bluuebunny/crossref_metadata_2025 huggingface dataset:
Community and health staff perceptions on non-communicable disease management in El Salvador’s health system: a qualitative study
Authors: Vidal Nicole , León-García Montserrat , Jiménez Marta , Bermúdez Keven , De Vos Pol
Published: May 2020

Background

Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders’ perceptions about the management of NCDs along the pathways of care in this health system.

Methods

During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data.

Results

This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management.

Conclusions

The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach – including long-term follow-up – with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
Apatinib suppresses tumor progression and enhances cisplatin sensitivity in esophageal cancer via the Akt/β-catenin pathway
Authors: Wei Bin , Wang Yuanyuan , Wang Jiawei , Cai Xiaomin , Xu Lingyan , Wu Jingjing , Wang Ying , Liu Wen , Gu Yanhong , Guo Wenjie , Xu Qiang
Published: May 2020

Background

Esophageal cancer is the sixth leading cause of cancer-related mortality worldwide, which is partially due to limited progress of therapy. Apatinib, an inhibitor of VEGFR2, has a promising antitumor effect on malignancies. However, the underlying mechanism of its antitumor effect on esophageal cancer remains poorly understood.

Materials and methods

Eighteen pairs of frozen esophageal cancer and their para-cancer samples and 25 paraffin specimens from advanced esophageal cancer patients treated with cisplatin-based regimen were collected. The effects of apatinib on cell growth, cell apoptosis, cell cycle and invasion/migration of esophageal cancer cells were assessed. Bioinformatics, luciferase reporter, immunoprecipitation and immunofluorescence assays were conducted for mechanic investigation. Quantitative RT-PCR, western blotting and immunohistochemistry were used to measure the expression of functional genes. Xenograft tumor growth of mice was performed.

Results

We found that VEGFR2 was highly expressed in esophageal cancer and associated with poor efficacy of cisplatin-based treatment. Apatinib displayed profound actions against tumor cell growth of human esophageal cancer via promoting cell apoptosis and cell cycle arrest. Also, apatinib displayed the inhibitory effects on cell migration and invasion. Moreover, apatinib strongly suppressed the growth of esophageal cancer xenografts in mice. The effects of apatinib on esophageal cancer were partially dependent on its block of the VEGFR2/Akt/β-catenin pathway. Specifically, apatinib induced the degradation of β-catenin and decreased its transcriptional activity through Akt/GSK-3β repression. Further in vitro and in vivo studies revealed that low dose apatinib had a synergistic antitumor effect with cisplatin on esophageal cancer.

Conclusion

Our study indicates that apatinib suppresses tumor progression and enhances cisplatin sensitivity in esophageal cancer by deactivating the Akt/β-catenin pathway. These findings provide a theoretical foundation for using apatinib as an effective therapeutic drug for esophageal cancer.
Leaving no one behind – understanding environmental inequality in Europe
Authors: Ganzleben Catherine , Kazmierczak Aleksandra
Published: May 2020

The European Union aims to deliver a healthy environment to its citizens, with significant progress achieved in tackling key environmental stressors in recent decades. At the same time, significant risks to health remain from air, soil and water pollution, noise, chemicals and the impacts of climate change. High quality environments - such as urban areas rich in green and blue spaces - offer significant benefits to health. The unequal distribution of these risks and benefits across society, whereby socially disadvantages groups are more likely to live in poorer environmental conditions, contributes to health inequity across Europe.

The European Environment Agency (EEA) is exploring how environmental risks and benefits are distributed across society. Recent evidence produced by EEA indicated that poorer European regions are more likely to be exposed to environmental health hazards at levels that negatively affect health. At country level, the disproportionate exposure of lower socio-economic groups to air pollution, noise and high temperatures is seen in urban areas. We also see inequality in terms of who generates pollution and who suffers the consequences. While poorer countries are likely to be worse affected by climate change, high incomes are linked to high carbon footprints across Europe. Quality environments offer benefits to health, in particular in urban areas, and can contribute to reducing health inequalities. Environmental inequality also plays out across generations, whereby future generations will have to tackle environmental degradation resulting from the activities of past and current populations, such as the accumulation of persistent chemicals in the environment, biodiversity loss and climate change.

