bluuebunny/crossref_metadata_2025 huggingface dataset:
Strength Measurement After Achilles Tendon Repair
Authors: Bäcker Henrik C. , Yenchak Adrian J. , Trofa David P. , Vosseller J. Turner
Published: December 2018

The goal of treatment after Achilles tendon rupture (ATR) is to restore appropriate tension to the tendon, so that normal baseline strength and functional soft-tissue length can be achieved. The assessment of plantarflexion strength has shown widespread variability. The purpose of this study is to document variations in strength assessment after the treatment of ATR in the literature. A comprehensive literature review was performed. In total, 2758 articles were found on Achilles tendon rupture and Achilles tendon strength measurement. The full text of articles including strength as a functional outcome measurement in the abstract were assessed. All objective strength measurements performed were reviewed and recorded for comparison. One-hundred articles were included in our study. In 78 articles, a dynamometer was used to measure strength, whereas in 22 articles, an endurance test (n=14) or formal gait assessment (n=8) was applied. When a dynamometer was used, there was wide variability in the various methods used including the incorporation of both isokinetic (n = 65) and isometric (n = 29) exercises utilizing varying degrees of knee flexion and patient testing position. Furthermore, the number of measurements at certain angular velocities varied. This study illustrates that no general consensus exists regarding an optimal method for measuring strength after ATR. The variability creates difficulty and challenges medical professionals’ ability to formulate consistent conclusions when determining functional performance outcomes. A more uniform way of measuring strength after ATR may allow for better comparisons between studies in the literature, potentially leading to a better understanding of strength.

Levels of Evidence: Therapeutic, Level II
Inferior Turbinate Hypertrophy: A Review of the Evolution of Management in Children
Authors: Komshian Sevan R. , Cohen Michael B. , Brook Christopher , Levi Jessica R.
Published: December 2018

Background

Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment.

Objective

To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time.

Methods

In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts.

Results

Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction.

Conclusion

This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.
Formulation of a covalently bonded hydroxyapatite and poly(ether ether ketone) composite
Authors: Hughes Erik AB , Parkes Andrew , Williams Richard L , Jenkins Mike J , Grover Liam M
Published: December 2018

Spinal fusion devices can be fabricated from composites based on combining hydroxyapatite and poly(ether ether ketone) phases. These implants serve as load-bearing scaffolds for the formation of new bone tissue between adjacent vertebrae. In this work, we report a novel approach to covalently bond hydroxyapatite and poly(ether ether ketone) to produce a novel composite formulation with enhanced interfacial adhesion between phases. Compared to non-linked composites (HA_PEEK), covalently linked composites (HA_L_PEEK), loaded with 1.25 vol% hydroxyapatite, possessed a greater mean flexural strength (170 ± 5.4 vs 171.7 ± 14.8 MPa (mean ± SD)) and modulus (4.8 ± 0.2 vs 5.0 ± 0.3 GPa (mean ± SD)). Although the mechanical properties were not found to be significantly different (p > 0.05), PEEK_L_HA contained substantially larger hydroxyapatite inclusions (100–1000 µm) compared to HA_PEEK (50–200 µm), due to the inherently agglomerative nature of the covalently bonded hydroxyapatite and poly(ether ether ketone) additive. Larger inclusions would expectedly weaken the HA_L_PEEK composite; however, there is no significant difference between the flexural modulus of poly(ether ether ketone) with respect to HA_L_PEEK (p = 0.13). In addition, the flexural modulus of HA_PEEK is significantly lower compared to poly(ether ether ketone) (p = 0.03). Ultimately, covalent linking reduces hydroxyapatite particulate de-bonding from the polymeric matrix and inhibits micro-crack development, culminating in enhanced transfer of stiffness between hydroxyapatite and poly(ether ether ketone) under loading.
Personalized learning system for visualizing knowledge structures and recommending study materials links
Authors: Nitchot Athitaya , Wettayaprasit Wiphada , Gilbert Lester
Published: December 2018

The aim of this research is to introduce a method of constructing knowledge structures which represent the relationships among the knowledge items in a pedagogically useful way. A prototype, “MyTeLeMap,” was implemented to support both learners and instructors. Learners could visualize the knowledge structures of different knowledge domains and obtain links to corresponding study materials. The system also offered learning paths and recommendations, for example, to related structures. Instructors could create and share their knowledge structures. An experiment compared the learning outcomes of learners using MyTeLeMap and those using a free-browsing mode. The results showed that MyTeLeMap helped learners more than free browsing. Future work includes the incorporation of a search application for learners and of management features for instructors to upload and share learning materials linked to specific knowledge domains.
Amifampridine phosphate in the treatment of muscle-specific kinase myasthenia gravis: a phase IIb, randomized, double-blind, placebo-controlled, double crossover study
Authors: Bonanno Silvia , Pasanisi Maria Barbara , Frangiamore Rita , Maggi Lorenzo , Antozzi Carlo , Andreetta Francesca , Campanella Angela , Brenna Greta , Cottini Lorenzo , Mantegazza Renato
Published: December 2018

Objective:

The aim of this study is to determine the safety and the efficacy of amifampridine phosphate in muscle-specific kinase antibody-positive myasthenia gravis, in a 1:1 randomized, double-blind, placebo-controlled, switchback, double crossover study.

