bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of Reproductive Coercion in Queensland Women
Authors: Price Elizabeth , Sharman Leah S. , Douglas Heather A. , Sheeran Nicola , Dingle Genevieve A.
Published: May 2019

Reproductive coercion is any interference with a person’s reproductive autonomy that seeks to control if and when they become pregnant, and whether the pregnancy is maintained or terminated. It includes sabotage of contraceptive methods and intervention in a woman’s access to health care. Our study sought to explore the prevalence and associations with reproductive coercion within Queensland, Australia, where legislation addressing domestic violence and abortion are largely state based and undergoing a period of law reform. The study was a retrospective analysis of 3,117 Queensland women who contacted a telephone counseling and information service regarding an unplanned pregnancy. All data were collected by experienced counselors regarding circumstances within a current pregnancy between January 2015 and July 2017. Overall, experience of current domestic violence was significantly more likely to co-occur with reproductive coercion (21.1%) compared with reproductive coercion identified in the absence of other domestic violence (3.1%). Furthermore, significantly more mental health issues were reported by 36.6% of women affected by reproductive coercion, compared with 14.1% of women with no reproductive coercion present. Disclosure for reproductive coercion, violence, and mental health issues was much higher among women who made a repeat contact to the counselors about their pregnancy (17.8%) compared with those who disclosed at first contact (5.9%). These findings demonstrate the importance for health services to ensure that appropriate screening (and re-screening) for reproductive coercion is completed as a distinct part of screening for violence during a health care relationship.
Ten Tips to Consider When Creating and Screening PBIS Films
Authors: Hirsch Shanna E. , Brown Courtney P. , Halley Emma A. , Beach John , MacSuga-Gage Ashley S. , Spence Sarah E. , Kennedy Michael
Published: May 2019

School personnel can benefit from creating and sharing their own positive behavioral interventions and supports (PBIS) videos. PBIS videos can (a) introduce a new initiative to faculty and students, (b) teach specific school or class expectations, (c) reinforce appropriate student and staff behavior, and (d) celebrate PBIS implementation successes. This discussion article lists and describes strategies that can be used to create and screen PBIS videos. Examples of school personnel using PBIS videos are included.
Skin autofluorescence as a measure of advanced glycation end product levels is associated with carotid atherosclerotic plaque burden in an elderly population
Authors: Jujić Amra , Östling Gerd , Persson Margaretha , Engström Gunnar , Nilsson Peter M , Melander Olle , Magnusson Martin
Published: May 2019

Background:

Advanced glycation end product is an established risk marker in diabetic vascular disease, but its possible associations with atherosclerosis in a general population are yet to be investigated. We studied the degree of carotid atherosclerosis and its association with skin autofluorescence in an elderly population.

Methods:

Carotid ultrasound and skin autofluorescence measurements were performed in a subpopulation within the ‘Malmö Diet and Cancer Cardiovascular Cohort’ re-examination study ( n = 523). Total plaque area including all prevalent plaques in the right carotid artery was calculated. Complete data on all variables were available for 496 subjects (mean age 72 years).

Results:

Each 1 standard deviation increment of skin autofluorescence was associated with increased risk of prevalent large plaques (odds ratio, 1.32; 95% confidence interval, 1.05–1.66; p = 0.018) independently of diabetes and cardiovascular risk factors. The top versus bottom tertile of the skin autofluorescence was associated with an approximately twofold risk of being in the population with the highest plaque burden [top quartile with total plaque area ⩾ 35 mm2 (odds ratio, 1.88; 95% confidence interval, 1.05–3.39; p for trend = 0.027)] in fully adjusted analysis.

Conclusion:

In an elderly population, skin autofluorescence was associated with increasing degree of carotid atherosclerosis measured as total plaque area, independently of diabetes and cardiovascular risk factors.
Effect of CYP2D6 and CYP3A4 Genotypes on the Efficacy of Cholinesterase Inhibitors in Southern Chinese Patients With Alzheimer’s Disease
Authors: Ma Suk Ling , Tang Nelson Leung Sang , Wat Karen Hong Yun , Tang Jenny Hoi Yin , Lau Ka Hin , Law Chun Bon , Chiu John , Tam Cindy Chi Woon , Poon Tin Keung , Lin Ka Leung , Kng Carolyn Poey Lyn , Kong Hing Leung , Chan Tak Yeung , Chan Wai Chi , Lam Linda Chiu Wa
Published: May 2019

Alzheimer’s disease (AD) is the most prevalent form of dementia, and age is strongly associated with the incidence of AD. This study aimed to investigate the association between the genotypes of CYP2D6, CYP3A4, and CYP2C9 genes to the clinical efficacy and tolerability of cholinesterase inhibitors (ChEIs) in Chinese patients with AD. One hundred seventy-nine patients with AD with newly prescribed with ChEIs were recruited. The clinical response and tolerability were evaluated at baseline, 3rd-, 6th-, and 12th-month follow-ups and were compared according to their genotypes of CYP2D6, CYP3A4, and CYP2C9. Among patients prescribed with donepezil/galantamine, CYP2D6*10 carriers showed significantly less side effects ( P = .009). CYP2D6*10 carriers responded better to ChEIs and resulted in better improvement in Alzheimer’s Disease Assessment Scale-Cognitive subscale ( P = .027) and Mini-Mental State Examination ( P = .012). Further study is required to replicate the finding, and it might be useful for clinicians to decide the medication based on the patients’ CYP genotypes.
Probing membrane protein properties using droplet interface bilayers
Authors: Allen-Benton Maxwell , Findlay Heather E , Booth Paula J
Published: May 2019

