bluuebunny/crossref_metadata_2025 huggingface dataset:
The impacts of time segment modeling in berth allocation and quay crane assignment on terminal efficiency
Authors: Ma Hoi-Lam , Wang Zhengxu , Chung S.H. , Chan Felix T.S.
Published: April 2019

Purpose

The purpose of this paper is to study the impacts of time segment modeling approach for berth allocation and quay crane (QC) assignment on container terminal operations efficiency.

Design/methodology/approach

The authors model the small time segment modeling approach, based on minutes, which can be a minute, 15 min, etc. Moreover, the authors divided the problem into three sub-problems and proposed a novel three-level genetic algorithm (3LGA) with QC shifting heuristics to deal with the problem. The objective function here is to minimize the total service time by using different time segments for comparison and analysis.

Findings

First, the study shows that by reducing the time segment, the complexity of the problem increases dramatically. Traditional meta-heuristic, such as genetic algorithm, simulated annealing, etc., becomes not very promising. Second, the proposed 3LGA with QC shifting heuristics outperforms the traditional ones. In addition, by using a smaller time segment, the idling time of berth and QC can be reduced significantly. This greatly benefits the container terminal operations efficiency, and customer service level.

Practical implications

Nowadays, transshipment becomes the main business to many container terminals, especially in Southeast Asia (e.g. Hong Kong and Singapore). In these terminals, vessel arrivals are usually very frequent with small handling volume and very short staying time, e.g. 1.5 h. Therefore, a traditional hourly based modeling approach may cause significant berth and QC idling, and consequently cannot meet their practical needs. In this connection, a small time segment modeling approach is requested by industrial practitioners.

Originality/value

In the existing literature, berth allocation and QC assignment are usually in an hourly based approach. However, such modeling induces much idling time and consequently causes low utilization and poor service quality level. Therefore, a novel small time segment modeling approach is proposed with a novel optimization algorithm.
Regulating and manipulating the corporeal functions of women academics through political rationality
Authors: Gaus Nurdiana
Published: April 2019

Purpose

The purpose of this paper is to examine the impacts of the politicisation of women academics body in higher education as a result of the implementation of audit culture of new public management.

Design/methodology/approach

The research was conducted in Indonesian universities, by conducting interviews to collect data from 20 women academics from two universities in eastern regions of Indonesia.

Findings

The impacts of audit culture on women academics’ body in this study can be understood from the constraints told by them, reflected on the creation of several types of bodies.

Research limitations/implications

This paper, though, has some limitations in terms of the inclusion of only women academics, exclusion of male academics and of their limitations of addressing important constructs to elaborate the politicisation of the women body, such as culture, religion, patriarchy, and academic tribes and territories.

Practical implications

The results of this study are important for the policy maker of Indonesia to take into account “gender perspective” on research productivity and publication policy to effectively obtain the political objectives of the government. For higher education in Indonesia, the result of this study may give an indication of the importance to establish different and distinctive standards of work performance evaluation on research and publication for female and male academics.

Originality/value

The analysis of this issue is framed within the bipolar diagram of power that seeks to gain political-economic function of the body (bio-power), via a set of control mechanisms of sovereign power to regulate and manipulate the population (bio-politics), developed by Foucault (1984).
A quantitative analysis of attitudes toward pornography use in secure hospitals: sexual, violent and non-offenders
Authors: Mellor Emily , Duff Simon
Published: April 2019

Purpose

The purpose of this paper is to investigate the attitudes of staff members in secure hospitals and the general population towards pornography use and their decision-making regarding access to pornography.

Design/methodology/approach

A between participants design was used whereby 324 participants, including 162 staff members and 162 people of general population, answered an online questionnaire. Vignettes were presented of six hypothetical patients in a secure hospital, based on gender (male/female) and offence type (sexual/violent/non-offender). Participants were required to decide whether the individual depicted in the vignette should have access to pornography. Finally, participants were given a psychometric assessment of their own attitudes towards pornography.

Findings

Participants were less likely to decide that the sex offender should have access to pornography than the violent or non-offender, thus the offence type of the patient was a significant predictor. There was a significant relationship between attitudes to pornography and whether the individual in the vignette should be given access to pornography. There was no significant difference between attitudes towards pornography of the general public and staff members or for male and female participants. Gender of the patient described in the vignette was not a significant predictor.

Practical implications

The research highlights the importance of our own attitudes towards pornography, our possible beliefs about sexual offenders and the effects these may have on decision-making.

Originality/value

The research determines attitudes towards pornography and explores how attitudes influence decision-making.
Quantum eigenlogic observables applied to the study of fuzzy behaviour of Braitenberg vehicle quantum robots
Authors: Toffano Zeno , Dubois François
Published: April 2019

Purpose

The purpose of this paper is to apply the quantum “eigenlogic” formulation to behavioural analysis. Agents, represented by Braitenberg vehicles, are investigated in the context of the quantum robot paradigm. The agents are processed through quantum logical gates with fuzzy and multivalued inputs; this permits to enlarge the behavioural possibilities and the associated decisions for these simple vehicles.

