bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of children and adolescents with bronchiectasis: summary of the ERS clinical practice guideline
Authors: Chang Anne B. , Grimwood Keith , Boyd Jeanette , Fortescue Rebecca , Powell Zena , Kantar Ahmad
Published: October 2021

Bronchiectasis, characterised by chronic wet/productive cough with recurrent respiratory exacerbations and abnormal bronchial dilatation on computed tomography scans, remains an increasingly recognised but often neglected chronic pulmonary disorder in children and adolescents. An early diagnosis combined with optimal management offers the prospect, at least in some patients, of curing a condition previously considered irreversible. However, unlike in adults, until now no international paediatric guidelines existed. The recently published European Respiratory Society clinical practice guidelines for the management of children and adolescents with bronchiectasis attempts to address this clinical information gap. The guidelines were formulated by panel members comprised of experts from several relevant health fields, the European Lung Foundation and parents of children with bronchiectasis. Systematic reviews and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach guided the nature and strength of recommendations. The recommendations are grouped into clinically relevant topics: diagnosis, evaluating for underlying causes, defining exacerbations, management, systematic care, monitoring, reversibility and prevention. The guidelines seek to achieve: 1) optimal lung growth, 2) preserved lung function, 3) enhanced quality of life, 4) minimal exacerbations, 5) few or no complications, and 6) if possible, reversal of lung injury for each child/adolescent with bronchiectasis. This review presents example cases that highlight the recommendations of the clinical practice guidelines.

Educational aims

This article is intended for those involved in caring for children/adolescents with bronchiectasis. It aims to inform:

Clinicians of the European Respiratory Society recommendations for the diagnosis and management of children/adolescents with bronchiectasis.

Adolescents and parents of children/adolescents with bronchiectasis of these recommendations, so as to assist discussions with healthcare teams and help facilitate access to appropriate care.
Comparative efficacy of delafloxacin for complicated and acute bacterial skin and skin structure infections: results from a network meta-analysis
Authors: Vlachaki Ioanna , Vacchelli Matteo , Zinzi Daniela , Falla Edel , Jiang Yilin , Mantopoulos Theo , Nathwani Dilip
Published: October 2021

Background

Delafloxacin is a novel fluoroquinolone with broad antibacterial activity against pathogens causing acute bacterial skin and skin structure infections (ABSSSI). This network meta-analysis (NMA) was conducted to evaluate the relative efficacy of delafloxacin versus other comparators used for managing patients with ABSSSI.

Methods

A systematic literature review was conducted to identify randomised controlled trials (RCTs) evaluating adults (≥ 18 years) with ABSSSI, complicated SSSI (cSSSI), complicated skin and soft tissue infections (cSSTI) or severe cellulitis with pathogen of gram-positive, gram-negative, or mixed aetiology. OVID MEDLINE®, Embase, Epub Ahead of Print, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched from inception through 12 April 2019. A feasibility assessment was conducted, followed by an NMA, which was run in a Bayesian framework. The interventions included in the NMA encompassed monotherapy or combination therapies of amoxicillin/clavulanate, ampicillin/sulbactam, ceftaroline, ceftobiprole, dalbavancin, daptomycin, delafloxacin, fusidic acid, iclaprim, linezolid, omadacycline, oxacillin + dicloxacillin, standard therapy, tedizolid, telavancin, tigecycline, vancomycin, vancomycin + aztreonam and vancomycin + linezolid.

Results

A feasibility assessment was performed and evidence networks were established for composite clinical response (n = 34 studies), early clinical response (n = 16 studies) and microbiological response (n = 14 studies) in the overall study population, composite clinical response (n = 4 studies) in obese subpopulation and for composite clinical response (n = 18 studies) and microbiological response (n = 14 studies) in patients with methicillin-resistantStaphylococcus aureus(MRSA) infection. Delafloxacin performed significantly better than fusidic acid, iclaprim, vancomycin, and ceftobiprole for composite clinical response. Delafloxacin was comparable to dalbavancin, daptomycin, fusidic acid, iclaprim, linezolid, omadacycline, tedizolid, vancomycin, vancomycin + aztreonam and vancomycin + linezolid in the analysis of early clinical response, whereas for microbiological response, delafloxacin was comparable to all interventions. In the obese subpopulation, the results favoured delafloxacin in comparison to vancomycin, whilst the results were comparable with other interventions among the MRSA subpopulation.

Conclusions

Delafloxacin is a promising new antibiotic for ABSSSI demonstrating greater improvement (composite clinical response) compared to ceftobiprole, fusidic acid, iclaprim, telavancin and vancomycin and comparable effectiveness versus standard of care for all outcomes considered in the study.
Parents’ and teachers’ views of the promotion of healthy eating in Australian primary schools
Authors: Aydin Gozde , Margerison Claire , Worsley Anthony , Booth Alison
Published: October 2021

Background

Primary schools have long been identified as appropriate settings for improving the healthy eating behaviours of children and helping them develop food skills. This qualitative study explored the views of Australian primary school parents and teachers about schools’ strengths and weaknesses in promoting healthy eating and equipping children with food skills.

