bluuebunny/crossref_metadata_2025 huggingface dataset:
Multirobot search for a stationary object placed in a known environment with a combination of GRASP and VND
Authors: Kulich Miroslav , Přeučil Libor
Published: April 2020

This paper addresses the problem of multirobot search for a stationary object in an a priori known environment. Two variants of the problem are studied given the working environment represented by a graph. The first variant is an extension of the traveling deliveryman problem for multiple vehicles, while the second variant is a generalization of the graph search problem. A novel algorithm is presented to solve both problems, which is based on a combination of greedy randomized adaptive search procedure with variable neighborhood descent. A set of experimental evaluations were conducted over the benchmark instances derived from the TSPLIB library. For both problems, the results obtained show that the proposed approach is comparable to state‐of‐the‐art heuristics. Moreover, for problems of a few hundred vertices, the solution times suggest that the approach is suitable for online decision‐making in search and rescue.
Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM‐CAM)
Authors: Mailhot Tanya , Darling Chad , Ela Jillian , Malyuta Yelena , Inouye Sharon K. , Saczynski Jane
Published: April 2020

OBJECTIVE

To examine the ability of the family‐rated Family Confusion Assessment Method (FAM‐CAM) to identify delirium in the emergency department (ED) among patients with and without dementia, as compared to the reference‐standard Confusion Assessment Method (CAM).

DESIGN

Validation study.

SETTING

Urban academic ED.

PARTICIPANTS

Dyads of ED patients, aged 70 years and older, and their family caregivers (N = 108 dyads).

MEASUREMENTS

A trained reference standard interviewer performed a cognitive screen, delirium symptom assessment, and scored the CAM. The caregiver self‐administered the FAM‐CAM. Dementia was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the medical record. For concurrent validity, performance of the FAM‐CAM was compared to the CAM. For predictive validity, clinical outcomes (ED visits, hospitalization, and mortality) over 6 months were compared in FAM‐CAM positive and negative patients, controlling for age, sex, comorbidity, and cognitive status.

RESULTS

Among the 108 patients, 30 (28%) were CAM positive for delirium and 58 (54%) presented with dementia. The FAM‐CAM had a specificity of 83% and a negative predictive value of 83%. Most false negatives (n = 9 of 13, 69%) were due to caregivers not identifying the inattention criteria for delirium on the FAM‐CAM. In patients with dementia, sensitivity was higher than in patients without (61% vs 43%). In adjusted models, a hospitalization in the following 6 months was more than three times as likely in FAM‐CAM positive compared to negative patients (odds ratio = 3.4; 95% confidence interval = 1.2‐9.3).

CONCLUSIONS

Among patients with and without dementia, the FAM‐CAM shows qualities that are important in the ED setting for identification of delirium. Using the FAM‐CAM as part of a systematic screening strategy for the ED, in which familiesʼ assessments could supplement healthcare professionalsʼ assessments, is promising. J Am Geriatr Soc 68:983–990, 2020
What can Strategy Learn from the Business Model Approach?
Authors: Bigelow Lyda S. , Barney Jay B.
Published: April 2020

The use of the business model concept has grown dramatically over the past several years, yet it remains difficult to distinguish the concept from conventional strategy. Despite a lack of consensus on a definition of business model, proponents of the concept assert that it is quite different from strategy. We generate alternative definitions of the business model concept and compare these to the received strategy literature to determine where/if potential theoretical or empirical advances might be likely. We identify opportunities for business model concepts to yield theoretical contributions and highlight why the concept may be so attractive to entrepreneurs and managers.
Diagnosing tooth wear, a new taxonomy based on the revised version of the Tooth Wear Evaluation System (TWES 2.0)
Authors: Wetselaar Peter , Wetselaar‐Glas Miranda J.M. , Katzer Lukasz D. , Ahlers M. Oliver
Published: April 2020

Background

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Physiological tooth wear is a slow process that normally does not lead to any subjective symptoms. When the condition progresses, it can become pathological, and several signs and symptoms may occur. The Tooth Wear Evaluation System (TWES) was described to implement a systematic diagnostic and management approach. Recently, management guidelines were presented in a European Consensus Statement (ECS) as well.

Objectives

To evaluate the TWES in practice and to integrate the principles described in the ECS in order to compose a renewed TWES 2.0 and a new taxonomy.

Methods

The TWES and the recommendations of the ECS were used by dental clinicians, in order to test its applicability in practice.

Results

Agreement was reached that the TWES 2.0 will use a stepwise approach, with a straightforward Tooth Wear Screening part and a more detailed Tooth Wear Status part. Also, the assessment of pathology from the ECS is incorporated in the TWES 2.0 (both classification and taxonomy).

