bluuebunny/crossref_metadata_2025 huggingface dataset:
PVDF Piezoelectric Sensors for Seeds Counting and Coulter Clogging Detection in Sowing Process Monitoring
Authors: Gierz Łukasz , Paszkiewicz Bartłomiej Kazimierz
Published: May 2020

The paper presents the results of a test on the use of piezoelectric sensors made of PVDF foil for counting grain and checking clogging in the sowing drill. The tests were carried out in a simulator of the sowing drill with the use of a measuring system with high input impedance. Two kinds of barley and triticale grains were investigated. Measurements were carried out for different feeding frequencies. On the basis of the signals recorded, an algorithm of counting the sown grain was developed and tested. The algorithm is based on signal statistic comparison in adjacent windows. The developed algorithm allows counting more than 90% of the sown grains.
Costs and Cost Drivers of Providing Option B+ Services to Mother‐Baby Pairs for PMTCT of HIV in Health Centre IV Facilities in Jinja District, Uganda
Authors: Mukose Aggrey D. , Kebede Senait , Muhumuza Christine , Makumbi Fredrick , Komakech Henry , Bayiga Esther , Busobozi Denis , Musinguzi Joshua , Kuznik Andreas , Stegman Peter , Forsythe Steven , Kagaayi Joseph
Published: May 2020

Background. In 2013, the World Health Organization (WHO) revised the 2012 guidelines on use of antiretroviral drugs (ARVs) for the prevention of mother‐to‐child transmission (PMTCT) of human immunodeficiency virus (HIV). The new guidelines recommended lifelong antiretroviral therapy (ART) for all HIV‐positive pregnant and breastfeeding women irrespective of CD4 count or clinical stage (also referred to as Option B+). Uganda started implementing Option B+ in 2012 basing on the 2012 WHO guidelines. Despite the impressive benefits of the Option B+ strategy, implementation challenges, including cost burden and mother‐baby pairs lost to follow‐up, threatened its overall effectiveness. The researchers were unable to identify any studies conducted to assess costs and cost drivers associated with provision of Option B+ services to mother‐baby pairs in HIV care in Uganda. Therefore, this study determined costs and cost drivers of providing Option B+ services to mother‐baby pairs over a two‐year period (2014–2015) in selected health facilities in Jinja district, Uganda. Methods. The estimated costs of providing Option B+ to mother‐baby pairs derived from the provider perspective were evaluated at four health centres (HC) in Jinja district. A retrospective, ingredient‐based costing approach was used to collect data for 2014 as base year using a standardized cost data capture tool. All costs were valued in United States dollars (USD) using the 2014 midyear exchange rate. Costs incurred in the second year (2015) were obtained by inflating the 2014 costs by the ratio of 2015 and 2014 USA Gross Domestic Product (GDP) implicit price deflator. Results. The average total cost of Option B+ services per HC was 66,512.7 (range: 32,168.2–102,831.1) USD over the 2‐year period. The average unit cost of Option B+ services per mother‐baby pair was USD 441.9 (range: 422.5–502.6). ART for mothers was the biggest driver of total mean costs (percent contribution: 62.6%; range: 56.0%–65.5%) followed by facility personnel (percent contribution: 8.2%; range: 7.7%–11.6%), and facility‐level monitoring and quality improvement (percent contribution: 6.0%; range: 3.2%–12.3%). Conclusions and Recommendations. ART for mothers was the major cost driver. Efforts to lower the cost of ART for PMTCT would make delivery of Option B+ affordable and sustainable.
Optimal Investment Policy for Insurers under the Constant Elasticity of Variance Model with a Correlated Random Risk Process
Authors: Liu Xiaotao , Liu Hailong
Published: May 2020

This paper investigates the optimal portfolio choice problem for a large insurer with negative exponential utility over terminal wealth under the constant elasticity of variance (CEV) model. The surplus process is assumed to follow a diffusion approximation model with the Brownian motion in which is correlated with that driving the price of the risky asset. We first derive the corresponding Hamilton–Jacobi–Bellman (HJB) equation and then obtain explicit solutions to the value function as well as the optimal control by applying a variable change technique and the Feynman–Kac formula. Finally, we discuss the economic implications of the optimal policy.
Glucocorticoid Receptor Expression Predicts Good Outcome in response to Taxane-Free, Anthracycline-Based Therapy in Triple Negative Breast Cancer
Authors: Elkashif Ahmed , Bingham Victoria , Haddock Paula , Humphries Matthew P. , McQuaid Stephen , Mullan Paul B. , McCarthy Helen O. , Buckley Niamh E.
Published: May 2020