Integral membrane proteins comprise a large proportion of drug targets, yet are challenging to study in vitro due to their amphiphilic nature. Conducting useful functional in vitro studies requires an artificial membrane that can mimic the lipid environment of the biogenic membrane. Droplet interface bilayer technology provides a method to form artificial bilayers with a robustness and physicochemical complexity that has not previously been possible, facilitating more sophisticated in vitro studies of membrane proteins. This mini-review examines functional studies of membrane proteins that utilize droplet interface bilayers to date and comments on possible directions of future research. Observations from our own laboratory regarding the study of a flippase protein in droplet interface bilayers are also presented.

Impact statement

The paper presents a comprehensive review of integral membrane protein studies utilizing droplet interface bilayers. Droplet interface bilayers are a novel method of constructing artificial lipid bilayers with enhanced stability and physicochemical complexity compared to existing methods. Their unique morphology also suggests applications in the construction of synthetic biological systems and protocells. As well as serving as a guide to in vitro membrane protein functional studies using droplet interface bilayers in the literature to date, a novel in vitro study of a flippase protein in a droplet interface bilayer is presented.
Simulation of entropy generation during the evolution of rotating stall in a two-stage variable-pitch axial fan
Authors: Zhang Lei , Zheng Zhi , Zhang Qian , Wang Songling
Published: May 2019

Rotating stall is a common instability phenomenon that occurs in turbomachinery. Rotating stall 3D instability can be characterized as one or more stall cells rotating at a fraction of rotor velocity. In this article, the ANSYS Fluent software was used to numerically simulate entropy generation. The relative velocity of the monitoring points in the rotor is discussed, and the type of stall inception is a spike. In addition, five typical conditions that affect the evolution of rotating stalls are presented and discussed with respect to characterizing entropy generation in a two-stage variable-pitch axial fan. The results reveal that entropy generation significantly improves after the stall phenomenon appears. Because rotating stall first occurs in the second rotor, its entropy production is higher than that of the first rotor over the entire evolution period. The high entropy generation region moves in the circumferential and radial directions of the first and second rotors during the evolution of rotating stall.
Safety Trial of Low-Intensity Monitoring After Thrombolysis: Optimal Post Tpa-Iv Monitoring in Ischemic STroke (OPTIMIST)
Authors: Faigle Roland , Butler Jaime , Carhuapoma Juan R. , Johnson Brenda , Zink Elizabeth K. , Shakes Tenise , Rosenblum Melissa , Saheed Mustapha , Urrutia Victor C.
Published: May 2019

Background and Purpose:

At present, stroke patients receiving intravenous thrombolysis (IVT) undergo monitoring of their neurological status and vital signs every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, and every hour thereafter up to 24 hours post-IVT. The present study sought to prospectively evaluate whether post-IVT stroke patients with low risk for complications may safely be cared for utilizing a novel low-intensity monitoring protocol.

Methods:

In this pragmatic, prospective, single-center, open-label, single-arm safety study, we enrolled 35 post-IVT stroke patients. Adult patients were eligible if their NIH Stroke Scale (NIHSS) was less than 10 at the time of presentation, and if they had no critical care needs by the end of the IVT infusion. Patients underwent a low-intensity monitoring protocol during the first 24 hours after IVT. The primary outcome was need for a critical care intervention in the first 24 hours after IVT.

Results:

The median age was 54 years (range: 32-79), and the median pre-IVT NIHSS was 3 (interquartile range [IQR]: 1-6). None of the 35 patients required transfer to the intensive care unit or a critical care intervention in the first 24 hours after IVT. The median NIHSS at 24 hours after IVT was 1 (IQR: 0-3). Four (11.4%) patients were stroke mimics, and the vast majority was discharged to home (82.9%). At 90 days, the median NIHSS was 0 (IQR: 0-1), and the median modified Rankin Scale was 0 (range: 0-6).

Conclusion:

Post-IVT stroke patients may be safely monitored in the setting of a low-intensity protocol.
Evaluation of aortic 18F-NaF tracer uptake using PET/CT as a predictor of aortic calcification in postmenopausal women: A longitudinal study
Authors: Cecelja Marina , Moore Amelia , Fogelman Ignac , Frost Michelle L , Blake Glen M , Chowienczyk Phil
Published: May 2019

Introduction

Aortic calcification as detected by computed tomography is associated with arterial stiffening and is an important predictor of cardiovascular morbidity and mortality. Uptake of 18F-sodium fluoride (18F-NaF) in the aortic wall reflects metabolically active areas of calcification. The aim of this study was to determine if 18F-NaF uptake in the aorta is associated with calcification and progression of calcification as detected by computed tomography.

Methods

Twenty-one postmenopausal women (mean age 62 ± 6 years) underwent assessment of aortic 18F-NaF uptake using positron emission tomography/computer tomography at baseline and a repeat computed tomography scan after a mean follow-up of 3.8 ± 1.3 years. Tracer uptake was quantified by calculating the target-to-background (TBR) ratios at baseline and follow-up. Calcification was assessed at baseline and follow-up using computed tomography.