Methods:

Eligible patients had muscle-specific kinase myasthenia gravis, >18 years of age, and Myasthenia Gravis Foundation of America class II–IV with a score of ⩾9 on Myasthenia Gravis Composite scale. After the run-in phase, during which amifampridine phosphate was titrated to a tolerable and effective dosage, patients were randomized to receive placebo–amifampridine–placebo sequence or amifampridine–placebo–amifampridine sequence daily for 7 days. Then, patients switched treatment arms twice, for a total of 21 days of double-blind treatment. Safety was determined by serial assessments of adverse events/serious adverse events, physical examinations, and clinical and laboratory tests. The co-primary outcome measures included changes from baseline of Quantitative Myasthenia Gravis score and Myasthenia Gravis–specific Activities of Daily Living Profile score. The secondary outcome measures comprised changes from baseline of Myasthenia Gravis Composite score, Myasthenia Gravis Quality of Life scale—15 questions, Fatigue Severity Scale, and Carlo Besta Neurological Institute–Myasthenia Gravis scale. Statistical analyses were assessed using a switchback model for three-period, two-treatment crossover design.

Results:

A total of 10 patients were screened, enrolled, and treated. Transient paresthesias (60%) were the only amifampridine phosphate–related adverse events reported. Four patients were randomized to receive placebo–amifampridine–placebo sequence and three patients to receive amifampridine–placebo–amifampridine sequence. The co-primary objectives were statistically met (Quantitative Myasthenia Gravis score: p = 0.0003 and Myasthenia Gravis–specific Activities of Daily Living Profile score: p = 0.0006), as well as all the secondary endpoints (Myasthenia Gravis Composite score: p < 0.0001, Myasthenia Gravis Quality of Life scale—15 questions: p = 0.0025, Fatigue Severity Scale: p = 0.0061, and Carlo Besta Neurological Institute–Myasthenia Gravis scale: p = 0.0014).

Conclusion:

Despite the low number of patients, MuSK-001 study provided evidence that amifampridine phosphate, in the range of 30–60 mg daily dose, was safe and effective in treating muscle-specific kinase myasthenia gravis, suggesting the need for a large multi-center trial to confirm these results.
Reaching out to diabetic soles: Outreach foot care pilot project
Authors: Rickards Tracey , Cornish Tammy
Published: December 2018

Objectives:

To assess the effectiveness of outreach foot care services as a tool for engagement with isolated vulnerable seniors. To improve foot health of diabetic seniors, thus avoiding expensive and potentially life-threatening diabetic complications.

Methods:

Four validated tools are used to gather data: InLow 60-second Diabetic Foot Screen©, Short Diabetes Knowledge Instrument for Older and Minority Adults, Brief Healthcare Questionnaire (Patient Health Questionnaire-9), and the Health-Related Quality of Life Questionnaire.

Results:

Five monthly visits to 20 participants resulted in multiple co-morbidities being identified, improvements in foot status and diabetic knowledge realized, and determinants of health addressed. Seniors needed support and resources to engage in diabetes self-management.

Conclusion:

The importance of regular foot care as a key element of any self-management plan for diabetes cannot be understated, nor can increasing social services spending to include coverage for foot care thereby avoiding expensive healthcare. Using foot care as a tool for engagement conferred access to vulnerable seniors who ultimately benefited from healthcare and social interactions with a provider.
Secessionist social services reduce the public costs of civilian killings: Experimental evidence from the United States and the United Kingdom
Authors: Flynn D.J. , Stewart Megan A.
Published: December 2018

How do international audiences evaluate the legitimacy of secessionist insurgencies? Although secessionists often propagate their behavioral choices, such as state-building and non-violence, to international audiences in the hopes of generating support, scholars know little about the effects of this information. In this article, we use survey experiments in the United States and the United Kingdom to examine how international audiences respond to two commonly used strategies of secession: civilian killings and social service provision. We find that international audiences view secessionists who avoid civilian killings and provide social services as more legitimate than secessionists who kill civilians and do not provide services, respectively. Further, we show that service provision can allow secessionists to reduce—and, in some cases, eliminate—the public costs of civilian killings. These findings have important implications for ongoing secessionist conflicts across the globe.
Complete laparoscopic excision of a hepatic cyst and omentopexy in a Persian cat
Authors: Lafuente Sofía , Fresno Laura , Anselmi Carlo , Lloret Albert , Espada Ivonne , Santos Laura
Published: December 2018