Conclusions

In the TWES 2.0 is described that tooth wear is pathological if moderate/severe/extreme tooth wear is present, in combination with one or several described signs and symptoms. Aetiology can be assessed by findings that indicate a chemical and/or a mechanical cause. The taxonomy may help to identify situations in which preventive (restorative) interventions in early stages of tooth wear can be indicated. The reliability and validity of the adapted parts must be proven.
Evaluation of IL‐6 levels and +3954 polymorphism of IL‐1β in burning mouth syndrome: A systematic review and meta‐analysis
Authors: Campello Camilla Porto , Pellizzer Eduardo Piza , Vasconcelos Belmiro Cavalcanti do Egito , Moraes Sandra Lúcia Dantas , Lemos Cleidiel Aparecido Araújo , Muniz Maria Tereza Cartaxo
Published: April 2020

This study evaluated IL‐6 salivary levels as well as the +3954 polymorphism of IL‐1β in patients with burning mouth syndrome and healthy individuals, through case‐control studies. This systematic review and meta‐analysis followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We conducted this research in PubMed/MEDLINE, Cochrane Library and Web of Science databases. The risk of bias was measured based in the Newcastle‐Ottawa Scale. Researches with a group of patients with burning mouth syndrome and a control group in which the presence of the +3954 polymorphism of IL‐1β and/ or IL‐6 salivary levels through non‐stimulated saliva were evaluated to detect if this interleukin concentrations are increased in patients and if the polymorphism is a risk factor for this syndrome. We identified seven studies with total of 440 participants, 229 patients with burning mouth syndrome and 211 healthy controls, ages 24‐84 years old. The female gender was predominant. Patients in the majority of studies did not present increased levels of IL‐6 and the +3954 polymorphism of IL‐1β is not a risk factor for this syndrome. A few studies researched biomarkers in this pathology and more investigations are required not only to identify salivary levels and the polymorphism evaluated, but also other interleukins and polymorphisms in order to clarify the etiopathogenesis of this syndrome as well as for propose new diagnostic methods and treatments.
Evolution and diversity of axon guidance Robo receptor family genes
Authors: Xu Yi‐Qin , Li Xin , Zhong Yang , Zheng Yu‐Fang
Published: April 2020

The diversity of axon guidance (AG) receptors reflects gains in complexity of the animal nervous system during evolution. Members of the Roundabout (Robo) family of receptors interact with Slit proteins and play important roles in many developmental processes, including AG and neural crest cell migration. There are four members of the Robo gene family. However, the evolutionary history of Robo family genes remain obscure. We analyzed the distribution of Robo family members in metazoan species ranging in complexity from hydras to humans. We undertook a phylogenetic analysis in metazoans, synteny analysis, and ancestral chromosome mapping in vertebrates, and detected selection pressure and functional divergence among four mammalian Robo paralogs. Based on our analysis, we proposed that the ancestral Robo gene could have undergone a tandem duplication in the vertebrate ancestor; then one round of whole genome duplication events occurred before the divergence of ancestral lamprey and gnathostome, generating four paralogs in early vertebrates. Robo4 paralog underwent segmental loss in the following evolutionary process. Our results showed that Robo3 paralog is under more powerful purifying selection pressure compared with other three paralogs, which could correlate with its unique expression pattern and function. Furthermore, we found four sites under positive selection pressure on the Ig1‐2 domains of Robo4 that might interfere with its binding to Slits ligand. Diverge analysis at the amino acid level showed that Robo4 paralog have relatively greater functional diversifications than other Robo paralogs. This coincides with the fact that Robo4 predominantly functions in vascular endothelial cells but not the nervous system.
Behavioral Consequences of Open Candidate Recruitment
Authors: Rehmert Jochen
Published: April 2020

Candidate‐selection methods (CSM) crucially affect the behavior of Members of Parliament (MPs). Extant research investigates the consequentiality of the selectorate, but is neglecting the candidacy dimension of CSM. But what are the behavioral implications of minimal candidacy‐eligibility criteria (CEC)? I theorize that parties adopt closed CEC in safe districts to ensure nominating loyalist candidates, while they use open CEC in contested districts to attract entrepreneur candidates able to woo decisive swing voters. Using survey and observational data from Japan, where parties have concurrently been nominating candidates through open and more closed CEC, I show that entrepreneur candidates are more responsive to their districts but less active in the legislature, measured by different types of activities. These findings corroborate my expectations that entrepreneur candidates lack political experience and are sidelined by their more traditional colleagues. Moreover, the results broaden our understanding of how CSM affect MPs’ behavior.
The genome of a cave plant, Primulina huaijiensis, provides insights into adaptation to limestone karst habitats
Authors: Feng Chao , Wang Jing , Wu Lingqing , Kong Hanghui , Yang Lihua , Feng Chen , Wang Kai , Rausher Mark , Kang Ming
Published: April 2020

Although whole genome duplication (WGD) has been suggested to facilitate adaptive evolution and diversification, the role of specific WGD events in promoting diversification and adaptation in angiosperms remains poorly understood. Primulina, a species‐rich genus with > 180 species associated with limestone karst habitat, constitutes an ideal system for studying the impact of WGD events on speciation and evolutionary adaptation.

We sequenced and assembled a chromosome‐level genome of the cave‐dwelling species P. huaijiensis to study gene family expansion and gene retention following WGDs.

We provide evidence that P. huaijiensis has undergone two WGDs since the γ triplication event shared by all eudicots. In addition to a WGD shared by almost all Lamiales (L event), we identified a lineage‐specific WGD (D event) that occurred in the early Miocene around 20.6–24.2 Myr ago and that is shared by almost the entire subtribe Didymocarpinae. We found that gene retentions following the D event led to gene family proliferation (e.g. WRKYs) that probably facilitated adaptation to the high salinity and drought stress in limestone karst.

