bluuebunny/crossref_metadata_2025 huggingface dataset:
The Preparation of Hyaluronic Acid Nanoparticles from Aspicilia lichens Using Bifido Bacteria for Help in the Treatment of Diabetes in Rats In Vivo
Authors: Esmaeili Akbar , Rajaee Shirin
Published: August 2017

Many common herbs and spices are claimed to have blood sugar lowering properties that make them useful for people with or at high risk of diabetes. The main of compounds of kiwifruit (Actinidia deliciosa), rhubarb (Rheum ribes), membrane inner of egg shell, wool of sheep, human fingernail (unguis), hyaluronic acid produced by the Bifidobacterium, and usnic acid of Aspicilia lichen were extracted by different methods. All compounds of the extract were divided into five groups. We used variables such as pH, different compounds, concentration, number of injections, and blood glucose monitoring in different situations. Our study, extracts changed to nanoform. The extract compounds and nanoparticles were analyzed by gas chromatography mass spectroscopy, Fourier transform infrared spectroscopy, hydrogen‐1 nuclear magnetic resonance, and scanning electron microscope. The average size of the nanoparticles was found to be 55 nm. Five groups of nanoparticles were injected into rats, and they reduced their blood glucose levels significantly (statistical significance was declared at p < 0.05). The synthesized hyaluronic acid helped to treat diabetes in rats. Copyright © 2017 John Wiley & Sons, Ltd.
Performance of Met Office hourly cycling NWP‐based nowcasting for precipitation forecasts
Authors: Simonin David , Pierce Clive , Roberts Nigel , Ballard Susan P. , Li Zhihong
Published: August 2017

The Met Office developed a prototype high‐resolution, hourly‐cycling NWP forecasting system using four‐dimensional variational data assimilation, covering the southern half of England. This system was known as the Met Office Nowcasting Demonstration Project (NDP), and ran in real time from June 2012 to March 2013 (covering the period of the London 2012 Olympics and Paralympic Games). It was principally developed to assess the abilities of a frequently updated NWP‐based nowcasting system to forecast precipitation at short range such as convective storms for flood forecasting.

This article provides a comprehensive assessment of the precipitation forecast skill of the NDP and its comparison against the Met Office operational nowcasting system. It was found that the NWP‐based nowcasting system becomes more skilful than an advanced extrapolation‐based nowcasting system from T + 1.5 to T + 2 h depending on weather type.
Prominent enhancing effects of substituents on the strength of π···σ‐hole tetrel bond
Authors: Wei Yuan‐Xin , Li Hai‐Bei , Cheng Jian‐Bo , Li Wen‐Zuo , Li Qing‐Zhong
Published: August 2017

The potential applications of tetrel bonds involving π‐molecules in crystal materials and biological systems have prompted a theoretical investigation of the strength of π···σ‐hole tetrel bond in the systems with acetylene and its derivatives of CH3, AuPH3, Li, and Na as well as benzene as the π electron donors. A weak tetrel bond (ΔE < 15 kJ/mol) is found between acetylene and tetrel donor molecule TH3F (T = C, Si, Ge, Sn, and Pb). All substituents strengthen the π tetrel bond, but the electron‐donating sodium atoms have the largest enhancing effect and the interaction energy is up to about 24 kJ/mol in C2Na2‐CH3F. The electron‐donating ability of the AuPH3fragment is intermediate between the methyl group and alkali metal atom. The origin of the stability of the π tetrel‐bonded complex is dependent on the nature of the tetrel donor and acceptor molecules and can be regulated by the substituents.
Combined plane wave and localized orbital electronic structure calculation: Adsorption energy of hydrogen on Pd(111)
Authors: Ishimoto Takayoshi , Kai Hiroyuki
Published: August 2017

To achieve the necessary accuracy when calculating the electronic structures of materials, for example, for surface or bulk models, we propose a combined plane wave (PW) and localized orbital (LO) electronic structure calculation approach. A high level theory calculation based on the LO approach can be used to describe chemical reactions and other electronic processes using a cluster model. Conversely, the electronic structure of a surface or bulk model is best calculated using a PW approach. In this study, we analyzed the potential energy surface of a hydrogen atom adsorption on a Pd(111) surface using our proposed combined PW and LO approach. We clearly demonstrate that the combined PW and LO approach is both effective and necessary to determine local surface phenomena. We expect that the proposed approach will be effective for a broad range of applications in the material science field.
Uterus transplantation: Toward clinical application in Japan
Authors: Suganuma Nobuhiko , Hayashi Ayako , Kisu Iori , Banno Kouji , Hara Hisako , Mihara Makoto
Published: August 2017

Background

In recent years, uterus transplantation (UTx) has been applied as the treatment for patients with uterine factor infertility worldwide. Thus, the clinical application of UTx in Japan should be considered through both the history of UTx technology development in the world and future prospects.

Methods

Recent information on UTx was collected via a literature survey and the Internet.