Design/methodology/approach

In eigenlogic, the eigenvalues of the observables are the truth values and the associated eigenvectors are the logical interpretations of the propositional system. Logical observables belong to families of commuting observables for binary logic and many-valued logic. By extension, a fuzzy logic interpretation is proposed by using vectors outside the eigensystem of the logical connective observables. The fuzzy membership function is calculated by the quantum mean value (Born rule) of the logical projection operators and is associated to a quantum probability. The methodology of this paper is based on quantum measurement theory.

Findings

Fuzziness arises naturally when considering systems described by state vectors not in the considered logical eigensystem. These states correspond to incompatible and complementary systems outside the realm of classical logic. Considering these states allows the detection of new Braitenberg vehicle behaviours related to identified emotions; these are linked to quantum-like effects.

Research limitations/implications

The method does not deal at this stage with first-order logic and is limited to different families of commuting logical observables. An extension to families of logical non-commuting operators associated to predicate quantifiers could profit of the “quantum advantage” due to effects such as superposition, parallelism, non-commutativity and entanglement. This direction of research has a variety of applications, including robotics.

Practical implications

The goal of this research is to show the multiplicity of behaviours obtained by using fuzzy logic along with quantum logical gates in the control of simple Braitenberg vehicle agents. By changing and combining different quantum control gates, one can tune small changes in the vehicle’s behaviour and hence get specific features around the main basic robot’s emotions.

Originality/value

New mathematical formulation for propositional logic based on linear algebra. This methodology demonstrates the potentiality of this formalism for behavioural agent models (quantum robots).
A proposed preliminary maturity grid for assessing sustainability reporting based on quality management principles
Authors: Isaksson Raine
Published: April 2019

Purpose

Sustainability reports (SRs) could be viewed as organisational measurements of sustainability performance. The purpose of this paper is to discuss how well SRs are measuring and communicating sustainability and how reporting could be assessed and improved by presenting a maturity grid based on quality management principles.

Design/methodology/approach

Quality management students have assessed publicly available SRs. A total of 55 student assessments have been analysed by the author and used to indicate how understandable reports are. Quality management principles and input from the student assessments have been used to propose a maturity grid for sustainability reporting quality.

Findings

The indication is that SRs are not easy to interpret. The word sustainability aspect used should be replaced with impact on vital stakeholder needs. Guidelines for analysing reports could be improved by using process focus to clearly describe scope of reporting as the entire value chain.

Research limitations/implications

Results are limited to assessing how sustainability is measured. How sustainable the organisations are is not assessed. The research is ongoing, and the proposed matrix is preliminary needing validation and further modification.

Practical implications

The proposed maturity grid for sustainability reporting forms a good basis for further development of SRs and the critical review of them.

Social implications

Results indicate a need to report sustainability in the entire value chain and to focus more on vital stakeholder needs such as poverty and climate change.

Originality/value

The paper discusses a field of synergies between quality and sustainability management, which is important but still sparingly researched.
Predictive factors of response to pulse methylprednisolone therapy in patients with alopecia areata: A follow‐up study of 105 Japanese patients
Authors: Fujii Hiroko , Endo Yuichiro , Dainichi Teruki , Otsuka Atsushi , Fujisawa Akihiro , Tanioka Miki , Miyachi Yoshiki , Kabashima Kenji
Published: April 2019

Pulse corticosteroid therapy is effective for alopecia areata (AA) in the early stage. The risk and efficacy of this therapy for patients with several backgrounds, however, remains controversial. To explore the predictive factors of the response and risk factors of this therapy, data from 105 AA patients treated with methylprednisolone (500 mg) i.v. for 3 days consecutively in our facility were retrospectively analyzed. Among good responders, longer time from the onset to therapy was correlated with longer time required for hair regrowth (P = 0.037, n = 27). Multivariate models demonstrated that “severity”, “relapse” and longer “duration from the latest onset” were significantly and independently associated with poorer outcome (P < 0.01). “History of atopic dermatitis (AD)” was also associated with poorer outcome, but this correlation could be explained by the effect that duration from the latest onset of AA was longer among participants with AD. We propose that earlier initiation of pulse corticosteroid therapy is preferable for better outcome of AA, particularly among patients with AD. Clinicians should be mindful of the occurrence of mild adverse effects in the elderly patients.
Constitutive and herbivore‐induced plant defences regulate herbivore population processes
Authors: Kersch‐Becker Mônica F. , Thaler Jennifer S.
Published: April 2019

Herbivore‐induced plant defences regulated by the phytohormones jasmonic acid (JA) and salicylic acid (SA) are predicted to influence herbivore population dynamics, in part because they can operate in a density‐dependent manner. While there is ample evidence that herbivore‐induced plant responses affect individual performance and growth of herbivores, whether they scale‐up to regulate herbivore population dynamics is still unclear.

We evaluated the consequences of variation in plant defences and herbivore density on herbivore development, reproduction and density‐dependent population growth. We investigated potential mechanisms affecting the strength of herbivore density‐dependent processes by manipulating jasmonate expression, quantifying plant defensive traits (phytohormones JA and SA and serine proteinase inhibitors) and adding aphids (Macrosiphum euphorbiae) at different densities to plants to simulate different initial population density and herbivore load. We manipulated jasmonate defences by using genetically modified lines of tomato plants (Solanum lycopersicum) with elevated or suppressed jasmonate‐dependent defences. Jasmonate‐insensitive plants cannot induce the defences regulated by the JA pathway, while jasmonate‐overexpressing plants constitutively express jasmonate‐dependent defences.

