bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
Authors: Andrilla C. Holly A. , Jones Kendall C. , Patterson Davis G.
Published: October 2019

Background

In 2016, the Comprehensive Addiction Recovery Act permitted nurse practitioners (NPs) and physician assistants (PAs) to obtain a waiver to prescribe buprenorphine to treat opioid use disorder (OUD), with the goal of increasing access to this treatment. This study's purpose was to describe the buprenorphine prescribing practices of NPs and PAs and compare the barriers rural and urban providers face delivering treatment.

Methods

From the October 2018 Drug Enforcement Administration list of providers with the waiver to prescribe buprenorphine, all rural NPs and PAs (1,057) and a random sample of 500 urban NPs and PAs were surveyed. The questionnaire queried respondents about demographics, prescribing practices, practice characteristics, reimbursement policies, and barriers to prescribing buprenorphine to treat OUD.

Results

Of the waivered NPs and PAs, 80.3% reported having prescribed buprenorphine and 71.1% said they were currently accepting new patients with OUD. Providers with the 30‐patient waiver were treating, on average, 13.2 patients; 37.0% were not treating any patients. The most common barrier, cited by half of providers, was concerns about diversion/medication misuse. More rural providers indicated lack of specialty backup and mental health providers as a barrier than urban providers. Never‐prescribers and former‐prescribers reported 6 barriers at significantly higher rates than did current prescribers. More rural providers accepted Medicaid and cash reimbursement than urban providers.

Conclusions

NPs and PAs face many of the same barriers to providing buprenorphine as physicians have reported. Interventions to address these barriers have the potential to benefit all providers with the waiver to prescribe buprenorphine.
Let's Talk About Maths: The Role of Observed “Maths‐Talk” and Maths Provisions in Preschoolers' Numeracy
Authors: von Spreckelsen Megan , Dove Emma , Coolen Ilse , Mills Annelot , Dowker Ann , Sylva Kathy , Ansari Daniel , Merkley Rebecca , Murphy Victoria , Scerif Gaia
Published: October 2019

Developmental cognitive neuroscience highlights the importance of interactions between children and their environment. As young children spend increasing time in childcare, it is key to investigate the impact of “maths‐talk” and maths provisions in preschools. Qualitative insights from early educators indicate a greater bias toward counting activities than would be expected given the Early Years curriculum. In addition, we quantified the observed breadth of preschool practitioners' maths language (e.g., place‐value language), setting‐based maths provisions (e.g., quality of maths‐related activities), and their relation with children's early numeracy skills. In settings with greater practitioners' breadth of maths language, children display greater cardinality skills although our data call for the further investigation of parental socioeconomic status and education. We conclude with a discussion on the need to operationalize children's maths learning environments as diversely as possible. Enriching practitioners' skill sets may be an effective and needed way of improving early maths outcomes.
Introverted Metaphysics
Authors: Kriegel Uriah
Published: October 2019

This paper pulls together three debates fundamental in metaphysics and proposes a novel unified approach to them. The three debates are (i) between bundle theory and substrate theory about the nature of objects, (ii) dispositionalism and categoricalism about the nature of properties, and (iii) regularity theory and production theory about the nature of causation. The first part of the paper suggests that although these debates are metaphysical, the considerations motivating competing approaches in each debate tend to be epistemological. The second part argues that the two underlying epistemological pictures supporting these competing views lead to highly unsatisfying conceptions of the world. The final part proposes an alternative epistemological picture, which I call “introverted empiricism,” and presents the way this alternative provides for a more satisfying grasp of the ultimate nature of objects, properties, and causation. It is a consequence of this alternative picture that there is a kind of intimate self‐understanding that underlies our understanding of the deep nature of reality.
Polyphasic identification of three new species in Alternaria section Infectoriae causing human cutaneous infection
Authors: Iturrieta‐González Isabel , Pujol Isabel , Iftimie Simona , García Dania , Morente Vanesa , Queralt Rosana , Guevara‐Suarez Marcela , Alastruey‐Izquierdo Ana , Ballester Frederic , Hernández‐Restrepo Margarita , Gené Josepa
Published: October 2019

Background

Cutaneous phaeohyphomycosis is an emerging disease in immunocompromised patients, being Alternaria one of the most common genera reported as a causative agent. Species identification is not carried out mainly due to the complexity of the genus. Analysis of the ITS barcode has become standard for fungal identification, but in Alternaria it is only able to discriminate among species‐groups or sections.

Methods

We present three cases of cutaneous infection caused by Alternaria isolates morphologically identified as belonging to section Infectoriae. They have been morphologically characterised and phylogenetically delineated with five molecular markers (ITS, ATPase, gapdh, rpb2 and tef1).

Results

Mycotic infections have been diagnosed by repeated cultures and histopathological examination in two of the cases. The polyphasic approach has allowed to delineate three new species of Alternaria section Infectoriae, that is A anthropophila, A atrobrunnea and A guarroi. ATPase has been the only locus able to discriminate most of the species (29 out of 31) currently sequenced in this section, including A infectoria the commonest reported species causing alternariosis. Susceptibility test showed different antifungal patterns for the three species, although terbinafine was the most active in vitro drug against these fungi.