Results

Basic research using various animals has been done mainly since 2000. In 2014, the world's first UTx baby was born in Sweden. In total, 24 UTx procedures have been performed at 10 institutes in nine countries and five births were obtained (as of May, 2017). In Japan, the “Project Team for Uterus Transplantation” initiated UTx experiments in 2008 and the “Japan Society for Uterus Transplantation” was organized in March, 2014. In the rest of the world, the “International Society for Uterus Transplantation” was established in January, 2016.

Conclusion

Uterus transplantation is still under development as a reproductive medicine tool and organ transplant procedure. A collaborative system that is not limited by facilities and specialties should strive to build an “all‐Japan” team.
Wonder as a tool to engage preservice elementary teachers in science learning and teaching
Authors: Gilbert Andrew , Byers Christie C.
Published: August 2017

This exploratory project considers the use ofwonderas a pedagogical tool with preservice elementary teachers (PSETs). An ongoing vexation facing science teacher educators is helping future elementary teachers overcome anxiety and negative associations with science due to their own school science experiences, while simultaneously encouraging innovative and ambitious teaching practice. Utilizing wonder as a pedagogical tool for emotional and aesthetic engagement with science holds promise as an entry point to connect future teachers with meaningful science content and practice. The link between wonder and science is well‐articulated by successful scientists throughout history, and yet is rarely employed explicitly within elementary or teacher education science learning contexts. Forging a pedagogy of wonder demands connection to the emotive embodiment of science as a uniquely human process that nurtures our intense need to know. This qualitative case study is an effort to better understand if utilizing pedagogy intentionally focused on wonder could impact PSETs’ perceptions of science and scientific thinking. This paper describes the key findings that emerged while utilizing pedagogy steeped in wonder with PSETs, and the degree to which engaging with wonder impacted their perceptions of science and their future science teaching. This research supports the critical role that wonder could play in changing PSETs’ relationship with science and assisting them in the development of the pedagogical courage necessary to envision possibilities beyond their past experiences.
Identifiability and estimation of causal mediation effects with missing data
Authors: Li Wei , Zhou Xiao‐Hua
Published: August 2017

Mediation analysis is a standard approach to understanding how and why an intervention works in social and medical sciences. However, the presence of missing data, especially missing not at random data, poses a great challenge for the applicability of this approach in practice. Current methods for handling such missingness are still lacking in causal mediation analysis. In this article, we first show the identifiability of causal mediation effects with different types of missing outcomes under different missingness mechanisms. We then provide corresponding approaches for estimation and inference. Especially for missing not at random data, we develop an estimating equation–based approach to estimate causal mediation effects, which can easily handle different types of mediators and outcomes, and we also establish the asymptotic results of the estimators. Simulation results show good performance for the proposed estimators in finite samples. Finally, we use a real data set from the Clinical Antipsychotic Trials of Intervention Effectiveness Research for Alzheimer disease to illustrate our approach.
Lerner aktivierende Lernformen für Bauingenieure – Beispiele für den Einsatz digitaler Medien in der universitären Lehre
Authors: Rädel Felicitas , Lange Jörg
Published: August 2017

Frau Univ.‐Prof. Dr.‐Ing. Ulrike Kuhlmann zur Vollendung ihres 60. Lebensjahres gewidmet

Die Digitalisierung der (Hochschul‐)Lehre ist seit mehreren Jahren ein auf vielen Ebenen diskutiertes Thema. Es existieren sehr viele verschiedene Ansätze, die sich auch unterschiedlich stark auf den Lehrbetrieb auswirken. Gleichzeitig wird politisch eine immer stärkere Kompetenzorientierung der Studiengänge gefordert. Am Fachgebiet Stahlbau der TU Darmstadt kommen digitale Medien seit einigen Jahren auf unterschiedliche Weise zum Einsatz. Im folgenden Artikel werden mehrere Varianten vorgestellt. Basis all dieser Lehrkonzepte ist der Gedanke, die Lernenden im Rahmen der Lehrveranstaltung stärker zu aktivieren und dadurch zu einer besseren Lernleistung beizutragen.
Zum Sprödbruch alter Baustähle
Authors: Sieber Lars , Stroetmann Richard
Published: August 2017

Frau Univ.‐Prof. Dr.‐Ing. Ulrike Kuhlmann zur Vollendung ihres 60. Lebensjahres gewidmet

