bluuebunny/crossref_metadata_2025 huggingface dataset:
Problem-based learning
Authors: Silva Anielson Barbosa Da , Bispo Ana Carolina Kruta de Araújo , Rodriguez Danilo Goncalves , Vasquez Francisco Ialyson Felipe
Published: April 2018

Purpose

The purpose of this paper is to present a proposal for structuring the use of problem-based learning (PBL) as an active teaching strategy and assess PBL’s implications for student learning in the undergraduate management degree program of a federal university in Northeastern Brazil. PBL can turn students into active subjects in their own learning and promote the development of decision-making abilities through the identification and analysis of real problems.

Design/methodology/approach

The study follows the assumptions of qualitative research and uses the action research approach. The data were collected through reflective reports (texts freely written by students describing their experiences in a course) and through interviews. The collected material formed the basis for analysis and discussion of the results using content analysis.

Findings

The results indicate that the PBL teaching strategy has positive implications for student learning in that it promotes the integration of theory and practice, which enhances the motivation to learn. The students perceived the practical aspect, teamwork and presence of an entrepreneur/manager in the PBL classes as factors facilitating learning. By contrast, teamwork and the time involved were seen as factors limiting learning.

Practical implications

The use of PBL demonstrates its potential for learning through the integration of students’ cognitive, behavioral and social dimensions, fostering closer integration with the context of professional activity. The presence of entrepreneurs/managers who present real problems to be analyzed by the students in the classroom can contribute significantly to the promotion of learning and reflection by undergraduate management students.

Originality/value

The results of this study reveals its originality and value to management education in Brazil because it defines a framework for the implementation of PBL as an active learning strategy in a management program, it indicates the potential of PBL for the development of students’ competencies, it increases the potential for integrating theory with professional practice and it can aid the process of training teachers as they assess the implications of PBL for student learning.
Treatment of ankylosing spondylitis with co‐amoxiclav
Authors: Öğrendik Mesut
Published: April 2018

This article presents the efficacy of co‐amoxiclav in two patients with ankylosing spondylitis. Both patients were administered oral co‐amoxiclav for 7 days. The primary efficacy variable was the ankylosing spondylitis activity index. Secondary outcome measures were the ankylosing spondylitis functional index and spinal mobility. We detected a marked improvement in all symptoms and physical examination parameters. Co‐amoxiclav has been shown to be effective against ankylosing spondylitis.
Allocating provincial CO2 quotas for the Chinese national carbon program
Authors: Jiang Minxing , Zhu Bangzhu , Chevallier Julien , Xie Rui
Published: April 2018

In order to improve the efficiency of climate change initiatives China launched its national carbon market in December 2017. Initial CO2 quota allocations are a matter of significant concern. How should we allocate CO2 emissions reduction responsibilities among Chinese provinces, assuming that provinces will not or cannot trade these responsibilities among themselves? In this paper, we allocate CO2 quota from the perspective of cost minimisation. First, we estimate the national CO2 marginal abatement cost (MAC) function and deduce the interprovincial MAC functions. Second, we build an allocation model with nonlinear programming for cost minimisation. Finally, we obtain the allocation results under the emissions reduction target by 2030. The results are as follows. (i) The national MAC was 134.3 Yuan/t (at the constant price of 1978) in 2011, with an overall upward trend from 1990 to 2011. (ii) The interprovincial MACs differ significantly and decline gradually from east to west. Hebei has the largest emissions reduction quota, and Shandong has the largest emissions quota by 2030. (iii) Compared with other criteria of per capita, gross domestic product (GDP), grandfathering and carbon intensity, the proposed approach is the most cost‐effective in achieving the reduction target, with cost savings of 37.7, 34.5, 47.9 and 33.87 per cent, respectively.
Translating value‐based health care: an experiment into healthcare governance and dialogical accountability
Authors: Bonde Morten , Bossen Claus , Danholt Peter
Published: April 2018

This article analyses an experiment into healthcare governance in Denmark inspired by principles of value‐based health care and intended to re‐orient the focus of healthcare governance from ‘productivity’ to ‘value for the patient’. The region in charge of the experiment exempted nine hospital departments from activity‐based financing and accountability based on diagnosis‐related groups, which allegedly incentivised hospitals in ‘perverse’ and counterproductive ways. Instead, the departments were to develop new indicators from their local practices to support and account for quality and value for the patient. Drawing on the actor‐network theory concept of ‘translation’, this article analyses how the experiment was received and put into practice in the nine departments, and how it established new kinds of accountability relations. We argue that the experiment provides fruitful inspiration for future governance schemes in healthcare to embrace the local complexities of clinical practices. In particular, we argue that the locally developed indicators facilitated what we call ‘dialogical accountability’, and we discuss whether this represents a feasible way forward for value‐based health care.
Challenge of Firearms Control in a Free Society
Authors: Cook Philip J.
Published: April 2018

