bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptotic symmetries and Weinberg’s soft photon theorem in Minkd+2
Authors: He Temple , Mitra Prahar
Published: October 2019

Abstract

We show that Weinberg’s leading soft photon theorem in massless abelian gauge theories implies the existence of an infinite-dimensional large gauge symmetry which acts non-trivially on the null boundaries "Image missing"
±
of (d + 2)-dimensional Minkowski spacetime. These symmetries are parameterized by an arbitrary function ε(x) of the d-dimensional celestial sphere living at "Image missing"
±
. This extends the previously established equivalence between Weinberg’s leading soft theorem and asymptotic symmetries from four and higher even dimensions to all higher dimensions.
Tumor regression during radiotherapy for non-small cell lung cancer patients using cone-beam computed tomography images
Authors: van Timmeren J. E. , van Elmpt W. , de Ruysscher D. , Reymen B. , Hansen O. , Brink C.
Published: October 2019

Purpose

Previous literature has reported contradicting results regarding the relationship between tumor volume changes during radiotherapy treatment for non-small cell lung cancer (NSCLC) patients and locoregional recurrence-free rate or overall survival. The aim of this study is to validate the results from a previous study by using a different volume extraction procedure and evaluating an external validation dataset.

Methods

For two datasets of 94 and 141 NSCLC patients, gross tumor volumes were determined manually to investigate the relationship between tumor volume regression and locoregional control using Kaplan–Meier curves. For both datasets, different subgroups of patients based on histology and chemotherapy regimens were also investigated. For the first dataset (n = 94), automatically determined tumor volumes were available from a previously published study to further compare their correlation with updated clinical data.

Results

A total of 70 out of 94 patients were classified into the same group as in the previous publication, splitting the dataset based on median tumor regression calculated by the two volume extraction methods. Non-adenocarcinoma patients receiving concurrent chemotherapy with large tumor regression show reduced locoregional recurrence-free rates in both datasets (p < 0.05 in dataset 2). For dataset 2, the opposite behavior is observed for patients not receiving chemotherapy, which was significant for overall survival (p = 0.01) but non-significant for locoregional recurrence-free rate (p = 0.13).

Conclusion

The tumor regression pattern observed during radiotherapy is not only influenced by irradiation but depends largely on the delivered chemotherapy schedule, so it follows that the relationship between patient outcome and the degree of tumor regression is also largely determined by the chemotherapy schedule. This analysis shows that the relationship between tumor regression and outcome is complex, and indicates factors that could explain previously reported contradicting findings. This, in turn, will help guide future studies to fully understand the relationship between tumor regression and outcome.
Not the story you want? Assessing the fit of a conceptual framework characterising mental health recovery narratives
Authors: Llewellyn-Beardsley Joy , Rennick-Egglestone Stefan , Bradstreet Simon , Davidson Larry , Franklin Donna , Hui Ada , McGranahan Rose , Morgan Kate , Pollock Kristian , Ramsay Amy , Smith Roger , Thornicroft Graham , Slade Mike
Published: October 2019

Purpose

Narratives of recovery have been central to the development of the recovery approach in mental health. However, there has been a lack of clarity around definitions. A recent conceptual framework characterised recovery narratives based on a systematic review and narrative synthesis of existing literature, but was based on a limited sample. The aims of this study were to assess the relevance of the framework to the narratives of more diverse populations, and to develop a refined typology intended to inform narrative-based research, practice and intervention development.

Method

77 narrative interviews were conducted with respondents from four under-researched mental health sub-populations across England. Deductive and inductive analysis was used to assess the relevance of the dimensions and types of the preliminary typology to the interview narratives.

Results

Five or more dimensions were identifiable within 97% of narratives. The preliminary typology was refined to include new definitions and types. The typology was found not to be relevant to two narratives, whose narrators expressed a preference for non-verbal communication. These are presented as case studies to define the limits of the typology.

Conclusion

The refined typology, based on the largest study to date of recovery narratives, provides a defensible theoretical base for clinical and research use with a range of clinical populations. Implications for practice include ensuring a heterogeneous selection of narratives as resources to support recovery, and developing new approaches to supporting non-verbal narrative construction.
De Finetti Theorems for Braided Parafermions
Authors: Bu Kaifeng , Jaffe Arthur , Liu Zhengwei , Wu Jinsong
Published: October 2019

The classical de Finetti theorem in probability theory relates symmetry under the permutation group with the independence of random variables. This result has application in quantum information. Here we study states that are invariant with respect to a natural action of the braid group, and we emphasize the pictorial formulation and interpretation of our results. We prove a new type of de Finetti theorem for the four-string, double-braid group acting on the parafermion algebra to braid qudits, a natural symmetry in the quon language for quantum information. We prove that a braid-invariant state is extremal if and only if it is a product state. Furthermore, we provide an explicit characterization of braid-invariant states on the parafermion algebra, including finding a distinction that depends on whether the order of the parafermion algebra is square free. We characterize the extremal nature of product states (an inverse de Finetti theorem).
A Novel Sandwich ELISA for Tartrate-Resistant Acid Phosphatase 5a and 5b Protein Reveals that Both Isoforms are Secreted by Differentiating Osteoclasts and Correlate to the Type I Collagen Degradation Marker CTX-I In Vivo and In Vitro
Authors: Mira-Pascual Laia , Patlaka Christina , Desai Suchita , Paulie Staffan , Näreoja Tuomas , Lång Pernilla , Andersson Göran
Published: October 2019

