bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multilevel Intervention: The Case of the Cyprus Gender Advisory Team (GAT) Achievements and Challenges
Authors: Hadjipavlou Maria , Mertan E. Biran
Published: August 2019

In this article, we discuss Gender Advisory Team (GAT)’s multilevel linkage strategy—Macro–Meso–Micro—in promoting women’s ideas and views on the different issues discussed at the negotiating table and raising public awareness on GAT’s recommendations regarding the issues of governance and power-sharing from a gender and feminist perspective as well as on property, economy, citizenship, and education in a federal reunited Cyprus. In this article, we give examples only on governance and citizenship. Our feminist take on these issues necessitates a perspective that transcends the ethnic divide and includes the Women, Peace and Security agenda. We argue that Cypriot women’s concerns, needs, and gender mainstreaming as well an inclusive process should be prioritised at all levels of institutions. We conclude with GAT’s impact and challenges.
Peace Education in Rwandan Secondary Schools: Coping With Contradictory Messages
Authors: Basabose Jean de Dieu , Habyarimana Heli
Published: August 2019

This study explores how peace education in Rwandan secondary schools has faced challenges linked with the content of the programme, its implementers, and the environment in which it has to evolve. The research focuses on how students take different sources of information and how they respond to messages contradictory to the curriculum peace content taught at school. The research shows how messages contradictory to the curriculum peace content were moulded in families and/or amongst peers outside the school. The students and teachers demonstrated three possible responses: they accepted the contradictory messages, rejected them, or, in a large number of the cases, articulated an inability to make a clear-cut decision between the curriculum content and the other content contradictory to it. This difficulty to handle these contradictory messages may constitute a risk to the achievement of the expected outcomes of the programme.
Twenty Years After Ottawa: “Unpacking” Mine Action in Peace Agreements
Authors: Forster Robert
Published: August 2019

Mine action is essential for long-term peacebuilding and post-conflict reconstruction. Using new data, this article explores the nexus between mine action and peace processes, providing an analysis of trends in the inclusion of mine action provisions in peace agreements. Initial findings indicate that the inclusion of mine action provisions within peace agreements have remained relatively stable at 9.6% over 26 years. This is the case, regardless of efforts by United Nations agencies and non-governmental organisations (NGOs) in promoting the inclusion of mine action in ceasefire and peace agreements. Thus, the inclusion of mine action in peace agreements appears determined by the perceived pragmatic needs required to be addressed by conflict parties. Nonetheless, around the ratification period of the 1997 Ottawa Treaty, there was a small peak in the percentage of agreements that referenced mine action. Other trends indicate that mine action is more prevalent in interstate rather than intra-state peace agreements, that NGOs have begun to take a greater role in the negotiation of mine action–specific agreements, and that there is a greater diffusion of mine action awareness to local-level peace agreements.
Social Capital Across Agro-Pastoral Assets in the Abyei Area With Reference to Amiet “Peace” Market
Authors: Furukawa Mitsuaki , Deng Daniel
Published: August 2019

The Abyei area, which straddles the border of the two Sudans, had been a theatre of war since 1965. In 2016, the Amiet market emerged from a remote forest grove to initiate a new kind of social contract making. It has quickly become a melting pot of various communities and created space for nurturing new relations but has also generated tensions that may threaten its own survival. As stakeholders negotiate a solution to the political dispute over Abyei, this article explains how agro-pastoral resources, including the market itself, factor in both conflict and cooperation. It cites evidence that social capital dynamics are changing along the lines of age and gender. It argues that these may present an opportunity for realigning interests amongst competitive communities, with Amiet market as a possible point of entry for policymakers. It concludes with recommendations for conflict transformation through commercialisation of the traditional agro-pastoral sector.
Leadership Development for International Crises Management: The Whole Person Approach
Authors: Zaidi Ifti , Bellak Blanka
Published: August 2019

Leadership development (LD) is critical in peacebuilding and crises management where leadership decisions have far-reaching consequences. As organisations navigate turbulence, agile leaders who can deal with information extremes, take critical decisions, and deliver change are needed. We find contemporary LD approaches are conceptually not geared to deliver such leaders. From a development perspective, the problem lies in the preponderance of reductionist ideas, an overwhelming focus on managerial skills and competencies, and a short-term outlook on development that diminish the value of leadership courses. This exploratory article emphasises the value of LD and proposes a rethink in how LD is approached at individual and organisational levels. A holistic, flexible, and longitudinal approach—the whole person approach (WPA)—is proposed, which encourages individuals and organisations to work jointly towards LD. WPA is equally relevant for other sectors and organisations where volatility, uncertainty, complexity, and ambiguity affect positive change.
Flow-T stenting with the Silk Vista Baby and Baby Leo stents for bifurcation aneurysms – A novel endovascular technique
Authors: Makalanda HLD , Wong K , Bhogal P
Published: August 2019

