bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study of toxicity for thermoplastic polyurethane and its flame-retardant composites
Authors: Liu Chen , Zong Ruowen , Chen Haiyan , Wang Junling , Wu Chaopeng
Published: September 2018

Toxic product in fire disasters is the most important reason for fire casualties. With wide application of polymer material, the toxic products in fire effluents are getting more and more diversified and complicated. Polyurethane is one of the most widely used materials. In this article, the fire toxicant release has been evaluated for thermoplastic polyurethane (TPU) and its flame-retardant composites. Ammonium polyphosphate (APP), aluminum hydroxide (ATH), and nano-montmorillonite (MMT) were combined into different flame-retardant combinations at certain ratios. Three kinds of flame-retardant combinations (APP-ATH, APP-MMT, and APP-ATH-MMT) were blended to reduce toxicity of TPU. The properties of thermal stability and decomposition were characterized by thermogravimetric analysis (TGA). TGA/infrared spectrometry, static tube furnace, and steady-state tube furnace were used to evaluate the toxic gases, including CO and HCN. Fractional effective dose (FED) was calculated based on the concentrations of CO, CO2, and HCN. The results showed that more than 50% toxicity effect in FED was accounted for HCN. The comprehensive toxicity of TPU was reduced in the samples with APP-ATH and APP-ATH-MMT. The yields of CO, CO2, and O2 consumption were indicated much lower in the samples with APP-ATH-MMT than the other two combinations.
Wood plastic composites made from post-used polystyrene foam and agricultural waste
Authors: Chun Koay Seong , Subramaniam Varnesh , Yeng Chan Ming , Meng Pang Ming , Ratnam Chantara Thevy , Yeow Tshai Kim , How Cheah Kean
Published: September 2018

Ever since the development of lightweight polystyrene foam, the material has become an attractive single-use product packaging in various industries. Despite its high versatilities, post consumed polystyrene foam has very low rate of recycling due to the high cost during transportation and there is hardly any established economical recycling route. The purpose of this research is to investigate the potential of converting the polystyrene foam waste as raw material for producing wood plastic composite (WPC). In the present study, predefined formulation of recycled polystyrene (rPS), durian husk fiber (DHF) and processing aid Ultra-PlastTM WP516 were melt blended with the aid of Haake internal mixer. The homogenous mixtures were subsequently compression molded to form WPC. The effect of material compositions on tensile, thermal, and morphological properties of the rPS/DHF composite was highlighted. The results showed that tensile strength and modulus increase with fiber content, while elongation at break and thermal stability were decreased. With higher loading of Ultra-PlastTM WP516, both tensile and thermal properties decreased. This research found that WPC with optimum strength of 18.8 MPa can be produced from rPS having 60 parts per hundred resin (phr) of DHF and 0.5 phr of Ultra-PlastTM WP516, albeit the measured tensile strength is lower compared to commercial alternatives. The resulting WPC possess great potential in none high strength, structurally demanding application.
Implementation of a Direct Oral Anticoagulation Screening Service at a Large Academic Medical Center Provided by a Pharmacist-managed Antithrombosis Clinic as a Method to Expand Antithrombotic Stewardship Efforts
Authors: Uppuluri Ellen M. , McComb Meghan N. , Shapiro Nancy L.
Published: September 2018

Background:

How and when to monitor direct oral anticoagulants (DOACs) for safety and efficacy is a question many anticoagulation clinics are trying to answer. A pharmacist-led antithrombosis clinic (ATC) initiated a clinical service to provide oversight for all prescribed DOACs.

Objective:

Describe the implementation and outcomes of a DOAC screening service.

Methods:

The service was initiated utilizing a daily electronic prescribing report of DOAC prescriptions. Prescriptions were reviewed by clinical pharmacists to assess patient insurance, eligibility, and accuracy of prescribed doses.

Results:

In the first year since service implementation in April 2016, 317 new prescriptions and 595 refill prescriptions were reviewed. A DOAC service pharmacist was able to reach 125 (39.4%) of 317 patients about their new prescription and 59 (9.9%) of 595 refill patients to provide education and follow-up on management as needed. Interventions were performed for 79 (28%) of 317 new prescriptions and 86 (14.5%) of 595 refill prescriptions. Common interventions with new prescriptions include contacting the prescriber for a medication or dose change (25.4%), assistance with medication access (21.5%), and coordinating appropriate lab and provider follow up (21.5%). Common interventions with refill prescriptions include recommending appropriate follow-up (50%) and contacting the prescriber for medication or dosage change (24.4%).