New opportunities exist to explore the complex linkages between environmental quality, socio-economic status, and health and well-being. These include combining existing data from across these domains with data from new sources, such as citizen science initiatives, smart phones, social media and satellite observation data. Knowledge that integrates the social and environmental domains and explores the drivers behind environmental health inequity is crucial to supporting implementation of the United Nations (UN) 2030 Agenda for Sustainable Development, in particular the pledge of leaving no one behind.
Role of non-statin lipid-lowering therapy in coronary atherosclerosis regression: a meta-analysis and meta-regression
Authors: Masson Walter , Lobo Martin , Siniawski Daniel , Molinero Graciela , Masson Gerardo , Huerín Melina , Nogueira Juan Patricio
Published: May 2020

Background

Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. However, these studies were mostly small and their results were not always robust. The objectives were: (1) to define if a dual lipid-lowering therapy (statin + non-statin drugs) is associated with coronary atherosclerosis regression, estimated by intravascular ultrasound (IVUS); (2) to assess the association between dual lipid-lowering-induced changes in low density lipoprotein cholesterol (LDL-C) and non-high-density-lipoprotein cholesterol (non-HDL-C) levels and atherosclerosis regression.

Methods

A meta-analysis including trials of non-statin lipid-lowering therapy, reporting LDL-C, non-HDL-C and total atheroma volume (TAV) with a minimum of 6 months of follow-up was performed. The primary endpoint was defined as the change in TAV measured from baseline to follow-up, comparing groups of subjects on statins alone versus combination of statin and non-statin drugs. The random-effects model and meta-regression were performed.

Results

Eight eligible trials of non-statin lipid-lowering drugs (1759 patients) were included. Overall, the dual lipid-lowering therapy was associated with a significant reduction in TAV [− 4.0 mm3 (CI 95% -5.4 to − 2.6)]; I2 = 0%]. The findings were similar in the stratified analysis according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors). In the meta-regression, a 10% decrease in LDL-C or non-HDL-C levels, was associated, respectively, with 1.0 mm3 and 1.1 mm3 regressions in TAV.

Conclusion

These data suggests the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in a significant regression of TAV.

Reduction of coronary atherosclerosis observed with non-statin lipid-lowering therapy is associated to the degree of LDL-C and non-HDL-C lowering. Therefore, it seems reasonable to achieve lipid goals according to cardiovascular risk and regardless of the lipid-lowering strategy used (statin monotherapy or dual treatment).
Association between fatigue, pain, digestive problems, and sleep disturbances and individuals’ health-related quality of life: a nationwide survey in South Korea
Authors: Baek Younghwa , Jung Kyungsik , Kim Hoseok , Lee Siwoo
Published: May 2020

Background

Physical symptoms such as fatigue, pain, digestive problems, and sleep disturbances are chief reasons individuals seek primary care, as they affect health-related quality of life. We investigated the associations between various combinations of these common symptoms and individuals’ health-related quality of life.

Methods

This large-scale survey study of 1100 Koreans aged ≥19 years was conducted in 2017 using multi-stage stratified sampling based on region, sex, and age. Data were collected using questionnaires administered face-to-face; then, a linear regression analysis was performed to assess how the symptoms were related to participants’ health-related quality of life. Complex symptoms were defined as co-occurrence of two or more of the four symptoms—fatigue, pain, digestive problems, and sleep disturbances.

Results

The most frequently observed stand-alone symptom was fatigue, while the most common combination was fatigue and pain. When examined individually, fatigue, digestive problems, and sleep disturbances were closely associated with mental health-related quality of life, and pain was associated with physical health-related quality of life. Complex symptoms were also related to health-related quality of life. Lower physical health-related quality of life was strongly associated when fatigue and pain or all four symptoms were co-occurring, and the lowest mental health-related quality of life was seen when all four symptoms were present, after adjusting for all variables.

Conclusions

Symptoms can be present in various combinations and are significantly associated with health-related quality of life. Extra attention should be given to patterns accompanying fatigue and pain and to those involving more symptoms. This elucidated the characteristics of symptoms that affect the health-related quality of life of South Korean adults.
Protocol for a matched-pair cluster control trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among women and girls seeking contraceptive services from community-based clinics in Nairobi, Kenya
Authors: Uysal Jasmine , Carter Nicole , Johns Nicole , Boyce Sabrina , Liambila Wilson , Undie Chi-Chi , Muketo Esther , Adhiambo Jill , Gray Kate , Wendoh Seri , Silverman Jay G.
Published: May 2020

Background

Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings.

Intervention

ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet.