Chapter 10 of   The Challenge of Crime in a Free Society, titled “Control of Firearms,” is a brief but strong statement in support of regulating gun transactions, possession, and carrying, with several specific recommendations, including the adoption of universal gun registration and permit‐to‐purchase requirements. The U.S. President's Commission on Law Enforcement and Administration of Justice, when writing the chapter, had no systematic research to draw on. Since its publication in 1967, the field of gun violence has become an active area of research, and much has been learned. But the nation has become far more polarized politically during the last 50 years, and gun policy has become a rigidly partisan issue. A new commission would have great difficulty reaching consensus, although there may be common ground on regulating guns vis‐à‐vis mental illness and domestic violence.
Addressing Juvenile Crime
Authors: Lane Jodi
Published: April 2018

At‐risk and offending juveniles remain the most promising target group for crime reduction efforts. Many of the problems these youths faced in the 1960s remain or have intensified, and policies to address them have shifted. Yet, research on the causes, consequences, and best responses to juvenile crime has advanced considerably and provides important lessons for policy makers and practitioners moving forward. These include (a) help don't hurt; (b) provide better procedural protections; (c) continue to build, implement, and refine evidence‐based programming; (d) tailor services; (e) tackle community‐level problems; (f) really listen and work together; (g) build better data systems; and (h) invest resources in children and teens. Providing a retrospective on the 1967 U.S. President's Commission on Law Enforcement and Administration of Justice report, I briefly summarize and update the Commission's findings on factors related to juvenile delinquency, outline the Commission's policy recommendations, review the research on policy and practice changes since the report, and consider current implications for policy and practice.
Policing Domestic Violence 1967–2017
Authors: Sherman Lawrence W.
Published: April 2018

The U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson in 1967 called for a program of research that would support evidence‐based tracking, targeting, and testing of policing domestic “disputes.” During the past 50 years, the amount of research on domestic violence has grown. The findings from targeting studies reveal a steep pyramid from many low‐harm cases at the base rising to a tiny fraction that are lethal. The findings from testing studies reveal that arrests reduce reoffending among employed persons in the short run while increasing recidivism among unemployed suspects. Arrests in one experiment increased all‐cause mortality of victims over 23 years. The findings from tracking research reveal wide variance across police agencies in implementing mandatory arrest. Since the Crime Commission, however, mandatory arrest laws were also enacted in 28 states in the 1980s, with uneven enforcement for misdemeanor domestic abuse. New research is needed to test the effectiveness of other domestic violence interventions, including restorative justice, as well as follow‐up studies of previous research sites.
The Commission and the Police
Authors: Skogan Wesley G.
Published: April 2018

The major conclusions advanced in the 1967 report by the U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson are reviewed in this article. Six of the Commission's visions for law enforcement are described, and subsequent changes in the character of American policing are traced. Many of the concerns of the Commission linger until this day. Progress on many fronts has been halting, their impact more muted than reformers had hoped, and the framework of institutions that define law enforcement in the United States has proved remarkably resistant to change.
Reflections on the Exercise of Prosecutorial Discretion 50 Years After Publication of The Challenge of Crime in a Free Society
Authors: Spohn Cassia
Published: April 2018

In The Challenge of Crime in a Free Society, the U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson in 1967 acknowledged the influential role that prosecutors play but lamented the fact that their highly discretionary charging and plea bargaining decisions were often made haphazardly and inconsistently. The Commission called for more transparency and accountability in charging and plea bargaining processes. I examine the exercise of prosecutorial discretion in the 50 years since the publication of the Commission's report, with a focus on the results of research and changes in policy and practice. Although the charging and plea bargaining processes have not been subject to the type of scholarly scrutiny directed at judges’ sentencing decisions, the research that has been published in the past several decades has become more theoretically grounded, methodologically sophisticated, and transdisciplinary. In terms of policy, decisions handed down by the Supreme Court since the 1960s have provided some minimal regulation of charging and plea bargaining, and the reforms embraced by state and federal prosecutors have affected the exercise of prosecutorial discretion.
Fifty Years After the 1967 Crime Commission Report
Authors: Belknap Joanne , Grant Deanne
Published: April 2018

In the 50 years since the U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson issued its report, feminist activism and both feminist and mainstream research have resulted in defining domestic violence (DV) as a social problem. This awareness of the seriousness and expansiveness of DV has spurred the development of unprecedented programs and policies. Although DV policing changes have been significant, so too have been the development of and changes in safehouses, no‐drop court policies, domestic violence courts, community‐coordinated responses, and batterer intervention programs. In this article, we review the nonpolice responses to DV cases and outcomes and provide recommendations. First, research and policies need to more regularly be aimed at addressing victims’ safety and their diverse needs and experiences. Second, assessments should include addressing the processing of these cases through the impact of responses by individual community and criminal legal system actors (e.g., victim advocates, police, prosecutors, and judges) to victims and offenders.
What Could a New Crime Commission Accomplish?
Authors: Gest Ted
Published: April 2018

Even though the crime rate in the United States has dropped since the U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson issued its report in 1967, the total number of serious crimes in the nation has increased, and public concern about the subject remains high. The 1960s Commission did not fully consider several major subjects that have emerged after it reported, including mental illness, immigration, cybercrime and other white collar crimes, indigent defense, crime victims, and evidence‐based crime policy. Many observers believe that the need to deal with these subjects in addition to those discussed by other researchers in this volume warrants an examination of crime and justice by a new commission. Congress has considered proposals for such a study for nearly a decade, but they are yet to be acted on amid ideological disputes over other criminal justice issues. If Congress fails to establish a new commission, it is still possible that one could be formed with the support of state, county, and local governments, as well as with the support of private foundations.
Psychotic‐like experiences in pre‐adolescence: what precedes the antecedent symptoms of severe mental illness?
Authors: Bolhuis K. , Koopman‐Verhoeff M. E. , Blanken L. M. E. , Cibrev D. , Jaddoe V. W. V. , Verhulst F. C. , Hillegers M. H. J. , Kushner S. A. , Tiemeier H.
Published: April 2018