Conclusion:

Implementation of a DOAC screening service identified and resolved dosing errors, improved medication access, provided patient education, and improved follow-up.
High char yields of DOPO/organosilicon-modified epoxy resins and phosphorus–silicon synergism of thermal stability
Authors: Luo Jiemin , Li Rui , Zou Huawei , Chen Yang , Liang Mei
Published: September 2018

The phosphorus/silicon-modified epoxy resin (ED231) was prepared via a two-step reaction process. Firstly, the 9, 10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO)-modified epoxy was synthesized by ring-opening reaction between DOPO and epoxy resin of diglycidyl ether of bisphenol A (E51). Afterward, the organic silicone intermediate (SY231) was grafted onto the DOPO-modified epoxy to obtain the ED231 product. The thermal stability and thermal–mechanical properties of ED231 systems were characterized by thermogravimetric analysis (TGA) and dynamic mechanical thermal analysis, respectively. TGA results indicated that the phosphorus/silicon-modified epoxy resin (ED231) exhibited high char yields. For example, the solid residue for ED231-40 (5 phr DOPO and 40 phr SY231) at 800°C increased from 16.77% for the pure epoxy resin to 36.25% under nitrogen atmosphere and from 0% to 14.29% under air atmosphere, respectively. Scanning electron microscopy observations suggested that the ED231 systems could form an intact and continuous char layer which could significantly improve the thermal properties.
Electrochemical discharge machining: A review on preceding and perspective research
Authors: Singh Manpreet , Singh Sarbjit
Published: September 2018

Electrochemical discharge machining has been proved to be efficient micro-machining process and significantly used for the machining of non-conductive materials. The miniaturized products have gained advantages in Lab-on-a-chip devices and microelectromechanical system because of advancement in technology. The challenge to produce micro features has been suitably addressed by electrochemical discharge machining and emerged as potential contender in generating micro holes and micro channels on electrically non-conductive materials. This article includes state-of-art review on different domains of electrochemical discharge machining, which includes work piece, electrolyte, behaviour of tool electrode, gas film formation, machining quality along with recent hybridizations in electrochemical discharge machining process. The conclusion focuses or summarizes the future research trends for enhancement of electrochemical discharge machining efficiency and tackles problems encountered in machining.
It’s Not Only Who You Are but Who You Are With: High School Composition and Individuals’ Attainment Over the Life Course
Authors: Göllner Richard , Damian Rodica Ioana , Nagengast Benjamin , Roberts Brent W. , Trautwein Ulrich
Published: September 2018

We examined life-course effects of attending selective schools using a longitudinal study of U.S. high school students begun in 1960 ( Ns ranging from 1,952 to 377,015). The effects, measured 11 and 50 years after the initial assessment, differed significantly across the two indicators of school selectivity that were used. School average socioeconomic background was positively related to students’ educational expectations, educational attainment, income, and occupational prestige at the 11-year follow-up (0.15 ≤ β ≤ 0.39; all ps < .001). Conversely, schools’ average achievement at the 11-year follow-up was negatively related to students’ expectations, attainment, income, and occupational prestige (−0.42 ≤ β ≤ −0.05; all ps < .05) when schools’ socioeconomic background was controlled for. All associations were mediated by students’ educational expectations. With the exception of income, these effects were consistent 50 years after high school, pointing to the long reach of beneficial learning resources and negative social comparison processes when attending selective schools.
Non-musicians recognize unfamiliar contemporary classical music excerpts with increasing repetition
Authors: Wu Verena S. , MacRitchie Jennifer , Stevens Catherine J.
Published: September 2018

This article aims to determine the effects of exposure and title information when applied to music excerpts that are unfamiliar both in terms of the single excerpt, and in the underlying tonal structures used (i.e. contemporary classical music). Twenty-three non-musicians participated in a two-session experiment: 32 musical excerpts were presented on Day 1 immediately followed by presentation of a title varying by type (no title, descriptive, semantic, affective). Music excerpts were varied by number of exposures (1 vs. 3 exposures). Participants were asked whether they remembered the excerpt from earlier in the experiment, and to rate their liking on a 7-point Likert scale. On Day 2, recognition for the 32 “old” (Day 1) excerpts was tested, along with 32 “new” excerpts, which were all presented without titles. Participants were also asked to rate their liking for the excerpts, as per Day 1. Accounting for response bias, recognition was above chance level across all conditions. Results indicated a significant effect of exposure on recognition ([Formula: see text] = .79). No other effects were significant. Examining the liking ratings of accurately recognized excerpts, a significant interaction between exposure and title was found ([Formula: see text] = .20), where the difference in ratings across exposure levels for affective titles was greater than that of the semantic titles ( d = .60). This suggests that the title type, although not influencing memory of the piece, affected enjoyment of music at different exposures.
Anticholinergic Burden in Hospice Patients With Dementia
Authors: Williams Anne , Sera Leah , McPherson Mary Lynn
Published: September 2018

Background:

End-of-life (EOL) patients with dementia have an increased risk for anticholinergic toxicities due to age-related pharmacokinetic and physiologic changes in conjunction with an increased susceptibility to drug-induced cognitive impairments. Despite this well-documented risk, the use of drugs with anticholinergic properties (DAPs) remains prevalent in EOL patients with dementia.

Objective:

The aims of this study were to describe prescribing patterns and characterize anticholinergic burden among hospice patients with dementia, as measured by the Anticholinergic Cognitive Burden (ACB) scale.

Methods:

This was a retrospective review of a national hospice patient information database. Patients included were admitted on January 1, 2016, discharged by death by December 31, 2016, and had a primary diagnosis of dementia. Patients’ anticholinergic burden was calculated using ACB scores.

