bluuebunny/crossref_metadata_2025 huggingface dataset:
A mixed methods research toward a framework of a maintenance management model
Authors: Naji Amal , EL Oumami Mohamed , Bouksour Otmane , Beidouri Zitouni
Published: September 2019

Purpose

The purpose of this paper is to provide a picture of the maintenance management status in a sample of Moroccan industries through highlighting the most impacting factors. A preliminary framework of a maintenance management model is proposed on the basis of the study findings.

Design/methodology/approach

A mixed methods research (MMR), including qualitative and quantitative independent studies, was conducted in a sample of Moroccan industries. The process of collecting data involved submission of questionnaires to industrial managers and on-site visits. Analyzing case studies and correlations between maintenance factors were used to define the status of maintenance management. The preliminary framework of a maintenance management model was presented through a basic graph.

Findings

The surveyed companies have three levels of maintenance management: inner, medium and good. The most impacting maintenance factors include the top management policy and maintenance department approach. Most of the companies surveyed do not have an overall maintenance model, as most of decisions are based on random factors rather than the data analysis approach. The preliminary framework of maintenance management model involves the main factors with recommendations to improve maintenance management performance.

Research limitations/implications

The sample in this study is limited to seven companies in the qualitative study and thirty-one companies in the quantitative study. The informants are the industrial managers of those companies. In order to apply this maintenance model in industry, an advanced version of this model is to be developed through providing key performance indicators (KPI) and an implementation process for each factor, including other participants in the companies from top management and operational levels.

Practical implications

The study may contribute to assess maintenance management and to develop a framework of maintenance management models in industries, especially when no previous basic study was conducted in a specific context.

Originality/value

The original contribution of this paper is using MMR to develop a preliminary framework of a maintenance management model. This methodology aims to narrow the gap between academic studies and maintenance management in industries.
Dorothea Lange
Authors: Hubbard Janie
Published: September 2019

Purpose

Dorothea Lange was one of the first US documentary photographers, and she was empowered by the belief that seeing the effects of injustice, in photographs, could elicit social and political reform. She famously documented the plight of Dust Bowl migrants during the US. Great Depression and harsh difficulties endured by incarcerated Japanese Americans during the Second World War. Lange’s photographs brought suppressed issues of class and race to the surface, depicting those impacted by national tragedies into recognizable, honorable, determined individuals. By showing Americans how suffering and injustice look in real life, she stimulated empathy and compassion. This inquiry is not particularly about the Great Depression or Japanese Internment, though disciplinary concept lessons would certainly support students’ prior knowledge. This lesson focuses students’ attention on broader ideas regarding social justice and how social and political documentary photography transform people’s views about distressing problems, even today. Supporting questions are: How can deep analysis of photographs affect our thoughts and emotions about social issues? What is empathy? How can social documentary photography affect people’s emotions? Supporting questions guide students to answer the greater compelling question, How can visuals, such as photographs, impact social change? The paper aims to discuss these issues.

Design/methodology/approach

This is an inquiry lesson plan based on a National Council for the Social Studies Notable Trade book for Young People award winner, Dorothea’s Eyes, written by Barb Rosenstock.

Findings

The paper is a lesson plan, which incorporates students’ analyses of primary sources and other research methods to engage the learner in understanding how Dorothea Lange helped change perspectives regarding the need for social and political reform. Though the story is historic, similar social justice topics still persist, worldwide, today.

Originality/value

Through inquiry and research, students begin to learn how social and political documentary photography began in the USA, and students create their own social documentaries. Though the US Great Depression and Japanese Internment are highly relevant within this lesson, the overall, greater message is about class, race, suffering and how to inspire empathy.
Dectin‐2‐mediated signaling triggered by the cell wall polysaccharides of Cryptococcus neoformans
Authors: Tanno Daiki , Yokoyama Rin , Kawamura Kotone , Kitai Yuki , Yuan Xiaoliang , Ishii Keiko , De Jesus Magdia , Yamamoto Hideki , Sato Ko , Miyasaka Tomomitsu , Shimura Hiroki , Shibata Nobuyuki , Adachi Yoshiyuki , Ohno Naohito , Yamasaki Sho , Kawakami Kazuyoshi
Published: September 2019

