bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the Relation Between Disability Severity Among Older Adults with Disabilities and Sibling Caregiving
Authors: Lee Chung eun , Burke Meghan M. , Arnold Catherine K.
Published: October 2019

Given the longer lives of individuals with disabilities and the increasing likelihood of siblings fulfilling family caregiving roles, it is critical to identify correlates of sibling caregiving. Yet, little research has examined the relation between the severity of the disability and sibling caregiving. The purpose of this study was to understand the relation between the severity of the disability (defined as functional ability and maladaptive behaviors) and sibling caregiving, including advocacy and future planning. Adult siblings of older individuals with disabilities ( N = 141) completed a national survey. Results indicated that individuals with less functional ability were significantly more likely to receive greater sibling caregiving, advocacy, and future planning. There was a nonlinear relation with respect to sibling caregiving and functional ability with individuals with severe disabilities requiring disproportionately greater sibling caregiving. Furthermore, there was a nonlinear relation between maladaptive behaviors and caregiving demands such that siblings of individuals with the greatest asocial behaviors reported significantly greater caregiving demands.
Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint
Authors: Cefalu Charles A. , Blazar Philip E. , Simmons Barry P. , Earp Brandon E.
Published: October 2019

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.
Serum visfatin level is associated with complexity of coronary artery disease in patients with stable angina pectoris
Authors: Duman Hakan , Özyıldız Ali Gökhan , Bahçeci İlkay , Duman Handan , Uslu Abdulkadir , Ergül Elif
Published: October 2019

Background:

Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD).

Methods:

The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the ‘Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)’ score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high).

Results:

Serum visfatin (8.6 ± 4.2 ng/ml versus 13.4 ± 5.2 ng/ml, p < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25–0.77) mg/dl versus 0.71 (0.32–1.10) mg/dl, p < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score ( r = 0.559, p < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10–1.36; p < 0.001], CRP (OR 6.22, 95% CI 1.70–22.7; p = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10–13.2; p = 0.034) were found to be independent predictors of SYNTAX score.

Conclusions:

Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.
Emotions at the Service of Cultural Construction
Authors: Rimé Bernard
Published: October 2019

Emotions signal flaws in the person’s anticipation systems, or in other words, in aspects of models of how the world works. As these models are essentially shared in society, emotional challenges experienced by any individual are of relevance to the community of others. Emotions emerge at the heart of the individual experience, the only place where collective knowledge can be tested against the world. Once felt, emotions generate a cascade of psychological facts: compelling concern, cognitive work, social sharing, and propagation of the social sharing. The larger the fault detected, the more intense the emotion, the more intensive the cognitive work it generates, and the broader the social sharing of the episodic information. Through the social sharing of emotions, common knowledge is updated and enriched.
Chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME) and Fibromyalgia (FM): the foundation of a relationship
Authors: Mckay Pamela G , Martin Colin R , Walker Helen , Fleming Mick
Published: October 2019

Introduction:

Chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME) and fibromyalgia (FM) are both debilitating syndromes with complex polysymptomatology. Early research infers that a relationship may exist even though the diagnosis provided may influence the management trajectory. In the absence of a diagnostic test and treatment, this study aims to confirm the symptoms and their severity, which may infer a relationship and influence future research.

Method:

A quasi-experimental design was utilised, using Internet-based self-assessment questionnaires focusing on nine symptom areas: criteria, pain, sleep, fatigue, anxiety and depression, health-related quality of life, self-esteem and locus of control. The questionnaires used for data collection are as follows: the American Centre for Disease Control and Prevention Symptom Inventory for CFS/ME (American CDC Symptom Inventory); the American College of Rheumatology (ACR) Criteria for FM; Fibromyalgia Impact Questionnaire (FIQ); McGill Pain Questionnaire (MPQ); Multidimensional Fatigue Inventory (MFI); Pittsburgh Sleep Quality Index (PSQI); Health-Related Quality of Life SF-36 V2 (HRQoL SF-36 V2); Hospital Anxiety and Depression Scale (HADS); Multidimensional Health Locus of Control (MHLOC) and the Rosenberg Self-Esteem Scale (RSES).

Setting and participants:

Participants were recruited from two distinct community groups, namely CFS/ME (n = 101) and FM (n = 107). Participants were male and female aged 17 (CFS/ME mean age 45.5 years; FM mean age 47.2 years).