Results:

A total of 1283 patients met the inclusion criteria. Of those, 37.1% (n = 476) were prescribed at least 1 DAP. Specifically, 28.9% (n = 371) were prescribed 1 DAP, 6.6% (n = 84) were prescribed 2 DAPs, 1.6% (n = 20) were prescribed 3 DAPs, and 0.08% (n = 1) were prescribed 4 DAPs. The majority of patients prescribed a DAP had an ACB score of 3 (n = 359, 75.4%) and an average ACB score of 3.8. The most common DAPs prescribed in patients with an ACB score of 2 or higher were quetiapine (n = 202, 42.4%), atropine (n = 155, 32.6%), hyoscyamine (n = 61, 12.8%), olanzapine (n = 46, 9.6%), and scopolamine (n = 35, 7.4%).

Conclusion:

Due to the limited benefit and increased harms with the use of DAPs, providers should aim to maximize nonpharmacologic options. By reducing the use of the top 5 DAPs identified in this study, the quality of life and care for EOL patients with dementia can potentially be improved.
Pubic Hair Removal Practices in Cross-Cultural Perspective
Authors: Craig Lyndsey K. , Gray Peter B.
Published: September 2018

The literature on pubic hair removal (PHR) practices primarily focuses on women in Western societies and attributes recent increases in PHR to product marketing, pornography, and pop culture. Here, we explore PHR and retention practices outside the cultural West through content coding of societies in the Human Relations Area Files’ database, eHRAF World Cultures. Thirty-one societies noted distinct PHR or retention practices. Descriptive data on 72 societies provided additional context to the perception of pubic hair and reasons for its removal or retention. Results indicate that women practice PHR more commonly than men cross-culturally and practices are often tied to concerns about hygiene and sexual activity. Findings show that some features of PHR cross-culturally resemble those of the cultural West in which these practices have been best characterized, though these practices cannot be attributed to the same suite of factors such as exposure to pornography or product marketing. We interpret these findings within cross-cultural and evolutionary perspectives.
Tricyclic Antidepressants Modulate Stressed Mitochondria in Glioblastoma Multiforme Cells
Authors: Bielecka-Wajdman Anna M. , Ludyga Tomasz , Machnik Grzegorz , Gołyszny Miłosz , Obuchowicz Ewa
Published: September 2018

A common feature of solid tumors, including glioblastoma multiforme (GBM), is mitochondrial dysfunction. However, it is reported that the current standard of anti-GBM therapies may potentiate mitochondrial damage and, in effect, support the aggressive character of cancer. As mitochondria are implicated in the modulation of cellular drug sensitivity and chemoresistance mechanisms, activation-stressed mitochondria in GBM cells may represent a new target for anti-GBM therapy that is nontoxic for normal cells.

Methods:

As mitochondria are possible targets for antidepressant drugs used as adjuvant therapy in patients with GBM, we examined their influence on mitochondrial volume and activity, reactive oxygen species level, extracellular lactate concentration, and p65 NF-κB gene expression in GBM cells.

Results:

Our investigation showed, for the first time, that tricyclic antidepressants, imipramine and amitriptyline, partially reverse GBM abnormalities.

Conclusion:

In the light of reported studies, the mitochondrial disturbance observed in glioma cells is a dynamic process that can be reversed or silenced. Moreover, imipramine and amitriptyline are attractive cellular metabolic modulators and can potentially be used to restoring a proper function of mitochondria in GBM cells.
Gene Therapy: A New Approach for Treatment of Cancer
Authors: Djeu Julie Y.
Published: September 2018

The identification of critical genes that encode for regulatory proteins has helped elucidate the molecular mechanisms that govern cell proliferation and malignant transformation. Several approaches to gene therapy for cancer have been described. These include the use of fibroblasts expressing suicide genes, restoration of expression of tumor suppressor genes, cytokine gene therapy, genetic modification of T lymphocytes, and protection of normal hemopoiesis in cancer patients. Clinical trials are underway in all these areas.
Diagnosis and Management of Thyroid Cancer
Authors: Alexander Christopher L. , Izquierdo Roberto E. , Figge James , Horton John
Published: September 2018

Thyroid carcinoma, which comprises the majority of endocrine malignancies, has a substantial annual morbidity and mortality based on age and other predisposing factors. Diagnosis of a growing thyroid nodule can be difficult, but ultrasonography, radionuclide scanning, and fine needle aspiration allow the majority of nodules to be properly characterized. Treatment of differentiated thyroid carcinoma remains controversial. Surgical resection continues to be the most important modality with long survival if the tumor is resected early. Newer imaging techniques have improved the diagnosis of locally recurrent or metastatic disease. Radioactive iodine ablation is indicated for patients with “high-risk” tumors or advanced age. Few patients respond to cytotoxic chemotherapy. In the past decade, advances in the screening and diagnosis of medullary thyroid carcinoma have led to earlier detection with improvement in survival.
Opioids and the Internet: Convergence of Technology and Policy to Address the Illicit Online Sales of Opioids
Authors: Mackey Tim K
Published: September 2018