Triple negative breast cancer (TNBC) is a poor outcome subset of breast cancers characterised by the lack of expression of ER α, PR, and HER2 amplification. It is a heterogeneous group of cancers which fail to derive benefit from modern, more targeted treatments such as Tamoxifen and Herceptin. Current standard of care (SoC) is cytotoxic chemotherapy, which is effective for some patients, with other patients deriving little/no benefit and lacking alternative treatments. This study has identified the glucocorticoid receptor (GR) as a potential predictive biomarker of response to anthracycline-based chemotherapy in triple negative breast cancer (TNBC). GR gene expression levels in patient samples were analysed through publicly available microarray datasets as well as protein expression through immunohistochemistry (IHC) and correlated with clinical/pathological outcomes, including survival. While the results confirmed previous observations that high GR expression is associated with poor outcome in response to taxane-based chemotherapy, this study shows for the first time that high GR expression is associated with improved outcomes in the context of anthracycline-based chemotherapy. GR therefore has the potential to be used as a predictive biomarker to guide treatment choices and ensure that patients derive the greatest benefit from first line treatment, avoiding unnecessary costs, side effects, and disease progression.
Ginsenoside Rb1 Improves Cognitive Impairment Induced by Insulin Resistance through Cdk5/p35‐NMDAR‐IDE Pathway
Authors: Yang Ranyao , Jiang Xue , He Xiqian , Liang Donglou , Sun Shusen , Zhou Guangyan
Published: May 2020

The relationship between diabetes mellitus (DM) and Alzheimer’s disease (AD) has attracted wide attention. Studies have reported that ginsenoside Rb1 can improve human cognitive ability and glucose tolerance during the development of diabetes. The mechanism behind the improvement in cognitive ability and glucose tolerance still remains unclear. In this study, streptozotocin‐ (STZ‐) injected mice were used as models to explore the mechanisms behind the cognitive improvement of ginsenoside Rb1. According to the results of behavioral tests, ginsenoside Rb1 improved memory and cognitive ability of STZ‐lesioned mice. In addition to that, ginsenoside Rb1 also relieved glucose intolerance induced by STZ injection by enhancing insulin sensitivity. These beneficial effects of ginsenoside Rb1 is most likely mediated by upregulating the expression of NMDAR1 and IDE in the hippocampus through inhibiting the activity of Cdk5/p35. This work will be of great importance in illustrating the mechanisms of ginsenoside Rb1 for improving cognitive ability, as well as revealing the relationship between diabetes and AD.
Percolation Theories for Multipartite Networked Systems under Random Failures
Authors: Cai Qing , Alam Sameer , Pratama Mahardhika , Wang Zhen
Published: May 2020

Real-world complex systems inevitably suffer from perturbations. When some system components break down and trigger cascading failures on a system, the system will be out of control. In order to assess the tolerance of complex systems to perturbations, an effective way is to model a system as a network composed of nodes and edges and then carry out network robustness analysis. Percolation theories have proven as one of the most effective ways for assessing the robustness of complex systems. However, existing percolation theories are mainly for multilayer or interdependent networked systems, while little attention is paid to complex systems that are modeled as multipartite networks. This paper fills this void by establishing the percolation theories for multipartite networked systems under random failures. To achieve this goal, this paper first establishes two network models to describe how cascading failures propagate on multipartite networks subject to random node failures. Afterward, this paper adopts the largest connected component concept to quantify the networks’ robustness. Finally, this paper develops the corresponding percolation theories based on the developed network models. Simulations on computer-generated multipartite networks demonstrate that the proposed percolation theories coincide quite well with the simulations.
AS1411-Templated Fluorescent Cu Nanomaterial’s Synthesis and Its Application to Detecting Melamine
Authors: Ga Lu , Ai Jun , Wang Yong
Published: May 2020

Herein, we report a novel approach to AS1411-templated formation of fluorescent copper nanomaterials and their application to melamine detection. Fluorescent copper nanomaterials were formed at room temperature by using AS1411 as a template and ascorbic acid as reductant. However, the fluorescence intensity decreased obviously in the presence of melamine. Under the optimized conditions, the quenching fluorescence intensities of copper nanomaterials showed a good linear relationship with the concentration of melamine in the range of 50 μmol/L–120 μmol/L, and the correlation coefficient was 0.9823. In addition, the method was successfully applied in the detection of melamine in milk samples. This method was cost-effective and convenient without any labels or complicated operations. Thus, this work successfully develops the capping AS1411 scaffolds of copper nanomaterials detection of melamine.
Effect of Hydrophobic Surface Treatment in Lowering Ionic Transport into Concrete
Authors: Kim Ki Hwan , Kim Min Jae , Kim Hansol , Ann Ki-Yong
Published: May 2020