Methods

Nineteen parents and 17 teachers from Victoria participated in semi-structured interviews. Audio recordings were transcribed and underwent thematic analysis using Nvivo.

Results

This study demonstrated that parents and teachers believed that several facilitators helped promote children’s healthy eating. These included food and nutrition education (FNE) programs, the community-based nature of schools, and teacher role modelling and the authority schools possess over children. Time scarcity, lack of teacher expertise, lack of leadership and funding were reported as barriers. School food environments such as canteens, lunch orders, fundraising events and school fairs were identified as both weaknesses and strengths by parents and teachers, which indicated inconsistent implementation of school nutrition policies across schools.

Conclusions

Australian primary schools demonstrate some useful efforts to promote healthy eating among children. However, there are numerous facilitators and barriers which impact on the promotion of healthy eating. These factors need to be addressed in order to develop healthy eating habits further among elementary students. These results provide directions for policymakers and school managers, as they point to the areas that need to be improved to assist the design of schools that better promote healthy eating among children.
CT-based and morphological comparison of glenoid inclination and version angles and mineralisation distribution in human body donors
Authors: Serrano Nabil , Kissling Marc , Krafft Hannah , Link Karl , Ullrich Oliver , Buck Florian M. , Mathews Sandra , Serowy Steffen , Gascho Dominic , Grüninger Patrick , Fornaciari Paolo , Bouaicha Samy , Müller-Gerbl Magdalena , Rühli Frank-Jakobus , Eppler Elisabeth
Published: October 2021

Background

For optimal prosthetic anchoring in omarthritis surgery, a differentiated knowledge on the mineralisation distribution of the glenoid is important. However, database on the mineralisation of diseased joints and potential relations with glenoid angles is limited.

Methods

Shoulder specimens from ten female and nine male body donors with an average age of 81.5 years were investigated. Using 3D-CT-multiplanar reconstruction, glenoid inclination and retroversion angles were measured, and osteoarthritis signs graded. Computed Tomography-Osteoabsorptiometry (CT-OAM) is an established method to determine the subchondral bone plate mineralisation, which has been demonstrated to serve as marker for the long-term loading history of joints. Based on mineralisation distribution mappings of healthy shoulder specimens, physiological and different CT-OAM patterns were compared with glenoid angles.

Results

Osteoarthritis grades were 0-I in 52.6% of the 3D-CT-scans, grades II-III in 34.3%, and grade IV in 13.2%, with in females twice as frequently (45%) higher grades (III, IV) than in males (22%, III). The average inclination angle was 8.4°. In glenoids with inclination ≤10°, mineralisation was predominantly centrally distributed and tended to shift more cranially when the inclination raised to > 10°. The average retroversion angle was − 5.2°. A dorsally enhanced mineralisation distribution was found in glenoids with versions from − 15.9° to + 1.7°. A predominantly centrally distributed mineralisation was accompanied by a narrower range of retroversion angles between − 10° to − 0.4°.

Conclusions

This study is one of the first to combine CT-based analyses of glenoid angles and mineralisation distribution in an elderly population. The data set is limited to 19 individuals, however, indicates that superior inclination between 0° and 10°-15°, and dorsal version ranging between − 9° to − 3° may be predominantly associated with anterior and central mineralisation patterns previously classified as physiological for the shoulder joint. The current basic research findings may serve as basic data set for future studies addressing the glenoid geometry for treatment planning in omarthritis.
Polymorphic variants in genes related to stress coping are associated with the awake bruxism
Authors: Maciejewska-Szaniec Zofia , Kaczmarek-Ryś Marta , Hryhorowicz Szymon , Przystańska Agnieszka , Gredes Tomasz , Maciejewska Barbara , Hoppe-Gołębiewska Justyna , Słomski Ryszard , Pławski Andrzej , Czajka-Jakubowska Agata
Published: October 2021

Background

Chronic stress is one of the leading predisposing factors in bruxism aetiology, but the influence of genetic factors is also suggested. We aimed to study whether sequence variants in genes involved in stress regulation pathways: NTRK2 and BDNF, may be associated with awake bruxism susceptibility, clinical presentation, and patients’ perceived stress level.

Methods

The study group included 104 patients with probable awake bruxism and 191 population controls. Patients underwent dental examination concerning the symptoms of bruxism and psychological testing. Genotyping was performed using HRMA and sequencing. Statistical analyses were conducted, and P values below 0.05 were considered statistically significant.

Results

We observed a positive correlation of measured stress level and pathological teeth attrition in the anterior segment (r = 0.45, P < 0.001), enamel attritions (r = 0.44, P < 0.001), tongue impressions (r = 0.50, P < 0.001) and posterior teeth attrition (r = 0.27, P = 0.005). Moreover, the c.196A variant (p.66Met) of the BDNF gene and c.1397-31392G allele of the NTRK2 gene were present with elevated frequency, comparing to controls.