Objective

Adolescent psychotic‐like experiences predict the onset of psychosis, but also predict subsequent non‐psychotic disorders. Therefore, it is crucial to better understand the aetiology of psychotic‐like experiences. This study examined whether (a) child emotional and behavioural problems at 3 and 6 years, or (b) childhood adversities were associated with psychotic‐like experiences at age 10 years.

Method

This prospective study was embedded in the Generation R Study; 3984 children (mean age 10 years) completed a psychotic‐like experiences questionnaire. Mothers reported problems of their child at ages 3, 6 and 10 years. Additionally, mothers were interviewed about their child's adversities.

Results

Psychotic‐like experiences were endorsed by ~20% of children and predicted by both emotional and behavioural problems at 3 years (e.g. emotional‐reactive problems: ORadjusted = 1.10, 95% CI: 1.06–1.15, aggressive behaviour: ORadjusted = 1.03, 95% CI: 1.02–1.05) and 6 years (e.g. anxious/depressed problems: ORadjusted = 1.11, 95% CI: 1.06–1.15, aggressive behaviour: ORadjusted = 1.04, 95% CI: 1.04–1.05). Childhood adversities were associated with psychotic‐like experiences (>2 adversities: ORadjusted = 2.24, 95% CI: 1.72–2.92), which remained significant after adjustment for comorbid psychiatric problems.

Conclusion

This study demonstrated associations between early adversities, childhood emotional and behavioural problems and pre‐adolescent psychotic‐like experiences, which will improve the understanding of children at increased risk of severe mental illness.
Prognostic value of positive T wave in lead aVR in patients with non‐ST segment myocardial infarction
Authors: Separham Ahmad , Sohrabi Bahram , Tajlil Arezou , Pourafkari Leili , Sadeghi Robabeh , Ghaffari Samad , Nader Nader D.
Published: April 2018

Background

Lead aVR provides prognostic information in various settings in patients with ischemia. We aim to investigate the role of a positive T wave in lead aVR in non‐ST segment myocardial infarction (NSTEMI).

Methods

In a prospective cohort study, we included 400 patients with NSTEMI. Presentation electrocardiogram (ECG) was investigated for presence of a positive T wave as well as ST segment elevation (STE) in aVR and study variables were compared. Predictors of primary outcome defined as hospital major adverse cardiovascular events (MACE) and secondary outcome, defined as three‐vessel coronary disease and/or left main coronary artery stenosis (3VD/LMCA) stenosis in angiography, were determined in multivariate logistic regression analysis.

Results

Patients with a positive T wave in aVR were significantly older and were more likely to be female. Left ventricular ejection fraction was significantly lower in patients of positive T group. Positive T group was more likely to have 3VD/LMCA stenosis (58.3% vs. 19.8%, p < .001). The prevalence of a positive T wave in aVR was significantly higher in MACE group (54.9 % vs. 24.8%, p < .001). However, in multivariate analysis, it was not an independent predictor of MACE (OR: 1.083 95% CI: [0.496–2.365], p: .841). Though, it was independently associated with presence of 3VD/LMCA stenosis (OR: 3.747 95% CI: [2.058–6.822], p < .001).

Conclusion

Though positive T wave in lead aVR was more common in patients with MACE; it was not an independent predictor. Additionally, a positive T wave in aVR was an independent predictor of 3VD/LMCA stenosis in NSTEMI.
Editorial: the impact of steatosis on liver stiffness quantification is minimal—Authors’ reply
Authors: Karlas T. , Petroff D. , Wiegand J.
Published: April 2018

Linked Content

This article is linked to Karlas et al and Hassan and Tapper papers. To view these articles visit https://doi.org/10.1111/apt.14529 and https://doi.org/10.1111/apt.14584.
Editorial: hepatocellular carcinoma as a consequence of hepatitis C direct‐acting anti‐virals—the great urban myth of hepatology
Authors: Hussaini T. , Zhu J. , Yoshida E. M.
Published: April 2018

Linked Content

This article is linked to Singer et al paper. To view this article visit https://doi.org/10.1111/apt.14593.
Developing an index of community competence in flood response for flood‐affected rural parishes on the Somerset Levels and Moors using composite and spatial datasets
Authors: Gerrard Ruth Elizabeth Cole
Published: April 2018