The United States is in the midst of an opioid public health emergency, one that is also influenced by a convergence of Internet-based technology, health policy, and the need for stakeholder collaboration and action around the need to combat the illicit online sales of opioids by illegal online pharmacies and digital drug dealers. This risk is not new, however, with calls to actively reduce online opioid availability as online pharmacies use a growing array of digital channels, including search engines, social media platforms, and the dark Web. In response, the US Food and Drug Administration convened a special June 2018 summit bringing together technology companies, government agencies, researchers, and advocacy groups with the goal of collaboratively developing and implementing solutions to tackle the problem. Yet after this meeting, stakeholders remain fragmented in approaches despite the availability of technology that can detect, classify, and report illicit sellers who are in direct violation of Federal law. Despite ongoing challenges, advances in data science and the resources and expertise technology companies can contribute will be a key factor in ensuring that the Internet helps end and not fuel the public health emergency of opioid abuse.
Computational urban design prototyping: Interactive planning synthesis methods—a case study in Cape Town
Authors: Miao Yufan , Koenig Reinhard , Knecht Katja , Konieva Kateryna , Buš Peter , Chang Mei-Chih
Published: September 2018

This article is motivated by the fact that in Cape Town, South Africa, approximately 7.5 million people live in informal settlements and focuses on potential upgrading strategies for such sites. To this end, we developed a computational method for rapid urban design prototyping. The corresponding planning tool generates urban layouts including street network, blocks, parcels and buildings based on an urban designer’s specific requirements. It can be used to scale and replicate a developed urban planning concept to fit different sites. To facilitate the layout generation process computationally, we developed a new data structure to represent street networks, land parcellation, and the relationship between the two. We also introduced a nested parcellation strategy to reduce the number of irregular shapes generated due to algorithmic limitations. Network analysis methods are applied to control the distribution of buildings in the communities so that preferred neighborhood relationships can be considered in the design process. Finally, we demonstrate how to compare designs based on various urban analysis measures and discuss the limitations that arise when we apply our method in practice, especially when dealing with more complex urban design scenarios.
SRS in Combination With Ipilimumab: A Promising New Dimension for Treating Melanoma Brain Metastases
Authors: Khan Muhammad , Lin Jie , Liao Guixiang , Tian Yunhong , Liang Yingying , Li Rong , Liu Mengzhong , Yuan Yawei
Published: September 2018

Stereotactic radiosurgery provides effective local control, but high recurrence rate are observed while ipilimumab have shown promising improvements in survival in the treatment of melanoma brain metastases. This meta-analysis was done to review the clinical evidence regarding the combination of stereotactic radiosurgery and ipilimumab in the treatment of brain metastases from melanoma. Comprehensive research of the electronic databases (PubMed and Cochrane Library) was carried out in April 2017. Different combination of MESH headings and words were used. Review Manager was used to analyze the outcome data of interest. According to heterogeneity, fixed effects model or random effects model was adapted. Six retrospective studies comparing stereotactic radiosurgery plus ipilimumab with stereotactic radiosurgery alone were found. Total of 411 participants were included in this meta-analysis. Of that, 128 patients had received stereotactic radiosurgery + ipilimumab, while 283 patients had received stereotactic radiosurgery only. Stereotactic radiosurgery plus ipilimumab significantly improved survival when compared to stereotactic radiosurgery alone (hazard ratio: 0.74 [95% confidence interval: 0.56-0.99, P = .04]), with no significant increase in the incidence of adverse events (odds ratio 0.57 [95% confidence interval: 0.28-1.17, P = .12]). Stereotactic radiosurgery with ipilimumab is safe and effective treatment option and can be recommended for the treatment of brain metastases in patients with melanoma.
Mycotic Aortic Aneurysm and Infected Aortic Graft After Intravesical Bacillus Calmette-Guérin Treatment for Bladder Cancer
Authors: Lareyre Fabien , Reverso-Meinietti Julie , Carboni Joseph , Gaudart Alice , Hassen-Khodja Réda , Raffort Juliette
Published: September 2018

Although intravesical therapy with bacillus Calmette-Guérin (BCG) has proven its efficiency in the treatment of early-stage bladder cancer, infectious complications can occur and mycotic aneurysms represent a rare but life-threatening complication. Here, we report the case of an aortic graft infection in a patient with abdominal aortic aneurysm who received BCG instillations for the treatment of bladder cancer. Based on the current knowledge on this rare vascular complication, we discuss factors that may have contributed to its occurrence and review issues to optimize its management and early detection.
Biological Consequences of Exposure to Mechanical Vibration
Authors: Bernardo-Filho Mario , Bemben Debra , Stark Christina , Taiar Redha
Published: September 2018

A special issue of the journal Dose-Response entitled “Biological Consequences of Exposure to Mechanical Vibration” is proposed. When there is the interaction of physical agents, such as mechanical vibration to a body, physiological stress can be generated leading to expected and unexpected consequences. The aim is to describe effects due to the stress generated by the energy delivered in biological systems by mechanical vibration produced by different sources through studies involving human beings and experimental models. The evaluation of effects in molecular, cellular, and systemic level will contribute to increase the medical and biological knowledge about the interaction of mechanical vibration, as well as the understanding of the stress and mechanisms of the biological responses of the mechanical vibrations. The main topics will be related to neurophysiological responses to mechanical vibration generated in different sources, clinical approaches of the mechanical vibration generated in oscillating/vibratory platform, undesirable effect of the mechanical vibration generated in oscillating/vibratory platform, mechanical vibration in occupational activities, biological effects of ultrasound and infrasound, and quantification and physical approaches of the mechanical vibration.
Free vibration and chatter stability of a rotating thin-walled composite bar
Authors: Ma Jingmin , Ren Yongsheng
Published: September 2018

