bluuebunny/crossref_metadata_2025 huggingface dataset:
Inclusion, acceptance, shame and isolation: Attitudes to autism in Aboriginal and Torres Strait Islander communities in Australia
Authors: Lilley Rozanna , Sedgwick Mikala , Pellicano Elizabeth
Published: June 2020

This is the first qualitative study to investigate experiences of, and attitudes towards, autism in Aboriginal and Torres Strait Islander communities in Australia. Understanding the complexity of these attitudes is crucial because they influence the recognition of autism as well as the ways in which individuals and families are supported. Twelve families with 16 autistic children living in diverse regions of Australia participated in a semi-structured interview. The interviews were thematically analysed using the six-step process outlined by Braun and Clarke. The analysis identified a marked tension in participants’ accounts. On the one hand, participants described negative feelings, including shame associated with atypical behaviour, stigmatisation and the social isolation of families, which potentially point towards under-identification or misdiagnosis. On the other hand, they also described inclusive attitudes, including ‘looking after each other’ and a growing acceptance of autistic differences. This positive model of support for and acceptance of autistic children and their families may well contribute to good outcomes for autistic children and adults in Aboriginal and Torres Strait Islander communities. More research is needed on cross-cultural and pluralistic understandings of autism, parental perceptions and family experience.

Lay Abstract

There has been almost no research done about autism in Aboriginal and Torres Strait Islander communities in Australia. This article is the first detailed report on attitudes to autism in these communities. Understanding attitudes to autism is important because they influence whether or not children are diagnosed, as well as the kinds of support autistic people are getting. Twelve families who lived in different parts of Australia were interviewed. They told us that there is a range of attitudes to autism in Aboriginal and Torres Strait Islander communities. These include negative ideas such as sometimes feeling shame associated with children’s unusual behaviour, as well as feeling stigmatised and socially isolated. The negative attitudes reported may mean that some children are missing out on an autism diagnosis or being wrongly diagnosed with a different condition in these communities. They also included positive ideas such as the importance of looking after each other and of accepting autistic people and their differences. We can all learn from these positive attitudes. It will be interesting to know in future projects whether these accepting attitudes lead to better outcomes for autistic children and adults in these communities. This research helps us to understand how autism is thought about in different cultures and how attitudes impact diagnosis and support. It will also help people to plan supports that reflect what Aboriginal and Torres Strait Islander families actually want and need.
Bibliometric analysis of adverse drug reactions and pharmacovigilance research activities in Nepal
Authors: Shrestha Sunil , Danekhu Krisha , KC Bhuvan , Palaian Subish , Ibrahim Mohamed Izham Mohamed
Published: June 2020

Background:

Bibliometric analyses have been used previously to study the measures of quality and impact of research performed in several health-related areas such as adverse drug reactions (ADRs) and pharmacovigilance (PV), etc. This method can assess the research performance of publications quantitatively and statistically. There is no evidence of bibilometric studies analyzing ADRs and PV from Nepal. Therefore, the present study aimed to assess scientific output on ADRs and PV-related research activities in Nepal using a bibliometric analysis of publications from 2004 January to December 2018, that is, 15 years.

Methods:

A systematic search was conducted in PubMed, Web of Science, Google Scholar, Scopus and Nepal Journal Online (NepJOL) databases. ‘Adverse Drug Reactions‘ or ‘ADRs‘ or ‘ADR‘ or ‘Adverse drug reaction‘ or ‘AE‘ or ‘Adverse Event‘ or ‘Drug-Induced Reaction‘ or ‘Pharmacovigilance‘ or ‘PV‘ and ‘Nepal‘. The search covered 15 years (January 2004 to December 2018) of study on ADRs and PV in Nepal. Only articles retrieved from databases were included, whereas published/unpublished drug bulletins, pharmacy newsletters and thesis were excluded. The articles thus retrieved were recorded, and thereafter analyzed. Word count code was used for the analysis of keywords used in the retrieved articles.

Results:

A total of 124 articles were retrieved, with the highest rate of publications in 2006 and 2007, with 16 papers each. Among the articles, 10 (8.1%) were published in Kathmandu University Medical Journal (KUMJ). Single papers were published in 38 different journals. Brief reports (1.6%), case reports (31.2%), case series (0.8%), education forums (0.8%), letters to the editor (5.6%), original research articles (41.9%), review articles (9.7%), short communications and short reports (8.1%) on ADRs and PV were recorded. Out of 124 papers, 52 (41.9%) were original research publications. The majority (74.1%) of research was done in the category of ADR incidence, types, prevention, and management, followed by policy and suggestions for strengthening national and regional pharmacovigilance centers of Nepal (14.5%).