Our study highlights the role of lineage‐specific WGD in species diversification and adaptation of plants from special habitats.
De novo indol‐3‐ylmethyl glucosinolate biosynthesis, and not long‐distance transport, contributes to defence of Arabidopsis against powdery mildew
Authors: Hunziker Pascal , Ghareeb Hassan , Wagenknecht Lena , Crocoll Christoph , Halkier Barbara Ann , Lipka Volker , Schulz Alexander
Published: April 2020

Powdery mildew is a fungal disease that affects a wide range of plants and reduces crop yield worldwide. As obligate biotrophs, powdery mildew fungi manipulate living host cells to suppress defence responses and to obtain nutrients. Members of the plant order Brassicales produce indole glucosinolates that effectively protect them from attack by non‐adapted fungi. Indol‐3‐ylmethyl glucosinolate is constitutively produced in the phloem and transported to epidermal cells for storage. Upon attack, indol‐3‐ylmethyl glucosinolate is activated by CYP81F2 to provide broad‐spectrum defence against fungi. How de novo biosynthesis and transport contribute to defence of powdery mildew‐attacked epidermal cells is unknown. Bioassays and glucosinolate analysis demonstrate that GTR glucosinolate transporters are not involved in antifungal defence. Using quantitative live‐cell imaging of fluorophore‐tagged markers, we show that accumulation of the glucosinolate biosynthetic enzymes CYP83B1 and SUR1 is induced in epidermal cells attacked by the non‐adapted barley powdery mildew Blumeria graminis f.sp. hordei. By contrast, glucosinolate biosynthesis is attenuated during interaction with the virulent powdery mildew Golovinomyces orontii. Interestingly, SUR1 induction is delayed during the Golovinomyces orontii interaction. We conclude that epidermal de novo synthesis of indol‐3‐ylmethyl glucosinolate contributes to CYP81F2‐mediated broad‐spectrum antifungal resistance and that adapted powdery mildews may target this process.
Root high‐affinity K+ and Cs+ uptake and plant fertility in tomato plants are dependent on the activity of the high‐affinity K+ transporter SlHAK5
Authors: Nieves‐Cordones Manuel , Lara Alberto , Silva Martha , Amo Jesús , Rodriguez‐Sepulveda Pascual , Rivero Rosa M. , Martínez Vicente , Botella M. Angeles , Rubio Francisco
Published: April 2020

Root K+ acquisition is a key process for plant growth and development, extensively studied in the model plant Arabidopsis thaliana. Because important differences may exist among species, translational research supported by specific studies is needed in crops such as tomato. Here we present a reverse genetics study to demonstrate the role of the SlHAK5 K+ transporter in tomato K+ nutrition, Cs+ accumulation and its fertility. slhak5 KO lines, generated by CRISPR‐Cas edition, were characterized in growth experiments, Rb+ and Cs+ uptake tests and root cells K+‐induced plasma membrane depolarizations. Pollen viability and its K+ accumulation capacity were estimated by using the K+‐sensitive dye Ion Potassium Green 4. SlHAK5 is the major system for high‐affinity root K+ uptake required for plant growth at low K+, even in the presence of salinity. It also constitutes a pathway for Cs+ entry in tomato plants with a strong impact on fruit Cs+ accumulation. SlHAK5 also contributes to pollen K+ uptake and viability and its absence produces almost seedless fruits. Knowledge gained into SlHAK5 can serve as a model for other crops with fleshy fruits and it can help to generate tools to develop low Cs+ or seedless fruits crops.
The necessity of antinuclear antibody investigation in pre‐phototherapy vitiligo patients: A retrospective study
Authors: Chaiyabutr Chayada , Wongpraparut Chanisada , Charoenpipatsin Norramon , Pruksaeakanan Chutipon , Silpa‐archa Narumol
Published: April 2020

Background

Narrowband UVB (NBUVB) phototherapy is the cornerstone treatment for vitiligo. Before its initiation, some experts recommend antinuclear antibody (ANA) screening out of concern for either photosensitivity to NBUVB or autoimmune disease exacerbation during treatment. As vitiligo is considered an autoimmune disorder, ANAs can be positively found in the disease without any clinical importance. The necessity for ANA investigations for pre‐phototherapy vitiligo patients is therefore questioned.

Methods

We conducted a retrospective study to investigate vitiligo patients who had been checked for ANA before commencing NBUVB phototherapy. Demographic data—including vitiligo type and age of onset—were collected. Samples of ANA, anti‐thyroglobulin, and anti‐thyroid peroxidase were obtained. The phototherapy treatment protocol and cutaneous reactions to the phototherapy were also recorded.

Results

Among 85 Thai vitiligo patients, the ANA prevalence was 35.3%. The speckled ANA pattern was the most common, and the large majority of patients (80%) had a titer of ≤1:100. Factors associated with positive ANA were female gender and positive anti‐thyroglobulin. There were no statistical differences between the phototoxic reactions or phototoxic doses of NBUVB of the ANA‐positive vitiligo and ANA‐negative vitiligo groups. No cases of SLE were detected in ANA‐positive group.