The free vibration and chatter stability of a rotating thin-walled composite bar under the action of regenerative milling force were investigated in this article. The free vibration equations of the rotating thin-walled composite bar were presented and solved by the Galerkin method according to the derived Lagrange equation for the rotating thin-walled composite bar, and the influences of the taper ratio, ply angle, and mode number on the first natural frequency were analyzed. In order to study the chatter stability of the rotating thin-walled composite bar, the time-delay motion equation of the system was derived with consideration of the effects of regenerative milling force and internal/external damping. The two-mode Galerkin method was used to discretize the time-delay free vibration equations, and the semi-discrete method in the time domain was employed to predict the stability lobes. Finally, the correctness of the method was validated, and the stability analysis of the rotating thin-walled composite bar was conducted. Emphatically, the influences of the ply angle, taper ratio, and internal/external damping on the chatter stability of the rotating thin-walled composite bar were analyzed.
Slug rivet assembly modeling and effects of procedure parameters on the quality of riveted lap joints
Authors: Lei Changyi , Bi Yunbo , Li Jiangxiong , Ke Yinglin
Published: September 2018

Slug rivet interference-fit riveting is one of the advanced connection technologies which has been widely applied in aerospace manufacture. This article presents an appropriate numerical model simulating the slug rivet upset process with countersunk hole structure. Many previous studies have focused on the riveted lap joints without countersunk hole structure and ignored its related process parameters. The main difference is that the hole expansion would be inhomogeneous through the thickness direction due to the impact of countersunk hole. To improve the riveting quality and reduce the inhomogeneity scale of the interference distribution, the effects of two procedure parameters have been assessed. The analysis results significantly improve knowledge about the slug rivet installation process as well as the effects of the corresponding process parameters. The study will pave the way for further investigations.
Fluticasone furoate/vilanterol 92/22 µg once a day: a 12-month study on outcomes in mild to moderate asthma
Authors: Dal Negro Roberto W. , Bonadiman Luca , Turco Paola
Published: September 2018

Background:

Fluticasone furoate/vilanterol (FF/V) is an effective long-acting β2 agonist/inhaled corticosteroid combination for managing persistent bronchial asthma. The aim of the study was to assess the outcomes achievable in patients with mild to moderate asthma receiving FF/V 92/22 µg once daily for 12 months.

Methods:

Data were automatically and anonymously obtained from the institutional database: forced expiratory volume in 1 s predicted values; the exacerbation and hospitalization rates; days of hospitalization; general practitioner (GP) or specialist visits; days of inactivity; courses of systemic steroids or antibiotics were recorded at baseline and after 3, 6 and 12 months of treatment. The overall adherence to treatment was also calculated. Analysis of variance was used for checking the trends of variables. The improvement in lung function was significant ( p < 0.001) and time dependent. The mean (±standard error) exacerbation rate per patient changed from 1.05 (±0.16) at baseline to 0.28 (±0.07) after 3 months, 0.33 (±0.08) after 6 months and 0.18 (±0.08) after 12 months ( p < 0.001). The mean hospitalization rate per patient changed from 0.30 (±0.07) at baseline to 0.08 (±0.04) after 3 months, 0.10 (±0.05) after 6 months and 0.03 (±0.03) after 12 months ( p < 0.001). Also mean duration of hospitalization and days of inactivity were reduced over time ( p < 0.001). GP visits were also reduced, together with specialist visits (both p < 0.001). Steroid and antibiotic courses dropped significantly ( p < 0.001 and p < 0.001, respectively). Moreover, changes in all outcomes considered proved time dependent, particularly over the second semester. Finally, over time, adherence to treatment was high.

Conclusions:

The once-daily inhalation of combined FF/V 92/22 µg optimized systematically the exacerbation and hospitalization rates in mild to moderate asthma, together with all other outcomes over time. The effectiveness of FF/V 92/22 µg once daily proved to be time dependent over the period of the study.
New strategies in immunotherapy for lung cancer: beyond PD-1/PD-L1
Authors: Villanueva Nicolas , Bazhenova Lyudmila
Published: September 2018

Immunotherapy has significantly altered the treatment landscape for many cancers, including non-small cell lung cancer (NSCLC). Currently approved immuno-oncology agents for lung cancer are aimed at the reversal of immune checkpoints, programmed death protein-1 (PD-1) and programmed death ligand-1 (PD-L1). Although responses to checkpoint inhibitors are encouraging, and in some cases durable, these successes are not universal among all treated patients. In order to optimize our treatment approach utilizing immunotherapy, we must better understand the interaction between cancer and the immune system and evasion mechanisms. In this review, we will provide an overview of the immune system and cancer, and review novel therapies that promote tumor antigen release for immune system detection, activate the effector T-cell response, and reverse inhibitory antitumor signals.
Neurological complications of immune checkpoint inhibitors: what happens when you ‘take the brakes off’ the immune system
Authors: Dalakas Marinos C.
Published: September 2018