Conclusions

This study hence the thesis that perceived stress level is a substantial contributing factor to awake bruxism occurrence and its clinical manifestations. Moreover, sequence variants in genes related to stress coping may be correlated with awake bruxism’s susceptibility via elevated perceived stress level.
Influence of restorative material and cement on the stress distribution of endocrowns: 3D finite element analysis
Authors: He Jiahui , Zheng Ziting , Wu Min , Zheng Chunqing , Zeng Yuting , Yan Wenjuan
Published: October 2021

Purpose

This study aimed to evaluate the influence of different types of restorative materials and resin cements on the stress distribution in the regions of the restoration, cement layer and dental remnant in endodontically treated posterior endocrowns.

Methods

A 3D finite element analysis (FEA) model of the first mandibular molar that was restored with an endocrown designed by computer-aided design (CAD) software was generated. Three kinds of restorative materials (Vita Enamic (VE), IPS e.max CAD (EMX) and Grandio blocs (GR)) and two types of cementing materials (NX3 and Maxcem Elite Chroma (MX)) were analysed with such a model. The food layer was also designed before vertical (600 N) forces were applied to simulate physiological masticatory conditions. Thermal expansion was used to simulate the polymerization shrinkage effects of cement layers. The results were obtained by colorimetric graphs of the maximum principal stress in the restoration and tooth remnant. The failure risk of the cement layer was also calculated based on the normal stress.

Results

The elastic modulus was positively correlated with the tensile stress peak values in the restoration, mainly at the intaglio surface. However, in the cervical enamel and cement layer, restorative material with a higher elastic modulus generated lower peak stress values. The cement with a higher elastic modulus resulted in higher stress peak values inside the cement layer. The combination of EMX (restorative material) and NX3 (cement material) in the cement layer resulted in the lowest failure risk.

Significance

The ceramic material EMX with a higher elastic modulus appeared to be more effective at protecting the cement layer and residual enamel tissue. Based on the analysis of the failure risk of the cement layer, the combination of EMX and NX3 was recommended as an optional material for endocrowns for endodontically treated posterior teeth.
Factors contributing to the recruitment and retention of rural pharmacist workforce: a systematic review
Authors: Terry Daniel , Phan Hoang , Peck Blake , Hills Danny , Kirschbaum Mark , Bishop Jaclyn , Obamiro Kehinde , Hoang Ha , Nguyen Hoang , Baker Ed , Schmitz David
Published: October 2021

Background

Recruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists’ retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages.

Methods

A systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists.

Results

The final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors.

Conclusions

The results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.
Influenza a virus NS1 resembles a TRAF3-interacting motif to target the RNA sensing-TRAF3-type I IFN axis and impair antiviral innate immunity
Authors: Lin Chun-Yang , Shih Meng-Cen , Chang Hung-Chun , Lin Kuan-Jung , Chen Lin-Fang , Huang Sheng-Wen , Yang Mei-Lin , Ma Sheng-Kai , Shiau Ai-Li , Wang Jen-Ren , Chen Kuan-Ru , Ling Pin
Published: October 2021

Background

Influenza A virus (IAV) evolves strategies to counteract the host antiviral defense for establishing infection. The influenza A virus (IAV) non-structural protein 1 (NS1) is a key viral factor shown to counteract type I IFN antiviral response mainly through targeting RIG-I signaling. Growing evidence suggests that viral RNA sensors RIG-I, TLR3, and TLR7 function to detect IAV RNA in different cell types to induce type I IFN antiviral response to IAV infection. Yet, it remains unclear if IAV NS1 can exploit a common mechanism to counteract these RNA sensing pathways to type I IFN production at once, then promoting viral propagation in the host.

Methods

Luciferase reporter assays were conducted to determine the effect of NS1 and its mutants on the RIG-I and TLR3 pathways to the activation of the IFN-β and NF-κB promoters. Coimmunoprecipitation and confocal microscopic analyses were used to the interaction and colocalization between NS1 and TRAF3. Ubiquitination assays were performed to study the effect of NS1 and its mutants on TRAF3 ubiquitination. A recombinant mutant virus carrying NS1 E152A/E153A mutations was generated by reverse genetics for biochemical, ex vivo, and in vivo analyses to explore the importance of NS1 E152/E153 residues in targeting the RNA sensing-TRAF3-type I IFN axis and IAV pathogenicity.

Results

Here we report that NS1 subverts the RIG-I, TLR3, and TLR7 pathways to type I IFN production through targeting TRAF3 E3 ubiquitin ligase. NS1 harbors a conserved FTEE motif (a.a. 150-153), in which the E152/E153 residues are critical for binding TRAF3 to block TRAF3 ubiquitination and type I IFN production by these RNA sensing pathways. A recombinant mutant virus carrying NS1 E152A/E153A mutations induces higher type I IFN production ex vivo and in vivo, and exhibits the attenuated phenotype in infected mice, indicating the importance of E152/E153 residues in IAV pathogenicity.