Bei der Beurteilung der Sicherheit bestehender Konstruktionen aus Flussstahl und der Entscheidung über notwendige Instandsetzungs‐ und Verstärkungsmaßnahmen ist der Nachweis ausreichender Werkstoffzähigkeit von wesentlicher Bedeutung. Die in DIN EN 1993‐1‐10 [1] geregelten Nachweise zur Beurteilung der Sprödbruchgefährdung wurden auf der Grundlage umfangreicher bruchmechanischer Untersuchungen entwickelt. Die Festlegung zulässiger Erzeugnisdicken für bestimmte Stahlsorten und Gütegruppen wurde für Schweißkonstruktionen aus Stählen nach DIN EN 10025 mit überwiegend hohen Zähigkeitswerten abgeleitet und in [1] tabelliert. Dieses vereinfachte Verfahren ist für alte Flussstahlkonstruktionen mit Lochschwächungen durch Niet‐ und Schraubenverbindungen nicht geeignet (vgl. [40]). In diesem Beitrag werden experimentelle und rechnerische Untersuchungen zum Sprödbruchverhalten gelochter Bauteile aus alten Flussstählen vorgestellt, die im Rahmen verschiedener Forschungsvorhaben am Institut für Stahl‐ und Holzbau der TU Dresden und dessen Kooperationspartnern durchgeführt wurden (z. B. [2]). Im Teil 2 werden mechanische und metallografische Untersuchungen im Bereich gestanzter Löcher und gescherter Bauteilkanten beschrieben, deren Ergebnisse für das Anrissverhalten quasi‐statisch beanspruchter Bauteile von Bedeutung sind. Nach einer kurzen Einführung in Grundlagen zum bruchmechanischen Nachweis werden analytische Modelle zur Bestimmung des Spannungsintensitätsfaktors KI an Rissen angegeben und auf die speziellen Belange von Anschlüssen mit Lasteinleitungen über Niete und Schrauben angepasst. Auf der Basis umfangreicher Parameterstudien durch FEM‐Berechnungen an Winkelprofilen mit unterschiedlichen Querschnitten und Anschlusskonfigurationen erfolgt eine Anpassung der K‐Faktor‐Lösungen. Es folgen Beispiele zur Bewertung der Sprödbruchgefährdung unter Ansatz der Werkstoffzähigkeit aus Teil 1 des Beitrags [40].
Entwurf der Talbrücke Rinsdorf
Authors: Hanswille Gerhard , Schubart Ralf
Published: August 2017

Frau Univ.‐Prof. Dr.‐Ing. Ulrike Kuhlmann zur Vollendung ihres 60. Lebensjahres gewidmet

Im Zuge der Erneuerung und des Ausbaus der A45 von Dortmund nach Frankfurt/M. werden eine Vielzahl von neuen Talbrücken in Verbundbauweise errichtet. Dabei sollen bevorzugt Kastenquerschnitte mit äußeren Längsträgern, die durch Diagonalen unterstützt werden, ausgeführt werden. Die Talbrücke Rinsdorf ist ein typisches Beispiel für diese Querschnittsform. Da die äußeren Diagonalen und insbesondere deren Anschlüsse sehr hohen ermüdungswirksamen Beanspruchungen ausgesetzt werden, wurden für die Talbrücke Rinsdorf umfangreiche experimentelle Untersuchungen durchgeführt, auf deren Grundlage eine realistische Abschätzung der Lebensdauer erfolgen kann. Es wird über die Entwurfsbearbeitung und die durchgeführten experimentellen Untersuchungen zur Ermüdungsfestigkeit der Diagonalenanschlüsse berichtet.
Reprogramming Antagonizes the Oncogenicity of HOXA13-Long Noncoding RNA HOTTIP Axis in Gastric Cancer Cells
Authors: Wu Deng-Chyang , Wang Sophie S.W. , Liu Chung-Jung , Wuputra Kenly , Kato Kohsuke , Lee Yen-Liang , Lin Ying-Chu , Tsai Ming-Ho , Ku Chia-Chen , Lin Wen-Hsin , Wang Shin-Wei , Kishikawa Shotaro , Noguchi Michiya , Wu Chu-Chieh , Chen Yi-Ting , Chai Chee-Yin , Lin Chen-Lung Steve , Kuo Kung-Kai , Yang Ya-Han , Miyoshi Hiroyuki , Nakamura Yukio , Saito Shigeo , Nagata Kyosuke , Lin Chang-Shen , Yokoyama Kazunari K.
Published: August 2017

Reprogramming of cancer cells into induced pluripotent stem cells (iPSCs) is a compelling idea for inhibiting oncogenesis, especially through modulation of homeobox proteins in this reprogramming process. We examined the role of various long noncoding RNAs (lncRNAs)-homeobox protein HOXA13 axis on the switching of the oncogenic function of bone morphogenetic protein 7 (BMP7), which is significantly lost in the gastric cancer cell derived iPS-like cells (iPSLCs). BMP7 promoter activation occurred through the corecruitment of HOXA13, mixed-lineage leukemia 1 lysine N-methyltransferase, WD repeat-containing protein 5, and lncRNA HoxA transcript at the distal tip (HOTTIP) to commit the epigenetic changes to the trimethylation of lysine 4 on histone H3 in cancer cells. By contrast, HOXA13 inhibited BMP7 expression in iPSLCs via the corecruitment of HOXA13, enhancer of zeste homolog 2, Jumonji and AT rich interactive domain 2, and lncRNA HoxA transcript antisense RNA (HOTAIR) to various cis-element of the BMP7 promoter. Knockdown experiments demonstrated that HOTTIP contributed positively, but HOTAIR regulated negatively to HOXA13-mediated BMP7 expression in cancer cells and iPSLCs, respectively. These findings indicate that the recruitment of HOXA13–HOTTIP and HOXA13–HOTAIR to different sites in the BMP7 promoter is crucial for the oncogenic fate of human gastric cells. Reprogramming with octamer-binding protein 4 and Jun dimerization protein 2 can inhibit tumorigenesis by switching off BMP7.
Re: Descriptive analysis of different phenotypes of cardiac remodeling in fetal growth restriction. M. Rodríguez‐López, M. Cruz‐Lemini, B. Valenzuela‐Alcaraz, L. Garcia‐Otero, M. Sitges, B. Bijnens, E. Gratacós and F. Crispi. Ultrasound Obstet Gynecol 2017; 50: 207–214.
Authors: Van Mieghem T.
Published: August 2017