Patients with advanced malignancies treated with immune checkpoint inhibitors are at increased risk for developing immune-related neurological complications. It is a phenomenon of immunological twist when immunotherapy against co-stimulatory molecules activates previously normal T cells to kill tumor cells but, in so doing, the T cells become unrestrained, triggering other autoimmune diseases for which conventional immunotherapy is needed. The most common autoimmune neurological diseases, usually occurring within 2–12 weeks after immune checkpoint inhibitor initiation, include: inflammatory myopathies, myasthenia gravis, acute and chronic demyelinating polyradiculoneuropathies, vasculitic neuropathies, isolated cranial neuropathies, aseptic meningitis, autoimmune encephalitis, multiple sclerosis and hypophysitis. The neurological events can evolve rapidly, necessitating the need for vigilance at all stages of treatment, even after completion, because early immunotherapeutic interventions are effective. The review addresses these complications and the applied therapies, discusses immune pathomechanisms including triggering preexisting autoimmunity, highlights the distinction between paraneoplastic and autoimmune etiologies, and identifies uncertainties regarding risk factors, use of immune checkpoint inhibitors in patients with known immune diseases or restarting therapy after a neurological event. Although the autoimmune neurological complications are not very common, their incidence will likely increase as the use of immune checkpoint inhibitors in metastatic cancer is growing rapidly.
Genetic Diversity and Structure of Syagrus romanzoffiana (Cham.) Glassman (Arecaceae) in Southern Brazil
Authors: Laindorf Bruna L. , de Freitas Karine E. J. , Lucini Fabiola , Stefenon Valdir M. , Küster Mariele C. T. , Schünemann Adriano L. , Putzke Jair , Victória Filipe C. , Pereira Antonio B.
Published: September 2018

The species Syagrus romanzoffiana is a monocot belonging to the family Arecaceae; it is a palm endemic to South America and is widely distributed throughout the southeast and south of Brazil, including the State of Rio Grande do Sul. To estimate the genetic diversity and structure of the species in the watersheds of Rio Grande do Sul, five simple sequence repeat markers were used to analyze 90 individuals, representing three populations. The genetic structure of S. romanzoffiana groups was evaluated through the analysis of molecular variance and a multivariate analysis based on Nei’s genetic distance. The evaluated populations showed significant intrapopulation molecular variation ( FST = 0.11). The observed heterozygosity ( HO = 0.17) was lower than the expected heterozygosity ( HE = 0.75). These data indicate that although the number of individuals is high, the diversity is low for some indices. Our findings suggest that further studies are needed, particularly on the genetics of natural populations of S. romanzoffiana in Rio Grande do Sul State, to fully characterize their genetic diversity and structure and determine strategies and priority areas for species conservation.
Assessment of Attractants for Neotropical Mammals
Authors: de Oliveira Barbosa Duarte Herbert , Norris Darren , Michalski Fernanda
Published: September 2018

Mammals play important ecological roles in tropical regions but are difficult to study due to discrete habits, low population densities, and large home ranges. Thus, the use of attractive substances has frequently been adopted to quantify the distribution and abundance of elusive mammals. However, the insight generated from studies using attractants is often limited by a lack of methodological standardization. To inform the use of attractants in the Neotropics, we reviewed 30 years of the scientific literature that used some type of attractant in mammal studies. From a total of 60 studies, the majority (65%) did not use any control (or pseudocontrol) in their sampling design and only 40% used some statistical test to explicitly evaluate the efficiency of the attractant used. A wide range of edible (animal or vegetal origin) and inedible substances (e.g., scent lures) were used alone or in combination and the effects differed greatly among orders and species. Most studies (67%) targeted or registered carnivores, and this order had the largest number of substances (edible and inedible) used across all studies. There seems to be only a consensus in the use and attraction effect with frugivorous bats (Phyllostomidae) with fruits, essential oils, and floral compounds. The lack of standardization of use of attractants in mammal studies undermines the comparability of results among studies. We conclude with some general guidelines to maximize comparability among studies and to enhance the potential usefulness of the use of attractants for mammals.
Grassroots resource mobilization through counter-data action
Authors: Meng Amanda , DiSalvo Carl
Published: September 2018

In this paper, we document the counter-data action and data activism of a grassroots affordable housing advocacy group in Atlanta. Our observation and insight into these data activities and strategies are achieved through ethnographic and engaged research and participatory design. We find that counter-data action through community-collected data is rooted in a legacy of Atlanta’s black activism and black scholarship; that this data activism enabled resource mobilization and critical conscious making; and that design and media production are essential post counter-data action activities in data activism. Based on these findings, we urge the field of open government data to broaden their concept of social impact of data to include the use data to mobilize resources within oppressed communities not to influence policy and government but to build capacities within community in order to transform, not join, political structures. We also advocate that scholars within the fields of open government data, critical data studies, and data activism recognize the legacy and historic practice of data activism by black communities working towards social change.
Giving Voice to Officers Who Experienced Life-Threatening Situations in the Line of Duty: Lessons Learned About Police Survival
Authors: Pitel Marian , Papazoglou Konstantinos , Tuttle Brooke
Published: September 2018