Conclusions

ANA positivity was not correlated with the incidence or dose of phototoxic reaction in phototherapy treated vitiligo, and it may not a predictive factor for SLE diagnosis in vitiligo. ANA might therefore not need to be routinely checked in pre‐phototherapy in vitiligo, unless there are clinical suspicions of an autoimmune disease. However, ANA might be involved in part of the cutaneous photoadaptation response to phototherapy.
A qualitative study of knowledge, behaviour and attitudes regarding vitamin D acquisition among patients with photosensitivity disorders
Authors: Orekoya Oluwafikunayo , Rhodes Lesley E. , Osman Joanne E. , Webb Ann R. , Farrar Mark D.
Published: April 2020

Background

Cutaneous exposure to sunlight is a major source of vitamin D. Individuals with photosensitivity disorders have symptoms provoked by sunlight and may not achieve the brief sunlight exposures that convey vitamin D acquisition.

Objective

To explore knowledge, behaviour and attitudes towards vitamin D and its acquisition in patients with photosensitivity.

Methods

Patients (n = 19) diagnosed with solar urticaria, erythropoietic protoporphyria or polymorphic light eruption at a specialist photoinvestigation centre participated in semi‐structured focus groups to discuss vitamin D knowledge, acquisition behaviours and attitudes towards vitamin D acquisition through sunlight and diet. Discussions were analysed by thematic analysis using MAXQDA11.

Results

Knowledge of vitamin D was variable. There was good awareness that sunlight exposure is an important source but knowledge of dietary sources was poor. Patients had little concern for their own vitamin D status prior to attending the photoinvestigation centre. Most patients avoided sunlight exposure, were unable to achieve the guidance on sun exposure for healthy individuals and were aware this could affect their vitamin D status. Use of oral vitamin D supplements was common, and all were willing to consider supplements if required. Patients recommended improving education of clinicians to increase patient awareness of vitamin D,

Conclusions

More targeted guidance is required on acquisition of vitamin D for patients with photosensitivity, supported by increased patient and clinician education.
Thrombophilia in hemodialysis patients: Transfer to peritoneal dialysis is life saving
Authors: Roumeliotis Athanasios , Vaios Vasilios , Girtovitis Fotios , Karligkiotis Apostolos , Leivaditis Konstantinos , Zebekakis Pantelis , Liakopoulos Vassilios
Published: April 2020

The majority of vascular access thrombosis episodes in hemodialysis patients are due to anatomic abnormalities. Thrombophilias are inherited, acquired or mixed disorders which also predispose to venous thromboembolism. They include protein C, protein S and antithrombin deficiencies, as well as gene mutations for prothrombin and factor V Leiden. The most important of the mixed cases is hyperhomocysteinemia, which includes both a genetic and an acquired substrate. We report two patients undergoing hemodialysis who suffered from multiple thrombotic events, the first due to factor V Leiden heterozygosity and the second because of hyperhomocysteinemia due to homozygosity for MTHFR C677T mutation. As no site for vascular access was left, transfer to peritoneal dialysis for both patients improved solute clearance and quality of life with no additional thrombotic events noted.
The syntax of weak and strong pronouns in Dagbani and Kusaal
Authors: Abubakari Hasiyatu , Issah Samuel Alhassan
Published: April 2020

Although studies in Dagbani and Kusaal have distinguished between weak and strong pronouns, their syntactic peculiarities remain largely uninvestigated. This paper aims to fill this gap by presenting a systematic investigation of the distribution of these pronouns drawing data from these two languages. We demonstrate that strong pronouns have dedicated syntactic positions including left peripheral focus, predicate focus, and fragmentary answers where pronominals are required. We further show that Dagbani and Kusaal behave differently regarding the distribution of strong and weak pronouns in two domains (i) conjunct ordering of pronouns in conjoined noun phrases and in (ii) fragmentary or elliptical answers. We contend that the ban on weak pronouns in positions of syntactic focus is attributable to their prosodic deficiency.
Development of the Analysis Procedure for the Ice-Induced Fatigue Damage of a Ship in Broken Ice Fields
Authors: Kim Jeong-Hwan
Published: April 2020

A simplified analysis method was developed to evaluate the fatigue damage of an ice-going ship under broken ice conditions. The ice resistance, which is available in the early design stages of an ice-going vessel, and the hull form information were used to estimate the local ice load acting on the outer-shell of the ship. The local ice load was applied to a finite element analysis model, and the Weibull parameters of the local stress range at the target fatigue point were derived. Finally, the fatigue damage was evaluated by applying the S–N curve and Palmgren–Miner rule. To verify the proposed method, numerical analyses using the direct approach, which takes into account the detailed interaction model among the fluid, structure, and ice, were performed under the same conditions. Fatigue analyses of the Baltic Sea for actual ice conditions were performed to check the validity and applicability of the proposed method, and the resulting fatigue damage was compared with that obtained by the classification society’s recommended practice.
Late Quaternary landscape evolution and bioclimatic change in the central Great Plains, USA
Authors: Layzell Anthony L. , Mandel Rolfe D.
Published: April 2020

A systematic study of floodplains, terraces, and alluvial fans in the Republican River valley of south-central Nebraska provided a well-dated, detailed reconstruction of late Quaternary landscape evolution and resolved outstanding issues related to previously proposed Holocene terrace sequences. Stable carbon isotope (δ13C) values determined on soil organic matter from buried soils in alluvial landforms were used to reconstruct the structure of vegetation communities and provided a means to investigate the relationships between bioclimatic change and fluvial activity for the period of record. Our study serves as a model for geomorphological and geoarcheological investigations in stream valleys throughout the central Great Plains and wherever loess-derived late Quaternary alluvial fans occur, in particular.