We present the first case using a novel flow diverter, the Silk Vista Baby (Balt, Montmorency, France), in combination with a low-profile braided stent, the Baby Leo (Balt, Montmorency, France), in a T configuration that we term Flow-T. We describe the technical characteristics of the case as well as the early follow-up results. We believe that this combination may provide an alternative to standard T-stenting and alternative to treat bifurcation aneurysms.
A study on a deep-drawing process with two shaping states for a fuel-filter cup using combined simulation and experiment
Authors: The-Thanh Luyen , Tien-Long Banh , The-Van Tran , Duc-Toan Nguyen
Published: August 2019

In this article, a deep-drawing process using a double-action hydraulic press is examined for its ability to machine the shaping deformation of a fuel-filter cup made from SPCC steel. Many researchers have studied the geometric, physical, and technological parameters of the deep-drawing process. However, most of those studies ignored the optimization parameters of the two shaping deformation states to ensure uniformity of thickness and the disappearance of wrinkling and tearing during machining. In this study, geometric and technological parameters (e.g. blank-holder force, die-shoulder radius, and radial clearance between punch and die) are optimized in both states. The deep-drawing process for a fuel-filter cup is simulated using ABAQUS software, and optimal parameters are determined by applying the Taguchi orthogonal array computation and combining it with an analysis of variance method. The numerical results are then verified with corresponding experiments. The obtained numerical and experimental results show that the die-shoulder radius is one of the most influential parameters affecting the shaping of the cup during the deep-drawing process. Moreover, the influences of technological parameters on the formability of sheet metal are finally analyzed and selected for designing and improving deep-drawing molds.
A nomogram based on a gene signature for predicting the prognosis of patients with head and neck squamous cell carcinoma
Authors: Yang Bowen , Fu Lingyu , Xu Shan , Xiao Jiawen , Li Zhi , Liu Yunpeng
Published: August 2019

Background:

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignant tumors. The purpose of this study was to establish and validate a gene-expression-based prognostic signature in non-metastatic patients with HNSCC.

Materials and methods:

All the patients were retrieved from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. We randomly divided the GSE65858 samples into 70% (training cohort, n = 190) and 30% (internal validation cohort, n = 72). A total of 36 samples collected from the TCGA HNSCC databases were selected as an independent external validation cohort. The oligo package in R was used to normalize the raw data before analysis. Data characteristics were extracted, and a gene signature was built via the least absolute shrinkage and selection operator regression model. The predictive model was developed by multivariable Cox regression analysis. T stage, N stage, human papilloma virus status, and the gene signature were incorporated in this predictive model, which was shown as a nomogram. Calibration and discrimination were performed to assess the performance of the nomogram. The clinical utility of this nomogram was assessed by the decision curve analysis.

Results:

Overall, 2001 significant messenger RNAs in HNSCC samples were identified compared with normal samples. The gene signature contained seven genes and significantly correlated with overall survival. The gene signature was also significant in subgroup analysis of the primary cohort. The calibration was plotted in the external cohort (C-index 0.90, 95% CI 0.85, 0.95) compared with the training (C-index 0.76, 95% CI 0.73, 0.79) and internal (C-index 0.71, 95% CI 0.66, 0.77) cohorts. In clinic, a decision curve analysis demonstrated that the model including the prognostic gene signature score status was better than that without it.

Conclusion:

This study developed and validated a predictive model, which can promote the individualized prediction of overall survival in non-metastatic patients with HNSCC.
Recommendations for improving clinical trial design to facilitate the study of youth-onset type 2 diabetes
Authors: Jalaludin Muhammad Yazid , Barrientos-Pérez Margarita , Hafez Mona , Lynch Jane , Shehadeh Naim , Turan Serap , Weghuber Daniel
Published: August 2019

Background

The prevalence of type 2 diabetes is increasing in youths and differs from adult-onset type 2 diabetes in its characteristics and progression. Currently, only two drugs are approved for youth-onset type 2 diabetes and many patients are not meeting glycemic targets. Clearly, there is an urgent need to complete clinical trials in youths with type 2 diabetes to increase the therapeutic choice for these patients. However, factors such as limited patient numbers, unwillingness of patients to participate in trials, failure to meet strict inclusion and exclusion criteria, and poor clinic attendance have limited the size and number of trials in this complicated patient demographic.

Recommendations

This is a narrative opinion piece on the design of clinical trials in youth-onset type 2 diabetes prepared by researchers who undertake this type of study in different countries. The review addresses possible ways to enhance trial designs in youth-onset type 2 diabetes to meet regulatory requirements, while minimizing the barriers to patients’ participation. The definition of adolescence, recruitment of sufficient patient numbers, increasing flexibility in selection criteria, improving convenience of trial visits, requirements of a control group, possible endpoints, and trial compliance are all considered. The authors recommend allowing extrapolation from adult data, using multiple interventional arms within future trials, broadening inclusion criteria, and focusing on endpoints beyond glucose control, among others, in order to improve the successful completion of more trials in this population.