Community resilience can help individuals to cope with the impacts of flooding, and indices can provide a quantified assessment of the spatial distribution of resilience characteristics. A key aspect of community resilience is community competence, describing the ability of a community to self‐organise to tackle problems. Community competence has been underrepresented in existing community resilience indices, sometimes dismissed as too intangible for such analyses. This research aimed to develop the first UK index‐based approach to measuring community competence, using proxy datasets, as a tool to improve information available to decision‐makers about which communities are more likely to mobilise an effective response to local flooding. Rural parishes on the Somerset Levels and Moors were chosen for study. A theoretical framework was created, populated by proxy datasets and tested against field data collected through surveys and interviews in six parishes affected by the 2013–2014 winter floods. Fieldwork results were used to refine the index. The final index was verified using a paired t test against field data, giving a p‐value of .0248 (statistically significant at p ≤ .05). This index was also compared with a vulnerability index based on existing methodology and was found to provide additional insights.
Returning to the country of origin in later life: Longitudinal evidence from the German Socio‐Economic Panel
Authors: Cela Eralba , Bettin Giulia
Published: April 2018

Although migration literature has largely explored the determinants of the intention to return to the country of origin, older migrants have only more recently become the focus of scientific interest. Building on the literature related to return migration, well‐being and ageing, we investigate quantitatively the determinants of return intentions in later life. We draw on longitudinal data from the German Socio‐Economic Panel (GSOEP) for the period 1984–2013 to address the role of subjective and objective well‐being in shaping later‐life (im)mobility intentions. Our findings highlight the key role of different dimensions of well‐being (economic and psychological factors) whose effects on return intentions are greatly shaped by gender; men are more influenced by economic conditions than women, for whom more intimate and subjective considerations seem to play a major role. Satisfaction with life in Germany plays a major role in permanent settlement for both female and male migrants. Other factors related to integration and to the (transnational) family structure significantly affect the desire to return to the country of origin.
Rambling with(in) the Wairarapa: Revisioning arcadia through affective creativity
Authors: Ream Rebecca
Published: April 2018

Rambling with human and non‐human beings with(in) the Wairarapa for my doctoral fieldwork was both affecting and creative. This paper recounts that period and contends that, on reflection, an affective creativity helped me to address my central thesis argument, which is broadly about revisioning arcadia. From a New Zealand perspective, arcadia is usually framed as a picturesque rural paradise, often illustrated with peaceful grazing stock, lush green grass and snow‐tipped mountains. However, even though this view of arcadia appears simple, the visions and ideologies of New Zealand arcadianism are actually complicated narratives that are underpinned by hyper‐masculinity and white human‐centrism. Thus, my fieldwork intended to interrogate these ideas by carrying out research alongside ten Pākehā women who lived on the land in the Wairarapa. Theoretically infused with the more‐than‐human feminism of Val Plumwood, the notions of affect and the reflections of Donna Haraway, I designed an interview process that emphasised embodiment, sensuality and meaning by using a blend of sit‐down interviewing, ethnographic ventures, and photography. Driven by the philosophical tenets of feminism and more‐than‐human perspectives, I found that producing the idea of affective creativity intersected these theoretical strands rather fruitfully. This journey has not been without its problems though and I have needed to draw on multiple creative avenues outside of Geography so as to respect the more‐than‐human presences and participants’ voices within this project. Thus, this paper contributes to the field of Geography by contending that the use of affective creativity is an interesting way of expressing and intersecting more‐than‐human and feminist geographies.
The edge of two worlds: A new review and synthesis on Eurasian forest‐steppes
Authors: Erdős László , Ambarlı Didem , Anenkhonov Oleg A. , Bátori Zoltán , Cserhalmi Dániel , Kiss Márton , Kröel‐Dulay György , Liu Hongyan , Magnes Martin , Molnár Zsolt , Naqinezhad Alireza , Semenishchenkov Yury A. , Tölgyesi Csaba , Török Péter
Published: April 2018

Aims

Eurasian forest‐steppes are among the most complex non‐tropical terrestrial ecosystems. Despite their considerable scientific, ecological and economic importance, knowledge of forest‐steppes is limited, particularly at the continental scale. Here we provide an overview of Eurasian forest‐steppes across the entire zone: (a) we propose an up‐to‐date definition of forest‐steppes, (b) give a short physiogeographic outline, (c) delineate and briefly characterize the main forest‐steppe regions, (d) explore forest‐steppe biodiversity and conservation status, and (e) outline forest‐steppe prospects under predicted climate change.

Location

Eurasia (29°–56°N, 16°–139°E).

Results and Conclusions

Forest‐steppes are natural or near‐natural vegetation complexes of arboreal and herbaceous components (typically distributed in a mosaic pattern) in the temperate zone, where the co‐existence of forest and grassland is enabled primarily by the semi‐humid to semi‐arid climate, complemented by complex interactions of biotic and abiotic factors operating at multiple scales. This new definition includes lowland forest–grassland macromosaics (e.g. in Eastern Europe), exposure‐related mountain forest‐steppes (e.g. in Inner Asia), fine‐scale forest–grassland mosaics (e.g. in the Carpathian Basin) and open woodlands (e.g. in the Middle East). Using criteria of flora, physiognomy, relief and climate, nine main forest‐steppe regions are identified and characterized. Forest‐steppes are not simple two‐phase systems, as they show a high level of habitat diversity, with forest and grassland patches of varying types and sizes, connected by a network of differently oriented edges. Species diversity and functional diversity may also be exceptionally high in forest‐steppes. Regarding conservation, we conclude that major knowledge gaps exist in determining priorities at the continental, regional, national and local levels, and in identifying clear target states and optimal management strategies. When combined with other threats, climate change may be particularly dangerous to forest‐steppe survival, possibly resulting in compositional changes, rearrangement of the landscape mosaic or even the latitudinal or altitudinal shift of forest‐steppes.
Risk factors for Burkitt lymphoma: a nested case‐control study in the UK Clinical Practice Research Datalink
Authors: Karimi Parisa , Birmann Brenda M. , Anderson Lesley A. , McShane Charlene M. , Gadalla Shahinaz M. , Sampson Joshua N. , Mbulaiteye Sam M.
Published: April 2018