Cryptococcus neoformans is rich in polysaccharides of the cell wall and capsule. Dectin‐2 recognizes high‐mannose polysaccharides and plays a central role in the immune response to fungal pathogens. Previously, we demonstrated Dectin‐2 was involved in the activation of dendritic cells upon stimulation with C. neoformans, suggesting the existence of a ligand recognized by Dectin‐2. In the present study, we examined the cell wall structures of C. neoformans contributing to the Dectin‐2‐mediated activation of immune cells. In a NFAT‐GFP reporter assay of the reported cells expressing Dectin‐2, the lysates, but not the whole yeast cells, of an acapsular strain of C. neoformans (Cap67) delivered Dectin‐2‐mediated signaling. This activity was detected in the supernatant of β‐glucanase‐treated Cap67 and more strongly in the semi‐purified polysaccharides of this supernatant using ConA‐affinity chromatography (ConA‐bound fraction), in which a large amount of saccharides, but not protein, were detected. Treatment of this supernatant with periodic acid and the addition of excessive mannose, but not glucose or galactose, strongly inhibited this activity. The ConA‐bound fraction of the β‐glucanase‐treated Cap67 supernatant was bound to Dectin‐2‐Fc fusion protein in a dose‐dependent manner and strongly induced the production of interleukin‐12p40 and tumour necrosis factor‐α by dendritic cells; this was abrogated under the Dectin‐2‐deficient condition. Finally, 98 kDa mannoprotein (MP98) derived from C. neoformans showed activation of the reporter cells expressing Dectin‐2. These results suggested that a ligand with mannose moieties may exist in the cell walls and play a critical role in the activation of dendritic cells during infection with C. neoformans.
Difficulties and reasonable adjustments carried out by Spanish faculty members to include students with disabilities
Authors: Moriña Anabel , Perera Víctor H. , Melero Noelia
Published: September 2019

This study focuses on the experience of 20 Spanish faculty members who teach students with disabilities. We conducted semi‐structured individual and group interviews, and analysed the data using an inductive system of categories and codes. The results of this work describe the difficulties that faculty members encountered when including students with disabilities, and how they attended, through reasonable adjustments, to the educational needs of their students. Their testimonies produced a profile of professionals who recognise their own shortcomings while valuing the actions that they have undertaken in order to meet the needs of their students. From their perspective, these actions were more closely linked to their own willingness and the students’ efforts than to the training they had received on disability. In this sense, the present study shows that universities must provide more meaningful training in the field of disability and make firm institutional commitments to supporting their faculty members.
Microencapsulation of Saffron Petal Phenolic Extract: Their Characterization, In Vitro Gastrointestinal Digestion, and Storage Stability
Authors: Ahmadian Zahra , Niazmand Razieh , Pourfarzad Amir
Published: September 2019

Saffron petal, as a byproduct of saffron processing, contains a considerable amount of antioxidant compounds. In the present study, the effect of drying methods (spray and freeze) and different wall structures (maltodextrin and pectin) was investigated on the physicochemical characteristics of microcapsules of saffron petal extracts. Results showed that the increase of the pectin ratio in wall composition leads to the increase of polyphenols content and antioxidant activity of microcapsules. Microencapsulation efficiency and loading capacity in pectin‐contained samples were higher than pure maltodextrin samples. Moreover, microcapsules obtained from spray drying method had higher microencapsulation efficiency and loading capacity in comparison with microcapsules obtained from freeze drying method. Also, scanning electron microscopy, X‐ray diffraction, and differential scanning calorimetry have been shown to be useful tools for establishing the difference between produced microcapsules. High‐performance liquid chromatography was used to evaluate the polyphenolic compounds of the microsphere. The chromatograms obtained from both encapsulation methods indicated high levels of routine in microcapsules of saffron petal extract. In addition, the release of polyphenols from microcapsules of saffron petal extract was evaluated under simulated gastrointestinal conditions. The results indicated that the release behavior of the microcapsules varied according to the type of drying method and wall composition. To assess the shelf life, the microcapsules were kept at different temperatures and relative humidities for 16 weeks. The microcapsules produced by freeze drying and containing high levels of pectin in wall composition had the highest antioxidant activity when kept in relative humidity of 11% and temperature of 4 °C.

Practical Application

Saffron petal is the huge amount of saffron by‐product and contains a number of various antioxidant compounds. Microencapsulation of its valuable compounds results in preventing the destruction of these compounds by environmental factors and their increased bioavailability. Indeed, this paper focuses on the release of microencapsulated powder in the simulated system of the digestive system that helps us to improve the shelf life of the final product during the process and controlled release of compounds in the food and pharmaceutical industries.
Prospective, observational study of carbon dioxide gaps and free energy change and their association with fluid therapy following cardiac surgery
Authors: Mahendran Sajeev , Nguyen John , Butler Ethan , Aneman Anders
Published: September 2019

Background

Venoarterial carbon dioxide pressure (pv‐aCO2) and content (Cv‐aCO2) differences, including the ratio to arteriovenous oxygen content difference (Ca‐vO2), and free energy changes (−∆∆Ga‐v) may reflect tissue hypoperfusion. The associations with changes in cardiac output (CO) or oxygen consumption (VO2) following fluid bolus administration were investigated.

Methods

Single‐centre, observational study of 89 adult post‐operative cardiac surgical patients admitted to ICU. The pv‐aCO2, Cv‐aCO2 and their ratios to Ca‐vO2 as well as the −∆∆Ga‐v were determined before and after a 250‐500 mL fluid bolus using arterial, central venous and mixed venous blood gas analyses. Responses associated with changes ≥ or <15% in CO or oxygen consumption (VO2) were compared.