We found that jasmonate defences provided resistance against aphids and influenced density‐dependent processes. Jasmonate‐overexpressing plants reduced aphid reproduction, prolonged developmental time, dampened aphid populations across all aphid densities and caused density‐independent aphid population growth. Jasmonate‐overexpressing plants showed high JA‐dependent constitutive levels of resistance and were unable to activate the SA pathway in response to aphid feeding. In contrast, jasmonate‐insensitive plants increased aphid reproduction, shortened developmental time, reduced population growth only at high initial densities and promoted strong negative density‐dependent population growth. Aphid feeding on jasmonate‐insensitive plants did not induce jasmonate‐dependent defences, but induced the SA pathway in a density‐dependent manner, which resulted in negative density‐dependent aphid population growth.

Aphid feeding on jasmonate‐insensitive and jasmonate‐overexpressing plants differentially activated the salicylate pathway, revealing a negative crosstalk between the defensive phytohormones JA and SA. By muting or enhancing jasmonate‐mediated responses and quantifying SA phytohormone induction, we demonstrated that plant defences are a key factor driving not only the performance, but also the density dependence processes and population growth of herbivores.
Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review
Authors: Novak Iona , Honan Ingrid
Published: April 2019

Introduction

Paediatric occupational therapy seeks to improve children's engagement and participation in life roles. A wide variety of intervention approaches exist. Our aim was to summarise the best‐available intervention evidence for children with disabilities, to assist families and therapists choose effective care.

Methods

We conducted a systematic review (SR) using the Cochrane methodology, and reported findings according to PRISMA. CINAHL, Cochrane Library, MEDLINE, OTSeeker, PEDro, PsycINFO were searched. Two independent reviewers: (i) determined whether studies met inclusion: SR or randomised controlled trial (RCT); an occupational therapy intervention for children with a disability; (ii) categorised interventions based on name, core components and diagnostic population; (iii) rated quality of evidence and determined the strength of recommendation using GRADE criteria; and (iv) made recommendations using the Evidence Alert Traffic Light System.

Results

129 articles met inclusion (n = 75 (58%) SRs; n = 54 (42%)) RCTs, measuring the effectiveness of 52 interventions, across 22 diagnoses, enabling analysis of 135 intervention indications. Thirty percent of the indications assessed (n = 40/135) were graded ‘do it’ (Green Go); 56% (75/135) ‘probably do it’ (Yellow Measure); 10% (n = 14/135) ‘probably don't do it’ (Yellow Measure); and 4% (n = 6/135) ‘don't do it’ (Red Stop). Green lights were: Behavioural Interventions; Bimanual; Coaching; Cognitive Cog‐Fun & CAPS; CO‐OP; CIMT; CIMT plus Bimanual; Context‐Focused; Ditto; Early Intervention (ABA, Developmental Care); Family Centred Care; Feeding interventions; Goal Directed Training; Handwriting Task‐Specific Practice; Home Programs; Joint Attention; Mental Health Interventions; occupational therapy after toxin; Kinesiotape; Pain Management; Parent Education; PECS; Positioning; Pressure Care; Social Skills Training; Treadmill Training and Weight Loss ‘Mighty Moves’.

Conclusion

Evidence supports 40 intervention indications, with the greatest number at the activities‐level of the International Classification of Function. Yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions could be discontinued because effective alternatives existed.
The function of extrafloral nectaries in the pollination and reproduction of Sambucus javanica
Authors: Jiang Xia , Deng Hui‐Ni , Qu Jiao , Zeng Hong , Cao Guo‐Xing
Published: April 2019

Sambucus javanica is a perennial herb with extrafloral nectaries (EFNs) on its inflorescences. To explore the ecological functions of EFNs, a factorial combination experiment of ant (access or exclusion) and EFNs (with or without) at the plant level was created in two populations. The role of EFNs in the attraction of ants and flying pollinators, the defensive role of ants against foliar herbivores, the effects of ants on pollinator visitation and the effects of ant–pollinator interactions on fruit production in one or both populations were assessed. Ants were common on the ant‐access plants with EFNs, but absent from the ant‐access plants without EFNs. Foliar herbivory was independent of ant and EFN treatments and their interactions. The visitation frequency of flying pollinators (honeybees and syrphid flies) and fruit set were significantly higher for plants with EFNs than plants without EFNs, but were not affected by ant treatments or their interactions with EFN treatments. These results suggest that EFNs in S. javanica attracted both ants and flying pollinators, but ants did not present a defensive role against herbivores, did not deter flying pollinators from visiting inflorescences and had no effects on fruit production. In addition, ants were not significant pollen vectors.
The phytopathogenic nature of Dickeya aquatica 174/2 and the dynamic early evolution of Dickeya pathogenicity
Authors: Duprey Alexandre , Taib Najwa , Leonard Simon , Garin Tiffany , Flandrois Jean‐Pierre , Nasser William , Brochier‐Armanet Céline , Reverchon Sylvie
Published: April 2019