Results

Over the follow-up period, aortic calcium volume increased from 0.46 ± 0.62 to 0.71 ± 0.93 cm3 ( P < 0.05). However, the change in calcium volume did not correlate with baseline TBR either unadjusted ( r = 0.00, P = 1.00) or adjusted for age and baseline calcium volume (beta coefficient = −0.18, P = 0.42). TBR at baseline did not differ between participants with ( n = 16) compared to those without ( n = 5) progression in calcium volume (2.43 ± 0.46 vs. 2.31 ± 0.38, P = 0.58). In aortic segments identified to have the highest tracer uptake at baseline, calcium volume did not significantly change over the follow-up period ( P = 0.41).

Conclusion

In a cohort of postmenopausal women, 18F-NaF uptake as measured by TBR in the lumbar aorta did not predict progression of aortic calcification as detected by computed tomography over a four-year follow-up.
Ovarian teratoma with recurrent urinary retention is misdiagnosed as bladder disease: A rare case report and review of the literature
Authors: Wang Ning , Wang Kai , Xie Xi , Cao Lin , He Huadong , Li Ning
Published: May 2019

We present a 22-year-old ovarian teratoma female patient with recurrent urinary retention. It was first misdiagnosed as bladder disease and the treatment is catheterization. During the follow-up, urinary abdominopelvic examination showed a heterogeneous hypoechoic zone of 66 mm × 25 mm on the upper wall of the bladder with 1125 mL residual urine, so the patient was reevaluated. Vaginal ultrasound showed no obvious abnormalities in the uterus and accessories. In the further evaluation, urinary computed tomography (CT) revealed a visible huge space-occupying lesions in the pelvis and lower abdomen, was considered a benign lesion, and it might be the accessories teratoma. Abdominal magnetic resonance imaging (MRI) revealed a visible huge cystic shadow in the pelvis and lower abdomen. Post-operative pathology confirmed the presence of pelvic mature cystic teratoma and mature neural tissue. Post-operative follow-up for 1 year, the patient had no symptoms such as abdominal pain, dysuria, or urinary retention. The clinical manifestations of ovarian teratoma are complex, but imaging examinations (e.g. CT, MRI, and ultrasound) are characteristic and valuable for clinical diagnosis.
Primary Bone Tumor of the Spine—An Evolving Field: What a General Spine Surgeon Should Know
Authors: Charest-Morin Raphaële , Fisher Charles G. , Sahgal Arjun , Boriani Stefano , Gokaslan Ziya L. , Lazary Aron , Reynolds Jeremy , Bettegowda Chetan , Rhines Laurence D. , Dea Nicolas
Published: May 2019

Study Design:

A narrative review of the literature.

Objective:

This article reviews the general principles of treatment and investigation for primary bone tumors of the spine. Furthermore, it explores the emerging alternatives.

Methods:

A review was performed using Medline, Embase, and Cochrane databases.

Results:

Primary bone tumors of the spine are rare entities that general spine surgeons may encounter only a few times in their career. The treatment algorithm of these complex tumors is filled with nuances and is evolving constantly. For these reasons, patients should be referred to experienced tertiary or quaternary centers who can offer a comprehensive multidisciplinary approach. For most malignant spinal bone tumors, surgery remains the cornerstone of treatment. Respecting oncologic principles has been associated with improved survival and decreased local recurrence in multiple settings. However, even in experienced centers, these surgeries carry a significant risk of adverse events and possible long-term neurologic impairment. The associated morbidity of these procedures and the challenges of local recurrence have encouraged professionals caring for these patients to explore alternatives or adjuncts to surgical treatment.

Conclusions:

Over the past few years, several advances have occurred in medical oncology, radiation oncology and interventional radiology, changing the treatment paradigm for some tumors. Other advances still need to be refined before being applied in a clinical setting.
Allogenic Stem Cells in Spinal Fusion: A Systematic Review
Authors: Hsieh Patrick C. , Buser Zorica , Skelly Andrea C. , Brodt Erika D. , Brodke Darrel , Meisel Hans-Joerg , Park Jong-Beom , Yoon S. Tim , Wang Jeffrey C.
Published: May 2019

Study Design:

Systematic review.

Objectives:

To review, critically appraise, and synthesize evidence on the use of allogenic stem cell products for spine fusion compared with other bone graft materials.

Methods:

Systematic searches of PubMed/MEDLINE, through October 31, 2018 and of EMBASE and ClinicalTrials.gov through April 13, 2018 were conducted for literature comparing allogenic stem cell sources for fusion in the lumbar or cervical spine with other fusion methods. In the absence of comparative studies, case series of ≥10 patients were considered.

Results:

From 382 potentially relevant citations identified, 6 publications on lumbar fusion and 5 on cervical fusion met the inclusion criteria. For lumbar arthrodesis, mean Oswestry Disability Index (ODI), visual analogue scale (VAS) pain score, and fusion rates were similar for anterior lumbar interbody fusion (ALIF) using allogenic multipotent adult progenitor cells (Map3) versus recombinant human bone morphogenetic protein–2 (rhBMP-2) in the one comparative lumbar study (90% vs 92%). Across case series of allogenic stem cell products, function and pain were improved relative to baseline and fusion occurred in ≥90% of patients at ≥12 months. For cervical arthrodesis across case series, stem cell products improved function and pain compared with baseline at various time frames. In a retrospective cohort study fusion rates were not statistically different for Osteocel compared with Vertigraft allograft (88% vs 95%). Fusion rates varied across time frames and intervention products in case series.