Methods

A matched-pair cluster control trial is being conducted to assess whether the ARCHES intervention (treatment condition), as compared to standard-of-care contraceptive counseling (control condition), reduces RC and IPV, and improves contraceptive outcomes for woman and girls of reproductive age (15 to 49 years) seeking contraceptive services from community-based clinics in Nairobi, Kenya. All six clinics were assigned to intervention-control pairs based on similarities in patient volume and demographics, physical structure and neighborhood context. Survey data will be collected from patients immediately prior to their clinic visit (baseline, T1), immediately after their clinic visit (exit), and at 3- and 6-months post-visit (T2 and T3, respectively).

Discussion

This study is the first to assess the efficacy of an adaptation of the ARCHES model to reduce GBV and improve reproductive health outside of the U.S., and one of only a small number of controlled trials to assess reductions in GBV associated with a clinic-based program in an LMIC context. Evidence from this trial will inform health system efforts to reduce GBV, and to enhance female contraceptive control and reproductive health in Kenya and globally.

Trial registration

Registered May 23, 2018 -ClinicalTrials.gov,NCT03534401. Unique Protocol ID: 170084.
Examining the accuracy of trackways for predicting gait selection and speed of locomotion
Authors: Marmol-Guijarro Andres , Nudds Robert , Folkow Lars , Codd Jonathan
Published: May 2020

Background

Using Froude numbers (Fr) and relative stride length (stride length: hip height), trackways have been widely used to determine the speed and gait of an animal. This approach, however, is limited by the ability to estimate hip height accurately and by the lack of information related to the substrate properties when the tracks were made, in particular for extinct fauna. By studying the Svalbard ptarmigan moving on snow, we assessed the accuracy of trackway predictions from a species-specific model and two additional Fr based models by ground truthing data extracted from videos as the tracks were being made.

Results

The species-specific model accounted for more than 60% of the variability in speed for walking and aerial running, but only accounted for 19% when grounded running, likely due to its stabilizing role while moving faster over a changing substrate. The error in speed estimated was 0–35% for all gaits when using the species-specific model, whereas Fr based estimates produced errors up to 55%. The highest errors were associated with the walking gait. The transition between pendular to bouncing gaits fell close to the estimates using relative stride length described for other extant vertebrates. Conversely, the transition from grounded to aerial running appears to be species specific and highly dependent on posture and substrate.

Conclusion

Altogether, this study highlights that using trackways to derive predictions on the locomotor speed and gait, using stride length as the only predictor, are problematic as accurate predictions require information from the animal in question.
Clinicians’ attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature
Authors: Bierbaum Mia , Rapport Frances , Arnolda Gaston , Nic Giolla Easpaig Brona , Lamprell Klay , Hutchinson Karen , Delaney Geoff P. , Liauw Winston , Kefford Richard , Olver Ian , Braithwaite Jeffrey
Published: May 2020

Background

Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs; however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence.

Methods

A systematic search was undertaken of five databases; Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework.

Results

The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs; (2) concern about the evidence underpinning CPGs; (3) clinician uncertainty and negative perceptions of CPGs; and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use; (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources; (7) awareness of CPGs and belief in their relevance; and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs.

Conclusion

These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs.

Trial registration

PROSPERO (2019) CRD42019125748.
Hypofractionated palliative volumetric modulated arc radiotherapy with the Radiation Oncology Study Group 8502 “QUAD shot” regimen for incurable head and neck cancer
Authors: Toya Ryo , Saito Tetsuo , Yamaguchi Kohsei , Matsuyama Tomohiko , Watakabe Takahiro , Matsumoto Tadashi , Yoshida Ryoji , Hirosue Akiyuki , Murakami Daizo , Orita Yorihisa , Nakayama Hideki , Oya Natsuo
Published: May 2020

Background

To review a single institutional experience of the Radiation Therapy Oncology Group (RTOG) 8502 “QUAD shot” regimen using volumetric modulated arc radiotherapy (VMAT) for incurable head and neck cancer (HNC).

Methods

Thirty-four consecutive patients with HNC were treated with at least one cycle of the RTOG 8502 regimen. Treatment plans included the use of VMAT with 6 MV photons generated by a linear accelerator. Two daily fractions of 3.7 Gy were delivered with an interval of at least 6 h for 2 consecutive days, totaling 14.8 Gy over 4 fractions. This was repeated every 3–4 weeks for a total of three cycles. No concurrent systemic therapy was performed.

