bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of wind effect reduction on square high-rise buildings by corner modification
Authors: Li Yi , Li Yong-Gui , Li Qiu-Sheng , Tee Kong-Fah
Published: December 2018

Although empirical formulas have been provided in relevant design code for estimating wind loads and wind-induced responses on square high-rise buildings, the effects of corner modification treatments on wind loads and wind-induced responses of square high-rise buildings need to be evaluated quantitatively. In this study, wind pressure measurements for a benchmark square high-rise building and three corner modified square high-rise buildings were first carried out to acquire the spatial-temporal varying pressure distributions. Moreover, the corresponding full-scale finite element models were established in ANSYS software to get their dynamic properties. Combined with wind tunnel test results and modal analysis, wind loads and wind-induced responses of the four square high-rise buildings were calculated and compared for designing the best aerodynamic treatment of reducing wind effects on square high-rise buildings. This article aims to provide visual comparisons of wind effect reduction for structural designers and owners of square high-rise buildings.
Structural damage detection based on iteratively reweighted l1 regularization algorithm
Authors: Zhou Xiaoqing , Hou Rongrong , Wu Yuhan
Published: December 2018

Structural damage usually appears in a few sections or members only, which is sparse compared with the total elements of the entire structure. According to the sparse recovery theory, the recently developed damage detection methods employ the l1 regularization technique to exploit the sparsity condition of structural damage. However, in practice, the solution obtained by the l1 regularization is typically suboptimal. The l0 regularization technique outperforms the l1 regularization in various aspects for sparse recovery, whereas the associated nonconvex optimization problem is NP-hard and computationally infeasible. In this study, a damage detection method based on the iteratively reweighted l1 regularization algorithm is proposed. An iterative procedure is employed such that the nonconvex optimization problem of the l0 regularization can be efficiently solved through transforming it into a series of weighted l1 regularization problems. Experimental example demonstrates that the proposed damage detection method can accurately locate the sparse damage over a large number of elements. The advantage of the iteratively reweighted l1 regularization algorithm over the l1 regularization in damage detection is also demonstrated.
Ventilation inlets design based on ventilation performance assessment using a dimensionless time scale
Authors: Cao Shi-Jie , Deng Hua-Yan , Zhou Xiaoqing , Deng Yelin
Published: December 2018

Ventilation configurations greatly influence indoor airflow and pollutant dispersion. This work aims to investigate the effect of vent inlet size (indicated as size ratio D/ L, inlet vent length to the cubic root of the room volume) on ventilation performance. A dimensionless time scale ratio (proportional to [Formula: see text], Richardson number Ri, mass flux ratio α) was proposed to represent ventilation performance assessment. Both methods of experiment and simulation were employed. Studies were conducted for five configurations with various inlet sizes (i.e. D/ L ratios equal to 0.2, 0.4, 0.6, 0.8 and 1) under three different air change rates per hour (ACHs; 4, 10 and 16). When keeping the same ACH, the smaller the inlet size (0.2 to 0.6), the larger the inlet ventilation rate. The larger the ACH, the smaller the average CO2 concentration at the outlet, but not within the occupied zone (for D/ L ratios of 0.8 and 1, CO2 concentration firstly decreased with ACH of 10 and then increased with ACH of 16). The results demonstrated that [Formula: see text] is smaller for cases with a small size ratio (with the critical value below 10−3) than with larger ones, showing a better pollutant removal performance. These findings can facilitate and improve the initial design for building ventilation.
Reimagining unfinished architectures: ruin perspectives between art and heritage
Authors: Arboleda Pablo
Published: December 2018

For the past five decades, hundreds of unfinished public works have been erected in Italy as the result of inconsistent planning and the presence of corruption and organised crime. A third of these constructions are located in Sicily alone, and so, in 2007, a group of artists labelled this phenomenon an architectural style: ‘ Incompiuto Siciliano’. Through this creative approach, the artists’ objective is to put incompletion back on the agenda by viewing it from a heritage perspective. This article reviews the different approaches that the artists have envisaged to handle unfinished public works; whether to finish them, demolish them, leave them as they are or opt for an ‘active’ arrested decay. The critical implications of these strategies are analysed in order to, ultimately, conclude that incompletion is such a vast and complex issue that it will surely have more than one single solution; but rather a combination of these four. This is important because it opens up a debate on the broad spectrum of possibilities to tackle incompletion – establishing this as one of the key contemporary urban themes not only in Italy but also in those countries affected by unfinished geographies after the 2008 financial crisis.
A prize for a price? HE marketisation and the question of value
Authors: Tomlinson Michael , Kelly Paul
Published: December 2018