Linked Comment: Ultrasound Obstet Gynecol 2017; 50: 207–214
Influence of gestational diabetes on fetal autonomic nervous system: a study using phase‐rectified signal‐averaging analysis
Authors: Lobmaier S. M. , Ortiz J. U. , Sewald M. , Müller A. , Schmidt G. , Haller B. , Oberhoffer R. , Schneider K. T. M. , Giussani D. A. , Wacker‐Gussmann A.
Published: August 2017

Objectives

Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase‐rectified signal averaging (PRSA) is an innovative signal‐processing technique that can be used to investigate fetal heart signals. The PRSA‐calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA.

Methods

This was a prospective clinical case–control study of 58 mothers with diagnosed GDM and 58 gestational‐age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow‐up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short‐term variation (STV) by CTG software according to Dawes–Redman criteria.

Results

Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry.

Conclusions

Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Postmortem examination of human fetuses: comparison of two‐dimensional ultrasound with invasive autopsy
Authors: Kang X. , Shelmerdine S. C. , Hurtado I. , Bevilacqua E. , Hutchinson C. , Mandalia U. , Segers V. , Cos Sanchez T. , Cannie M. M. , Carlin A. , Sebire N. J. , Arthurs O. J. , Jani J. C.
Published: August 2017

Objective

To assess the diagnostic accuracy of postmortem ultrasound performed by operators blinded to prenatal findings and to invasive autopsy results in fetuses at different gestational ages and to investigate the effect of various parameters on its diagnostic success.

Methods

We performed postmortem two‐dimensional ultrasound examination, blinded to clinical details, on 163 fetuses at 13–42 weeks' gestation. Logistic regression analysis was used to investigate the effect of: (i) gestational age at postmortem ultrasound, (ii) presence of maceration and (iii) mode of death, on whether the exam succeeded or failed to reach a diagnosis. In 123 cases in which invasive autopsy was available, the diagnostic accuracy of ultrasound in detecting major organ abnormalities was evaluated, using invasive autopsy as the gold standard.

Results

For the fetal brain, postmortem ultrasound exam was non‐diagnostic in significantly more fetuses with maceration (39.5%; 17/43) vs those without maceration (20.0%; 24/120) (P = 0.013). For the fetal thorax, the exam was non‐diagnostic in 34.1% (15/44) of fetuses < 20 weeks of gestation and in 10.9% (13/119) of fetuses ≥ 20 weeks (P < 0.001). For the heart and abdominal organs, there was no association between non‐diagnostic postmortem ultrasound and the variables tested. For fetuses < 20 weeks, specificity of postmortem ultrasound examination was 83.3% for detection of anomalies of the brain, 68.6% for the thorax and 77.4% for the heart. For fetuses ≥ 20 weeks, sensitivity and specificity were, respectively, 61.9% and 74.2% for detection of anomalies of the brain, 29.5% and 87.0% for the thorax and 65.0% and 83.1% for the heart. For the fetal abdominal organs, sensitivity was 60.7% and specificity 75.8%, and postmortem ultrasound was particularly useful for detection of abnormalities of the kidneys, irrespective of gestational age.

Conclusion

Although maceration may lead to failure of postmortem ultrasound examination in some cases, this technique achieves diagnostically acceptable levels of accuracy for fetal brain and abdominal organs, compared with conventional autopsy. It may therefore play a role as a first‐line examination before other virtual autopsy techniques are indicated. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Analytical similarity assessment
Authors: Chow Shein‐Chung , Song Fuyu
Published: August 2017

For regulatory review and approval of biosimilar products, the United States (US) Food and Drug Administration (FDA) recommended a stepwise approach for demonstrating biosimilarity between a proposed biosimilar product and an innovative (reference) biological product (e.g., an US‐licensed product).1–3 The stepwise approach is to provide totality‐of‐the‐evidence for demonstrating biosimilarity between the proposed biosimilar product and the reference product. The stepwise approach starts with analytical studies for functional and structural characterization of critical quality attributes (CQAs) at various stages of manufacturing process. For the assessment of analytical similarity of CQAs, FDA suggests, first, identifying the CQAs that are relevant to clinical outcomes, and then classifying the identified CQAs into several tiers depending upon their criticality or risk ranking. FDA also suggests different methods be used to assess similarity for CQAs from different tiers. For example, equivalence test for CQAs from Tier 1, quality range approach for CQAs from Tier 2, and descriptive raw data and graphical comparison for CQAs from Tier 3. In this article, controversial issues regarding the FDA’s recommended approaches are discussed followed by alternative methods for assessment of similarity for CQAs from Tier 1. WIREs Comput Stat 2017, 9:e1407. doi: 10.1002/wics.1407