Conclusions

Together our work uncovers a novel mechanism of IAV NS1-mediated immune evasion to promote viral infection through targeting the RNA sensing-TRAF3-type I IFN axis.
Accuracy and precision of volumetric bone mineral density assessment using dual-source dual-energy versus quantitative CT: a phantom study
Authors: Koch Vitali , Hokamp Nils Große , Albrecht Moritz H. , Gruenewald Leon D. , Yel Ibrahim , Borggrefe Jan , Wesarg Stefan , Eichler Katrin , Burck Iris , Gruber-Rouh Tatjana , Lenga Lukas , Vogl Thomas J. , Martin Simon S. , Wichmann Julian L. , Hammerstingl Renate M. , Alizadeh Leona S. , Mader Christoph , Huizinga Nicole A. , D’Angelo Tommaso , Ascenti Giorgio , Mazziotti Silvio , Booz Christian
Published: October 2021

Background

Dual-source dual-energy computed tomography (DECT) offers the potential for opportunistic osteoporosis screening by enabling phantomless bone mineral density (BMD) quantification. This study sought to assess the accuracy and precision of volumetric BMD measurement using dual-source DECT in comparison to quantitative CT (QCT).

Methods

A validated spine phantom consisting of three lumbar vertebra equivalents with 50 (L1), 100 (L2), and 200 mg/cm3 (L3) calcium hydroxyapatite (HA) concentrations was scanned employing third-generation dual-source DECT and QCT. While BMD assessment based on QCT required an additional standardised bone density calibration phantom, the DECT technique operated by using a dedicated postprocessing software based on material decomposition without requiring calibration phantoms. Accuracy and precision of both modalities were compared by calculating measurement errors. In addition, correlation and agreement analyses were performed using Pearson correlation, linear regression, and Bland-Altman plots.

Results

DECT-derived BMD values differed significantly from those obtained by QCT (p < 0.001) and were found to be closer to true HA concentrations. Relative measurement errors were significantly smaller for DECT in comparison to QCT (L1, 0.94% versus 9.68%; L2, 0.28% versus 5.74%; L3, 0.24% versus 3.67%, respectively). DECT demonstrated better BMD measurement repeatability compared to QCT (coefficient of variance < 4.29% for DECT, < 6.74% for QCT). Both methods correlated well to each other (r = 0.9993; 95% confidence interval 0.9984–0.9997; p < 0.001) and revealed substantial agreement in Bland-Altman plots.

Conclusions

Phantomless dual-source DECT-based BMD assessment of lumbar vertebra equivalents using material decomposition showed higher diagnostic accuracy compared to QCT.
Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS
Authors: El Fayomy Nervana Mohamed , Mohamed Hanan Helmy , Kamal Manal Mohamed , Alsayyad Aya Hamid , Alsayyad Enas Hamid , Shamloul Reham Mohamed
Published: October 2021

Background

The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment.

Results

T1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS.

Conclusion

Early conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.
Effects of Tirzepatide, a Dual GIP and GLP-1 RA, on Lipid and Metabolite Profiles in Subjects With Type 2 Diabetes
Authors: Pirro Valentina , Roth Kenneth D , Lin Yanzhu , Willency Jill A , Milligan Paul L , Wilson Jonathan M , Ruotolo Giacomo , Haupt Axel , Newgard Christopher B , Duffin Kevin L
Published: October 2021

Context

Tirzepatide substantially reduced hemoglobin A1c (HbA1c) and body weight in subjects with type 2 diabetes (T2D) compared with the glucagon-like peptide 1 receptor agonist dulaglutide. Improved glycemic control was associated with lower circulating triglycerides and lipoprotein markers and improved markers of beta-cell function and insulin resistance (IR), effects only partially attributable to weight loss.

Objective

Assess plasma metabolome changes mediated by tirzepatide.

Design

Phase 2b trial participants were randomly assigned to receive weekly subcutaneous tirzepatide, dulaglutide, or placebo for 26 weeks. Post hoc exploratory metabolomics and lipidomics analyses were performed.

Setting

Post hoc analysis.

Participants

259 subjects with T2D.

Intervention(s)

Tirzepatide (1, 5, 10, 15 mg), dulaglutide (1.5 mg), or placebo.

Main Outcome Measure(s)

Changes in metabolite levels in response to tirzepatide were assessed against baseline levels, dulaglutide, and placebo using multiplicity correction.

