bluuebunny/crossref_metadata_2025 huggingface dataset:
Adult with intestinal malrotation and colocolic intussusception: an unusual combo
Authors: Gandhi Vidhyachandra , Pai Nitin , Kashiva Reema , Mane Dileep
Published: July 2019

Intestinal malrotation is a congenital anomaly that results from an abnormality in the rotation and fixation of the gut as it returns to the abdominal cavity during development. Intussusception is a condition characterised by telescoping of one segment of the bowel into another segment. The combination of malrotation and intussusception is frequently a cause of intestinal obstruction in the paediatric age group. The coexistence of these two conditions is termed as Waugh syndrome and is uncommon in adults. We share our experience with an elderly woman who was admitted with diarrhoea and anaemia. Investigations revealed a large colonic polyp, colocolic intussusception and malrotation. The adenomatous polyp and mobile right colon would have lead to intussusception. The diagnosis was based on the findings of colonoscopy and contrast-enhanced CT scan of the abdomen. She was managed with a transverse colectomy with an uneventful recovery.
Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures
Authors: Fogg Alexandra Jane , Welsh Jennifer , Banks Emily , Abhayaratna Walter , Korda Rosemary J
Published: July 2019

Objectives

The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.

Design

This is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.

Setting

This was conducted in New South Wales, Australia.

Participants

The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).

Outcome measures

The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.

Results

Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively.

Conclusions

Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.
Physical activity counselling in Ireland: a survey of doctors’ knowledge, attitudes and self-reported practice
Authors: O'Brien Sarah , Prihodova Lucia , Heffron Mairéad , Wright Peter
Published: July 2019

Objective

Physical activity (PA) counselling has been shown to raise awareness of the importance of PA and to increase the rate of PA engagement among patients. While much attention has been paid to examining the knowledge, attitudes and practice of general practitioners in relation to PA counselling, there is less literature examining such issues in hospital-based doctors in Ireland and further afield. This study aimed to explore doctors’ PA counselling practices and to analyse how this related to their level of PA knowledge, training and attitudes.

Methods

An invitation to participate in an online survey was sent to 4692 members of the Royal College of Physicians of Ireland who were listed as having an address in Ireland. Descriptive and explorative analyses of the data were performed using IBM SPSS V.22.0.

Results

A total of 595 valid responses were included (response rate 12.7%; 42.7% male, 42.6±12.1 years). The majority reported enquiring about PA levels (88.0%) and providing PA counselling (86.4%) in at least some of their patients. Doctors who saw it as their role and those who felt more effective/confident in providing PA counselling were significantly more likely to do so. A perceived lack of patient interest in PA and patient preference for pharmaceutical intervention were significant barriers to undertaking PA counselling.

Conclusion

This study demonstrates the need for further education and training in PA counselling in Ireland with a particular focus on improving the attitudes and self-efficacy of doctors in this area at both undergraduate and postgraduate levels.
Manganese-enhanced MRI of the myocardium
Authors: Spath Nick B , Thompson Gerard , Baker Andrew H , Dweck Marc R , Newby David E , Semple Scott I K
Published: July 2019

Gadolinium-based contrast media are widely used in cardiovascular MRI to identify and to highlight the intravascular and extracellular space. After gadolinium, manganese has the second highest paramagnetic moment and was one of the first MRI contrast agents assessed in humans. Over the last 50 years, manganese-enhanced MRI (MEMRI) has emerged as a complementary approach enabling intracellular myocardial contrast imaging that can identify functional myocardium through its ability to act as a calcium analogue. Early progress was limited by its potential to cause myocardial depression. To overcome this problem, two clinical formulations of manganese were developed using either chelation (manganese dipyridoxyl diphosphate) or coadministration with a calcium compound (EVP1001-1, Eagle Vision Pharmaceuticals). Preclinical studies have demonstrated the efficacy of MEMRI in quantifying myocardial infarction and detecting myocardial viability as well as tracking altered contractility and calcium handling in cardiomyopathy. Recent clinical data suggest that MEMRI has exciting potential in the quantification of myocardial viability in ischaemic cardiomyopathy, the early detection of abnormalities in myocardial calcium handling, and ultimately, in the development of novel therapies for myocardial infarction or heart failure by actively quantifying viable myocardium. The stage is now set for wider clinical translational study of this novel and promising non-invasive imaging modality.
Probability of cancer in lung nodules using sequential volumetric screening up to 12 months: the UKLS trial
Authors: Marcus Michael W , Duffy Stephen W , Devaraj Anand , Green Beverley A , Oudkerk Matthijs , Baldwin David , Field John
Published: July 2019

Background

Estimation of the clinical probability of malignancy in patients with pulmonary nodules will facilitate early diagnosis, determine optimum patient management strategies and reduce overall costs.

Methods

Data from the UK Lung Cancer Screening trial were analysed. Multivariable logistic regression models were used to identify independent predictors and to develop a parsimonious model to estimate the probability of lung cancer in lung nodules detected at baseline and at 3-month and 12-month repeat screening.