Dickeya is a genus of phytopathogenic enterobacterales causing soft rot in a variety of plants (e.g. potato, chicory, maize). Among the species affiliated to this genus, Dickeya aquatica, described in 2014, remained particularly mysterious because it had no known host. Furthermore, while D. aquatica was proposed to represent a deep‐branching species among Dickeya genus, its precise phylogenetic position remained elusive. Here, we report the complete genome sequence of the D. aquatica type strain 174/2. We demonstrate the affinity of D. aquatica strain 174/2 for acidic fruits such as tomato and cucumber and show that exposure of this bacterium to acidic pH induces twitching motility. An in‐depth phylogenomic analysis of all available Dickeya proteomes pinpoints D. aquatica as the second deepest branching lineage within this genus and reclassifies two lineages that likely correspond to new genomospecies (gs.): Dickeya gs. poaceaephila (Dickeya sp NCPPB 569) and Dickeya gs. undicola (Dickeya sp 2B12), together with a new putative genus, tentatively named Prodigiosinella. Finally, from comparative analyses of Dickeya proteomes, we infer the complex evolutionary history of this genus, paving the way to study the adaptive patterns and processes of Dickeya to different environmental niches and hosts. In particular, we hypothesize that the lack of xylanases and xylose degradation pathways in D. aquatica could reflect adaptation to aquatic charophyte hosts which, in contrast to land plants, do not contain xyloglucans.
The Growth Effects of the Bulging Economically Active Population in Sub‐Saharan Africa: Do Institutions Matter?
Authors: Bonuedi Isaac , Kamasa Kofi , Boateng Elliot
Published: April 2019

This paper examines the importance of good institutions in harnessing the growth effects of the bulging economically active population in sub‐Saharan Africa (SSA). The paper utilizes a panel dataset comprising 39 countries over the period 2002–13. Based on the system generalized method of moments estimator, this paper finds that an increase in the relative size of the working‐age population has no direct significant impact on growth, except through the presence of strong and high‐quality institutions. The paper also finds that control of corruption, rule of law and political stability are the specific aspects of institutions that matter the most in reaping the dividend. These results do not only highlight the primacy of strong institutions but also shed light on the key institutional pillars that need to be strengthened to rake in the positive effects of an increasing working age population on economic growth in SSA.
Heterogeneous emergency department management of published recommendation defined hypotension in patients with acute traumatic spinal cord injury: A multi‐centre overview
Authors: Sharwood Lisa N , Joseph Anthony , Guo Cici , Flower Oliver , Ball Jonathon , Middleton James W
Published: April 2019

Objective

Evidence‐based management for patients with acute traumatic spinal cord injury (TSCI) in the ED has a critical impact on long‐term outcomes. Acute hypotension post‐injury may compromise spinal cord perfusion and extend neurological damage. Published guidelines recommend mean arterial blood pressure (BP) maintenance between 85 and 90 mmHg for 7 days post‐injury; the extent to which this is followed in Australia is unknown.

Methods

Prospective observational study of patients ≥16 years with TSCI, treated at 48 hospitals across two Australian states. Mean arterial BPs were recorded in the Ambulance, and ED arrival and discharge. Patients’ medical records documented treatment provided (intravenous fluids, vasopressors or both) for BP augmentation. Hypotension was defined as mean arterial BP <85 mmHg, per the American Association of Neurological Surgeons guidelines.

Results

The 208 patients with TSCI in the present study were more likely to receive BP augmentation if they experienced direct transport to a Spinal Cord Service hospital (OR 5.57, 95% CI 2.32–10.11), had a cervical level injury (OR 2.32, 95% CI 1.01–5.5) or were hypotensive on ED arrival (OR 2.42, 95% CI 1.34–4.39). Of the 112 patients who were hypotensive, 71 (63.4%) received treatment for this; however, the majority (76%) remained hypotensive on discharge.

Conclusion

Hypotensive patients’ post‐TSCI experienced heterogeneous ED care discordant with published guidelines; varying by hospital type. Specialist care and more severe injury increased likelihood of guideline adherence. Lack of adherence may influence patient outcomes. Level 1 evidence is needed along with consistent guideline implementation and clinician training to likely improve TSCI management and outcomes.
What are the main areas of focus to prevent or treat non‐alcoholic fatty liver disease?
Authors: Mansour Asieh , Hekmatdoost Azita , Mirmiran Parvin
Published: April 2019

Recently, a growing body of information has accumulated to suggest that nutritional status and food compounds impact on the development or progression of non‐alcoholic fatty liver disease (NAFLD). The best strategy to prevent and treat NAFLD is to modify diet and lifestyle by maintaining a healthy weight, following a well‐balanced diet with appropriate energy intake and increasing physical activity or strength training. Here we review the literatures and discuss existing and potential therapeutic strategies for the prevention and management of NAFLD, emphasizing the description of nutritional status and its clinical impact on the outcomes of NAFLD.
Mortality prediction in systemic lupus erythematosus patients with pulmonary infection
Authors: Lu Zhimin , Li Jing , Ji Juan , Gu Zhifeng , Da Zhanyun
Published: April 2019

Objective

The impact of pulmonary infection (PI) on mortality of patients with systemic lupus erythematosus (SLE) has been established. Nevertheless, the effect of risk factors in mortality remains controversial. The objective of this study is to determine the risk factors of short‐term mortality among SLE patients with PI.