This article is categorized under:

Applications of Computational Statistics > Clinical Trials
Lepton flavor changing Higgs decays in the littlest Higgs model with T-parity
Authors: del Aguila Francisco , Ametller Lluis , Illana Jose Ignacio , Santiago Jose , Talavera Pere , Vega-Morales Roberto
Published: August 2017

Abstract

We calculate loop induced lepton flavor violating Higgs decays in the Littlest Higgs model with T-parity. We find that a finite amplitude is obtained only when all contributions from the T-odd lepton sector are included. This is in contrast to lepton flavor violating processes mediated by gauge bosons where the partners of the right-handed mirror leptons can be decoupled from the spectrum. These partners are necessary to cancel the divergence in the Higgs mass introduced by the mirror leptons but are otherwise unnecessary and assumed to be decoupled in previous phenomenological studies. Further-more, as we emphasize, including the partner leptons in the spectrum also introduces a new source of lepton flavor violation via their couplings to the physical pseudo-Goldstone electroweak triplet scalar. Although this extra source also affects lepton flavor changing gauge transitions, it decouples from these amplitudes in the limit of heavy mass for the partner leptons. We find that the corresponding Higgs branching ratio into taus and muons can be as large as ∼ 0.2 × 10−6 for T-odd masses of the order a few TeV, a demanding challenge even for the high luminosity LHC.
Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture
Authors: Varshney Vaibhav Kumar , Saluja Sundeep Singh , Mishra Pramod Kumar , Sisodia Kshitij , Sachan Ashish , Sheetal Pushp
Published: August 2017

Background

Corrosive stricture of esophagus may be associated with variable involvement of stomach. We analyzed the outcome of gastric conduit used in the management of corrosive esophageal stricture with concomitant antro‐pyloric stricture.

Study design

Among 101 esophageal replacements performed, 53 patients had combined esophagus and stomach strictures. Colon was used as a conduit in 43 patients, while stomach was used in ten patients. Indications, perioperative complications and early/late outcomes of patients with gastric pull‐up were reviewed and compared with those undergone colon pull‐up.

Results

The indications of using gastric conduit were impromptu in four patients [colonic conduit ischemia (n = 2) and an oversight of antro‐pyloric stricture after forming the gastric conduit (n = 2)]. Six patients had preconceived gastric conduit (distal antro‐pyloric stricture with distended stomach). The median age was 29 years (range 16–50), and median BMI was 15.4 kg/m2 (range 14.5–20.1). The stomach was drained using loop gastrojejunostomy (n = 7) or Roux‐en‐Y gastrojejunostomy (n = 3). One patient died due to sepsis secondary to anastomotic leak. Median hospital stay was 9 days (range 7–22). At median follow‐up of 25 months (range 14–80), the remaining nine patients are able to have solid diet and have gained weight. The level of esophageal stricture was low (p = 0.01), and duration of surgery (p = 0.02) and median hospital stay (p = 0.04) were significantly less in patients with gastric conduit plus drainage as compared to patients undergone colonic pull‐up.

Conclusion

Gastric conduit in a subject with distal antro‐pyloric stricture can be used safely along with gastrojejunostomy in selected patients of corrosive esophageal stricture.
Validation of an Electronic Surgical Outcomes Database at Mbarara Regional Referral Hospital, Uganda
Authors: Anderson Geoffrey A. , Ilcisin Lenka , Ngonzi Joseph , Ttendo Stephen , Twesigye Deus , Benitez Noralis Portal , Firth Paul , Nehra Deepika
Published: August 2017

Background

Accurate, complete and sustainable methods of tracking patients and outcomes in low‐resource settings are imperative as we launch efforts to improve surgical care globally. The Surgical services QUality Assessment Database (SQUAD) at the Mbarara Regional Referral Hospital in Uganda is one of very few electronic surgical databases in a low‐resource setting. We evaluated the completeness and accuracy of SQUAD.

Methods

Data were prospectively collected on 20 of the most clinically relevant variables captured by SQUAD for all general surgery patients admitted to MRRH over a two‐week period. Patients were followed until discharge, death or hospital day 30; whichever occurred first. These data were compared to that in SQUAD for the same time period for completeness and accuracy.

Results

Of 186 unique patients seen over the two‐week period, 172 (92.5%) were captured by SQUAD. The capture rate was greater than 86% for each of the 20 variables evaluated, except American Society of Anesthesiologists score, which had a 69% capture rate. Regarding accuracy, there was almost perfect agreement for 16/20 variables (all k > 0.81), substantial agreement for 2/20 variables (k 0.63, 0.73) and moderate agreement for the remaining 2/20 variables (k 0.43, 0.48) between SQUAD and the prospectively collected data.