Results

At 26 weeks, a higher dose tirzepatide modulated a cluster of metabolites and lipids associated with IR, obesity, and future T2D risk. Branched-chain amino acids, direct catabolic products glutamate, 3-hydroxyisobutyrate, branched-chain ketoacids, and indirect byproducts such as 2-hydroxybutyrate decreased compared to baseline and placebo. Changes were significantly larger with tirzepatide compared with dulaglutide and directly proportional to reductions of HbA1c, homeostatic model assessment 2-IR indices, and proinsulin levels. Proportional to metabolite changes, triglycerides and diglycerides were lowered significantly compared to baseline, dulaglutide, and placebo, with a bias toward shorter and highly saturated species.

Conclusions

Tirzepatide reduces body weight and improves glycemic control and uniquely modulates metabolites associated with T2D risk and metabolic dysregulation in a direction consistent with improved metabolic health.
Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers
Authors: Burghgraef T. A. , Hol J. C. , Rutgers M. L. , Crolla R. M. P. H. , van Geloven A. A. W. , Hompes R. , Leijtens J. W. A. , Polat F. , Pronk A. , Smits A. B. , Tuynman J. B. , Verdaasdonk E. G. G. , Verheijen P. M. , Sietses C. , Consten E. C. J.
Published: October 2021

Background

Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account.

Methods

This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression.

Results

The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account.

Conclusion

The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands.
Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma
Authors: Ishido Keinosuke , Kimura Norihisa , Wakiya Taiichi , Nagase Hayato , Hara Yutaro , Kanda Taishu , Fujita Hiroaki , Hakamada Kenichi
Published: October 2021

Background

Resectable pancreatic ductal adenocarcinoma (R-PDAC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment.

Patients and methods

One hundred and seventy-eight patients diagnosed with R-PDAC on computed tomography (CT) imaging and undergoing radical resection at Hirosaki University Hospital from 2005 to 2019 were retrospectively analyzed. Patients with recurrence within 6 months after resection formed the early recurrence (ER) group, while other patients constituted the non-early recurrence (non-ER) group. Early recurrence prediction score (ERP score) was developed using preoperative parameters.

Results

ER was observed in 45 patients (25.3%). The ER group had significantly higher preoperative CA19-9 (p = 0.03), serum SPan-1 (p = 0.006), and CT tumor diameter (p = 0.01) compared with the non-ER group. The receiver operating characteristic (ROC) curve analysis identified cutoff values for CA19-9 (133 U/mL), SPan-1 (78.2 U/mL), and preoperative tumor diameter (23 mm). When the parameter exceeded the cutoff level, 1 point was given, and the total score of the three factors was defined as the ERP score. The group with an ERP score of 3 had postoperative recurrence-free survival (RFS) of 5.5 months (95% CI 3.02–7.98). Multivariate analysis for ER-related perioperative and surgical factors identified ERP score of 3 [odds ratio (OR) 4.63 (95% CI 1.82–11.78), p = 0.0013] and R1 resection [OR 3.20 (95% CI 1.01–10.17), p = 0.049] as independent predictors of ER.

Conclusions

For R-PDAC, ER could be predicted by the scoring system using preoperative serum CA19-9 and SPan-1 levels and CT tumor diameter, which may have great significance in identifying patients with poor prognoses and avoiding unnecessary surgery.
Τέχνη και καλλιτέχνης στη δεύτερη φάση της εικονομαχίας
Authors: Αχτίδα Βασιλική
Published: October 2021

Με την παρούσα διδακτορική διατριβή επιχειρείται να καλυφθεί το κενό που διαπιστώνεται στην μέχρι τώρα έρευνα του φαινομένου της εικονομαχίας και ειδικά στην εικονολογία της εποχής αυτής, δηλαδή στις θεωρητικές προϋποθέσεις της βυζαντινής τέχνης. Με αφετηρία τις απόψεις του πατριάρχη Νικηφόρου για την τέχνη και τον καλλιτέχνη, παρουσιάζεται μια «εικονολογική ανάγνωση» των έργων του, και μια σύγκριση της επιχειρηματολογίας του με τις αντίστοιχες θεωρητικές απόψεις του Ιωάννη Δαμασκηνού και του Θεόδωρου Στουδίτη, ενώ λαμβάνονται υπόψη και οι προγενέστερες της εικονομαχίας αντιλήψεις για την τέχνη και τη χρήση της στη βυζαντινή κοινωνία. Παράλληλα εξετάζονται οι αναφορές σχετικά με τη χρήση των εικόνων και των έργων τέχνης ως αντικειμένων καθημερινής και λατρευτικής ζωής, καθώς με τον τρόπο αυτό διαφαίνεται η σημασία της βυζαντινής τέχνης στη διαμόρφωση της πολιτικής ιδεολογίας της βυζαντινής αυτοκρατορίας. Εκτός από την παρουσίαση και ανάλυση των περί τέχνης απόψεων του Νικηφόρου διερευνάται η αρχαιογνωσία του, και ιδιαίτερα οι πλατωνικές και αριστοτελικές επιδράσεις στην εικονολογική του σκέψη. Πέρα από όλα αυτά, μέσα από τα σχετικά κείμενα του πατριάρχη, εξετάζεται ο ρόλος του καλλιτέχνη-τεχνίτη στη βυζαντινή κοινωνία και η σύνδεσή του με τις αρχαιοελληνικές αντιλήψεις.
Durability of multi-scale reinforced epoxy composites
Authors: Μπαλτζής Δημήτριος
Published: October 2021