Holocene alluvial landforms in the river valley include a broad floodplain complex (T-0a, T-0b, and T-0c), a single alluvial terrace (T-1), and alluvial fans that mostly grade to the T-1 (AF-1) and T-0c (AF-0c) surfaces. Remnants of a late Pleistocene terrace (T-2), mantled by Holocene (Bignell) loess, are also preserved, and some Holocene alluvial fans (AF-2) grade to T-2 surfaces.

Radiocarbon ages suggest that the T-1 fill and AF-1 fans aggraded between ca. 9000–1000 yr B.P. Hence, nearly all of the Holocene alluvium in the river valley is stored in these landforms. Sedimentation, however, was interrupted by several periods of landscape stability and soil formation. Radiocarbon ages from the upper A horizons of buried soils in the T-1 and AF-1 fills, indicating approximate burial ages, cluster at ca. 6500, 4500, 3500, and 1000 yr B.P. Also, based on the radiocarbon ages, the T-0c fill and AF-0c fans were aggrading between ca. 2000–900 yr B.P. Given that the T-0c fill and upper parts of the T-1 fill were both aggrading after ca. 2000 yr B.P., we suggest that the T-1 surface was abandoned between ca. 4500–3500 yr B.P., but subsequent aggradation of both the T-1 and T-0c fills occurred due to large-magnitude flood events during the late Holocene.

The δ13C data indicate a shift from ∼40% C4 biomass at ca. 6000 to ∼85% at ca. 4500 yr B.P. We propose a scenario where (1) a reduction in C3 vegetation after 6000 yr B.P. destabilized the uplands, resulting in an increase in sediment supply and aggradation of the T-1 fill and AF-1 fans, and (2) the establishment of C4 vegetation by ca. 4500 yr B.P. stabilized the uplands, resulting in a reduction in sediment supply and subsequent incision and abandonment of the T-1 and most AF-1 surfaces. The proposed timing and nature of landscape and bioclimatic change are consistent with regional records from the central Great Plains.
Prognostic significance of immune checkpoints in the tumour–stromal microenvironment of sebaceous gland carcinoma
Authors: Singh Lata , Singh Mithalesh Kumar , Rizvi Moshahid Alam , Pushker Neelam , Bakhshi Sameer , Sen Seema , Kashyap Seema
Published: April 2020

Background

Immune checkpoint blockade strategies have gained attention in the treatment/prognosis of cancers by targeting the programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway alone or in combination with cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) blockade and are currently in clinical trials. The present study investigated the expression of the PD-1, PD-L1, CTLA-4, CD4 and CD8 proteins and their prognostic value in the tumour microenvironment of sebaceous gland carcinoma (SGC).

Methods

The expression levels of PD-1, PD-L1, CTLA-4, CD4 and CD8 proteins were assessed in 52 cases of SGC by immunohistochemistry and validated by western blotting. mRNA expression was measured by quantitative real-time PCR. Kaplan-Meier curves and Cox proportional hazard models were used to analyse the correlation of protein expression with clinicopathological parameters and disease-free survival.

Results

The expression of PD-L1 was found to be higher in tumour cells than in stromal cells. In univariate analysis, the expression of PD-1 in tumour-infiltrating lymphocytes (tPD-1) and PD-L1 in tumour cells was associated with reduced disease-free survival, whereas PD-L1 expression in stromal lymphocyte infiltration (sPD-L1) was associated with the increased survival of patients (p<0.05). However, by multivariate analysis, the expression of tPD-1 was found to be an independent prognostic factor for poor survival.

Conclusion

Our study highlights the prognostic outcome of PD-1 and PD-L1 protein expression in cells of tumour–stromal compartments. These results indicate that the PD-1/PD-L1 pathway mediates important interactions within the tumour microenvironment in SGC.
Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury
Authors: Kim Kyoung-Eun , Kim E-J , Park J , Kim SW , Kwon J , Moon G
Published: April 2020

Introduction

Humeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm wrestling, in young Korean soldiers and examined whether humeral fracture is related to demographic characteristics and the presence of radial nerve palsy.

Methods

We reviewed 7.5 years (July 2012 to June 2019) of medical records covering patients who had experienced a humeral shaft fracture after entering military service and had received surgery for open reduction and internal fixation. Data were obtained on basic demographics, initial event provoking the fracture, presence of radial nerve palsy, initial and follow-up severity of the weakness, and any discharge from military service because of prolonged radial nerve palsy.