Conclusion

SQUAD is an electronic surgical database that has been implemented and sustained in a low‐resource setting. For the 20 variables evaluated, the data within SQUAD are highly complete and accurate. This database may serve as a model for the development of additional surgical databases in low‐resource environments.
Cancer Genetic Counseling and Testing: Perspectives of Epithelial Ovarian Cancer Patients and Gynecologic Oncology Healthcare Providers
Authors: Liang Margaret I. , Wong Deanna H. , Walsh Christine S. , Farias‐Eisner Robin , Cohen Joshua G.
Published: August 2017

Multi‐gene panel testing has expanded the genetic information available to cancer patients. The objective was to assess provider behaviors and attitudes and patient knowledge and attitudes towards genetic counseling and testing. An online survey was distributed to Society of Gynecologic Oncology members and a written questionnaire was administered to patients diagnosed with epithelial ovarian cancer at a tertiary care referral center. Most of the 233 (18% response rate) provider respondents were gynecologic oncologists. Access to a genetic counselor was reported by 87% of providers and 55% deferred all testing to genetic counselors. Of 53 ovarian cancer patient respondents, two‐thirds had previously seen a genetic counselor or undergone testing. Patients’ attitudes about genetic counseling and/or testing were favorable with respect to themselves (70–81%) and their family members (94%). Less than 25% of patients indicated worrying about health care discrimination, lack of privacy, or high cost. Seventy‐seven percent of patients demonstrated a desire to obtain genetic information even if the results were not currently actionable, and 20% of providers stated they test for only those genes with guideline‐supported actionable results. Provider practice differences were identified in screening and prevention strategies for patients with deleterious non‐BRCA mutations and variants of uncertain significance. The variation in clinical interpretation of results associated with poorly defined cancer risks signals a need for more comprehensive training and guidelines to ensure access to evidence‐based care.
Theory of Mind: Towards an Evolutionary Theory
Authors: Tsoukalas Ioannis
Published: August 2017

Theory of mind is an important mental faculty. However, despite almost half a century of research, we only have a limited understanding of its evolutionary past. The present article proposes a novel hypothesis on the origin of this unique human capacity. According to this hypothesis theory of mind descended from two, closely related, defensive reactions, namely tonic immobility and immobilization stress. Both reactions are conserved in many vertebrate species and are highly prevalent in immature individuals. They are produced by a combination of manual handling and restraint (common in many nursing activities) and implicated in the management of stressful encounters. Most importantly, they have been shown to facilitate eye-contact, gaze-following, and intentional attributions. These traits, and several others detailed in the text, make them prime candidates in the search for the origin of theory of mind. The article presents conceptual arguments and empirical facts in support of this hypothesis.
Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population
Authors: Holvoet Lien , Huys Wim , Coppens Violette , Seeuws Jantien , Goethals Kris , Morrens Manuel
Published: August 2017

Background

Bondage and discipline, dominance and submission, and sadism and masochism (BDSM) is gaining popularity through the mainstream media. Nevertheless, very little is known about the prevalence of BDSM-related fantasies and activities in the general population.

Aim

To determine the prevalence of BDSM fantasies and behavioral involvement in four different age groups of the general population in Belgium.

Methods

By use of a cross-sectional survey questionnaire, the level of interest in several BDSM-related activities was investigated in a sample representative of the general Belgian population (N = 1,027). The questionnaire evaluated interest in 54 BDSM activities and 14 fetishes. Self-identification as BDSM practitioner, situational context of BDSM practice, age at awareness of these interests, and transparency to others were queried.

Outcomes

Individual item scores and summary scores on four BDSM categories were included in the analyses.

Results

A high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. When asked whether they saw themselves as being interested in BDSM, 26% stated this to be the case and 7.6% self-identified as BDSM practitioners. Interests in dominant and submissive activities were comparable and, remarkably, were highly intercorrelated. BDSM and fetish interests were significantly higher in men than in women. The older group (48–65 years) had significantly lower BDSM scores compared with their younger peers. Of participants with a BDSM interest, 61.4% became aware of it before 25 years of age.

Clinical Implications

There is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests.

Strengths and Limitations

This is the first thorough study concerning prevalence of interest in and fantasies about a wide range of BDSM-related activities in the general population worldwide. Although our findings tend to argue against it, we cannot completely rule out participation bias introduced by non-interest in the non-completers. In addition, some topics might have been subject to interpretation by the respondents.

Conclusion

Interest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction.
Impact of a Newly Constructed Motor Vehicle Road on Altitude Illness in the Nepal Himalayas
Authors: Reisman Jonathan , Deonarain Dinesh , Basnyat Buddha
Published: August 2017

Objective

This study investigated the impact that motor vehicle travel along a newly constructed road has on altitude illness (including acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema). The new road from Besisahar (760 m) to Manang (3540 m) in Nepal was completed in December 2014.

Methods

We enrolled all patients diagnosed with altitude illness at the Himalayan Rescue Association Manang clinic in fall 2016. Phi coefficients were calculated to test for an association between Nepali ethnicity and rapid ascent by motor vehicle. A retrospective review looked at all patients with altitude illness from fall (September-November) 2010 to spring (February-May) 2016.