Assessing the value of HE has now become embroiled in discussions of its functions and outputs in the context of increased marketisation. Much of this is based on a fairly crude value framing concerning the economic impact, return value and, measured performance, derived from HE. This article explores the concept of value associated with the work of Dewey and applies this to current market principles and dynamics in HE, particularly the distinctions he draws between value means and ends in the process of valuation. As well as examining the tensions and possible interplays between intrinsic and instrumental values, and ways of bridging this tension, the article analyses the implications this has for HE in its current market form. It critically engages with the characteristic ways in which dominant measurement and markers of value are applied in assessing the value generated by institutions and discusses the implications for market-orientated HE systems.
I Need You to Tell My Story: Qualitative Inquiry for/With Transnational Black Women
Authors: Burkhard Tanja
Published: December 2018

Drawing on a yearlong qualitative research project with seven Black transnational women, this article employs a transnational Black feminist approach. It is guided by the following questions: What does it look like to conduct qualitative research rooted in a transnational Black feminist framework? What implications related to storytelling, reciprocity, and the relationships with participants emerge from this work? In exploring these questions, I consider some of the ways transnational Black feminist theory can be operationalized to counter re-inscriptions of dominant ideologies onto the research process with marginalized communities, particularly under consideration of contemporary national and transnational processes and discourses.
Maximizing traffic flow of automated guided vehicles based on Jamology and applications
Authors: Kumagai Kenji , Sawada Kenji , Shin Seiichi
Published: December 2018

This study aims to propose and investigate a theoretical maximum traffic flow method. Furthermore, we propose a merging timing control based on the results obtained from this method, which are verified using actual automated guided vehicles. The results (micro-level optimization) enable automated guided vehicles to achieve a fabrication level optimization (macro-level optimization). Engineers working in the field of automated guided vehicles have found that there is an optimal headway distance that achieves a maximum traffic throughput when automated guided vehicles operate with merging points. “Zipper merging” is known to be a suitable merging method resulting from “Jamology.” In this study, first, we will verify the results using the “Zipper merging” simulation model. Second, we develop a mathematical model and verify its simulations and experiments using actual automated guided vehicles. Finally, we develop a merging timing control to augment transfer flow and verify the effects using a small full fabrication simulation. We predict that this control will improve factory model throughput when used in practical applications.
Autonomous feature type selection based on environment using expectation maximization in self-localization
Authors: Özkucur Nezih Ergin , Akın H Levent
Published: December 2018

Self-localization in autonomous robots is one of the fundamental issues in the development of intelligent robots, and processing of raw sensory information into useful features is an integral part of this problem. In a typical scenario, there are several choices for the feature extraction algorithm, and each has its weaknesses and strengths depending on the characteristics of the environment. In this work, we introduce a localization algorithm that is capable of capturing the quality of a feature type based on the local environment and makes soft selection of feature types throughout different regions. A batch expectation–maximization algorithm is developed for both discrete and Monte Carlo localization models, exploiting the probabilistic pose estimations of the robot without requiring ground truth poses and also considering different observation types as blackbox algorithms. We tested our method in simulations, data collected from an indoor environment with a custom robot platform and a public data set. The results are compared with the individual feature types as well as naive fusion strategy.
Tough medicine: Ensuring access to affordable drugs requires fixing trade agreements starting with NAFTA
Authors: Jorge Maria Fabiana
Published: December 2018

The negotiation of trade agreements, which is conducted in secret, poses serious risks for the generic/biosimilar industry as the originator industry uses them as a tool to ratchet up the protection of intellectual property rights to broaden and extend their monopolies, and forcing changes in the laws and regulations of the countries as international law supersede national law. The Trans Pacific Partnership (TPP) demonstrated that the constructive engagement of the generic/biosimilar industry can make a difference in these negotiations to strike a balance that both fosters innovation while ensuring patients’ expedited access to more affordable drugs. The industry needs to be vigilant in the ongoing negotiations for the modernisation of the North American Free Trade Agreement (NAFTA) between Canada, Mexico and the United States, which will not only affect those three pharmaceutical markets, but also set a precedent for future trade negotiations.
A bivariate replacement policy for an imperfect repair system based on geometric processes
Authors: Dong Qinglai , Cui Lirong , Gao Hongda
Published: December 2018

A repair replacement model for a deteriorating system with delayed repair is studied, in which the successive working times after repair and the consecutive repair times of the system are described by geometric processes. The instantaneous availability is studied in the case of general distributions for the working time, repair time and delayed repair time. A bivariate replacement policy is considered, that is, the system is replaced whenever the working age of the system reaches T or at the first hitting time of the working time after repair with respect to the working time threshold τ, whichever occurs first. The explicit expression of the long-run average cost rate under the replacement policies is derived. The corresponding optimal replacement policy can be determined numerically, and numerical examples are presented to demonstrate the application of the developed model and approach. It is shown that the optimal solution and optimal value are sensitive to the tiny change in the ratios of the Geometric processes and the expectation of the delayed repair time.
An Exploratory Investigation of Americans’ Expression of Gender Bias Before and After the 2016 Presidential Election
Authors: Georgeac Oriane A. M. , Rattan Aneeta , Effron Daniel A.
Published: December 2018