Conclusions:

During the study years, there was an increase in scientific publications on drug safety. A total of 124 published articles were found during bibliometric analysis of ADRs and PV research activities in Nepal.
Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network
Authors: Canciello Grazia , Mancusi Costantino , Izzo Raffaele , Morisco Carmine , Strisciuglio Teresa , Barbato Emanuele , Trimarco Bruno , Luca Nicola De , de Simone Giovanni , Losi Maria Angela
Published: June 2020

Background

Determinants of changes of aortic root dimension over time are not well defined.

Design

We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network.

Methods

N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution.

Results

At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0–8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up (p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time (p < 0.05). Anti-renin–angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension.

Conclusions

Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
The Adaptive Challenges of Curriculum Implementation: Insights for Educational Leaders Driving Standards-Based Reform
Authors: Pak Katie , Polikoff Morgan S. , Desimone Laura M. , Saldívar García Erica
Published: June 2020

The ambitious goals of standards-based reform call for both technical and adaptive leadership to address problems of practice involving the technical and adaptive alignment of teachers’ instruction to the standards. Thus, standards-aligned curriculum implementation necessitates both types of strategies; otherwise, adaptive challenges will persist. In this study, we analyze case studies of four districts where new English Language Arts and math curricula were recently adopted to help align teachers’ practice with their state’s English Language Arts and math standards. We draw from interviews with district leaders, principals, instructional coaches, and teachers to illustrate how mostly technical strategies for curriculum implementation do little to address the adaptive challenges that prevent teachers from fundamentally shifting their practice to be more aligned to the standards and to meet the needs of all learners. We conclude with a set of insights and implications for educational leaders approaching curriculum implementation in both technical and adaptive ways.
Concurrent tuberculous chorioretinitis with choroidal neovascularization and tuberculous meningitis: a case report
Authors: Zhang Yan-Kun , Fu Hong-Yi , Guan Yan , Li Yu-Jing , Bai Hong-Zhong
Published: June 2020

Background

Tuberculosis (TB) remains a severe health burden worldwide. The manifestation of concurrent tuberculous cerebral and ocular involvements associated with TB is uncommon.

Case presentation

We report a 17-year-old girl with concurrent tuberculous cerebral and ocular involvements and visual impairment due to choroidal neovascularization. This study emphasizes the definite diagnosis with the combination of ophthalmological examination, multimodal imaging and routine tuberculosis testing, and the proper management with intravitreal anti-VEGF injection accompanied by systemic anti-tuberculosis therapy.

Conclusion

Combined applications of routine TB tests, fundus multimodal imaging and diagnostic therapy greatly help the clinician to establish a precise diagnosis and in monitoring the therapeutic response.
Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
Authors: Verburg Hennie , van Zeeland Koobs Linda , Niesten Dieu Donné , Pilot Peter , Mathijssen Nina
Published: June 2020

Background

To evaluate the reliability of two different techniques for measuring penetration and distribution of the cement mantle in the proximal tibia after total knee arthroplasty (TKA) with Computer Tomography (CT) in vivo.

Methods

Standardized CT scans of the proximal tibia were taken 1 to 2 years after total knee arthroplasties implanted with a surface cementing technique. These prospectively acquired transversal CT images of the surface of the proximal tibia were divided into four quadrants and were assessed once manually and once with a numerical computing program (MATLAB® Update 2, The MathWorks, Inc.) based on Hounsfield Units by one of the researchers. The assessments were repeated by the same and a second researcher. The ratio cement/trabecular bone was calculated 1, 3 and 5 mm distal of the tibia tray per quadrant. Kruskall-Wallis tests with multiple pairwise comparisons (Dunn’s test) were used to determine differences between the quadrants. Intra- and inter-rater reliability as well as the inter method reliability were assessed with the Intraclass Correlation Coefficient (ICC) per level of depth and with Bland-Altman plots.

Results

A total of 92 CT scans were included. The intra- and inter-rater reliability of the manual method ranged from 0.22 and 0.52. The intra- and inter-rater reliability of the matlab method varied between 0.98 to 0.99.

The median percentage cement measured with the matlab method 1 mm underneath the tibial tray varied between 82 and 88%; at 3 mm depth between 38 and 54% and at 5 mm between 15 and 25%. There was significantly (p < 0.05) less cement in the antero-medial quadrant compared to the antero-lateral and postero-lateral quadrant at 3 mm and 5 mm depth.

Conclusions

Distribution and penetration of cement in the proximal tibia in a total knee arthroplasty can be measured reliably with CT in combination with the matlab method presented in this manuscript. This method can be used for clinical purposes as well as for scientific research.

