bluuebunny/crossref_metadata_2025 huggingface dataset:
A Ptolemaic-Roman Temple Foundation at Tell Timai
Authors: Bennett James E.
Published: April 2020

The mission of the University of Hawai’i at Tell Timai in 2009 began excavating the remains of a limestone temple foundation platform in the north-west area of the site. The foundations had been partially recorded in survey work conducted in 1930 by Alexander Langsdorff and Siegfried Schott, and again in the 1960s by New York University, however no known investigations of the structure were conducted. In 2017 as part of an Egypt Exploration Society Fieldwork and Research Grant, excavations were renewed to finalise the understanding of the temple’s construction techniques, and the date of the temple. The foundations were of a casemate design with internal fills of alternating silt and limestone chips. The ceramic evidence from within the construction fills dates its construction from the end of the Ptolemaic to the early Roman Period, and the temple’s superstructure was most likely taken down and the blocks reused in the late Roman Period (fourth to fifth century ce).
Structural Heart Disease Emergencies
Authors: Jentzer Jacob C. , Ternus Bradley , Eleid Mackram , Rihal Charanjit
Published: April 2020

Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
Novel Methods, Novel Metrics: Using a Meta-Ethnography to Create a Plan Quality Framework for Sustainable and Resilient Social–Ecological Systems
Authors: Dyckman Caitlin S. , Conroy Maria Manta
Published: April 2020

Social–ecological resilience (SER) and sustainable commons management (SCM) are process- and outcome-based paradigms for natural resource management. Resource management plans foster them, but traditional plan quality assessment typically omits process dimensions. We examined what constitutes an appropriate plan quality evaluation framework for resource management plans that reflect these SER and SCM paradigms. In order to create a plan quality instrument for assessing embedded SER and SCM processes, we employed a two-part methodology of a meta-ethnographic analysis and then used the results to augment current advances in plan quality evaluation to assess adaptation efforts. While methodologically novel in the academic planning canon, the meta-ethnographic approach has been used to inductively synthesize qualitative studies’ results in, for example, the fields of public health, medicine, and education. Our use advances plan quality evaluation with a new metric that combines the paradigmatic resource management strategies and addresses identified shortcomings in the more novel adaptive plan quality evaluation approach that builds on the former, traditional one.
Preparing for a “Good Life”: Extracurriculars and the Romanian Middle Class
Authors: Savu Alin , Lipan Ștefan , Crăciun Magdalena
Published: April 2020

Investment in an “education with an edge” in the form of costly extracurriculars is a growing phenomenon in urban post-socialist Romania. To a certain extent, this is a typical strategy of middle-class reproduction, more intensely pursued in contexts where middle-class reproduction is imagined as uncertain. However, in a post-socialist context, a sense of fragility permeates both the experience of the present and imaginings of the future. Despite its political idealisation and programmatic support, Romania’s middle class remains of modest dimensions and is extending itself to live a “good enough life.” Parents’ realisation that their children might experience even more difficulties than themselves prompt them to use their economic capital to acquire as many and varied cultural and social resources as possible. An ethnographic investigation of this experience from both the parents’ and children’s perspectives throws light on the ongoing processes of class formation under post-socialist conditions of possibility.
The Utility of Cognitive Screeners in the Detection of Dementia Spectrum Disorders in Spanish-Speaking Populations
Authors: Burke Shanna L. , Grudzien Adrienne , Burgess Aaron , Rodriguez Miriam J. , Rivera Yesenia , Loewenstein David
Published: April 2020

Increasing rates of dementia spectrum disorders among Spanish-speaking geriatric populations necessitate the development of culturally appropriate cognitive screening tests that can identify neurodegenerative disorders in their earliest stages when emerging disease-modifying treatments are most likely to be effective. This scoping review identified 26 brief Spanish language cognitive screening tools (<20 minutes) by searching academic databases using a combination of search terms. Results suggest that the Mini-Mental Status Examination and Montreal Cognitive Assessment appear to be less valid than other screeners. Instruments such as the 7-Minute Screen and Mini-Cog evidence higher classification rates of dementia, while Phototest detected mild cognitive impairment at higher rates more consistently than other screeners. Different sensitivity and specificity outcomes and cutoffs were observed when the same cognitive screener was evaluated in different countries. Results indicate that it is imperative to increase nation-specific validation and normative data for these instruments to best serve diverse populations.
The influence of leading-edge deflection on the stability of the leading-edge vortices
Authors: Zhang Jiao-Long , Jun-Hu  , Yu Yong , Xuan Hai-Bin
Published: April 2020