Conclusions:

The overall quality (strength) of evidence of effectiveness and safety of allogenic stem cells products for lumbar and cervical arthrodesis was very low, meaning that we have very little confidence that the effects seen are reflective of the true effects.
Camanchacaite, chinchorroite, espadaite, magnesiofluckite, picaite and ríosecoite: six new hydrogen-arsenate minerals from the Torrecillas mine, Iquique Province, Chile
Authors: Kampf Anthony R. , Nash Barbara P. , Celestian Aaron J. , Dini Maurizio , Molina Donoso Arturo A.
Published: May 2019

The new minerals camanchacaite, NaCaMg2[AsO4]2[AsO3(OH)2], chinchorroite, Na2Mg5(As2O7)2(AsO3OH)2(H2O)10, espadaite, Na4Ca3Mg2[AsO3(OH)]2[AsO2(OH)2]10(H2O)6·H2O, magnesiofluckite, CaMg(AsO3OH)2(H2O)2, picaite, NaCa[AsO3OH][AsO2(OH)2] and ríosecoite, Ca2Mg(AsO3OH)3(H2O)2, were discovered on two closely related specimens collected from the Torrecillas mine, Iquique Province, Chile. These minerals occur as secondary phases on massive quartz–hematite also in association with anhydrite, gypsum, halite and talmessite. Camanchacaite is monoclinic,C2/c,a= 12.470(9),b= 12.554(9),c= 6.848(9) Å, β = 113.75(2)°,V= 981.3(16) Å3andZ= 4. It has a protonated alluaudite-type structure. Chinchorroite is triclinic,P$\bar{1}$,a= 8.7777(2),b= 8.8570(3),c= 9.7981(7) Å, α = 91.097(6), β = 110.544(8), γ = 103.167(7)°,V= 690.43(7) Å3andZ= 1. The structure contains abbreviated chains of five edge-sharing Mg octahedra that are linked by pyroarsenate and hydrogen-arsenate groups. Espadaite is orthorhombic,Ccca,a= 12.3649(10),b= 22.181(2),c= 18.3292(13) Å,V= 5027.1(7) Å3andZ= 4. The structure is based on heteropolyhedral sheets of formula {Ca3Mg2[AsO3(OH)]2[AsO2(OH)2]10}4−that contain large voids; NaO6polyhedra occupy the interlayer region. Magnesiofluckite is triclinic,P$\bar{1}$,a= 8.4143(6),b= 7.5321(5),c= 6.8917(4) Å, α = 82.477(6), β = 97.682(6), γ = 95.379(6)°,V= 427.84(5) Å3andZ= 2. It is isostructural with fluckite. Picaite is monoclinic,P21/c,a= 7.2474(4),b= 14.6547(7),c= 7.2624(5) Å, β = 99.520(7)°,V= 760.70(8) Å3andZ= 4. The structure contains chains of edge-sharing Na− and Ca octahedra with bridging AsO3(OH) and AsO2(OH)2tetrahedra. Ríosecoite is triclinic,P$\bar{1}$,a= 6.8110(9),b= 7.3156(12),c= 11.7773(17) Å, α = 83.466(6), β = 84.394(6), γ = 79.779(6)°,V= 571.95(15) Å3andZ= 2. The structure contains tetramers of edge-sharing CaO7and CaO8polyhedra linked by MgO6octahedra and bridging AsO3(OH) groups to form chains.
Stress perturbations around the deep salt structure of Kuqa depression in the Tarim Basin
Authors: Wang Mingwen , Sun Yunqiang , Luo Gang , Zhang Rui
Published: May 2019

Drilling into and around salt bodies can present different kinds of geohazards, such as shrinkage or stuck and crushed casings, resulting in well abandonment and huge economic losses. These engineering disasters are more likely to happen when ignoring the stress perturbations caused by the geomechanical interactions between the salt and surrounding sediments. For a better understanding of the stress perturbations, we use a commercial finite-element software, Abaqus, to build a 2D plane-strain finite-element model of the salt structure of Kuqa depression in the Tarim Basin and simulate the stress perturbations around the salt body in the environment of tectonic compression. By analyzing the patterns of stress perturbations due to different salt geometries such as concave and convex salt, we have come to the conclusion that the convex salt causes compressional stresses on the horizontal and out-of-plane directions but the extensional stress on the vertical direction. On the contrary, the concave salt induces extensional stresses on the horizontal and out-of-plane directions but compressional stress on the vertical direction. The results of stress perturbations near a salt structure in the environment of compressional tectonic stress are opposite to those in the environment of extensional tectonic stress, such as the Mad Dog, in the deepwater northern Gulf of Mexico. The shear stress ([Formula: see text]) near the salt structure is bigger than those far away from the salt structure, but is much smaller when compared with horizontal, vertical, and out-of-plane stresses ([Formula: see text]) in the profile, in the salt body, horizontal stress drops and converges to vertical stress and von Mises stress ([Formula: see text]) equals to zero due to isotropic stresses. The results provide scientific insights on stress perturbations and wellbore drilling design near salt structures in the Tarim Basin.
Mental health services for war-affected children
Authors: Jones Lynne , Rrustemi Alban , Shahini Mimoza , Uka Aferdita
Published: May 2019

Background

In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions.