The present study concerns hydrophobic surface treatments with silane‐based liquid and crème on the concrete surface against external ionic transport for the application to concrete pavement coating. To quantify their effectiveness in mitigating the ionic penetration, water absorption and chloride transport were measured. Especially, back‐scattered image analysis and the electrochemical impedance spectroscopy were used to identify the effect of pore‐blocking at the interface of coating agents and the concrete. As a result, the surface treatment with both liquid and crème could significantly reduce the water absorption and chloride ingresses at all depths of measured concrete, due to a modification of the porosity. Moreover, the surface treatment on concrete substrate increased the polarization resistance, thereby enhancing the resistance to ionic transport into the concrete, and the crème type was slightly more effective at the same dosage of treatment.
Flink-ER: An Elastic Resource-Scheduling Strategy for Processing Fluctuating Mobile Stream Data on Flink
Authors: Li Ziyang , Yu Jiong , Bian Chen , Pu Yonglin , Wang Yuefei , Zhang Yitian , Guo Binglei
Published: May 2020

As real-time and immediate feedback becomes increasingly important in tasks related to mobile information, big data stream processing systems are increasingly applied to process massive amounts of mobile data. However, when processing a drastically fluctuating mobile data stream, the lack of an elastic resource-scheduling strategy limits the elasticity and scalability of data stream processing systems. To address this problem, this paper builds a flow-network model, a resource allocation model, and a data redistribution model as the foundation for proposing Flink with an elastic resource-scheduling strategy (Flink-ER), which consists of a capacity detection algorithm, an elastic resource reallocation algorithm, and a data redistribution algorithm. The strategy improves the performance of the platform by dynamically rescaling the cluster and increasing the parallelism of operators based on the processing load. The experimental results show that the throughput of a cluster was promoted under the premise of meeting latency constraints, which verifies the efficiency of the strategy.
Multimotor Improved Relative Coupling Cooperative Control Based on Sliding-Mode Controller
Authors: Zhang Changfan , Xiao Mingjie , He Jing
Published: May 2020

To provide cooperative control under complex working conditions of a filling multimotor system, this paper proposes a relative coupling control strategy with a switching system structure. Firstly, a multistation transmission system composed of a filling motor and a transfer motor is designed according to different filling processes. Secondly, a stable sliding-mode surface common to the multimotor system is selected, and an equivalent sliding-mode controller corresponding to each motor is designed. Thirdly, public Lyapunov stability theory is used to prove that the switched system can move from any initial state to the common sliding surface of the system, thereby ensuring the asymptotic stability of the entire system. Simulation results show that this method has a more significant control effect on the system error of each motor in comparison with the traditional relative coupling control structure.
A Method for Solving LiDAR Waveform Decomposition Parameters Based on a Variable Projection Algorithm
Authors: Wang Ke , Liu Guolin , Tao Qiuxiang , Wang Luyao , Chen Yang
Published: May 2020

Light detection and ranging (LiDAR) is commonly used to create high-resolution maps; however, the efficiency and convergence of parameter estimation are difficult. To address this issue, we evaluated the structural characteristics of received LiDAR signals by decomposing them into Gaussian functions and applied the variable projection algorithm of the separable nonlinear least-squares problem to the process of waveform fitting. First, using a variable projection algorithm, we separated the linear (amplitude) and nonlinear (center position and width) parameters in the Gaussian function model; the linear parameters are expressed with nonlinear parameters by the function. Thereafter, the optimal estimation of the characteristic parameters of the Gaussian function components was transformed into a least-squares problem only comprising nonlinear parameters. Finally, the Levenberg–Marquardt algorithm was used to solve these nonlinear parameters, whereas the linear parameters were calculated simultaneously in each iteration, and the estimation results satisfying the nonlinear least-square criterion were obtained. Five groups of waveform decomposition simulation data and ICESat/GLAS satellite LiDAR waveform data were used for the parameter estimation experiments. During the experiments, for the same accuracy, the separable nonlinear least-squares optimization method required fewer iterations and lesser calculation time than the traditional method of not separating parameters; the maximum number of iterations was reached before the traditional method converged to the optimal estimate. The method of separating variables only required 14 iterations to obtain the optimal estimate, reducing the computational time from 1128 s to 130 s. Therefore, the application of the separable nonlinear least-squares problem can improve the calculation efficiency and convergence speed of the parameter solution process. It can also provide a new method for parameter estimation in the Gaussian model for LiDAR waveform decomposition.
Is the High-Speed Rail Opening Environmentally Friendly? Taking the Difference-in-Differences Test in Jiangsu, China
Authors: Wang Shijin , Zhou Huiying , Hua Guihong
Published: May 2020