To examine the effect of leading-edge deflected angle [Formula: see text] on the stability of the leading-edge vortex, the three-dimensional flow field of a flapping wing is simulated by a numerical method. The multi domain mesh generation, dynamic mesh and large eddy simulation technology are employed to capture the finer flowfield structure. The wings perform pure periodic oscillations, and the Reynolds number ( Re) is 4527 based on the chord length c. The folding line formed after the deflection coincides with the pitch axis and is located at the 1/4 c from the leading edge. The results show that the increase of [Formula: see text] maintains the strength of the leading-edge vortex for longer time, and weakens the influence of the motion of the wing on the leading-edge vortex intensity. The flowfield topological analysis shows that the increase of [Formula: see text] also prevents the formation of secondary vortices between the wing surface and the leading-edge vortices, which indirectly contributes to the attachment of the leading-edge vortices to the wing. Moreover, the vortex dynamics equations have been analyzed, and the results indicate that the increase of [Formula: see text] will delay the occurrence of spanwise convection of vorticity and weaken its intensity. In addition, it can also suppress the spanwise flow behind the leading-edge vortices toward the symmetric plane. As a result, increasing [Formula: see text] stabilizes the boundary layer in this region and thereby stabilizes the leading-edge vortices indirectly. Finally, a new parameter is introduced to quantitatively evaluate the proximity of the leading-edge vortex to the surface of the plate. Our method comprehensively considers the influence of the leading-edge vortex scale and the core motion on the approaching of the leading-edge vortex to the wing, and some important conclusions on the developing law of the leading-edge vortex, which are agreement with the experimental measurement, are obtained.
Nonepidemic Kaposi sarcoma in a young man
Authors: Cabezas-Calderon Victor , Vall-Mayans Martí
Published: April 2020

Kaposi sarcoma (KS) is an angioproliferative tumour with four widely recognized epidemiological forms: endemic, epidemic, iatrogenic and classic. However, the increasing evidence of KS in human immunodeficiency virus (HIV)-seronegative men who have sex with men (MSM) has led to the recent appearance of a new category, nonepidemic KS. Nonepidemic KS is still unknown by many physicians and may lead to a notable anxiety to the patient and unnecessary explorations. Our aim was to reflect this reality and raise awareness of the existence and peculiarities of this new variant. We report a case of a KS diagnosed in a young HIV-negative man, previously managed with a notable confusion by other practitioners. The patient had high risk behaviour for infection with KS-associated herpes virus. Repeated negative HIV tests confirmed the diagnosis of nonepidemic KS. Extracutaneous involvement was not suspected. Surgical excision of the tumour was performed, achieving complete response with no relapses in the following months. Nonepidemic KS is a new entity described in young MSM, characterized by few lesions, infrequent visceral involvement and with good prognosis. We emphasize the importance for clinicians to recognize this cutaneous tumour to prompt proper evaluation and better counselling.
Union citizens’ rights against their own Member State after Brexit
Authors: Bernard Nicolas
Published: April 2020

The treatment by the United Kingdom of Union citizens remaining on its territory after Brexit and conversely that of UK nationals by EU27 Member States on theirs has given rise to much discussion and analysis. By contrast, there has been comparatively little systematic and detailed exploration of the question of the impact of Brexit on the exercise of Union citizens’ rights against their own Member State. It is an issue which is for the most part ignored in the current Withdrawal Agreement. The purpose of this article is to show that this blind spot opens up a potential gap in legal protection of the rights of Union citizens, which is likely to remain regardless of the outcome of the Brexit negotiations and whether a withdrawal agreement is concluded or not. The paper discusses the extent to which the adversarial nature of the withdrawal process has contributed to this failure to address this issue and the ways in which courts could step in to provide the legal protection that political processes were unable to deliver.
Bilateral retinoblastoma and osteogenesis imperfecta, a very rare association: Two cases
Authors: De Francesco Sonia , Sgheri Arianna , Di Maggio Alessandro , Rana Francesco , Anna Maria Pinto , Alessandra Renieri , Hadjistilianou Theodora
Published: April 2020

Introduction

This case report presents two patients affected by a very rare association of bilateral retinoblastoma and osteogenesis imperfecta.

Case report

Two Caucasian males with familial history and clinical signs of osteogenesis imperfecta came to our attention for bilateral leukocoria. The ocular fundus examination revealed bilateral retinoblastoma. Proper therapies were dispensed in order to achieve full regression. Genetic counseling was performed.