Η παρούσα διδακτορική διατριβή ασχολήθηκε με την μελέτη της επίδρασης της κλίμακας μεγέθους ανθρακικών πρόσθετων, στις τελικές ιδιότητες σύνθετων υλικών με εποξική μητρική φάση. Μέσω προκαταρκτικών μελετών επιλέχθηκαν οι νανοσωλήνες πολλαπλού τοιχώματος και ο άμορφος άνθρακας ως ενισχυτικά πρόσθετα, τα οποία είτε μεμονωμένα είτε συνδυαστικά εφαρμόστηκαν σε αναμείξεις υψηλών διατμητικών δυνάμεων. Πραγματοποιήθηκαν μετρήσεις για μελέτη της επίδρασης της μεθοδολογίας τροποποίησης (μίας ή πολλαπλής κλίμακας), σε εύρος ιδιοτήτων συναρτήσει πρωτόκολλων υδροθερμικής καταπόνησης. Επιλέχθηκε να μελετηθεί ένα εύρος μηχανικών, θερμομηχανικών, ηλεκτρικών και φυσικών ιδιοτήτων ώστε να μελετηθούν τα όρια και οι περιορισμοί της εκάστοτε μεθοδολογίας τροποποίησης τόσο σε επίπεδο ενίσχυσης εποξικού συνθέτου, αλλά και σε επίπεδο μητρικής φάσης σύνθετων υλικών με ινώδη ενισχυτική φάση.Στην πλειοψηφία των αποτελεσμάτων, η τροποποίηση πολλαπλής κλίμακας, οδήγησε σε σημαντικές βελτιώσεις ιδιοτήτων, ενώ αποδείχτηκε ικανότερη στην μείωση φαινομένων υδροθερμικής καταπόνησης. Χαρακτηριστικά, στην περίπτωση της αντοχής σε διάτμηση τύπου-ΙΙ σε επίπεδο σύνθετου με τροποποιημένη εποξική μήτρα σε πολλαπλή κλίμακα, η αθροιστική αύξηση άγγιξε το 120%, η οποία ήταν και η υψηλότερη βελτίωση στη σχετική βιβλιογραφία κατά την περίοδο των μετρήσεων. Η σημαντικές βελτιώσεις ιδιοτήτων, αποδόθηκαν στην δημιουργία τρισδιάστατου δικτύου σωματιδίων με συνεργιστικά φαινόμενα μεταξύ των διαφορετικών νάνο- και μίκρο- κλίμακας πρόσθετων. Το υβριδικό δίκτυο σωματιδίων το οποίο αποτελείτο από μεμονωμένους νανοσωλήνες, συσσωματώματα νανοσωλήνων μίκρο- και νάνο- διαστάσεων, μικρό-ίνες άνθρακα και άμορφο γραφίτη, εμφανίστηκε πιο αποτελεσματικό συγκρινόμενο με τα μίας κλίμακας αντίστοιχα δίκτυα, στην ενίσχυση ιδιοτήτων όπως δυναμικό ιξώδες, δυσθραυστότητα τύπου-Ι και -ΙΙ.Σε παράλληλη μελέτη, εφαρμόστηκε η τεχνική Ακουστικής Εκπομπής σε μετρήσεις ηλεκτροχημείας υποστρωμάτων αλουμινίου επικαλυμμένα με εποξικές επικαλύψεις τροποποιημένες σε μία και πολλαπλή κλίμακας μεγέθους, με στόχο τη μελέτη δυνατοτήτων της τεχνικής σαν εργαλείο ελέγχου διάβρωσης. Η τεχνική ακουστικής εμφάνισε ικανότητες σαν εργαλείο ελέγχου καθώς χαρακτηριστικοί δείκτες των σημάτων εμφάνισαν συσχέτιση με χαρακτηριστικές περιοχές και φαινόμενα διάβρωσης.
Functional genomics of supergene-controlled behavior in the white-throated sparrow
Authors: Holland Peter W H , Jiggins Chris D , Liedvogel Miriam , Warren Graham , Wurm Yannick
Published: October 2021

Supergenes are regions of suppressed recombination that may span hundreds of genes and can control variation in key ecological phenotypes. Since genetic analysis is made impossible by the absence of recombination between genes, it has been difficult to establish how individual genes within these regions contribute to supergene-controlled phenotypes. The white-throated sparrow is a classic example in which a supergene controls behavioral differences as well as distinct coloration that determines mate choice. A landmark study now demonstrates that differences between supergene variants in the promoter sequences of a hormone receptor gene change its expression and control changes in behavior. To unambiguously establish the link between genotype and phenotype, the authors used antisense oligonucleotides to alter the level of gene expression in a focal brain region targeted through a cannula. The study showcases a powerful approach to the functional genomic manipulation of a wild vertebrate species.
The Educational Process As a Space for Understanding Global Challenges: A Socio-Philosophical Analysis
Authors: Mineev V. , Artemyeva Svetlana , Popkova N.
Published: October 2021