Method

The clinical data of 54 SLE patients with 59 episodes of PI who were hospitalized from January 2013 to May 2018 was retrospectively analyzed. Demographic data, clinical features, and outcomes were collected. Logistic regression analysis was carried out to determine the independent predictors of 60‐day mortality during hospitalization. We used receiver operating characteristics (ROC) curves to verify the indices as mortality predictors in the study patients.

Results

There were a total of 54 patients with 59 episodes of PI. There were 12 deaths during hospitalization. In multivariate analysis, 24‐hour urinary protein (24h‐PRO) (odds ratio [OR]: 2.713, 95% CI: 1.234‐5.965, P = 0.013), peripheral lymphocyte count (OR: 0.066, 95% CI: 0.005‐0.887, P = 0.040), and serum complement 3 level (C3) (OR: 0.097, 95% CI: 0.010‐0.954, P = 0.045) were associated with mortality among our cohort of SLE patients with PI. ROC curve values were 0.818 for lymphocyte count (95% CI: 0.696‐0.907, P = 0.001), 0.894 for 24h‐PRO (95% CI: 0.786‐0.959, P < 0.001) and 0.825 for C3 (95% CI: 0.704‐0.912, P = 0.001). The cut‐off value of lymphocytes, 24h‐PRO and C3 were 0.53 × 109/L, 0.92 g and 0.52 g/L, respectively.

Conclusion

The presence of albuminuria, lymphopenia and low complement C3 levels were independent prognostic predictors of short‐term mortality in SLE patients with PI.
Overlap myositis, a distinct entity beyond primary inflammatory myositis: A retrospective analysis of a large cohort from the REMICAM registry
Authors: Nuño‐Nuño Laura , Joven Beatriz Esther , Carreira Patricia E. , Maldonado‐Romero Valentina , Larena‐Grijalba Carmen , Llorente Cubas Irene , Tomero Eva , Barbadillo‐Mateos María Carmen , García de la Peña Lefebvre Paloma , Ruiz‐Gutiérrez Lucía , López‐Robledillo Juan Carlos , Moruno‐Cruz Henry , Pérez Ana , Cobo‐Ibáñez Tatiana , Almodóvar Raquel , Lojo Leticia , García de Yébenes María Jesús , López‐Longo Francisco Javier
Published: April 2019

Background

Inflammatory idiopathic myositis (IIM) comprises a heterogeneous group of systemic muscular diseases that can occur together with other connective tissue diseases (CTD), named overlap myositis (OM). The question of whether OM is a distinct entity still remains controversial.

Aim

The present study was conducted to assess the clinical and prognostic differences between patients diagnosed with OM, primary polymyositis (PM) and primary dermatomyositis (DM).

Method

The study consists of a retrospective longitudinal and multicenter series of IIM patients. Patients were classified as OM, PM and DM. Overlap myositis was defined as patients fulfilling criteria for IIM plus criteria for other CTD (namely systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, rheumatoid arthritis and primary Sjögren's syndrome).

Result

A total of 342 patients were included (98 OM, 137 PM and 107 DM). Overlap myositis patients, in comparison with PM and DM, showed significant differences, with more extramuscular involvement, particularly more arthritis (66%, 34.6% and 48.1%, respectively), puffy fingers (49.5%, 11.1% and 24.3%), sclerodactyly (45.4%, 2.2% and 2%), dysphagia (41.8%, 18.2% and 26.4%), Raynaud phenomenon (65.3%, 16.9% and 19.8%), leucopenia (28.9%, 2.2% and 8.4%), thrombocytopenia (8.2%, 2.2% and 1.9%), interstitial lung disease (ILD) (48%, 35% and 30.8%), renal manifestations (13.4%, 3.7% and 1.9%), and more severe infections (41.3%, 26.7% and 21%). No significant differences were found in survival between groups in log rank test (P = 0.106). Multivariate adjusted survival analyses revealed a worse prognosis for severe infections, ILD and baseline elevation of acute phase reactants.

Conclusion

Overlap myositis stands out as a distinct entity as compared to PM and DM, featuring more extramuscular involvement and more severe infections. Close monitoring is recommended in this subset for early detection and treatment of possible complications.
Efficacy of PD‐1/PD‐L1 inhibitors in patients with advanced non‐small cell lung cancer: A meta‐analysis of randomized clinical trials
Authors: Peng Tzu‐Rong , Wu Ta‐Wei
Published: April 2019

Background

This meta‐analysis systematically evaluated the efficacy of PD‐1 and PD‐L1 inhibitors for the treatment of advanced non‐small cell lung cancer (NSCLC) and investigated the efficacy of first‐line therapy and PD‐1 versus PD‐L1 inhibitors.

Methods

PubMed, The Cochrane Library, and Embase were searched up to November 2018 for randomized controlled trials (RCTs) for eligible studies. The outcome of interest was overall survival (OS). The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and Cochrane Collaboration guidelines. Data were pooled by using the random effects model and expressed as hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Heterogeneity was assessed and quantified (I
2).