Results

The number of completed cycles was 1 in 6 (18%) patients, 2 in 5 (15%), and 3 in 23 (68%). Tumor response was achieved in 29 (85%) patients and symptom relief in 20 (77%) of 26 patients. Overall response (tumor response or symptom relief) was achieved in 32 (94%) patients. All patients who received 2 or more treatment cycles achieved overall response. Median overall survival (OS) was 5.7 months. Multivariate analysis revealed that completion of all three treatment cycles was significantly associated with better OS (P = 0.002). Grade 2 toxicity was observed in four (12%) patients, but no acute Grade ≥ 3 or late toxicity was observed.

Conclusions

The RTOG 8502 “QUAD shot” regimen using VMAT is effective for incurable HNC with highly reduced toxicity. Treatment with multiple cycles is recommended for better treatment response and/or survival.
Synovial bone sialoprotein indicates aseptic failure in total joint arthroplasty
Authors: Busch André , Jäger Marcus , Dittrich Florian , Wegner Alexander , Landgraeber Stefan , Haversath Marcel
Published: May 2020

Background

Until today, a reliable diagnostic discrimination between periprosthetic joint infections (PJI) and aseptic failure (AF) after total joint arthroplasty (TJA) remains challenging. Nearly all recent research focused on synovial markers to be elevated in PJI rather than in AF patients. In this study, synovial bone sialoprotein (sBSP) was investigated in PJI and AF arthroplasty patients before revision surgery.

Methods

sBSP and C-reactive protein (CRP) were determined in synovial fluid samples of PJI (n= 13) patients fulfilling the MSIS criteria and AF (n= 25) patients. Beside descriptive analysis and comparison, computed statistics determined the area under the receiver operating characteristics curve (AUC) to evaluate the discrimination ability of the tested synovial markers.

Results

In patients with PJI according to the MSIS criteria, mean sBSP was significantly lower: 14.8 ng/ml (95% CI 5.5-24.1) vs. 38.2 ng/ml in the AF group (95% CI 31.1-45.3),p≤ 0.001. Conversely, mean sCRP was significantly higher in PJI patients: 8.4 μg/ml (95% CI 0-17.2) vs. 1.8 μg/ml in the AF group (95% CI 0.9-2.8),p= 0.032. The AUC of sCRP in PJI patients was 0.71. The AUC of sBSP in AF revision arthroplasty patients was 0.83. The detection of osteolyses was not associated with higher sBSP concentrations.

Conclusions

Considering the MSIS criteria, significantly higher sBSP concentrations were found in synovial fluid samples of AF compared to PJI patients. sCRP showed only fair, sBSP good discrimination potential. If it is not clear whether PJI is present or not, sBSP may be considered as an add-on synovial marker.
Circ_0008532 promotes bladder cancer progression by regulation of the miR-155-5p/miR-330-5p/MTGR1 axis
Authors: Chen Liang , Yang Xiong , Zhao Jun , Xiong Ming , Almaraihah Raya , Chen Zhaohui , Hou Teng
Published: May 2020

Background

Circular RNAs (circRNAs) have been associated with bladder cancer (BC), but the specific underlying molecular mechanism of their association with BC development has not been fully explored.

Methods

Levels of Circ_0008532, MTGR1 and miR-155-5p/miR-330-5p in bladder cancer cell lines and tissues were determined with quantitative real-time PCR and western blotting assays. In vitro and in vivo assays were performed to investigate the function of circ_0008532 in tumorigenesis in bladder cancer cells. The relationships of Circ_0008532, MTGR1 and miR-155-5p/miR-330-5p were predicted using bioinformatic tools and verified by RNA-FISH, RIP and luciferase assays. The effects of circ_0008532 on the Notch signaling pathway were determined by GSEA analysis and western blotting assay.

Results

We found that circ_0008532 is upregulated in BC cell lines and tissues. Moreover, overexpression of circ_0008532 promotes, and silencing of circ_0008532 inhibits the capacity for invasive in BC cells. In addition, circ_0008532 can directly interact with miR-155-5p and miR-330-5p as an miRNA sponge which mediates the expression of the miR-155-5p/miR-330-5p target gene MTGR1 and downstream Notch signaling.