In view of rapid development of high-speed rail, the relationship between high-speed rail and air pollution needs to be tested and determined. Most research studies focused on the impact of high-speed rail on environmental pollution and just viewed high-speed rail as a control variable, which lacked a direct study on this relationship. Also, these rarely involved regional research, which is short of pertinence and insufficient understanding of regional issues. Therefore, based on the difference-in-differences (DID) model which is a natural experiment evaluation method, this study examined the impact of high-speed rail opening on air pollution by using the panel data of Jiangsu province, China, from the year of 2000 to 2017. The empirical results showed that the opening of Jiangsu high-speed rail, which increases cities’ good day significantly by 21.5%, has inhibitory effect on air pollution. Among control variables, there is no inverted “U” relationship between the economic development level and air pollution. Personal income and urbanization significantly improve air pollution, whereas foreign direct investment exacerbates it. And the results are still valid after robustness tests, including trend test and counterfactual test. Moreover, this study explores the relationship between the degree of reducing pollution caused by high-speed rail and the location of cities, which found that the opening of high-speed rail can greatly improve air pollution of areas in central city circle. Finally, it is found that when high-speed rail and other possible pollution items coexist, the improved effect of high-speed rail on air pollution is still obvious. Therefore, in order to exert the mitigating effect of high-speed rail on air pollution, it is necessary to rationally plan high-speed railway lines and develop the high-speed railways in cities closer to Shanghai.
Familial Mediterranean Fever Complicated by a Triad of Adrenal Crisis: Amyloid Goiter and Cardiac Amyloidosis
Authors: Abukhalaf Sadi A. , Dandis Beesan W. , Za’tari Tasnim , Amro Adham M. , Alzughayyar Tareq Z. , Rajabi Yazan A.
Published: May 2020

Background. FMF is a common disease in the Mediterranean populations and may be complicated by AA amyloidosis. The coexistence of adrenal and thyroid amyloidosis in AA amyloidosis secondary to familial Mediterranean fever (FMF) is an extremely rare reported condition. We presented a previously unreported triad of adrenal, thyroid, and cardiac amyloidosis secondary to FMF. Presentation of Case. We reported a 23-year-old Palestinian male patient presented with hypotension, vomiting, diarrhea, and abdominal pain. The patient was subsequently diagnosed to have an adrenal crisis with both amyloid goiter and cardiac amyloidosis. Conclusion. It is crucial to recognize the adrenal crisis in patients with AA amyloidosis secondary to FMF who present similarly to acute FMF inflammatory episodes. The adrenal crisis has high morbidity and mortality, especially if not recognized early in the course of the disease.
Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda
Authors: Kakembo Samuel , Atuhairwe Christine , Taremwa Ivan Mugisha
Published: May 2020

Background. Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman’s quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. Method. A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. Results. Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P<0.001), employment status (P<0.001), energy for everyday life (P<0.001), capacity to work (P<0.001), satisfaction with personal relationships (P<0.001), feelings of loneliness (P<0.001), negative feelings (P=0.002), and self-confidence (P<0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019–517.467), formal education (OR = 9.9497; CI = 1.075–92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149–2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447–74.824). Conclusion. A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.
Rare Case of a Calcified Catheter-Related Sheath Embolizing to the Right Pulmonary Artery
Authors: Rousslang Lee K. , Wood Jonathan R.
Published: May 2020

Catheter-related sheaths, formerly known as “fibrin sheaths,” are the most common complications of central venous catheters. Although usually harmless, they can very rarely detach from the venous wall against which they were formed and embolize with effects ranging from subclinical embolisms to death. This rare occurrence has only been described a few times in the literature to date, and to our knowledge, the embolized sheath has never been directly visualized with CT. We report the case of catheter-related sheath embolization to the right pulmonary artery in a child, as confirmed on CT.
Traveling Wave Solution of the Olver–Rosenau Equation Solved by Dynamics System
Authors: Xiong Mei , Chen Longwei , Yang Na
Published: May 2020

Olver–Rosenau equations presented by Olver and Rosenau can be rewritten to the dynamic system by the wave transformation. The system is a Hamiltonian system with the first integral, and its phase-space and equilibrium point analysis are given in different parameter spaces in detail. On this basis, we can derive various solutions of the original equation relating these orbits in different phase-space planes, and the theoretical basis of the numerical solution is provided for engineering application and production practice.
User Authentication Method Based on MKL for Keystroke and Mouse Behavioral Feature Fusion
Authors: Wang Xiujuan , Zheng Qianqian , Zheng Kangfeng , Wu Tong
Published: May 2020