Results

Of 1994 participants who underwent CT scan, 1013 participants had a total of 5063 lung nodules and 52 (2.6%) of the participants developed lung cancer during a median follow-up of 4 years. Covariates that predict lung cancer in our model included female gender, asthma, bronchitis, asbestos exposure, history of cancer, early and late onset of family history of lung cancer, smoking duration, FVC, nodule type (pure ground-glass and part-solid) and volume as measured by semiautomated volumetry. The final model incorporating all predictors had excellent discrimination: area under the receiver operating characteristic curve (AUC 0.885, 95% CI 0.880 to 0.889). Internal validation suggested that the model will discriminate well when applied to new data (optimism-corrected AUC 0.882, 95% CI 0.848 to 0.907). The risk model had a good calibration (goodness-of-fit χ[8] 8.13, p=0.42).

Conclusions

Our model may be used in estimating the probability of lung cancer in nodules detected at baseline and at 3 months and 12 months from baseline, allowing more efficient stratification of follow-up in population-based lung cancer screening programmes.

Trial registration number

78513845.
Quantifying progressive failure of micro-anchored fiber optic cable–sand interface via high-resolution distributed strain sensing
Authors: Zhang Cheng-Cheng , Zhu Hong-Hu , Liu Su-Ping , Shi Bin , Cheng Gang
Published: July 2019

Distributed fiber optic sensing (DFOS) is gaining increasing interest in geotechnical monitoring. By using soil-embedded fiber optic cables, strain profiles as well as deformation patterns of geotechnical infrastructures can be captured. Probing the fiber optic cable–soil interfacial behavior is vital to the advancement of DFOS-based geotechnical monitoring and our understanding of the soil–inclusion interaction mechanism. To this aim, laboratory pullout tests were performed to investigate the progressive failure of the interface between micro-anchored cables and the surrounding sand. High-resolution strain profiles recorded using Brillouin optical time-domain analysis (BOTDA) not only elucidated the influence of anchorage on strain measurements, but also allowed the classical soil–inclusion interaction problem to be studied in detail. Interfacial shear stresses calculated from step-like strain profiles provided clear evidence of the contribution of each micro-anchor to the pullout resistance. The cable–soil contact is a combination of overall bonding and point fixation depending on the level of mobilized interfacial shear stress, and therefore the validity of measured strains is correlated to a three-stage process of interface failure. This study also shows that installing heat-shrink tubes on the fiber optic cable is a rapid, low-cost, effective approach to make an anchored DFOS system for deformation monitoring of earth structures.
Capacity estimation of unsignalized intersections under heterogeneous traffic conditions
Authors: Mohan Mithun , Chandra Satish
Published: July 2019

Capacity of movements at unsignalized intersections are usually estimated based on gap acceptance theory and accuracy of such estimation largely depends on the extent to which its inherent assumptions are satisfied. However, owing to the typical traffic operations at intersections in developing countries, many of these assumptions remain unsatisfied and hence, estimating capacity as per the procedure laid down in the capacity manuals of developed countries will prove inaccurate. The present research focuses on developing the entire procedure for estimating the capacities of movements at unsignalized intersections dealing with heterogeneous traffic. This study is based on data collected from eight different unsignalized intersections located in various parts of India and by using Harders’ capacity model as base, the procedure to estimate the parameters of this model is revised to suit the traffic operations in developing countries and further modifies the Harders’ model using the movement capacities measured in the field.
Interval Methods in Knowledge Representation
Authors: Kreinovich V.
Published: July 2019

Please send your abstracts (or copies of papers that you want to see reviewed here) to vladik@utep.edu, or by regular mail to Vladik Kreinovich, Department of Computer Science, University of Texas at El Paso, El Paso, TX 79968, USA.
Geochronology of Caledonian metamorphic allochthons in the Otta–Heidal region, South Norway; tectonostratigraphic and palaeogeographical implications
Authors: Corfu F. , Heim M.
Published: July 2019

The Caledonian–Appalachian belt formed in the Early Paleozoic by the assembly and dispersal of continental and oceanic crustal fragments of diverse provenance. The characterization of these terranes and information on their origins are essential in reconstructing the course of the orogeny. The region of northern Gudbrandsdalen in Norway is important for elaborating these questions as it represents a geological transition in architectural style and composition of the Caledonian nappes and the meeting point of tectonic elements with diverse geological histories of both Baltic and exotic origins. In the past century this complexity has generated conflicting interpretations, which we have tested with new mapping and isotope dilution thermal ionization mass spectrometry U–Pb dating. The new data show the following: (1) a metagabbro low in the tectonostratigraphy has an age of 1497 ± 5 Ma, correlating with the Espedalen Complex of Telemarkian (1550–1480 Ma) affinity; (2) the structurally higher crystalline Rudihøe–Mukampen Suite was metamorphosed at high grade during the Sveconorwegian Orogeny, mainly between 980 and 900 Ma, with older components pointing to a Gothian (1700–1600 Ma) affinity; (3) these ages and mapping indicate that the Rudihøe–Mukampen Suite is a lateral equivalent of the Upper Jotun Nappe; (4) the overlying, dominantly metasedimentary Steinhø Complex was metamorphosed in the Ordovician at about 473 ± 3 Ma; (5) both the Rudihøe–Mukampen Suite and Steinhø Complex were intruded by trondhjemite dykes at 430–427 Ma. These units are structurally overlain by the lowest elements of the Trondheim Nappe Complex, which includes serpentinite lenses and conglomerates, the products of hyperextension, locally with Ordovician fossils. The new results dispel some of the problematic interpretations proposed earlier and represent new firm elements that will anchor future tectonic reconstructions of the Caledonides in this region.
Curiosity Did Not Kill the Robot
Authors: Doering Malcolm , Liu Phoebe , Glas Dylan F. , Kanda Takayuki , Kulić Dana , Ishiguro Hiroshi
Published: July 2019