Burkitt lymphoma (BL) occurs as three subtypes: endemic BL, immunosuppression‐related BL and sporadic BL. Descriptive studies of BL age‐specific incidence patterns have suggested multimodal peaks near 10, 40 and 70 years of age, but the risk factors for BL at different ages are unknown. We investigated risk factors for BL in the United Kingdom among 156 BL cases and 608 matched BL‐free controls identified in the Clinical Practice Research Datalink (CPRD) between 1992 and 2016. Associations with pre‐diagnostic body mass index, cigarette smoking, alcohol consumption, hepatitis, Epstein–Barr virus (EBV), human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), malaria, allergic and autoimmune conditions, and prednisone use were evaluated. Overall, we identified inverse associations between smoking and BL risk, and positive associations between prior EBV infection, HIV/AIDS and prescription or use of prednisone with BL risk. In age‐group stratified analyses, BL was associated with malaria exposure (vs. no exposure, odds ratio [OR] 8·00, 95% confidence interval [CI] 1·46–43·7) among those aged 20–59 years old and with hepatitis infection (vs. no infection, OR 3·41, 95% CI 1·01–11·5) among those aged 60+ years old. The effects of EBV, malaria, HIV/AIDS, prednisone and hepatitis on BL remained significant in mutually‐adjusted age‐group‐specific analyses. No risk factors were associated with childhood BL. We report novel associations for BL in non‐endemic settings.
Cardiac manifestations in sickle cell disease varies with patient genotype
Authors: Guedeney Paul , Lionnet François , Ceccaldi Alexandre , Stankovic Stojanovic Katia , Cohen Ariel , Mattioni Sarah , Montalescot Gilles , Bachmeyer Claude , Isnard Richard , Haymann Jean‐Philippe , Hammoudi Nadjib
Published: April 2018

Cardiac involvement is well characterized in sickle cell anaemia (SCA) but cardiac features associated with Haemoglobin SC (HbSC) disease are mostly unknown. We compared 60 patients with HbSC disease (median age 31 years, 25 men) to 60 SCA patients and 60 controls matched for age and gender. Left ventricular ejection fraction (LVEF), left ventricle (LV) mass index (LVMi), cardiac index and peak tricuspid regurgitation velocity (TRV) were measured using echocardiography. LV filling pressures were assessed using the ratio of early diastolic transmitral velocity to tissue velocity (E/e’ ratio). The LVMi was higher in both genotypes compared to controls. However, whereas LV hypertrophy was observed only in 3(5%) HbSC patients, this condition was diagnosed in 27(45%) SCA patients (P < 0·0001). While cardiac index and TRV were similar in HbSC compared to controls, SCA patients exhibited elevated cardiac output and TRV. LVEF was similar in the 3 groups. However, both genotypes had a higher E/e’ ratio compared to controls. Cardiac involvement in SCA was related to anaemia and haemolysis, while LV diastolic dysfunction and TRV in HbSC disease patients were related to arterial hypertension and overweight comorbidities. In summary, cardiac involvement and its determinants are different in HbSC disease and SCA. Patient's genotype should be considered with regard to the echocardiographic indications and findings.
The Enlightenment of Evidence and the Leap in the Dark
Authors: Oelsner Robert
Published: April 2018

This article is a free inspiration following R.D. Hinshelwood's ‘Intuition from beginning to end?’. The author tries to show Bion's Kleinian skill to listen to every detail of the clinical hour, picking up clues and putting them together to render meanings and presenting them to the patient. While doing so, Bion created a richness of concepts for analysts to try out as tools for observation and understanding of their patients’ mental functioning. Several of these concepts along with the clinical inspirations are described here. The author believes, therefore, that even during his ‘loyalty to Klein’ period, Bion was also extremely creative though inspired by Klein. When it comes to intuition, the author prefers to be modest, listen to the patient's free associations and allow intuitions to mate with concepts before getting back to the patient.
Introduction to a Comparative Assessment of W.R. Bion and D.W. Winnicott's Clinical Theories
Authors: Aguayo Joseph , Lundgren John
Published: April 2018