Results

Seven RCTs were included in this study. PD‐1/PD‐L1 inhibitors achieved superior OS compared to chemotherapy (HR 0.72, 95% CI 0.63–0.82; P < 0.0001). OS was superior in previously treated patients compared to untreated patients (HR 0.69, 95% CI 0.63–0.76; HR 0.82, 95% CI 0.47–1.44, respectively). No significant differences in OS were observed between PD‐1 and PD‐L1 inhibitors (HR 0.71, 95% CI 0.59–0.86; HR 0.73, 95% CI 0.63–0.84, respectively).

Conclusions

PD‐1/PD‐L1 inhibitors significantly prolonged the OS of previously treated patients. No significant differences in OS were observed between PD‐1 and PD‐L1 inhibitors.
Chronic post‐surgical pain after colon surgery in patients included in an enhanced recovery program
Authors: Lois Fernande , Lavand'homme Patricia , Leonard Daniel , Remue Christophe , Bellemans Vanessa , Kartheuser Alex
Published: April 2019

Background

Enhanced recovery after surgery (ERAS) program improves immediate recovery. Beyond immediate benefits, long‐term impact of ERAS implementation is not yet evident. This retrospective single‐center cohort study investigates prevalence and characteristics of chronic post‐surgical pain (CPSP) in patients who underwent colon surgery.

Methods

Two hundred and ninety‐seven patients enrolled prospectively in our ERAS database were contacted by mail to question the presence of CPSP. In case of CPSP, intensity, location, and type of pain, impact of pain on quality of life and treatment taken were assessed. Post‐operative pain experience during hospital stay, recall of pain, and discomfort duration when back home were assessed in all patients. Comparison between patients with and without CPSP was made to approach the risk factors of CPSP in this population.

Results

At 27 months after colon surgery, 25/198 patients reported CPSP (12.6%) and pain was severe in 5 patients (2.5%). CPSP had a deep abdominal component in 56% of patients and a parietal component in 20% of patients. Patients with CPSP+ differed from patients CPSP− for pre‐operative pain presence (56% vs 24.8%, P = 0.004), recalled post‐operative pain intensity (4 vs 3, P = 0.045), duration of discomfort after discharge (2 vs 1 weeks, P = 0.035). Pre‐operative pain was found as a significant CPSP risk factor (odds ratio 1.34; 95% CI: 1.05‐1.70).

Conclusion

CPSP prevalence after laparoscopic colon surgery seems not much affected by ERAS context. Pre‐operative presence of pain emerged as an important risk factor. These findings should be confirmed in a prospective multicenter study.
Chronic pain among the hospitalized patients after the 22 July 2011 terror attacks in Oslo and at Utøya Island
Authors: Wisløff‐Aase Kristin , Ræder Johan , Månum Grethe , Løvstad Marianne , Schanke Anne‐Kristine , Dyb Grete , Ekeberg Øivind , Stanghelle Johan Kvalvik
Published: April 2019

Background

On 22 July 2011, 48 people were hospitalized due to physical injuries from gun shots or explosion, following 2 terror attacks in the Oslo area, Norway. In this study, we have investigated the occurrence of chronic pain, the severity and consequences of chronic pain in these patients, 3 to 4 years after the incidents.

Methods

Totally 43 eligible terror trauma patients were invited to participate in the study, 30 patients were included. They underwent a consultation with a psychologist and a physician; containing psychological assessment, neuropsychological screening, a standardized clinical interview, medical examination, and a pain protocol.

Results

In 18 (60%) the injury was severe, as defined by New Injury Severity Score > 15. Twenty‐four patients (80%) reported injury‐related chronic pain after the trauma, in 22 with consequences on daily life. Analgesics were used by 20 patients, including 5 in need of opioids. Ten patients had unmet needs of further specialist pain care.

In 12 patients, the average pain score last week was above three on a 0‐10 Numeric Rating Scale. In these patients, clinical signs of neuropathic pain were evident in 10, as tested by the Douleur Neuropathique score. There were significant correlations (P < 0.05) between severity of chronic pain and presence of post‐traumatic stress symptoms, reduced quality of life, reduced psychosocial and physical function; but no correlation with pre‐injury patient characteristics or the degree of physical injury.

Conclusion

Chronic pain was frequent and significant, irrespective of injury severity, in these patients who obtained their physical injuries under extreme psychological conditions.
Cell‐type‐specific role of lamin‐B1 in thymus development and its inflammation‐driven reduction in thymus aging
Authors: Yue Sibiao , Zheng Xiaobin , Zheng Yixian
Published: April 2019

Cellular architectural proteins often participate in organ development and maintenance. Although functional decay of some of these proteins during aging is known, the cell‐type‐specific developmental role and the cause and consequence of their subsequent decay remain to be established especially in mammals. By studying lamins, the nuclear structural proteins, we demonstrate that lamin‐B1 functions specifically in the thymic epithelial cells (TECs) for proper thymus organogenesis. An up‐regulation of proinflammatory cytokines in the intra‐thymic myeloid immune cells during aging accompanies a gradual reduction of lamin‐B1 in adult TECs. We show that these cytokines can cause senescence and lamin‐B1 reduction of the young adult TECs. Lamin‐B1 supports the expression of TEC genes that can help maintain the adult TEC subtypes we identified by single‐cell RNA‐sequencing, thymic architecture, and function. Thus, structural proteins involved in organ building and maintenance can undergo inflammation‐driven decay which can in turn contribute to age‐associated organ degeneration.
Acute Ethanol Produces Ataxia and Induces Fmr1 Expression via Histone Modifications in the Rat Cerebellum
Authors: Dulman Russell S. , Auta James , Teppen Tara , Pandey Subhash C.
Published: April 2019