Results

Of 123 cases, arm wrestling was the leading cause (52.8%). A high energy injury, such as falling from a height (11.4%), and sports related slips (10.6%) were other causes. All humeral shaft fractures caused by forceful contraction were spiral, while 40% of the fractures caused by external force related events were of a transverse type. The percentage of left-sided fractures was significantly higher for fractures arising from an external force than in those caused by forceful contraction related events. Radial nerve palsy was found in 34 patients (27.6%), and 16 were discharged from the military because of prolonged radial nerve palsy 6 months after the fracture. The causative events and other factors did not affect the presence of radial nerve palsy.

Conclusion

Arm wrestling was the leading cause of humeral fracture in young Korean soldiers but the chance of developing comorbid radial nerve palsy did not differ from that of other causes. These epidemiologic findings in this young active group may help in understanding the causes of humeral shaft fracture in soldiers and in the wider young population.
Lifestyle, genomic types and non-communicable diseases in Korea: a protocol for the Korean Medicine Daejeon Citizen Cohort study (KDCC)
Authors: Baek Younghwa , Seo Bok-Nam , Jeong Kyoungsik , Yoo Horyong , Lee Siwoo
Published: April 2020

Introduction

Non-communicable diseases (NCDs) are the leading cause of death worldwide, including in Korea; thus, customised techniques for chronic disease management for the prevention, early diagnosis and treatment of NCDs are crucial. The Korean Medicine Daejeon Citizen Cohort (KDCC) study has been tasked with developing precise health promotion model for preventing and managing chronic diseases that considers individual traits, lifestyle factors and clinical data based on traditional Korean medicine.

Methods and analysis

The KDCC study is a prospective cohort study of the community-based population in Korea. This study will sample 2000 adults aged 30–55 years in Daejeon area using stratified cluster sampling. The baseline survey began in 2017 and was completed in 2019, and follow-up surveys will be conducted three times every 2 years until 2025. In follow-ups, factors related to cardiovascular disease, metabolic syndrome and relevant diseases, as well as respondents’ health status information, will be examined via questionnaire surveys and health examinations.

Discussion

The KDCC study will investigate the effects of an interaction of Korean medicine type with genome based, lifestyle and various clinical information on chronic diseases and individuals’ health status using longitudinal epidemiological data. These findings are expected to inform the development of tailored health promotion programmes based on precision Korean medicine.

Trial registration number

KCT0004297.
Delphi study to determine the key qualities consultant histopathologists look for in their trainees
Authors: Brierley Daniel J , Farthing Paula M , Zijlstra-Shaw Sandra
Published: April 2020

Aims

A Delphi study to triangulate and determine the relative importance of the key qualities of trainees identified from qualitative interviews that sought to understand how consultant histopathologists determine diagnostic competences in trainees.

Methods

Twelve participants were purposively chosen for the Delphi to form an expert panel of relevant stakeholders. Participants were asked to score and rank the items presented to them.

Results

A total of 22 out of 27 of the key qualities of trainees (items) reached ‘consensus in’ after round 2 suggesting participants were able to agree that the majority of the items identified in the qualitative interviews were important to diagnostic competence. Five items reached ‘no consensus’. Participants did not suggest any additional items. Participants particularly valued qualities of reflection and professionalism and trainees who understood the process of reaching a diagnosis and how their pathological report could impact on patient care.

Conclusions

This study has triangulated findings from our qualitative interviews and show that consultants value a wide variety of qualities when determining diagnostic competence in their trainees. The judgement is complex and is therefore best assessed longitudinally and on a number of cases, so consultants can look for consistency of both approach to diagnosis and of trainee behaviour.
Prepared for practice? UK Foundation doctors’ confidence in dealing with ethical issues in the workplace
Authors: Corfield Lorraine , Williams Richard Alun , Lavelle Claire , Latcham Natalie , Talash Khojasta , Machin Laura
Published: April 2020

This paper investigates the medical law and ethics (MEL) learning needs of Foundation doctors (FYs) by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners’ views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response.
Allocation of scarce resources during the COVID-19 pandemic: a Jewish ethical perspective
Authors: Solnica Amy , Barski Leonid , Jotkowitz Alan
Published: April 2020

The novel COVID-19 pandemic has placed medical triage decision-making in the spotlight. As life-saving ventilators become scarce, clinicians are being forced to allocate scarce resources in even the wealthiest countries. The pervasiveness of air travel and high rate of transmission has caused this pandemic to spread swiftly throughout the world. Ethical triage decisions are commonly based on the utilitarian approach of maximising total benefits and life expectancy. We present triage guidelines from Italy, USA and the UK as well as the Jewish ethical prospective on medical triage. The Jewish tradition also recognises the utilitarian approach but there is disagreement between the rabbis whether human discretion has any role in the allocation of scarce resources and triage decision-making.
Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits
Authors: Lee Vivien H , Thakur Gaurav , Nimjee Shahid M , Youssef Patrick P , Lakhani Sushil , Heaton Sharon , Powers Ciaran J
Published: April 2020

Background

We sought to determine the rate of early neurologic decline (END) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) who presented with mild deficits and received intravenous tissue plasminogen activator (IVtPA).

Methods

Among 1022 patients with AIS who received IVtPA from 2014 to 2019, we identified 313 (30.6%) with LVO, of which 94 (30%) presented with National Institute of Health Stroke Scale (NIHSS) score ≤7. Thirteen patients were excluded, leaving 81 for analysis. END was defined as NIHSS worsening of ≥4 points within 24 hours.