Did the 2016 U.S. presidential election’s outcome affect Americans’ expression of gender bias? Drawing on theories linking leadership with intergroup attitudes, we proposed it would. A preregistered exploratory survey of two independent samples of Americans pre- and postelection ( ns = 1,098 and 1,192) showed no pre–post differences in modern sexism, concern with the gender pay gap, or perceptions of gender inequality and progress overall. However, supporters of Donald Trump (but not of Hillary Clinton) expressed greater modern sexism post- versus preelection—which in turn predicted reporting lower disturbance with the gender pay gap, perceiving less discrimination against women but more against men, greater progress toward gender equality, and greater female representation at top levels in the United States. Results were reliable when evaluated against four robustness standards, thereby offering suggestive evidence of how historic events may affect gender-bias expression. We discuss the theoretical implications for intergroup attitudes and their expression.
Moving beyond growth in the Anthropocene
Authors: Reichel André , Perey Robert
Published: December 2018

From a sociological and political perspective, a key contribution of the discourse on the Anthropocene is its ability to act as a boundary object, to bring natural scientists and social scientists into conversation with each other and with the wider public. The Anthropocene then shifts scientific debate from the technical to the political, thus forcing science to change its mode of inquiry from normal to post-normal science, where political stakes as well as uncertainty of decision outcomes are high, and pressuring science to become a political actor. The current understanding of the Anthropocene, both stratigraphically and metaphorically, is based on the detrimental ecological impact of humanity and this leads us to propose that the Anthropocene commences with a new age we have called the ‘Auxocene’, after the ancient Greek Horae of growth. We argue that the social imaginary constituting the Auxocene rests on an unchallenged basic driver: expansionist differentiation and unchecked growth. We explore the notion of ‘Degrowth’ as a powerful discursive tool to facilitate the emergence of new social imaginaries and creating new socio-economic models that will provide beneficial ecological consequences for living in the Anthropocene.
Do Tibial Eminence Fractures and Anterior Cruciate Ligament Tears Have Similar Outcomes?
Authors: Melugin Heath P. , Desai Vishal S. , Camp Christopher L. , Milbrandt Todd A. , Dahm Diane L. , Levy Bruce A. , Stuart Michael J. , Krych Aaron J.
Published: December 2018

Background:

Avulsion fractures involving the tibial eminence are considered equivalent in terms of the cause to anterior cruciate ligament (ACL) tears; however, there are limited data comparing the outcomes of adolescent patients undergoing surgical fixation of a tibial eminence fracture (TEF) with those undergoing ACL reconstruction.

Purpose:

To compare the clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent TEF fixation with patients with midsubstance ACL tears who required acute reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included a group of patients with TEFs treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years 2001 and 2015. Data regarding the initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using a physical examination, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and the Tegner activity score.

Results:

Sixty patients with a mean follow-up of 57.7 months (range, 24-206 months) were included; 20 patients (11 male, 9 female; mean age, 11.9 years [range, 7-15 years]) who underwent surgical fixation for a TEF were matched to a group of 40 patients (23 male, 17 female; mean age, 12.5 years [range, 8-5 years]) who underwent reconstruction for ACL tears. The TEF group demonstrated significantly lower postoperative IKDC scores (TEF group, 94.0; ACL group, 97.2; P = .04) and Lysholm scores (TEF group, 92.4; ACL group, 96.9; P = .02). The TEF group returned to sport 119 days sooner ( P < .01), but there was no difference in postoperative Tegner scores (TEF group, 7.3; ACL group, 7.6; P = .16). The TEF group demonstrated increased postoperative anterior laxity ( P = .02) and a higher rate of postoperative arthrofibrosis ( P = .04). There was no difference in subsequent ACL injuries ( P = .41).

Conclusion:

Both groups demonstrated quality outcomes at a minimum 2-year follow-up. Patients with TEFs demonstrated lower mean clinical outcome scores compared with patients with ACL tears, but the differences were less than reported minimal clinically important difference values. Additionally, the TEF group experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in the rate of subsequent ACL injuries. The TEF group returned to sport sooner than the ACL group, but the postoperative activity levels were similar.
Invisible Social Identity Exercise
Authors: Duncan Kathleen B.
Published: December 2018

Diversity courses cover a variety of relevant topics, but it is difficult to convey the dilemmas those with stigmatized, invisible social identities may encounter in the workplace. This exercise attempts to situate students in the perspective of both the person with the invisible identity and those who may unintentionally place that person in a difficult situation. Five role-plays with scenarios that reflect real-world situations allow students to heighten their sensitivity and understanding in workplace situations that may involve invisible social identities. The learning builds on the students’ lived experience and links stigma and invisible social identity theory to their workplace environment.
Psychiatric and Interpersonal Correlates of Suicide Ideation in Military Sexual Trauma Survivors: The National Health and Resilience in Veterans Study
Authors: Monteith Lindsey L. , Smith Noelle B. , Holliday Ryan , Pietrzak Robert H.
Published: December 2018

Background

Veterans who experience military sexual trauma are at increased risk for experiencing suicidal ideation, suicide attempt, and suicide. Yet few studies have attempted to discern factors that relate to suicidal ideation and suicide attempts among survivors of military sexual trauma. The present study aimed to identify psychiatric and interpersonal correlates of suicidal ideation (primary aim) and suicide attempt (secondary aim) among survivors of military sexual trauma.