Results

In 234 boluses, the mixed venous to arterial pv‐aCO2 and its ratio to Ca‐vO2 were independently associated with an increase in CO; odds ratio 1.3 (95% CI 1.1‐1.5) and 1.7 (95% CI 1.5‐1.9) respectively, P < .001) and VO2; odds ratio 2.1 (95% CI 1.3‐3.1), P < .001 for Ca‐vO2. No measures of pv‐aCO2, Cv‐aCO2 or related ratios to the Ca‐vO2 were associated with an increase in CO ≥15% following a single volume bolus. The mixed venous and central venous Cv‐aCO2 to Ca‐vO2 ratios were different for the first bolus episode only; mean differences 0.81 (95% CI 0.13‐1.5), P = .02 and 0.44 (95% CI 0.06‐0.82), P = .02, respectively, for increased VO2 ≥ 15%. The −∆∆Ga‐v did not change.

Conclusion

The venoarterial carbon dioxide gradients and related calculations to assess the adequacy of tissue perfusion before a fluid bolus were not associated with subsequent increases in CO of oxygen consumption.

Editorial Comment

In some shock conditions, regional tissue hypoperfusion can be obvious and arterio‐venous differences for CO2 or O2 may reflect this. This is not always the case; sometimes there are A‐V differences or even a high lactate level without any obvious regional tissue hypoperfusion. Fluid therapy is a cornerstone in shock resuscitation treatment, but determining optimal fluid therapy is challenging, particularly as fluid overload may be detrimental. Fluid challenges are used as an “ex juvantebus” method to dose fluid therapy, but it is not clear if a positive response reflects a state of hypoperfusion or the existence of a cardiac reserve. Still, a better understanding on how to target and guide fluid therapy is welcome, and studies digging into the problem are needed. Here, invasively monitored post‐operative cardiac surgery patients are assessed as a model to investigate if carbon dioxide gaps and free energy charge may be useful in detecting possible tissue hypoperfusion.
Unobserved ties between corporate executives and mutual fund managers
Authors: Lin Jing , Ling Leng , Zhou Mingshan
Published: September 2019

After corporate executives relocate from origin firms to destination firms, only 3.6 percent of mutual fund managers follow the departing executives: they divest from origin firms while initiating investments in destination firms. This phenomenon is more pronounced for those funds that earned superior returns from investments in the origin firms, and that demand more information regarding the destination firms. Further, comigration funds’ holding changes in destination firms more accurately predict cumulative abnormal returns around earnings announcements than do their investments in other stocks and non‐comigration funds’ new investments. Hiring the migrating executives does not improve the destination firms’ operating performance.
Response to the reader
Authors: Vannini Phillip , Vannini April S.
Published: September 2019

In this short rebuttal of the reader's response, we reiterate the main arguments driving our original paper.
Health monitoring of young children with Down syndrome: A parent‐report study
Authors: Mengoni Silvana E. , Redman Sandra
Published: September 2019

Accessible summary

Young children with Down syndrome often have serious health conditions, such as heart or thyroid problems.

It is important that health professionals follow guidelines to make sure that these health conditions are diagnosed and treated.

We asked parents of children with Down syndrome aged 0–5 years whether their child had received health care as set out in the guidelines.

Parents reported that guidelines were mostly followed at birth and for diagnosed health conditions. Guidelines were less likely to be followed after birth and for checking for undiagnosed health conditions.

Background

Children with Down syndrome have an increased risk of serious health conditions, particularly in early childhood. Published guidelines promote the identification and monitoring of health issues and adherence could reduce health inequalities, yet there is limited research about the extent to which health monitoring occurs as recommended. This study aimed to investigate the health monitoring of children with Down syndrome aged 0–5 years in the UK.

Materials and Methods

Twenty‐four parents of children with Down syndrome with a mean age of 32 months (10–65 months) participated. They completed a questionnaire about their child's healthcare usage, diagnoses of health conditions and whether health checks had been completed at birth and since birth. The results of the questionnaires were charted and compared to the schedule of checks produced by the Down Syndrome Medical Interest Group UK.

Results

Children with Down syndrome had high usage of health services and reported significant health issues. There was high adherence to published guidelines for the majority of health checks at birth, although 38% of children had not received all recommended checks. Not all health domains had been monitored since birth for all children, particularly breathing and blood (excluding thyroid). With the potential exception of sleep apnoea, diagnosed conditions appeared to be monitored.

Conclusions

This study suggests that health monitoring after birth and screening for nondiagnosed health conditions is variable for children with Down syndrome. Further research should examine convergence of these findings with medical records and clinicians' experiences across the UK.
Acellular mineralized allogenic block bone graft does not remodel during the 10 weeks following concurrent implant placement in a rabbit femoral model
Authors: Cohen D. Joshua , Scott Kayla M. , Kulkarni Aniket N. , Wayne Jennifer S. , Boyan Barbara D. , Schwartz Zvi
Published: September 2019

Objectives

Due to bone loss, endosseous implants often require addition of a bone graft to support adequate primary fixation, bone regeneration, and osseointegration. The aim of this study was to compare effectiveness of autogenic and allogenic bone grafts when used during simultaneous insertion of the implant.