Conclusions

Improvements in trial design will enable better recruitment and retention and thereby more evidence for treatment outcomes for youth-onset type 2 diabetes.
A tale of two cities: A comparative study of media narratives of the battles for Aleppo and Mosul
Authors: Scherling Johannes
Published: August 2019

The battles for Aleppo (2012–2016) and Mosul (2016–2017) were two intense and brutal sieges, which resulted in 31,000 and 40,000 largely civilian casualties, respectively, as well as hundreds of thousands of refugees. Even though both campaigns were similar in many ways, they received an entirely different media echo. While Aleppo in its final phase was covered almost daily, detailing the suffering of civilians and the brutality of the Syrian government and its Russian allies, while ignoring actions of rebels, Mosul received much sparser treatment, mostly relating to atrocities committed by the Islamic State (backgrounding casualties inflicted by coalition forces). In both cases, the respective governments claimed to be fighting terrorists, but only in the case of Mosul was this narrative naturalized by the media. Drawing on various methods from critical media studies, this article analyses how and why the two battles were reported on differently by British mainstream media across the ideological spectrum. The purpose is to show how systemic bias based on a binary us vs them distinction leads to distortion and a reinforcement of dominant, populistic and partisan narratives that may threaten to background or ignore uncomfortable but important facts that would challenge people in power.
The act of documenting: Joshua Oppenheimer’s The Act of Killing
Authors: Demaria Cristina , Violi Patrizia
Published: August 2019

The case study considered by the authors of this article is a peculiar example of a documentary that intervened in the landscape of democratization conflicts in the opaque context of current democracy in Indonesia. Half a century after the genocide, the film reopens the memory of a terrible and non- elaborated past, questioning the impact of the genocide in a difficult democratization process. Is it possible to move from an authoritarian regime that infected and corrupted all aspects of civil coexistence to a new and supposedly more democratic era without working through its traumatic legacy? What role might remorse and forgiveness play in the foundation of a possible new democratic pact? Joshua Oppenheimer’s film, The Act of Killing, confronts all these questions through the documentary use of the Indonesia genocide perpetrators’ words, body images, silences and denials. Engaging the images of this film through a semiotic perspective, the authors interrogate the relationship between aesthetic texts and political emancipating processes, as well as the role of traumatic memory elaboration in the foundation of democratization. Essential for their analysis is the investigation of how moving images are implicated in the imagination and actions of perpetrators, including their possible functions and effects in relation to the audience.
Why the critical race theory concept of ‘White supremacy’ should not be dismissed by neo-Marxists: Lessons from contemporary Black radicalism
Authors: Walton Sean
Published: August 2019

Since entering the field of education studies, critical race theory has had an uneasy relationship with Marxism. One particular point of disagreement between Marxists and critical race theory scholars centres on the critical race theory concept of ‘White supremacy’. Some Marxist scholars suggest that, because of its reliance on ‘White supremacy’, critical race theory is unable to explain the prevalence of racism in Western, capitalist societies. These Marxists also argue that ‘White supremacy’ as understood within CRT is actively damaging to radical, emancipatory movements because the concept misrepresents the position of the White working class as the beneficiaries of racism, and in doing so, it alienates White workers from their Black counterparts. Some neo-Marxist thinkers have sought to replace the concept of ‘White supremacy’ with ‘racialisation’, a concept which is grounded in capitalist modes of production and has a historical, political and economic basis. Drawing on arguments from critical race theory, Marxism and Black radicalism, this paper argues that the critical race theory concept of ‘White supremacy’ is itself grounded in historical, political and economic reality and should not be dismissed by neo-Marxists. Incorporating ‘White supremacy’ into a neo-Marxist account of racism makes it more appealing to a broader (Black) radical audience.
Desarrollo del sentido de comunidad: una propuesta para las universidades promotoras de la salud
Authors: Pérez-Wilson Patricia , Álvarez-Dardet Carlos , Ruiz Cantero María Teresa , Martínez-Riera José Ramón , Carrasco-Portiño Mercedes
Published: August 2019

Resumen:

Las Universidades Promotoras de la Salud (UPS) promueven que las personas movilicen sus recursos para participar e influir en las decisiones que les afectan, creando oportunidades de desarrollo para la mejora continua de la salud y el bienestar en el campus. La búsqueda de las condiciones que generan salud es la base de la salutogénesis. Desde el modelo de activos en salud, podría visualizarse la comunidad universitaria como un recurso que potencia la capacidad de sus integrantes para mantenerse sanos. Se propone incorporar de manera más explícita entre los lineamientos de la UPS el desarrollo del sentido de comunidad como elemento clave que actuaría de forma sinérgica individual y colectivamente, facilitando que las personas se sientan parte de la comunidad universitaria, se apropien de esta iniciativa y puedan participar activamente de ella, lo que podría ser un elemento de distinción que contribuiría a revitalizar la estrategia de las UPS.
A culturally informed lower-extremity complication prevention program for people living with diabetes in south India
Authors: Peacock Amanda , Skemp Lisa , Seetharam Sridevi , Shanmukha Rekha , Prasad Manohar , Seetharam Mysore Ramachandra
Published: August 2019

Background:

Diabetes and its complications are increasing in frequency worldwide. Lower-extremity complications carry a high risk for morbidity and mortality, yet are largely preventable through education and self-monitoring. In India, rural areas lack access to education, care, and treatment. Despite existing evidence-based programs to reduce diabetes-related lower-extremity complications in areas with limited resources, uptake and sustainability may be hampered by the lack of translation to the local cultural context.