Conclusions

The ATPase gene is recommended as an alternative barcode locus to identify Alternaria clinical isolates in section Infectoriae. Our results reinforce the relevance of identification of Alternaria isolates at the species level and the necessity to carry out antifungal susceptibility testing to determine the most adequate drug for treatment.
Family socioeconomic status, parental attention, and health behaviors in middle childhood: A cross‐sectional study
Authors: Eo Yong‐Sook , Kim Ji‐Soo
Published: October 2019

This study examined the relationships among family socioeconomic status, parental attention, and health behaviors in children during middle childhood. For this descriptive cross‐sectional study, six elementary schools in a metropolitan city in South Korea were selected for recruitment. We surveyed 857 elementary school students aged 8 to 10 years by using self‐report questionnaires. A hierarchical multilinear regression analysis found that family socioeconomic status positively related to children's health behaviors and that parental attention had a moderating effect on this relationship. These results suggest that family socioeconomic status influences health behaviors from the child's perspective. The influence of family socioeconomic status on children's health behaviors might be weakened by parental attention. Healthcare providers should be aware of children's health behaviors and focus interventions on families with low socioeconomic status. Nurses should emphasize to parents that parental supervision and monitoring might benefit their children and improve their health behaviors.
Anatomical relationship between the maxillary posterior teeth and the sinus floor according to an anterior overbite
Authors: Son Woo‐Sung , Kim Yong‐Il , Kim Seong‐Sik , Park Soo‐Byung , Kim Sung‐Hun
Published: October 2019

Objective

To evaluate the vertical relationship between the maxillary sinus floor (MSF) and the maxillary posterior teeth (MPT) according to an anterior overbite.

Settings and Sample Population

The patients were divided into three groups according to an anterior overbite. The open bite group (OBG) included patients with an anterior overbite of ≤0 mm, the normal overbite group (NBG) included patients with an overbite of 0‐3 mm, and the deep bite group (DBG) included patients with an overbite ≥3 mm. Thirty patients were randomly matched into each group based on age and sex.

Materials and Methods

The distances and vertical relationship between the MSF and the MPT was analysed using cone‐beam computer tomography. The vertical relationship between the two was classified as either favourable or unfavourable for the intrusion of the posterior teeth.

Results

A higher ratio of patients in the OBG had MPT positioned close to the MSF than the DBG. Intrusion of the posterior teeth was unfavourable for an average of 87.2%, 77.2% and 70.2% molars in the OBG, NBG and DBG, respectively.

Conclusions

The vertical distance between the MSF and the MPT is associated with an anterior overbite. The posterior teeth were in an unfavourable position for the orthodontic intrusion in the OBG as compared to the other groups. Additional caution is needed when planning orthodontic intrusion treatment for patients with an anterior open bite. But, there were some individual variations within each group.
New clade of silicified bolidophytes that belong to Triparma (Bolidophyceae, Stramenopiles)
Authors: Yamada Kazumasa , Sato Shinya , Yamazaki Masashi , Yoshikawa Shinya , Kuwata Akira , Ichinomiya Mutsuo
Published: October 2019

The small phytoplankton genus Triparma belongs to the class Bolidophyceae and contains two distinct forms: silicified species and naked flagellated species (formerly Bolidomonas). Recent studies showed that four silicified species/strains (Triparma laevis f. inornata, T. laevis f. longispina, T. strigata, and T. aff. verrucosa) belong to a single clade that is paraphyletic, because it also contains an unclassified flagellated strain, and is sister to a flagellated species, T. eleuthera. In this study, we isolated and characterized two new strains of silicified species to test the phylogenetic unity of silicified bolidophytes. The isolates were identified as T. retinervis strains because they possessed fine areolation on the cell wall. 18S rDNA and rbcL phylogenetic analyses demonstrated that T. retinervis formed a new silicified clade that is sister to the flagellated species T. pacifica. This reveals that there are at least two distinct clades including both silicified and flagellated Triparma species.
Affective life and cultural economy: Payday loans and the everyday space‐times of credit‐debt in the UK
Authors: Anderson Ben , Langley Paul , Ash James , Gordon Rachel
Published: October 2019

Analysing the affective geographies of digitally mediated payday loans in the UK, this paper advocates and exemplifies an approach to cultural economy that focuses on how economic worlds are affectively animated and lived. Supplementing the two versions of “culture” that cultural economy approaches have to date been organised around – culture as signifying system or culture as assembled effect – we propose a cultural economy of everyday space‐times which is attuned to the affective composition of forms of living. Drawing on empirical work with 40 users of digitally mediated payday loans, we employ this approach to trace how their loans become part of three intersecting forms of living: relief, as a pressing concern is deferred to the immediate future; separation, as private spaces are created within ordinary life and obligations are felt as individual responsibilities; and pressure, as demands to pay intensify the sense that debt is spiralling out of control and already‐ongoing precarity cannot be sustained. In conclusion, we pose further questions for a cultural economy approach orientated to the analysis of forms of living.
Abnormal Sysmex XT‐2000iV DIFF scattergram in a cat with a prominent mastocytemia
Authors: Lavabre Typhaine , Betting Adeline , Bourgès‐Abella Nathalie , Layssol‐Lamour Catherine , Trumel Catherine
Published: October 2019