Materials and Methods

4‐mm‐diameter rabbit diaphyseal bone autografts or allografts (n = 16/group) with a 3.2‐mm pre‐drilled hole in the center were placed into a 4 mm defect in the proximal femur of 3.5 kg male New Zealand White rabbits. Machined 3.2 × 10 mm grit‐blasted, acid‐etched titanium–aluminum–vanadium (Ti6Al4V) implants were placed. Control implants were placed into progressively drilled 3.2‐mm holes in the contralateral limbs. Post‐insertion day 70, samples were analyzed by micro‐CT and calcified histology, or by mechanical torque and push‐out testing followed by decalcified histology.

Results

Both grafts were integrated with the native bone. Micro‐CT showed less bone volume (BV) and bone volume/total volume (BV/TV) in the allograft group, but histology showed no differences in BV or BV/TV between groups. Allograft lacked living cells, whereas autograft was cellularized. No difference was found in maximum removal torque between groups. Compressive loading at the graft‐to‐bone interface was significantly lower in allograft compared with autograft groups.

Conclusions

There was less bone in contact with the implant and significantly less maximum compressive load in the allograft group compared with autograft. The allograft remained acellular as demonstrated by empty lacunae. Taken together, block allograft implanted simultaneously with an implant produces a poorer quality bone compared with autograft.
Factors associated with skin cancer in lung transplant recipients: A single‐center experience
Authors: Elnahas Shaimaa , Olson Michael T. , Kang Paul , Panchanathan Roshan , Masuda Takahiro , Walia Rajat , Zeitouni Nathalie C. , Smith Michael A. , Bremner Ross M.
Published: September 2019

Background

Skin cancer is common after solid organ transplantation, but few have investigated it after lung transplant (LTx).

Objective

We assessed incidence and predictors of non‐melanoma skin cancer (NMSC) post‐LTx.

Methods

We studied patients who underwent LTx at our center from 2012 to 2015.

Results

Of 287 patients, mean age was 59.6 ± 11 years, 170 (59.2%) were men, and 231 (80.5%) were white. Seventy‐six (26.5%) developed NMSC over a median follow‐up of 32 months (IQR, 23‐45). Of those with NMSC, 37% developed subsequent skin cancer of the same type. Independent predictors of decreased odds of NMSC and squamous cell carcinoma (SCC) were non‐white race (P = .002; P = .003) and body mass index >30 kg/m2 compared with underweight patients (P = .001, P = .009). Patients with skin cancer pre‐LTx had higher risk of post‐LTx skin cancer (P = .02). Voriconazole use ≥100 days was associated with increased risk of SCC (P = .03), but not increased risk of basal cell carcinoma. Out of 76, 4 (5.3%) died from skin cancer.

Limitations

Retrospective, single‐center study.

Conclusion

Squamous cell carcinoma risk post‐LTx may increase with prolonged voriconazole use in white patients with pre‐LTx history of skin cancer, whereas excess body weight may be protective from NMSC. Regular pre‐ and post‐LTx skin cancer screenings and guidelines are warranted.
How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors
Authors: Nakayama Atsushi , Kato Motohiko , Takatori Yusaku , Shimoda Masayuki , Mizutani Mari , Tsutsumi Koshiro , Kiguchi Yoshiyuki , Akimoto Teppei , Sasaki Motoki , Mutaguchi Makoto , Takabayashi Kaoru , Maehata Tadateru , Ochiai Yasutoshi , Kanai Takanori , Yahagi Naohisa
Published: September 2019

There are no reports on detailed endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors (SNADET) except for relatively small case series. Herein, we conducted a prospective observational study to investigate the relationship between endoscopic findings and histopathological diagnosis of SNADET. A total of 163 SNADET diagnosed using magnified endoscopic examination with image‐enhanced endoscopy (IEE‐ME) were prospectively registered in this study. We investigated location, size, macroscopic type, color, and IEE‐ME findings including surface structure (closed‐ or open‐loop) and presence of white opaque substance (WOS) in SNADET. We analyzed association between these findings and histopathological diagnosis of SNADET based on the Vienna classification (VCL) using logistic regression analysis. In univariate analysis, lesion size, superficial structure, and WOS deposition showed statistical significance, and the oral side of the lesion location showed statistical tendency for association with VCL C4/5. In multivariate analysis, lesion size (odds ratio [OR], 2.92; 95% CI, 1.94–4.39; P < 0.05) and negative WOS (OR, 5.59; 95% CI, 1.72–18.1; P < 0.05) were significantly associated with VCL C4/5 lesions. Superficial structures with a closed‐loop pattern on the surface showed statistical tendency for predicting VCL C4/5 lesions (OR, 2.15; 95% CI, 0.86–5.37; P = 0.10). Based on these findings, we concluded that negative WOS by IEE‐ME and lesion size were independent predictors of VCL C4/5 SNADET. These factors may help us to understand of pathophysiology of SNADET and to select appropriate therapeutic strategies.
South African International Migration and its Impact on Older Family Members
Authors: Marchetti‐Mercer Maria C. , Swartz Leslie , Jithoo Vinitha , Mabandla Nthopele , Briguglio Alessandra , Wolfe Maxine
Published: September 2019