Learning from human interaction data is a promising approach for developing robot interaction logic, but behaviors learned only from offline data simply represent the most frequent interaction patterns in the training data, without any adaptation for individual differences. We developed a robot that incorporates both data-driven and interactive learning. Our robot first learns high-level dialog and spatial behavior patterns from offline examples of human--human interaction. Then, during live interactions, it chooses among appropriate actions according to its curiosity about the customer's expected behavior, continually updating its predictive model to learn and adapt to each individual. In a user study, we found that participants thought the curious robot was significantly more humanlike with respect to repetitiveness and diversity of behavior, more interesting, and better overall in comparison to a non-curious robot.
An Ontology for Human-Human Interactions and Learning Interaction Behavior Policies
Authors: Oguz Ozgur S. , Rampeltshammer Wolfgang , Paillan Sebastian , Wollherr Dirk
Published: July 2019

Robots are expected to possess similar capabilities that humans exhibit during close proximity dyadic interaction. Humans can easily adapt to each other in a multitude of scenarios, ensuring safe and natural interaction. Even though there have been attempts to mimic human motions for robot control, understanding the motion patterns emerging during dyadic interaction has been neglected. In this work, we analyze close-proximity human-human interaction and derive an ontology that describes a broad range of possible interaction scenarios by abstracting tasks and using insights from attention theory. This ontology enables us to group interaction behaviors into separate cases, each of which can be represented by a particular graph. Using imitation learning, we train unique interaction policies with recurrent neural networks for each case. The ontology offers a unified and generic approach to categorically analyze and learn close-proximity interaction behaviors that can both be utilized as base models for future studies and enhance natural human-robot collaboration.
Time-Multiplexed FPGA Overlay Architectures
Authors: Li Xiangwei , Maskell Douglas L.
Published: July 2019

This article presents a comprehensive survey of time-multiplexed (TM) FPGA overlays from the research literature. These overlays are categorized based on their implementation into two groups: processor-based overlays, as their implementation follows that of conventional silicon-based microprocessors, and; CGRA-like overlays, with either an array of interconnected processor-based functional units or medium-grained arithmetic functional units. Time-multiplexing the overlay allows it to change its behavior with a cycle-by-cycle execution of the application kernel, thus allowing better sharing of the limited FPGA hardware resource. However, most TM overlays suffer from large resource overheads, due to either the underlying processor-like architecture (for processor-based overlays) or due to the routing array and instruction storage requirements (for CGRA-like overlays). Reducing the area overhead for CGRA-like overlays, specifically that required for the routing network, and better utilizing the hard macros in the target FPGA are active areas of research.
Explicitly Modeling Word Translations in Neural Machine Translation
Authors: Han Dong , Li Junhui , Li Yachao , Zhang Min , Zhou Guodong
Published: July 2019

In this article, we show that word translations can be explicitly incorporated into NMT effectively to avoid wrong translations. Specifically, we propose three cross-lingual encoders to explicitly incorporate word translations into NMT: (1)
Factored
encoder, which encodes a word and its translation in a vertical way; (2)
Gated
encoder, which uses a gated mechanism to selectively control the amount of word translations moving forward; and (3)
Mixed
encoder, which stitchingly learns a word and its translation annotations over sequences where words and their translations are alternatively mixed. Besides, we first use a simple word dictionary approach and then a word sense disambiguation (WSD) approach to effectively model the word context for better word translation. Experimentation on Chinese-to-English translation demonstrates that all proposed encoders are able to improve the translation accuracy for both traditional RNN-based NMT and recent self-attention-based NMT (hereafter referred to as
Transformer
). Specifically,
Mixed
encoder yields the most significant improvement of 2.0 in BLEU on the RNN-based NMT, while
Gated
encoder improves 1.2 in BLEU on
Transformer
. This indicates the usefulness of an WSD approach in modeling word context for better word translation. This also indicates the effectiveness of our proposed cross-lingual encoders in explicitly modeling word translations to avoid wrong translations in NMT. Finally, we discuss in depth how word translations benefit different NMT frameworks from several perspectives.
Melanoma Extracellular Vesicles Generate Immunosuppressive Myeloid Cells by Upregulating PD-L1 via TLR4 Signaling
Authors: Fleming Viktor , Hu Xiaoying , Weller Céline , Weber Rebekka , Groth Christopher , Riester Zeno , Hüser Laura , Sun Qian , Nagibin Vasyl , Kirschning Carsten , Bronte Vincenzo , Utikal Jochen , Altevogt Peter , Umansky Viktor
Published: July 2019