Trial registration

METC-nr: 06–104 Dossier NL14807.098.06/versie 06.
Factors associated with screening positive for high falls risk in fragility fracture patients: a cross-sectional study
Authors: Rotondi Nooshin K. , Beaton Dorcas E. , Sujic Rebeka , Bogoch Earl , Inrig Taucha , Linton Denise , Weldon Jennifer , Jain Ravi , Sale Joanna E. M.
Published: June 2020

Background

We sought to report the prevalence of fragility fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk.

Methods

The study population included fragility fracture patients 50+ years of age who were screened at 35 hospital fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, fracture-related, and health-related characteristics were evaluated using logistic regression.

Results

Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50–64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk.

Conclusions

Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in fragility fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the fragility fracture population is warranted.
The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis
Authors: Wang Bingjin , Hua Wenbin , Ke Wencan , Zhang Yukun , Zeng Xianlin , Yang Cao
Published: June 2020

Background

The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.

Methods

We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.

Results

All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6 ± 9.3°. The Cobb angle was reduced to 10.6 ± 2.6° postoperatively and was found to be 11.4 ± 3.1° at the final follow-up. The mean angle correction was 23.0 ± 8.9°, and the correction rate was 66.2 ± 12.2%. The mean angle lost was 0.8 ± 0.9°, and the lost rate was 5.8 ± 5.4% at the final follow-up.

Conclusions

Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.
Evaluation of quality and use of health management information system in primary health care units of east Wollega zone, Oromia regional state, Ethiopia:
Authors: Kebede Mekonen , Adeba Emiru , Chego Melese
Published: June 2020

Background

Health care practice relies on evidence-based decisions and needs the use of quality health care data. Health management information system (HMIS) is among the core elements of health system building blocks. In our study setting, there is a lack of adequate information on the quality of health information data. This study aimed at exploring the quality of health management information system data in terms of timeliness, completeness, and accuracy. The specific objectives were to evaluate the quality and use of the health management information system in Primary health care units of East Wollega zone, Ethiopia.

Methods

A cross-sectional study was conducted from April to June 2016 on 316 health professionals/health information technicians. The sample was obtained by simple random sampling technique. Qualitative data were obtained from 16 purposefully selected key informants by Focus group discussion (FGD). We observed 50 selected health facilities using an observation checklist. We analyzed quantitative data by SPSS version 20 using descriptive and logistic regression analysis techniques. we applied a thematic analysis approach to analyze qualitative data.

Results

Timeliness of report, registration completeness, report completeness, and data accuracy level of the selected facilities were 70, 78.2, 86, and 48%, respectively. All results are below the expected national standards. Commonly reported reasons for the poor practice of data quality were; poor support of management, lack of accountability for the false report, poor supportive supervision, and lack of separate and responsible unit for health information management.

Conclusion

The Health information management system is poorly coordinated at the primary health units. Accountability should be assured through continuous in-service training, supportive supervision, and concrete feedbacks. Electronic management of health information should be available in primary health care units.
Early maternal separation accelerates the progression of endometriosis in adult mice
Authors: Long Qiqi , Liu Xishi , Guo Sun-Wei
Published: June 2020

Background

A large body of research highlights the importance of early-life environmental impact on the health outcome in adulthood. However, whether early-life adversity (ELA) has any impact on the development of endometriosis is completely unclear. In this study, we tested the hypothesis that ELA, as manifested by neonatal separation, can accelerate the progression of endometriosis in mouse through activation of the adrenergic receptor β2 (ADRB2) signaling pathway, leading to increased angiogenesis and progression of endometriotic lesions.

Methods

Eight female Balb/C mice, in late pregnancy, were used used for this study, which later gave birth to 22 female newborn pubs. Eleven additional female Balb/C mice were also used as donors of uterine tissues. The 22 newborn pubs were randomly divided into 2 equal-sized groups, maternal separation (MS) and no separation (NS). Pubs in the MS group were separated from their dams for 3 h/day from postnatal day (PND) 1 to 21, while those in the NS control remained in the home cage with their dams. In adulthood (8-week old), 3 mice in each group were randomly selected to undergo a battery of behavior tests. The remaining 8 mice in each group were induced with endometriosis by intraperitoneal injection of uterine fragments from donor mice. Four weeks after the induction, all mice were sacrificed and their endometriotic lesions were excised for quantification and then prepared for immunohistochemistry analysis.

Results

We confirmed that MS during infancy resulted in anxiety and depression-like behaviors as previously reported. We also found that in MS mice the lesion weight was increased by over 2 folds and generalized hyperalgesia was also significantly increased as compared with NS mice. Immunostaining analysis demonstrated that MS accelerated the development of endometriosis likely through decreased dopamine receptor D2 (DRD2) expression and activation of the ADRB2/cAMP-response element binding protein (CREB) signaling pathway, leading to increased angiogenesis and progression of endometriotic lesions.