Discussion

The primary role of genetics in retinoblastoma pathogenesis in widely known, and different genes have been identified. Osteogenesis imperfecta is a rare connective tissue disorders, caused by mutated genes encoding for collagen. The single gene defect in osteogenesis imperfecta type VI is Serpin Family F Member 1 ( SERPINF1), a neurotrophic factor for the neuronal differentiation in retinoblastoma cells. The association of bilateral retinoblastoma and osteogenesis imperfecta could be the result of the mutation of a single gene playing a role in a hypothetical common pathway.
Mapping Perceived Social Values to Support a Respondent-Defined Restoration Economy: Case Study in Southeastern Arizona, USA
Authors: Petrakis Roy E , Norman Laura M , Lysaght Oliver , Sherrouse Benson C , Semmens Darius , Bagstad Kenneth J , Pritzlaff Richard
Published: April 2020

Investment in conservation and ecological restoration depends on various socioeconomic factors and the social license for these activities. Our study demonstrates a method for targeting management of ecosystem services based on social values, identified by respondents through a collection of social survey data. We applied the Social Values for Ecosystem Services (SolVES) geographic information systems (GIS)-based tool in the Sonoita Creek watershed, Arizona, to map social values across the watershed. The survey focused on how respondents engage with the landscape, including through their ranking of 12 social values (eg, recreational, economic, or aesthetic value) and their placement of points on a map to identify their associations with the landscape. Additional information was elicited regarding how respondents engaged with water and various land uses, as well as their familiarity with restoration terminology. Results show how respondents perceive benefits from the natural environment. Specifically, maps of social values on the landscape show high social value along streamlines. Life-sustaining services, biological diversity, and aesthetics were the respondents’ highest rated social values. Land surrounding National Forest and private lands had lower values than conservation-based and state-owned areas, which we associate with landscape features. Results can inform watershed management by allowing managers to consider social values when prioritizing restoration or conservation investments.
Bringing agency back into the study of partisan politics: A note on recent developments in the literature on party politics
Authors: Wenzelburger Georg , Zohlnhöfer Reimut
Published: April 2020

The question of whether political parties make a systematic difference in terms of public policies is one of the classics of comparative public policy research. However, unstable class cleavages and changing party strategies challenge the assumptions of traditional partisan theory, namely that parties represent a stable group of voters and implement policies according to the preferences of this group. Against this backdrop, several recent studies have called for an “electoral turn” in partisan theory and suggest establishing a party–voter link on the microlevel, depending on the policy area at stake. In this article, we propose a different view on partisan effects. While we do not argue that public opinion is unimportant for parties, we maintain that the electoral turn literature has a tendency to black-box the political actors and their preferences, because they become mere agents of voter preferences. Our argument builds on a growing literature that shows that political actors both at the party member and the elite level do have preferences and that these may or may not be coherent with those of the voters. Hence, the effect of partisan ideology on public policies may also be situated on the level of the parties or policy-makers themselves.
Living and Teaching Internationally: Teachers Talk about Personal Experiences, Benefits, and Challenges
Authors: Ospina Nelly Sierra , Medina Sergio Lopera
Published: April 2020

This study reports on the impact of international visiting faculty’s teaching experiences in the United States on their personal, professional, and intercultural development. It is based on the principles of qualitative research and can be described as a case study. Data collection involved a questionnaire, a written narrative, and a semi-structured interview with each of a number of teachers. Participants included a group of 22 visiting faculty. Three main categories, each of which can be subdivided into benefits and challenges, emerged from the analysis: intercultural matters, professional matters, and personal matters. A wide range of benefits was identified, suggesting that the participants adapted to new life styles, became more mature, obtained a deeper understanding of themselves, reaffirmed their own educational values and philosophies, raised cultural awareness, became more flexible, and developed attitudes that involved tolerance and respect. Conversely, visiting faculty reported that they faced challenges related to language barriers, interaction with native speakers, classroom management, lack of support from school administrators, and separation from family.
Toxic Responses Induced at High Doses May Affect Benchmark Doses
Authors: Zarn Jürg A. , Zürcher Ursina A. , Geiser H. Christoph
Published: April 2020

To derive reference points (RPs) for health-based guidance values, the benchmark dose (BMD) approach increasingly replaces the no-observed-adverse-effect level approach. In the BMD approach, the RP corresponds to the benchmark dose lower confidence bounds (BMDLs) of a mathematical dose–response model derived from responses of animals over the entire dose range applied. The use of the entire dose range is seen as an important advantage of the BMD approach. This assumes that responses over the entire dose range are relevant for modeling low-dose responses, the basis for the RP. However, if part of the high-dose response was unnoticed triggered by a mechanism of action (MOA) that does not work at low doses, the high-dose response distorts the modeling of low-dose responses. Hence, we investigated the effect of high-dose specific responses on BMDLs by assuming a low- and a high-dose MOA. The BMDLs resulting from modeling fictitious quantal data were scattered over a broad dose range overlapping with the toxic range. Hence, BMDLs are sensitive to high-dose responses even though they might be irrelevant to low-dose response modeling. When applying the BMD approach, care should be taken that high-dose specific responses do not unduly affect the BMDL that derives from low doses.
The Changing Face of Qualitative Inquiry
Authors: Morse Janice
Published: April 2020