A 2‐year‐old neutered male domestic shorthair cat was presented to the emergency service of the National Veterinary School of Toulouse (France) for acute vomiting and diarrhea with lethargy, inappetence, and adypsia for the past 48 hours. Complete blood counts were performed with the ProCyte DX at the emergency department and with the Sysmex XT‐2000iV at the laboratory 2 weeks later. The scattergrams from the two analyzers revealed similar unusual and abnormal dot plots. The Sysmex XT‐2000iV DIFF scattergram also showed no clear separation between different leukocyte populations. The eosinophil cluster was in an abnormal location compared with that of the “typical” location in a normal cat. A blood smear evaluation revealed the presence of numerous mast cells. Thus, we hypothesized that the Sysmex XT‐2000iV had detected the mast cell population, and this led to errors in the differential counts. To explore this hypothesis, we manually gated on the DIFF scattergram and performed a manual differential on the blood smear. With this new gating strategy, the Sysmex XT‐2000iV and manual differentials were similar. Thus, in the case of systemic mastocytosis, mast cells can be located between the lymphocyte, monocyte, and eosinophil clusters on scattergrams.
CAD-CAM en prótesis total. Reporte de caso
Authors: Matiz Cuervo Jimmy
Published: October 2019

Antecedentes: En los últimos 15 años, la robótica ha incursionado en el campo de la prostodoncia total a través de la cual se han desarrollo técnicas clínicas y de laboratorio para elaborar dentaduras. Objetivo: Rehabilitar un paciente desdentado total con una técnica actual que utiliza la robótica y acrílicos industrializados. Descripción del caso:  El tratamiento prostodóntico de un paciente desdentado total superior e inferior se realizó mediante tecnología de diseño y manufacturación asistidas por computador (CAD-CAM). Resultado: Se emplearon impresiones digitales y acrílicos industriales de alto rendimiento, así como escáner, programa de computador y fresadora. El caso fue exitoso en cuanto a estabilidad, retención y soporte del tratamiento efectuado.
Frecuencia, hallazgos y variaciones óseas en radiografías panorámicas de personas con edentulismo total
Authors: Escolano Rivas Johan , Barrientos Sánchez Silvia , Rodríguez Ciodaro Adriana
Published: October 2019

Antecedentes: Según el Estudio Nacional de Salud Bucal del 2014, el 5,20 % de la población colombiana presenta edentulismo total y el 32,8 % en la población de más de 65 años. Sin embargo, otros parámetros relevantes para el correcto abordaje del edentulismo, deben ser analizados con estudios radiográficos. Objetivo: Identificar la frecuencia y características de los hallazgos y las variaciones óseas en radiografías panorámicas de pacientes totalmente edéntulos. Métodos: Se realizó un estudio observacional descriptivo en 10.000 radiografías panorámicas de las cuales se analizaron las que correspondían a pacientes con edentulismo total mediante el programa CliniView 9.3. Se registraron variables de sexo, edad, altura de rebordes alveolares, altura de rama y cóndilo mandibulares, así como los hallazgos radiográficos. Resultados: Se encontraron 112 radiografías de pacientes con edentulismo total, 51,8 % con algún tipo de hallazgo. El más frecuente fueron los implantes 33,9 % seguido por restos radiculares en 13,4 %. No hubo diferencias en los promedios de las medidas óseas en los dos lados. Los hombres tienen mayor altura de reborde alveolar en el maxilar inferior que las mujeres (p<0,05). Los valores de altura condilar fueron similares para ambos sexos. Se encontró mayor valor de la altura de la rama mandibular en los hombres (p<0,05). Conclusiones: La frecuencia de hallazgos radiográficos en pacientes edéntulos totales es considerable. Las variaciones óseas ocasionadas por la ausencia de dientes, deben ser tenidas en cuenta para la toma de las decisiones clínicas de restauración con prótesis total o con implantes.
Type A Botulinum Toxin as Complement to Gingivoplasty in the Treatment of Gummy Smile. Case Report
Authors: Pedron Irineu Gregnanin
Published: October 2019

Background: The pursuit of esthetic excellence has become a major goal in the dental treatment. Gummy smile is one of the complaints of the patients, since such a situation can influence self-esteem and social relationships. The beauty of the smile is not only constituted by the shape, position and size of the teeth, but also based on the characteristics of the gingival tissue and conformation of the lips, which should be as harmonious as teeth. The development of new more conservative techniques may provide a better therapeutic option than surgical procedures, such as the application of botulinum toxin, in the treatment of gummy smile. Purpose: to present the case of a patient who presented dentogingival discrepancy caused by gingival overgrowth and gummy smile, treated by gingivoplasty and complemented by application of botulinum toxin. Description of the case: The gingivoplasty was performed followed by the application of botulinum toxin type A. Results: The gingivoplasty resulted of the improvement of gingival arches and the application of botulinum toxin promoted the dehiscence of upper lip, reducing the gingival exposure. Conclusions: The application of botulinum toxin, associated with gingivoplasty, is an important tool at the management of gummy smile, optimizing smile harmony and achieving improved self-esteem and quality of life.
Elaboración de un biodiente: enfoque actual y desafíos
Authors: Intriago Morales Ruth Viviana , Álvarez Vásquez José Luis
Published: October 2019

