB, 14 (32.6%); and blaOXA-1, 7 (16.3%). Occurrence of class C β-lactamases genes was blaAmpC 22 (81.5%) and blaDHA 8 (29.6%). In total, 3 (11.1%) isolates were positive for both blaAmpC and blaDHA genes.

Conclusion: Ps. aeruginosa isolates showed a high rate of β-lactamases production, with co-resistance to other antibiotic classes. The lowest resistance rate of Ps. aeruginosa was to Imipenem followed by Gentamicin and Ciprofloxacin. No statistically significant relationship between production of β-lactamases in Ps. aeruginosa and resistance to third generation cephalosporins was found.
Eliciting Risk Preferences and Elasticity of Substitution
Authors: Burgaard Johan , Steffensen Mogens
Published: September 2020

Risk aversion and elasticity of intertemporal substitution (EIS) are separated via the celebrated recursive utility building on certainty equivalents of indirect utility. Based on an alternative separation method, we formulate a questionnaire for simultaneous and consistent estimation of risk aversion, subjective discount rate, and EIS. From a representative group of 1,153 respondents, we estimate parameters for these preferences and their variability within the population. Risk aversion and the subjective discount rate are found to be in the orders of 2 and 0, respectively, not diverging far away from results from other studies. Our estimate of EIS in the order of 10 is larger than often reported. Background variables like age and income have little predictive power for the three estimates. Only gender has a significant influence on risk aversion in the usually perceived direction that females are more risk-averse than males. Using individual estimates of preference parameters, we find covariance between preferences toward risk and EIS. We present the background reasoning on objectives, the questionnaire, a statistical analysis of the results, and economic interpretations of these, including relations to the literature.
Distribution-Free Inventory Risk Pooling in a Multilocation Newsvendor
Authors: Govindarajan Aravind , Sinha Amitabh , Uichanco Joline
Published: September 2020

We study a multilocation newsvendor network when the only information available on the joint distribution of demands are the values of its mean vector and covariance matrix. We adopt a distributionally robust model to find inventory levels that minimize the worst-case expected cost among the distributions consistent with this information. This problem is NP-hard. We find a closed-form tight bound on the expected cost when there are only two locations. This bound is tight under a family of joint demand distributions with six support points. For the general case, we develop a computationally tractable upper bound on the worst-case expected cost if the costs of fulfilling demands have a nested structure. This upper bound is the optimal value of a semidefinite program whose dimensions are polynomial in the number of locations. We propose an algorithm that can approximate general fulfillment cost structures by nested structures, yielding a computationally tractable heuristic for distributionally robust inventory optimization on general newsvendor networks. We conduct experiments on networks resembling U.S. e-commerce distribution networks to show the value of a distributionally robust approach over a stochastic approach that assumes an incorrect demand distribution.

This paper was accepted by Chung Piaw Teo, optimization.