Aims:

To address this gap, this study used the Culturally Informed Healthy Aging nursing process to develop a lower extremity complication prevention program in a rural village. The paper describes the results of a community health needs assessment conducted annually from 2009 to 2014, and subsequent pilot test of an intervention incorporating these results.

Methods:

The Culturally Informed Healthy Aging process is a naturalistic, inductive method used to identify and address health needs. Components include community partnership, community assessment, program planning, selection of health priorities, workgroup formation and translation of evidence, and program outcome evaluation. The programming is assessed using process evaluation, which allows for continuous monitoring and program modification.

Results:

Community assessment revealed a number of values, beliefs, and practices related to foot care and assessment in rural south India. These were incorporated into culturally informed programming and evidence-based protocols were adapted for use in the local context. Programming resulted in increased community capacity for lower extremity complication prevention, accessible population screening, and culturally informed foot care education.

Discussion:

Strengths, limitations and implications for care in rural India and other areas are discussed.
The effect of exercise training on blood pressure in African and Asian populations: A systematic review and meta-analysis of randomized controlled trials
Authors: Bersaoui Marina , Baldew Se-Sergio M , Cornelis Nils , Toelsie Jerry , Cornelissen Veronique A
Published: August 2019

Background

Exercise is key in the primary prevention and management of hypertension. Yet, current exercise recommendations are predominantly based on meta-analyses involving populations of European descent. Since blood pressure (BP) responses to pharmaceutical interventions are known to differ among ethnic groups, we aimed to investigate the BP responses to exercise training in non-European descendants.

Purpose

The aim of this study was to systematically summarize the available literature on the efficacy of exercise on BP in healthy adults (age ≥18 years) of African or Asian origin.

Methods

We searched the MEDLINE database for randomized controlled trials that evaluated the effect of exercise training on BP in healthy African and Asian adults with optimal BP, elevated BP or hypertension and published in a peer-reviewed journal up to May 2019. Random effect models were fitted to estimate the effect sizes.

Results

We identified 22 trials involving individuals of Asian origin ( n = 931; mean age: 44 years; 41% male) and four trials involving individuals of African origin ( n = 510; mean age: 56.7 years; 80% male). Aerobic exercise training significantly ( p < 0.001) reduced systolic and diastolic BP in each ethnic group. Resistance training did not affect the BP of Asian participants with optimal BP. The effect of resistance training in Asians with elevated BP or hypertension and Africans could not be determined due to lack of data. Sub-analyses suggested somewhat larger reductions in systolic BP following aerobic training in hypertensive Africans compared with hypertensive Asians.

Conclusions

We found favorable effects of aerobic exercise training on BP in the African and the Asian populations. However, the overall low number of studies and especially the lack of data on resistance training and combined training in African and Asian populations warrant more research to improve the quality of evidence.
A caring relationship as a prerequisite for patient participation in a psychiatric care setting: A qualitative study from the nurses' perspective
Authors: Keresi Zuzana , Carlsson Gunilla , Lindberg Elisabeth
Published: August 2019

The participation of patients in their treatment and care is perceived as desirable; however, patients with mental illnesses experience limited opportunities to participate in their own care. As nurses play a key role in taking care of patients with mental illnesses, this study aimed to investigate how nurses within psychiatric care settings experience patients' participation and how they act to increase it. Semi-structured interviews were conducted with eight registered nurses, four of whom worked in a psychiatric institutional care setting and four of whom worked with outpatients. Data were analysed using a qualitative content analysis approach. The analysis identified a theme: a caring relationship is a prerequisite for patient participation. This theme was further developed through five subthemes. The findings illustrate critical aspects of the caring relationship by which the nurse–patient relationship can either facilitate or impede patient participation. A caring relationship builds trust and increases the patient's sense of responsibility for their own condition. Because patients with mental illness are cared for in many different contexts, the results of the present study have implications for a broad range of healthcare environments.
Does the drain placement technique affect the amount of postoperative spinal epidural hematoma after microendoscopic decompressive laminotomy for lumbar spinal stenosis?
Authors: Merter Abdullah , Shibayama Motohide
Published: August 2019

Objective:

To prospectively evaluate with magnetic resonance imaging (MRI), the relationship between the distance from the incision of the drain output location and postoperative spinal epidural hematoma (SEH) in patients performed with microendoscopic decompressive laminotomy (MEDL) for lumbar spinal stenosis.