Aims

To describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented.

Method

Data were collected on 559 patients over 2 years, including their referring problems and diagnoses.

Results

Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to atraumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories.

Conclusions

Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in ‘depathologising’ normative responses.
Validity of Natural Language Processing for Ascertainment of EGFR and ALK Test Results in SEER Cases of Stage IV Non–Small-Cell Lung Cancer
Authors: Goulart Bernardo Haddock Lobo , Silgard Emily T. , Baik Christina S. , Bansal Aasthaa , Sun Qin , Durbin Eric B. , Hands Isaac , Shah Darshil , Arnold Susanne M. , Ramsey Scott D. , Kavuluru Ramakanth , Schwartz Stephen M.
Published: May 2019

PURPOSE

SEER registries do not report results of epidermal growth factor receptor ( EGFR) and anaplastic lymphoma kinase ( ALK) mutation tests. To facilitate population-based research in molecularly defined subgroups of non–small-cell lung cancer (NSCLC), we assessed the validity of natural language processing (NLP) for the ascertainment of EGFR and ALK testing from electronic pathology (e-path) reports of NSCLC cases included in two SEER registries: the Cancer Surveillance System (CSS) and the Kentucky Cancer Registry (KCR).

METHODS

We obtained 4,278 e-path reports from 1,634 patients who were diagnosed with stage IV nonsquamous NSCLC from September 1, 2011, to December 31, 2013, included in CSS. We used 855 CSS reports to train NLP systems for the ascertainment of EGFR and ALK test status (reported v not reported) and test results (positive v negative). We assessed sensitivity, specificity, and positive and negative predictive values in an internal validation sample of 3,423 CSS e-path reports and repeated the analysis in an external sample of 1,041 e-path reports from 565 KCR patients. Two oncologists manually reviewed all e-path reports to generate gold-standard data sets.

RESULTS

NLP systems yielded internal validity metrics that ranged from 0.95 to 1.00 for EGFR and ALK test status and results in CSS e-path reports. NLP showed high internal accuracy for the ascertainment of EGFR and ALK in CSS patients—F scores of 0.95 and 0.96, respectively. In the external validation analysis, NLP yielded metrics that ranged from 0.02 to 0.96 in KCR reports and F scores of 0.70 and 0.72, respectively, in KCR patients.

CONCLUSION

NLP is an internally valid method for the ascertainment of EGFR and ALK test information from e-path reports available in SEER registries, but future work is necessary to increase NLP external validity.
Early Detection of Metastatic Relapse and Monitoring of Therapeutic Efficacy by Ultra-Deep Sequencing of Plasma Cell-Free DNA in Patients With Urothelial Bladder Carcinoma
Authors: Christensen Emil , Birkenkamp-Demtröder Karin , Sethi Himanshu , Shchegrova Svetlana , Salari Raheleh , Nordentoft Iver , Wu Hsin-Ta , Knudsen Michael , Lamy Philippe , Lindskrog Sia Viborg , Taber Ann , Balcioglu Mustafa , Vang Søren , Assaf Zoe , Sharma Shruti , Tin Antony S. , Srinivasan Ramya , Hafez Dina , Reinert Thomas , Navarro Samantha , Olson Alexander , Ram Rosalyn , Dashner Scott , Rabinowitz Matthew , Billings Paul , Sigurjonsson Styrmir , Andersen Claus Lindbjerg , Swenerton Ryan , Aleshin Alexey , Zimmermann Bernhard , Agerbæk Mads , Lin Cheng-Ho Jimmy , Jensen Jørgen Bjerggaard , Dyrskjøt Lars
Published: May 2019

PURPOSE

Novel sensitive methods for early detection of relapse and for monitoring therapeutic efficacy may have a huge impact on risk stratification, treatment, and ultimately outcome for patients with bladder cancer. We addressed the prognostic and predictive impact of ultra-deep sequencing of cell-free DNA in patients before and after cystectomy and during chemotherapy.

PATIENTS AND METHODS

We included 68 patients with localized advanced bladder cancer. Patient-specific somatic mutations, identified by whole-exome sequencing, were used to assess circulating tumor DNA (ctDNA) by ultra-deep sequencing (median, 105,000×) of plasma DNA. Plasma samples (n = 656) were procured at diagnosis, during chemotherapy, before cystectomy, and during surveillance. Expression profiling was performed for tumor subtype and immune signature analyses.

RESULTS

Presence of ctDNA was highly prognostic at diagnosis before chemotherapy (hazard ratio, 29.1; P = .001). After cystectomy, ctDNA analysis correctly identified all patients with metastatic relapse during disease monitoring (100% sensitivity, 98% specificity). A median lead time over radiographic imaging of 96 days was observed. In addition, for high-risk patients (ctDNA positive before or during treatment), the dynamics of ctDNA during chemotherapy was associated with disease recurrence ( P = .023), whereas pathologic downstaging was not. Analysis of tumor-centric biomarkers showed that mutational processes (signature 5) were associated with pathologic downstaging ( P = .024); however, no significant correlation for tumor subtypes, DNA damage response mutations, and other biomarkers was observed. Our results suggest that ctDNA analysis is better associated with treatment efficacy compared with other available methods.