Given the high-risk nature of police work, officers are often exposed to life-threatening critical incidents in the line of duty. The present study uses qualitative methods to explore the experiences of police officers ( n = 10) during and after life-threatening incidents as well as the strategies they utilized to cope with these experiences. In particular, the participants, who were all operational police officers during the index incidents, took part in in-depth, semi-structured interviews consisting of open-ended questions. These interviews were recorded, transcribed, verified, and then examined to identify themes, using Denzin’s approach for extracting interactional features between narratives. Several common themes between the officers’ stories were identified and organized into broader clusters of (a) experiences during life-threatening situations, (b) strategies utilized during life-threatening situations, (c) experiences after life-threatening situations, and (d) strategies utilized after life-threatening situations. Family, clinical, and organizational implications are discussed, with a unifying conclusion that highlights the importance of collaborative efforts to support officers in recovering from life-threatening situations. Finally, future research that (a) encourages studies of qualitative nature exploring the research questions with larger sample sizes and (b) investigates the interaction between family, clinical, and organizational sources of support is recommended.
Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study
Authors: Kobayashi Kazuyoshi , Ando Kei , Kato Fumihiko , Kanemura Tokumi , Sato Koji , Hachiya Yudo , Matsubara Yuji , Kamiya Mitsuhiro , Sakai Yoshihito , Yagi Hideki , Shinjo Ryuichi , Ishiguro Naoki , Imagama Shiro
Published: September 2018

Study Design:

Retrospective analysis of a prospectively database.

Objectives:

To identify factors associated with prolonged length of stay (LOS) in posterior /transforaminal lumbar interbody fusion (PLIF/TLIF).

Methods:

The subjects were patients who underwent PLIF/TLIF at 10 facilities from 2012 to 2014. A total of 1168 such patients with a mean age of 65.9 ± 12.5 years (range 18-87 years) were identified in the database. Operations were PLIF (n = 675), TLIF (n = 443), minimally invasive surgery (MIS)-PLIF (n = 22), and MIS-TLIF (n = 32). Age, gender, body mass index, ambulatory status, comorbidities, perioperative American Society of Anesthesiologists (ASA) grade, operative factors, and complications were examined. LOS was defined as the number of calendar days from the operation to hospital discharge. LOS was categorized as normal (<75th percentile) or prolonged (≥75th percentile).

Results:

The average LOS was 20.8 ± 9.8 days (range 7-77 days). There was a significant correlation between LOS and age ( P < .05). Reoperation during hospitalization was performed in 20 cases for surgical site infection (n = 12), epidural hematoma (n = 5), and screw misplacement (n = 3). In multivariate analysis, prolonged LOS was associated with preoperative variables of age ≥70 years (odds ratio [OR] 1.87, 95% CI 1.38-2.54), and ASA class ≥III (OR 1.52, 95% CI 1.04-2.25); surgical variables of open procedures (OR 5.84, 95% CI 1.74-19.63), fused levels ≥3 (OR 5.17, 95% CI 3.17-8.43), operative time ≥300 minutes (OR 1.88, 95% CI 1.15-3.07), and estimated blood loss ≥500 mL (OR 1.71, 95% 1.07-2.75).

Conclusions:

The factors identified in this study should help with obtaining informed consent, surgical planning and complication prevention to reduce health care costs associated with prolonged LOS.
Sports Hernia/Athletic Pubalgia Among Women
Authors: Zoland Mark P. , Iraci Joseph C. , Bharam Srino , Waldman Leah E. , Koulotouros John P. , Klein Devon
Published: September 2018

Background:

“Athletic pubalgia,” a term that has gained acceptance over “sports hernia,” is more common in men than women; however, it represents a significant source of morbidity for patients of both sexes. Inconsistent terminology surrounding this entity poses a diagnostic challenge and makes studying the populations at risk difficult.

Purpose:

To review a case series of women with athletic pubalgia by analyzing their presentations, concomitant pathologies, and surgical outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Between 2013 and 2016, 197 patients were seen and evaluated for the diagnosis of athletic pubalgia. Eighteen patients seen during this time were women. All patients received “pubalgia protocol” magnetic resonance imaging and subsequent surgical intervention for their pathologies. Outcomes among 17 women were assessed with a patient questionnaire >1 year after surgery.

Results:

Of the 17 women, 9 had rectus aponeurotic plate injury only, or pure athletic pubalgia; the remaining 8 had athletic pubalgia in combination with ≥1 inguinal, obturator, and femoral hernias. Regarding female patients in both groups, 88.2% reported that the surgery was a success at follow-up.

Conclusion:

Surgical repair of athletic pubalgia among women is successful in dramatically reducing pain levels in this important subset of patients.
General Practitioners’ Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients
Authors: Laursen Jannie , Kornholt Jonatan , Betzer Cecilie , Petersen Tonny S. , Christensen Mikkel B.
Published: September 2018

Purpose:

The aim of this study was to explore whether general practitioners (GPs) experienced barriers toward medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic.

Design:

The study was descriptive and exploratory and had a qualitative design with a phenomenological/hermeneutic orientation for the interviews.