Methods:

Between January 2016 and June 2018, three different kinds of drain placement techniques, according to the drain output location, were performed to a total of 184 patients after MEDL for single-level spinal stenosis. The location of the drain output was within the incision in group 1, 1 cm lateral of the incision in group 2, and 5 cm lateral of the incision in group 3. At 24 h postoperatively, before removal of the drain, MRI examination was carried out in patients. A specific classification was developed by the authors to measure SEH, and the groups were evaluated by comparison.

Results:

The mean postoperative dural sac cross-sectional area was 1.73 cm2 (standard deviation (SD): 0.711) in group 1, 1.66 cm2 (SD: 0.732) in group 2, and 1.52 cm2 in group 3 (SD: 0.841).The mean cross-sectional area of the postoperative hematoma was 1.45 cm2 (SD: 1.007) in group 1, 1.57 cm2 (SD: 1.053) in group 2, and 2.11 cm2 (SD: 1.024) in group 3. Four grades were defined according to the specific classification. According to this classification, grades C and D postoperative hematomas were determined at a statistically significantly higher rate in group 3 patients (drain output 5 cm lateral from the incision) compared to the other groups ( p = 0.000). No significant difference was determined between groups 1 and 2 in respect of hematoma classification.

Conclusion:

In conclusion, it was determined that better drainage was provided in groups 1 and 2, where the drain output location was in the incision or close to it.
Opportunities and Challenges for Undergraduate Public Health Education in Australia and New Zealand
Authors: Luu Xuan , Dundas Kate , James Erica L.
Published: August 2019

The international emergence of undergraduate education in public health has transformed the public health education landscape. While this shift is clearest and most widely evaluated in the United States, efforts in other parts of the world—such as Australasia—have not kept pace. This article aims to redress the evidence gap by identifying and discussing the different approaches through which Australian and New Zealand universities deliver public health education at the undergraduate level. A content analysis was conducted of online handbook information published by 47 universities across Australia and New Zealand, to gauge the various ways in which these universities implement undergraduate public health education. Each offering identified was assigned to one of four predetermined categories. Of the 47 universities, 45 were found to offer some form of undergraduate coursework in public health. Offerings took primarily the form of single subjects. Less commonly implemented were specializations ( n = 20), stand-alone undergraduate degrees ( n = 11), and double degree combinations ( n = 6). This breadth of activity highlights the need for renewed efforts in evaluating undergraduate public health education across the region. Further research is recommended into three areas: (1) emerging best practices in curriculum development and implementation, (2) explorations of public health accreditation in the region, and (3) the outcomes achieved by students and graduates of undergraduate public health degrees across Australia and New Zealand. These efforts will ultimately strengthen the operationalization and contribution of this education in helping shape the future public health workforce in Australasia.
Does Increasing the Experiential Component Improve Efficacy of the “This Is Public Health” Photo Essay Task? A Nonrandomized Trial
Authors: Dundas Kate , Johnson Natalie A. , Paras Lorraine , Hancock Stephen , Barker Daniel , Chiu Simon , James Erica L.
Published: August 2019

Opportunities for evaluating experiential learning activities in tertiary public health education are growing. It has previously been shown that utilizing the “This is Public Health” (TIPH) sticker campaign as an experiential photo essay task led to increased understanding of public health. Emerging mobile technologies such as geocaching, which provide an opportunity to increase the experiential component of the TIPH photo essay task, have not been evaluated. This study aimed to determine whether adding geocaching to the TIPH photo essay task increased the efficacy of learning about public health, when compared with the TIPH photo essay task alone. A two-arm nonrandomized trial was conducted with 785 allied health and preprofessional teaching students studying first-year public health courses. Students were allocated to either the TIPH photo essay task ( n = 210) or the TIPH photo task plus geocaching ( n = 92) according to the course they were enrolled into. The primary outcome was the quality of the definition of public health provided by students, which was assessed using the Definition of Public Health Rating Scale. Data were analyzed using a linear mixed model. Of 302 (39%) students who consented to participate, 212 (70%) provided baseline and follow-up data. After adjusting for baseline demographic differences, the geocaching group had improved knowledge of public health at follow-up according to the Definition of Public Health Rating Scale (increasing 0.29 units more than the traditional group; p = .03). As this increase in knowledge score is unlikely to be of practical significance, the additional burden of implementing geocaching may not be justified.
Bilayer Graft for Incisionless In‐Office Endoscopic Repair of Tympanic Membrane Perforations: A Pilot Study
Authors: Kozin Elliott D. , Lee Daniel J. , Remenschneider Aaron K.
Published: August 2019