Antecedentes: El edentulismo es uno de los mayores problemas de salud oral que cause alteraciones fisiológicas, sociales, estéticas, fonéticas y nutricionales. Las terapias actuales para el remplazo dental son artificiales y no satisfacen los requisitos básicos de un diente natural. La bioingeniería de tejidos constituye una alternativa para la sustitución de dientes perdidos. Objetivo: Identificar los enfoques/técnicas disponibles actualmente para obtener un diente completo por bioingeniería (biodiente), así como puntualizar sus desafíos y perspectivas futuras. Métodos: Se realizó una revisión integrativa de la literatura, por medio de las siguientes palabras clave: biodiente, bioingeniería de tejidos, diente entero y células madre. Los años de la búsqueda fueron 2000-2018, en las bases de datos: PubMed, Scopus, EBSCO, Science Direct, Wiley Online Library, Lilacs y Google Académico/Scholar, en inglés y español. Se seleccionaron únicamente artículos y libros de mayor relevancia y pertinencia. Resultados: Se obtuvieron 53 artículos y 10 libros. Para la elaboración de un biodiente se emplean los siguientes métodos: andamios, sin andamios, células madre pluripotentes inducidas, germen de órganos, diente quimérico y estimulación de la formación de la tercera dentición. El tamaño y forma normales del diente, así como la obtención de células epiteliales, son los principales desafíos. Conclusiones: La posibilidad de crear y desarrollar un biodiente en un ambiente oral adulto es cada vez más real gracias a los avances biotecnológicos que ocurren diariamente. Es posible que estos conceptos sean la base de la odontología restauradora en un futuro próximo.
Planes de Universitas Odontologica para el bienio 2019-2020
Authors: Delgado Troncoso Jorge Enrique , Delgado Troncoso Sandra Cecilia
Published: October 2019

Este editorial describe los planes de trabajo de la revista para el bienio 2019-2020. Entre otros temas, se aumentará la cantidad de dossier tematicos por edición y se promoverá la escritura de más revisiones de literatura, revisiones que, además de analizar críticamente la evidencia existente, hagan nuevas contribuciones al conocimiento al escudrinar el alcance, los destinos y las áreas que todavía estan sin respuesta en la investigación dental en Iberoamérica y el mundo.
Condições associadas a atividade de planejamento nos centros de especialidades odontológicas
Authors: De Lucena Edson Hilan Gomes , De Lucena Carolina Dantas Rocha Xavier , De Goes Paulo Savio Angeiras , De Sousa Maria Fátima
Published: October 2019

Antecedentes: O planejamento nos serviços de saúde visa especificamente melhorar o estado de saúde de uma determinada população, garantindo o acesso com equidade e justiça, bem como agilizar a resposta do sistema de saúde às necessidades percebidas pela comunidade. Objetivo: Analisar a associação entre o relato da prática do planejamento nos Centros de Especialidades Odontológicas (CEO) com as características do município, do serviço e do gestor do serviço. Método: É um estudo de natureza quantitativa, onde se utilizou o banco de dados da Avaliação Externa do primeiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade dos CEO (PMAQ-CEO), relativos ao módulo de entrevista com o Gerente e um Cirurgião-Dentista do CEO, além de verificação de documentos. A análise ocorreu do ponto de vista descritiva e analítica para a qual aplicou-se o teste qui-quadrado de Pearson, considerando o nível de significância de 5 %. Resultados: A maioria dos CEO que relataram ter realizado alguma atividade de planejamento, nos últimos 12 meses, está na Região Centro-Oeste (88,7 %) e Sul (82,1 %), em municípios com menor cobertura de saúde bucal da estratégia Saúde da Família e com alto Índice de Desenvolvimento Humano (IDHM). Porém não houve correlação com o porte populacional dos municípios. Conclusões: Os CEO que possuem gerente, com um tempo de atuação no serviço maior do que 2 anos e que tenha uma formação complementar na área de gestão pública ou de saúde coletiva tendem a realizar atividades de planejamento.
Política pública nacional de salud bucodental del Paraguay 2009-2018
Authors: Caballero García Cristina Raquel , Giménez de Chamorro Concepción Elizabeth , Flores Alatorre Francisco
Published: October 2019

Antecedentes: la Política Pública Nacional de Salud Bucodental  (SBD) “Por el Derecho de Volver a Sonreír” se inició en el marco de la reforma de salud del año 2008 dirigida hacia un sistema de salud basado en la Atención Primaria de Salud. Objetivo: Analizar el proceso del desarrollo e implementación de la Política Pública Nacional de SBD del Ministerio de Salud Pública y Bienestar Social del Paraguay (MSPBS) 2009-2018. Análisis de la política: Se expone la experiencia del Paraguay utilizando el marco de referencia propuesto por la Organización Mundial de la Salud para la redacción de políticas de SBD. Se describe el proceso dinámico de formulación de la política que incluye: el contexto del Sistema Nacional de Salud, la identificación de la necesidad, las estrategias de intervención implementadas, los pilares que la sustentaron, su evaluación, desafíos y logros. Conclusiones: El establecimiento de la Política Pública Nacional de SBD del MSPBS 2009-2018, logró posicionar a la SBD en la agenda pública del país ubicándola en un sitial de privilegio, nunca antes logrado dentro de la Institución. Su consolidación requirió de una profunda restructuración del programa, así como la implementación de diversas líneas de acción, cuyas evaluaciones, permitieron visualizar un fortalecimiento en la prestación de los servicios y un impacto positivo en la SBD de la población.
La salud bucal en la República Argentina. Análisis del sector
Authors: González y Rivas Melania
Published: October 2019