Tartrate-resistant acid phosphatase type 5 (TRAP) exists as two isoforms, 5a and 5b. 5b is a marker of osteoclast number and 5a of chronic inflammation; however, its association with bone resorption is unknown. In this study, a double-TRAP 5a/5b sandwich ELISA measuring 5a and 5b protein in the same sample was developed. TRAP 5a and 5b protein levels were evaluated as osteoclast differentiation/activity markers in serum and in culture, and their correlation to the resorption marker CTX-I was examined. Serum TRAP 5a and 5b concentrations in healthy men were 4.4 ± 0.6 ng/ml and 1.3 ± 0.2 ng/ml, respectively, and they correlated moderately to each other suggesting that their secretion is coupled under healthy conditions. A correlation was also observed between serum TRAP 5a and 5b with CTX-I, suggesting that both TRAP isoforms associate with osteoclast number. During osteoclast differentiation on plastic/bone, predominantly 5b increased in media/lysate from M-CSF/RANKL-stimulated CD14+ PBMCs. However, substantial levels of 5a were detected at later stages suggesting that both isoforms are secreted from differentiating OCs. More TRAP 5b was released on bone indicating a connection to osteoclast resorptive activity, and a peak in TRAP 5b/5a-ratio coincided with rapid CTX-I release. At the end of the culture period of M-CSF + RANKL-stimulated CD14+ PBMCs, there was a correlation between the secretion of TRAP 5a and 5b proteins with CTX-I. The correlation of not only 5b but also 5a with collagen degradation, both in serum and osteoclast cultures indicates that a considerable proportion of the TRAP 5a originates from osteoclasts and may reflect a hitherto undisclosed regulatory mechanism during bone resorption and bone remodeling.
Curative Surgery Improves Survival for Colorectal Cancer in Rural Kenya
Authors: Parker Robert K. , Mwachiro Michael M. , Ranketi Sinkeet S. , Mogambi Faith C. , Topazian Hillary M. , White Russell E.
Published: October 2019

Background/aims

Colorectal cancer (CRC) is increasing in low‐ and middle‐income countries. Surgical care is essential for the treatment. Many patients do not have access to curative surgery for colorectal cancer in rural Kenya. To better understand the impact of surgical care on colorectal cancer in a resource‐limited setting, we compared the experience of patients undergoing operations to those who did not.

Methods

All patients with histologically confirmed CRC at Tenwek Hospital from January 1, 1999, to December 31, 2017, were reviewed. Demographic and clinical data were extracted from records when available. The exposure was either curative operation, palliative operation, or no operation. The primary outcome was survival at 5 years, assessed with Cox proportional hazard analysis after propensity‐score matching for age, sex, tumor site, time period, and stage.

Results

One hundred and sixty‐five patients were identified on chart review. Survival information was available for 150 patients with a median follow‐up of 319 days. Fifty‐two percent had colon cancer and 48% had rectal cancer. At diagnosis, the mean age was 55.4 years (SD: 16.7) and the male to female ratio was 1.1:1. Thirty‐nine percent underwent curative operations, 25% palliative operations, and 36% no operations. One‐year survival was estimated to be 98% for curative surgery, 73% for palliative surgery, and 83% for no surgery (p = 0.0005). On crude analysis, 5‐year survival improved with curative operation in comparison to no operation with a hazard ratio of 0.30 (CI: 0.14–0.64) (p = 0.002). After propensity matching, the hazard ratio for curative operation versus no operation remained significant, 0.34 (CI: 0.14–0.80) (p = 0.01).

Conclusions

Curative surgery improves survival in our resource‐limited environment. Although various factors contribute to the use of surgical treatment, the survival advantage persists after adjusted analysis. Barriers exist for access to prompt surgical evaluation and treatment. Surgical care should be a priority to address the increasing burden of CRC in resource‐limited settings.
The Efficacy of Coil Embolization to Obtain Intrahepatic Redistribution in Radioembolization: Qualitative and Quantitative Analyses
Authors: Alsultan Ahmed A. , van Roekel Caren , Barentsz Maarten W. , Braat Arthur J. A. T. , van Doormaal Pieter Jan , Lam Marnix G. E. H. , Smits Maarten L. J.
Published: October 2019

Purpose

To evaluate the efficacy of coil embolization to obtain intrahepatic redistribution in patients undergoing radioembolization.