Conclusions

Circ_0008532 may act as an oncogene in BC through a novel circ_0008532/miR-155-5p, miR-330-5p /MTGR1/Notch pathway axis, which in turn may provide potential biomarkers and a therapeutic target for the management of bladder cancer.
Characterization of splenic MRC1hiMHCIIlo and MRC1loMHCIIhi cells from the monocyte/macrophage lineage of White Leghorn chickens
Authors: Yu Keesun , Gu Min Jeong , Pyung Young Jin , Song Ki-Duk , Park Tae Sub , Han Seung Hyun , Yun Cheol-Heui
Published: May 2020

Monocytes/macrophages, which are found in a variety of organs, maintain tissue homeostasis at a steady state and act as the first line of defence during pathogen-induced inflammation in the host. Most monocyte/macrophage lineage studies in chickens have been largely performed using cell lines, while few studies using primary cells have been conducted. In the present study, the phenotypic and functional characteristics of splenic monocyte/macrophage lineage cells during steady state and inflammatory conditions were examined. Splenic monocyte/macrophage lineage cells could be identified as MRC1loMHCIIhiand MRC1hiMHCIIlocells based on their surface expression of MRC1 and MHCII. In the steady state, MRC1loMHCIIhicells were more frequently found among MRC1+cells. MRC1loMHCIIhicells expressed a higher number of antigen-presenting molecules (MHCII, MHCI, and CD80) than MRC1hiMHCIIlocells. In contrast, MRC1hiMHCIIlocells showed better phagocytic and CCR5-dependent migratory properties than MRC1loMHCIIhicells. Furthermore, MRC1hiMHCIIlocells infiltrated the spleen in vivo and then became MRC1loMHCIIhicells. During lipopolysaccharide (LPS)-induced inflammatory conditions that were produced via intraperitoneal (i.p.) injection, the proportion and absolute number of MRC1hiMHCIIlocells were increased in the spleen. Uniquely, inflammation induced the downregulation of MHCII expression in MRC1hiMHCIIlocells. The major source of inflammatory cytokines (IL-1β, IL-6, and IL-12) was MRC1loMHCIIhicells. Furthermore, MRC1hiMHCIIlocells showed greater bactericidal activity than MRC1loMHCIIhicells during LPS-induced inflammation. Collectively, these results suggest that two subsets of monocyte/macrophage lineage cells exist in the chicken spleen that have functional differences.
Existence and uniqueness for fuzzy differential equation with Hilfer–Katugampola fractional derivative
Authors: Chen Xingru , Gu Haibo , Wang Xingzhao
Published: May 2020

In this paper, we study a kind of fuzzy differential equation with Hilfer–Katugampola fractional derivative and nonlocal condition. By using successive approximation method, we obtain some sufficient conditions to ensure the existence and uniqueness of solution. An illustrative example is given to show the practical usefulness of the analytical results.
Asymptotically almost periodic solutions for certain differential equations with piecewise constant arguments
Authors: Feng Zonghong , Wang Yong , Ma Xin
Published: May 2020

It is well known that differential equations with piecewise constant arguments is a class of functional differential equations, which has fascinated many scholars in recent years. These delay differential equations have been successfully applied to diverse models in real life, especially in biology, physics, economics, etc. In this work, we are interested in the existence and uniqueness of asymptotically almost periodic solution for certain differential equation with piecewise constant arguments. Due to the particularity of the equations, we cannot use the traditional method to convert it into the difference equation with exponential dichotomy. Through constructing Cauchy matrix of the investigated system to find the corresponding Green matrix of the difference equation, we need the concept of exponential dichotomy and the Banach contraction fixed point theorem of the corresponding system. Then we give some sufficient conditions to obtain the existence and uniqueness of asymptotically almost periodic solutions for these systems.
Jindalrae and Gaenari numbers and polynomials in connection with Jindalrae–Stirling numbers
Authors: Kim Taekyun , Kim Dae San , Jang Lee-Chae , Lee Hyunseok
Published: May 2020

The aim of this paper is to study Jindalrae and Gaenari numbers and polynomials in connection with Jindalrae–Stirling numbers of the first and second kinds. For this purpose, we first introduce Jindalrae–Stirling numbers of the first and second kinds as extensions of the notions of the degenerate Stirling numbers of the first and second kinds, and deduce several relations involving those special numbers. Then we introduce Jindalrae and Gaenari numbers and polynomials and obtain some explicit expressions and identities associated with those numbers and polynomials. In addition, we interpret our results by using umbral calculus.
Existence theory and numerical analysis of three species prey–predator model under Mittag-Leffler power law
Authors: Abdo Mohammed S. , Panchal Satish K. , Shah Kamal , Abdeljawad Thabet
Published: May 2020

In this manuscript, the fractional Atangana–Baleanu–Caputo model of prey and predator is studied theoretically and numerically. The existence and Ulam–Hyers stability results are obtained by applying fixed point theory and nonlinear analysis. The approximation solutions for the considered model are discussed via the fractional Adams Bashforth method. Moreover, the behavior of the solution to the given model is explained by graphical representations through the numerical simulations. The obtained results play an important role in developing the theory of fractional analytical dynamic of many biological systems.
Construct and factorial validity of Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE)
Authors: Sanders James Ladell , Netelenbos Nicole , Dei Samuel Ofori
Published: May 2020

Background

ND-PAE, as a condition needing further study, requires validation. Few studies have assessed the validity of ND-PAE with none using a prospective sample.