Conclusions

Exposure of female mouse pups to ELA such as MS during their infancy period accelerates the progression of endometriosis, possibly through altered neuronal wiring and hyperactivity of the hypothalamic-pituitary-adrenal axis.
Association between body mass index and survival outcomes for cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis
Authors: An Yue , Wu Zhonghua , Wang Ningning , Yang Zhidong , Li Yue , Xu Boyang , Sun Mingjun
Published: June 2020

Background

Immune checkpoint inhibitors (ICIs) have been increasingly applied in the treatment of several kinds of malignancies. Some clinical demographic characteristics were reported to be associated with the ICIs efficacy. The purpose of our current meta-analysis was to clearly evaluated the relationship between BMI and ICIs efficacy for cancer patients receiving immunotherapy.

Methods

A systematic search of Pubmed, EMBASE and conference proceedings was performed to investigate the influence of BMI on ICIs efficacy. Pooled analysis for overall survival (OS), progression-free survival (PFS) and immune-related adverse effects (IRAEs) were analyzed in current study.

Results

A total of 13 eligible studies comprising 5279 cancer patients treated with ICIs were included in the analysis. The pooled analysis showed there is positive association between high BMI and improved OS and PFS among patients with ICIs treatment (OS: HR = 0.62, 95% CI 0.55–0.71, P < 0.0001; I2 = 26.3%, P = 0.202); PFS: HR = 0.71, 95% CI 0.61–0.83, P < 0.0001; I2 = 0%, P = 0.591). There is no significant difference between the incidence of all grade IRAEs between obese, overweight patients and normal patients (Overweight vs Normal: pooled RR = 1.28, 95% CI 0.76– 2.18, P = 0.356; Obese vs Normal: pooled RR = 1.36, 95% CI 0.85– 2.17, P = 0.207).

Conclusion

An improved OS and PFS were observed in patients with high BMI after receiving ICIs treatment compared with patients of low BMI. No significant association between BMI and incidence of IRAEs was found in cancer patients after ICIs treatment.
CX3CR1-microglia mediates neuroinflammation and blood pressure regulation in the nucleus tractus solitarii of fructose-induced hypertensive rats
Authors: Ho Chiu-Yi , Lin Yu-Te , Chen Hsin-Hung , Ho Wen-Yu , Sun Gwo-Ching , Hsiao Michael , Lu Pei-Jung , Cheng Pei-Wen , Tseng Ching-Jiunn
Published: June 2020

Background

Inflammation is a common pathophysiological trait found in both hypertension and cardiac vascular disease. Recent evidence indicates that fractalkine (FKN) and its receptor CX3CR1 have been linked to inflammatory response in the brain of hypertensive animal models. Here, we investigated the role of CX3CR1-microglia in nitric oxide (NO) generation during chronic inflammation and systemic blood pressure recovery in the nucleus tractus solitarii (NTS).

Methods

The hypertensive rat model was used to study the role of CX3CR1-microglia in NTS inflammation following hypertension induction by oral administration of 10% fructose water. The systolic blood pressure was measured by tail-cuff method of non-invasive blood pressure. The CX3CR1 inhibitor AZD8797 was administered intracerebroventricularly (ICV) in the fructose-induced hypertensive rat. Using immunoblotting, we studied the nitric oxide synthase signaling pathway, NO concentration, and the levels of FKN and CX3CR1, and pro-inflammatory cytokines were analyzed by immunohistochemistry staining.

Results

The level of pro-inflammatory cytokines IL-1β, IL-6, TNF-α, FKN, and CX3CR1 were elevated two weeks after fructose feeding. AZD8797 inhibited CX3CR1-microglia, which improved the regulation of systemic blood pressure and NO generation in the NTS. We also found that IL-1β, IL-6, and TNF-α levels were recovered by AZD8797 addition.