Case summary

Congenital or acquired hepatic cystic lesions in cats are a rare condition. Congenital hepatic cysts are often present as part of a systemic polycystic disease involving several organs. Most cats with hepatic cysts remain clinically normal for their lives, although some patients may show abdominal distension, vomiting, abdominal pain and jaundice. An 11-year-old female neutered Persian cat was presented to our institution 3 days after the onset of inappropriate defecation and urination. This patient had a history of polycystic kidney disease and a small hepatic cystic lesion. Physical examination showed pain on abdominal palpation. Abdominal ultrasonography revealed an increase in the size of the hepatic cyst and a partial obstruction of the biliary tract. Owing to the progression of the hepatic cyst, laparoscopic excision and omentalisation were performed. The cyst was completely resected using a 5 mm laparoscopic vessel sealer/divider device. It was removed from the abdomen through one of the portals and was submitted for histological study. After cyst excision, omentopexy was performed using 4-0 USP braided absorbable material. At follow-up examination 5 days later, the physical examination was normal and abdominal palpation was not painful. A biopsy report confirmed the diagnosis of a liver cyst. A follow-up abdominal ultrasonography performed 6 months after surgery revealed no recurrence of the liver cyst.

Relevance and novel information

To our knowledge, this is the first case report describing the laparoscopic technique of liver cystectomy and omentopexy in veterinary medicine. Minimally invasive surgery is gaining widespread acceptance within the veterinary community because of its benefits. However, further investigation with prospective studies are necessary.
Fatal pulmonary hemorrhage associated with vascular amyloid deposition in a cat
Authors: Mawby Dianne I , Whittemore Jacqueline C , Donnell Robert L
Published: December 2018

Case summary

An adult female spayed Siamese-cross cat of unknown age was presented for bilateral hemorrhagic otorrhea. Nasopharyngeal polyps were diagnosed by CT and biopsy; bilateral ventral bulla osteotomies were performed. Episodic epistaxis, otic hemorrhage and hemoptysis with respiratory distress progressed over 18 months. Systolic blood pressure, complete blood count, plasma biochemistries, prothrombin time, partial thromboplastin time and coagulation factor 12, 9 and 8 activities were normal. Serial thoracic radiographs revealed patchy interstitial to alveolar patterns. Airway hemorrhage prevented diagnostic bronchoscopy. Respiratory hemorrhage was ultimately fatal. Amyloid deposition was identified in pulmonary vasculature, bronchial wall, lymphoid tissues, nasal-pharyngeal tissue and tympanic bullae based on microscopic examination and confirmed by Congo red staining with green birefringence under polarized light.

Relevance and novel information

Amyloidosis should be considered as a differential diagnosis in cats with spontaneous hemorrhage of the respiratory or otic tracts. Although systemic amyloidosis is associated with a grave prognosis, this case suggests that prolonged survival is possible after the initial onset of signs in cats with pulmonary amyloidosis.
Differences in the Nasal Inflammatory Response to Cynodon dactylon From Rural and Urban Areas in Patients With Allergic Rhinitis
Authors: Sánchez Jorge , Sánchez Andres , Sánchez Jorge
Published: December 2018

Background

Epidemiological and experimental studies suggest that air pollution has a negative impact on human health and modifies the environment. However, the clinical implications of changes in environmental allergens secondary to air pollution have been little studied.

Objectives

To explore if the growth conditions of the Cynodon dactylon (rural vs urban area) modify the inflammatory response among patients with allergic rhinitis. Methodology: Two extracts were prepared for diagnostic test with Cyn d proteins obtained from rural and urban environment. Skin prick test (SPT), nasal challenge test (NCT), and eosinophil count in nasal mucus were performed in 3 groups: healthy subjects without rhinitis, rhinitis with (+) Cyn d, and rhinitis with (−) Cyn d.

Results

There was a 97% concordance in the positive and negative results of the SPT with the 2 extracts. However, Cyn d-urban extract generated larger wheals ( P = .03) and a higher number of patients with rhinitis presented a positive NCT to this extract (n = 7 vs 14, P = .04). Patients with positive NCT had a significant increase in eosinophils in mucus, but there was no difference between the extracts. The healthy controls did not react to the extracts tested in the skin or nasal test.

Conclusion

The findings suggest that the growth conditions in urban area of Cynodon dactylon can generate changes in the protein extract and have clinical implications in patients with allergic rhinitis.
Trajectories of Unsecured Debt across the Life Course and Mental Health at Midlife
Authors: Sun Amy Ruining , Houle Jason N.
Published: December 2018