Background

The cerebellum is fundamental for motor coordination and therefore crucial in ethanol (EtOH)‐induced ataxia. EtOH contributes to cerebellar pathophysiology. Fragile‐X mental retardation protein (FMRP) is a complex regulator of RNA and synaptic plasticity implicated in fragile‐X tremor and ataxia syndrome, a phenotype featuring increased Fmr1 mRNA expression. Recent studies have implicated glutamatergic targets of FMRP in hereditary cerebellar ataxias including the main cerebellar excitatory amino acid (Eaa1) transporter and a subtype of metabotropic glutamate receptor (Grm5). However, EtOH‐induced changes in cerebellar Fmr1 expression and its epigenetic regulation have not been investigated. Here, we examined the effects of acute EtOH exposure on ataxic behavior, gene expression, and epigenetic regulation of the Fmr1 gene and its glutamatergic targets in the rat cerebellum.

Methods

Male adult Sprague Dawley rats received acute EtOH (2 g/kg) intraperitoneally 1 hour prior to ataxic behavioral testing on the accelerating rotarod and were sacrificed immediately thereafter. Cerebellar tissues were analyzed for gene expression and epigenetic regulation of the Fmr1 gene and its glutamatergic targets in the rat cerebellum using real‐time quantitative polymerase chain reaction (PCR) and chromatin immunoprecipitation.

Results

Acute EtOH exposure caused marked ataxia on the accelerating rotarod test compared with saline‐treated controls. This ataxic response was associated with increases in mRNA levels of Fmr1, postsynaptic density 95 (Psd95), Eaa1, and Grm5 in the cerebellum. In addition, we found increased H3K27 acetylation both at the promoter region of Fmr1 and at a proposed cyclic adenosine monophosphate (cAMP) response‐element binding (CREB) site downstream of the Fmr1 transcription start site. Furthermore, acute EtOH exposure significantly increased Creb1 and the histone acetyltransferases (HAT) CREB binding protein (Cbp), and p300 mRNA transcripts.

Conclusions

Overall, EtOH regulates cerebellar Fmr1 expression most likely via HAT‐mediated increase in histone acetylation. We propose that FMRP regulation of glutamatergic transcripts plays an important role in disrupting the excitatory–inhibitory balance in the cerebellum underlying EtOH‐induced ataxia.
Uterus duplex bicollis, Vagina simplex in laboratory Guinea pigs (Cavia porcellus), rats (Rattus norvegicus forma domestica) and mice (Mus musculus forma domestica)
Authors: Bertram Christof A. , Klopfleisch Robert , Erickson Nancy A. , Müller Kerstin
Published: April 2019

The female genital tract originates from the Müllerian ducts during embryological development. Fusion of the ducts occurs in different segments depending on the animal species, resulting in a variational number of the respective organ. Current literature on genital tract morphology of laboratory rodents is controversial. Therefore, the present study aimed at determining an anatomically correct definition of the uterus in laboratory guinea pigs, mice and rats. In all three rodent species, we found two separate cervical canals that communicate with an individual uterus via discrete ostia uteri interna. The correct anatomical definition should therefore be uterus duplex bicollis, vagina simplex.
Prognostic factors in metastatic germ‐cell cancer
Authors: Beyer J.
Published: April 2019

Determining stage and anticipating prognosis are the two crucial steps after the diagnosis of a germ‐cell cancer that both guide subsequent treatment decisions. This review focuses on metastatic disease, which means germ‐cell cancers beyond stage I limited to the testis. In the past, major centers developed separate staging and prognostic classifications for metastatic germ‐cell cancer, which heavily impaired communication and comparisons across clinical trials. More recently, the classification system of the International Germ‐Cell Cancer Collaborative Group (IGCCCG) has found acceptance worldwide and is currently being updated.
What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?
Authors: Boullenois Hortense , Lefevre Jérémie H. , Creavin Ben , Calmels Mélanie , Voron Thibault , Debove Clotilde , Chafai Najim , Parc Yann
Published: April 2019

Background

Delayed coloanal anastomosis (DCAA) may be used in patients with complex rectal conditions, such as chronic pelvic sepsis, low recto‐vaginal and recto‐vesical fistula; however, limited data are available. The aim is to report the morbidity and functional results of DCAA in redo rectal surgery.

Methods

All patients undergoing DCAA between January 2014 and August 2017 were retrospectively included. Success was defined as a functional anastomosis without stoma, evaluated using the Low Anterior Resection Syndrome (LARS) score and the Gastrointestinal Quality of Life Index (GIQLI) functional assessment tools.