Conclusion

We conclude that CX3CR1-microglia represses the nNOS signaling pathway and promotes chronic inflammation in fructose-induced hypertension. Collectively, our results reveal the role of chemokines such as IL-1β, IL-6, and TNF-α in NTS neuroinflammation with the involvement of FKN and CX3CR1.
A phase 1 trial of the safety, tolerability and biological effects of intravenous Enadenotucirev, a novel oncolytic virus, in combination with chemoradiotherapy in locally advanced rectal cancer (CEDAR)
Authors: O’Cathail Séan M. , Davis Steven , Holmes Jane , Brown Richard , Fisher Kerry , Seymour Leonard , Adams Richard , Good James , Sebag-Montefiore David , Maughan Tim , Hawkins Maria A.
Published: June 2020

Background

Chemoradiotherapy remains the standard of care for locally advanced rectal cancer. Efforts to intensify treatment and increase response rates have yet to yield practice changing results due to increased toxicity and/or absence of increased radiosensitization. Enadenotucirev (EnAd) is a tumour selective, oncolytic adenovirus which can be given intravenously. Pre-clinical evidence of synergy with radiation warrants further clinical testing and assessment of safety with radiation.

Methods

Eligibility include histology confirmed locally advanced rectal cancer that require chemoradiation. The trial will use a Time-to-Event Continual Reassessment Model-based (TiTE-CRM) approach using toxicity and efficacy as co-primary endpoints to recommend the optimal dose and treatment schedule 30 patients will be recruited. Secondary endpoints include pathological complete response the neoadjuvant rectal score. A translational program will be based on a mandatory biopsy during the second week of treatment for ‘proof-of-concept’ and exploration of mechanism. The trial opened to recruitment in July 2019, at an expected rate of 1 per month for up to 4 years.

Discussion

Chemoradiation with Enadenotucirev as a radiosensitiser in locally Advanced Rectal cancer (CEDAR) is a prospective multicentre study testing a new paradigm in radiosensitization in rectal cancer. The unique ability of EnAd to selectively infect tumour cells following intravenous delivery is an exciting opportunity with a clear translational goal. The novel statistical design will make efficient use of both toxicity and efficacy data to inform subsequent studies.

Trial registration

ClinicalTrial.gov, NCT03916510. Registered 16th April 2019.
Strongly $(\eta ,\omega )$-convex functions with nonnegative modulus
Authors: Tameru Ana M. , Nwaeze Eze R. , Kermausuor Seth
Published: June 2020

We introduce a new class of functions called strongly $(\eta,\omega)$(η,ω)-convex functions. This class of functions generalizes some recently introduced notions of convexity, namely, the η-convex functions and strongly η-convex functions. We also establish inequalities of the Hermite–Hadamard–Fejér’s type, which generalize results of Delavar and Dragomir (Math. Inequal. Appl. 20(1):203–216, 2017) and Awan et al. (Filomat 31(18):5783–5790, 2017). In addition, we obtain some new results for this class of functions. Finally, we apply our results to the k-Riemann–Liouville fractional integral operators to obtain more results in this direction.
Optimal harvesting of an abstract population model with interval biological parameters
Authors: Huang Lirong , Cai Donghan , Liu Weiyi
Published: June 2020

We study the optimal harvesting policy for fishery in the marine protected and unreserved areas. In the literature, it is generally assumed that the fish population follows a concrete growth law. In contrast, we consider an abstract model with migration from the reserved area to the unreserved one. Then we examine and analyze the existence and stability of a nontrivial equilibrium point of the model. We also discuss the bionomic equilibrium. After that, we use the Pontryagin maximum principle to obtain the optimal harvest policy, where, instead of the well-known Hamiltonian function, we use the current Hamiltonian function to ease the calculation. Finally, we give some numerical examples to further illustrate our statements, where we also find that in practice the impreciseness of the parameters can influence the existence of the system positive equilibrium.
Cut Bogner-Fox-Schmit elements for plates
Authors: Burman Erik , Hansbo Peter , Larson Mats G.
Published: June 2020

We present and analyze a method for thin plates based on cut Bogner-Fox-Schmit elements, which are$$C^1$$C1elements obtained by taking tensor products of Hermite splines. The formulation is based on Nitsche’s method for weak enforcement of essential boundary conditions together with addition of certain stabilization terms that enable us to establish coercivity and stability of the resulting system of linear equations. We also take geometric approximation of the boundary into account and we focus our presentation on the simply supported boundary conditions which is the most sensitive case for geometric approximation of the boundary.
Understanding relatives’ experience of death rattle
Authors: van Esch Harriëtte J. , Lokker Martine E. , Rietjens Judith , van Zuylen Lia , van der Rijt Carin C. D. , van der Heide Agnes
Published: June 2020

Background

Death rattle is a frequently occurring symptom in the last phase of life. The experience of death rattle of relatives has been found to vary. It is unclear if treatment with medication is useful. The most fitting solution for this symptom is still under debate.

Aim

This study aims to better understand the experience of relatives of their loved ones’ death rattle.

Design

A qualitative interview study with a phenomenological approach was performed. Data were collected through semi-structured interviews which were audio recorded, transcribed and analyzed using qualitative content analysis.