Results:

All participants in the CFS/ME and FM groups satisfied the requirements of their individual criteria. Results confirmed that both groups experienced the debilitating symptoms measured, with the exception of anxiety and depression, impacting on their quality of life. Results suggest a relationship between CFS/ME and FM, indicating the requirement for future research.
Dynamics between market categories: A study of the (in) visibility of the plus-size fashion market
Authors: Dion Delphine , Tachet Béatrice
Published: October 2019

By studying fashion market, this research analyzes domination stakes existing between two market categories: the primary market of mainstream fashion and the secondary market of plus size fashion. It observes dynamics based on practices and material tools which create symbolic and physical (in)visibility of market categories. This study opens up new perspectives in our efforts to understand market dynamics. First, it shows that categorisation is not only a matter of representations, discourses or social interactions, but also involves material initiatives. Materiality emerges as a tool of visibility and invisibility. Second, this study reveals the stakes of social visibility. Behind physical invisibility (not being seen, being hidden, …) lies social invisibility (not existing socially), which explains the feelings of stigmatization and exclusion among curvaceous women.
Knowledge, Attitudes, and PrEP Prescribing Practices of Health Care Providers in Philadelphia, PA
Authors: Carter Margaret R. , Aaron Erika , Nassau Tanner , Brady Kathleen A.
Published: October 2019

Introduction: Preexposure prophylaxis (PrEP) is an effective biomedical intervention that has the potential to dramatically decrease the incidence of HIV but remains an underutilized method of HIV prevention. The Philadelphia Department of Public Health administered an online survey to health care providers in the Philadelphia area with the aim of characterizing PrEP attitudes, knowledge, and prescribing practices. Methods: Online surveys were distributed to 1000 providers who were recruited through distribution lists of Philadelphia medical providers between September and December 2017. A Likert-type response scale was utilized to analyze participant self-reported responses. Participant practice settings included HIV/ID, family and internal medicine, women’s health, and pediatric/adolescent clinics. Results and Discussion: The response rate of the survey was 9%. Of 81 complete responses, 75% (N = 61) felt comfortable providing PrEP and 77% (N = 62) had ever written a PrEP prescription. Compared with primary care providers, HIV care providers were significantly more knowledgeable about required laboratory testing for prescribing PrEP ( P = .03) and were more likely to have prescribed PrEP to more than 10 patients ( P = .006). Women’s health and pediatric providers reported feeling less comfortable providing PrEP to their patients ( P = .0003). Conclusion: The majority of health care providers in the Philadelphia area who responded to the survey reported experience with providing PrEP to their patients. In the present study, HIV care providers were significantly more comfortable and knowledgeable about prescribing PrEP compared with providers in primary care, women’s health, and/or adolescent/pediatric medicine. Results were limited by sampling bias, as providers who responded to the survey may have prior experience with PrEP. Future Health Department educational trainings need to target primary and preventive care providers, providers who have never prescribed PrEP, and providers who see few patients living with HIV.
Controlling Terrorism Through the Nudging of Social Interactions
Authors: Mitra Siddhartha
Published: October 2019

The article explains how ‘nudge theory’ can be applied to alleviate the incidence of terrorism. Nudges, which bring about a change in the environment in which individual choice is exercised, do not just modify the behaviour of individuals in a society but thereby influence the social environment which impacts both the human brain and behaviour. Thus, a nudge when appropriately administered to a large number of individuals can potentially bring about social evolution. This article seeks to reap dividends from this analytical argument by setting up an axiomatic system which captures present-day individual and social behaviour and then elaborates on the resultant social dynamics, which lead to growth of terrorism inducing intercommunity hatred. As humans can evolve, any axioms about human and social behaviour are not timeless. The article therefore suggests nudges for utilizing the bidirectional causality between the human brain and social environment to render one or more axioms toothless and diminish the societal propensity for terrorism. The recommended nudges include those that promote formation of mixed neighbourhoods by discreetly inducing more frequent interactions of a positive nature between members of hitherto hostile socio-economic groups; cultural exchange on neutral ground; and corporate social responsibility fostering the wellbeing of poor communities.

JEL Classification: B55, D74, D87
Saudi Aramco: A Blend between Profit and Politics
Authors: Ahmed Jashim Uddin , Sultana Hafiza , Khan Md. Muinuddin
Published: October 2019

The case study is based on Saudi Aramco, the largest state-owned oil company of the Kingdom of Saudi Arabia (KSA), which has become a world leader in hydrocarbons exploration, production, refining, distribution and marketing. The study analyses the organization’s strategies, product lines, domestic and global operations, key performance, recent initiatives for an IPO, and role in economic development and politics of the kingdom in the backdrop of global oil market. Through a combination of own facilities and joint ventures, Aramco produces a slate of refined products and high-value petrochemicals for domestic and international industries. The partnerships of the company with refining and marketing ventures across the globe has enabled it to go across the length of its value chain, from wellhead to the consumers. The separation of its operational decision-making and financial structure from the state intervention is one unique characteristic which might be linked to its sound financial performance and organizational excellence. On the other hand, the delay in its IPO indicates the possible problems that might arise from this influence.
Command, Leadership, Intelligence and Management (CLIM): A Proposed Theory for Improved Strategic Leadership
Authors: Keeton William
Published: October 2019