Tumor cell–derived extracellular vesicles (EV) convert normal myeloid cells into myeloid-derived suppressor cells (MDSC), inhibiting antitumor immune responses. Here, we show that EV from Ret mouse melanoma cells upregulate the expression of programmed cell death ligand 1 (PD-L1) on mouse immature myeloid cells (IMC), leading to suppression of T-cell activation. PD-L1 expression and the immunosuppressive potential of EV-generated MDSC were dependent on the expression of Toll-like receptors (TLR). IMC from Tlr4−/− mice failed to increase T-cell PD-L1 expression and immunosuppression with Ret-EV treatment, and this effect was dependent on heat-shock protein 86 (HSP86) as HSP86-deficient Ret cells could not stimulate PD-L1 expression on normal IMC; IMC from Tlr2−/− and Tlr7−/− mice demonstrated similar results, although to a lesser extent. HSP86-deficient Ret cells slowed tumor progression in vivo associated with decreased frequency of tumor-infiltrating PD-L1+CD11b+Gr1+ MDSC. EV from human melanoma cells upregulated PD-L1 and immunosuppression of normal monocytes dependent on HSP86. These findings highlight a novel EV-mediated mechanism of MDSC generation from normal myeloid cells, suggesting the importance of EV targeting for tumor therapy.

Significance:

These findings validate the importance of TLR4 signaling in reprogramming normal myeloid cells into functional myeloid-derived suppressor cells.
Distinct Colorectal Cancer–Associated APC Mutations Dictate Response to Tankyrase Inhibition
Authors: Schatoff Emma M. , Goswami Sukanya , Zafra Maria Paz , Foronda Miguel , Shusterman Michael , Leach Benjamin I. , Katti Alyna , Diaz Bianca J. , Dow Lukas E.
Published: July 2019

The majority of colorectal cancers show hyperactivated WNT signaling due to inactivating mutations in the adenomatous polyposis coli (APC) tumor suppressor. Genetically restoring APC suppresses WNT and induces rapid and sustained tumor regression, implying that reengaging this endogenous tumor-suppressive mechanism may be an effective therapeutic strategy. Here, using new animal models, human cell lines, and ex vivo organoid cultures, we show that tankyrase (TNKS) inhibition can control WNT hyperactivation and provide long-term tumor control in vivo, but that effective responses are critically dependent on how APC is disrupted. Mutant APC proteins truncated within the mutation cluster region physically engage the destruction complex and suppress the WNT transcriptional program, while APC variants with early truncations (e.g., ApcMin) show limited interaction with AXIN1 and β-catenin, and do not respond to TNKS blockade. Together, this work shows that TNKS inhibition, like APC restoration, can reestablish endogenous control of WNT/β-catenin signaling, but that APC genotype is a crucial determinant of this response.

Significance:

This study reveals how subtle changes to the mutations in a critical colorectal tumor suppressor, APC, influence the cellular response to a targeted therapy. It underscores how investigating the specific genetic alterations that occur in human cancer can identify important biological mechanisms of drug response and resistance.

This article is highlighted in the In This Issue feature, p. 1325
Pentostatin, Cyclophosphamide, and Rituximab Followed by Alemtuzumab for Relapsed or Refractory Chronic Lymphocytic Leukemia: A Phase 2 Trial of the ECOG-Acrin Cancer Research Group (E2903)
Authors: Kempin Sanford , Sun Zhuoxin , Kay Neil E. , Paietta Elisabeth M. , Mazza Joseph J. , Ketterling Rhett P. , Frankfurt Olga , Claxton David F. , Saltzman Joel N. , Srkalovic Gordan , Callander Natalie S. , Gross Gerald , Tallman Martin S.
Published: July 2019

Patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) may benefit from salvage chemoimmunotherapy (CIT). To explore further the use of CIT in the pre-novel agent era, ECOG-ACRIN undertook a phase 2 trial (E2903) for R/R CLL utilizing pentostatin, cyclophosphamide, and rituximab (PCR) followed by a consolidation course of alemtuzumab. This trial enrolled 102 patients with a median age of 64 years. Treatment consisted of 6 cycles of PCR followed by alemtuzumab for either 4 or 18 weeks depending on the initial response to PCR. The overall response after PCR (complete remission, CR, nodular partial remission, nPR, and partial remission, PR) was 55%. Major responses (CR or nPR) were achieved in 6%. The median overall survival (OS) and the median progression-free survival were 28 and 12 months, respectively. The most serious nonlethal adverse events were myelosuppression, febrile neutropenia, fatigue, nausea, and hyponatremia. PCR is an effective and well-tolerated nucleoside-based regimen for heavily pretreated CLL patients with R/R disease. The addition of alemtuzumab to CLL patients with a minor response (PR) or stable disease did not result in a significant number of higher responses (CR or nPR) nor an improvement in OS.
The Protective Effect of Aesculus hippocastanum (Venoplant®) Against Concanavalin A-Induced Liver Injury
Authors: Wu Shujin , Sa Rina , Gu Zhirong , Zhao Pei , Yu Jing , Wang Yanhong , Ge Bin
Published: July 2019