Methods

This cross-sectional analysis included 115 veterans (56 females; mean age = 53.24) who participated in the National Health and Resilience in Veterans Study and reported experiencing military sexual trauma. Self-report measures assessed psychological distress, hazardous alcohol use, social support, loneliness, social acknowledgment following one’s worst trauma, suicidal ideation, and suicide attempts.

Results

Military sexual trauma survivors who reported more severe psychological distress (OR = 2.88), hazardous alcohol use (OR = 1.14), and perceived general disapproval from others (OR = 1.14) were significantly more likely to report experiencing suicidal ideation in the past two weeks. Hazardous alcohol use (OR = 1.19) and perceived general disapproval from others (OR = 1.36) were associated with being more likely to report attempting suicide in adulthood.

Conclusions

Addressing alcohol misuse, psychological distress, and perceived general disapproval from others in relation to one’s worst traumatic event is recommended when assessing and managing suicide risk among veterans who have experienced military sexual trauma. Findings also contribute to a growing literature highlighting the importance of understanding perceptions of the interpersonal response to trauma. Considering the cross-sectional design, longitudinal research is needed to further elucidate the roles of these constructs in predicting suicidal ideation and suicide attempt following military sexual trauma.
Corneal endothelial cell dysfunction: etiologies and management
Authors: Feizi Sepehr
Published: December 2018

A transparent cornea is essential for the formation of a clear image on the retina. The human cornea is arranged into well-organized layers, and each layer plays a significant role in maintaining the transparency and viability of the tissue. The endothelium has both barrier and pump functions, which are important for the maintenance of corneal clarity. Many etiologies, including Fuchs’ endothelial corneal dystrophy, surgical trauma, and congenital hereditary endothelial dystrophy, lead to endothelial cell dysfunction. The main treatment for corneal decompensation is replacement of the abnormal corneal layers with normal donor tissue. Nowadays, the trend is to perform selective endothelial keratoplasty, including Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty, to manage corneal endothelial dysfunction. This selective approach has several advantages over penetrating keratoplasty, including rapid recovery of visual acuity, less likelihood of graft rejection, and better patient satisfaction. However, the global limitation in the supply of donor corneas is becoming an increasing challenge, necessitating alternatives to reduce this demand. Consequently, in vitro expansion of human corneal endothelial cells is evolving as a sustainable choice. This method is intended to prepare corneal endothelial cells in vitro that can be transferred to the eye. Herein, we describe the etiologies and manifestations of human corneal endothelial cell dysfunction. We also summarize the available options for as well as recent developments in the management of corneal endothelial dysfunction.
Randomized trial of ibrutinib vs ibrutinib plus rituximab in patients with chronic lymphocytic leukemia
Authors: Burger Jan A. , Sivina Mariela , Jain Nitin , Kim Ekaterina , Kadia Tapan , Estrov Zeev , Nogueras-Gonzalez Graciela M. , Huang Xuelin , Jorgensen Jeffrey , Li Jianling , Cheng Mei , Clow Fong , Ohanian Maro , Andreeff Michael , Mathew Thomas , Thompson Philip , Kantarjian Hagop , O’Brien Susan , Wierda William G. , Ferrajoli Alessandra , Keating Michael J.
Published: December 2018

Ibrutinib, an oral covalent inhibitor of Bruton’s tyrosine kinase, is an effective therapy for patients with chronic lymphocytic leukemia (CLL). To determine whether rituximab provides added benefit to ibrutinib, we conducted a randomized single-center trial of ibrutinib vs ibrutinib plus rituximab. Patients with CLL requiring therapy were randomized to receive 28-day cycles of once-daily ibrutinib 420 mg, either as a single agent (n = 104), or together with rituximab (375 mg/m2; n = 104), given weekly during cycle 1, then once per cycle until cycle 6. The primary end point was progression-free survival (PFS) in the intention-to-treat population. We enrolled 208 patients with CLL, 181 with relapsed CLL and 27 treatment-naive patients with high-risk disease (17p deletion or TP53 mutation). After a median follow-up of 36 months, the Kaplan-Meier estimates of PFS were 86% (95% confidence interval [CI], 76.6-91.9) for patients receiving ibrutinib, and 86.9% (95% CI, 77.3-92.6) for patients receiving ibrutinib plus rituximab. Similarly, response rates were the same in both arms (overall response rate, 92%). However, time to normalization of peripheral blood lymphocyte counts and time to complete remission were shorter, and residual disease levels in the bone marrow were lower, in patients receiving ibrutinib plus rituximab. We conclude that the addition of rituximab to ibrutinib in relapsed and treatment-naive high-risk patients with CLL failed to show improvement in PFS. However, patients treated with ibrutinib plus rituximab reached their remissions faster and achieved significantly lower residual disease levels. Given these results, ibrutinib as single-agent therapy remains current standard-of-care treatment in CLL. This trial was registered at www.clinicaltrials.gov as #NCT02007044.
Tuberculosis elimination in Oman: winning the war on the disease
Authors: Al Awaidy Salah T.
Published: December 2018