Participants

Nineteen family members of 15 patients were interviewed.

Results

Most relatives had experienced death rattle as a distressing symptom. Concerns about how long the rattling would last resulted in more distress. Experience of death rattle was less fierce when other symptoms such as pain or dyspnea prevailed. Hearing the sound of death rattle sometimes reminded relatives of previously witnessed dying trajectories, which seemed to increase their current level of distress. The experience of death rattle is not always influenced by the amount and quality of information given about the symptom.

Conclusion

Death rattle is a stressful symptom and the experience of relatives is influenced by more factors than the sound itself. Communication and information alone seem inefficient to address relatives’ distress. The best approach for dealing with this symptom is unclear. Further research needs to show if prophylactically given drugs may be helpful in its prevention.
Uncovering hidden jewels: an investigation of the pictorial layers of an 18th-century Taskin harpsichord
Authors: Cortea Ioana Maria , Ghervase Luminița , Ratoiu Lucian , Dinu Monica , Rădvan Roxana
Published: June 2020

The Peleș National Museum in Sinaia, Romania, includes within its collection of musical instruments a unique harpsichord of the Taskin workshop. The instrument is representative of the eighteenth century French harpsichords, finished in 1772 by Taskin Pascal, a master instrument-maker of his time. This paper presents the results of a comprehensive diagnostic investigation carried out on the exterior decoration of the harpsichord, by means of multiple non-invasive and micro-invasive analytical techniques: multispectral imaging, X-ray fluorescence (XRF) spectroscopy, laser-induced breakdown spectroscopy (LIBS), Fourier transform infrared spectroscopy (FTIR), and optical microscopy (OM). Imaging investigation highlighted various past interventions and restorations—fillings, consolidation and chromatic reintegration of the paint layer, as well as some interesting details related to the preparatory layer and on the painting technique. Results of the elemental analysis indicated that a rich color palette was used for the luxurious decorations: vermilion for most of the red areas, lead white, a copper-based pigment for the blue and violet hues, along with Prussian blue, chromium oxides for the green tones and possibly emerald green, and iron oxides for the red, yellow and ochre tones. FTIR analysis highlighted the existence of two-layers ground based on the first layer of chalk and animal glue, covered by a second oil-bound layer of lead white. Metal soaps, gypsum, barium sulfate as well as an intermediate sizing layer based on shellac were also identified. Examination of samples’ cross-sections revealed a rich stratigraphy, up to ten layers being highlighted for samples taken from the case sides’ painting. The presence of two gold foils on the gilded areas, one at the top and the other within the intermediate layers, provides clear evidence of later interventions. The corroborated results offer valuable physico-chemical insights on the complex history of this prestigious harpsichord with remarkable aesthetic and historical value, as well as key information for its most suitable restoration approach.
Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths
Authors: Bechtel Kirsten , Gawel Marcie , Vincent Gregory A. , Violano Pina
Published: June 2020

Background

Sudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. The objective of our study was to understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments.

Methods

We surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011–2015) and after implementation of the legislation (2016–2018). Chi-Square and Fisher’s exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation.

Results

All 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law (p < 0.01).

Conclusions

Despite most CT hospitals providing caregivers with anticipatory guidance on safe sleep at newborn hospital discharge, SUIDs rates associated with positional asphyxia increased in CT after the passage of the legislation. The role of legislation for reducing the number of SUIDs from hazardous sleep environments should be reconsidered.
Chemical profiling of volatile organic compounds from shoe odour for personal identification
Authors: Mohd Kamal Muhammad Hafizuddin , Zakaria Yusmazura , Md Isa Muhammad Lokman , Nik Hassan Nik Fakhuruddin
Published: June 2020

Background

Body odour of an individual has a unique composition due to the combined influences of genetic, dietary, and environmental factors. This exploratory study was conducted to investigate the feasibility of obtaining unique chemical signatures of individuals from the shoe odour as a human chemical fingerprint for forensic identification.

Methods

Five adult males and five adult females participated in this study and provided with two pairs of new canvas sports shoes. The participants were asked to do strenuous activities while wearing the shoes for 2 weeks. Two different extraction methods: swabbing technique, followed with direct extraction using different solvents, and air passive sampling technique, were compared for the effectiveness to extract the volatile organic compounds (VOCs) from the shoes. The variations of VOCs were investigated using gas chromatography coupled with flame ionisation detector (GC-FID), and the resultant chromatogram profiles collected from the shoe odour were further studied for individual identification purposes. In addition, principal component-discriminant analyses (PCA-DA) were then carried out on the GC dataset.