Aim: The present study was performed to investigate the effect of Aesculus hippocastanum (AH; Venoplant®) on concanavalin A (ConA)-induced acute liver injury and explore the mechanism in mice. Methods: ConA (20 mg/kg) was administered via tail vein injection to induce hepatic damage. The groups of AH (Venoplant®) were given at 65.8, 131.6, and 263.2 mg/kg by oral gavages for 20 days. The serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), total protein (TP), and albumin (Alb) were determined by automatic biochemical analyzer, and the Alb/globulin (A/G) ratio was calculated. Tumor necrosis factor-α (TNF-α) and IFN-γ levels were assayed by enzyme-linked immunosorbent assay. The liver tissue was attained by hematoxylin and eosin, and the histopathological changes were calculated. The cell apoptosis was assayed by terminal dUTP nick-end labeling. The malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) content of liver tissue were assayed by related kits. The activity of caspase-3 was detected by spectrophotometry. The expressions of cytochrome c, Bax, Bcl-2, c-Jun N-terminal kinase (JNK), and p-JNK were detected by western blot. Results: The results showed that the levels of ALT, AST, IFN-γ, and TNF-α in AH (Venoplant®) groups were significantly lower than those in ConA-injured group, while the levels of TP, Alb, and A/G were significantly higher. The SOD and GSH levels were significantly increased, and the MDA level was decreased; liver histopathology was changed consistently with the serological indicators, AH (Venoplant®) treatment significantly reduced the pathological damage and cell apoptosis; while in AH (Venoplant®) group, the expressions of cytochrome c, caspase-3, Bax/Bcl-2 ratio, and p-JNK were significantly decreased. Conclusion: AH (Venoplant®) could significantly protect the ConA-induced acute liver injury in mice via inhibition of reactive oxygen species and JNK pathway.
Blue Light Imaging and Linked Color Imaging for the Characterization of Mucosal Changes in Chronic Gastritis: A Clinicians View and Brief Technical Report
Authors: Weigt Jochen , Malfertheiner Peter , Canbay Ali , Haybaeck Johannes , Bird-Lieberman Elizabeth , Link Alexander
Published: July 2019

Background: Blue light imaging (BLI) and linked color imaging (LCI) are new imaging modalities for the endoscopic evaluation of mucosal changes within the digestive tract. There is little experience with these modalities in the characterization of chronic gastritis (CG) intestinal metaplasia (IM) and atrophy in the stomach. Aims and Methods: In a single-center observational pilot study, we correlated endoscopic findings with histology in selected patients. Results: Findings from 29 patients were included in the analysis. Six patients had macroscopically normal gastric mucosa at endoscopy, and this was confirmed histologically in 5 of them. At endoscopy, 15 patients had the presence of IM in the antrum predicted, and this was confirmed histologically in 11 (73%). In the corpus, we predicted the presence of IM in 14 patients, and this was confirmed in 11 (78%) at histology. Eleven patients had the endoscopic suspicion of atrophy in antrum, which was confirmed in 9 patients (82%). In total, 14 patients had endoscopic suspicion of atrophy in corpus mucosa at endoscopy, but only 10 were confirmed in histology (71%). The concordance of endoscopic classification and histology was 93% for antrum and 88% for corpus. The positive predictive value and negative predictive value for IM were 0.74 and 0.83 and for atrophy 0.63 and 0.97, respectively. Conclusions: LCI and BLI are helpful in characterization of mucosal changes in CG. The ability to rule out premalignant conditions by endoscopy only reflects the clinical use and harbors significant clinical implications.
Feasibility and Usability Aspects of Continuous Remote Monitoring of Health Status in Palliative Cancer Patients Using Wearables
Authors: Pavic Matea , Klaas Vanessa , Theile Gudrun , Kraft Johannes , Tröster Gerhard , Guckenberger Matthias
Published: July 2019

Background: Mobile health is a promising strategy aiming to anticipate and prevent the deterioration of health status in palliative cancer patients. A prerequisite for successful implementation of this technology into clinical routine is a high level of usability and acceptance of devices. Objectives: We aimed to evaluate feasibility as well as patients’ acceptance of remote monitoring using wearables in palliative cancer patients. Methods: In this prospective single-center observational feasibility study, 30 cancer patients treated with palliative intent in an inpatient setting with an estimated life expectancy of >8 weeks and <12 months were provided with a smartphone including a pre-installed “Activity Monitoring” app and a sensor-equipped bracelet and monitored over a period of 12 weeks starting at discharge from hospital. We report detailed feasibility and usability aspects and comment on patients’ acceptance of the wearables. Results: Between February 2017 and May 2018 a total of 30 patients were included in the study. From these, 25 participants (83%) completed the whole study period. On average, the bracelet was worn on 53% and smartphone used on 85% of the study days. The completion rate of daily digital questionnaires for subjective ratings (pain and distress scale) was 73%, and 28 patients were able to handle the wearables and to operate the app without major problems. Use of the bracelet was low during the night hours, with a wearing time of 1.7% of all night hours (8 p.m. to 8 a.m.). Conclusions: Remote monitoring of health care status in palliative cancer patients with a limited life expectancy is feasible and patients are able to handle the smartphone and the sensor-equipped bracelet. Feedback towards use of this monitoring system was mostly positive.
Accuracies of Endoscopic Diagnosis of Helicobacter pylori-Gastritis: Multicenter Prospective Study Using White Light Imaging and Linked Color Imaging
Authors: Ono Shoko , Dohi Osamu , Yagi Nobuaki , Sanomura Yoji , Tanaka Shinji , Naito Yuji , Sakamoto Naoya , Kato Mototsugu
Published: July 2019