Materials and Method

All patients treated with radioembolization at our institute were retrospectively analyzed, and all cases in which a tumor-feeding vessel was coil-embolized were selected. Two nuclear medicine physicians visually assessed the effect of redistribution. Furthermore, the redistribution of microspheres was measured by quantifying the activity distributed to the coil-embolized (dependent) segment relative to the other (non-dependent) segments and to the tumor(s) in that segment. Quantitative analysis was performed on post-treatment 90Y-PET and 166Ho-SPECT using Simplicit90Y software. Lesion response was measured according to RECIST 1.1 criteria at 3 months post-treatment.

Results

Out of 37 cases, 32 were suitable for quantitative analysis and 37 for qualitative analysis. In the qualitative analysis, redistribution was deemed successful in 69% of cases. The quantitative analysis showed that the median ratio of the activity to the dependent embolized segments and the non-dependent segments was 0.88 (range 0.26–2.05) and 0.80 (range 0.19–1.62) for tumors in dependent segments compared with tumors in non-dependent segments. Using a cutoff ratio of 0.7 (30% lower activity concentration in comparison with the rest of the liver), 57% of cases were successful. At 3 months post-treatment, 6% of dependent tumors had partial response, 20% progressive disease, and 74% stable disease. In non-dependent tumors, this was, respectively, 16%, 20%, and 64%.

Conclusion

Coil embolization of hepatic arteries to induce redistribution of microspheres has a limited success rate. Qualitative assessment tends to overrate redistribution.
Investigating the risk of breast cancer among women exposed to chemicals: a nested case–control study using improved exposure estimates
Authors: Videnros Cecilia , Selander Jenny , Wiebert Pernilla , Albin Maria , Plato Nils , Borgquist Signe , Manjer Jonas , Gustavsson Per
Published: October 2019

Purpose

The aim of this study was to examine if exposures to chemicals at the workplace were associated with an increased risk of postmenopausal breast cancer, using improved exposure estimates.

Methods

The design is a case–control study, nested within a cohort of women from the Malmö Diet and Cancer Study. The study comprised 2400 women, 731 cases and 1669 matched controls, born 1923–1950 and living in Malmö, Sweden between 1991 and 1996. An occupational hygienist reclassified the probability for exposure given by a job-exposure matrix, using individual data on work tasks. First-time diagnoses of invasive breast cancer were identified through the Swedish Cancer Registry.

Results

Women exposed to chemicals in their occupational environment had a statistically significantly increased risk (OR 1.59, 95% CI 1.11–2.29) of breast cancer, and the risk correlated positively with duration of exposure but not with exposure intensity. Women exposed to chlorinated hydrocarbon solvents for more than 10 years had a significant higher risk of breast cancer (OR 3.06, 95% CI 1.18–7.96) as well as women exposed to oil mist for more than 10 years (OR 3.08, 95% CI 1.12–8.49).

Conclusions

This study gives some support to the hypothesis that exposure to organic solvents as well as oil mist is associated with increased risk of breast cancer.
Evaluation of preoperative risk factors for postpancreatectomy hemorrhage
Authors: Izumo Wataru , Higuchi Ryota , Yazawa Takehisa , Uemura Shuichiro , Shiihara Masahiro , Yamamoto Masakazu
Published: October 2019

Purpose

To investigate the risk factors for post-pancreatectomy hemorrhage (PPH).

Methods

The incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy.

Results

The incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0–2 (2%) and 3–4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy.

Conclusion

Our study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes “absence of DM” for predicting PPH.
Dose-dependent green tea effect on decrease of inflammation in human oral gingival epithelial keratinocytes: in vitro study
Authors: Hagiu Ana , Attin Thomas , Schmidlin Patrick R. , Ramenzoni Liza L.
Published: October 2019

Objectives

This in vitro study aimed to analyze the anti-inflammatory and wound healing potential of green tea extract (GTE) in human gingival epithelial keratinocytes (HGEK) treated with lipopolysaccharides (LPS).

Materials and methods

A cell viability assay was conducted using MTT to determine nontoxic levels of GTE on immortalized HGEK. Cells were concomitantly treated with LPS (1 μg/ml) and GTE (1 mg/ml, 2.5 mg/ml, 5 mg/ml, and 10 mg/ml) to assess inflammation. Gene expression levels of inflammatory markers IL-β1, IL-6, and TNFα were measured by RT-PCR and their protein production was assessed by ELISA. The scratch wound healing assay was used to investigate the effects of different concentrations of GTE on cell migration. We also explored the effect of GTE on the induction of the Nrf2/HO-1 pathway in the cells with or without LPS.

Results

GTE at concentrations of 2.5 mg/ml, 5 mg/ml, and 10 mg/ml significantly enhanced cell viability (p < 0.05). And IL-β1, IL-6, and TNFα gene expression presented up to 10-fold decrease compared with LPS-treated cells, which was also similarly found on the protein levels. At the same concentrations, cell migration increased.

Conclusions

The mechanism results showed that GTE produced the anti-inflammatory response by activating the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway and increasing the level of anti-oxidant protein heme oxygenase-1 (HO-1).