Tympanic membrane (TM) perforations may result in significant patient morbidity. While intraoperative myringoplasty or tympanoplasty allow for effective repair, not all patients are candidates for general anesthesia. Herein, we describe a novel graft design and technique for in‐office repair of TM perforations in the clinic setting. Two pieces of porcine submucosa material were interdigitated to create a bilayer design with lateral and medial flanges. Topical and injected lidocaine were used for local anesthesia. The perforation was rimmed. Grafts were grasped, and medial flanges were placed through the perforation, with lateral flanges resting on the TM surface. TM repair occurred in 5 awake patients with a mean age of 72 years. There were no complications. All perforations healed, with 1 case requiring a minor in‐office revision. Audiometry was performed at 4 weeks. The preoperative air‐bone gap (mean 0.25, 0.5, 1, 2, and 4 kHz) was 12.2 ± 4.1 dB, and postoperatively, it was 4.2 ± 2.4 dB (P =. 001). Novel design of available graft material may allow for effective in‐office TM repair.
Challenge of Rechallenge: When to Resume Immunotherapy Following an Immune-Related Adverse Event
Authors: Nakajima Erica C. , Lipson Evan J. , Brahmer Julie R.
Published: August 2019

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Why Must We Learn About It?
Authors: de Oliveira Sermoud Letícia Morais Coelho , Romano Sérgio , Chveid Maurício , da Silva Amorim Gilberto Luiz
Published: August 2019

Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, breast implant–associated T-cell lymphoma in which CD30 is expressed and anaplastic lymphoma kinase ( ALK) expression is absent. However, despite the low risk of developing the disease, more information on BIA-ALCL is necessary, because the number of women with breast implants has been increasing worldwide; Brazil is one of the main markets for this type of implant. The objectives of this review are to clarify the issue of BIA-ALCL occurrence after risk-reducing mastectomy, to show the importance of this disease, and to raise awareness among the medical community about this rare pathologic condition. In 2016, BIA-ALCL was included by WHO in the new classification of lymphomas, and this demonstrates the attention that medical entities should give to this disease. Thus, awareness about BIA-ALCL must be broadened among the medical societies and regulatory authorities, both to foster better approaches to this disease, which should be evaluated in a multidisciplinary manner, and to provide better knowledge among health care professionals and the target population about the use of implants.
How Do Common Comorbidities Modify the Association of Frailty With Survival After Elective Noncardiac Surgery? A Population-Based Cohort Study
Authors: Hui Yin , van Walraven Carl , McIsaac Daniel I.
Published: August 2019

BACKGROUND:

Older people with frailty have decreased postoperative survival. Understanding how comorbidities modify the association between frailty and survival could improve risk stratification and guide development of interventions. Therefore, we evaluated whether the concurrent presence of common and high-risk comorbidities (dementia, chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], diabetes mellitus, heart failure [HF]) in conjunction with frailty might be associated with a larger decrease in postoperative survival after major elective surgery than would be expected based on the presence of the comorbidity and frailty on their own.

METHODS:

This cohort study used linked administrative data from Ontario, Canada to identify adults >65 years having elective noncardiac surgery from 2010 to 2015. Frailty was identified using a validated index; comorbidities were identified with validated codes. We evaluated the presence of effect modification (also called interaction) between frailty and each comorbidity on (1) the relative (or multiplicative) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was different than the product of the risks associated with each condition; and (2) the absolute risk difference (or additive) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was greater than the sum of the risks associated with each condition.

RESULTS:

11,150 (9.7%) people with frailty died versus 7826 (2.8%) without frailty. After adjustment, frailty was associated with decreased survival (adjusted hazard ratio [HR] = 2.42; 95% confidence interval [CI], 2.31–2.54). On the relative (multiplicative) scale, only diabetes mellitus demonstrated significant effect modification (P value for interaction .03; reduced risk together). On the absolute risk difference (additive) scale, all comorbidities except for coronary disease demonstrated effect modification of the association of frailty with survival. Co-occurrence of dementia with frailty carried the greatest excess risk (Synergy Index [S; the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation] = 2.29; 95% CI, 1.32–10.80, the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation).

CONCLUSIONS:

Common comorbidities modify the association of frailty with postoperative survival; however, this effect was only apparent when analyses accounted for effect modification on the absolute risk difference, as opposed to relative scale. While the relative scale is more commonly used in biomedical research, smaller effects may be easier to detect on the risk difference scale. The concurrent presence of dementia, COPD, and HF with frailty were all associated with excess mortality on the absolute risk difference scale.
Mannose glycosylation is an integral step for NIS localization and function in human breast cancer cells
Authors: Rathod Maitreyi , Chatterjee Sushmita , Dutta Shruti , Kalraiya Rajiv , Bhattacharyya Dibyendu , De Abhijit
Published: August 2019