In this paper, we contribute to a growing literature on debt and mental health and ask whether patterns of unsecured debt accumulation and repayment over two decades are associated with depressive symptoms at age 50. Using data from the National Longitudinal Study of Youth 1979 Cohort and group trajectory models, we have three key findings. First, we find substantial heterogeneity in debt trajectories across the life course. Second, respondents who report consistently high debt levels across the life course or who cycle in and out of high debt report significantly more depressive symptoms than respondents who hold consistently low levels of debt. These findings hold for both absolute and relative (debt-to-income) debt. Third, we find that the association between debt and depressive symptoms is strongest among respondents with less than a college degree, but we find less evidence for heterogeneity by race in this cohort.
“I Need My Children to Know That I Will Always Be Here for Them”: Young Care Leavers’ Experiences With Their Own Motherhood in Buenos Aires, Argentina
Authors: Coler Lucía
Published: December 2018

For care leavers in Argentina, the transition to an autonomous lifestyle is a process that begins at 18 years old when they are no longer protected by Children’s Rights laws. This transition is particularly challenging without any family support, and studies have demonstrated that female care leavers are likely to have children within the first few years after leaving care. The aim of this research is to explore and analyze young women’s identities, experiences, and perceptions about their own motherhood and family relationships after leaving the institutional care system in Buenos Aires, Argentina. Throughout a qualitative, small-scale study using life-history interviews, an insight of how these young women’s life experiences have influenced their identities is obtained. In this respect, the findings suggest that female care leavers offer a different type of childhood to their own children than the childhood they experienced, thus providing security, health, education, and love for their children. Moreover, an ambivalent relationship with their birth families has encouraged these women to develop their autonomy with new, meaningful bonds. Finally, motherhood and community participation have empowered these young women and promoted their agency.
Risk Profile of Customary and Statutory Property Rights: Implication for Real Estate Development in Port Harcourt
Authors: Okorji Utchay Augustine , Omirin Modupe Moronke
Published: December 2018

Real estate developments are characterised with risk and uncertainty. The more knowledge of the environment, unique characteristics and experience of a location, the easier it is to manage risk and reduce the possibility of unpleasant situations occurring. This article considers the risk profile of customary and statutory property rights in order to inform developers, investors and stakeholders on issues that need to be understood while dealing with such property rights in Port Harcourt. Litigations arising from intra-family and intra-communal disputes over boundaries are the main challenges to the security of customary property rights. On the other hand, the fallout of weak governance and conflicts between customary and statutory property rights constitute the major challenges to the security of statutory property rights. This article concludes by highlighting steps that could be taken to make Port Harcourt more investor friendly to the betterment of the real estate sector and the general economy.
Scars: The Long-term Effects of Combat Exposure on Health
Authors: Schnittker Jason
Published: December 2018

Although the effects of combat exposure on mental health receive a good deal of attention, less attention has been directed to the long-term effects of combat exposure on physical health, apart from combat injuries. Using the 2010 National Survey of Veterans, the author evaluates the long-term effects of combat generally, as well as more specific dimensions of combat experience, including exposure to the dead and wounded. The results indicate that combat exposure increases the likelihood of poor health and disability years later, though exposure to the dead and wounded is even more powerful and accounts for the entire unadjusted relationship between combat service and health. Furthermore, only a small part of the relationship between combat and health is attributable to service-connected disabilities. More of the relationship can be explained by social and behavioral processes subsequent to combat. Relative to veterans who were not exposed to the dead or wounded, veterans with combat exposure are more likely to smoke, less likely to be married, and more likely to report being unprepared for the transition to civilian life. Together these factors explain a large part of the relationship between combat and health, even more than is explained by service-connected disabilities. The effects of feeling unprepared on physical health are as large as those of exposure to combat. The results encourage greater appreciation of combat exposure as a source of stress proliferation, with ongoing implications for health channeled through experiences in civilian life.
Management of Coats Disease Microaneurysms With Fundus Fluorescein Angiography-Guided Navigated Laser
Authors: Brown David , Kozak Igor , Lampen Shaun I. R. , Chhablani Jay
Published: December 2018

Purpose:

The purpose of this case series is to test the safety and efficacy of navigated laser in the treatment of microaneurysms in Coats disease.

Methods:

In a multicenter, retrospective case series, 10 individuals with active, leaking Coats-related microaneurysms in the macula were included. All participants were treated with the Navilas navigated laser (OD-OS, GmbH, Teltow, Germany) in a navigated treatment mode guided by fundus fluorescein angiography with a minimum of 4-month follow-up. Primary outcomes included central retinal thickness, best-corrected visual acuity, and microaneurysm closure rate.

Results:

Mean age at navigated laser was 38.8 years (range, 14-61 years). Anatomic improvement or stabilization was noted in all participants (–10 µm), with stability within 10 letters of presenting visual acuity (±0.0 logarithm of the minimum angle of resolution [logMAR] [Snellen equivalent, 20/20]). No patient received any additional antivascular endothelial growth factor (anti-VEGF) treatment after the first navigated laser session. Patients could even discontinue previous anti-VEGF treatments.