Clinical relevance

GTE may be potentially used as oral rinse anti-inflammatory drug for treatment and prevention of oral inflammatory diseases, which is shown here by the ability to reduce the inflammation and increase in cell migration in a dose-dependent manner.
Micro-mechanical investigation of railway ballast behavior under cyclic loading in a box test using DEM: effects of elastic layers and ballast types
Authors: Kumar Nishant , Suhr Bettina , Marschnig Stefan , Dietmaier Peter , Marte Christof , Six Klaus
Published: October 2019

Ballasted tracks are the commonly used railway track systems with constant demands for reducing maintenance cost and improved performance.
Elastic layers are increasingly used for improving ballasted tracks. In order to better understand the effects of elastic layers, physical understanding at the ballast particle level is crucial. Here, discrete element method (DEM) is used to investigate the effects of elastic layers – under sleeper pad ($$\text {USP}$$USP) at the sleeper/ballast interface and under ballast mat ($$\text {UBM}$$UBM) at the ballast/bottom interface – on micro-mechanical behavior of railway ballast. In the DEM model, the Conical Damage Model (CDM) is used for contact modelling. This model was calibrated in Suhr et al. (Granul Matter 20(4):70, 2018) for the simulation of two different types of ballast. The CDM model accounts for particle edge breakage, which is an important phenomenon especially at the early stage of a tamping cycle, and thus essential, when investigating the impact of elastic layers in the ballast bed. DEM results confirm that during cyclic loading, $$\text {USP}$$USP reduces the edge breakage at the sleeper/ballast interface. On the other hand, $$\text {UBM}$$UBM shows higher particle movement throughout the ballast bed. Both the edge breakage and particle movement in the ballast bed are found to influence the sleeper settlement. Micro-mechanical investigations show that the force chain in deeper regions of the ballast bed is less affected by $$\text {USP}$$USP for the two types of ballast. Conversely, dense lateral forces near to the box bottom were seen with $$\text {UBM}$$UBM. The findings are in good (qualitative) agreement with the experimental observations. Thus, DEM simulations can aid to better understand the micro-macro phenomena for railway ballast. This can help to improve the track components and track design based on simulation models taking into account the physical behavior of ballast.

Graphical Abstract
Si cycling in transition zones: a study of Si isotopes and biogenic silica accumulation in the Chesapeake Bay through the Holocene
Authors: Nantke Carla K. M. , Frings Patrick J. , Stadmark Johanna , Czymzik Markus , Conley Daniel J.
Published: October 2019

Si fluxes from the continents to the ocean are a key element of the global Si cycle. Due to the ability of coastal ecosystems to process and retain Si, the ‘coastal filter’ has the potential to alter Si fluxes at a global scale. Coastal zones are diverse systems, sensitive to local environmental changes, where Si cycling is currently poorly understood. Here, we present the first palaeoenvironmental study of estuarine biogenic silica (BSi) fluxes and silicon isotope ratios in diatoms (δ30Sidiatom) using hand-picked diatom frustules in two sediment cores (CBdist and CBprox) from the Chesapeake Bay covering the last 12000 and 8000 years, respectively. Constrained by the well-understood Holocene evolution of the Chesapeake Bay, we interpret variations in Si cycling in the context of local climate, vegetation and land use changes. δ30Sidiatom varies between + 0.8 and + 1.7‰ in both sediment cores. A Si mass balance for the Chesapeake Bay suggests much higher rates of Si retention (~ 90%) within the system than seen in other coastal systems. BSi fluxes for both sediment cores co-vary with periods of sea level rise (between 9500 and 7500 a BP) and enhanced erosion due to deforestation (between 250 and 50 a BP). However, differences in δ30Sidiatom and BSi flux between the sites emphasize the importance of the seawater/freshwater mixing ratios and locally variable Si inputs from the catchment. Further, we interpret variations in δ30Sidiatom and the increase in BSi fluxes observed since European settlement (~ 250 a BP) to reflect a growing human influence on the Si cycle in the Chesapeake Bay. Thereby, land use change, especially deforestation, in the catchment is likely the major mechanism.
Real-life experience of using brinzolamide/brimonidine fixed drop combination in a tertiary glaucoma centre
Authors: Kóthy Péter , Holló Gábor
Published: October 2019

Purpose

To investigate the intraocular pressure (IOP)-lowering efficacy and tolerance of brinzolamide/brimonidine fixed combination (BBFC) under real-life conditions in a tertiary glaucoma centre.

Methods

Medical records of all ocular hypertensive and open-angle glaucoma patients (n = 52) treated with BBFC were retrospectively analysed.