Objetivo: Realizar una reflexión sobre las políticas de salud bucal de la salud Bucal en la República Argentina. Métodos: Se analizan las políticas de salud bucal, su pertinencia y relevancia en el marco de contexto nacional del sistema de salud, la legislación vigente y los antecedentes epidemiológicos. Se hace especial referencia a las características de la odontología en un país federal y sus condicionantes sociales, geográficos, económicos e institucionales particulares. Conclusión: Se proponen recomendaciones y líneas de acción con la premisa de constituir a la salud bucal como política de Estado. Se concluye que es prioritario lograr la participación mancomunada de todos los actores políticos, sociales, económicos, académicos y de prestación de servicios de salud para optimizar la salud bucal de todos sus habitantes, con énfasis en los más vulnerables.
“I Don’t Really Know What the Magic Wand Is to Get Yourself in There”: Women’s Sense of Organizational Fit as Coach Developers
Authors: Norman Leanne
Published: October 2019

Building on the body of research that has addressed the experiences of female coaches, the present study examines women’s role as coach developers. English football served as the context for the research. Figures demonstrate women are underrepresented in this role more so than they are as coaches, and their distribution across the coach developer pathway is unevenly balanced, with most women qualified at Level I of the pathway. Using the concept of ‘organizational fit’, the research connects the experiences of the 10 coach developers interviewed, to the structural practices of their national and local governing bodies. These practices were symptomatic of the organizations’ culture that is created and upheld by masculine ideals. Work expectations and the environment were structured on the image of men as coaches and coach developers. Cultural barriers to women’s sense of organizational fit were specifically found to be: the incentive to progress (return on investment from higher coaching qualifications), the degree of organizational support and nurture, and the opportunity to progress and practice. Consequently, organizational expectations and values do not support the ambitions of women to climb the coach developer career ladder, and restrict their sense of choice and control. Future research should direct its attention towards a greater interrogation of aspects of sport organizational culture that may serve to ‘push’ female coaches away from its core, or alternatively, pull them closer to engage and make use of their expertise and abilities as coach developers.
Apixaban-induced haematoma causing small bowel intussusception
Authors: Santos Ariel P , Rodriguez Jennifer M , Berry Grace
Published: October 2019

Apixaban (Eliquis) is a direct acting oral anticoagulant (DOAC) indicated for treatment of deep vein thrombosis, non-valvular atrial fibrillation, pulmonary embolism and postoperative venous thromboprophylaxis following hip or knee replacement. Complications are minimal and include, but are not limited to, bleeding and intracranial haemorrhage, and haematoma formation. Our patient is a 73-year-old woman who presented with clinical and radiographic findings of small bowel obstruction. She was found to be taking apixaban for atrial fibrillation. CT scan showed small bowel intussusception. She underwent an exploratory laparotomy and resection of the small bowel intussusception with primary side-to-side anastomosis. Histopathological examination showed that the intussusception was caused by an intramural haematoma. This case presents a rare instance of adult intussusception caused by a DOAC. To our knowledge, no case of intussusception caused by apixaban has yet been found in literature.
Ectomesenchymal chondromyxoid tumour: an uncommon characteristic tumour of the anterior tongue
Authors: Riju Jeyashanth , Ahamed Shameer , Thomas Regi , Telugu Ramesh Babu
Published: October 2019

Ectomesenchymal chondromyxoid tumour (ECMT) is a rare benign tumour which classically presents in the anterior tongue. This tumour is grossly under-reported due to lack of immunohistochemical staining in many centres. We report a 46-year-old man who presented with mass in the anterior tongue and was diagnosed with ECMT. Further management of this lesion is explained with a review of the literature.
Wilson disease: a diagnostic challenge in a patient with alcoholic liver disease
Authors: Patel Roshni
Published: October 2019

A 32-year-old man with alcoholic cirrhosis presented with worsening abdominal distension and jaundice. He was diagnosed with cirrhosis 2 years prior after a hospitalisation for acute liver failure, during which viral, autoimmune and metabolic workup was unrevealing. Heavy alcohol consumption was his only obvious risk factor for liver disease, so his decompensation was attributed to alcohol. At the present time, he was admitted with acute-on-chronic liver failure and acute renal failure. The severity of his presentation and the disproportionately mild elevation in alkaline phosphatase relative to his hyperbilirubinaemia prompted repeating a ceruloplasmin level, which, though previously normal, was now low, and eventually led to a diagnosis of Wilson disease (WD) with concomitant alcoholic liver disease. Clinicians must recognise limitations in ceruloplasmin and copper levels when screening for WD and maintain suspicion for WD in young patients, even if there is an already established aetiology of liver disease.
Low-dose (0.01%) atropine eye-drops to reduce progression of myopia in children: a multicentre placebo-controlled randomised trial in the UK (CHAMP-UK)—study protocol
Authors: Azuara-Blanco Augusto , Logan Nicola , Strang Niall , Saunders Kathryn , Allen Peter M , Weir Ruth , Doherty Paul , Adams Catherine , Gardner Evie , Hogg Ruth , McFarland Margaret , Preston Jennifer , Verghis Rejina , Loughman James J , Flitcroft Ian , Mackey David A , Lee Samantha Sze-Yee , Hammond Christopher , Congdon Nathan , Clarke Mike
Published: October 2019

Background/aims

To report the protocol of a trial designed to evaluate the efficacy, safety and mechanism of action of low-dose atropine (0.01%) eye-drops for reducing progression of myopia in UK children.