Conclusion:

In this study, angiography-guided navigated laser treatment was a safe and effective treatment modality for Coats disease. The digital planning and navigated application of the laser seem to allow for good efficacy and a low complication rate.
Adsorption capacity of sodic- and dendrimers-modified stevensite
Authors: Hajjaji Mohamed , Beraa Abdellah , Coppel Yannick , Laurent Régis , Caminade Anne-Marie
Published: December 2018

The adsorption capacities of nano-sized organoclays composed of a stevensite-rich clay (R), phosphorus dendrimers (GC1 and GC2) and Na+-saturated clay were evaluated for their capacity to adsorb chromate and methylene blue (MB) in the range of 298–318 K. The adsorption kinetics and the isotherms were analysed based on kinetic equations and isotherm models and by adopting a non-linear regression procedure. In addition, the organoclays and the Na+-saturated clays were characterized principally by solid-state nuclear magnetic resonance spectroscopy. The pseudo-second-order rate equation described kinetics data well, and the adsorption rates were not limited by the intraparticle diffusion or by the liquid film diffusion. Both chemical species were adsorbed spontaneously (–31 <ΔG°T<–10 kJ/mol), but the adsorbents had a high affinity for MB species. The adsorption isotherms of chromate were fitted better by the Freundlich model, while those of MB followed the Langmuir model. Chromate adsorption took place at the edges and the free surfaces of stevensite, particularly at the protonated aluminols. MB was adsorbed as MBH2+and MB+. The MB protonation occurred at the clay surfaces, and MB+ions were located at the planar surfaces of stevensite as well as at the external surfaces of aggregates. Moreover, the tetrahedral sheet of stevensite involved in the formation of GC1-based organoclays was the subject of a partial chemical modification.
The effect of calcination temperature on metakaolin structure for the synthesis of zeolites
Authors: Król Magdalena , Rożek Piotr
Published: December 2018

The aim of this research was to determine the temperature of kaolin calcination in order to obtain an intermediate product (metakaolin) for the synthesis of geopolymers with potential application as self-supporting zeolitic membranes. The products obtained were analysed with X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM). The structural analysis of the metakaolins obtained suggested that the optimal temperature for the proposed application is 700°C. After alkali activation of metakaolin, it is possible to obtain zeolite A and hydroxysodalite. The factors analysed, determining the type and quantity of crystalline phases, were activation temperature and concentration of sodium hydroxide solution (activator). The largest amounts of zeolites were obtained by alkali activation with 9 mol/dm3 NaOH solution at 70°C.
Interactions of bentonite with metal and concrete from the FEBEX experiment: mineralogical and geochemical investigations of selected sampling sites
Authors: Kaufhold S. , Dohrmann R. , Ufer K. , Kober F.
Published: December 2018

The FEBEX experiment, a full-scale, high-level radioactive waste repository test, ran for ~18 years and hence is the longest-running disposal test to date. The test consisted of a heater emplaced in an envelope of compacted bentonite at the Grimsel test site, Switzerland. The water content of the bentonite was somewhat lower near the heater and increased towards the granite. This phenomenon probably led to gradients in the exchangeable cation population at various locations within the bentonite buffer. The cement (shotcrete) bentonite interface of one block was characterized by a thin (0.1–1.0 mm) reaction zone in which bentonite constituents, carbonates and sulfates occurred. Cation exchange and a slight decrease of the cation exchange capacity were observed near the heater. Oxic corrosion was observed predominantly at the bentonite/steel liner interfaces, pointing towards a role of air entrapped between the liner and heater during emplacement. At the liner surface, intimate intergrowth of bentonite constituents, metal and corrosion products was observed. At the face of the heater, the bentonite blocks were in direct contact with the heater surface without any signs of metal corrosion. Instead, a significant increase in the Mg content was recorded, which is in agreement with previous large-scale disposal tests. The FEBEX experiment proved that the Mg increase and corrosion were independent processes. The increase in Mg may be explained by the formation of trioctahedral domains or the precipitation of neoformed silicates. For the first time, however, brucite was identified as an additional phase that formed at the metal/bentonite interface, pointing towards a special role for Mg mobility in the bentonite barrier.
CD19 Chimeric Antigen Receptor Therapy for Refractory Aggressive B-Cell Lymphoma
Authors: Jacobson Caron A.
Published: December 2018

PURPOSE

Anti-CD19–directed chimeric antigen receptor (CAR) T-cell therapy has had a resounding effect on the treatment of chemotherapy-insensitive aggressive B-cell non-Hodgkin lymphoma (B-NHL). There are now two US Food and Drug Administration (FDA)–approved products available for treating these patients, and a third product is expected to be approved in the coming months. The question remains: Is there a preferred or best product for my patient? However, answering that question is more complicated than simply balancing the reported efficacy and toxicity results.

DESIGN

This review outlines potential confounding factors involving the three products and their pivotal clinical trials and highlights additional considerations of manufacturing reliability and overall cost that must be considered when weighing one product against another. It will also review the directions in which the field is moving and strategies being examined to improve efficacy as well as toxicity.