This article is a theoretical perspective, building on command, leadership and management principles that are grounded within the military ( Young & Dulewicz, 2005 ). The aim of this new theoretical perspective is to introduce the fourth element of intelligence that will represent command, leadership, intelligence and management (CLIM) applied to business executives seeking to improve performance. Moreover, this article fills the gap in the previous theory by identifying and bringing intelligence into the framework. The article will focus on key propositions for each of the four factors of CLIM. Each section will describe the operationalization for the function of the four factors, setting the conditions to conduct future studies. The article concludes with the expected beneficial measures of the attributes needed to maximize strategic leadership which will benefit senior executives.
Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States
Authors: Johnson Taylor R. , Nguyen Alexander , Shah Kush , Hogue Grant D.
Published: October 2019

Background:

The meniscus is vital for load bearing, knee stabilization, and shock absorption, making a meniscal tear a well-recognized sport-related injury in children and young adults. An inverse relationship between the quality and value of orthopaedic care provided and the overall treatment cycle exists in which delayed meniscal tear treatment increases the likelihood of unfavorable outcomes. Although a majority of children and young adults have health insurance, many athletes within this demographic still face significant barriers in accessing orthopaedic services because of insurance type and household income.

Purpose:

To determine the impact of insurance status and socioeconomic markers on the time to orthopaedic evaluation and treatment as well as the rate of surgical interventions for meniscal tears in children and young adult athletes in the United States.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We conducted a retrospective review of all patients ≤22 years of age who presented to our institution between 2008 and 2016 and who were diagnosed with meniscal tears. Patients were categorized based on insurance and socioeconomic status. Dates of injury, referral, evaluation by an orthopaedic surgeon, and surgery were also recorded. Chi-square and regression analyses were utilized to determine the significance and correlation between the influencing factors and time to referral, evaluation, and surgery.

Results:

Publicly insured, commercially insured, and uninsured patients comprised 49.4%, 26.6%, and 24.1%, respectively, of the 237 patients included in this study. Insurance status was predictive of time to orthopaedic referral, initial evaluation, and surgery ( P < .01). Uninsured and publicly insured patients experienced significant delays during their orthopaedic care compared with commercially insured patients. However, no correlation was found between insurance status or household income and the rate of surgical interventions.

Conclusion:

Publicly insured and uninsured pediatric and college-aged patients faced significant barriers in accessing orthopaedic services, as demonstrated by substantially longer times between the initial injury and referral to an orthopaedic evaluation and surgery; however, these socioeconomic factors did not affect the rate of surgical management. Clinical competency regarding the effects of socioeconomic factors on the time to orthopaedic care and efforts to expedite care among underinsured and underserved children are vital for improving patient outcomes.
Pivotal role of PDK1 in megakaryocyte cytoskeletal dynamics and polarization during platelet biogenesis
Authors: Geue Sascha , Aurbach Katja , Manke Mailin-Christin , Manukjan Georgi , Münzer Patrick , Stegner David , Brähler Caroline , Walker-Allgaier Britta , Märklin Melanie , Borst Carla E. , Quintanilla-Fend Leticia , Rath Dominik , Geisler Tobias , Salih Helmut R. , Seizer Peter , Lang Florian , Nieswandt Bernhard , Gawaz Meinrad , Schulze Harald , Pleines Irina , Borst Oliver
Published: October 2019

The investigators explore the role of PDK1 (phosphoinositide-dependent protein kinase 1) in the cytoskeletal regulation of platelet production and furnish new insights into megakaryocyte maturation and proplatelet formation.
IL-6 dysregulation originates in dendritic cells and mediates graft-versus-host disease via classical signaling
Authors: Wilkinson Andrew N. , Chang Karshing , Kuns Rachel D. , Henden Andrea S. , Minnie Simone A. , Ensbey Kathleen S. , Clouston Andrew D. , Zhang Ping , Koyama Motoko , Hidalgo Juan , Rose-John Stefan , Varelias Antiopi , Vuckovic Slavica , Gartlan Kate H. , Hill Geoffrey R.
Published: October 2019

Key Points

DCs are the principal source of IL-6 dysregulation after alloSCT. IL-6–dependent GVHD is driven by classical signaling of IL-6R on donor T cells but is regulated by trans signaling.
Hypertension and incident cardiovascular events following ibrutinib initiation
Authors: Dickerson Tyler , Wiczer Tracy , Waller Allyson , Philippon Jennifer , Porter Kyle , Haddad Devin , Guha Avirup , Rogers Kerry A. , Bhat Seema , Byrd John C. , Woyach Jennifer A. , Awan Farrukh , Addison Daniel
Published: October 2019