Results

Thirty-nine patients had primary open-angle, 6 exfoliative, 2 pigment, 1 normal tension and 1 juvenile open-angle glaucoma and 3 ocular hypertension. The prior therapy was a prostaglandin analogue (PG) (n = 4), PG/timolol (n = 20), PG/timolol and topical carbonic anhydrase inhibitor (CAI; n = 19), timolol/CAI (n = 1), PG and CAI (n = 4), timolol/pilocarpine and PG (n = 1), timolol/brimonidine and PG (n = 1) and timolol/brimonidine, PG and CAI (n = 2). These were simplified to PG/timolol and BBFC (n = 41), PG and BBFC (n = 9), timolol and BBFC (n = 1) and timolol/pilocarpine, PG and BBFC (n = 1). The IOP on the study eyes was 21.2 ± 3.7 mmHg before and 16.9 ± 2.6, 16.0 ± 2.2, 17.6 ± 3.1 and 18.0 ± 3.1 mmHg after the introduction of BBFC at month 1, 3, 6 and 12, respectively (p < 0.0003 for all time points compared to baseline, p = 1.0 for all other comparisons). Thirty-one patients (59.6%) experienced no adverse event, 17 (32.7%) reported ocular and 6 (11.5%) systemic adverse events. BBFC therapy was terminated on 27 patients (51.9%): on 19 (36.5%) due to adverse events and on 8 (15.4%) due to insufficient IOP reduction.

Conclusion

In real-life practice, the introduction of BBCF allows significant and clinically meaningful IOP reduction and therapy simplification in glaucoma patients requiring complex medication, but in more than one third of the patients it is not tolerated due to adverse events.
Electrostatic-field and surface-shape similarity for virtual screening and pose prediction
Authors: Cleves Ann E. , Johnson Stephen R. , Jain Ajay N.
Published: October 2019

We introduce a new method for rapid computation of 3D molecular similarity that combines electrostatic field comparison with comparison of molecular surface-shape and directional hydrogen-bonding preferences (called “eSim”). Rather than employing heuristic “colors” or user-defined molecular feature types to represent conformation-dependent molecular electrostatics, eSim calculates the similarity of the electrostatic fields of two molecules (in addition to shape and hydrogen-bonding). We present detailed virtual screening performance data on the standard 102 target DUD-E set. In its moderately fast screening mode, eSim running on a single computing core is capable of processing over 60 molecules per second. In this mode, eSim performed significantly better than all alternate methods for which full DUD-E data were available (mean ROC area of 0.74, p $$< 10^{-9}$$<10-9, by paired t-test, compared with the best performing alternate method). In addition, for 92 targets of the DUD-E set where multiple ligand-bound crystal structures were available, screening performance was assessed using alternate ligands or sets thereof (in their bound poses) as similarity targets. Using the joint alignment of five ligands for each protein target, mean ROC area exceeded 0.82 for the 92 targets. Design-focused application of ligand similarity methods depends on accurate predictions of geometric molecular relationships. We comprehensively assessed pose prediction accuracy by curating nearly 400,000 bound ligand pose pairs across the DUD-E targets. Overall, beginning from agnostic initial poses, we observed an 80% success rate for RMSD $$\le 2.0$$≤2.0 Å  among the top 20 predicted eSim poses. These examples were split roughly 50/50 into cases with high direct atomic overlap (where a shared scaffold exists between a pair) and low direct atomic overlap (where where a ligand pair has dissimilar scaffolds but largely occupies the same space). Within the high direct atomic overlap subset, the pose prediction success rate was 93%. For the more challenging subset (where dissimilar scaffolds are to be aligned), the success rate was 70%. The eSim approach enables both large-scale screening and rational design of ligands and is rooted in physically meaningful, non-heuristic, molecular comparisons.
Identification and resolution of drug-related problems in a tertiary hospital respiratory unit in China
Authors: Zhu Yulin , Liu Cheng , Zhang Yong , Shi Qingping , Kong Yiqiu , Wang Muqun , Xia Xuemei , Zhang Feng
Published: October 2019

Background The prevalence of drug-related problems in patients hospitalized at respiratory care units is unknown in mainland China. Objective To identify and categorize drug-related problems in a respiratory care unit in China. Setting Respiratory care unit in a tertiary university hospital in China. Methods Clinical pharmacy services were introduced and documented during an 18-months study period. The problems were categorized using the Pharmaceutical Care Network Europe DRP classification tool V8.02. Main outcome measures Problems and causes of drug-related problems, interventions proposed, and outcome of pharmacy recommendations. Results A total of 474 patients were reviewed, 164 patients had DRPs (34.6%). Total 410 problems were identified, an average of 2.5 per patient. Treatment effectiveness was the major type of problem detected (219; 53.4%) followed by treatment safety (140; 34.1%). The most common causes of the problems were patient-related (25.8%), drug selection (24.0%), and drug use process (23.4%). Pharmacist made 773 interventions; average 1.9 per drug-related problem. A total of 96.2% of these interventions were accepted leading to solving 81.9% of the identified problems. Conclusion There is a high prevalence of drug-related problems in patients hospitalized at the respiratory unit of this clinic. Clinical pharmacists should focus on improving prescribing practice and patient counseling.
The Importance of Self-Mastery in Enhancing Quality of Life and Social Participation of Individuals Experiencing Homelessness: Results of a Mixed-Method Study
Authors: Rutenfrans-Stupar Miranda , Hanique Naomi , Van Regenmortel Tine , Schalk René
Published: October 2019