CONCLUSION

Because a randomized three-arm clinical trial is unlikely, a product may have to be chosen on the basis of results from treatment centers that have experience with all three products. But by the time those results are available, they are likely to be outdated because, given the rapid evolution of the field, the next product will probably have been identified.
Narcolepsy, Anesthesia, and Sedation: A Survey of the Perioperative Experience of Patients With Narcolepsy
Authors: Hershner Shelley , Kakkar Rahul , Chung Frances , Singh Mandeep , Wong Jean , Auckley Dennis
Published: December 2018

BACKGROUND:

Patients with narcolepsy may be at increased perioperative risk due to the interactions among anesthesia, narcolepsy, and narcolepsy medications. This study sought to determine the perioperative experience of narcoleptic patients undergoing anesthesia or sedation, the frequency of perioperative counseling, and self-reported surgical complications.

METHODS:

A 22-question survey was developed by expert consensus and distributed by the Narcolepsy Network. Recruitment was via the Narcolepsy Network’s list-serve and a Facebook link to the survey. One thousand and twenty respondents reported a diagnosis of narcolepsy and 1 or more procedures under anesthesia or sedation. Descriptive, comparative statistics and logistic regression were utilized.

RESULTS:

Respondents were mostly women (79.5%) and Caucasian (84.9%), with a mean age of 45 ± 16 years. Most respondents did not receive counseling regarding the possibility of increased sleepiness (70%), cataplexy (90%), or drowsy driving (59%) postanesthesia. More than half of respondents reported adverse events (medication withdrawal symptoms, inadequate pain relief, increased cataplexy). Subjects with cataplexy more frequently reported surgical complications (70% vs 31%; P = .03) and medication withdrawal symptoms (stimulant medications: odds ratio, 3.0 [95% CI, 1.9, 3.06]; P > .001 and antidepressant medications: odds ratio, 6.5 [95% CI, 2.1–19.5]; P = .001). Of the total sample, 18% indicated surgical complications. Undergoing 5 or more separate surgeries or procedures was associated with a 2-fold increase in self-reported complications (odds ratio, 2.2 [95% CI, 1.3–3.4]; P = .001), difficulty waking (odds ratio, 2.1 [95% CI, 1.45–3.06]; P = .001), and inadequate pain relief (odds ratio, 1.77 [95% CI, 1.01–3.13]; P < .05).

CONCLUSIONS:

Most narcoleptic patients report not receiving counseling regarding potential worsening of narcolepsy symptoms postanesthesia or an increased risk of drowsy driving. Enhanced education of perioperative providers about potential narcolepsy-related issues is essential. Respondents frequently self-report adverse events in the perioperative period. Future studies should clarify the perioperative risk associated with narcolepsy to optimize the care and safety of narcoleptic patients.
A Key Role for the Genetic Counsellor in the Genomics Era
Authors: Joseph Flora M.
Published: December 2018

New genetic testing technologies such as microarrays and whole exome sequencing mean the diagnostic potential for a child with a development disorder is greatly increased over traditional testing techniques.  With this increased potential comes increased expectations from families and professionals about the answers a diagnosis will provide.  However, limitations remain and a proportion of individuals will continue to remain undiagnosed.  In addition, some individuals will receive novel or very rare diagnoses about which very little is known in terms of prognosis and effective treatments.  In this paper, I present an argument for why these families would benefit from additional Genetic Counsellor support and how Clinical Genetics services in the UK could provide this support.  I acknowledge that resources are limited, but as demands on services increase and interactions with families become shorter, I argue that this kind of service should be prioritised, for the benefit of these families.
Beyond transcription factors: roles of mRNA decay in regulating gene expression in plants
Authors: Sieburth Leslie E , Vincent Jessica N
Published: December 2018

Gene expression is typically quantified as RNA abundance, which is influenced by both synthesis (transcription) and decay. Cytoplasmic decay typically initiates by deadenylation, after which decay can occur through any of three cytoplasmic decay pathways. Recent advances reveal several mechanisms by which RNA decay is regulated to control RNA abundance. mRNA can be post-transcriptionally modified, either indirectly through secondary structure or through direct modifications to the transcript itself, sometimes resulting in subsequent changes in mRNA decay rates. mRNA abundances can also be modified by tapping into pathways normally used for RNA quality control. Regulated mRNA decay can also come about through post-translational modification of decapping complex subunits. Likewise, mRNAs can undergo changes in subcellular localization (for example, the deposition of specific mRNAs into processing bodies, or P-bodies, where stabilization and destabilization occur in a transcript- and context-dependent manner). Additionally, specialized functions of mRNA decay pathways were implicated in a genome-wide mRNA decay analysis in Arabidopsis. Advances made using plants are emphasized in this review, but relevant studies from other model systems that highlight RNA decay mechanisms that may also be conserved in plants are discussed.
Anergy into T regulatory cells: an integration of metabolic cues and epigenetic changes at the Foxp3 conserved non-coding sequence 2
Authors: Silva Morales Milagros , Mueller Daniel
Published: December 2018