In a retrospective analysis, Dickerson et al report that the incidence of hypertension in patients treated with ibruitinib is nearly 80% and is associated with an increased rate of adverse cardiovascular events, primarily atrial fibrillation. Cardiac events can be reduced by treating the hypertension.
The bending properties of bamboo strand board I-beams
Authors: Sun Yuhui , Jiang Zehui , Liu Huanrong , Sun Zhengjun , Fang Changhua
Published: October 2019

Novel bamboo I-beams fabricated from bamboo oriented strand boards as structural members were investigated. Bending tests were performed to determine the stiffness and strength properties of bamboo I-beams. The results showed that the stiffness and strength properties exceeded the requirements of APA EWS Performance-Rated I-joist in PRI-400-2012. Increasing section depth had obvious effect on the ultimate load capacity, stiffness and failure mode of bamboo I-beams. Moreover, the bending properties of bamboo I-beams were also affected by flange materials, joint type in web, and reinforcement of flange finger joints. The strain measurements indicated that the plane assumption could be applied to the bamboo I-beams. Based on the stiffness calculation formula of I-beams recommended in Canadian standard and the moment capacity calculation formula corresponding to each failure mode of I-beams, the calculated stiffness and ultimate load capacity of specimens were relatively close to the experimental results.
A machine learning-based service for estimating quality of genomes using PATRIC
Authors: Parrello Bruce , Butler Rory , Chlenski Philippe , Olson Robert , Overbeek Jamie , Pusch Gordon D. , Vonstein Veronika , Overbeek Ross
Published: October 2019

Background

Recent advances in high-volume sequencing technology and mining of genomes from metagenomic samples call for rapid and reliable genome quality evaluation. The current release of the PATRIC database contains over 220,000 genomes, and current metagenomic technology supports assemblies of many draft-quality genomes from a single sample, most of which will be novel.

Description

We have added two quality assessment tools to the PATRIC annotation pipeline. EvalCon uses supervised machine learning to calculate an annotation consistency score. EvalG implements a variant of the CheckM algorithm to estimate contamination and completeness of an annotated genome.We report on the performance of these tools and the potential utility of the consistency score. Additionally, we provide contamination, completeness, and consistency measures for all genomes in PATRIC and in a recent set of metagenomic assemblies.

Conclusion

EvalG and EvalCon facilitate the rapid quality control and exploration of PATRIC-annotated draft genomes.
Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial
Authors: Berntsen G. K. R. , Dalbakk M. , Hurley J. S. , Bergmo T. , Solbakken B. , Spansvoll L. , Bellika J. G. , Skrøvseth S. O. , Brattland T. , Rumpsfeld M.
Published: October 2019

Background

Person-centred care (PCC) focusing on personalised goals and care plans derived from “What matters to you?” has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by “What matters to you?” with 2) IC and 3) pro-active care is unknown.

Methods

Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014–2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up.

Results

The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months.

Conclusion

Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better.

Trial registration

ClinicalTrials.gov (identifier:NCT02541474), registered Sept 2015.
A systematic review on anti-malarial drug discovery and antiplasmodial potential of green synthesis mediated metal nanoparticles: overview, challenges and future perspectives
Authors: Kojom Foko Loick P. , Eya’ane Meva Francois , Eboumbou Moukoko Carole E. , Ntoumba Agnes A. , Ngaha Njila Marie I. , Belle Ebanda Kedi Philippe , Ayong Lawrence , Lehman Leopold G.
Published: October 2019

Background

The recent emergence in Southeast Asia of artemisinin resistance poses major threats to malaria control and elimination globally. Green nanotechnologies can constitute interesting tools for discovering anti-malarial medicines. This systematic review focused on the green synthesis of metal nanoparticles as potential source of new antiplasmodial drugs.

Methods

Seven electronic database were used following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

A total of 17 papers were included in the systematic review. 82.4% of the studies used plant leaves to produce nanoparticles (NPs) while three studies used microorganisms, including bacteria and fungi. Silver was the main metal precursor for the synthesis of NPs. The majority of studies obtained nanoparticles spherical in shape, with sizes ranging between 4 and 65 nm, and reported no or little cytotoxic effect of the NPs. Results based on 50% inhibitory concentration (IC50) varied between studies but, in general, could be divided into three NP categories; (i) those more effective than positive controls, (ii) those more effective than corresponding plant extracts and, (iii) those less effective than the positive controls or plant extracts.

Conclusions

This study highlights the high antiplasmodial potential of green-synthesized metal nanoparticles thereby underscoring the possibility to find and develop new anti-malarial drugs based on green synthesis approaches. However, the review also highlights the need for extensive in vitro and in vivo studies to confirm their safety in humans and the elucidation of the mechanism of action.