Introduction: The diagnosis of Helicobacter pylori infection status with white light imaging (WLI) is difficult. We evaluated the accuracies of using WLI and linked color imaging (LCI) for diagnosing H. pylori-active gastritis in a multicenter prospective study setting. Methods: Patients who underwent esophagogastroduodenoscopy were prospectively included. The image collection process was randomized and anonymous, and the image set included 4 images with WLI or 4 images with LCI in the corpus that 5 reviewers separately evaluated. Active gastritis was defined as positive when there was diffuse redness in WLI and crimson coloring in LCI. The H. pylori infection status was determined by the urea breath test and the serum antibody test. Cases in which both test results were negative but atrophy or intestinal metaplasia was histologically confirmed were defined as past infections. The primary endpoint was the diagnostic accuracies of WLI and LCI, and the secondary endpoint was inter-observer agreement. Results: Data for 127 patients were analyzed. The endoscopic diagnostic accuracy for active gastritis was 79.5 (sensitivity of 84.4 and specificity of 74.6) with WLI and 86.6 (sensitivity of 84.4 and specificity of 88.9) with LCI (p = 0.029). LCI significantly improved the accuracy in patients with past infections over WLI (36.8 in WLI and 78.9 in LCI, p < 0.01). The κ values were 0.59 in WLI and 0.70 in LCI. Conclusions: LCI is useful for endoscopic diagnosis of H. pylori-active or inactive gastritis, and it is advantageous for patients with past infections of inactive gastritis.
Feasibility of Nurse Consultation in Oral Tumor Therapy: A Web-Based Survey among Physicians and Nonmedical Specialists
Authors: Kaiser Florian , Vehling-Kaiser Ursula , Hermes-Moll Kerstin , Walawgo Thomas , Baumann Walter
Published: July 2019

Background: Oral antiproliferative therapies have become increasingly important in the treatment of tumors. To ensure patient safety, medical care is focused on adherence and side effects. Objectives: To meet increased personnel and time requirements, delegation of tasks to nonmedical specialists (NMS) may be a solution; however, presently, little is known about the options in Germany. Method: At least 3,300 members of the German Society for Hematology and Medical Oncology (DGHO), 580 members of the Professional Association of Office-Based Hematologists and Oncologists in Germany (BNHO), and 1,500 members of the Conference on Oncology Nursing and Pediatric Nursing (KOK) were contacted via a web-based survey. The survey focused on the feasibility of oncology nurse consultation as an additional consulting service for patients undergoing oral tumor therapy. Results: In total, 255 (physicians) and 206 (NMS) questionnaires were evaluable; 90.9% of the physicians were hematologists/oncologists, 87.8% advocated oncology nurse consultation, 34.1% had previously implemented/scheduled such consultations, 58.3% of the NMS were nursing staff, 46.1% had advanced training in oral tumor therapy, 94.2% were interested in further qualifications, 37.8% worked at facilities with established/planned nurse consultations, and 62.1% personally conducted/preferred conducting consultations. Conclusions: Throughout Germany, there seems to exist a group of qualified NMS who are motivated to provide care to patients undergoing oral tumor therapy. Particular physicians actively support these nurse consultations. Extensive implementation of delegation concepts in standard care of patients undergoing oral tumor therapy is not yet underway.
Cancer Prevention with Nutrition and Lifestyle
Authors: Kerschbaum Eva , Nüssler Volkmar
Published: July 2019

Background: Although the crucial role of nutrition on wellbeing was known several hundreds of years ago in ancient healing methods such as traditional Chinese medicine, it often plays a minor role in modern society. However, 30–50% of all cancer cases are preventable by following a healthy diet and lifestyle, in accordance with the World Cancer Research Fund (WCRF) cancer prevention recommendations. Summary: In addition to maintaining a healthy weight and being physically active, a balanced plant-based diet with limited amounts of fast foods, sugar-sweetened drinks, red meat, and alcohol is recommended for enhancing health. Such a way of life helps to prevent both cancer and other noncommunicable diseases (NCDs) because of the common risk factors. Although these facts are widely known, the figures are still alarming. Only a fraction of the population follows the WCRF recommendations. Key Message: Urgent policy action is needed to promote healthy ways of living and to create health-enhancing environments to effectively reduce the risk of cancer and NCDs.
Effect of Access to Prescribed PCSK9 Inhibitors on Cardiovascular Outcomes
Authors: Myers Kelly D. , Farboodi Niloofar , Mwamburi Mkaya , Howard William , Staszak David , Gidding Samuel , Baum Seth J. , Wilemon Katherine , Rader Daniel J.
Published: July 2019

Background:

Atherosclerotic cardiovascular disease remains a major cause of death and disability, especially for high-risk familial hypercholesterolemia individuals. PCSK9i (proprotein convertase subtilisin kexin type 9 inhibitors) reduce low-density lipoprotein cholesterol levels and cardiovascular event rates. However, PCSK9i prescriptions are rejected at high rates by payers, and use is often delayed or eventually abandoned as a treatment option. We tested the hypothesis that acute coronary syndromes, coronary interventions, stroke, and cardiac arrest are more prevalent in patients with rejected or abandoned PCSK9i prescriptions than for those with paid PCSK9i prescriptions.