In order to improve the recognition rate of users with single behavioral feature and prevent impostors from restricting an input device to avoid detection, a dual-index user authentication method based on Multiple Kernel Learning (MKL) for keystroke and mouse behavioral feature fusion was proposed in this paper. Due to the heterogeneity between the keystroke features and the mouse features, we argue that each type of features is mapped to a suitable kernel and the weights of each kernel are obtained through computing and then summed to obtain a compound kernel that implements the multifeature fusion. The dataset used in this paper was collected under complete uncontrolled condition from some volunteers by using our data collection program. The experimental results show that the proposed method can obtain the best recognition accuracy of 89.6%. Compared to the traditional methods of single feature, the dual-index method can get more stable and effective authentication. Therefore, the proposed method in this paper fully demonstrates the reliability of dual-index user authentication.
Dynamic Stabilization Adjacent to Fusion versus Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease: A Meta‐Analysis
Authors: Sun Xiangyao , Chen Zhaoxiong , Sun Siyuan , Wang Wei , Zhang Tongtong , Kong Chao , Lu Shibao
Published: May 2020

This study evaluated differences in outcome variables between dynamic stabilization adjacent to fusion (DATF) and posterior lumbar interbody fusion (PLIF) for the treatment of lumbar degenerative disease. A systematic review of PubMed, EMBASE, and Cochrane was performed. The variables of interest included clinical adjacent segment pathologies (CASPs), radiological adjacent segment pathologies (RASPs), lumbar lordosis (LL), visual analogue scale (VAS) of back (VAS‐B) and leg (VAS‐L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery (DS), estimated blood loss (EBL), complications, and reoperation rate. Nine articles identified as meeting all of the inclusion criteria. DATF was better than PLIF in proximal RASP, CASP, and ODI during 3 months follow‐up, VAS‐L. However, no significant difference between DATF and PLIF was found in distal RASP, LL, JOA score, VAS‐B, ODI after 3 months follow‐up, complication rates, and reoperation rate. These further confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The differences between hybrid surgery and topping‐off technique were located in DS and EBL in comparison with PLIF. Our study confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to the fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The difference between hybrid surgery and topping‐off technique was not significant in treatment outcomes.
Review of Atypical Organometallic Compounds as Antimalarial Drugs
Authors: Kwofie Samuel K. , Broni Emmanuel , Dankwa Bismark , Enninful Kweku S. , Teye Joshua , Davidson Cedar R. , Nimely Josephine B. , Chioma Orizu J. , Kempaiah Prakasha , Rathi Brijesh , Miller Whelton A.
Published: May 2020

Organometallic compounds are molecules that contain at least one metal-carbon bond. Due to resistance of the Plasmodium parasite to traditional organic antimalarials, the use of organometallic compounds has become widely adopted in antimalarial drug discovery. Ferroquine, which was developed due to the emergence of chloroquine resistance, is currently the most advanced organometallic antimalarial drug and has paved the way for the development of new organometallic antimalarials. In this review, a general overview of organometallic antimalarial compounds and their antimalarial activity in comparison to purely organic antimalarials are presented. Furthermore, recent developments in the field are discussed, and future applications of this emerging class of therapeutics in antimalarial drug discovery are suggested.
Dimensionality Reduction with Sparse Locality for Principal Component Analysis
Authors: Li Pei Heng , Lee Taeho , Youn Hee Yong
Published: May 2020

Various dimensionality reduction (DR) schemes have been developed for projecting high-dimensional data into low-dimensional representation. The existing schemes usually preserve either only the global structure or local structure of the original data, but not both. To resolve this issue, a scheme called sparse locality for principal component analysis (SLPCA) is proposed. In order to effectively consider the trade-off between the complexity and efficiency, a robust L2,p-norm-based principal component analysis (R2P-PCA) is introduced for global DR, while sparse representation-based locality preserving projection (SR-LPP) is used for local DR. Sparse representation is also employed to construct the weighted matrix of the samples. Being parameter-free, this allows the construction of an intrinsic graph more robust against the noise. In addition, simultaneous learning of projection matrix and sparse similarity matrix is possible. Experimental results demonstrate that the proposed scheme consistently outperforms the existing schemes in terms of clustering accuracy and data reconstruction error.
Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status
Authors: Hidaka Masaoki , Osaki Masato , Yamaguchi Shinya , Sayama Tetsuro , Arakawa Shuji , Kitazono Takanari
Published: May 2020