Graphical abstract
Applying new fixed point theorems on fractional and ordinary differential equations
Authors: Karapınar Erdal , Abdeljawad Thabet , Jarad Fahd
Published: October 2019

In this paper, we consider a fixed point theorem that extends and unifies several existing results in the literature. We apply the proven fixed point results on the existence of solution of ordinary boundary value problems and fractional boundary value problems with integral type boundary conditions in the frame of some Caputo type fractional operators.
The influence of phytase, pre-pellet cracked maize and dietary crude protein level on broiler performance via response surface methodology
Authors: Moss Amy F. , Chrystal Peter V. , Dersjant-Li Yueming , Selle Peter H. , Liu Sonia Yun
Published: October 2019

Background

The reduction of crude protein levels in diets for broiler chickens may generate economic, environmental and flock welfare and health benefits; however, performance is usually compromised. Whole grain feeding and phytase may improve the utilization of reduced crude protein diets.

Results

The effects of pre-pellet cracked maize (0, 15% and 30%) and phytase (0, 750 and 1500 FTU/kg) in iso-energetic maize-soy diets with three levels of crude protein (22%, 19.5% and 17%) were evaluated via a Box-Behnken response surface design. Each of 13 dietary treatments were offered to 6 replicate cages (6 birds/cage) of male Ross 308 broiler chicks from 7 to 28 d post-hatch. Model prediction and response surface plots were generated from experimental data via polynomial regression in R and only significant coefficients were included and discussed in the predicted models. Weight gain, feed intake and FCR were all influenced by pre-pellet cracked maize, phytase and crude protein level, where crude protein level had the greatest influence. Consequently, the reduction from 22% to 17% dietary crude protein in non-supplemented diets reduced weight gain, feed intake, relative gizzard weight, relative gizzard content and relative pancreas weight but improved FCR. However, the inclusion of 30% cracked maize to 17% crude protein diets restored gizzard weight and 1500 FTU phytase inclusion to 17% crude protein diets increased relative gizzard contents and pancreas weights. Cracked maize and phytase inclusion in tandem to 17% crude protein diets increased weight gain, feed intake and FCR; however, this FCR was still more efficient than broilers offered the non-supplemented 22% crude protein diet. Broilers offered the pre-pellet cracked maize and phytase inclusions reduced AME in 22% crude protein diets but improved AME by 2.92 MJ (14.16 versus 11.24 MJ; P < 0.001) in diets containing 17% crude protein. Ileal N digestibility was greater in broilers offered diets with 17% crude protein than those offered the 22% crude protein diet; irrespective of phytase and pre-pellet cracked maize.

Conclusion

Pre-pellet cracked maize and phytase inclusions will improve the performance of broilers offered reduced crude protein diets.
Targeted Therapy in Advanced Melanoma With Rare BRAF Mutations
Authors: Menzer Christian , Menzies Alexander M. , Carlino Matteo S. , Reijers Irene , Groen Emma J. , Eigentler Thomas , de Groot Jan Willem B. , van der Veldt Astrid A.M. , Johnson Douglas B. , Meiss Frank , Schlaak Max , Schilling Bastian , Westgeest Hans M. , Gutzmer Ralf , Pföhler Claudia , Meier Friedegund , Zimmer Lisa , Suijkerbuijk Karijn P.M. , Haalck Thomas , Thoms Kai-Martin , Herbschleb Karin , Leichsenring Jonas , Menzer Alexander , Kopp-Schneider Annette , Long Georgina V. , Kefford Richard , Enk Alexander , Blank Christian U. , Hassel Jessica C.
Published: October 2019

PURPOSE

BRAF/MEK inhibition is a standard of care for patients with BRAF V600E/K–mutated metastatic melanoma. For patients with less frequent BRAF mutations, however, efficacy data are limited.

METHODS

In the current study, 103 patients with metastatic melanoma with rare, activating non-V600E/K BRAF mutations that were treated with either a BRAF inhibitor (BRAFi), MEK inhibitor (MEKi), or the combination were included. BRAF mutation, patient and disease characteristics, response, and survival data were analyzed.

RESULTS

Fifty-eight patient tumors (56%) harbored a non-E/K V600 mutation, 38 (37%) a non-V600 mutation, and seven had both V600E and a rare BRAF mutation (7%). The most frequent mutations were V600R (43%; 44 of 103), L597P/Q/R/S (15%; 15 of 103), and K601E (11%; 11 of 103). Most patients had stage IV disease and 42% had elevated lactate dehydrogenase at BRAFi/MEKi initiation. Most patients received combined BRAFi/MEKi (58%) or BRAFi monotherapy (37%). Of the 58 patients with V600 mutations, overall response rate to BRAFi monotherapy and combination BRAFi/MEKi was 27% (six of 22) and 56% (20 of 36), respectively, whereas median progression-free survival (PFS) was 3.7 months and 8.0 months, respectively ( P = .002). Of the 38 patients with non-V600 mutations, overall response rate was 0% (zero of 15) to BRAFi, 40% (two of five) to MEKi, and 28% (five of 18) to combination treatment, with a median PFS of 1.8 months versus 3.7 months versus 3.3 months, respectively. Multivariable analyses revealed superior survival (PFS and overall survival) with combination over monotherapy in rare V600 and non-V600 mutated melanoma.