Results

Among 81 patients with LVO and low NIHSS score, the mean age was 65.8 years (range 25–93) and 41% were female. The mean time to IVtPA from last known well was 2.5 hours (range 0.8–7). LVO sites were as follows: 5 (6%) carotid, 23 (28%) M1, and 53 (65%) M2 occlusions. Among the 81 patients, 28 (34.6%) had END, and these patients were older (70.8 vs 63.2 years, p=0.036). The mean change in NIHSS score at 24 hours in those with END was 10.4 (range 4–22). Patients with END were less likely to be discharged home (25% vs 66%, p=0.004).

Conclusions

Among patients with LVO AIS who received IVtPA, 30% presented with initial mild deficits. END occurred in one-third of LVO patients with initial mild deficits despite receiving IVtPA. Clinicians should be aware that the natural history of LVO with initial mild deficits is not benign and these patients are eligible for rescue thrombectomy in the 24-hour window if they deteriorate.
Medical management of a unilateral obstructive ureterolith in a pet rabbit (Oryctolagus cuniculus)
Authors: Keeble Emma , Eatwell Kevin , Longo Maurizio , Schwarz Tobias
Published: April 2020

A 5‐year‐old neutered male French lop rabbit presented with a 6‐hour history of stranguria and reduced faecal output. Routine haematology, serum biochemistry, urinalysis and diagnostic imaging were performed. Ultrasonography revealed left renal pelvis and ureter distension due to the presence of a proximal and distal calculus and marked heterogenous bladder sediment. A diagnosis of left hydronephrosis due to ureteral obstruction with a suspected underlying pyelonephritis and hypercalciuria was made. The rabbit was treated medically with intravenous fluid therapy, prokinetic drugs, analgesia, systemic antibiotics and nutritional support, as well as closely monitored by ultrasonographic examination. Three days later, clinical signs and urinary tract findings had resolved. Repeat imaging at 7 days post‐treatment was normal. This is the first report of successful medical management of obstructive ureterolithiasis in a pet rabbit. The small ureteral diameter in rabbits and consequent surgical limitations make medical therapy with close serial ultrasonographic monitoring an alternative option to surgical intervention in select cases that are evaluated as stable. Surgical intervention, however, should always be considered in cases that do not respond to medical therapy.
Developing a science outreach program and promoting “PhUn” all year with rural K–12 students
Authors: Hendrickson Jana L. , Bye Thomas K. , Cockfield Benjamin A. , Carter Kathryn R. , Elmer Steven J.
Published: April 2020

Demonstrating how science relates to human health is an important step for generating K–12 student interest in health-related careers. Science outreach is often performed in urban areas; however, ~20% of K–12 schools are in rural areas. Michigan Technological University is located in Michigan’s upper peninsula, which accounts for 30% of the state’s land mass but only 3% of the total population. Our goal was to create a science outreach program for reaching K–12 students in our rural region. We assembled a team of undergraduate and graduate students, staff, and faculty to implement science outreach with K–12 students. Specifically, we leveraged existing national and international science outreach events [Physiology Friday, Physiology Understanding (PhUn) Week, National Biomechanics Day] to offer hands-on physiology and biomechanics activities during the year. Between 2016 and 2019, we connected with 31 K–12 schools and impacted 327 elementary (19%), 351 middle school (21%), and 1,018 high school (60%) students (total impact 1,696). Over 90% of the outreach visits took place at the K–12 schools. The hands-on activities were delivered by more than 85 undergraduate and graduate students and 10 faculty. Together, the supportive culture and resources within the department (e.g., outreach coordinator, participation from students and faculty, grant funding) were key to developing the program. We recommend starting with a single outreach event, working as a team, and being flexible with K–12 schools. The program also provided service-learning and professional development opportunities for undergraduate and graduate students and faculty. Our robust science outreach program promoted “PhUn” all year-round with rural K–12 students.
Effect of carvedilol on atrial excitation-contraction coupling, Ca2+ release, and arrhythmogenicity
Authors: Martinez-Hernandez E. , Blatter L. A.
Published: April 2020

Here we show that the clinically widely used β-blocker carvedilol has profound effects on Ca2+ signaling and ion currents, but also antiarrhythmic effects in adult atrial myocytes. Carvedilol inhibits sodium and calcium currents and leads to failure of ECC but also prevents spontaneous Ca2+ release from cellular sarcoplasmic reticulum (SR) Ca2+ stores in form of arrhythmogenic Ca2+ waves. The antiarrhythmic effect occurs by carvedilol acting directly on the SR ryanodine receptor Ca2+ release channel.
Numerical Solution of a Class of Time-Fractional Order Diffusion Equations in a New Reproducing Kernel Space
Authors: Zhang Xiaoli , Zhang Haolu , Jia Lina , Wang Yulan , Zhang Wei
Published: April 2020