CONCLUSION

ctDNA assessment for early risk stratification, therapy monitoring, and early relapse detection in bladder cancer is feasible and provides a basis for clinical studies that evaluate early therapeutic interventions.
Treatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala
Authors: Zamorano Abigail S. , Barnoya Joaquin , Gharzouzi Eduardo , Chrisman Robbins Camaryn , Orozco Emperatriz , Polo Guerra Sarita , Mutch David G.
Published: May 2019

PURPOSE

Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes.

METHODS

A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated.

RESULTS

Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded.

CONCLUSION

The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.
The Triaxial Physical Activity Signature Associated with Metabolic Health in Children
Authors: AADLAND EIVIND , KVALHEIM OLAV MARTIN , ANDERSSEN SIGMUND ALFRED , RESALAND GEIR KÅRE , ANDERSEN LARS BO
Published: May 2019

Purpose

The use of uniaxial summary measures from accelerometry (i.e., counts per minute or minutes spent in moderate-to-vigorous intensity) substantially restricts information about physical activity (PA), and is probably a result of reliance on analytic approaches that cannot handle collinear variables. In the present study, we aimed to determine the multivariate triaxial PA intensity signature related to metabolic health in children, by investigating associations of the whole spectra of PA intensities from all axes using multivariate pattern analysis.

Methods

We included 841 children (age, 10.2 ± 0.3 yr; body mass index, 18.0 ± 3.0; 50% boys) from the Active Smarter Kids study conducted in Norway 2014 to 2015 providing valid data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0 to 100 to ≥10,000 counts per minute for separate axes and used multivariate pattern analysis to analyze the data.

Results

The explained variance of metabolic health was 3.2% for counts per minute from the vertical axis, 17.0% for the vertical axis intensity spectrum, and 29.5% for the full model including all axes. Thus, including full triaxial intensity spectra improved the model for metabolic health tenfold compared with using overall PA (counts per minute) from the vertical axis only. The intensity signature associated with metabolic health differed across the axes.

Conclusions

Our findings show that the three different axes carry distinct information about children’s PA and the relation of PA to their health and demonstrate a great potential for triaxial accelerometry and a multivariate analytic approach to advance the field of PA epidemiology.
Foot Angle and Loading Rate during Running Demonstrate a Nonlinear Relationship
Authors: STIFFLER-JOACHIM MIKEL R. , WILLE CHRISTA M. , KLIETHERMES STEPHANIE A. , JOHNSTON WILLIAM , HEIDERSCHEIT BRYAN C.
Published: May 2019

Vertical loading rates are typically found to be lower in forefoot compared to rearfoot strikers, promoting the idea that forefoot striking is desirable and may reduce running injury risk. However, prior work using linear models has shown that foot inclination angle (FIA) at initial contact is a poor predictor of vertical loading rate, suggesting a more complex association exists.

Purpose

To determine if a nonlinear model superiorly describes the relationship between FIA and average vertical loading rate (AVLR). Secondary analyses assessed the influence of sex and sport on the association between FIA and AVLR.

Methods

Whole body kinematics and vertical ground reaction forces were collected for 170 healthy National Collegiate Athletic Association Division I athletes (97 males; 81 cross-country runners) during treadmill running at 2.68, 3.35, and 4.47 m·s−1. Foot inclination angle and AVLR were calculated for 15 strides and averaged across strides for each limb. Polynomial mixed effects models assessed linear and nonlinear trends in the relationship between FIA and AVLR across the entire sample and accounting for sex and sport participation.

Results

Average vertical loading rate was lowest at the extremes of FIA (i.e., −15°, 20°), whereas greater AVLR were observed between 5° and 10°. The cubic model resulted in a significantly better fit than the linear model (P < 0.001). Average vertical loading rate was also more variable among FIA associated with rearfoot and midfoot strike than forefoot strike. Adding sex to the model did not influence model fit; though, controlling for sport minimally improved model fit.

Conclusions

The relationship between FIA and AVLR is best represented by a cubic model. Consequently, FIA should be treated as a continuous variable. Reducing FIA into categories may misrepresent the relationship between FIA and other gait variables.
Physiological motion of the optic chiasm and its impact on stereotactic radiosurgery dose
Authors: Xiang Michael , Chan Cynthia , Wang Lei , Jani Khushboo , Holdsworth Samantha J. , Iv Michael , Pollom Erqi L. , Soltys Scott G.
Published: May 2019

Objective:

Avoidance of radiation-induced optic neuropathy (RION) from stereotactic radiosurgery (SRS) requires precise anatomical localization; however, no prior studies have characterized the physiologic motion of the optic chiasm. We measured the extent of chiasm motion and its impact on SRS dose.

Methods:

In this cross-sectional study, serial MRI was performed in multiple planes in 11 human subjects without optic pathway abnormalities to determine chiasm motion across time. Subsequently, the measured displacement was applied to the hypothetical chiasm dose received in 11 patients treated with SRS to a perichiasmatic lesion.

Results:

On sagittal images, the average anteroposterior chiasm displacement was 0.51 mm [95% confidence interval (CI) 0.27 – 0.75 mm], and the average superior-inferior displacement was 0.48 mm (95% CI 0.22 – 0.74 mm). On coronal images, the average superior–inferior displacement was 0.42 mm (95% CI 0.13 – 0.71 mm), and the average lateral displacement was 0.75 mm (95% CI 0.42 – 1.08 mm). In 11 patients who underwent SRS to a perichiasmatic lesion, the average displacements increased the maximum chiasm dose (Dmax) by a mean of 14 % (range 6–23 %; p < 0.001).