CONCLUSION

Patients with rare BRAF mutations can respond to targeted therapy, however, efficacy seems to be lower compared with V600E mutated melanoma. Combination BRAFi/MEKi seems to be the best regimen for both V600 and non-V600 mutations. Yet interpretation should be done with care because of the heterogeneity of patients with small sample sizes for some of the reported mutations.
Lanreotide Therapy vs Active Surveillance in MEN1-Related Pancreatic Neuroendocrine Tumors < 2 Centimeters
Authors: Faggiano Antongiulio , Modica Roberta , Lo Calzo Fabio , Camera Luigi , Napolitano Vincenzo , Altieri Barbara , de Cicco Federica , Bottiglieri Fialomena , Sesti Franz , Badalamenti Giuseppe , Isidori Andrea M , Colao Annamaria
Published: October 2019

Purpose

Pancreatic neuroendocrine tumors (pNETs) are frequent in multiple endocrine neoplasia type 1 (MEN1) syndrome. They are usually not surgically treated unless larger than 1 to 2 cm or a growth rate > 0.5 cm per year. Somatostatin analogues represent one of the main therapeutic options in pNETs, but they have never been prospectively investigated in MEN1-related pNETs. The aim of this study was to prospectively evaluate the effectiveness of lanreotide in patients with MEN1-related pNETs < 2 cm.

Methods

MEN1 patients with 1 or more pNETs < 2 cm of maximal diameter were considered. Study design was prospective observational, comparing patients treated with lanreotide autogel 120 mg every 28 days (LAN group) and patients in active surveillance, not receiving any therapy (AS group).

Results

Forty-two patients were enrolled: 23 in LAN and 19 in AS group. Median follow-up was 73 months. Initial imaging identified a total of 91 pNETs. The median progression-free survival was significantly longer in the LAN than in the AS group (median not reached vs 40 months, P < 0.001). In the LAN group, 4 patients had an objective tumor response, 15 patients had stable disease, while 4 had tumor progression. In the AS group, 13 patients had pNET progression, while 6 were stable.

Conclusions

This is the first prospective study evaluating the efficacy of somatostatin analogues in MEN1-related pNETs. These findings highlight that lanreotide autogel is effective as antiproliferative therapy in MEN1-related pNETs < 2cm, suggesting the utility of somatostatin analogues to arrest the development of tumor lesions as well as to delay or avoid pancreatic surgery.
Associations Between Anti-Mullerian Hormone and Cardiometabolic Health in Reproductive Age Women Are Explained by Body Mass Index
Authors: Rios Julie S , Greenwood Eleni A , Pavone Mary Ellen G , Cedars Marcelle I , Legro Richard S , Diamond Michael P , Santoro Nanette , Sun Fangbai , Robinson Randal D , Christman Gregory , Zhang Heping , Huddleston Heather G
Published: October 2019

Context

The relationship between reproductive and cardiometabolic aging is unclear. It is unknown if the relationship differs across different clinical populations.

Objective

To determine whether markers of ovarian reserve are associated with cardiometabolic risk in reproductive aged women with unexplained infertility (UI), polycystic ovary syndrome (PCOS), and regularly cycling women (OVA).

Design and setting

Cross-sectional data from 8 US-based academic centers.

Participants

Women aged 25–40 from 3 clinical populations: 870 with UI, 640 with PCOS, and 921 community-based OVA.

Main Outcome Measures

Multivariable linear regression models were used to relate anti-mullerian hormone (AMH) and antral follicle count with cardiometabolic parameters including body mass index (BMI), waist circumference (WC), fasting glucose and insulin, homeostasis model assessment-insulin resistance (HOMA-IR), lipids, and C-reactive protein.

Results

In age and study site-adjusted models, AMH inversely related to BMI in the UI and OVA groups (P = 0.02 and P < 0.001). Among women with PCOS, AMH inversely related to BMI (P < 0.001), and also to WC (P < 0.001), fasting insulin (P < 0.01), HOMA-IR (P < 0.01), triglycerides (P = 0.04), and C-reactive protein (P < 0.001) and directly related to higher total (P = 0.02), low-density lipoprotein (P < 0.01), and high-density lipoprotein cholesterol (P < 0.01). In OVA, AMH also varied inversely with WC (P < 0.001), fasting insulin (P = 0.02), and HOMA-IR (P = 0.02). Adjustment for BMI eliminated associations in the OVA group but in PCOS, the relationship of AMH to total (P = 0.03) and low-density lipoprotein cholesterol (P = 0.003) remained.