When examining the changes in society and the concomitant changes in research methods in the last century, unquestionably qualitative inquiry has been superseded by quantitative methods and had to work to find its niche in the social sciences. Here, I explore the push factors that have made space for the establishment and legitimization of qualitative inquiry. I discuss what we are doing well in qualitative methods, then examine the status quo—present worries, concerns, and future trends. I present three major problems that need attention, critique, and resolution in qualitative methods to further strengthen our foothold as we move forward. Methodological development is one of the primary purposes of the International Institute of Qualitative Methods (IIQM). In closing, I examine the role of the IIQM in the global development of qualitative methods.
Nomogram for predicting overall survival of patients with bladder cancer: A population-based study
Authors: Wang Jiawu , Wu Yan , He Weiyang , Yang Bo , Gou Xin
Published: April 2020

Objective:

The aim of this study was to develop and validate a reliable nomogram to estimate overall survival in bladder cancer.

Method:

Patients diagnosed with bladder cancer identified in the Surveillance, Epidemiology, and End Results database were randomly divided into training and validation cohorts. The powerful prognostic variables were examined using Cox regression analyses. A nomogram was developed on the prognostic factors.

Results:

The results suggested that age, sex, race, grade, histologic type, primary site, pathological stage, surgical treatment, and number of primary tumors, were the powerful prognostic factors. All these factors were integrated to construct the nomogram. The nomogram for predicting overall survival showed better discrimination power than the tumor-node-metastasis (TNM) stage system 8th edition.

Conclusion:

The nomogram has the potential to provide an individualized prediction of overall survival in patients with bladder cancer.
The effects of positive and negative emotional text content on knowledge revision
Authors: Trevors Greg , Kendeou Panayiota
Published: April 2020

Across three experiments, we sought to determine the effects of positive and negative emotional content in refutation texts on misconceptions about vaccines. The addition of negative emotional content to texts that identify, refute, and explain vaccine misconceptions improved knowledge revision observed during reading (Experiment 1). However, the addition of positive emotional content to refutation texts weakened this effect (Experiment 2). A direct comparison between negative and positive emotional content provided corroborating evidence for these findings (Experiment 3). Across experiments, results show that all refutation texts (with or without positive or negative emotional content) improved learning assessed after reading. These findings show the differential effects of emotional content on processing misconceptions about an important socio-scientific topic and provide consistent support for refutation texts as a potentially useful tool in these corrective efforts.
Management of tachyarrhythmias in pregnancy – A review
Authors: Kugamoorthy Priyanka , Spears Danna A
Published: April 2020

The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.
Eating Potatoes Is Patriotic: State, Market, and the Common Good in Contemporary China
Authors: Klein Jakob
Published: April 2020

The article explores recent materials, including cookbooks and a television documentary, backed by the state to promote the potato as a Chinese staple food. These materials attempt to convince would-be eaters that the tuber is a highly nutritious food, suited to modern lifestyles and health concerns, and that it is both cosmopolitan and embedded in Chinese regional food traditions. They articulate a moral economy of food in which the market is a key mechanism for achieving the greater good of national grain security and a healthy population, and in which state and citizen are jointly responsible for “nourishing the people.” Consumers are encouraged to purchase potatoes and potato foods not only to cultivate their own health, but also out of a duty to the well-being of the country. In framing potato-eating as a patriotic act, potato campaigns chime with emerging practices in China of “ethical food consumption.”
Design, Synthesis, and Anticancer Activity of Natural Product Hybrids With Paclitaxel Side Chain Inducing Apoptosis in Human Colon Cancer Cells
Authors: Zheng Ling-Li , Wen Guan , Yao Yun-Xin , Li Xiao-Huan , Gao Feng
Published: April 2020

Based on the strong activity dependence of paclitaxel (PTX; Taxol) or docetaxel (Taxotere) on the C-13 side chain, a small library of dehydroepiandrosterone, cholesterol, vitamin D2, and alkaloids talatisamine and songorine-PTX hybrids have been synthesized and evaluated for in vitro anticancer activity by MTT assay against human breast (MCF-7), colon (HCT116), lung carcinoma (A549), and renal adenocarcinoma (786-0) cancer cell lines. Most hybrids (11b, 12b, 13b, 15b, and 18b) reduced the growth of MCF-7 and 786-0 cells with low PTX sensitivity in vitro. Among the synthesized compounds, hybrid 11b was better in inhibiting the growth of the 4 cells than PTX. A relatively low IC50 value of compound 11b (8.16 ± 0.04 μM) was also examined after exposure for 48 hours. Hybrid 11b showed a proapoptotic effect in HCT116 cells evaluated by Annexin V/propidium iodide binding assay. The level of hybrid 11b leading to protective cell death in HCT116 cells was detected using western blot and not easily observed in our basic examinations.
Cultivating Self-Control: Foundations and Methods in the Christian Theological Tradition
Authors: Spiegel James S.
Published: April 2020