In this article, we explore the impact of South African families’ emigration on parents/grandparents who must renegotiate their lives in their loved ones’ physical absence. We adopted a transnational perspective in a bigger qualitative project to consider both sides of the migratory spectrum. Here we focus on elderly family members who remain behind—a group largely neglected in prior research. Our findings illustrate the complex emotions and relational changes experienced by elderly people whose families emigrate. New technologies bridge distances, allowing new ways to connect and take care of each other, and of re‐imagining transnational relationships and what constitutes family life, but these bridges cannot negate the loss experienced by those remaining. People have to make sense of the emigration and forge new relational bonds with remaining family members. Our findings stress grandparents’ meaningful role in a family system and highlight some gendered and racial differences in families’ experiences.
Characterization of Familial and Sporadic Migraine
Authors: Ravn Julie , Chalmer Mona A. , Oehrstroem Emil L. , Kogelman Lisette J. A. , Hansen Thomas F.
Published: September 2019

Background

It is unknown whether clinical parameters differ between migraineurs with and without first‐degree family members with migraine.

Objectives

The present cross‐sectional study describes differences between familial and sporadic migraine with a focus on migraine characteristics, migraine severity, comorbidities, and treatment.

Method

From the Danish Headache Center we recruited 358 patients with familial migraine and 1727 patients with sporadic migraine. Each participant was assessed using a validated semi‐structured interview.

Results

No differences in age (Mean = 44 and 44 [SD = 12.28 and 12.58] for familial and sporadic migraineurs, respectively; P = .900) or sex (295/358 (82.4%) and 1413/1727 (81.8%) women in familial and sporadic migraineurs, respectively; P = .853) were found. Familial migraineurs had more aphasic aura than sporadic migraineurs (41% vs 27%, P = .001). Sporadic migraineurs had more lifetime attacks ie, >100 attacks (45% vs 70%, P < .001) and prolonged attacks ie, lasting >72 hours (5% vs 12%, P < .001) than familial migraineurs. Further, sporadic migraineurs had a higher incidence of concussions (37% vs 41%, P = .001) compared to familial migraineurs. In agreement with a previous study, there was no difference between familial and sporadic migraine regarding triptan response (84% vs 81%, P = .440).

Conclusion

Headache characteristics, triptan response, and comorbidities where similar in individulas with and without inherited migraine, suggesting that migraine are to be considered a hmogenoues disease. The difference in the clinical presentation of migraine with aura symptoms among patients with familial migraine should be considered in future studies. Further, more severe migraine among patients with sporadic migraine with aura could suggest that sporadic migraineurs have been exposed to stronger or multiple environmental factors and indicate that an early intervention in migraine treatment could lessen the severity of migraine.
Emulsifying properties of Ghanaian grewia gum
Authors: Kpodo Fidelis Mawunyo , Agbenorhevi Jacob Kwaku , Alba Katerina , Kontogiorgos Vassilis
Published: September 2019

Grewia gums were extracted with phosphate (PB) and sodium metabisulphite buffers (SMB) and their emulsification properties in acidic oil‐in‐water emulsions on ageing were studied by means of droplet size distribution, ζ‐potential measurements, interfacial composition analysis and viscometry. PB extracts showed smaller droplet sizes (~10 μm) than SMB isolates (>35 μm) and greater long‐term stability. PB‐stabilised emulsions also demonstrated the least polysaccharide (~0.6 mg m−2) and protein (~0.2 mg m−2) interfacial coverage compared with SMB counterparts (~1.5 mg m−2 for polysaccharide and ~ 1 mg m−2 for protein). ζ‐Potential measurements revealed negative interfacial charge for all emulsions confirming the presence of polysaccharide‐laden interfaces. Droplet size distribution also varied among emulsions during ageing indicating a complex relationship between interfacial composition and stability. The present work shows that different emulsifying properties may be obtained depending on the extraction technique employed that could be exploited in preparation of emulsions for flavour or bioactive‐delivery applications.
Perspectives and safety of horsemeat consumption
Authors: Balji Yuriy , Knicky Martin , Zamaratskaia Galia
Published: September 2019

In some countries, use of horsemeat as a food is inhibited by ethical and cultural concerns. However, horsemeat has potential health benefits, such as low fat and high unsaturated fatty acid content compared with other meats, as well as attractive sensory properties. Although there are many contradictory data on the dietary value in relation to human health, the effects of horsemeat have not been studied to a large extent. In this paper, we summarise existing knowledge on horsemeat quality and effects on human health. Our conclusion is that horsemeat may be consumed as a healthy alternative to other types of meat, provided that risks associated with microbial contamination during storage and possible presence of contaminants in horsemeat are taken into consideration. Future studies should evaluate the health‐promoting properties and safety of horsemeat and associated byproducts.
Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate
Authors: Enikeev Dmitry , Netsch Christopher , Rapoport Leonid , Gazimiev Magomed , Laukhtina Ekaterina , Snurnitsyna Olesya , Alekseeva Tatyana , Becker Benedikt , Taratkin Mark , Glybochko Petr
Published: September 2019

Objective

To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc).