Conclusion

Associations observed between AMH and cardiometabolic indices are largely explained by BMI in women with and without PCOS. (J Clin Endocrinol Metab XX: 0-0, 2019)
Impulse Control Disorders in Dopamine Agonist-Treated Hyperprolactinemia: Prevalence and Risk Factors
Authors: De Sousa Sunita M C , Baranoff John , Rushworth R Louise , Butler Jessica , Sorbello Jane , Vorster Juanita , Thompson Tanya , McCormack Ann I , Inder Warrick J , Torpy David J
Published: October 2019

Context

There are growing reports of dopamine agonist (DA)-induced impulse control disorders (ICDs) in hyperprolactinemic patients. However, the magnitude of this risk and predictive factors remain uncertain.

Objective

To determine ICD prevalence and risk factors in DA-treated hyperprolactinemic patients compared to community controls.

Design, Setting and Participants

Multicenter cross-sectional analysis of 113 patients and 99 healthy controls.

Main Outcome Measures

Participants completed a neuropsychological questionnaire consisting of the Depression Anxiety Stress Scale (DASS21), Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP-S), Hypersexual Behavior Inventory (HBI), Hypersexual Behavior Consequences Scale and Social Desirability Response Set Scale. Demographic and clinical data were collated to determine ICD risk factors. Patients testing positive for an ICD were offered a semistructured psychological interview.

Results

Patients were more likely than controls to test positive by QUIP-S for any ICD (61.1 vs 42.4%, P = .01), hypersexuality (22.1 vs 8.1%, P = .009), compulsive buying (15.9 vs 6.1%, P = .041) and punding (18.6 vs 6.1%, P = 0.012), and by HBI for hypersexuality (8.0 vs 0.0%, P = 0.004). Independent risk factors were male sex (odds ratio [OR] 13.85), eugonadism (OR 7.85), Hardy’s tumor score and psychiatric comorbidity (OR 6.86) for hypersexuality, and age (OR 0.95) for compulsive buying. DASS21 subset scores were higher in patients vs controls and in patients with vs without different ICDs. Only 19/51 (37.3%) interviewed patients were aware of the relationship between DAs and ICDs before the study.

Conclusions

DA therapy poses a high, previously underestimated risk of ICDs, especially in the form of hypersexuality in eugonadal men.
Higher Caloric Exposure in Critically Ill Patients Transiently Accelerates Thyroid Hormone Activation
Authors: McKeever Liam , Peterson Sarah J , Lateef Omar , Freels Sally , Fonseca Tatiana L , Bocco Barbara M L C , Fernandes Gustavo W , Roehl Kelly , Nowak Kristen , Mozer Marisa , Bianco Antonio C , Braunschweig Carol A
Published: October 2019

Introduction

The inflammatory response of critical illness is accompanied by nonthyroidal illness syndrome (NTIS). Feeding has been shown to attenuate this process, but this has not been explored prospectively over time in critically ill patients.

Objective

To explore the impact of calorie exposure on NTIS over time in critically ill patients.

Methods

Mechanically ventilated patients with systemic inflammatory response syndrome (SIRS) were randomized to receive either 100% or 40% of their estimated caloric needs (ECN). Thyroid hormones were measured daily for 7 days or until intensive care unit discharge or death. Mixed level regression modeling was used to explore the effect of randomization group on plasma triiodothyronine (T3), reverse triiodothyronine (rT3), thyroxine (T4), and thyroid stimulating hormone (TSH), as well as the T3/rT3 ratio.

Results

Thirty-five participants (n=19 in 100% ECN; n=16 in 40% ECN) were recruited. Adjusting for group differences in baseline T3/rT3 ratio, the parameters defining the fitted curves (intercept, linear effect of study day, and quadratic effect of study day) differed by randomization group (P = 0.001, P = 0.01, and P = 0.02 respectively). Plots of the fitted curves revealed that participants in the 100% ECN group had a 54% higher T3/rT3 ratio on postintervention day 1 compared with the 40% ECN group, a difference which attenuated over time. This was driven by a 23% higher plasma T3 and 10% lower plasma rT3 levels on postintervention 1.