In the New Testament the concept of self-control or voluntary restraint of one’s desires is highlighted as a “fruit of the Spirit,” a trait of the spiritually mature, and a hallmark of Christian leadership. But as a Christian virtue, self-control is a product of spiritual discipline, a trait for which the Christian must engage in “strict training.” This biblical theme has inspired a long history of Christian moral-spiritual practices aimed at cultivating self-mastery or strength of will. Here I discuss several of these as found in the writings of the Desert Fathers, Augustine of Hippo, Julian of Norwich, Thomas Aquinas, John Calvin, Thomas à Kempis, and John Wesley. Despite their theological diversity, these Christian thinkers are united in the belief that self-control can and ought to be intentionally nurtured via the systematic practice of self-denial.
Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses
Authors: Yu Tao , Xiong Yuan , Kang Alex , Zhou Haichao , He Wenbao , Zhu Hui , Yang Yunfeng
Published: April 2020

Purpose:

Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA.

Methods:

We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles.

Results:

Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale.

Conclusion:

The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.
Perceived Need and Acceptability of a Community-Based Peer Navigator Model to Engage Key Populations in HIV Care in Tijuana, Mexico
Authors: Pitpitan Eileen V. , Mittal Maria Luisa , Smith Laramie R.
Published: April 2020

Introduction:

Prior work found <4% of key populations living with HIV (KPLWH) in Tijuana, Mexico, were on antiretroviral therapy (ART). The goal of this pilot study was to examine community stakeholders’ perceived need and acceptability of a peer-navigator program to improve ART coverage.

Methods:

We held a community forum and measured perspectives of key stakeholders in local organizations that serve KPLWH using online surveys, and in-depth interviews (with select key informants).

Results:

Univariate descriptive statistics and emergent thematic analysis illustrated that there was general consensus that the program could improve ART coverage for KPLWH by helping to overcome geographic, transportation, and sociostructural barriers to HIV care. Police harassment, mobility, and non-HIV comorbidities were identified as challenges the program would need to navigate.

Conclusions:

Community stakeholders expressed perceived need and acceptability of a program to improve HIV care outcomes among KPLWH in Tijuana. The program should address the challenges identified by community stakeholders.
Management of Patients With Sepsis in Canadian Community Emergency Departments: A Retrospective Multicenter Observational Study
Authors: Lo Victor C. K. , Su Haitong , Lam Yuet Ming , Willis Kathleen , Pullar Virginia , Kowgier Matthew , Hubner Ryan P. , Tsang Jennifer L. Y.
Published: April 2020

Background:

Sepsis is a life-threatening syndrome and a leading cause of morbidity and mortality representing significant financial burden on the health-care system. Early identification and intervention is crucial to maximizing positive outcomes. We studied a quality improvement initiative with the aim of reviewing the initial management of patients with sepsis in Canadian community emergency departments, to identify areas for improving the delivery of sepsis care. We present a retrospective, multicenter, observational study during 2011 to 2015 in the community setting.

Methods:

We collected data on baseline characteristics, clinical management metrics (triage-to-physician-assessment time, triage-to-lactate-drawn time, triage-to-antibiotic time, and volume of fluids administered within the first 6 hours of triage), and outcomes (intensive care unit [ICU] admission, in-hospital mortality) from a regional database.

Results:

A total of 2056 patients were analyzed. The median triage-to-physician-assessment time was 50 minutes (interquartile range [IQR]: 25-104), triage-to-lactate-drawn time was 50 minutes (IQR: 63-94), and triage-to-antibiotics time was 129 minutes (IQR: 70-221). The median total amount of fluid administered within 6 hours of triage was 2.0 L (IQR: 1.5-3.0). The ICU admission rate was 36% and in-hospital mortality was 25%. We also observed a higher ICU admission rate (51% vs 24%) and in-hospital mortality (44% vs 14%) in those with higher lactate concentration (≥4 vs ≤2 mmol/L), independent of other sepsis-related parameters.

Conclusion:

Time-to-physician-assessment, time-to-lactate-drawn, time-to-antibiotics, and fluid resuscitation in community emergency departments could be improved. Future quality improvement interventions are required to optimize management of patients with sepsis. Elevated lactate concentration was also independently associated with ICU admission rate and in-hospital mortality rate.
In Memoriam Eivind Berge, MD, PhD, 1964–2020
Authors: Sandercock Peter , van der Worp Bart , Sandset Else C
Published: April 2020

Professor Eivind Berge, MD, PhD died from cancer on 6 February 2020. He was a highly respected stroke expert, clinical trialist and clinician scientist who made substantial contributions to evidence-based stroke medicine and the work of the European Stroke Organisation.
Isolated headache and its association with characteristics and outcome of cerebral venous sinus thrombosis
Authors: Shakibajahromi Banafsheh , Borhani-Haghighi Afshin , Vardanjani Hossein Molavi , Ghaedian Mehrnaz , Feiz Farnia , Safari Anahid , Hooshmandi Etrat , Mowla Ashkan
Published: April 2020