In 2014, the World Health Assembly adopted the new End TB Strategy that targets ending tuberculosis (TB) by 2035. This article describes the progress made to eliminate TB in Oman.

Data from officials and other sources provided the information to assess the situation in Oman.

In the period 1981–1992, TB notifications decreased by 11% per year. Between 1992 and 2016, the rates declined more slowly at 4.6% per year,i.e.from 16 to 7.8 per 100 000. During 2010–2016, 2352 TB cases (80% males and 60% Omani nationals) were reported. Bacteriologically confirmed TB cases decreased from 47 to 38 per million population, with a cumulative decline of 19%. The success rate of TB treatment was >87%. Among the new cases, 1.2% were multidrug-resistant TB cases. TB mortality rate dropped by 39% between 1990 and 2016.

TB control efforts in Oman have produced remarkable effects. However, the pre-elimination threshold set at <10 notified TB cases per million population per year is not yet in reach. There is a need for an urgent national response and careful consideration of new available interventions.
MEIS2 regulates endothelial to hematopoietic transition of human embryonic stem cells by targeting TAL1
Authors: Wang Mengge , Wang Hongtao , Wen Yuqi , Chen Xiaoyuan , Liu Xin , Gao Jie , Su Pei , Xu Yuanfu , Zhou Wen , Shi Lihong , Zhou Jiaxi
Published: December 2018

Background

Despite considerable progress in the development of methods for hematopoietic differentiation, efficient generation of transplantable hematopoietic stem cells (HSCs) and other genuine functional blood cells from human embryonic stem cells (hESCs) is still unsuccessful. Therefore, a better understanding of the molecular mechanism underlying hematopoietic differentiation of hESCs is highly demanded.

Methods

In this study, by using whole-genome gene profiling, we identified Myeloid Ectopic Viral Integration Site 2 homolog (MEIS2) as a potential regulator of hESC early hematopoietic differentiation. We deleted MEIS2 gene in hESCs using the CRISPR/CAS9 technology and induced them to hematopoietic differentiation, megakaryocytic differentiation.

Results

In this study, we found that MEIS2 deletion impairs early hematopoietic differentiation from hESCs. Furthermore, MEIS2 deletion suppresses hemogenic endothelial specification and endothelial to hematopoietic transition (EHT), leading to the impairment of hematopoietic differentiation. Mechanistically, TAL1 acts as a downstream gene mediating the function of MEIS2 during early hematopoiesis. Interestingly, unlike MEIS1, MEIS2 deletion exerts minimal effects on megakaryocytic differentiation and platelet generation from hESCs.

Conclusions

Our findings advance the understanding of human hematopoietic development and may provide new insights for large-scale generation of functional blood cells for clinical applications.
Alarming levels of antimicrobial resistance among sepsis patients admitted to ICU in a tertiary care hospital in India - a case control retrospective study
Authors: Nagarjuna D. , Mittal Gajanand , Dhanda Rakesh Singh , Gaind Rajni , Yadav Manisha
Published: December 2018

Background

Hospital acquired infections (HAI) are principal threats to the patients of intensive care units. An increase in the antimicrobial resistance (AMR) observed in gram negative bacteria is a great challenge to deal with. HAI and AMR lead to prolonged hospitalization and additional doses of anti-microbial treatment affecting patient’s fitness and finances. Present study was undertaken to determine the pathotypes, genetic diversity and the antimicrobial resistance of E.coli in isolates from the patients admitted to intensive care unit at a tertiary care hospital in Delhi, India.

Methods

E.coli isolates (N = 77) obtained from the blood culture of patients diagnosed with sepsis and the isolates (N = 71) from the stool culture of patients admitted in intensive care unit (ICU) but not diagnosed with sepsis were investigated for their pathotypes, adherence patterns and genetic diversity by Enterobacterial Repeated Intergenic Consensus-polymerase chain reaction (ERIC-PCR). A Kirby-Bauer Disc diffusion test and antimicrobial susceptibility assays were performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum β-lactamase (ESBL) genes and sequence type 131 (ST131) clone were characterised genotypically by gene-specific PCRs.