Self-mastery plays a basic role in strength-based and recovery-oriented approaches applied by (mental) health-care institutions and social services. However, no research has been conducted on a comprehensive model that could provide insight into enhancing self-mastery and outcomes, such as social participation and quality of life, for individuals experiencing homelessness. The current mixed-method study investigated associations between person-related variables (optimism, age, education level) and care-related variables (experiences with care, duration of support) as predictors of both social participation and quality of life through the mediator of self-mastery among clients of a Dutch shelter facility. Quantitative analysis (Structural Equation Modeling;n = 97) showed that: (1) Self-mastery is related to social participation and quality of life; (2) Optimism predicts social participation and quality of life through self-mastery; (3) Age squared predicts social participation through self-mastery, but is not related to quality of life; (4) The variable, clients’ experiences with care, is not related to self-mastery, but directly to social participation and quality of life; (5) Education level and duration of support do not predict self-mastery, social participation and quality of life. Qualitative analysis (semi-structured interviews;n = 36) revealed: (1) Contrary to the results of the quantitative study qualitative data indicated that there is a positive association between experiences with care and self-mastery; (2) Social participation and health are associated with self-mastery; (3) The absence of external locus of control should also be included as an aspect of self-mastery; (4) Additional promoting and impeding factors for self-mastery (e.g., a daily structure, privacy, house rules). Based on these results we formulated guidelines for social and mental health-care workers to enhance their clients’ self-mastery.
The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study
Authors: Ma Guiyue , Luo Aijing , Shen Zhiying , Duan Yinglong , Shi Shuangjiao , Zhong Zhuqing
Published: October 2019

The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.
Caristi–Kirk and Oettli–Théra ball spaces and applications
Authors: Błaszkiewicz Piotr , Ćmiel Hanna , Linzi Alessandro , Szewczyk Piotr
Published: October 2019

Based on the theory of ball spaces introduced by Kuhlmann and Kuhlmann, we introduce and study Caristi–Kirk and Oettli–Théra ball spaces. We show that if the underlying metric space is complete, then these have a very strong property: every ball contains a singleton ball. This fact provides quick proofs for several results which are equivalent to the Caristi–Kirk fixed point theorem, namely Ekeland’s variational principles, the Oettli–Théra theorem, Takahashi’s theorem and the flower petal theorem.
Comparison of Different Leaching Media and Their Effect on REEs Recovery from Spent Nd-Fe-B Magnets
Authors: Liu Fupeng , Porvali Antti , Halli Petteri , Wilson Benjamin P. , Lundström Mari
Published: October 2019

Recycling rare-earth elements (REEs) from Nd-Fe-B magnet waste is an important step towards building a sustainable REE supply chain. In this study, two different processes were systematically investigated and compared. In the leaching stage, the effect of increasing H2SO4 or HCl concentrations were studied and it was determined that, although both can successfully promote REEs, B, Fe and Co leaching, HCl solutions extracted a wider range of metals. After leaching, the oxalate and double-sulfate precipitation methods were utilized to separate REEs from either HCl or H2SO4 leachates. Results suggest that, although > 99% REEs precipitation rates could be achieved with oxalate, the purity of REE-containing products is significantly affected by impurities like Fe and Co. In contrast, REE double-sulfate precipitation resulted in a product purity of > 99%; however, high levels of Na2SO4 (8 times the stoichiometric amount) were needed to achieve > 98% of REE precipitation.
What Can an Understanding of the Changing Small-Scale Forest Owner Contribute to Rural Studies? The Swedish Case
Authors: Keskitalo E. Carina H.
Published: October 2019

Over the centuries, Swedish rural areas have been formed in close interaction with their inhabitants and different and various uses. Based on studies, particularly of “new forest owners” in Sweden, this article illustrates how an understanding of forest and forest ownership can highlight the dynamic and shifting role of rural areas: as both rural and urban, based on both forest property and second-home ownership. It also illustrates that rural areas are not only post-productive but also continuously over time production areas, in addition to many other use patterns, and that rural areas can be areas of forest-related industrial and services growth, and thus rural growth. The article also illustrates that forest areas in Sweden, but also more broadly Fennoscandia, can be seen as areas with different habitation patterns and linkages between nature and population than what has often been described in broader rural literature.
Artificial Intelligence, Responsibility Attribution, and a Relational Justification of Explainability
Authors: Coeckelbergh Mark
Published: October 2019