We aimed to evaluate the clinical characteristics and outcome, hospital stay, and intracranial hemorrhage (ICH) development of patients with cerebral venous sinus thrombosis (CVST) who presented with isolated headache. In a retrospective study, consecutive patients with a definite diagnosis of CVST referred to Namazi hospital (Shiraz University of Medical Sciences) from 2012 to 2016 were included. Clinical, radiological, and prognostic characteristics and outcome on discharge (using modified Rankin Scale (mRS)) were compared between the CVST patients who presented with isolated headache and other CVST patients through univariate analyses. The associations of isolated headache with poor outcome (mRS > 2), presence or development of ICH, and duration of hospital stay were assessed through multivariable analyses. Of the 174 patients, 45 (26.0%) presented with isolated headache. Presence of isolated headache was more frequent in men ( p value = 0.048) and patients with thrombophilia ( p value = 0.040). Lateral sinus involvement was more common in patients with isolated headache ( p value = 0.005). After adjustment for other variables, the isolated headache was significantly associated with shorter hospital stay (odds ratio (OR): 0.85, confidence interval (CI): 0.73–0.99) and lower risk of early ICH (OR: 0.314, CI: 0.132–0.749). Although poor outcome was significantly less frequent in patients with isolated headache on univariate analysis ( p value < 0.001), this association was not significant in multivariable analysis (OR: 0.324, CI: 0.035–2.985). CVST patients with isolated headache had lower ICH events and shorter hospital stay. CVST should be considered as a possible differential diagnosis in certain patients who present only with headache, particularly those with diffuse progressive headache, or underlying provocative conditions.
Ultramicrostructural reductions in teeth: implications for dietary transition from non-avian dinosaurs to birds
Authors: Li Zhiheng , Wang Chun-Chieh , Wang Min , Chiang Cheng-Cheng , Wang Yan , Zheng Xiaoting , Huang E-Wen , Hsiao Kiko , Zhou Zhonghe
Published: April 2020

Background

Tooth morphology within theropod dinosaurs has been extensively investigated and shows high disparity throughout the Cretaceous. Changes or diversification in feeding ecology, i.e., adoption of an herbivorous diet (e.g., granivorous), is proposed as a major driver of tooth evolution in Paraves (e.g., Microraptor, troodontids and avialans). Here, we studied the microscopic features of paravian non-avian theropod and avialan teeth using high-spatial-resolution synchrotron transmission X-ray microscopy and scanning electron microscopy.

Results

We show that avialan teeth are characterized by the presence of simple enamel structures and a lack of porous mantle dentin between the enamel and orthodentin. Reduced internal structures of teeth took place independently in Early Cretaceous birds and a Microraptor specimen, implying that shifts in diet in avialans from that of closely related dinosaurs may correlate with a shift in feeding ecology during the transition from non-avian dinosaurs to birds.

Conclusion

Different lines of evidence all suggest a large reduction in biting force affecting the evolution of teeth in the dinosaur-bird transition. Changes in teeth microstructure and associated dietary shift may have contributed to the early evolutionary success of stemward birds in the shadow of other non-avian theropods.
RETRACTED ARTICLE: Psychometric properties of a short version of the Job Anxiety Scale
Authors: Schmalbach Bjarne , Kalkbrenner Andreas , Bassler Markus , Hinz Andreas , Petrowski Katja
Published: April 2020

Background

Occupational stress and specifically job anxiety are crucial factors in determining health outcomes, job satisfaction as well as performance. In order to assess this phenomenon, the Job Anxiety Scale is one of the instruments available. It consists of 70 items that are clustered in 14 subscales and five dimensions. The aim of this paper is to create a more efficient, short version of the Job Anxiety Scale, while retaining the five dimensions, and to assess its psychometric properties.

Methods

The sample consists of 991 – mostly psychosomatic – patients from two different clinics. We applied methods of factor analysis and bivariate correlations to explore and test factor structure and the nomological net of related constructs.

Results

After reducing the item pool via the construction of subsets and tests using ant-colony-optimization, a 15-item version of the Job Anxiety Scale evinced very good psychometric properties. We found very good model fit, high internal consistency, and invariance across participant age and sex. It displayed improved discriminant validity compared to the original scale, and we found the expected pattern of convergent correlations.

Conclusions

With this short version of the Job Anxiety Scale, researchers can assess job related worries in a much more economic manner. The questionnaire is particularly useful in large-scale surveys and/or in samples that struggle with extensive assessments.
Comparative cost-effectiveness of cabozantinib as second-line therapy for patients with advanced hepatocellular carcinoma in Germany and the United States
Authors: Sieg Maximilian , Hartmann Michael , Settmacher Utz , Arefian Habibollah
Published: April 2020

Background

Cabozantinib was approved by the European Medicines Agency and the Federal Drug Administration as an option for sorafenib-resistant advanced hepatocellular carcinoma, increasing overall survival and progression-free survival compared with placebo. We evaluated the cost-effectiveness of cabozantinib in the second-line setting for patients with an advanced hepatocellular carcinoma from the German statutory health insurance perspective compared with an US scenario using US prices.