Methods

A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score‐quality of life). Preoperative prostate volumes and prostate‐specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification.

Results

Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 ± 10.2 vs 39.9 ± 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate‐specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 ± 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 ± 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 ± 0.4 g/dL and 1.1 ± 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 ± 0.8 g/dL and 4.1 ± 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316).

Conclusions

Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate‐specific antigen decrease, indicating more complete removal of adenoma.
Optimal decision trees for the algorithm selection problem: integer programming based approaches
Authors: Vilas Boas Matheus Guedes , Santos Haroldo Gambini , Merschmann Luiz Henrique de Campos , Vanden Berghe Greet
Published: September 2019

Even though it is well known that for most relevant computational problems, different algorithms may perform better on different classes of problem instances, most researchers still focus on determining a single best algorithmic configuration based on aggregate results such as the average. In this paper, we propose integer programming‐based approaches to build decision trees for the algorithm selection problem. These techniques allow the automation of three crucial decisions: () discerning the most important problem features to determine problem classes, () grouping the problems into classes, and () selecting the best algorithm configuration for each class. To evaluate this new approach, extensive computational experiments were executed using the linear programming algorithms implemented in the COIN‐OR branch‐and‐cut solver across a comprehensive set of instances, including all MIPLIB benchmark instances. The results exceeded our expectations. While selecting the single best parameter setting across all instances decreased the total running time by 22%, our approach decreased the total running time by 40% on average across 10‐fold cross‐validation experiments. These results indicate that our method generalizes quite well and does not overfit.
Left bundle branch pacing from distal His‐bundle region by tricuspid valve annulus angiography
Authors: Hu Yiran , Gu Min , Hua Wei , Li Hui , Liu Xi , Niu Hongxia , Zhang Nixiao , Zhang Shu
Published: September 2019

A 78‐year‐old man presenting with amaurosis was admitted to the outpatient clinic 1 week ago. His baseline electrocardiogram showed Mobitz type II atrioventricular block and right bundle branch block. The patient's heart rate from Holter was only 32 bpm and therefore the indication for pacemaker implantation.
Cardiac resynchronization therapy restores muscular metaboreflex control
Authors: Spaggiari Caio V. , Kuniyoshi Ricardo R. , Antunes‐Correa Lígia M. , Groehs Raphaela V. , de Siqueira Sérgio F. , Martinelli Filho Martino
Published: September 2019

Introduction

The muscular metaboreflex, whose activation regulates blood flow during isometric and aerobic exercise, is blunted in patients with heart failure (HF), and cardiac resynchronization therapy (CRT) may restore this regulatory reflex.

Objective

To evaluate metaboreflex responses after CRT.

Methods

Thirteen HF patients and 12 age‐matched healthy control subjects underwent the following evaluations (pre‐ and post‐CRT implantation in the patient group): (a) heart rate, blood pressure, and forearm blood flow measurements; (b) muscle sympathetic nerve activity (MSNA) evaluation; and (c) peak oxygen consumption (VO2peak). Examinations were performed at rest, during moderate isometric exercise (IE), and during forearm ischemia (metaboreflex activation). The primary outcome was the increment in MSNA during limb ischemia compared to the rest moment (ΔMSNA rest to metaboreflex activation).

Results

After CRT, rest MSNA decreased in the HF participants: 50.4 ± 9.2 bursts/min pre‐CRT vs 34.0 ± 14.4 bursts/min post‐CRT, P = .001, accompanied by an improvement in systolic blood pressure and in rate‐pressure product. MSNA during limb ischemia decreased: 56.6 ± 11.5 bursts/min pre‐CRT vs 43.6 ± 12.7 bursts/min post‐CRT, P = .001, and the ΔMSNA rest to metaboreflex activation increased: 0% (interquartile range [IQR)], −7 to 9) vs 13% (IQR, 5‐30), P = .03. An augmentation of mean blood pressure during limb ischemia post‐CRT was noticed: 94 mmHg (IQR, 81‐104) vs 110 mmHg (IQR, 100‐117), P = .04. CRT improved VO2peak, and this improvement was correlated with diminution in ΔMSNA pre‐ to post‐CRT at rest moment (rs = ‐0.74, P = .006).

Conclusion

CRT provides metaboreflex sensitization and MSNA enhancement. The restoration of sympathetic responsiveness correlates with the improvement in functional capacity.
Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care
Authors: Nelson‐Brantley Heather , Buller Carol , Befort Christie , Ellerbeck Edward , Shifter Ariel , Ellis Shellie
Published: September 2019

Purpose

To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings.