This paper discusses the problem of responsibility attribution raised by the use of artificial intelligence (AI) technologies. It is assumed that only humans can be responsible agents; yet this alone already raises many issues, which are discussed starting from two Aristotelian conditions for responsibility. Next to the well-known problem of many hands, the issue of “many things” is identified and the temporal dimension is emphasized when it comes to the control condition. Special attention is given to the epistemic condition, which draws attention to the issues of transparency and explainability. In contrast to standard discussions, however, it is then argued that this knowledge problem regarding agents of responsibility is linked to the other side of the responsibility relation: the addressees or “patients” of responsibility, who may demand reasons for actions and decisions made by using AI. Inspired by a relational approach, responsibility as answerability thus offers an important additional, if not primary, justification for explainability based, not on agency, but on patiency.
Dexmedetomidine Protects Against Oxygen–Glucose Deprivation-Induced Injury Through Inducing Astrocytes Autophagy via TSC2/mTOR Pathway
Authors: Zhu Chen , Zhou Quan , Luo Cong , Chen Ying
Published: October 2019

Although there is an increment in stroke burden in the world, stroke therapeutic strategies are still extremely limited to a minority of patients. We previously demonstrated that dexmedetomidine (DEX) protects against focal cerebral ischemia via inhibiting neurons autophagy. Nevertheless, the role of DEX in regulating astrocytes autophagic status in oxygen–glucose deprivation, a condition that mimics cerebral ischemia, is still unknown. In this study, we have shown that DEX and DEX + RAPA (autophagy inducer) increased viability and reduced apoptosis of primary astrocytes in oxygen–glucose deprivation (OGD) model compared with DEX + 3-methyladenine (3-MA) (autophagy inhibitor). DEX induced the expression of microtubule-associated protein 1 light chain 3 (LC3) and Beclin 1, while reduced the expression of p62 in primary cultured astrocytes through induction of autophagy. In addition, DEX enhanced the expression of tuberous sclerosis complex 2 (TSC2) in primary cultured astrocytes, while reduced the expression of mammalian target of rapamycin (mTOR). In conclusion, our study suggests that DEX exerts a neuroprotection against OGD-induced astrocytes injury via activation of astrocytes autophagy by regulating the TSC2/mTOR signaling pathway, which provides a new insight into the mechanisms of DEX treatment for acute ischemic injury.
Codesigning biodiversity-based agrosystems promotes alternatives to mycorrhizal inoculants
Authors: Chave Marie , Angeon Valérie , Paut Raphaël , Collombet Robin , Tchamitchian Marc
Published: October 2019

Facing the challenge of the ecological transition of agriculture, biodiversity opens new avenues to enhance ecological interactions and reduce chemical input dependency. Designing biodiversity-based agrosystems requires an agroecological approach that combines key principles: exploring a wide range of concepts and solutions, adopting systemic reasoning, implementing a site-specific approach, developing an action-oriented process, and maintaining a continuous improvement dynamic. This type of approach has never been developed to harness mycorrhizal fungi, which are key components of soil biodiversity, because their beneficial action on crops depends on complex and underexploited ecological interactions. At present, mycorrhizae are mainly used through industrial inoculants that fit within the productionist paradigm. To shift toward agroecological approaches, we implemented a methodological framework conceived to better address the design of mycorrhiza-friendly cropping systems by sharing knowledge with farmers in four different study areas (Provence, French Guiana, Guadeloupe, and Martinique). This framework includes participative workshops, a board game, and prospective exercises to collect farmers’ proposals and the factors that prevent from implementing mycorrhiza-friendly cropping systems. We showed that 90% of the farmers proposed alternatives to industrial inoculants, 50% of them adopted systemic reasoning by combining these alternative proposals. Most farmers understood that they were all potential “mycorrhizae producers”. We showed, for the first time through on-farm experiments that valorization of indigenous mycorrhizal fungi strains using a donor plant is an effective practice to increase root colonization before planting (up to a frequency of 95% and an intensity of 32%). Considering the increasing supply of mycorrhizal inoculants and despite the uncertainty of related knowledge, we codesigned innovative practices. Learning communities (technical advisors, high school teachers, etc.) assumed responsibility for continuous improvement in knowledge and practices. Finally, beyond the issue of mycorrhizae, we showed that an agroecological approach could bring stakeholders one step further into the design of biodiversity-based agrosystems.
Peak width of skeletonized mean diffusivity and its association with age‐related cognitive alterations and vascular risk factors
Authors: Lam Bonnie Yin Ka , Leung Kam Tat , Yiu Brian , Zhao Lei , Biesbroek J. Matthijs , Au Lisa , Tang Yumi , Wang Kai , Fan Yuhua , Fu Jian‐Hui , Xu Qun , Song Haiqing , Tian Xiaolin , Chu Winnie Chiu Wing , Abrigo Jill , Shi Lin , Ko Ho , Lau Alexander , Duering Marco , Wong Adrian , Mok Vincent Chung Tong
Published: October 2019

Introduction

Only two studies investigated the associations between peak width of skeletonized mean diffusivity (PSMD) and age‐related cognitive alterations, whereas none of the studies investigated the association with vascular risk factors.