Results

Of the 72 redo pelvic surgeries, 29 (40.3%) DCAA were performed over a 4‐year period. Indications for redo resection were chronic pelvic sepsis (n = 13, 44.8%), recto‐vaginal fistula (n = 11, 37.9%) and recto‐vesical fistula (n = 5, 17.2%). Mean interval period between the two procedures was 14 ± 3 days (8–21). Global major morbidity (Clavien‐Dindo III or IV) was seen in six patients (20.7%). Stoma closure was feasible for 22 (75.9%) patients after a median period of 78 days (interquartile range 61–98). The 6‐month success rate was 79.3%. Mean LARS was 28.8 ± 10.2 (3–41) (minor LARS) for 18 patients with no stoma at the end of follow‐up. LARS score was significantly better with a follow‐up >2 years (23.3 ± 12.2 versus 32.3 ± 7.9), P = 0.074. Mean GIQLI score was 79.2 ± 14.3 (48–98).

Conclusions

Transanal colonic pull through with delayed anastomosis for redo‐surgery in complex pelvic situations had low morbidity and avoided a permanent stoma in three out of four patients with an acceptable quality of life.
The cnidome and ultrastructural morphology of late planulae in Lophelia pertusa (Linnaeus, 1758)—With implications for settling competency
Authors: Strömberg Susanna M. , Östman Carina , Larsson Ann I.
Published: April 2019

The larval pre‐competency period and competency window are important in delimiting the potential dispersal distance for pelagic larvae of sessile marine fauna. Here, we provide evidence for morphological changes in the late planulae of Lophelia pertusa that have implications for their dispersal potential. Three weeks after spawning, the planulae gain functional cnidocysts, indicating that they are competent to settle at this time. Cnidae have been shown to be used for primary anchoring during settling, and before this time point, the larvae most probably do not have the ability to attach to a substrate in high flow conditions. The appearance of functional cnidae coincides with larvae gaining a flexible mouth that can be opened to the full width of the larva. The larval isorhizas differ the most from the adult polyps isorhizas, while the p‐ and b‐mastigophores bear more resemblance to the adult homologues of similar size. The external and internal morphology of late planulae is further described with demonstration of long apical cilia and its effect on swimming agility, morphological changes of the ciliated cells in the larval mouth region and an internal nerve plexus. This study also indicates that L. pertusa planulae seek out cryptic spaces for settling.
The Beliefs in Trichotillomania Scale (BiTS): Factor analyses and preliminary validation
Authors: Rehm Imogen C. , Nedeljkovic Maja , Moulding Richard , Thomas Anna
Published: April 2019

Objectives

The role of cognitions and beliefs in trichotillomania (TTM; hair pulling disorder) has been the subject of only limited investigation. This study aimed to develop and validate the Beliefs in TTM Scale (BiTS).

Methods

A pool of 50 items based upon themes identified in previous research was administered online to 841 participants with and without self‐reported problematic, non‐cosmetic hair pulling behaviours.

Results

Exploratory and confirmatory factor analyses conducted in randomly split‐halves of the sample supported retention of 14 items comprising three factors: negative self‐beliefs, low coping efficacy, and perfectionism.

Conclusions

The BiTS demonstrated satisfactory psychometric properties and all three subscales significantly correlated with greater hair pulling severity. Negative self‐beliefs predicted hair pulling severity over and above mood symptoms, suggesting the importance of addressing self‐construals in psychological treatments for TTM. Validation in a clinician diagnosed sample is required.

Practitioner points

Research supports cognitive therapies for treating trichotillomania (hair pulling disorder), although studies investigating the nature and role of cognitions and beliefs in this disorder have been lacking.

This study developed and validated a self‐report measure of three styles of beliefs most relevant to trichotillomania: negative self‐beliefs, low coping efficacy, and perfectionism.

Negative self‐beliefs predicted the severity of trichotillomania symptoms over and above depression and anxiety, suggesting such cognitions may not necessarily be due to comorbidities.

Future research should validate the new measure in a clinician diagnosed sample, and therapies for trichotillomania may be enhanced by targeting shame specifically.
Muted voices: The unexplored sexuality of young persons with learning disability in Malta
Authors: Azzopardi Lane Claire L. , Cambridge Paul , Murphy Glynis
Published: April 2019

Accessible summary

Persons with learning disability who live in Malta, especially women, feel they do not have as many opportunities to make friends and form relationships as other persons who do not have a learning disability.

Persons with learning disability feel lonely but wish they had the opportunity to do the things non‐disabled people do, such as have relationships, get married, live on their own and have children.

At times, their parents and people who work with them do not help them with this.

It is important that persons with learning disability from a young age are supported and empowered so that they can exercise their sexual rights.

Background

This paper explores the sexuality of young persons with learning disability in Malta with respect to their opportunities and the constraints they experience.

Materials and Methods

Interpretative phenomenological analysis was used to decode qualitative data collected from persons with learning disability.

Results

Findings reveal a context of disabling social attitudes, stereotypical gender imagery and exclusionary social practices. In addition, youth with learning disability experience a lack of community support and social networking, thus calling for platforms and spheres where they can form and maintain friendships and relationships.

Conclusions

It is concluded that Malta lacks the fundamental social acceptance that persons with learning disability are sexual beings, with the right to express their sexuality and to form relationships. Overcoming such cultural hurdles will empower persons with learning disability to establish and express their sexual identities.