Design

Scoping review of the literature.

Methods

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence‐Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies.

Findings

Four steps to ACP were specified: identification, conversation, documentation, and follow‐up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow‐up, providers expressed a desire for electronic reminders as a behavioral regulator to follow‐up.

Conclusions

While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight‐knit community might be important facilitators of ACP in rural primary care.

Clinical Relevance

Findings from this study can be used to accelerate ACP implementation in rural primary care.
Sequential peeling as a monotherapy for treatment of milder forms of acne vulgaris
Authors: Zayed Amira Amin , Sobhi Rehab Mohamed , El Aguizy Randa Mohamed Saleh , Sabry Dina , Mahmoud Sara Bahaa
Published: September 2019

Background

Glycolic acid (GA) and salicylic acid (SA) peels have been used separately for acne treatment, not as a sequential peel.

Aim

To evaluate the efficacy and safety of sequential peeling with 70% GA and 20% SA as a monotherapy and as an adjuvant to systemic doxycycline in treatment of mild to moderate acne and the effect on serum interleukin (IL) 17 and tissue IL‐1α.

Patients/Methods

Forty‐five mild to moderate acne vulgaris patients were randomly assigned into three groups. Group [A] underwent sequential application of 70% GA followed by 20% SA biweekly for three months. Group [B] underwent sequential peeling and doxycycline PO100 mg BD for 1 month followed by 100 OD for 2 months. Group [C] received oral doxycycline. Acne grading, lesion counting, and patient satisfaction were assessed. Serum samples and perilesional skin biopsies were obtained at onset and 2 weeks after finishing the treatment for assessment of serum IL‐17 and tissue IL‐1α.

Results

All groups showed statistically significant decrease in acne grading and lesion count, increase in patient satisfaction, and decrease in serum IL‐17 and tissue IL‐1 α after treatment. There was no significant difference between the 3 groups before or after treatment, except regarding patient satisfaction after treatment, which was significantly higher in groups [A] and [B] than group [C] (P = .001).

Conclusions

This study recommends using sequential GA 70% and SA 20% peels in the treatment of mild or moderate acne vulgaris as a new cost‐effective mode, with low‐down time and potential safety, in noncompliant patients on medical therapy.
Multiple oral cancer development—Clinico‐pathological features in the Hong Kong population
Authors: Choi Siu‐Wai , Thomson Peter
Published: September 2019

Background

Multiple squamous cell carcinoma (SCC) development within the oral cavity is an important consequence of mucosal field cancerization. We have previously profiled contemporaneous demographics and confirmed a rising incidence of oral cancer within the Hong Kong population. In this further study, we sought to characterize the presenting clinico‐pathological features and clinical outcome consequent upon multiple primary tumour (PT) development.

Methods

Having accessed the Hong Kong Hospital Authority (HA) database to identify new cases of oral SCC diagnosed during an 18‐year period (November 1999 to October 2018), specific clinico‐pathological data were retrieved for patients who developed multiple oral SCCs during the study period.

Results

Out of 6706 identified SCC cases, 769 patients (11.5%) developed multiple PTs, most commonly 2 (663) but 3 (91), 4 (12), 5 (2) and 6 (1) were also observed. The male to female ratio was 2.25 to 1 (P = .004), with female patients significantly older at first tumour presentation (P = .002), demonstrating longer periods before second PT development (P = .001) and better long‐term survival than males (P = .001). Buccal mucosa (143), oropharynx (134) and tongue (112) were the sites most frequently affected by second tumours. Whilst buccal SCC showed a propensity for subsequent buccal tumour development (60), oropharynx primaries developed second PTs most frequently on the tonsil (28) and tongue (27). Tongue primaries were associated with second PTs on the floor of mouth (61) and oropharynx (57).

Conclusion

Development of multiple oral cancers is a significant risk in Hong Kong, particularly for male patients. Following initial tumour management, regular and careful patient follow‐up is important for early recognition of multiple SCC development.
Effect of dietary l‐carnitine supplementation and energy level on oxidant/antioxidant balance in laying hens subjected to high stocking density
Authors: Çetin Ebru , Güçlü Berrin Kocaoğlu
Published: September 2019