Chasing an intriguing biological question on the disparity of sodium iodide symporter (NIS, officially known as SLC5A5) expression and function in the clinical scenario of breast cancer, this study addresses key molecular defects involved. NIS in cancer patients has primarily been recorded to be a cytoplasmic protein, thus limiting the scope for targeted radio-iodine therapy. We developed NIS transgene-overexpressing MCF-7 breast cancer cells, and found a few clonal derivatives that show predominant expression of NIS in the plasma membrane. The majority of clones, however, showed cytosolic NIS expression over long passages. Cells expressing membranous NIS show unperturbed dynamic trafficking of NIS through secretory pathway organelles when compared to cells expressing cytoplasmic NIS or to parental cells. Further, treatment of cells expressing membranous NIS with specific glycosylation inhibitors highlighted the importance of inherent glycosylation processing and an 84 gene signature glycosylation RT-Profiler array revealed that clones expressing NIS in their membrane cluster separately compared to the other cells. We further confirm a role of three differentially expressed genes, i.e. MAN1B1, MAN1A1 and MAN2A1, in regulating NIS localization by RNA interference. Thus, this study shows the important role of mannosidase in N-glycosylation processing in order to correctly traffic NIS to the plasma membrane in breast cancer cells.

This article has an associated First Person interview with the first author of the paper.
Comparison of radiomics tools for image analyses and clinical prediction in nasopharyngeal carcinoma
Authors: Liang Zhong-Guo , Tan Hong Qi , Zhang Fan , Rui Tan Lloyd Kuan , Lin Li , Lenkowicz Jacopo , Wang Haitao , Wen Ong Enya Hui , Kusumawidjaja Grace , Phua Jun Hao , Gan Soon Ann , Sin Sze Yarn , Ng Yan Yee , Kiat Tan Terence Wee , Soong Yoke Lim , Fong Kam Weng , Park Sung Yong , Soo Khee-Chee , Seng Wee Joseph Tien , Zhu Xiao-Dong , Valentini Vincenzo , Boldrini Luca , Sun Ying , Kiang Chua Melvin Lee
Published: August 2019

Objective:

Radiomics pipelines have been developed to extract novel information from radiological images, which may help in phenotypic profiling of tumours that would correlate to prognosis. Here, we compared two publicly available pipelines for radiomics analyses on head and neck CT and MRI in nasopharynx cancer (NPC).

Methods and materials:

100 biopsy-proven NPC cases stratified by T- and N-categories were enrolled in this study. Two radiomics pipeline, Moddicom (v. 0.51) and Pyradiomics (v. 2.1.2) were used to extract radiomics features of CT and MRI. Segmentation of primary gross tumour volume was performed using Velocity v. 4.0 by consensus agreement between three radiation oncologists. Intraclass correlation between common features of the two pipelines was analysed by Spearman’s rank correlation. Unsupervised hierarchical clustering was used to determine association between radiomics features and clinical parameters.

Results:

We observed a high proportion of correlated features in the CT data set, but not for MRI; 76.1% (51 of 67 common between Moddicom and Pyradiomics) of CT features and 28.6% (20 of 70 common) of MRI features were significantly correlated. Of these, 100% were shape-related for both CT and MRI, 100 and 23.5% were first-order-related, 61.9 and 19.0% were texture-related, respectively. This interpipeline heterogeneity affected the downstream clustering with known prognostic clinical parameters of cTN-status and GTVp. Nonetheless, shape features were the most reproducible predictors of clinical parameters among the different radiomics modules.

Conclusion:

Here, we highlighted significant heterogeneity between two publicly available radiomics pipelines that could affect the downstream association with prognostic clinical factors in NPC

Advances in knowledge:

The present study emphasized the broader importance of selecting stable radiomics features for disease phenotyping, and it is necessary prior to any investigation of multicentre imaging datasets to validate the stability of CT-related radiomics features for clinical prognostication.
Evaluation of a new image reconstruction method for digital breast tomosynthesis: effects on the visibility of breast lesions and breast density
Authors: Krammer Julia , Zolotarev Sergei , Hillman Inge , Karalis Konstantinos , Stsepankou Dzmitry , Vengrinovich Valeriy , Hesser Jürgen , M. Svahn Tony
Published: August 2019

Objective:

To compare image quality and breast density of two reconstruction methods, the widely-used filtered-back projection (FBP) reconstruction and the iterative heuristic Bayesian inference reconstruction (Bayesian inference reconstruction plus the method of total variation applied, HBI).

Methods:

Thirty-two clinical DBT data sets with malignant and benign findings, n = 27 and 17, respectively, were reconstructed using FBP and HBI. Three experienced radiologists evaluated the images independently using a 5-point visual grading scale and classified breast density according to the American College of Radiology Breast Imaging-Reporting And Data System Atlas, fifth edition. Image quality metrics included lesion conspicuity, clarity of lesion borders and spicules, noise level, artifacts surrounding the lesion, visibility of parenchyma and breast density.

Results:

For masses, the image quality of HBI reconstructions was superior to that of FBP in terms of conspicuity,clarity of lesion borders and spicules (p < 0.01). HBI and FBP were not significantly different in calcification conspicuity. Overall, HBI reduced noise and supressed artifacts surrounding the lesions better (p < 0.01). The visibility of fibroglandular parenchyma increased using the HBI method (p < 0.01). On average, five cases per radiologist were downgraded from BI-RADS breast density category C/D to A/B.