Methods

Fifty-eight children underwent multidisciplinary FASD assessments and were evaluated for ND-PAE using a prospective, clinical approach. Construct and factorial validity of ND-PAE were assessed, and associations between domains and symptoms described. Post hoc analysis assessed external validity of factors.

Results

ND-PAE demonstrated weak construct validity with variable convergence and divergence within and between symptoms. Factor analysis revealed one strong factor consisting of abilities associated with adaptive behavior and general cognitive ability. Relative contribution of symptoms and domains were variable.

Conclusion

This study provides an evidence-based approach to assessing ND-PAE symptoms and is a starting point to elucidating its neurobehavioral pattern.
MRI-guided percutaneous thermoablation in combination with hepatic resection as parenchyma-sparing approach in patients with primary and secondary hepatic malignancies: single center long-term experience
Authors: Winkelmann Moritz T. , Archid Rami , Gohla Georg , Hefferman Gerald , Kübler Jens , Weiss Jakob , Clasen Stephan , Nikolaou Konstantin , Nadalin Silvio , Hoffmann Rüdiger
Published: May 2020

Background

Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach.

Methods

Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method.

Results

A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases (n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively.

Conclusion

The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.
Use of simulation as a needs assessment to develop a focused team leader training curriculum for resuscitation teams
Authors: Zern Susan Coffey , Marshall William J. , Shewokis Patricia A. , Vest Michael T.
Published: May 2020

Background

Many inpatients experience cardiac arrest and mortality in this population is extremely high. Simulation is frequently used to train code teams with the goal of improving these outcomes. A key step in designing such a training curriculum is to perform a needs assessment. We report on the effectiveness of a simulation-based training program for residents designed using unannounced in-situ simulation cardiac arrest data as a needs assessment.

Methods

In order to develop the curriculum for training, a needs assessment was done using in-situ simulation. Prior to instruction, residents were assessed in their ability to lead a simulated resuscitation using a standardized checklist. During the intervention phase, residents participated in didactic and team training. The didactic training consisted of pharmacology review, ACLS update and TeamSTEPPS training. Residents took turns as code team leader in three simulation sessions. Rapid cycle deliberate practice (RCDP) was employed as part of simulation sessions. All residents returned, for post-intervention assessment. Mean pre-post test scores were analyzed to determine if there was a significant difference.

Results

Twenty-seven residents participated. Mean pre-training assessment score was 47.6 (95% CI 37.5-57.9). The mean post-training assessment score was 84.4 (95% CI 79.0-89.5). The mean time to defibrillation after pads were placed in scenario with shockable rhythm decreased from 102.2 seconds (95% CI 74.0-130.5) to 56.3 (95% CI 32.7-79.8).

Conclusion

Using unannounced in-situ cardiac arrest simulations as a needs assessment, a simulation-based training program was developed that significantly improved resident performance as team leader. Future work is needed to determine if this improvement translates into patient benefits and is sustainable. However, in-situ simulation is a promising tool for curriculum development.
Parental age at childbirth and children’s educational outcomes: evidence from upper-secondary schools in Italy
Authors: Cantalini Stefano , Guetto Raffaele , Panichella Nazareno
Published: May 2020

In the last decades, Western societies have been involved in huge demographic changes, amongst which one of the most important has been the increasing postponement of the transition to parenthood. This paper aims at analysing the consequences of later motherhood and fatherhood on children’s participation in upper-secondary schools in Italy, considering both the vertical and horizontal dimensions of education. It also aims at highlighting the role of father-mother age difference and heterogeneity in the effects by parental SES and birth order. Using Italian labour force survey data (2005-2014), results show that late parenthood is positively associated with educational attainment, whereas teenage and early parenthood negatively affect children’s educational outcomes, net of detailed information on parental SES. Age at parenthood affects the educational achievement mostly for children of low- and middle-educated parents, who are more penalized by early childbearing and more favoured by late parenthood than the offspring of the tertiary educated. Moreover, only children are less affected by age at parenthood, especially in comparison with later-born children. Finally, children’s educational outcomes are worse when the mother is older than the father, independently from the educational outcome considered, whereas they are better in case of parental age homogamy or when the father is slightly older than the mother.
How to use and assess qualitative research methods
Authors: Busetto Loraine , Wick Wolfgang , Gumbinger Christoph
Published: May 2020