Philosophy has historically developed, first of all, as a socio-pedagogical enterprise, not so much the reflections of individuals, but rather an institutional mentoring activity, a technology for the formation of a certain type of a person. On the other hand, pedagogy has basically been and remains a philosophical search, over which certain educational technologies are only being built. There is a deep interpenetration between the sphere of philosophical thought and the sphere of education: the forms of introduction to philosophical thought have a significant impact on the content of philosophical theory. Therefore, scientific and philosophical reflection on the global problems of our time is inseparable from the educational process, within which these problems are constructed both at the level of professional consciousness and at the level of mass consciousness. In this regard, the authors focus not on the usual political or environmental aspects of the subject, but on the place of global problems as a phenomenon of human existence in the structure of the life-world. The appeal to the life-world – one of the central concepts of phenomenology – allows us to bridge the gap between the objective scientific picture of nature (including society) and its living-through in our consciousness, that is, the actual being of a human (we will try to avoid the term "subjectivity"). This gap is obviously one of the reasons for the inefficiency of environmental practices over the past hundred years. The authors used the phenomenological method, logical analysis, interviewing and surveys, methods of humanitarian expertise of the educational project. The research included grounding phenomenological approach to the problem (V.V. Mineev), concretization of the initial philosophical concept and conducting empirical research, including questionnaires, surveys and interviews (N.A. Popkova), as well as psychological and pedagogical expertise, assessment of the applicability of the approach in practice (S.I. Artemyeva). This article presents only a part of the results obtained. It is shown that the human life-world can be considered as the basis for the unity of global problems that express one of the deep phenomena of being-in-the-world which is being-to-death. In the modern epoch, all elements of the structure of the life-world are undergoing transformation, and the task of education is to promote maintaining consciousness of personal responsibility for solving universal problems, for being itself.
Technological Goal-Setting in The framework of the New Educational Area «Big Data» for the System of Professional Training of the Future Economist
Authors: Vlasov Dmitriy
Published: October 2021

A weighty argument in favor of including the new educational area «Big Data» in the practice of professional training of the future economist is the competence in the field of building adequate predictive models, which is in demand in the modern labor market. Indeed, any leader is interested in improving the quality of the decisions made. This interest increases in conditions of sanctions pressure and post-pandemic restrictions, in difficult socio-economic conditions, when most of the resources are limited, the previously identified cause-and-effect relationships lose their relevance and the responsibility for decisions is significantly increased. Features of the implementation of the technological approach to disclosing the content of the new educational area «Big Data» in the system of professional training of the future economist is presented in this article as follows: firstly, in the form of a system of micro-goals at the basic level, and secondly, in the form of a system of micro-goals at an advanced level. Thus, within the framework of the technological goal-setting of the content of the new educational field, the principle of variability of the professional training of the future economist is implemented. Substantively presented in the article micro-goals cover various issues of using quantitative methods, mathematical and computational modeling. In addition, the formulations of micro-goals include requirements for the development of new tools that support big data analysis. Note that the implementation of technological goal-setting is necessary to strengthen the applied orientation of the training of a future economist, allows us to make a methodological emphasis on applied problems of socio-economic topics, the methods of solving which are in demand in future professional activities. The material of the article can be useful to teachers of the higher school of economics, as well as to anyone interested in modern methodological approaches to structuring educational content and achievements in the field of big data.
Achieving a Balance Between Privacy Protection and Data Collection: A Field Experimental Examination of a Theory-Driven Information Technology Solution
Authors: Liu Bailing , Pavlou Paul A. , Cheng Xiufeng
Published: October 2021

Companies face a trade-off between creating stronger privacy protection policies for consumers and employing more sophisticated data collection methods. Justice-driven privacy protection outlines a method to manage this trade-off. We built on the theoretical lens of justice theory to integrate justice provision with two key privacy protection features, negotiation and active-recommendation, and proposed an information technology (IT) solution to balance the trade-off between privacy protection and consumer data collection. In the context of mobile banking applications, we prototyped a theory-driven IT solution, referred to as negotiation, active-recommendation privacy policy application, which enables customer service agents to interact with and actively recommend personalized privacy policies to consumers. We benchmarked our solution through a field experiment relative to two conventional applications: an online privacy statement and a privacy policy with only a simple negotiation feature. The results showed that the proposed IT solution improved consumers’ perceived procedural justice, interactive justice, and distributive justice and increased their psychological comfort in using our application design and in turn reduced their privacy concerns, enhanced their privacy awareness, and increased their information disclosure intentions and actual disclosure behavior in practice. Our proposed design can provide consumers better privacy protection while ensuring that consumers voluntarily disclose personal information desirable for companies.
What Happens When a Retailer Drops a Product Category? Investigating the Consequences of Ending Tobacco Sales
Authors: Goli Ali , Chintagunta Pradeep K.
Published: October 2021