Participants:

The study comprised 14 interviews with 14 different GPs from the Capital Region of Denmark.

Results:

Three themes emerged from the interviews: (1) The care of patients With polypharmacy is challenged by the lack of professional dialogue and collaboration between GPs and hospital-based clinical pharmacologists, (2) the relationship between the patients with polypharmacy and the GP is characterized by care and individual considerations, and (3) the culture encourages adding medication and inhibits dialogue about medication withdrawal even for patients with polypharmacy.

Conclusion and implications for practice:

This study found that the primary barriers toward multimorbid patients with polypharmacy were the need for communication and teamwork with specialists (cardiologists, neurologists, endocrinologists, etc). Often, GPs felt that the specialists at the hospitals were more concerned about following standards and guidelines regarding specific diseases instead of a more holistic patient approach. To improve management of polypharmacy patients, the GPs suggest that a joint force is necessary, a partner-like relationship with greater transparency regarding information transfer, feedback, and shared decision-making, but also more education in the pharmacological field is essential.
Comparison of reversal activity and mechanism of action of UHRA, andexanet, and PER977 on heparin and oral FXa inhibitors
Authors: Kalathottukaren Manu T. , Creagh A. Louise , Abbina Srinivas , Lu Genmin , Karbarz Mark J. , Pandey Anjali , Conley Pamela B. , Kizhakkedathu Jayachandran N. , Haynes Charles
Published: September 2018

Key Points

Anticoagulant therapy–associated bleeding is a concern; a specific antidote is needed for emergency reversal of anticoagulant activity. Thermodynamic, electron microscopic, and clotting studies reveal distinct mechanisms of action for 3 different antidotes in development.
TREM-like transcript 1: a more sensitive marker of platelet activation than P-selectin in humans and mice
Authors: Smith Christopher W. , Raslan Zaher , Parfitt Lola , Khan Abdullah O. , Patel Pushpa , Senis Yotis A. , Mazharian Alexandra
Published: September 2018

Key Points

Platelet activation in vitro results in a more rapid and greater upregulation of TLT-1 surface expression compared with P-selectin. TLT-1 is more rapidly translocated to the surface of activated platelets than P-selectin during thrombus formation in vivo.
Characterization of Tfrc-mutant mice with microcytic phenotypes
Authors: Conway Ashlee J. , Brown Fiona C. , Rank Gerhard , Kile Benjamin T. , Morton Craig J. , Jane Stephen M. , Curtis David J.
Published: September 2018

Key Points

Novel Tfrc-mutant mouse identified in ENU mutagenesis screen with stable receptor expression. Flow imaging cytometry demonstrates microcytosis in mutants derives from dysfunctional receptor-mediated endocytosis of Tf-TfR complex.
Inter-α inhibitor proteins maintain neutrophils in a resting state by regulating shape and reducing ROS production
Authors: Htwe Soe Soe , Wake Hidenori , Liu Keyue , Teshigawara Kiyoshi , Stonestreet Barbara S. , Lim Yow-Pin , Nishibori Masahiro
Published: September 2018

Key Points

IAIP, but not bikunin, maintains spherical shape, small size, and smooth surface of human neutrophils and supports capillary passage. IAIP reduced ROS production from neutrophils in a concentration-dependent manner probably through the p47phox phosphorylation on Ser328.
Complement-mediated thrombotic microangiopathy associated with lupus nephritis
Authors: Park Mi Hee , Caselman Nicholas , Ulmer Scott , Weitz Ilene Ceil
Published: September 2018

Key Points

CM-TMA is a unique subset of patient with LN. CM-TMA in LN is responsive to complement inhibition with eculizumab.
Severe aplastic anemia: allogeneic bone marrow transplantation as first-line treatment
Authors: Georges George E. , Doney Kris , Storb Rainer
Published: September 2018

Treatment of severe aplastic anemia has improved significantly over the past 4 decades. This review will summarize the key areas of progress in the use of allogeneic hematopoietic cell transplantation and nontransplant immunosuppressive therapy (IST) for the treatment of aplastic anemia and then summarize the recommendations for first-line treatment. Based on recent data, we argue that guidelines for the initial treatment of patients with newly diagnosed severe aplastic anemia require revision. At the time of diagnosis, before beginning treatment, HLA typing should be done to identify a marrow donor among family members or in the unrelated donor registries, and a marrow transplant should be considered first-line therapy. The priority order of donor source for bone marrow transplantation is: (1) HLA-identical sibling, (2) HLA-matched unrelated donor, and (3) HLA-haploidentical donor if an HLA-matched unrelated donor is not rapidly available. Each of these donor marrow sources may be preferable to nontransplant IST. We make this recommendation because of the long-term persistent risk for disease relapse and secondary myelodysplastic syndrome or acute myeloid leukemia with the use of nontransplant IST for patients with aplastic anemia. In contrast, marrow transplantation is associated with high cure rates of aplastic anemia and a relatively low risk for graft-versus-host disease, with many patients now living for decades without the risk for disease recurrence or the development of clonal disorders. Implementation of this first-line treatment strategy will provide patients with severe aplastic anemia the best chance of long-term disease-free survival.