An Anglo‐American group of analysts recently dialogued on the theoretical differences in the work of W.R. Bion and D.W. Winnicott. This group heard keynote papers (Hinshelwood and Caldwell) that surveyed the work of Bion and Winnicott, which were commented upon (Oelsner and Goldberg). Preceding this event was an all‐day, Tavistock Group Relations Conference, in which half of the attendees (N=35) participated in varying group experiences that focused on the analysts’ ‘group selves’ as a needed fourth leg to their traditional tri‐partite training. In this regard, the implicit authority structure of having British analysts give keynote papers to a group of American analysts came under examination. The organizers of the Regional Bion Symposium (Aguayo and Lundgren) both introduced this work, then compared some of Bion and Winnicott's key differences: these findings both verged towards and away from each other. While both theorists moved the psychoanalytic ‘internal world’ paradigms of Freud and Klein in an intersubjective direction, each did so in a distinctive way. Lastly, the conference organizers comment on how the structure underlied the freedom of attendees to articulate diverse views in the context of the analyst's individual and group identity.
β‐arrestin1‐medieated inhibition of FOXO3a contributes to prostate cancer cell growth in vitro and in vivo
Authors: Kong Zhenzhen , Deng Tuo , Zhang Mengping , Zhao Zhijian , Liu Yang , Luo Lianmin , Cai Chao , Wu Wenqi , Duan Xiaolu
Published: April 2018

Recently, β‐arrestin1 has been indicated as a prostate cancer promoter through promoting cell proliferation and epithelial to mesenchymal transition, but its underlying mechanism remains unclear. Here, our data revealed that β‐arrestin1 could promote cell growth through inhibiting the transcriptional activity and expression of FOXO3a in prostate cancer cells in vitro and in vivo. We found that β‐arrestin1 could promote the cell and tumor growth of prostate cancer, and β‐arrestin1 expression represented a negative correlation with FOXO3a expression but not FOXO1 expression in prostate cancer cell lines and tissues. In addition, forced expression of β‐arrestin1 induced a significant decrease of FOXO3a expression but had no clear effect on FOXO1 expression. Mechanistically, β‐arrestin1 could interact with FOXO3a and MDM2, respectively, and promote the interaction between FOXO3a and MDM2, whereas it had no obvious interaction with FOXO1. Furthermore, β‐arrestin1 could inhibit the transcriptional activity of FOXO3a via Akt and ERK1/2 pathways. Together, our results revealed a novel mechanism for β‐arrestin1 in the regulation of the prostate cancer procession through inhibiting FOXO3a.
Efficacy studies of Sclerotium rolfsii lectin on breast cancer using NOD SCID mouse model
Authors: Hegde Prajna , Narasimhappagari Jagadeesh , Swamy Bale M. , Inamdar Shashikala R.
Published: April 2018

Expression of altered glycans such as TF, Tn, and sTn antigens has been observed in a number of carcinomas which are targeted in cancer therapy. Sclerotium rolfsii lectin (SRL) is known to recognize TF and its substituted forms. Clinical potential of SRL has been demonstrated by studying its interaction with different types of cancer cells. Here we report, in vitro studies of SRL on breast cancer MDA‐MB‐468 cells and in vivo studies with MCF‐7 xenografts. In vitro growth inhibitory studies of SRL on metastatic triple negative breast cancer MDA‐MB‐468 cells were performed by MTT assay, flow cytometry, adhesion, and CAM assay. In vivo efficacy studies of SRL were performed using NOD SCID mice bearing MCF‐7 xenografts. SRL has strong binding to MDA‐MB‐468 cells with MFI of 85.5 and has growth inhibitory effect with IC50 of 32 μg/ml at 48 hr. SRL has antiangiogenesis effect and also anti adhesive effect with fibronectin and collagen at 20 μg/ml by 36% and 42%, respectively. In vivo efficacy studies of SRL on NOD SCID mice bearing MCF‐7 xenogratfs revealed 61.77% and 75.71% tumor regressing effect, respectively, at 20 and 30 mg/kg body weight without any toxicity. All these results substantiate clinical potential of SRL on breast cancer.
Indirect co-cultures of healthy mesenchymal stem cells restore the physiological phenotypical profile of psoriatic mesenchymal stem cells
Authors: Campanati A , Orciani M , Sorgentoni G , Consales V , Mattioli Belmonte M , Di Primio R , Offidani A
Published: April 2018

Psoriasis microenvironment, characterized by an imbalance between T helper type 1 (Th1)/Th17 and Th2 cytokines and also influences the mesenchymal stem cells (MSCs) phenotypical profile. MSCs from healthy donors (H-MSCs) can exert a strong paracrine effect by secreting active soluble factors, able to modulate the inflammation in the microenvironment. To evaluate the influence of H-MSCs on MSCs from psoriatic patients (PsO-MSCs), H-MSCs and PsO-MSCs were isolated and characterized. Indirect co-culture of H-MSCs with PsO-MSCs was performed; effects on proliferation and expression of cytokines linked to Th1/Th17 and Th2 pathways were assayed before and after co-culture. The results show that before co-culture, proliferation of PsO-MSCs was significantly higher than H-MSCs (P < 0·05) and the levels of secreted cytokines confirmed the imbalance of Th1/Th17 versus the Th2 axis. After co-culture of H-MSCs with PsO-MSCs, healthy MSCs seem to exert a ‘positive’ influence on PsO-MSCs, driving the inflammatory phenotypical profile of PsO-MSCs towards a physiological pattern. The proliferation rate decreased towards values nearer to those observed in H-MSCs and the secretion of the cytokines that mostly identified the inflammatory microenvironment that characterized psoriasis, such as interleukin (IL)-6, IL-12, IL-13, IL-17A, tumour necrosis factor (TNF)-α and granulocyte–macrophage colony-stimulating factor (G-CSF), is significantly lower in co-cultured PsO-MSCs than in individually cultured PSO-MSCs (P at least < 0·05). In conclusion, our preliminary results seem to provide an intriguing molecular explanation for the ever-increasing evidence of therapeutic efficacy of allogeneic MSCs infusion in psoriatic patients.
Further audiovestibular characterization of DFNB77, caused by deleterious variants in LOXHD1, and investigation into the involvement of Fuchs corneal dystrophy
Authors: Wesdorp M. , Schreur V. , Beynon A.J. , Oostrik J. , van de Kamp J.M. , Elting M.W. , van den Boogaard M.‐J.H. , Feenstra I. , Admiraal R.J.C. , Kunst H.P.M. , Hoyng C.B. , Kremer H. , Yntema H.G. , Pennings R.J.E. , Schraders M.
Published: April 2018