Methods

Multicentre, double-masked, superiority, placebo-controlled, randomised trial. We will enrol children aged 6–12 years with myopia of −0.50 dioptres or worse in both eyes.

We will recruit 289 participants with an allocation ratio of 2:1 (193 atropine; 96 placebo) from five centres. Participants will instil one drop in each eye every day for 2 years and attend a research centre every 6 months. The vehicle and preservative will be the same in both study arms.

The primary outcome is SER of both eyes measured by autorefractor under cycloplegia at 2 years (adjusted for baseline). Secondary outcomes include axial length, best corrected distance visual acuity, near visual acuity, reading speed, pupil diameter, accommodation, adverse event rates and allergic reactions, quality of life (EQ-5D-Y) and tolerability at 2 years. Mechanistic evaluations will include: peripheral axial length, peripheral retinal defocus, anterior chamber depth, iris colour, height and weight, activities questionnaire, ciliary body biometry and chorioretinal thickness. Endpoints from both eyes will be pooled in combined analysis using generalised estimating equations to allow for the correlation between eyes within participant. Three years after cessation of treatment, we will also evaluate refractive error and adverse events.

Conclusions

The Childhood Atropine for Myopia Progression in the UK study will be the first randomised trial reporting outcomes of low-dose atropine eye-drops for children with myopia in a UK population.

Trial registration number

ISRCTN99883695,NCT03690089.
Reducing waste: a guidelines-based approach to reducing inappropriate vitamin D and TSH testing in the inpatient rehabilitation setting
Authors: Bateman Emma A , Gob Alan , Chin-Yee Ian , MacKenzie Heather M
Published: October 2019

Background

Laboratory overutilisation increases healthcare costs, and can lead to overdiagnosis, overtreatment and negative health outcomes. Discipline-specific guidelines do not support routine testing for Vitamin D and thyroid-stimulating hormone (TSH) in the inpatient rehabilitation setting, yet 94% of patients had Vitamin D and TSH tests on admission to inpatient rehabilitation at our institution. Our objective was to reduce Vitamin D and TSH testing by 25% on admission to inpatient Stroke, Spinal Cord Injury, Acquired Brain Injury and Amputee Rehabilitation units.

Methods

A fishbone framework for root cause analysis revealed potential causes underlying overutilisation of Vitamin D and TSH testing. A series of Plan-Do-Study-Act (PDSA) cycles were introduced to target remediable factors, starting with an academic detailing intervention with key stakeholders that reviewed applicable clinical guidelines for each patient care discipline and the rationale for reducing admission testing. Simultaneously, computerised clinical decision support (CCDS) limited Vitamin D testing to specific criteria. Audit and feedback were used in a subsequent PDSA cycle. Frequency of Vitamin D and TSH testing on admission was the primary outcome measure. The number of electronic admission order caresets containing automatic Vitamin D and/or TSH orders before and after the interventions was the process measure. Rate of Vitamin D supplementation and changes in thyroid-related medication were the balancing measures.

Results

After implementation, 2.9% of patients had admission Vitamin D testing (97% relative reduction) and 53% of patients had admission TSH testing (43% relative reduction). Admission order caresets with prepopulated Vitamin D and TSH orders decreased from 100% (n=6) to 0%. The interventions were successful; similar to previous literature, CCDS was more effective than education and audit and feedback interventions alone. The interventions represent >$9000 annualised savings.
Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia
Authors: Aljabri Ahmed , Perona Stephen , Alshibani Mohannad , Khobrani Moteb , Jarrell Daniel , Patanwala Asad E
Published: October 2019

Background

Dextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.

Methods

This was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.

Results

A total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).

Conclusions

The extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.
Expression of hypoxia-induced proteins in ductal carcinoma in situ and invasive cancer of the male breast
Authors: Vermeulen Marijn A , van Deurzen Carolien HM , Schroder Carolien P , Martens John WM , van Diest Paul J
Published: October 2019

Aims

The aim of this study was to determine the role of hypoxia in male breast carcinogenesis by evaluating the expression of the hypoxia-related proteins, hypoxia-inducible factor-1α (HIF-1α), carbonic anhydrase IX (CAIX) and glucose transporter-1 (Glut-1), in ductal carcinoma in situ (DCIS) of the male breast in relation to invasive cancer (IC).

Methods

Tumour tissue blocks of 18 cases of pure DCIS, 58 DCIS cases adjacent to IC (DCIS-AIC) and the 58 IC cases were stained by immunohistochemistry for HIF-1α, CAIX and Glut-1, and expression frequencies and patterns (diffuse and/or perinecrotic) were noted.