This paper aims to provide an overview of the use and assessment of qualitative research methods in the health sciences. Qualitative research can be defined as the study of the nature of phenomena and is especially appropriate for answering questions of why something is (not) observed, assessing complex multi-component interventions, and focussing on intervention improvement. The most common methods of data collection are document study, (non-) participant observations, semi-structured interviews and focus groups. For data analysis, field-notes and audio-recordings are transcribed into protocols and transcripts, and coded using qualitative data management software. Criteria such as checklists, reflexivity, sampling strategies, piloting, co-coding, member-checking and stakeholder involvement can be used to enhance and assess the quality of the research conducted. Using qualitative in addition to quantitative designs will equip us with better tools to address a greater range of research problems, and to fill in blind spots in current neurological research and practice.
Report of two rare cases of adrenal incidentalomas with different origins: revisiting pathological and radiological findings with a short review of the literature
Authors: Elbaset M. A. , Zahran Mohamad H. , Badawy Mohamed , Elhameed M. Abd , Osman Yasser
Published: May 2020

Background

Adrenal tumors can be detected incidentally in 4 to 8% of patients radiologically. Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rare histopathological findings are uncommon. We aimed to report two rare primary adrenal tumors diagnosed initially as incidentalomas to identify clinical characteristics, management, and clinical outcomes after treatment.

Case presentation

The first case was a 52-year-old man presented with an incidentally discovered locally advanced primary adrenal angiosarcoma. The patient was managed surgically with no adjuvant therapy. The patient was followed up for 3 years without evidence of local recurrence. The second case was a 63-year-old woman, presented with an incidentally discovered primary diffuse B-cell lymphoma of the left adrenal gland. She was treated by adrenalectomy. Later on, adjuvant six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were given. After 6 months follow-up, the patient was alive and disease-free.

Conclusion

The diagnosis of adrenal tumors increased nowadays because of the widespread use of imaging studies, though rare pathologies should be taken into consideration.
ASCEND: Phase III, Randomized Trial of Acalabrutinib Versus Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia
Authors: Ghia Paolo , Pluta Andrzej , Wach Malgorzata , Lysak Daniel , Kozak Tomas , Simkovic Martin , Kaplan Polina , Kraychok Iryna , Illes Arpad , de la Serna Javier , Dolan Sean , Campbell Phillip , Musuraca Gerardo , Jacob Abraham , Avery Eric , Lee Jae Hoon , Liang Wei , Patel Priti , Quah Cheng , Jurczak Wojciech
Published: May 2020

PURPOSE

Acalabrutinib, a highly selective, potent, Bruton tyrosine kinase inhibitor, was evaluated in this global, multicenter, randomized, open-label, phase III study in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL).

METHODS

Eligible patients, aged ≥ 18 years with R/R CLL, were randomly assigned 1:1 centrally and stratified by del(17p) status, Eastern Cooperative Oncology Group performance status score, and number of prior lines of therapy. Patients received acalabrutinib monotherapy or investigator’s choice (idelalisib plus rituximab [I-R] or bendamustine plus rituximab [B-R]). The primary end point was progression-free survival (PFS) assessed by an independent review committee (IRC) in the intent-to-treat population. Key secondary end points included IRC-assessed overall response rate, overall survival, and safety.

RESULTS

From February 21, 2017, to January 17, 2018, a total of 398 patients were assessed for eligibility; 310 patients were randomly assigned to acalabrutinib monotherapy (n = 155) or investigator’s choice (n = 155; I-R, n = 119; B-R, n = 36). Patients had received a median of two prior therapies (range, 1-10). After a median follow-up of 16.1 months (range, 0.03-22.4 months), median PFS was significantly longer with acalabrutinib monotherapy (PFS not reached) compared with investigator’s choice (16.5 months [95% CI, 14.0 to 17.1 months]; hazard ratio, 0.31 [95% CI, 0.20 to 0.49]; P < .0001). Estimated 12-month PFS was 88% (95% CI, 81% to 92%) for acalabrutinib and 68% (95% CI, 59% to 75%) for investigator’s choice. Serious adverse events occurred in 29% of patients (n = 44 of 154) treated with acalabrutinib monotherapy, 56% (n = 66 of 118) with I-R, and 26% (n = 9 of 35) with B-R. Deaths occurred in 10% (n = 15 of 154), 11% (n = 13 of 118), and 14% (n = 5 of 35) of patients receiving acalabrutinib monotherapy, I-R, and B-R, respectively.