This study focuses on further characterization of the audiovestibular phenotype and on genotype‐phenotype correlations of DFNB77, an autosomal recessive type of hearing impairment (HI). DFNB77 is associated with disease‐causing variants in LOXHD1, and is genetically and phenotypically highly heterogeneous. Heterozygous deleterious missense variants in LOXHD1 have been associated with late‐onset Fuchs corneal dystrophy (FCD). However, up to now screening for FCD of heterozygous carriers in DFNB77 families has not been reported. This study describes the genotype and audiovestibular phenotype of 9 families with DFNB77. In addition, carriers within the families were screened for FCD. Fifteen pathogenic missense and truncating variants were identified, of which 12 were novel. The hearing phenotype showed high inter‐ and intrafamilial variation in severity and progression. There was no evidence for involvement of the vestibular system. None of the carriers showed (pre‐clinical) symptoms of FCD. Our findings expand the genotypic and phenotypic spectrum of DFNB77, but a clear correlation between the type or location of the variant and the severity or progression of HI could not be established. We hypothesize that environmental factors or genetic modifiers are responsible for phenotypic differences. No association was found between heterozygous LOXHD1 variants and the occurrence of FCD in carriers.
An alternative technique of arterial anastomosis in mouse heart transplantation
Authors: Cui Deli , Tan Changjun , Liu Zhong
Published: April 2018

Objective

To investigate the characters and feasibility of continuous‐interrupted suture (CIS) method for arterial anastomosis in mouse heart transplantation (MHT).

Methods

A MHT model was adopted. End‐to‐end anastomosis of donor ascending aorta to recipient abdominal aorta was achieved by CIS or continuous suture (CS) method. In both groups, end‐to‐end anastomosis of pulmonary vein to inferior vena cava (IVC) was achieved by CS. Technical indexes and histological examination were analyzed between 2 groups.

Results

The total operative time in CIS group was 92.83 ± 2.13 minutes, and in CS group was 92.40 ± 3.85 minutes. In CS group, artery anastomosis time was 20.13 ± 1.89 minutes; in CIS group, it was 20.36 ± 1.09 minutes. Additionally, venous anastomosis time in CS group was 14.80 ± 0.84 minutes, and in CIS group was 15.03 ± 0.85 minutes. Operation success rate in CIS group was 100%, and in CS group was 80%. There were no significant histological findings differences in graft between 2 groups. However, cell arrangement of anastomosis site was lightly irregular and the vascular alignment was poor in CS group. In CIS group, cell arrangement of anastomosis site was well arranged and vessels were well aligned.

Conclusions

CIS method could avoid arterial anastomosis‐related complications induced by CS and improve the success rate.
Value of additional endoscopic ultrasonography for surveillance after surgical removal of intraductal papillary mucinous neoplasms
Authors: Kamata Ken , Takenaka Mamoru , Minaga Kosuke , Omoto Shunsuke , Miyata Takeshi , Yamao Kentaro , Imai Hajime , Nakai Atsushi , Tanaka Hidekazu , Chiba Yasutaka , Watanabe Tomohiro , Sakurai Toshiharu , Nishida Naoshi , Chikugo Takaaki , Matsumoto Ippei , Takeyama Yoshifumi , Kitano Masayuki , Kudo Masatoshi
Published: April 2018

Background and Aim

This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast‐enhanced harmonic EUS (CH‐EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN).

Methods

This was a single‐center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN‐concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated.

Results

Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast‐enhanced computed tomography (CE‐CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra‐pancreatic recurrence and eight with extra‐pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE‐CT. Two patients developed IPMN‐concomitant PDAC during follow up. EUS combined with CH‐EUS successfully detected small IPMN‐concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH‐EUS was useful for better visualization of the margins of IPMN‐concomitant PDAC in one of these two patients.

Conclusion

Endoscopic ultrasonography combined with CH‐EUS may improve follow up of patients with resected IPMN.
Anticoagulation in the management of neonatal cerebral sinovenous thrombosis: a systematic review and meta‐analysis
Authors: Rossor Thomas , Arichi Tomoki , Bhate Sanjay , Hart Anthony R , Raman Singh Rahul
Published: April 2018

Aim

To determine whether anticoagulation therapy (ACT) in the treatment of neonatal cerebral sinovenous thrombosis (CSVT) improves outcomes, in the presence or absence of pre‐existing intracerebral haemorrhage (ICH).