Results

HIF-1α overexpression was observed in 61.1% (11/18) of pure DCIS, in 37.9% (22/58) of DCIS-AIC and in 36.2% (21/58) of IC cases (not significant (n.s.)). CAIX overexpression was observed in 16.7% (3/18) of pure DCIS, in 37.9% (22/58) of DCIS-AIC and in 24.1% (14/58) of IC cases (n.s.). Glut-1 overexpression was observed in 61.1% (11/18) of pure DCIS, in 75.9% (44/58) of DCIS-AIC and in 62.1% (36/58) of IC cases (n.s.). Expression of hypoxia-related proteins was seen around necrosis in a little over one-third of DCIS cases, and often coincided with expression in adjacent IC when present. All these observations indicate that the hypoxia response is already at its maximum in the preinvasive DCIS stage.

Conclusions

In conclusion, male DCIS frequently shows activated hypoxia response, comparable to male IC. This indicates that the activated hypoxia response previously seen in male IC is not a late bystander but likely a genuine carcinogenetic event.
Impact of reperfusion pump power on technical and clinical outcomes after direct aspiration thrombectomy (ADAPT)
Authors: Alawieh Ali , Chalhoub Reda , Korson Clayton J , Anadani Mohammad , Lena Jonathan , Spiotta Alejandro
Published: October 2019

Introduction

Higher aspiration forces using larger bore catheters in direct aspiration thrombectomy (ADAPT) have been associated with shorter procedure time and better outcomes in patients treated for acute ischemic stroke (AIS). However, the effect of using reperfusion pumps of higher aspiration power on outcomes of ADAPT has not been investigated. We evaluated the effect of using pumps with different aspiration powers on technical and clinical outcomes after ADAPT.

Methods

We reviewed a retrospective database of AIS cases between January 2018 and February 2019, while comparing technical and clinical outcomes between patients undergoing ADAPT using the MAX pump (28.5 inHg power) vs the ENGINE pump(29.2 inHg power).

Results

Among 194 patients (48% females, age 69±15 years) included in the study, 73 patients undergoing ADAPT using the ENGINE pump were age-, gender-, comorbidities-, and operator-matched to 118 patients treated using the MAX pump. The ENGINE group had shorter procedure time (20±17 vs 27±21 mins, p=0.017), lower number of aspiration attempts (2.2±1.6 vs 2.8±1.9, p=0.047), and similar rates of favorable 90 day modified Rankin Scale. Using multivariate linear regression, the use of the ENGINE reperfusion pump with higher vacuum power was independently and inversely correlated with procedure time (coefficient −2.23, p=0.027). While controlling for confounders, there was a trend toward an inverse correlation between use of the ENGINE pump and the number of attempts on linear regression (coefficient −1.04, p=0.09) and lower odds of PH2/intracranial (ICH) hemorrhages on logistic regression (OR 0.227, p=0.075).

Conclusion

Our findings suggest that the use of the ENGINE reperfusion pump of higher aspiration power during ADAPT decreases procedure time, without increasing complications and post-procedural hemorrhage rates.
The pharmacokinetics of mycophenolic acid in rats with orotic acid induced nonalcoholic fatty liver disease
Authors: Subali Dionysius , Kwon Mi Hye , Bang Won Seok , Kang Hee Eun
Published: October 2019

Post-transplantation nonalcoholic fatty liver disease (NAFLD) is common in liver transplant recipients. Changes in the expression levels and activities of drug-metabolizing enzymes and drug transporters have been reported in patients with NAFLD and relevant rodent models. Here, we evaluated whether the pharmacokinetics of mycophenolic acid (MPA), an immunosuppressant, would be altered in rats with NAFLD. NAFLD was induced by feeding a diet containing 1% (w/w) orotic acid for 20 days. The extent of hepatic glucuronidation of MPA to a major metabolite, mycophenolic acid-7-O-glucuronide (MPAG), did not differ between rats with NAFLD and controls. The expression levels of hepatic multidrug resistance-associated protein 2, responsible for biliary excretion of MPAG, were comparable in rats with NAFLD and controls; the biliary excretion of MPAG was also similar in the two groups. Compared with control rats, rats with NAFLD did not exhibit significant changes in the areas under the plasma concentration – time curves of MPA or MPAG after intravenous (5 mg/kg) or oral (10 mg/kg) administration of MPA. However, delayed oral absorption of MPA was observed in rats with NAFLD compared with controls; the MPA and MPAG peak plasma concentrations fell significantly and the times to achieve them were prolonged following oral administration of MPA.
Asymptotically flat vacuum solution in modified theory of Einstein’s gravity
Authors: Kalita Surajit , Mukhopadhyay Banibrata
Published: October 2019

A number of recent observations have suggested that the Einstein’s theory of general relativity may not be the ultimate theory of gravity. The f(R) gravity model with R being the scalar curvature turns out to be one of the best bet to surpass the general relativity which explains a number of phenomena where Einstein’s theory of gravity fails. In the f(R) gravity, behaviour of the spacetime is modified as compared to that of given by the Einstein’s theory of general relativity. This theory has already been explored for understanding various compact objects such as neutron stars, white dwarfs etc. and also describing evolution of the universe. Although researchers have already found the vacuum spacetime solutions for the f(R) gravity, yet there is a caveat that the metric does have some diverging terms and hence these solutions are not asymptotically flat. We show that it is possible to have asymptotically flat spherically symmetric vacuum solution for the f(R) gravity, which is different from the Schwarzschild solution. We use this solution for explaining various bound orbits around the black hole and eventually, as an immediate application, in the spherical accretion flow around it.
Substrate Effects in GaN-on-Silicon RF Device Technology
Authors: Chandrasekar Hareesh
Published: October 2019