Methods

We evaluated 801 stroke‐ and dementia‐free elderlies with baseline and 3‐year follow‐up assessments. Regression analyses were used to assess the association between age‐related cognitive functions and PSMD. Simple mediation models were used to study the mediation effect of PSMD between vascular risk factors and age‐related cognitive outcomes.

Results

PSMD was negatively associated with processing speed at baseline and negatively associated with processing and memory scores at 3‐year follow‐up. The association between vascular risk factors and age‐related cognition was mediated by PSMD, as well as other diffusion tensor imaging markers.

Discussion

PSMD is preferred over other diffusion tensor imaging markers as it is sensitive to age‐related cognitive alterations and calculation is fully automated. PSMD is proposed as a research tool to monitor age‐related cognitive alterations.
War rectal injuries with its complications during civil violence in Iraq
Authors: Al- Doghan Ibrahim Ekhlayef Mughir , Majeed Yahia Hameed , Jasim Hasanain Abdulameer
Published: October 2019

ABSTRACT

Background:

Traumatic injuries to the rectum is not uncommon in war surgery, increasing numbers of rectal injuries were encountered by Iraqi surgeons due nature civil violence in Iraq. Failure of adequate management of such injury can lead to serious complications like perineal and pelvic sepsis and even death.

Objective:

To define the wound pattern, injury mechanism, incidence, surgical treatment and associated complications of war rectal injuries suffered in the civil violence of Iraq war.

Patients and methods:

A retrospective study. In all, 3650 war injured patient with penetrating injuries to the pelvis and abdomen were admitted to the Ameria AL-Fallujah Hospital. Anbar, Iraq and the Al-Yarmouk Teaching Hospital, Baghdad, Iraq from Feb. 2004–May 2008. Of these, 62 (1.7%) patients had rectal injuries.

Result:

Of 62 injured patients, 40 (64, 5%) were civilians injured patients and 22 (35, 5%) were Iraqi military injured patients. 50 males and 12 females. The age ranges from 16 to 58year. The rectal injuries were caused by an improvised explosive device in 40 (64.5%) patients and by individual firearms in 22 (35.5%). The surgical treatment included diversion and distal washout in 13 (21%) patients, diversion in 31 (50%) patients, distal washout, drainage and diversion in 6 (9%) patients, presacral drainage with diversion in 7 (11%) and 5 (8%) patients just suturing of serosa. The complications were found in 36 (58%) of injured patients. No death in this study.

Conclusion:

War rectal injuries were caused mainly by improvised explosive device. Most of the injured patients were civilians and a minority was military stuff. War injuries of the rectum were successfully managed by proximal fecal diversion, and presacral drainage, recommending that distal washout may be not always necessary in the management of war rectal injuries. Despite that rectal injury still combined with a high rate of complications.

Highlights:
Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update
Authors: Schmidt Andrew C. , Sempsrott Justin R. , Hawkins Seth C. , Arastu Ali S. , Cushing Tracy A. , Auerbach Paul S.
Published: October 2019

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management and treatment of drowning in out-of-hospital and emergency medical care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel’s collective clinical experience and judgment when published evidence was lacking. This is the first update to the original practice guidelines published in 2016.
Endoscopic endonasal intraconal orbit surgery
Authors: Banks Catherine , Husain Qasim , Bleier Benjamin S.
Published: October 2019

Endoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post‐operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.
Multiscale fluid–particle thermal interaction in isotropic turbulence
Authors: Carbone M. , Bragg A. D. , Iovieno M.
Published: October 2019

We use direct numerical simulations to investigate the interaction between the temperature field of a fluid and the temperature of small particles suspended in the flow, employing both one- and two-way thermal coupling, in a statistically stationary, isotropic turbulent flow. Using statistical analysis, we investigate this variegated interaction at the different scales of the flow. We find that the variance of the carrier flow temperature gradients decreases as the thermal response time of the suspended particles is increased. The probability density function (PDF) of the carrier flow temperature gradients scales with its variance, while the PDF of the rate of change of the particle temperature, whose variance is associated with the thermal dissipation due to the particles, does not scale in such a self-similar way. The modification of the fluid temperature field due to the particles is examined by computing the particle concentration and particle heat fluxes conditioned on the magnitude of the local fluid temperature gradient. These statistics highlight that the particles cluster on the fluid temperature fronts, and the important role played by the alignments of the particle velocity and the local fluid temperature gradient. The temperature structure functions, which characterize the temperature fluctuations across the scales of the flow, clearly show that the fluctuations of the carrier flow temperature increments are monotonically suppressed in the two-way coupled regime as the particle thermal response time is increased. Thermal caustics dominate the particle temperature increments at small scales, that is, particles that come into contact are likely to have very large differences in their temperatures. This is caused by the non-local thermal dynamics of the particles: the scaling exponents of the inertial particle temperature structure functions in the dissipation range reveal very strong multifractal behaviour. Further insight is provided by the flux of temperature increments across the scales. Altogether, these results reveal a number of non-trivial effects, with a number of important practical consequences.