The paper measures the cross-category spillover effects of a retailer changing its assortment at the extensive margin (by dropping an entire category from its portfolio) on the outcomes for its rivals in the industry.
English as a foreign language instruction in Ecuador: Implementation of the Content and Language Integrated-Learning during 2019-2021
Authors: Barre Pamela , Villafuerte-Holguin Jhonny
Published: October 2021

Ecuadorian educational policy for English as Foreign Language instruction in Ecuador mandated in 2016 to introduce Content and Language Integrated-Learning (CLIL) methodology to improve the teaching and learning process. This research aims to analyze the implementation of CLIL methodology in zone 4 of Ecuador during 2019-2021. This work subscribed to the transformative paradigm and administrated quantitative and qualitative methods of educational research. The participants were 70 English as a Foreign Language teachers from nine public and private educational institutions located in Manabi Province of Ecuador. The instrument used was the Instructor Perceptions of Differentiated Instruction of Turner, Solis, and Kincade (2017) in an observation format. The information collection techniques used were in-depth interview and focus group discussion. The results allowed the research team to determine the impact of the pandemic on the CLIL implementation in zone 4 of Ecuador. The results show differences in the implementation of the methodology between public and private schools which are linked to internet and technology devices access, teachers' knowledge regarding CLIL methodology, and institutional policies. In regards COVID19 pandemic, it is concluded that it has pacted the implementation of CLIL methodology in both public and private secondary schools that participated in the study.
Acute hypercapnic respiratory failure and its management on the acute medical take
Authors: Saigal Anita , Shah Amar J , Mandal Swapna
Published: October 2021

Acute hypercapnic respiratory failure accounts for 50 000 hospital admissions each year in the UK. This article discusses the pathophysiology and common causes of acute hypercapnic respiratory failure, and provides practical considerations for patient management in acute medical settings. Non-invasive ventilation for persistent acute hypercapnic respiratory failure is widely recognised to improve patient outcomes and reduce mortality. National audits highlight a need to improve patients' overall care and outcomes through appropriate patient selection and treatment initiation. Multidisciplinary involvement is essential, as this underpins inpatient care and follow up after hospital discharge. New non-invasive ventilation modalities may offer better patient comfort and compensate better for sleep-related changes in respiratory mechanics. Emerging therapies, such as nasal high flow, may offer an alternative treatment approach in those who cannot tolerate non-invasive ventilation, but more research is required to completely understand its effectiveness in treating acute hypercapnic respiratory failure.
Prophylactic use of proton pump inhibitors post-cardiac surgery
Authors: Azzopardi Matthew , Paris Jean-Luc , Sladden David
Published: October 2021

Aims/Background

Gastrointestinal bleeding significantly increases morbidity and mortality rates postoperatively in patients undergoing cardiac surgery. The prophylactic prescribing of proton pump inhibitors post-cardiac surgery is currently a class IIa recommendation of the European Association of Cardio-Thoracic Surgery.

Method

A retrospective review of patients who underwent cardiac surgery between July and December 2019 in the authors' hospital was carried out, using discharge summaries. New treatment charts were introduced with a pre-printed proton pump inhibitor included in the ‘regular medication’ section of the treatment chart and two reaudits were performed using the same methodology.

Results

Before the intervention, 47% were prescribed omeprazole postoperatively, compared to 74% (P<0.001) and 66% (P=0.008) in the first and second reaudits respectively. Gastrointestinal bleeding was more common pre-intervention (4% vs 1% respectively; P=0.10).

Conclusions

This intervention resulted in a statistically significant improvement in the prescription of postoperative omeprazole and a decrease in gastrointestinal bleeds. However, other risk factors such as diabetes mellitus, arteriosclerosis and procedure urgency may have contributed to the absence of statistical significance in the latter.
Legal aspects of prescribing
Authors: Flavell Benjamin
Published: October 2021

Paramedic independent prescribing is in its infancy and there are limitations to the range of medicines that can be prescribed when compared with other professions undertaking independent prescribing. Medication and prescribing errors are common events within the NHS in England, resulting in a substantial number of litigation and fitness-to-practise proceedings against other professions in relation to prescribing and medicines management. It is foreseeable that paramedic independent prescribers could also find themselves subject to legal action. This article considers a fictitious scenario where a patient suffers harm as a result of a prescribing decision and the legal implications for the prescriber.
A day in the life of a forensic paramedic
Authors: Moore Angela
Published: October 2021

In this month's instalment of Paramedic Roles, Angela Moore provides an insight into the role of a forensic paramedic, with a brief run-down of her daily responsibilities, as well as a reflection on her overall motivation