Results

This study demonstrated that air passive sampling technique using methanol as the extraction solvent was effective for the detection of shoe odour. PCA-DA had successfully distinguished GC profile patterns and discriminated the shoe odour samples accordingly to their owners. The accuracy of DA for classification was 100%, with all samples were classified correctly to their groups.

Conclusion

The chemical compounds of shoe odour have the potential to be utilised to aid the forensic investigation by identifying and narrowing down the possible suspect if shoes were recovered as evidence at the crime scene.
Systemic sclerosis: correlation between lung abnormalities on high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs)
Authors: Ibrahim Iman Mohamed Hamdy , Gamal Sherif Mohamed , Salama Adham Mamdouh , Khairy Mostafa Ahmed
Published: June 2020

Background

Systemic sclerosis is a connective tissue disease that affects multiple systems and causes fibrosis of the skin and internal organs. There are two ways in which the lungs can be involved in patients with systemic sclerosis, either isolated pulmonary hypertension or interstitial lung fibrosis. The purpose of this study is to correlate the high resolution CT findings with pulmonary function tests in patients with systemic sclerosis to evaluate the severity of lung changes.

Results

Significant inverse correlations were found between the maximal extent radiological score, maximal severity radiological score as well as total (global) radiological score on one hand and the pulmonary function tests on the other hand

Conclusion

The combination of high resolution CT and pulmonary function tests are recommended for better assessment of the extent and severity of systemic sclerosis associated interstitial lung disease.
Seismic prediction of soil distribution for the Chang-Bin offshore wind farm in the Taiwan Strait
Authors: Han Wei-Chung , Lu Yi-Wei , Lo Sheng-Chung
Published: June 2020

Direct soil measurements are limited to borehole locations and are therefore sparse in the oceans. To effectively characterize the soil distributions for the Chang-Bin offshore wind farm, which is an area with the greatest wind energy potential in the Taiwan Strait, we have developed a workflow to predict the soil distribution in the subsurface based on integrated analysis of seismic data and borehole data. First, we characterize the key seismic units and their seismic response in order to understand the regional stratigraphy. Then, we correlate the soil types to each stratigraphic unit as the constraint for the input and quality control to train a neural network based on seismic multiattribute analysis. Finally, we develop a neural network that is suitable for soil prediction in the Chang-Bin offshore wind farm. Five seismic units identified from the seismic profiles reveal that the regional stratigraphy has been greatly affected by sea-level change and the sediment transportation process. Confirmed by independent in situ borehole data, the neural network is considered reliable up to 60 m below the seafloor, whereas decreased signal-to-noise ratios at greater depths lead to poorer prediction accuracy. Compared to previous studies that mainly are based on high-quality 3D seismic and well logging data, our method can predict the soil distribution by analyzing 2D seismic profiles and simplified soil layers alone. The prediction results reveal detailed lithologic variations that are tested by in situ borehole measurements. Therefore, we are confident that this approach could effectively obtain the soil distribution prediction and thus reduce the costs in offshore engineering applications.
International Rare Cancers Initiative Multicenter Randomized Phase II Trial of Cisplatin and Fluorouracil Versus Carboplatin and Paclitaxel in Advanced Anal Cancer: InterAAct
Authors: Rao Sheela , Sclafani Francesco , Eng Cathy , Adams Richard A. , Guren Marianne G. , Sebag-Montefiore David , Benson Al , Bryant Annette , Peckitt Clare , Segelov Eva , Roy Amitesh , Seymour Matt T. , Welch Jack , Saunders Mark P. , Muirhead Rebecca , O’Dwyer Peter , Bridgewater John , Bhide Shree , Glynne-Jones Rob , Arnold Dirk , Cunningham David
Published: June 2020

PURPOSE

To compare cisplatin plus fluorouracil (FU) versus carboplatin plus paclitaxel in chemotherapy-naïve advanced anal cancer to establish the optimal regimen.

PATIENTS AND METHODS

Patients who had not received systemic therapy for advanced anal cancer were randomly assigned 1:1 to intravenous cisplatin 60 mg/m2 (day 1) plus FU 1,000 mg/m2 (days 1-4) every 21 days or carboplatin (area under the curve, 5; day 1) plus paclitaxel 80 mg/m2 (days 1, 8, and 15) every 28 days for 24 weeks, until disease progression, intolerable toxicity, or withdrawal of consent. Primary end point was objective response rate (ORR). Primary and secondary end points were assessed in a hierarchic model to compare the regimens and pick the winner.