Results

In fall 2016, more than half (54%) of patients with altitude illness traveled to Manang by motor vehicle, and one-third (33%) reached Manang from low altitude (Besisahar) in less than 48 hours. Nepali nationality had a significant association with motor vehicle travel (phi +0.69, P < .0001) as well as with rapid ascent to Manang (phi +0.72, P < .0001). Compared to previous seasons, fall 2016 saw the most patients diagnosed with altitude illness. The proportion of people with altitude illness who traveled by vehicle and reached Manang in less than 48 hours was significantly greater than the proportion prior to completion of the road ( P < .0001 for both).

Conclusions

Rapid ascent by the newly constructed road from Besisahar to Manang appears to be related to a significant increase in the number of patients with all forms of altitude illness, especially among Nepalis. The authors believe that educational interventions emphasizing prevention are urgently needed.
BEYOND THE PEARSON CORRELATION: HEAVY-TAILED RISKS, WEIGHTED GINI CORRELATIONS, AND A GINI-TYPE WEIGHTED INSURANCE PRICING MODEL
Authors: Furman Edward , Zitikis Ričardas
Published: August 2017

Gini-type correlation coefficients have become increasingly important in a variety of research areas, including economics, insurance and finance, where modelling with heavy-tailed distributions is of pivotal importance. In such situations, naturally, the classical Pearson correlation coefficient is of little use. On the other hand, it has been observed that when light-tailed situations are of interest, and hence when both the Gini-type and Pearson correlation coefficients are well defined and finite, these coefficients are related and sometimes even coincide. In general, understanding how these correlation coefficients are related has been an illusive task. In this paper, we put forward arguments that establish such a connection via certain regression-type equations. This, in turn, allows us to introduce a Gini-type weighted insurance pricing model that works in heavy-tailed situations and thus provides a natural alternative to the classical capital asset pricing model. We illustrate our theoretical considerations using several bivariate distributions, such as elliptical and those with heavy-tailed Pareto margins.
FOURIER SPACE TIME-STEPPING ALGORITHM FOR VALUING GUARANTEED MINIMUM WITHDRAWAL BENEFITS IN VARIABLE ANNUITIES UNDER REGIME-SWITCHING AND STOCHASTIC MORTALITY
Authors: Ignatieva Katja , Song Andrew , Ziveyi Jonathan
Published: August 2017

This paper introduces the Fourier Space Time-Stepping algorithm to the valuation of variable annuity (VA) contracts embedded with guaranteed minimum withdrawal benefit (GMWB) riders when the underlying fund dynamics evolve under the influence of a regime-switching model. Mortality risk is introduced to the valuation framework by incorporating a two-factor affine stochastic mortality model proposed in Blackburn and Sherris (2013). The paper considers both, static and dynamic policyholder withdrawal behaviour associated with GMWB riders and assesses how model parameters influence the fees levied on providing such guarantees. Our numerical experiments reveal that the GMWB fees are very sensitive to regime-switching parameters; a percentage increase in the force of interest results in significant decrease in guarantee fees. The guarantee fees increase substantially with increasing volatility levels. Numerical experiments also highlight an increasing importance of mortality as maturity of the VA contract increases. Mortality has less impact on shorter maturity contracts regardless of the policyholder's withdrawal behaviour. As much as mortality influences pricing results for long maturities, the associated guarantee fees are decreasing functions of maturities for the VA contracts. Robustness checks of the Fourier Space Time-Stepping algorithm are performed by making numerical comparisons with several existing valuation approaches.
A new species of Diomedenema (Nematoda, Rhabditida, Spiruromorpha) from Spheniscus magellanicus (Aves, Sphenisciformes) found on the southern coast of Brazil
Authors: Knoff M. , Santos J.N. , Giese E.G. , Gomes D.C. , Silva-Souza Â.T.
Published: August 2017

A new species of the genus Diomedenema, a spiruromorph nematode, collected from the lung of Spheniscus magellanicus (Sphenisciformes) found on the southern coast of the state of Rio Grande do Sul, Brazil, is described. The new species is differentiated from the only previously described species of the genus, D. diomedeae Johston & Mawson, 1952, by males possessing a set of caudal papillae with three pairs of precloacal, two pairs of adcloacal and one pair of postcloacal papillae; precloacal papillae with the papillae of the first two pairs being closer to each other than those of the third pair; a longer and pointed tail in males; and females with the vulva at mid-body. This is the first report of a nematode infecting the lung of a sphenisciforme host.
Ralstonia infection in cystic fibrosis
Authors: GREEN H. D. , BRIGHT-THOMAS R. , KENNA D. T. , TURTON J. F. , WOODFORD N. , JONES A. M.
Published: August 2017