This study aimed to investigate the effect of l‐carnitine and energy level and on oxidant/antioxidant balance in laying hens subjected to high stocking density. A total of 176, 32‐week‐old laying hens were assigned to eight groups with four replicates and hens in four groups were placed at the normal stocking densities of 500 cm2/hen (four hens per cage) and in the remaining four groups were placed at the high stocking densities of 287.5 cm2/hen (seven hens per cage). Hens received diets of high (2,850 kcal/kg ME) or normal (2,650 kcal/kg ME) energy which are supplemented with 0 or 200 mg/kg l‐carnitine for 70 days. Results showed that exposure to high stocking density increased (p < .05) plasma malondialdehyde (MDA) and nitric oxide (NO) levels and decreased (p < .05) erythrocyte superoxide dismutase (SOD), catalase (CAT) and superoxide dismutase (GPx) activities. l‐carnitine supplementation increased (p < .05) erythrocyte SOD, CAT and GPx activities, and decreased (p <.05) MDA and NO level in high stocking densities. The oxidan/antioxidan balance of birds was not influenced by increasing dietary energy level. The results of the present study indicate that the supplementation of l‐carnitine to the birds subjected to high stocking density could effectively reverse the negative effects of high stocking density by improving oxidant/antioxidant balance. Therefore, l‐carnitine supplementation at level of 200 mg/kg to diet may be as a favourable alternative to deal with oxidative stress caused by high stocking density in laying hens.
Metabolomics and microbial composition increase insight into the impact of dietary differences in cirrhosis
Authors: Cox I. Jane , Idilman Ramazan , Fagan Andrew , Turan Dilara , Ajayi Lola , Le Guennec Adrien D. , Taylor‐Robinson Simon D. , Karakaya Fatih , Gavis Edith , Andrew Atkinson R. , Williams Roger , Sikaroodi Masoumeh , Nizam Shahzor , Gillevet Patrick M. , Bajaj Jasmohan S.
Published: September 2019

Background & Aims

Dietary changes can modulate gut microbiota and interact with cirrhosis. Our prior study demonstrated that microbial diversity was higher in cirrhotics from Turkish vs the USA, which was associated with lower risk of 90‐day hospitalizations. We aimed to define gut microbial functional and metabolomic changes to increase insight into benefits of the Mediterranean compared to Western diets.

Methods

In all, 139 Turkish (46 controls/50 compensated/43 decompensated) and 157 American subjects (48 controls/59 compensated/50 decompensated) were studied. Turkish subjects consumed a modified Mediterranean diet with daily fermented milk intake, whereas Americans consumed a Western diet. Predicted gut microbial functionalities and plasma metabolomics were compared between/within countries. Correlation network differences between microbiota and metabolites in cirrhotics from Turkey vs the USA were evaluated.

Results

Predicted microbial function showed lower amino acid, bioenergetics and lipid pathways, with functions related to vitamin B, glycan, xenobiotic metabolism, DNA/RNA synthesis, in cirrhotics from Turkey compared to the USA. Plasma metabolomics demonstrated higher relative lactate levels in Turkey vs the USA. The metabolite changes in decompensated cirrhosis, compared to controls, showed similar trends in Turkey and the USA, with reduced lipids and phosphocholines. Phosphocholines were significantly lower in patients hospitalized in 90 days (P = .03). Correlation networks in cirrhotics demonstrated linkage differences between beneficial taxa, Blautia and Oscillispira, and lactate and unsaturated lipids, in Turkey compared to American patients.

Conclusions

A modified Mediterranean diet was associated with altered plasma metabolomics and beneficially alters microbiota functionality and correlations compared to Western diet in cirrhosis. These altered diet‐microbial interactions could potentially affect the 90‐day hospitalization risk.
ULTRAPETALA1 maintains Arabidopsis root stem cell niche independently of ARABIDOPSIS TRITHORAX1
Authors: Ornelas‐Ayala Diego , Vega‐León Rosario , Petrone‐Mendoza Emilio , Garay‐Arroyo Adriana , García‐Ponce Berenice , Álvarez‐Buylla Elena R. , Sanchez María de la Paz
Published: September 2019

During plant development, morphogenetic processes rely on the activity of meristems. Meristem homeostasis depends on a complex regulatory network constituted by different factors and hormone signaling that regulate gene expression to coordinate the correct balance between cell proliferation and differentiation.

ULTRAPETALA1, a transcriptional regulatory protein described as an Arabidopsis Trithorax group factor, has been characterized as a regulator of the shoot and floral meristems activity. Here, we highlight the role of ULTRAPETALA1 in root stem cell niche maintenance.

We found that ULTRAPETALA1 is required to regulate both the quiescent center cell division rate and auxin signaling at the root tip. Furthermore, ULTRAPETALA1 regulates columella stem cell differentiation.

These roles are independent of the ARABIDOPSIS TRITHORAX1, suggesting a different mechanism by which ULTRAPETALA1 can act in the root apical meristem of Arabidopsis. This work introduces a new component of the regulatory network needed for the root stem cell niche maintenance.
Treatment of an intraoral mandibular defect due to MRONJ, with an Integra dermal regeneration system and a vacuum formed splint
Authors: Bradshaw T. , Beech A. , Farrier S. , Spicer K. , Farrier J.
Published: September 2019

Treatment of medication related osteonecrosis of the jaw with free‐flaps, leads to increased morbidity and scarring for patients. We present an alternative method of reconstruction post debridement, using a one stage dermal regeneration template system (Integra, Integra Life Sciences Corp, Plainsboro, NJ, USA) and acrylic splint to aid retention and healing.