RESULTS

We conducted an international multicenter randomized phase II study in 60 centers between December 2013 and November 2017. Median follow-up was 28.6 months. A total of 91 patients were randomly assigned: 46 to cisplatin plus FU and 45 to carboplatin plus paclitaxel. ORR was 57% (95% CI, 39.4% to 73.7%) for cisplatin plus FU versus 59% (95% CI, 42.1% to 74.4%) for carboplatin plus paclitaxel. More serious adverse events were noted in the cisplatin plus FU arm (62%) compared with the carboplatin plus paclitaxel arm (36%; P = .016). Median progression-free survival was 5.7 months (95% CI, 3.3 to 9.0 months) for cisplatin plus FU compared with 8.1 months (95% CI, 6.6 to 8.8 months) for carboplatin plus paclitaxel. Median overall survival was 12.3 months for cisplatin plus FU (95% CI, 9.2 to 17.7 months) compared with 20 months (95% CI, 12.7 months to not reached) for carboplatin plus paclitaxel (hazard ratio, 2.00; 95% CI, 1.15 to 3.47; P = .014).

CONCLUSION

This is the first international randomized trial to our knowledge conducted in chemotherapy-naïve advanced anal cancer. Although there was no difference in ORR, the association with clinically relevant reduced toxicity and a trend toward longer survival suggest that carboplatin plus paclitaxel should be considered as a new standard of care.
Water-Soluble Red-Fluorescent Dyes for Two-Photon Deep-Tissue Imaging
Authors: Onishi Shozo , Suzuki Yasutaka , Ano Hikari , Kawamata Jun
Published: June 2020

To realize in vivo deep two-photon fluorescence microscopy (TPFM), a probe is required that can undergo two-photon excitation and emit in the optical window of tissues (650–1100 nm). In addition, the probe should have high water solubility to avoid harmful organic solvents. 2,5-Dimethoxy-1,4-bis{1-[2-[2-(2-hydroxyethoxy)ethoxy]ethyl]-4-(1,3-butadien-1-yl)pyrinium}benzene iodide (MPBBI-PEG) was designed to meet all these criteria. Its water solubility is 10−4 mol dm−3, which is sufficient to stain biomaterials without organic solvents. The two-photon absorption (TPA) maximum is 960 nm with a cross section of 638 GM (1 GM = 1 × 10−50 cm4 per photon per molecule), and the fluorescence emission maximum is 663 nm. Distinct two-photon microscope images of HEK293 cells stained with aqueous MPBBI-PEG were obtained with less than 2 mW excitation. Thus, MPBBI-PEG is especially suitable for non-invasive TPFM imaging of deep tissues.
The Limit of Stationary Distributions of Many-Server Queues in the Halfin–Whitt Regime
Authors: Aghajani Reza , Ramanan Kavita
Published: June 2020

We consider the so-called GI/GI/N queue, in which a stream of jobs with independent and identically distributed service times arrive as a renewal process to a common queue that is served by [Formula: see text] identical parallel servers in a first-come, first-served manner. We introduce a new representation for the state of the system and, under suitable conditions on the service and interarrival distributions, establish convergence of the corresponding sequence of centered and scaled stationary distributions in the so-called Halfin–Whitt asymptotic regime. In particular, this resolves an open question posed by Halfin and Whitt in 1981. We also characterize the limit as the stationary distribution of an infinite-dimensional, two-component Markov process that is the unique solution to a certain stochastic partial differential equation. Previous results were essentially restricted to exponential service distributions or service distributions with finite support, for which the corresponding limit process admits a reduced finite-dimensional Markovian representation. We develop a different approach to deal with the general case when the Markovian representation of the limit is truly infinite dimensional. This approach is more broadly applicable to a larger class of networks.
Imaging in trauma of the facial skeleton and soft tissues of the neck
Authors: Bitar George , Touska Philip
Published: June 2020

Trauma to the face and neck is a frequent reason for emergency department attendance. Imaging is invaluable in the characterisation of such injuries, enabling delineation of fracture patterns as well as identification of vascular and other soft tissue injuries. It may also be used to prevent long-term mortality and morbidity and provide a roadmap for surgical intervention so that form and function may be restored. This article gives a pictorial review of the imaging of craniofacial trauma, stratified according to the thirds of the face, followed by a review of blunt and penetrating trauma of the neck. It discusses appropriate imaging modalities for each trauma category, describes major patterns of craniofacial trauma on cross-sectional imaging and identifies clinically relevant imaging features that should trigger subspecialist review or be of relevance to pre-surgical planning. It starts with the upper third comprising frontal sinus fractures before describing the component fractures of the middle third (including nasal, zygomaticomaxillary and orbital fractures) and then focusing on the lower third (specifically mandibular and dentoalveolar fractures). The article concludes with a review of soft tissue injuries of the neck, particularly penetrating, blunt and laryngeal trauma.