Method

We searched CENTRAL, MEDLINE, Embase, CINAHL, the Web of Science, and clinical trial databases. We considered data from retrospective and prospective cohort studies, case series, and randomized controlled studies evaluating outcomes of CSVT treated with anticoagulation or no anticoagulation. Studies were included if they involved infants either younger than 28 days of age or younger than 44 weeks postmenstrual age at the time of diagnosis of CSVT in which ACT was considered.

Results

Seven non‐randomized studies were included in meta‐analysis. ACT had no significant effect on mortality before discharge either in the presence or absence of pre‐existing ICH, nor on the incidence of extension of pre‐existing ICH. ACT was associated with a reduced risk of propagation of thrombus (risk ratio 0.14, 95% confidence interval 0.03–0.72).

Interpretation

There are no randomized trials assessing the safety and efficacy of ACT in the treatment of neonatal CSVT. The results of this meta‐analysis would justify a position of equipoise and support the need for well‐designed randomized controlled trials of ACT in this population.

What this paper adds

No randomized studies have evaluated anticoagulation therapy (ACT) in neonatal cerebral sinovenous thrombosis.

ACT may reduce thrombus propagation.

No evidence of increased morbidity or mortality with ACT was demonstrated.

A position of equipoise is justified, supporting the need for placebo‐controlled randomized trials.
Neonatal cerebral sinovenous thrombosis: the anticoagulation debate
Authors: Kouzmitcheva Elizabeth , Moharir Mahendranath
Published: April 2018

This commentary is on the systematic review by Rossor et al. on pages 884–891 of this issue.
Evaluation of the left atrial appendage by real time three‐dimensional transesophageal echocardiography online
Authors: Zhang Juan , Cui Cun‐Ying , Huang Dan‐Qing , Liu Yuan‐Yuan , Qin Yun‐Yun , Zhang Lian‐Zhong , Liu Lin
Published: April 2018

Objective

The objective of this study was to evaluate the feasibility of online real time three‐dimensional transesophageal echocardiography (RT3DTEE) in the measurement of left atrial appendage (LAA) orifice size. We also analyzed the correlation between LAA ejection fraction (EF) and its peak empty velocity (PEV).

Methods

There were 91 subjects enrolled in this study, with 46 patients with AF and 45 individuals with sinus rhythm (SR). RT3DTEE was performed by four methods including iSlice and iCrop online and QLAB software 3DQ and GI‐3DQ off‐line which were used to measure LAA orifice area, long diameter, short diameter, depth in the largest LAA, and number of LAA lobes. These LAA parameters achieved by the four methods were compared, respectively. GI‐3DQ off‐line was used to measure LAA end‐diastolic and end‐systolic volumes to calculate EF of LAA. Two‐dimensional (2D) TEE was applied to measure PEV of LAA. The correlation between EF and PEV was analyzed.

Results

There were no significant differences in all LAA parameters between any two RT3DTEE methods (All P > .05). There was a significant and positive correlation between PEV and EF (r = .423, P = .000). There were statistical differences in LAA EF and PEV between patients with AF and SR individuals (0.38 ± 0.12 vs 0.61 ± 0.07, 35.7 ± 12.1 vs 49.5 ± 10.0 cm/s, P = .000).

Conclusion

Using online RT3DTEE for measuring LAA orifice size is feasible, and online RT3DTEE is more convenient than offline RT3DTEE. EF is positively correlated with PEV. LAA function is significantly decreased in patients with AF.
Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis
Authors: Kobayashi Sayuki , Utsunomiya Hiroto , Shiota Takahiro
Published: April 2018

Background

In aortic valve stenosis (AS), congestive heart failure (CHF) is a well‐established symptom that indicates the need for surgical aortic valve replacement (SAVR). However, it is difficult to judge whether CHF symptoms such as dyspnea are caused by severe AS or other conditions, especially in elderly persons with restricted mobility or other organ complications. It is important to identify objective and noninvasive parameters associated with severe CHF symptoms in severe AS.

Methods

One hundred ninety‐eight patients with severe AS without left ventricular (LV) dysfunction were retrospectively studied. CHF symptoms were classified by New York Heart Association (NYHA) functional class. Echo parameters were compared between NYHA I–III and NYHA IV.

Results

Patients with NYHA IV (n = 40; 20%) were older (86 ± 6 vs 82 ± 8 years; P = .001) and had a larger LV mass index (LVMI) (157 ± 43 vs 114 ± 34 g/m2, P < .001), a higher transmitral flow velocity ratio (E/A) (1.31 ± 0.62 vs 0.93 ± 0.42; P = .001), a shorter deceleration time (DT) (202 ± 72 vs 286 ± 98 ms; P < .001), and a higher systolic pulmonary arterial pressure (SPAP) (44 ± 13 vs 35 ± 13 mm Hg; P < .001) than patients with NYHA I–III. On multivariable analysis, LVMI and DT were independently associated with NYHA IV. Receiver operating characteristic curve analysis identified LVMI ≥ 142 g/m2 and DT ≤ 194 ms as the cutoff values associated with NYHA IV in patients with severe AS.

Conclusion

Left ventricular mass index and DT were independently associated with severe heart failure (NYHA IV). These echo parameters could be helpful to judge whether CHF symptoms are caused by severe AS.