CONCLUSION

Acalabrutinib significantly improved PFS compared with I-R or B-R and has an acceptable safety profile in patients with R/R CLL.
Rehearsing for Reconstruction: The Archipelagic Afterlives of the Port Royal Experiment
Authors: Carmody Todd
Published: May 2020

This essay traces the cultural legacy of the Port Royal Experiment, the Civil War–era social experiment in free labor conducted by Union forces on the Sea Islands of South Carolina and Georgia. Whereas literary and cultural historians typically focus on the “discovery” of slave spirituals by Northern missionaries and educators at Port Royal, this essay tracks how later writers, performers, and sociologists returned to the Sea Islands to reimagine the promise of free labor. The archive thus assembled includes Civil War–era ethnographies, memoirs, and reports; the scholarly monographs in UNC Press’s Social Study Series; and DuBose Heyward’s popular “Negro novel” Porgy (1925). Across this interdisciplinary tradition, writers of various stripes seek by turns to celebrate and contain the threat of the free but noncapitalist black body. The latter figure, recalling the disability category’s historical role in sorting people into work-based or need-based systems of social distribution, is commonly represented as disabled. Ultimately, the essay documents a dual development in US political economy as the marginalization of contraband slaves as capitalist laborers on the Sea Islands—the “failure” of the Port Royal Experiment—gives way to the consolidation of “black culture,” a success of a different kind.
Lost Archives, Lost Lands: Rereading New Mexico’s Imagined Environments
Authors: Nugent Carlos Alonso
Published: May 2020

This article describes how Nuevomexicanas/os have used texts, images, and other media to reclaim the lands they lost in the US-Mexico War. Along the way, it models a method for reading “imagined environments”—the frameworks through which human groups have represented, related to, and resided in their more-than-human worlds. This article focuses on two generations of writer-activists. In the 1930s, 1940s, and 1950s, Adelina Otero-Warren and Fabiola Cabeza de Baca situated themselves in the Precarious Desert, an imagined environment of constraints, contingencies, and struggles for survival. Then, in the 1960s and 1970s, the Alianza Federal de Mercedes revived the Pueblo Olvidado, an imagined environment saturated with laws, treaties, and cultural traditions. Despite many differences, both generations shared a desire to settle on and profit from Native lands. But though they never became environmentalists, they experimented with environmental writing and politics. By recovering these experiments, this article shows how media produce—rather than simply portray—lands and waters. Ultimately it tells the story of the borderlands as a series of struggles over what environments are, whom they can contain, and how they should be used.
Ultrasound Tissue Characterization (UTC) of the Achilles Tendon in Pre- and Post-Pubertal Dancers
Authors: Steinberg Nili , Pantanowitz Michal , Zeev Aviva , Stern Myriam , Dar Gali
Published: May 2020

This study examined whether maturation status, body physique, and the impact of training are related to the development of Achilles tendon structure in young dancers. Seventy-one pre- and post-menarche dancers (12 to 15 years of age) were recruited. The Achilles tendon of each dancer
was examined via ultrasonography tissue characterization (UTC) imaging. The cross-sectional area (CSA) and the fibrillar structure (echo types I to IV) were measured. The participants were screened for anthropometric parameters (weight, height, and leg length) with body mass index (BMI) and
BMI percentile calculated; for hours and impact of training; for Tanner pubertal maturation; and for pain in their Achilles tendon (VAS scale). In addition, age and age at onset of menarche were documented. Tendon structure was found to differ between pre- and post-menarche dancers. Post-menarche
dancers had a significantly lower percentage of echo type I fibers and a significantly higher percentage of echo type II, III, and IV fibers, with a greater CSA compared to pre-menarche dancers. The tendon structure was found to be correlated with BMI percentile, but no correlations were found
with chronologic age or the impact of dance training. Furthermore, ANCOVA showed that BMI had a statistically significant effect on fiber types II and III (p < 0.005) and that the effect of menarche was significant, meaning that pre-menarche dancers had a lower BMI compared with those who
were post-menarche. It is concluded that pre- and post-menarche dancers had developed different patterns of Achilles tendon fiber structure. Body mass index was found to be the most significant factor influencing the different tendon structures in young pubertal dancers.