A 31-year-old woman presented with sudden onset of weakness in her left upper limb. Magnetic resonance imaging revealed acute cerebral infarctions in the right frontal and parietal lobes. Magnetic resonance angiography showed stenosis in the proximal portions of the bilateral middle cerebral arteries and terminal portions of the bilateral internal carotid arteries. The patient also complained of thyrotoxic symptoms, such as tachycardia, goiter, and fine finger tremor. She was diagnosed with acute ischemic stroke due to moyamoya vasculopathy (MMV) associated with Basedow disease. The patient’s thyroid hormone status normalized and intracranial artery stenosis gradually improved. However, after 6 months, she developed transient left hemiparesis during the 7th week of gestation. Her thyroid function deteriorated, and MMV progressed. Then, MMV improved again with the normalization of her thyroid function. This case shows that MMV associated with Basedow disease could worsen or improve depending on the thyroid hormone status.
Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients
Authors: Chisholm-Burns Marie A. , Spivey Christina A. , Potukuchi Praveen K. , Streja Elani , Kalantar-Zadeh Kamyar , Kovesdy Csaba P. , Molnar Miklos Z.
Published: May 2020

Introduction: Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs). Objective: The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant. Methods: Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed. Results: A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07–0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03–0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses. Conclusions: Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.
Urinary Metabolic Profile of Patients with Transfusion-Dependent β-Thalassemia Major Undergoing Deferasirox Therapy
Authors: Capolongo Giovanna , Zacchia Miriam , Beneduci Amerigo , Costantini Silvia , Cinque Patrizia , Spasiano Anna , De Luca Giuseppina , Di Pietro Maria Enrica , Ricchi Paolo , Trepiccione Francesco , Capasso Giovambattista , Filosa Aldo
Published: May 2020

Introduction: Renal dysfunction is a frequent complication in patients suffering from β-thalassemia major (β-TM). The aim of this study was to analyze the renal function and urine metabolomic profile of β-TM patients undergoing transfusions and deferasirox (DFX) therapy, in order to better characterize and shed light on the pathogenesis of renal disease in this setting. Methods and Subjects: 40 patients affected by β-TM treated with DFX and 35 age- and gender-matched healthy controls were enrolled in the study. Renal function was assessed. Glomerular filtration rate (GFR) was estimated with CKD-EPI and Schwartz formula for adults and children, respectively. Renal tubular function and maximal urine concentration ability were tested. Urine specimens were analyzed by nuclear magnetic resonance spectroscopy to identify the urinary metabolite profiles. Results: The study of renal function in β-TM patients revealed normal estimated (e)GFR mean values and the albumin-to-creatinine ratio was <30 mg/g. The analysis of tubular function showed normal basal plasma electrolyte levels; 60% of patients presented hypercalciuria and many subjects showed defective urine concentration. Several amino acids, N-methyl compounds, and organic acids were overexcreted in the urine of thalassemic patients compared with controls. Discussion: The major finding of this work is that β-TM patients and controls exhibit different concentrations of some metabolites in the urine. Early recognition of urinary abnormalities may be useful to detect and prevent kidney damage.
Fiberoptic Endoscopic Evaluation of Swallowing in Patients with Type 2 Diabetes Who Have Self-Reported Swallowing Difficulties
Authors: Gölaç Hakan , Atalık Güzide , Türkcan Alper Kutalmış , Yapar Dilek , Sel Aydın Tuncer , Karakoç Mehmet Ayhan , Yılmaz Metin
Published: May 2020

Introduction: People with diabetes frequently have gastrointestinal problems and related deglutition disorders. Objective: The aims of the present study are to determine the symptomatic swallowing complaints and to evaluate the functionality of oropharyngeal swallowing in patients with type 2 diabetes mellitus (T2DM) by using the Turkish Eating Assessment Tool-10 (T-EAT-10) and fiberoptic endoscopic evaluation of swallowing (FEES). Methods: In this descriptive cross-sectional study, the T-EAT-10 questionnaire was completed by 121 patients with diabetes, and FEES was planned for each individual whose baseline score of the T-EAT-10 was ≥3. Before swallowing trials via samples of nectar-thick consistency, laryngeal sensation and severity of secretion in the hypopharynx were observed. While the swallowing safety was determined using the Penetration-Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale was used to assess the swallowing efficiency. Results: Of the total participants, 22.3% (n = 27) were found to have abnormal swallowing function (T-EAT-10 ≥3), 27.3% (n = 33) had concomitant neuropathy and 28.1% (n = 34) mentioned a reflux complaint. The results of the multivariate linear regression analysis exposed that the T-EAT-10 score was significantly associated with neuropathy (r = 3.763, p < 0.001) and reflux complaint (r = 2.254, p = 0.031). Of the total FEES-tested subjects (n = 20), 95% (n = 19) had a safe swallowing function (PAS = 1). However, diminished laryngeal sensation, increased secretion and presence of residue revealed that patients with T2DM who have self-reported swallowing difficulties have reduced swallowing efficiency. Conclusions: This study has demonstrated that almost 1 out of 4 T2DM patients reported to have swallowing-related problems, and the score of the T-EAT-10 was found to be independently associated with both neuropathy and reflux complaint. FEES results pointed out that swallowing efficiency was relatively reduced in the target population. However, further research is still necessary before obtaining a definitive answer to oropharyngeal swallowing problems in patients with T2DM.
Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature
Authors: Zhao Youlu , Huang Junwen , Su Tao , Yang Zhikai , Zheng Xizi , Yang Liu , Zhou Xujie , Yu Xiaojuan , Wang Hui , Wang Suxia , Liu Gang , Yang Li
Published: May 2020

Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU. Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas. Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.
Increased Peripheral Blood Heteroplasmy of the mt.3243A>G Mutation Is Associated with Earlier End-Stage Kidney Disease: A Case Report and Review of the Literature
Authors: Shand James A.D. , Potter Howard C. , Pilmore Helen L. , Cundy Tim , Murphy Rinki
Published: May 2020

The mitochondrial DNA mutation mt.3243A>G is most commonly associated with maternally inherited diabetes and deafness (MIM 52,000), but it has protean phenotypes including renal disease due to focal segmental glomerulosclerosis. We describe monozygotic twins who both harboured this mutation and developed ESRD. Although otherwise genetically identical, the twins differed in their peripheral blood leucocyte levels of circulating mt.3243A>G heteroplasmy: 20 versus 10%, when assessed at 42 years of age. The twin with the higher heteroplasmy load developed end-stage kidney disease 15 years earlier than her sister. A review of the published literature supports a relationship between heteroplasmy level and the age at the development of the end stage of renal failure in patients with mt.3243A>G-related kidney disease.
Desvendando os sentidos do trabalho
Authors: Ferraz Deise Luiza da Silva , Fernandes Paula Cristina de Moura
Published: May 2020

Neste texto, objetivamos analisar os conteúdos presentes na definição de sentido(s) do trabalho que possuem maior influência no campo das ciências sociais aplicadas no Brasil. Para tanto, efetuamos uma análise imanente dos artigos mais referenciados na área, identificados por meio de um estudo bibliométrico nos portais Capes, Spell e Scielo, entre os anos de 2000 a 2017. A partir do levantamento bibliométrico, foi constatado que os estudos acerca do sentido do trabalho possuem dois autores basilares: Estelle Morin e Ricardo Antunes. Para Morin, o trabalho só adquire sentido se houver a intensificação do trabalho e ele for produtivo para o capital; para Antunes, o trabalho só tem sentido para além do capital. Por isso, é epistemologicamente incoerente dialogar os dois autores em um mesmo trabalho, pois um afirma o status quo e o outro o nega. A compreensão emanada dos textos analisados permitiu reafirmarmos a necessidade de resgatar a categoria “trabalho” em sua particularidade histórica, defendermos a postura filosófica da determinação ontoprática do pensamento e propormos reflexões sobre uma agenda de pesquisa.
Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta‐Analysis
Authors: Zhao Min , Woodward Mark , Vaartjes Ilonca , Millett Elizabeth R. C. , Klipstein‐Grobusch Kerstin , Hyun Karice , Carcel Cheryl , Peters Sanne A. E.
Published: May 2020

Background

Sex differences in the management of cardiovascular disease have been reported in secondary care. We conducted a systematic review with meta‐analysis of systematically investigated sex differences in cardiovascular medication prescription among patients at high risk or with established cardiovascular disease in primary care.

Methods and Results

PubMed and Embase were searched between 2000 and 2019 for observational studies reporting on the sex‐specific prevalence of aspirin, statins, and antihypertensive medication prescription, including beta blockers, calcium channel blockers, angiotensin‐converting enzyme inhibitors, and diuretics, in primary care. Random effects meta‐analysis was used to obtain pooled women‐to‐men prevalence ratios for each cardiovascular medication prescription. Metaregression models assessed the impact of age and year on the findings. A total of 43 studies were included, involving 2 264 600 participants (28% women) worldwide. Participants’ mean age ranged from 51 to 76 years. The pooled prevalence of cardiovascular medication prescription for women was 41% for aspirin, 60% for statins, and 68% for any antihypertensive medications. Corresponding rates for men were 56%, 63%, and 69% respectively. The pooled women‐to‐men prevalence ratios were 0.81 (95%
CI
, 0.72–0.92) for aspirin, 0.90 (95%
CI
, 0.85–0.95) for statins, and 1.01 (95%
CI
, 0.95–1.08) for any antihypertensive medications. Women were less likely to be prescribed angiotensin‐converting enzyme inhibitors (0.85; 95%
CI
, 0.81–0.89) but more likely with diuretics (1.27; 95%
CI
, 1.17–1.37). Mean age, mean age difference between the sexes, and year of study had no significant impact on findings.