Methods and Results:

We identified 139 036 individuals aged ≥18 years who met the following 3 criteria: prescribed PCSK9i between August 2015 and December 2017, had claims history, and had an established date of exposure for paid, rejected, or abandoned status. To compare the effects of rejected versus paid and abandoned versus paid status, propensity score matching was performed to minimize confounding because of baseline differences in patient groups. Cox regression analyses and incidence density rates for cardiovascular events were estimated on the propensity score-matched cohorts. Patients who received 168 or more days of paid PCSK9i medication within a 12-month period were defined as paid. The hazard ratios for composite cardiovascular events outcome in propensity score-matched analyses were 1.10 (95% CI, 1.01–1.19;
P
=0.02) for rejected versus paid and 1.12 (95% CI, 1.01–1.24;
P
=0.03) for abandoned versus paid. In a stricter analysis where paid patients were defined by receiving 338 or more days of therapy within 12-months, hazard ratio was 1.16 (95% CI, 1.02–1.30;
P
=0.04) for rejected versus paid and 1.21 (95% CI, 1.04–1.38;
P
=0.03) for the abandoned versus paid status. Higher PCSK9i rejection rates were observed with women, racial minorities, and lower-income groups.

Conclusions:

Individuals in the rejected and abandoned cohorts had significantly increased risk of cardiovascular events compared with those in the paid cohort. Rejection, abandonment, and disparities related to PCSK9i prescriptions are related to higher cardiovascular outcome rates.
Use of Percutaneous Coronary Intervention Among Black and White Patients With End‐Stage Renal Disease in the United States
Authors: Nee Robert , Yan Guofen , Yuan Christina M. , Agodoa Lawrence Y. , Norris Keith C.
Published: July 2019

Background

Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (
PCI
) in the general population are well documented; however, national‐level data on such disparities in the end‐stage renal disease (
ESRD
) population are lacking. We assessed racial differences in
PCI
between black and white patients with
ESRD
on maintenance dialysis.

Methods and Results

Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for
PCI
in a cohort of 268 575 Medicare‐primary patients who initiated treatment on maintenance dialysis from January 1, 2009, through June 1, 2013. We conducted Cox regression analyses with
PCI
being the event, adjusted for demographic characteristics, Hispanic ethnicity, cause of
ESRD
, comorbidities, and socioeconomic factors. We also assessed the probability of
PCI
, accounting for death or transplant in competing risk regression models. The crude incidence rate of
PCI
among white patients was 25.8 per 1000 patient‐years versus 15.5 per 1000 patient‐years among black patients. Cox regression analyses demonstrated that black patients were significantly less likely to undergo
PCI
compared with white patients (adjusted hazard ratio: 0.64; 95%
CI
, 0.62–0.67;
P
<0.001). In the competing risk models, the racial gap for
PCI
among black and white patients remained significant with death (subdistribution hazard ratio: 0.81; 95%
CI
, 0.76–0.85;
P
<0.001) or transplant as a competing event (subdistribution hazard ratio: 0.67; 95%
CI,
0.64–0.70;
P
<0.001).

Conclusions

A racial gap exists in
PCI
use among dialysis patients despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors, and death or transplant as competing events.
Age‐Related Trends in Home Blood Pressure, Home Pulse Rate, and Day‐to‐Day Blood Pressure and Pulse Rate Variability Based on Longitudinal Cohort Data: The Ohasama Study
Authors: Satoh Michihiro , Metoki Hirohito , Asayama Kei , Murakami Takahisa , Inoue Ryusuke , Tsubota‐Utsugi Megumi , Matsuda Ayako , Hirose Takuo , Hara Azusa , Obara Taku , Kikuya Masahiro , Nomura Kyoko , Hozawa Atsushi , Imai Yutaka , Ohkubo Takayoshi
Published: July 2019

Background

Home blood pressure is a more accurate prognosticator than office blood pressure and allows the observation of day‐to‐day blood pressure variability. Information on blood pressure change during the life course links the prediction of blood pressure elevation with age. We prospectively assessed age‐related trends in home blood pressure, home pulse rate, and their day‐to‐day variability evaluated as a coefficient of variation.

Methods and Results

We examined 1665 participants (men, 36.0%; mean age, 56.2 years) from the general population of Ohasama, Japan. A repeated‐measures mixed linear model was used to estimate the age‐related trends. In a mean of 15.9 years, we observed 5438 points of measurements including those at baseline. The home systolic blood pressure linearly increased with age and was higher in men than in women aged <70 years. There was an inverse‐U‐shaped age‐related trend in home diastolic blood pressure. The day‐to‐day home systolic blood pressure linearly increased with age in individuals aged >40 years. However, an U‐shaped age‐related trend in day‐to‐day diastolic blood pressure variability with the nadir point at 65 to 69 years of age was observed. No significant sex differences in the day‐to‐day blood pressure variability were observed (
P
≥0.22). The average and day‐to‐day variability of home pulse rate decreased with age but were lower and higher, respectively, in men than in women.