Conclusion:

HBI significantly improves lesion visibility compared to FBP. HBI-visibility of breast parenchyma increased, leading to a lower breast density rating. Applying the HBIR algorithm should improve the diagnostic performance of DBT and decrease the need for additional imaging in patients with dense breasts.

Advances in knowledge:

Iterative heuristic Bayesian inference (HBI) image reconstruction substantially improves the image quality of breast tomosynthesis leading to a better visibility of breast carcinomas and reduction of the perceived breast density compared to the widely-used filtered-back projection (FPB) reconstruction. Applying HBI should improve the accuracy of breast tomosynthesis and reduce the number of unnecessary breast biopsies. It may also reduce the radiation dose for the patients, which is especially important in the screening context.
Wood-decaying fungi found in Southern Ghana: A potential source of new anti-infective compounds
Authors: Aboagye Samuel Yaw , Amarh Vincent , Lartey Paul A. , Arthur Patrick Kobina
Published: August 2019

Background: Discovery of bioactive natural products are instrumental for development of novel antibiotics. The discovery and development of natural products such as penicillin represented a major milestone in the treatment of bacterial infections. Currently, many antibiotics have lost their relevance in clinics due to the emergence of drug-resistant microbial pathogens. Hence, there is the need for continuous search of new compounds endowed with potent antimicrobial activity. In this study, wood-decaying fungi (WDF) from Southern Ghana were explored for their potential as sources of novel antimicrobial compounds with intent of expanding the effort into a drug discovery programme in the near future.

Methods: A total of 54 WDF isolates were fermented in potato dextrose broth and the secondary metabolites obtained were analyzed for the presence of antimicrobial agents using the disc diffusion assay. Chromatography techniques were used for preliminary analysis of the chemical composition of the extracts and for fractionation of the extracts that showed antimicrobial activity.

Results: The extracts from 40 out of the 54 WDF isolates exhibited significant antimicrobial activity against either Staphylococcus aureus, Escherichia coli or Candida albicans. Fractionation of these bioactive extracts, followed by bioassay of the organic fractions obtained, indicate that extracts exhibiting antimicrobial activity against more than one of the three test organisms could be attributed to the presence of different bioactive compounds. Analysis of the composition of the extracts revealed that terpenes were predominant.

Conclusions: This study suggests that a significant proportion of WDF in Southern Ghana produce antimicrobial compounds which could be potential sources of novel anti-infective agents and support the plans of developing a drug discovery programme in Ghana based on the fermentation of WDF.
Implementing neuroimaging and eye tracking methods to assess neurocognitive development of young infants in low- and middle-income countries
Authors: Katus Laura , Hayes Nathan J. , Mason Luke , Blasi Anna , McCann Samantha , Darboe Momodou K. , de Haan Michelle , Moore Sophie E. , Lloyd-Fox Sarah , Elwell Clare E.
Published: August 2019

Infants and children in low- and middle-income countries (LMICs) are frequently exposed to a range of environmental risk factors which may negatively affect their neurocognitive development. The mechanisms by which factors such as undernutrition and poverty impact development and cognitive outcomes in early childhood are poorly understood. This lack of knowledge is due in part to a paucity of objective assessment tools which can be implemented across different cultural settings and in very young infants. Over the last decade, technological advances, particularly in neuroimaging, have opened new avenues for research into the developing human brain, allowing us to investigate novel biological associations. This paper presents functional near-infrared spectroscopy (fNIRS), electroencephalography (EEG) and eye tracking (ET) as objective, cross-cultural methods for studying infant neurocognitive development in LMICs, and specifically their implementation in rural Gambia, West Africa. These measures are currently included, as part of a broader battery of assessments, in the Brain Imaging for Global Health (BRIGHT) project, which is developing brain function for age curves in Gambian and UK infants from birth to 24 months of age. The BRIGHT project combines fNIRS, EEG and ET with behavioural, growth, health and sociodemographic measures. The implementation of these measures in rural Gambia are discussed, including methodological and technical challenges that needed to be addressed to ensure successful data acquisition. The aim is to provide guidance to other groups seeking to implement similar methods in their research in other LMICs to better understand associations between environmental risk and early neurocognitive development.
The Concept of the Organizational and Economic Mechanism for the Functioning of Internal Control
Authors: Аристархова М. , Aristarhova M. , Фахрутдинов В. , Fahrutdinov V.
Published: August 2019

Th e presented article touches upon topical issues of the functioning of internal control at the enterprise. A toolkit has been developed for the organizational and economic mechanism for the functioning of internal control, which includes principles, functions, logisation, the time aspect, controlling, and norms. Th e structural and functional components of internal control are highlighted. An adaptive organizational structure of the risk management and internal control system has been formed, which can be the basis for the formation of a model for the functioning of the internal control of a gas transmission company.