Results

Pathotypes analysis revealed 46 and 16% of the blood E.coli isolates were ETEC and EAEC respectively, in contrast to the fecal isolates wherein 22% of the isolates were ETEC and 28.5% were EAEC. EPEC, STEC and EIEC pathotypes were not detected in blood or fecal isolates. Of all the isolates studied, more than 90% of the blood and 70% of the fecal isolates were found to be resistant to cephalosporins. On the other hand, 68% of blood and 44% of the fecal isolates were found to be ESBL producers. Interestingly 83% of the blood isolates contained CTX-M15, whereas only 21% of them contained CTX-M9 genes. On the other hand CTX-M15 genes were found in 90% and CTX-M9 genes were found in 63% of the fecal isolates.

Conclusion

The antimicrobial resistant profile found in this study is alarming and poses a great threat to public health. Apparently an increased antimicrobial resistance to the extensively used cephalosporins is affecting an optimal drug therapy for patients. In addition, the presence of catheters, prolonged duration of stay in the hospital and poor hygienic conditions due to infrequent urination of the patient can lead to an additional vulnerability. Therefore continuous surveillance and rational use of antibiotics along with effective hygienic measures are urgently recommended in such settings.
Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle?
Authors: Beitsch Peter D. , Whitworth Pat W. , Hughes Kevin , Patel Rakesh , Rosen Barry , Compagnoni Gia , Baron Paul , Simmons Rache , Smith Linda Ann , Grady Ian , Kinney Michael , Coomer Cynara , Barbosa Karen , Holmes Dennis R. , Brown Eric , Gold Linsey , Clark Patricia , Riley Lee , Lyons Samuel , Ruiz Antonio , Kahn Sadia , MacDonald Heather , Curcio Lisa , Hardwick Mary Kay , Yang Shan , Esplin Ed D. , Nussbaum Robert L.
Published: December 2018

Purpose

An estimated 10% of breast and ovarian cancers result from hereditary causes. Current testing guidelines for germ line susceptibility genes in patients with breast carcinoma were developed to identify carriers of BRCA1/ 2 variants and have evolved in the panel-testing era. We evaluated the capability of the National Comprehensive Cancer Network (NCCN) guidelines to identify patients with breast cancer with pathogenic variants in expanded panel testing.

Methods

An institutional review board–approved multicenter prospective registry was initiated with 20 community and academic sites experienced in cancer genetic testing and counseling. Eligibility criteria included patients with a previously or newly diagnosed breast cancer who had not undergone either single- or multigene testing. Consecutive patients 18 to 90 years of age were consented and underwent an 80-gene panel test. Health Insurance Portability and Accountability Act–compliant electronic case report forms collected information on patient demographics, diagnoses, phenotypes, and test results.

Results

More than 1,000 patients were enrolled, and data records for 959 patients were analyzed; 49.95% met NCCN criteria, and 50.05% did not. Overall, 8.65% of patients had a pathogenic/likely pathogenic (P/LP) variant. Of patients who met NCCN guidelines with test results, 9.39% had a P/LP variant. Of patients who did not meet guidelines, 7.9% had a P/LP variant. The difference in positive results between these groups was not statistically significant (Fisher’s exact test P = .4241).

Conclusion

Our results indicate that nearly half of patients with breast cancer with a P/LP variant with clinically actionable and/or management guidelines in development are missed by current testing guidelines. We recommend that all patients with a diagnosis of breast cancer undergo expanded panel testing.
Areca nut extract demonstrated apoptosis-inducing mechanism by increased caspase-3 activities on oral squamous cell carcinoma
Authors: Sari Liza Meutia , Subita Gus Permana , Auerkari Elza Ibrahim
Published: December 2018

Background: Oral squamous cell carcinoma is a neoplasm of keratinocyte cells of oral mucosa epithelium that can potentially spread through lymphatic tissue or blood vessel. Although areca nut is one of the plants with a risk of inducing that cancer, areca nut is believed to have high antioxidant properties. Due to the current interest in the apoptosis effects from areca nut for oral cancer treatment, we investigated its ability to induce apoptosis and caspase-3 activity in oral cancer cell lines: HSC-2 and HSC-3.

Methods: We examined the effect of areca nut on apoptosis and caspase-3 activity in HSC-2 and HSC-3 cells. Flow cytometry was conducted for the quantification of the cells that were apoptotic and expressing the caspase-3 enzyme for 24 and 48 hours.

Results: Areca nut induced a significant increase (p<0.01) in late apoptosis of HSC-2 cells and mostly occurred over 48 hours. The study also found that in HSC-3, there were significant increases (p<0.01) the percentage of cells in early apoptosis after 24 hours and late apoptosis at 48 hours. Caspase-3 activity increased after 24 and 48 hours of areca nut exposure in both cells.