Conclusions

The current descriptive data are needed to predict future home blood pressure and pulse rate. The data also provide information on the mechanism of day‐to‐day blood pressure and pulse rate variability.
Enacting the Rubric: Teacher Improvements in Windows of High-Stakes
Observation
Authors: Phipps Aaron R. , Wiseman Emily A.
Published: July 2019

Teacher evaluation systems that use in-class observations, particularly in high-stakes settings, are frequently understood as accountability systems intended as nonintrusive measures of teacher quality. Presumably, the evaluation system motivates teachers to improve their practice—an accountability mechanism—and provides actionable feedback for improvement—an information mechanism. No evidence exists, however, establishing the causal link between an evaluation program and daily teacher practices. Importantly, it is unknown how teachers may modify their practice in the time leading up to an unannounced in-class observation, or how they integrate feedback into their practice post-evaluation, a question that fundamentally changes the design and philosophy of teacher evaluation programs. We disentangle these two effects with a unique empirical strategy that exploits random variation in the timing of in-class observations in the Washington, DC, teacher evaluation program IMPACT. Our key finding is that teachers work to improve during periods in which they are more likely to be observed, and they improve with subsequent evaluations. We interpret this as evidence that both mechanisms are at work, and as a result, policy makers should seriously consider both when designing teacher evaluation systems.
Hidden Markov Models Predict the Future Choice Better Than a PSTH-Based Method
Authors: Marcos Encarni , Londei Fabrizio , Genovesio Aldo
Published: July 2019

Beyond average firing rate, other measurable signals of neuronal activity are fundamental to an understanding of behavior. Recently, hidden Markov models (HMMs) have been applied to neural recordings and have described how neuronal ensembles process information by going through sequences of different states. Such collective dynamics are impossible to capture by just looking at the average firing rate. To estimate how well HMMs can decode information contained in single trials, we compared HMMs with a recently developed classification method based on the peristimulus time histogram (PSTH). The accuracy of the two methods was tested by using the activity of prefrontal neurons recorded while two monkeys were engaged in a strategy task. In this task, the monkeys had to select one of three spatial targets based on an instruction cue and on their previous choice. We show that by using the single trial's neural activity in a period preceding action execution, both models were able to classify the monkeys' choice with an accuracy higher than by chance. Moreover, the HMM was significantly more accurate than the PSTH-based method, even in cases in which the HMM performance was low, although always above chance. Furthermore, the accuracy of both methods was related to the number of neurons exhibiting spatial selectivity within an experimental session. Overall, our study shows that neural activity is better described when not only the mean activity of individual neurons is considered and that therefore, the study of other signals rather than only the average firing rate is fundamental to an understanding of the dynamics of neuronal ensembles.
The Turn Toward Extraversion: The Changing Psychological Profile of Anglican Clergy
Authors: Francis Leslie J. , Village Andrew , Voas David
Published: July 2019

Recent research has drawn attention to two features associated with extraversion in Anglican ministry. Extraverts are under-represented among Anglican clergy. Extravert leaders are associated with church growth. The present reanalysis of data collected within the Church Growth Research Programme from 1,372 stipendiary clergy serving in the Church of England who were aged 70 or under demonstrated that in recent decades there has been a slight tendency for the Church of England to ordain more extraverts, a feature that cannot simply be explained by the reduced numbers of Anglo-Catholics (who are more likely to be introverts) or growth in charismatic influence. This slight growth, however, has been insufficient to address what may be interpreted as covert discrimination against extraverts in selection for ordination. It is argued that a commitment to inclusivity in recruiting clergy might need to take account of psychological type characteristics of those presenting for selection as much as monitoring their ethnic background.
The Four Lives of Customary International Law
Authors: d’Aspremont Jean
Published: July 2019

This article tells the story of customary international law in the 98 years between the introduction of the draft rules to the new Permanent Court of International Justice and the adoption of the Conclusions on the identification of customary international law by the International Law Commission in 2018. This story is articulated around four moments of rupture and metamorphoses: 1920, 1927, 1986, and 2018. Each of these four metamorphoses originates in powerful interventions by actors resulting in a redefinition of how arguments about the customary status of a rule ought to be made. It is argued that the doctrine of customary international law, by undergoing these four metamorphoses, has gone through 4 different stages: the age of innocence (1920–1927), the age of dualism (1927–1986), the age of turmoil (1986–2018), and the return to innocence (2018-present). The story offered in this article is a story about the four lives of customary international law.
Reflections on Custom Critique and on Functional Equivalents in the Work of Jean d’Aspremont
Authors: Lippold Matthias
Published: July 2019

The present article engages with the custom critique and functional equivalents in the work of Jean d’Aspremont. It reflects on the emphasis given to the distinction between ascertainment and content-determination. If one engages in the politics of law-ascertainment, or the politics of sources and their evaluation, it is submitted here to adopt a contextualized perspective that includes content-determination as well. The article will conclude by pointing out three examples that merit ongoing attention in order to evaluate the distribution of normativity within a system of multiple sources.