Peripheral immune self-tolerance relies on protective mechanisms to control autoreactive T cells that escape deletion in the thymus. Suppression of autoreactive lymphocytes is necessary to avoid autoimmunity and immune cell–mediated damage of healthy tissues. An intriguing relationship has emerged between two mechanisms of peripheral tolerance—induction of anergy and Foxp3+regulatory T (Treg) cells—and is not yet well understood. A subpopulation of autoreactive anergic CD4 T cells is a precursor of Treg cells. We now hypothesize that phenotypic and mechanistic features of Treg cells can provide insights to understand the mechanisms behind anergy-derived Treg cell differentiation. In this short review, we will highlight several inherent similarities between the anergic state in conventional CD4 T cells as compared with fully differentiated natural Foxp3+Treg cells and then propose a model whereby modulations in metabolic programming lead to changes in DNA methylation at the Foxp3 locus to allowFoxp3expression following the reversal of anergy.
The Interaction of the University with External Partners: Trends, Experience, Industry Specifics
Authors: Тихонов А. , Tihonov A. , Федотова М. , Fedotova M. , Коновалова В. , Konovalova Valyeriya
Published: December 2018

The article deals with the role of universities from the perspective of socio-economic development of society on the basis of the «triple helix» model. The work of educational structures (universities) is considered as a complex network of interaction with: other universities; multi-level educational organizations; enterprises, business, government agencies. The authors identify areas, possible forms and results of interaction between the University and various partners for the formation of youth labor activity. A number of examples in this article are based on the experience of the Department of «personnel Management» of the Moscow Aviation Institute.
Leadership and Leadership Development Tools in a Vuca World
Authors: Твердола Н. , Tverdola N.
Published: December 2018

The challenge of the VUCA’s world to us is about the development of not only narrowly professional competencies, but also of the individual as a whole, that is the process of forming “big” minds. What is “leader” and “leadership” for us now? What needs to be changed in our perception of the term “leadership” in order not only to survive, but also to be on the “crest of a wave” in the time we are experiencing VUCA? How to create a community of leaders and a living environment, an incubator environment where leaders can emerge and effectively manifest themselves? The author offers his view on the choice of leadership development tools. The article summarizes the author’s interview with one of the game developers, whose methodology is based on integrative vector modeling.
Value Characteristics and Motivation Features of the Z Generation Labor Activity
Authors: Зименкова А. , Zimenkova A. , Котенко Е. , Kotenko E. , Парамонова Т. , Paramonova T. , Ржанова И. , Rzhanova I. , Сергушкина В. , Sergushkina V.
Published: December 2018

The article discusses the value characteristics and features of the motivation of the labor activity of the generation Z, whose representatives will be actively entering the labor market in a couple of years. Generation Z is the first generation for which the Internet and mobile communications are available from childhood. For them, there is no world without high technology, so they have their own characteristics and interests. All employers are interested in the question of what employees they will own, and what methods of motivation will be effective when working with them. This article presents an analysis of the cost characteristics and features of Z generation based on the data obtained in the framework of the study of motivation involving the Z-generation. Based on these data, conclusions are made about the ways of motivation of this generation, which will allow the company to develop a system of motivation and stimulation of employees that will match the similarities and differences of employees, and will increase the level of involvement of specialists of different ages.
Increasing the Adaptive Capacity of Young People in the Labour Market: The Experience of the Ural Federal University (Ekaterinburg)
Authors: Казакова Ю. , Kazakova Yu. , Охотников О. , Ohotnikov O.
Published: December 2018

The current situation in the youth segment of the labour market is characterized by high unemployment and instability. The mechanisms regulating relations between the labour market and the educational services market do not ensure that the educational process of young people meets the needs and requirements of employers. In this regard, a necessary condition today is to improve the mechanisms with greater adaptive capacity, which would effectively solve the problem of youth employment. Thus, the purpose of this article is to study the practical mechanisms used in the UrFU to improve the adaptive capacity of young professionals and to assess the views of graduates on their application in the University. To this end, the empirical material obtained in the study of the opinion of students aged 20 to 21 years, on the basis of UrFU in Yekaterinburg, was analyzed using the questionnaire method. The relevance of the study is due to the existence of the problem of adaptation of young people in the labor market, which requires improvement, and is enhanced by the fact that it has a practical orientation. The materials of the work can be used in subsequent research of the youth segment of the labor market, as well as in the preparation of textbooks and reading training courses in universities on the basics of employment technologies and the effective behavior of young people in the labor market. The results of the study showed: 1. UrFU pays special attention to the promotion of employment and adaptation in the labor market of graduates, using mechanisms that have a more General (universal) character, but do not contain targeted (individual) assistance to graduates. 2. To solve the identified problems, the authors develop a special training course «technology of effective employment», aimed at improving the adaptive capacity of graduates of UrFU.
German literature of the 1990s. The situation is "turning»
Authors: Чугунов Дмитрий , Chugunov Dmitriy
Published: December 2018