Conclusion:

Average motion of the optic chiasm was approximately 0.50–0.75 mm, which increased chiasm Dmax by a mean of 14%. In the occasional patient with higher-than-average chiasm motion in a region of steep dose gradient, the increase in chiasm Dmax and risk of RION could be even larger. Similarly, previously reported chiasm dose constraints may underestimate the true dose received during radiosurgery.

Advances in knowledge:

To limit the risk of RION, clinicians may consider adding a 0.50–0.75 mm expansion to the chiasm avoidance structure.
RESEARCH AND DEVELOPMENT OF INSTALLATION FOR PRE-SOWING TREATMENT OF POTATOES EXPOSURE TO ELECTROPHYSICAL FACTORS
Authors: Котин Александр , Kotin Aleksandr , Новикова Галина , Novikova Galina , Зайцев Петр , Zaycev Petr , Михайлова Ольга , Mihaylova Ol'ga
Published: May 2019

The purpose of processing potato tubers before planting by the complex effect of electrophysical factors is disinfection from a number of pests, activating the cells of potato tubers to accelerate and increase their germination, with the exception of side effects on the physico-chemical composition of the grown potatoes. The installation contains a toroidal cavity, inside the torus there is a conveyor, an unloading stopper and moving fluoroplastic scrapers. In the condenser space are electro-discharge lamps, connected to sources of a kHz frequency and a rotating disk, with a distributor. On the surface of the torus mounted magnetrons. An induction heater is installed under the torus. The torus has windows for unloading potato tuber waste. The developed installation contains various sources of electromagnetic radiation: microwave generators, which provide endogenous heating of potato tubers and prevent diseases and pests; induction heater to kill beetles and other pests due to thermal burns; high-frequency (110 kHz) alternating pulsed current generators with high voltage and electro-gas-discharge lamps, which accelerate biochemical reactions, saturate tubers with oxygen, increase the elasticity of the tuber peel and its permeability. This whole complex of energy sources contributes to the activation of potato tuber cells, accelerating and improving germination. Using a single unit with a capacity of up to 300 kg/h, it is possible to carry out preplant processing of up to 20 tons of potato tubers no larger than 6 cm in size, with specific energy expenditures of up to 0.2 kW h/kg.
Optimal Risk-Based Group Testing
Authors: Aprahamian Hrayer , Bish Douglas R. , Bish Ebru K.
Published: May 2019

Group testing (i.e., testing multiple subjects simultaneously with a single test) is essential for classifying a large population of subjects as positive or negative for a binary characteristic (e.g., presence of a disease). We study optimal group testing designs under subject-specific risk characteristics and imperfect tests, considering classification accuracy-, efficiency- and equity-based objectives, and characterize important structural properties of optimal testing designs. These properties allow us to model the testing design problems as partitioning problems, develop efficient algorithms, and derive insights on equity versus accuracy trade-off. One of our models reduces to a constrained shortest path problem, for a special case of which we develop a polynomial-time algorithm. We also show that determining an optimal risk-based Dorfman testing scheme that minimizes the expected number of tests is tractable, resolving an open conjecture. We demonstrate the value of optimal risk-based testing schemes with a case study of public health screening.

This paper was accepted by Yinyu Ye, optimization.
Illiquidity and Price Informativeness
Authors: Kerr Jon , Sadka Gil , Sadka Ronnie
Published: May 2019

This paper shows that liquidity conditions are important determinants of the predictability of earnings. Liquid stock prices are more informative about future firm earnings growth than illiquid stock prices. Because information-related illiquidity can arise when uncertainty is high, we focus our analysis on evidence that noninformational liquidity affects price informativeness. Endogeneity is further addressed using controls for market uncertainty and several exogenous shocks as natural experiments. Thus, our results lend support for the impact of liquidity on price discovery.

This paper was accepted by Lauren Cohen, finance.
Hydrosurgical debridement as an approach to wound healing: an animal thermal burn model
Authors: Hirokawa Eiko , Sato Tomoya , Fujino Takashi , Gotoh Yoshiya , Yokogawa Hideki , Ichioka Shigeru
Published: May 2019

Objective:

This study investigates the advantages of hydrosurgical debridement compared with surgical debridement.

Method:

Thermal skin burns were created on the backs of male Wistar rats. Surgical debridement was used to treat one wound and hydrosurgical debridement (Versajet Hydrosurgery System, Smith&Nephew, UK) used to treat the second wound. Debridement time, blood loss volume, time-to-heal and histologic changes in the wound areas were compared.

Results:

A total of 23 rats were used in the study. Debridement time and time-to-heal were significantly shorter with hydrosurgical debridement than with surgical debridement (p<0.01 and p<0.05, respectively). Blood loss volume was significantly less with hydrosurgical debridement (p<0.01), and the wound surface area was significantly smaller on days two (p<0.01), four (p<0.05) and seven (p<0.05). Dense inflammatory cell infiltration into dermal muscle was deeper after surgical debridement (p=0.017). Reactive fibrotic tissue at the wound surface was significantly thinner (p<0.001) and the vascular endothelial cell count was significantly higher (p<0.001) after hydrosurgical debridement.