Conclusions: The study showed that areca nut could be considered as a potential anticancer agent through its capability in inducing a caspase-dependent apoptosis.
Recent advances in understanding chronic rhinosinusitis endotypes
Authors: Succar Eric F. , Turner Justin H.
Published: December 2018

Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease with an as-yet-undefined etiology. The management of CRS has historically been phenotypically driven, and the presence or absence of nasal polyps has frequently guided diagnosis, prognosis, and treatment algorithms. Research over the last decade has begun to question the role of this distinction in disease management, and renewed attention has been placed on molecular and cellular endotyping and a more personalized approach to care. Current research exploring immunologic mechanisms, inflammatory endotypes, and molecular biomarkers has the potential to more effectively delineate distinct and clinically relevant subgroups of CRS. The focus of this review will be to discuss and summarize the endotypic characterization of CRS and the potential diagnostic and therapeutic implications of this approach to disease management.
Collection of algorithms of dental manipulations to the final state certification
Authors: Колесник Камила , Kolesnik Kamila , Райда Антонина , Rayda Antonina , Каладзе Наталья , Kaladze Natal'ya , Жирова Виктория , Zhirova Viktoriya , Шеремета Елена , Sheremeta Elena , Безруков Григорий , Bezrukov Gregory
Published: December 2018

In the training manual the technique of diagnostic and therapeutic manipulations is structured in the form of a description of the stage sequence of actions with the criteria for monitoring their implementation, providing dental instruments and materials, requirements to the doctor.
The urgent task is to improve the quality of training of dental specialists, the formation of their professional competencies in accordance with the requirements of the GEF IN the direction of "Dentistry". When training, it is important to work out manual skills to the level of high skill.
The manual will assist in the preparation of both the final state certification and accreditation of graduates.
The Use of Procalcitonin as a Sepsis Marker in a Community Hospital
Authors: De Oro Nathalia , Gauthreaux Maria E , Lamoureux Julie , Scott Joseph
Published: December 2018

Background

Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients.

Methods

This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation.

Results

Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods.

Conclusions

There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.
Pediatric Anaerobic Blood Culture Practices in Industrialized Countries
Authors: Thé Tama , Curfman Alison , Burnham Carey-Ann D , Hayes Ericka , Schnadower David ,   with the Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC)
Published: December 2018

Background

Routine anaerobic blood culture collection in febrile children is controversial, as clinicians try to account for the severe but relative infrequency of anaerobic bacteremia. Furthermore, clinical and laboratory practice variation among institutions may lead to potentially inaccurate epidemiological data. Our goal was to assess blood culture practices in pediatric patients throughout an international network of hospitals in industrialized countries.

Methods

We conducted a survey of current clinical and laboratory practice patterns in a convenience sample of international institutions participating in 6 pediatric emergency research networks in the US, Canada, Europe, Australia, and New Zealand. A lead clinician at each institution queried institutional practices from the emergency department, pediatric intensive care unit, and oncology medical directors. The microbiology director at each institution completed the laboratory survey.

Results

Sixty-five of 160 (41%) invited institutions participated in the survey. Routine anaerobic blood cultures are collected in 30% of emergency departments, 30% of intensive care units, and 48% of oncology wards. Reasons for restricting anaerobic culture collection included concerns regarding blood volume (51%), low pretest probability (22%), and cost-effectiveness (16%). The most common reasons institutions allow for selectively obtaining anaerobic cultures are clinical suspicion (64%) and patients who are immunosuppressed (50%). The microbiology survey showed variation in systems, although most use the BACTEC™ culture system and MALDI-TOF for organism identification.

Conclusions

There is broad variation in anaerobic blood culture practices among a network of pediatric hospitals in industrialized countries.
It's Not Just a Needlestick: Exploring Phlebotomists' Knowledge, Training, and Use of Comfort Measures in Pediatric Care to Improve the Patient Experience
Authors: Piazza Julie , Merkel Sandra , Neusius Harry , Murphy Susan , Gargaro Joan , Rothberg Brooke , Kullgren Kristin A
Published: December 2018

Background

Blood draws are a routine element of the pediatric patient experience. They are also associated with the greatest fear and pain for a child. Because of the limited literature regarding phlebotomists' knowledge, experience, training, or stress related to their use of comfort techniques during pediatric blood draws, this study explored current practices and training methods. Phlebotomist training tends to focus on clinical technique rather than pediatric or patient comfort support. The study includes aims to develop a measurement for phlebotomists' use of comfort techniques for pediatric blood draws.

Method

Focus groups of parent advocates (n = 24) and pediatric phlebotomists (n = 11) reviewed the survey questionnaire, and it was revised before being e-mailed to hospital system phlebotomists (n = 128).

Results

Almost half of the sample group lacked training in child development. The most frequently used comfort measures were words of explanation and reassurance, positioning of the child, and distraction. Requesting child life specialist support and using pain management devices or topical anesthetics were used less often. Primary challenges to performing pediatric blood draws were anxious patients and parents.