Methods

A Markov model was developed to compare the costs and effectiveness of cabozantinib with best supportive care in the second-line treatment of advanced hepatocellular carcinoma over a lifetime horizon. Health outcomes were measured in discounted life years and discounted quality-adjusted life years. Survival probabilities were estimated using parametric survival distributions based on CELESTIAL trial data. Utilities were derived from the literature. Costs contained drugs, monitoring and adverse events measured in US Dollars. Model robustness was addressed in univariable, scenario and probabilistic sensitivity analyses.

Results

Cabozantinib generated a gain of 0.18 life years (0.15 quality-adjusted life years) compared with best supportive care. The total mean cost per patient was $56,621 for cabozantinib and $2064 for best supportive care in the German model resulting in incremental cost-effectiveness ratios for cabozantinib of $306,778/life year and $375,470/quality-adjusted life year. Using US prices generated costs of $177,496 for cabozantinib and $4630 for best supportive care and incremental cost-effectiveness ratios of $972,049/life year and $1,189,706/quality-adjusted life year.

Conclusions

Our analysis established that assuming a willingness-to-pay threshold of $163,371/life year (quality-adjusted life year) for the German model and $188,559/life year (quality-adjusted life year) for the US model, cabozantinib is not cost-effective compared with best supportive care. Sensitivity analyses showed that cabozantinib was not cost-effective in almost all our scenarios.
HBsAg quantification predicts off-treatment response to interferon in chronic hepatitis B patients: a retrospective study of 250 cases
Authors: Wu Shuai , Luo Wenfan , Wu Yin , Chen Hongjie , Peng Jie
Published: April 2020

Background

For chronic hepatitis B (CHB) patients without willingness to extend the routine duration of interferon (IFN) therapy, it is important to identify patients who will benefit from treatment cessation. Hepatitis B surface antigen (HBsAg) quantification is recommended for management of IFN therapy. At present, the understanding on end-of-treatment (EOT) HBsAg level predicting post-treatment response to IFN is still finite.

Methods

A total of 2451 non-cirrhosis, HBsAg-postive patients treated with IFN-based therapy during the period from December 2010 to December 2017 at Nanfang Hospital were enrolled in this study. Serum HBsAg levels at EOT were measured to evaluate the associations between EOT HBsAg levels (Group 1, HBsAg > 0.05 and ≤ 10 IU/mL; Group 2, HBsAg > 10 and ≤ 200 IU/mL; Group 3, HBsAg > 200 IU/mL) with post-treatment HBsAg loss. Chi-squared, t-test,,Kaplan-Meier analysis, Cox regression analysis, and Multivariate Logistic regression analysis were used to analyse and evaluate differences between the there groups.

Results

The cumulative HBsAg loss rates 5 years after treatment in Group 1–3 were 30.4% (17/56), 9.8%(4/41) and 0%(0/153) (p < 0.001). An EOT HBsAg level of > 10 IU/mL showed relatively high negative predictive value (NPV) of up to 97.9% for HBsAg loss. Low baseline HBsAg level < 25,000 IU/mL, on-treatment HBsAg decline > 1 log10IU/mL at week 24 and EOT HBsAg level ≤ 10 IU/mL were found significantly associated with HBsAg loss. A total of 6 patients have achieved HBsAg loss at EOT and 17 patients with EOT HBsAg level ≤ 10 IU/mL have achieved post-treatment HBsAg loss. Baseline characteristics, dynamic changes of on-treatment HBsAg and duration of IFN therapy were balanced across patients with EOT or post-treatment HBsAg loss.

Conclusion

EOT HBsAg level can serve as a monitoring indicator for IFN therapy. EOT HBsAg level ≤ 10 IU/mL was found to lead to high rate of post-treatment HBsAg loss. For patients without willingness to extend IFN treatment, off-treatment follow-up could be considered when HBsAg level decreased to ≤10 IU/mL.
Odontogenic cutaneous sinus tracts due to infection with nontuberculous mycobacteria: a report of three cases
Authors: Pérez-Alfonzo Ricardo , Poleo Brito Luisa Elena , Vergara Marialejandra Solano , Ruiz Damasco Angela , Meneses Rodríguez Perla Luiguimar , Kannee Quintero Carmen Elena , Carrera Martinez Carolina , Rivera-Oliver Ismar Alejandra , Da Mata Jardin Omaira J. , Rodríguez-Castillo Bárbara A. , de Waard Jacobus H.
Published: April 2020

Background

Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging.