Conclusions

Sex differences in the prescription of cardiovascular medication exist among patients at high risk or with established cardiovascular disease in primary care, with a lower prevalence of aspirin, statins, and angiotensin‐converting enzyme inhibitors prescription in women and a lower prevalence of diuretics prescription in men.
Improving Stroke Care in Times of the COVID-19 Pandemic Through Simulation
Authors: Kurz Martin W. , Ospel Johanna Maria , Daehli Kurz Kathinka , Goyal Mayank
Published: May 2020

During the coronavirus disease 2019 (COVID-19) pandemic, infectious disease control is of utmost importance in acute stroke treatment. This is a new situation for most stroke teams that often leads to uncertainty among physicians, nurses, and technicians who are in immediate contact with patients. The situation is made even more complicated by numerous new regulations and protocols that are released in rapid succession. Herein, we are describing our experience with simulation training for COVID-19 stroke treatment protocols. One week of simulation training allowed us to identify numerous latent safety threats and to adjust our institution-specific protocols to mitigate them. It also helped our physicians and nurses to practice relevant tasks and behavioral patterns (eg, proper donning and doffing PPE, where to dispose potentially contaminated equipment) to minimize their infectious exposure and to adapt to the new situation. We therefore strongly encourage other hospitals to adopt simulation training to prepare their medical teams for code strokes during the COVID-19 pandemic.
Delays in Stroke Onset to Hospital Arrival Time During COVID-19
Authors: Teo Kay-Cheong , Leung William C.Y. , Wong Yuen-Kwun , Liu Roxanna K.C. , Chan Anna H.Y. , Choi Olivia M.Y. , Kwok Wing-Man , Leung Kung-Ki , Tse Man-Yu , Cheung Raymond T.F. , Tsang Anderson Chun-On , Lau Kui Kai
Published: May 2020

Background and Purpose:

The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong.

Methods:

We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020–March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre–COVID-19: January 23, 2019–March 24, 2019).

Results:

Seventy-three patients in COVID-19 were compared with 89 patients in pre–COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (
P
>0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre–COVID-19 (154 versus 95 minutes,
P
=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%,
P
=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%,
P
=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (
P
>0.05 for all comparisons).

Conclusions:

During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.
Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions
Authors: Zhao Jing , Li Hang , Kung David , Fisher Marc , Shen Ying , Liu Renyu
Published: May 2020

Background and Purpose:

When the coronavirus disease 2019 (COVID-19) outbreak became paramount, medical care for other devastating diseases was negatively impacted. In this study, we investigated the impact of the COVID-19 outbreak on stroke care across China.

Methods:

Data from the Big Data Observatory Platform for Stroke of China consisting of 280 hospitals across China demonstrated a significant drop in the number of cases of thrombolysis and thrombectomy. We designed a survey to investigate the major changes during the COVID-19 outbreak and potential causes of these changes. The survey was distributed to the leaders of stroke centers in these 280 hospitals.

Results:

From the data of Big Data Observatory Platform for Stroke of China, the total number of thrombolysis and thrombectomy cases dropped 26.7% (
P
<0.0001) and 25.3% (
P
<0.0001), respectively, in February 2020 as compared with February 2019. We retrieved 227 valid complete datasets from the 280 stroke centers. Nearly 50% of these hospitals were designated hospitals for COVID-19. The capacity for stroke care was reduced in the majority of the hospitals. Most of the stroke centers stopped or reduced their efforts in stroke education for the public. Hospital admissions related to stroke dropped ≈40%; thrombolysis and thrombectomy cases dropped ≈25%, which is similar to the results from the Big Data Observatory Platform for Stroke of China as compared with the same period in 2019. Many factors contributed to the reduced admissions and prehospital delays; lack of stroke knowledge and proper transportation were significant limiting factors. Patients not coming to the hospital for fear of virus infection was also a likely key factor.

Conclusions:

The COVID-19 outbreak impacted stroke care significantly in China, including prehospital and in-hospital care, resulting in a significant drop in admissions, thrombolysis, and thrombectomy. Although many factors contributed, patients not coming to the hospital was probably the major limiting factor. Recommendations based on the data are provided.
Morphylapxis
Authors: Lara Malvacías Luis
Published: May 2020

As a brown, Latinx, immigrant, queer artist, metamorphosis, transformation, and multiplicity are ways of becoming, and disguising. Using masks, wigs, costumes as a survival strategy, I have lived for years disguised both on the stage and in my everyday life. In this work, I apply the tactic of metamorphosis and concealment by superposing images of costumes and masks from past performances.