Conclusion

Phlebotomists' use of available comfort measures occurs infrequently. Including child development and comfort techniques in training programs is essential to providing pediatric patients with a more satisfactory experience.
REVERSING THE LENS, WACANA PERLAWANAN SEJARAH 1965 DALAM FILM THE ACT OF KILLING
Authors: Witriani Witriani
Published: December 2018

As a study, documentary film is often used as a reference because of its historical, social, cultural and political representation which signifies the facts in society. It is no wonder that the production as well as the analysis of the film genre and its development around the world have created such debate, including in the academic realm. The film The Act of Killing is one of them. Directed by an American filmmaker, Joshua Oppenheimer, the film tries to reveal the other facts of Indonesian history which have been covered and never imagined before, especially, the implications of Indonesian Communist Party (PKI) massacre in 1965. Taking the testimony of the actors, the film is quite controversial because it tells and descibes kind of sadism and human rights violations on PKI elements and other ethnicity. Thus it changes the world opinion about the Indonesian history in 1965. However, as a construction, film is a film. Sometimes, there is always a bias. What depicted in a film is a result of the cineast interpretation of historical events that may be different from other point of view. For instance, a contradictory between humanity and ideology has created a discourse among the viewers. While the director focus on a violation of human rights and set everything based on this perspectives, the actors or the perpetrators feel that what they did was a form of struggle to defense the country.
VARIASI KELUASAN MAKNA PENGALAMAN DALAM PENERJEMAHAN NOVEL RONGGENG DUKUH PARUK KE DALAM BAHASA INGGRIS
Authors: Khristianto Khristianto
Published: December 2018

There is no “real equivalence” in translation; it is always relative, finding the best among the defect possibilities. This study was aimed to discover the the types of variations of the experiential meaning breadth (EMB) in a novel, 'Ronggeng Dukuh Paruk' in Indonesian and English, to find out the EMB variation level.This is a descriptive qualitative endevour, applying a content analysis method, focusing on the experiential meaning, particularly on its breadth dimension. The data sources are two language versions of the novel, Indonesian (Ind) and English (En). The data are clause units of transitivity. The results of this study indicate that the most dominant EMB variation is 0 variation. The intertextual bond is proved to be strong in leading the translators to create the meaning of the clauses. In general the variation level of EMB is very low, 9.16. This indicates that the intertextual context plays a very dominant role to lead the decision of the translator in realizing the meaning. The variations in the EMB in general do not affect the completeness of the meaning.
PEMBEBASAN PEREMPUAN DALAM NOVEL BANĀT AL-RIYĀḌ KARYA RAJA’ ABD ALLĀH AL-ṢĀNI’
Authors: Faisol M. , Kholil Ahmad
Published: December 2018

In the midst of dominant patriarchal culture ini Saudi Arabia, Banāt al-Riyāḍ novel by Raja’ ‘Abd Allāh al-Ṣāni’ is present as an effort to liberate women from the dominant patriarchal confines. As woman author, Raja’ ‘Abd Allāh al-Ṣāni’ made criticism and resistance in her work as an effort to liberate women. Through women as writer approach, this paper aims to reveal efforts to fight for women’s rights and liberation from the dominance of tyrannical hegemonic masculinity in the Saudi Arabian setting. The results of the analysis show that female leaders emerged in the movement of awareness when their rights were taken. They made efforts to free themselves by suing the confines of tradition and patriarchal religious construction. Liberating women from the oppressive male domination by the leaders is the attempt to free women, both in the domestic and public shpheres. Novel Banāt al-Riyāḍ is an author’s strategy in its efforts to fight for the rights of Saudi Arabian women and to free them from patriarchal confines.
Soluble myeloid triggering receptor expressed on myeloid cell 1 might have more diagnostic value for bacterial ascites than C-reactive protein
Authors: Guo Qiang , Xu Chuanqin , Sun Chao , Zhao Yubao , Zhang Weifu
Published: December 2018

The timely and accurate diagnosis of ascites is of great significance for early treatment and prognostication. This study explored the value of soluble myeloid triggering receptor expressed on myeloid cell 1 (sTREM-1) and C-reactive protein (CRP) for assessing ascites. A total of 133 patients with ascites who received treatment at the Affiliated Hospital of Taishan Medical University between September 2015 and September 2017 were retrospectively analyzed. The ascites in 22, 45, 33 and 33 patients were tuberculous, bacterial, tumorous, and transudative, respectively. Healthy volunteers (n=30) who received a health examination at the same hospital during the same period constituted the control group. Before treatment, both ascitic sTREM-1 and CRP showed significant differences among the ascites subgroups (P<0.001), with the highest levels in the bacterial subgroup. Serum sTREM-1 and CRP also showed significant differences among the groups. A correlation analysis showed a positive correlation between sTREM-1 and CRP. ROC curves of the bacterial subgroup showed that when the optimal cutoff point was set to 20.2, the sensitivity, specificity, positive predictive value, and negative predictive value of the serum sTREM-1 index were 0.933, 0.955, 0.914, and 0.965, respectively. sTREM-1 may provide more diagnostic value than CRP for the diagnosis of bacterial ascites.