Conclusion:

The hydrosurgical system used appears to provide for minimally invasive debridement that can be performed in a relatively short period of time. Use of the device appears to minimise injury to healthy tissue and ameliorate inflammation, which in turn promotes early wound healing and reduces scar contracture. Hydrosurgical debridement appears to cause less damage to normal tissues. Furthermore, it is easier and requires less time.
Ultrasonic debridement management of lower extremity wounds: retrospective analysis of clinical outcomes and cost
Authors: Messa Charles A , Chatman Brett C , Rhemtulla Irfan A , Broach Robyn B , Mauch Jaclyn T , D'Angelantonio Albert M , Fischer John P
Published: May 2019

Objective:

The aim of this study was to assess wound healing outcomes following direct, low-frequency, high-intensity, ultrasonic debridement as a surgical adjunct for non-healing lower extremity wounds.

Methods:

A retrospective review was conducted for patients undergoing lower extremity wound treatment with direct, low-frequency (22.5 kHz), high-intensity (~60 W/cm2) ultrasonic debridement between January 2010 and January 2016. Clinical outcomes were assessed up to 180-days post-ultrasonic debridement. Descriptive statistics, cost and univariate analysis were performed.

Results:

Overall, 82 wounds in 51 patients were included. Mean age was 57.0 years (range: 32–69), and average body mass index (BMI) was 30.8 kg/m². Patient comorbidities consisted of smoking (47%; n=24), hypertension (75%; n=38), diabetes (45%; n=23), and peripheral vascular disease (51%, n=26). Average wound age at initial presentation was 1013 days (range: 2–5475 days) with an average wound size of 9.0cm x 7.4cm. At 180-days post-debridement, 60% (n=49) of wounds had completely healed. Readmission (47%; n=24) and reoperation (45%; n=23) rates were characterised by the reason for readmission and reoperation respectively. Readmission for wound healing (70%, n=39) was primarily for further debridements (41%; n=16). Wound infection (30%; n=7) was the most common readmission for wound complications (30%; n=17). Reoperations primarily consisted of treatments for further wound healing 96% (n=51). Cost analysis showed a lower total treatment cost for patients with improved healing ($78,698), compared with non-improved wounds ($137,707).

Conclusion:

In a complex, heterogeneous cohort of chronic extremity wounds, the use of direct, low-frequency, high-intensity, ultrasonic debridement is a safe and reliable adjunctive therapy for the management of these wounds.
An evaluation of dehydrated human amnion/chorion membrane allografts for pressure ulcer treatment: a case series
Authors: Berhane Chi Chi , Brantley Kimberly , Williams Sandra , Sutton Erica , Kappy Carlyn
Published: May 2019

Objective:

Pressure ulcers (PU; also known as pressure injuries) affect about three million adults in the US and cost an estimated $11 billion dollars annually to treat. Prevention is most desirable, however, once a patient develops a PU, the focus shifts to effective treatment and rapid closure to improve health outcomes. We sought to evaluate outcomes in 10 patients with category II and III PUs treated with dehydrated human amnion/chorion membrane (dHACM) allografts.

Method:

All patients were treated with weekly application of dHACM plus standard wound care (SoC) and followed for eight weeks.

Results:

Of the PUs, two were category II and eight were category III. The average PU size at dHACM initiation was 3.42±1.76cm2. After the first application of dHACM 7/10 (70%) of PUs responded to treatment with a reduction in wound size. Within two weeks of dHACM initiation into the plan of care, 4/10 (40%) of PUs had reduced in size by >50%. By week four, 60% of PUs (6/10) had reduced in size by >50%. Overall, during the eight week evaluation period, 9/10 PUs reduced in size, three of which healed completely.

Conclusion:

dHACM allografts appear to be a viable treatment option for category II and III PUs.
Support for home enteral nutrition
Authors: Noakes Amy
Published: May 2019

Home enteral feeding for children by parents need to be motivated, informed and able to cope with the medical aspects of this form of feeding including any possible complications, says Amy Noakes
GDPR: Patient consent and the law
Authors: Lurie Suzanne
Published: May 2019

This article examiness the lawful bases for processing data under GDPR, why consent is not an appropriate lawful basis and which lawful basis a clinician should rely on for the processing of personal data
Health and wellbeing trends in practice
Authors: Mackay Rachael , Kennedy Louise
Published: May 2019

The latest Health and Wellbeing at Work survey collected responses from 1,021 organisations in reference to 4.6 million employees across the UK. This article provides a brief overview of the survey findings
Performance and Economic Results for Two Full-scale Biotrickling Filters to Remove H2S from Dairy Manure-derived Biogas
Authors: Shelford Timothy James , Gooch Curt A , Lansing Stephanie A
Published: May 2019

Abstract. Anaerobic digestion (AD) of dairy manure produces renewable energy in the form of biogas. Hydrogen sulfide (H2S) is formed in the produced biogas in variable quantities (up to 8,000 ppmv). H2S can cause corrosion damage to biogas-fueled engine-generator sets (EGSs), resulting in high operating temperatures, high maintenance costs, and/or lost revenues for farmers. Biotrickling filters are a common technology for H2S removal, however, there is a need for information about the performance, capital, and operational costs associated with biotrickling filters to better inform producers using or considering such systems. Keywords: Click here to enter keywords and key phrases, separated by commas, with a period at the end