In this paper, we structure some new reproducing kernel spaces based on Jacobi polynomial and give a numerical solution of a class of time fractional order diffusion equations using piecewise reproducing kernel method (RKM). Compared with other methods, numerical results show the reliability of the present method.
On a Conjecture of Yamaguchi and Yokura
Authors: Zaim Abdelhadi , Chouingou Saloua , Hilali Mohamed Anas
Published: April 2020

Let F⟶E⟶pB be a fibration of simply connected elliptic spaces. Our paper investigates the conjecture proposed by T. Yamaguchi and S. Yokura, states that dim Ker π∗pℚ≤ dim Ker H∗p;ℚ+1. Our goal is to prove this conjecture when F and B satisfy the condition πevenFℚ=πevenBℚ=0. We go also on to establish a well-known conjecture of Hilali for a class of spaces which puts it into the context of fibration.
Real-Life Management of Diabetic Macular Edema with Dexamethasone Intravitreal Implant: A Retrospective Analysis of Long-Term Clinical Outcomes
Authors: Nicolò Massimo , Musetti Donatella , Marenco Maria , Cotti Lorenzo , Bonetto Monica , Giacomini Mauro , Traverso Carlo Enrico
Published: April 2020

Purpose. Inflammation plays a key role in the pathogenesis of diabetic macular edema (DME), and intravitreal corticosteroids are among the recommended therapies. The goal of this retrospective analysis was to describe outcomes with dexamethasone intravitreal implant (DEX implant) in real life. Methods. Medical digital records of DME patients treated with DEX implant and followed up for 3 years were analyzed. Treatment with DEX implant was started either as first-line therapy in pseudophakic patients and in patients with cardiovascular comorbidities or as second-line therapy in patients refractory to the inhibitor of the vascular endothelial growth factor (anti-VEGF) therapy. Analyzed outcomes included central macular thickness (CMT) and best-corrected visual acuity (BCVA). Mean number of implant injections per patient and mean duration of the interval between injections were also estimated. Results. Seventy-five patients (mean age 65.7 (±12.3) years; 53 phakic and 22 pseudophakic) with DME were included. Overall, 84 eyes were treated. Mean CMT improved from 380.1 (±100.3) µm at baseline to 306.8 (±77.0) µm at 36 months (p=0.0003). Mean BCVA improved for up to 6 months (p=0.08) and then started to decrease reaching values lower than baseline after 24 months. In pseudophakic patients, BCVA improvements were more pronounced and sustained up to 36 months (p=0.6). Over 36 months, each patient received on average 2.4 (±1.6) intravitreal injections of DEX implant. The time interval between consecutive injections was included between 180 and 240 days. No unexpected safety issues were reported. Conclusions. With fewer than 3 injections per patient over a 3-year period, DEX implant was able to improve anatomic outcomes in DME patients. Only pseudophakic eyes showed also a long lasting functional benefit at 36 months.
Efficient Data Collection Method in Sensor Networks
Authors: Cao Keyan , Liu Haoli , Liu Yefan , Meng Gongjie , Ji Si , Li Gui
Published: April 2020

Wireless sensor networks are widely used in many fields, such as medical and health care, military monitoring, target tracking, and people’s life, because of their advantages of convenient deployment, low cost, and good concealment. However, due to the low battery capacity of sensor nodes and environmental changes, the energy consumption of nodes is serious and the accuracy of data collection is low. In the data collection method of multiple random paths, due to the uneven geographical distribution between nodes and the influence of the environment, it is easy to cause the communication between nodes to be blocked and the construction of random paths to fail. This paper proposes an efficient data collection algorithm for this problem. The algorithm is improved on the basis of the random node selection algorithm. This method can effectively avoid the failure of random path node selection and improve the node selection of random path in wireless sensor networks. Then, the sensor network in the dynamic environment is analyzed based on the static environment. An efficient data collection algorithm based on the position prediction of extreme learning machines is proposed. This method uses extreme learning machine methods to perform trajectory prediction for nodes in a dynamic environment.
Research of Vehicle Rear-End Collision Model considering Multiple Factors
Authors: Luo Qiang , Zang Xiaodong , Yuan Jie , Chen Xinqiang , Yang Junheng , Wu Shubo
Published: April 2020

The accuracy of the rear-end collision models is crucial for the early warning of potential traffic accident identification, and thus analyzes of the main factors influencing the rear-end collision relevant models is an active topic in the field. The previous studies have tried to determine the single factor influence on the rear-end collision model performance. Less attention was paid to exploit mutual influences on the model performance. To bridge the gap, we proposed an improved vehicle rear-end collision model by integrating varied factors which influence two parameters (i.e., response time and road adhesion coefficient). The two parameters were solved with the integrated weighting and neural network models, respectively. After that we analyzed the relationship between varied factors and the minimum car-following distance. The research findings support both the theoretical and practical guidance for transportation regulations to release more reasonable minimum headway distance to enhance the roadway traffic safety.
A Cyclic Method for Solutions of a Class of Split Variational Inequality Problem in Banach Space
Authors: Ali Bashir , Adam Aisha A. , Ibrahim Yusuf
Published: April 2020

In this paper, a cyclic algorithm for approximating a class of split variational inequality problem is introduced and studied in some Banach spaces. A strong convergence theorem is proved. Some applications of the theorem are presented. The results presented here improve, unify, and generalize certain recent results in the literature.