The monograph highlights the key points of the literary process in Germany at the turn of XX-XXI centuries, shows the changes that have occurred in the interpretation of recent historical events, analyzes the new perception of the world by man.
The publication is addressed to University students, the General scientific community, as well as all those interested in modern European literature.
Presentation and visualization of research results
Authors: Логунова Оксана , Logunova Oksana , Романов Петр , Romanov Petr , Егорова Людмила , Egorova Lyudmila , Ильина Елена , Il'ina Elena
Published: December 2018

The textbook describes the main technologies and means of presentation and visualization of research results. The results of scientific research, the main trends in the presentation of scientific material for modern journals. The main attention is paid to the visualization of the results using the methods of generalization and its implementation by means of computer technology. To master practical skills, exercises are offered, tasks for which are based on the results of scientific research carried out and defended in the framework of scientific dissertations under the guidance of the authors in 2013-2017.
Meets the requirements of the Federal state educational standards of higher education of the last generation.
It is intended for graduate students of all directions in the study of the discipline "Methodology and information technology in research", "Presentation of research results", etc.
Photobiomodulation therapy in neuroischaemic diabetic foot ulcers: a novel method of limb salvage
Authors: Maiya Arun G. , Kumar A. Sampath , Hazari Animesh , Jadhav Radhika , Ramachandra L , Hande H. Manjunatha , Rajgopal Shenoy K , Maiya Shubha G. , Kalkura Prabath , Keni Laxmikant G.
Published: December 2018

Objective:

Low-level laser therapy (also known as photobiomodulation therapy, PBMT) promotes accelerated healing of diabetic foot ulcers (DFUs), thereby preventing the risk of future complications and amputation. The aim of this study was to determine the effect of PBMT, with structured, graded mobilisation and foot care, on DFU healing dynamics.

Method:

Patients diagnosed with type 2 diabetes, diabetic peripheral neuropathy and presenting with a chronic neuroischaemic DFU, were treated with PBMT using scanning and non-contact probe methods. The DFU was clinically observed and the area measured every seven days until complete healing. Neuropathic parameters were also measured. The PBMT was administered until complete closure of the DFU and patients also undertook a programme of graded mobilisation.

Results:

A total of 17 participants were recruited, with a mean age of 69±8 years, and a mean duration of diabetes of 13±5 years. Mean complete closure time was 26±11days. In addition, a mean reduction of the semi-quantitative vibration pressure threshold from 49±2 volts to 20±4 volts was observed in all participants.

Conclusion:

PBMT can be effectively used as a treatment mode for neuroischaemic DFUs in patients with type 2 diabetes. Graded mobilisation with focused foot care could improve the function of people living with type 2 diabetes with a chronic DFU.
The relationship between pressure ulcer risk assessment and preventative interventions: a systematic review
Authors: Lovegrove Josephine , Miles Sandra , Fulbrook Paul
Published: December 2018

Objective:

Hospital-acquired pressure ulcers (PU) continue to occur despite an ongoing focus on prevention. The aim of this review was to identify and evaluate primary research which links pressure ulcer risk assessment with prescription and implementation of preventative interventions for hospitalised adults.

Method:

A systematic review of the databases EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus and Web of Science was undertaken, using search terms related to pressure ulcers, hospital-acquired, risk, planning, implementation, prevention and outcome. Primary research reports that linked PU risk assessment with prescription and implementation of preventative interventions in some way were included.

Results:

From 589 potentially eligible publications, 20 primary research reports were included. Of these, seven linked PU risk assessment to preventative intervention implementation and 13 linked it to preventative intervention prescription and implementation in some way. No studies linked PU risk assessment to preventative intervention prescription alone.

Conclusion:

While the included studies linked these components in some way, there was little focus on the relationship between the three. PU preventative intervention prescription is not well defined, with inconsistencies noted in intervention prescription across studies. Many studies reported inadequate provision of prevention measures for patients at risk of PU. Further research is required to explore the relationship between PU risk assessment and preventative intervention prescription alone, and with implementation.
An introduction to effective leadership of teams
Authors: Kerrigan Lynne
Published: December 2018

Within a healthcare setting, effective team work is achieved when team members understand, believe in and work towards the shared purpose of caring and working for improving outcomes for patients. This sense of common purpose should however never be assumed. Team leaders should talk about it at every opportunity and ensure all team members are striving towards it within their daily work. Team leaders should develop a ‘teaming strategy’ to plan how their staff will act and work together. Anecdotal evidence would suggest that many veterinary nurses become head nurse or team leader with no leadership development training being offered; as the purpose of a team can seem so self-evident, it is often overlooked or wrongly assumed to be in existence by those new to a leadership role. This article will serve as an introduction to team development and leadership for those aspiring or new to the role.