The influence of the semiconducting Si substrate on the performance of GaN-on-Si RF technology is reviewed. Firstly, the formation of a parasitic conduction channel at the substrate-epitaxy interface is discussed in terms of its physical mechanism and its influence on RF loss, followed by schemes to minimize this effect. Secondly, it is shown that the presence of the parallel channel serves to backbias the III-nitride epitaxial stack and lead to current collapse even on the highly-resistive Si substrates used for RF device fabrication, analogous to GaN-on-doped Si power devices. Strategies to mitigate this issue are also presented and critically compared. Thirdly, thermal generation of carriers in Si at elevated operating temperatures leading to increased substrate loss is quantified, also followed by a discussion of possible techniques to reduce its influence on RF loss.
β-(Al,Ga)2O3 for High Power Applications — A Review on Material Growth and Device Fabrication
Authors: Jian Ashley (Zhe) , Khan Kamruzzaman , Ahmadi Elaheh
Published: October 2019

Gallium Oxide has attracted a great deal of attention for power electronics due to its large bandgap (∼4.8 eV) as well as availability of cost effective, large area, high quality substrates. In this article, we will discuss advancements in homoepitaxial and heteroepitaxial growth of β-(Al,Ga)2O3 and their heterostructures via different growth techniques with the emphasis on metal organic chemical vapor deposition, molecular beam epitaxy, and halide vapor phase epitaxy. We will also review various device structures demonstrated for high power applications.
Relations in the semigroup of 2 × 2 upper-triangular matrices
Authors: Esbelin Henri-Alex , Gutan Marin
Published: October 2019

Let [Formula: see text] with [Formula: see text] be [Formula: see text] upper-triangular matrices with rational entries. In the multiplicative semigroup generated by these matrices, we check if there are relations of the form [Formula: see text] where [Formula: see text] [Formula: see text] and [Formula: see text] We give algorithms to find relations of the previous form. Our results are extensions of some theorems obtained by Charlier and Honkala in [The freeness problem over matrix semigroups and bounded languages, Inf. Comput. 237 (2014) 243–256]. Our paper is at the interface between algebra, number theory and theoretical computer science. While the main results concern decidability and semigroup theory, the methods for obtaining them come from number theory.
Exit time asymptotics for dynamical systems with fast random switching near an unstable equilibrium
Authors: Bakhtin Yuri , Gaál Alexisz
Published: October 2019

We consider the exit problem for a one-dimensional system with random switching near an unstable equilibrium point of the averaged drift. In the infinite switching rate limit, we show that the exit time satisfies a limit theorem with a logarithmic deterministic term and a random correction converging in distribution. Thus, this setting is in the universality class of the unstable equilibrium exit under small white-noise perturbations.
On the one-parameter Lorentzian spatial motions
Authors: Alluhaibi Nadia , Abdel-Baky R. A.
Published: October 2019

In this paper, differential properties of the one-parameter Lorentzian spatial motions are developed with explicit expressions independent of coordinates systems. In term of this, we calculate the Disteli formulae of a spacelike line trajectory and derive the connections with kinematic geometry of the axodes. Lastly, a theoretical expression of a spacelike inflection line congruence are investigated in detail.
The congruence equation a¯ + b¯ ≡c¯(modp)
Authors: Chan Tsz Ho
Published: October 2019

In this paper, we consider the congruence equation [Formula: see text] with [Formula: see text] where [Formula: see text] denotes the multiplicative inverse of [Formula: see text]. We prove that its number of solutions is asymptotic to [Formula: see text] when [Formula: see text] by estimating a certain average of Kloosterman sums via Gauss sums. On the other hand, when [Formula: see text], the number of solutions has order of magnitude at least [Formula: see text]. It would be interesting to better understand its transition of behavior. By transforming the question slightly, one can relate the problem to a certain first moment of Dirichlet [Formula: see text]-functions at [Formula: see text].
Explicit calculation of the mod 4 Galois representation associated with the Fermat quartic
Authors: Ishitsuka Yasuhiro , Ito Tetsushi , Ohshita Tatsuya
Published: October 2019

We use explicit methods to study the [Formula: see text]-torsion points on the Jacobian variety of the Fermat quartic. With the aid of computer algebra systems, we explicitly give a basis of the group of [Formula: see text]-torsion points. We calculate the Galois action, and show that the image of the mod [Formula: see text] Galois representation is isomorphic to the dihedral group of order [Formula: see text]. As applications, we calculate the Mordell–Weil group of the Jacobian variety of the Fermat quartic over each subfield of the [Formula: see text]th cyclotomic field. We determine all of the points on the Fermat quartic defined over quadratic extensions of the [Formula: see text]th cyclotomic field. Thus, we complete Faddeev’s work in 1960.