Conclusions

Higher caloric exposure in NTIS patients transiently attenuates the drop of the plasma T3/rT3 ratio, an effect that is minimized and finally lost over the following 3 days of continued higher caloric exposure.
The Loss of ARNT/HIF1β in Male Pancreatic β-Cells Is Protective Against High-Fat Diet–Induced Diabetes
Authors: Hoang Monica , Paglialunga Sabina , Bombardier Eric , Tupling A Russell , Joseph Jamie W
Published: October 2019

The transcription factor aryl hydrocarbon receptor nuclear translocator (ARNT)/hypoxia-inducible factor (HIF)-1β (ARNT/HIF1β) plays a key role in maintaining β-cell function and has been shown to be one of the most downregulated transcription factors in islets from patients with type 2 diabetes. We have shown a role for ARNT/HIF1β in glucose sensing and insulin secretion in vitro and no defects in in vivo glucose homeostasis. To gain a better understanding of the role of ARNT/HIF1β in the development of diabetes, we placed control (+/+/Cre) and β-cell–specific ARNT/HIF1β knockout (fl/fl/Cre) mice on a high-fat diet (HFD). Unlike the control (+/+/Cre) mice, HFD-fed fl/fl/Cre mice had no impairment in in vivo glucose tolerance. The lack of impairment in HFD-fed fl/fl/Cre mice was partly due to an improved islet glucose-stimulated NADPH/NADP+ ratio and glucose-stimulated insulin secretion. The effects of the HFD-rescued insulin secretion in fl/fl/Cre islets could be reproduced by treating low-fat diet (LFD)–fed fl/fl/Cre islets with the lipid signaling molecule 1-monoacylglcyerol. This suggests that the defects seen in LFD-fed fl/fl/Cre islet insulin secretion involve lipid signaling molecules. Overall, mice lacking ARNT/HIF1β in β-cells have altered lipid signaling in vivo and are resistant to an HFD’s ability to induce diabetes.
Impact of bowel preparation on caecal intubation time during colonoscopy
Authors: Alvi Haris , Rasheed Tazeen , Shaikh Majid Ahmed , Ali Faiza Sadaqat , Zuberi Bader Faiyaz , Samejo Asad Ali
Published: October 2019

Objective: To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale.

Methods: This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection.

Results: In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection.

Conclusion: The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness.

doi: https://doi.org/10.12669/pjms.35.6.1031

How to cite this:Alvi H, Rasheed T, Shaikh MA, Ali FS, Zuberi BF, Samejo AA. Impact of bowel preparation on caecal intubation time during colonoscopy. Pak J Med Sci. 2019;35(6):1516-1519. doi: https://doi.org/10.12669/pjms.35.6.1031

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.
Blood transfusion and high-order cesarean delivery; Report from a developing country
Authors: Abbas Shahida , Mughal Saba , Hussain Syeda Namayah Fatima , Hossain Nazli
Published: October 2019

Background and Objective: Blood loss in cesarean deliveries has already been established in previous researches but a detailed insight into the correlates has not been done. This study examined whether the number of previous Cesarean sections is related to the need for blood transfusion, and risk factors for blood transfusion.

Methods: A retrospective review of 239 females who had undergone two or more Cesarean sections during the time period of 2015-2018 was done. Data collected included type of surgery (elective or emergency), age, parity, body mass index, estimated blood loss, operating time, level of surgeon, presence or absence of adhesions and number of transfused packed cell volume.

Results: About 9.2% patients received blood transfusion with an estimated average blood loss of 618.18 ml. Patients with adhesions from previous surgery, presence of placenta previa, multiparity were significantly likely to receive blood transfusion. It was found that women with more than two caesarian sections had high proportion of blood transfusion as compared to women who had two caesarian sections. However non-significant difference was observed in numbers of caesarean sections with blood transfusion.

Conclusion: Women undergoing Cesarean sections combined with any of the risk factors like increased body mass index, dense adhesions, uterine atony, hypertension and presence of placenta previa, were found to be at increased risk for a need for blood transfusions.

doi: https://doi.org/10.12669/pjms.35.6.539

How to cite this:Abbas S, Mughal S, Hussain SNF, Hossain N. Blood transfusion and high-order cesarean delivery; Report from a developing country. Pak J Med Sci. 2019;35(6):1520-1525. doi: https://doi.org/10.12669/pjms.35.6.539

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.
Financial stability of the Bank
Authors: Софронова Валентина , Sofronova Valentina
Published: October 2019

The textbook deals with the most topical issues of the theory and practice of financial stability management of credit institutions; approaches to the assessment of financial stability, based on the econometric method of assessing the probability of default of the Bank. Innovations in the field of regulation of various aspects of financial stability assessment and financial stability management in crisis situations are analyzed. The main methods of financial stability assessment used by banking supervision bodies and commercial banks are presented. It contains practical examples of evaluation using the presented techniques, educational tasks, tests, compiled by the author, to verify the knowledge gained by students.
Meets the requirements of the Federal state educational standards of higher education of the last generation.
It is intended for practical development of students of bachelor's and master's full-time and correspondence forms of training of economic specialties of methods of assessment of financial stability of banks, and also for courses of advanced training of financiers.