This study aimed to determine prevalence of Ralstonia spp. in cystic fibrosis patients, look for any evidence of cross infection and to describe clinical outcomes for patients infected by Ralstonia spp. Prevalence of Ralstonia spp. was calculated annually from 2008 to 2016. Pulsed-field gel electrophoresis was performed on ⩾1 sample from patients with an isolation of Ralstonia spp. between 2008 and 2016. A prospective, longitudinal observational study of adult patients was performed with 12 months follow-up from recruitment. Prevalence of Ralstonia spp. rose from 0·6% in 2008 to 2·4% in 2016. In total 12 out of 14 (86%) patients with ⩾1 isolation of Ralstonia spp. developed chronic infection. A pair and a group of three unrelated patients with epidemiological connections shared strains of Ralstonia mannitolilytica. Lung function of Ralstonia spp. infected patients was moderately to severely impaired. Prevalence of Ralstonia spp. is low but increasing. The risk of a patient developing chronic Ralstonia spp. infection following first acquisition is high and cross-infection may be possible. Whether Ralstonia spp. infection causes increased pulmonary exacerbation frequency and lung function decline needs to be evaluated in larger prospective studies.
The Institutional Critique of Effective Altruism
Authors: BERKEY BRIAN
Published: August 2017

In recent years, the effective altruism movement has generated much discussion about the ways in which we can most effectively improve the lives of the global poor, and pursue other morally important goals. One of the most common criticisms of the movement is that it has unjustifiably neglected issues related to institutional change that could address the root causes of poverty, and instead focused its attention on encouraging individuals to direct resources to organizations that directly aid people living in poverty. In this article, I discuss and assess this ‘institutional critique’. I argue that if we understand the core commitments of effective altruism in a way that is suggested by much of the work of its proponents, and also independently plausible, there is no way to understand the institutional critique such that it represents a view that is both independently plausible and inconsistent with the core commitments of effective altruism.
Filling a significant gap in the cardiac ICU: implementation of individualised developmental care
Authors: Butler Samantha C. , Huyler Kate , Kaza Aditya , Rachwal Chris
Published: August 2017

Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child’s behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child’s survival but also optimising development through individualised developmental care in the cardiac ICU.
Left ventricular diastolic dysfunction without left ventricular hypertrophy in obese children and adolescents: a Tissue Doppler Imaging and Cardiac Troponin I Study
Authors: El Saiedi Sonia A. , Mira Marwa F. , Sharaf Sahar A. , Al Musaddar Maysoun M. , El Kaffas Rania M. H. , AbdelMassih Antoine F. , Barsoum Ihab H. Y.
Published: August 2017

Background

Obesity increases the risk for various cardiovascular problems. Increase in body mass index is often an independent risk factor for the development of elevated blood pressure and clustering of various cardiovascular risk factors.

Objective

To determine early markers of left ventricular affection in obese patients before the appearance of left ventricular hypertrophy.

Methods

In this cross-sectional study, we evaluated 42 obese patients and 30 healthy controls. Their ages ranged from 6 to 19 years. Studied children were subjected to anthropometric, lipid profile, and serum Troponin I level measurements. Echocardiographic evaluation performed to assess the left ventricle included left ventricular dimension measurement using motion-mode echocardiography, based on which patients with left ventricular hypertrophy (10 patients) were eliminated, as well as conventional and tissue Doppler imaging.

Results

Tissue Doppler findings in the study groups showed that the ratio of transmitral early diastolic filling velocity to septal peak early diastolic myocardial velocity (E/e′) was significantly higher in cases compared with controls [6.9±1.4 versus 9.0±1.6, p (Pearson’s coefficient)=0.001, respectively]. The level of cardiac troponin I was significantly higher in cases compared with controls [0.14±0.39 ng/ml versus 0.01±0.01 ng/ml, p (Pearson’s coefficient)=0.047, respectively] and there was a significant correlation between troponin I and transmitral early diastolic filling velocity to septal peak early diastolic myocardial velocity ratio (E/e′) [R (correlation coefficient)=0.6].

Conclusion

Tissue Doppler Imaging and Troponin I evaluation proved useful tools to detect early affection of the left ventricle in obese patients even in the absence of left ventricular hypertrophy.
Assessing and Improving Hospital Mass-Casualty Preparedness: A No-Notice Exercise
Authors: Waxman Daniel A. , Chan Edward W. , Pillemer Francesca , Smith Timothy WJ , Abir Mahshid , Nelson Christopher
Published: August 2017

In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals’ true capacity to respond to a no-notice event under real-world conditions. To address this gap, the US Department of Health and Human Services (Washington, DC USA), Office of the Assistant Secretary for Preparedness and Response (ASPR), sponsored development of a set of tools meant to allow any hospital to run a real-time, no-notice exercise, focusing on the first hour and 15 minutes of a hospital’s response to a sudden MCI, with the goals of minimizing burden, maximizing realism, and providing meaningful, outcome-oriented metrics to facilitate self-assessment. The resulting exercise, which was iteratively developed, piloted at nine hospitals nationwide, and completed in 2015, is now freely available for anyone to use or adapt. This report demonstrates the feasibility of implementing a no-notice exercise in the hospital setting and describes insights gained during the development process that might be helpful to future exercise developers. It also introduces the use of ED “immediate bed availability (IBA)” as an objective, dynamic measure of an ED’s physical capacity for new arrivals.

WaxmanDA, ChanEW, PillemerF, SmithTWJ, AbirM, NelsonC. Assessing and improving hospital mass-casualty preparedness: a no-notice exercise. Prehosp Disaster Med. 2017;32(6):662–666.