Case presentation

We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM.

Conclusions

Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.
No association between the Ser9Gly polymorphism of the dopamine receptor D3 gene and schizophrenia: a meta-analysis of family-based association studies
Authors: Li Xiao-na , Zheng Ji-long , Wei Xiao-han , Wang Bao-jie , Yao Jun
Published: April 2020

Background

Previous studies found that Ser9Gly (rs6280) might be involved in the occurrence of schizophrenia. However, no consist conclusion has yet been achieved. Compared to the case-control study, the family-based study took into account stratification bias. Thus, we conducted a meta-analysis of family-based studies to measure a pooled effect size of the association between Ser9Gly and the risk of schizophrenia.

Methods

The relevant family-based studies were screened using the electronic databases by the inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to measure the correction between Ser9Gly polymorphism and schizophrenia susceptibility. Subgroup analysis was performed by stratification of ethnicity (i.e., East Asian, Caucasian, and other populations). Additionally, publication bias was evaluated by the funnel plot.

Results

After literature searching, a total of 13 family-based association studies were included, which contained 11 transmission disequilibrium test (TDT) studies with 1219 informative meiosis and 5 haplotype-based haplotype relative risk (HRR) studies. No statistical significance of the heterogeneity was detected in TDT and HRR studies. Thus, the pooled effect size was calculated under the fixed effect model. The results found that the association was significantly protective in East Asian in TDT studies (204 informative meiosis, OR = 0.744, 95% CI = 0.564–0.980, Z-value = − 2.104, p = 0.035).

Conclusions

The meta-analysis based on the family study found a protective association of Ser9Gly in East Asian. In future, large sample molecular epidemiology studies are needed to validate our findings.
Factors of microinflammation in non-diabetic chronic kidney disease: a pilot study
Authors: Olivier Valerie , Dunyach-Remy Catherine , Corbeau Pierre , Cristol Jean-Paul , Sutra Thibault , Burtey Stephane , Lavigne Jean-Philippe , Moranne Olivier
Published: April 2020

Background

The relationships between digestive bacterial translocation, uremic toxins, oxidative stress and microinflammation in a population of chronic kidney disease (CKD) patients without metabolic nor inflammatory disease are unknown.

Methods

Bacterial translocation, uremic toxins, oxidative stress, and inflammation were assessed by measuring plasma levels of 16S  ribosomal DNA (16S rDNA), p-cresyl sulfate (PCS), indoxyl sulfate (IS), indole acetic acid (IAA), F2-isoprostanes, hsCRP and receptor I of TNFα (RITNFα) in patients without metabolic nor inflammatory disease. 44 patients with CKD from stage IIIB to V and 14 controls with normal kidney function were included from the nephrology outpatients. 11 patients under hemodialysis (HD) were also included. Correlations between each factor and microinflammation markers were studied.

Results

16S rDNA levels were not increased in CKD patients compared to controls but were decreased in HD compared to non-HD stage V patients (4.7 (3.9–5.3) vs 8.6 (5.9–9.7) copies/μl, p = 0.002). IS, PCS and IAA levels increased in HD compared to controls (106.3 (73.3–130.4) vs 3.17 (2.4–5.1) μmol/l, p < 0.0001 for IS; 174.2 (125–227.5) vs 23.7 (13.9–52.6) μmol/l, p = 0.006 for PCS; and 3.7 (2.6–4.6) vs 1.3 (1.0–1.9) μmol/l, p = 0.0002 for IAA). Urea increased in non-HD stage V patients compared to controls (27.6 (22.7–30.9) vs 5.4 (4.8–6.4) mmol/l, p < 0.0001) and was similar in HD and in non-HD stage V (19.3 (14.0–24.0) vs 27.6 (22.7–30.9) mmol/l, p = 0.7). RITNFα levels increased in HD patients compared to controls (12.6 (9.6–13.3) vs 1.1 (1.0–1.4) ng/ml, p < 0.0001); hsCRP levels increased in non-HD stage V patients compared to controls (2.9 (1.4–8.5) vs 0.8 (0.5–1.7) mg/l, p = 0.01) and remained stable in HD patients (2.9 (1.4–8.5) vs 5.1 (0.9–11.5) mg/l, p = 1). F2-isoprostanes did not differ in CKD patients compared to controls. Among uremic toxins, IS and urea were correlated to RITNFα (r = 0.8, p < 0.0001 for both). PCS, IS and urea were higher in patients with hsCRP≧5 mg/l (p = 0.01, 0.04 and 0.001 respectively). 16S rDNA, F2-isoprostanes were not correlated to microinflammation markers in our study.

Conclusions

In CKD patients without any associated metabolic nor inflammatory disease, only PCS, IS, and urea were correlated with microinflammation. Bacterial translocation was decreased in patients under HD and was not correlated to microinflammation.