bluuebunny/crossref_metadata_2025 huggingface dataset:
Ideological Boundaries of Status Advantages: Legislative Effectiveness in the United States House of Representatives
Authors: Collet François , Carnabuci Gianluca , Ertug Gokhan , Zou Tengjian
Published: April 2020

Prior research assumes that high-status actors have greater organizational influence than lower-status ones, that is, it is easier for the former to get their ideas and initiatives adopted by the organization than it is for the latter. Drawing from the literature on ideology, we posit that the status–influence link is contingent on actors’ ideological position. Specifically, status confers organizational influence to the degree that the focal actor is ideologically mainstream. The more an actor’s ideology deviates from the mainstream the less will her status translate into increased organizational influence. We find support for this hypothesis using data on the work of legislators in the House of Representatives in the United States Congress. By illuminating how and under what conditions status leads to increased influence, this study qualifies and extends current understandings of the role of status in organizations.
Next‐Day Loading of a Bone‐Anchored Hearing System: Preliminary Results
Authors: McElveen John T. , Green J. Douglas , Arriaga Moises A. , Slattery William H.
Published: April 2020

Objectives

To demonstrate the feasibility and efficacy for next‐day loading of a percutaneous bone‐anchored hearing device.

Study Design

Multicenter prospective cohort study.

Setting

Tertiary neurotologic referral centers.

Subject and Methods

In this multicenter prospective study, a 4.5‐mm laser‐etched bone‐anchored hearing device was implanted in adult subjects who had conductive/mixed hearing loss or single‐sided deafness. One day following implantation, the surgical site was assessed for soft tissue reaction per the Holgers Scale, and implant stability was evaluated by manual palpation and resonance frequency analysis. On the same day, subjects were fitted with the processor. Follow‐up evaluations were at 1 week, 4 weeks, 3 months, 6 months, and 12 months. The Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires were completed postoperatively.

Results

Fourteen devices were implanted in 12 subjects. Two subjects underwent bilateral implantation. Implant stability was rated as firm at every interval for all ears, and the Implant Stability Quotient values at 3 months were stable or increased as compared with day 1 measurements. Skin irritation was limited to Holgers grade 0 and 1, with the majority having no skin irritation. The mean Glasgow Benefit Inventory global score was +43.8, and the mean Abbreviated Profile of Hearing Aid Benefit global benefit score was 60.2%. All 14 implants have remained firmly anchored.

Conclusions

Next‐day loading of this 4.5‐mm‐diameter percutaneous bone‐anchored hearing device appears to be a feasible alternative to the original 3‐month delayed loading. Although this is a preliminary study, the results support continued investigation of a next‐day loading strategy.
Cognitive and Behavioral Functioning in Hearing‐Impaired Children with and without Language Delay
Authors: Williams Alisha , Pulsifer Margaret , Tissera Kristin , Mankarious Leila A.
Published: April 2020

Poor language development in patients with sensorineural hearing loss (SNHL) may be related to an auditory deficit and/or other neurologic condition that influences the ability to communicate. A retrospective chart review of children (mean age = 4.0 years) with congenital, bilateral SNHL was performed to assess for linguistic and nonlinguistic neurodevelopmental differences between those who were language‐impaired (LI) versus non–language‐impaired (NLI). Language, neurodevelopmental functioning, and behavior were assessed. Twenty‐two patients were identified: 12 were LI and 10 were NLI. Average pure‐tone thresholds and nonverbal intelligence were not different between the language groups, but the LI group demonstrated significantly lower median overall adaptive skills, personal living skills, and motor skills. Behavioral dysregulation was significantly higher in the LI versus NLI group (58% vs 10%; P =. 031), although the median neurodevelopmental scores did not differ significantly. These findings introduce the possibility that nonlinguistic processing deficit(s) may be confounding the ability to develop language.
The experiences of, and need for, palliative care for people with motor neurone disease and their informal caregivers: A qualitative systematic review
Authors: Flemming Kate , Turner Victoria , Bolsher Samantha , Hulme Bill , McHugh Elizabeth , Watt Ian
Published: April 2020

Background:

Despite being a terminal neurodegenerative disease, the role of palliative care is less recognised for motor neurone disease than for other life-limiting conditions. Understanding the experiences of, and need for, palliative care for patients and carers is key to configuring optimal policy and healthcare services.

Aim:

To explore the experiences of, and need for, palliative care of people with motor neurone disease and their informal carers across the disease trajectory.

Design:

A systematic review of qualitative research conducted using Thematic Synthesis – PROSPERO registration CRD42017075311.

Data Sources:

Four electronic databases were searched (MEDLINE, CINAHL, PsycINFO, Social Science Citation Index) using terms for motor neurone disease, amyotrophic lateral sclerosis, palliative care, and qualitative research, from inception to November 2018. Included papers were data extracted and assessed for quality.

Results:

A total of 41 papers were included, representing the experiences of 358 people with motor neurone disease and 369 caregivers. Analytical themes were developed detailing patients’ and carers’ experiences of living with motor neurone disease and of palliative care through its trajectory including response to diagnosis, maintaining control, decision-making during deterioration, engaging with professionals, planning for end-of-life care, bereavement.

Conclusion:

The review identified a considerable literature exploring the care needs of people with motor neurone disease and their carers; however, descriptions of palliative care were associated with the last days of life. Across the disease trajectory, clear points were identified where palliative care input could enhance patient and carer experience of the disease, particularly at times of significant physical change.
Patients choose music with high energy, danceability, and lyrics in analgesic music listening interventions
Authors: Howlin Claire , Rooney Brendan
Published: April 2020

Self-selected music is the best predictor of a successful outcome in music interventions, but the reasons behind this are unclear. One suggestion is that patients choose different types of music compared to experimenters. To explore this suggestion, the current study identified specific pieces of music that were used in previous studies for pain management using a scoping review, and analyzed each track in terms of the Spotify audio features of energy, danceability, instrumentalness, valence, and tempo. Music was categorized depending on whether it was chosen by the patient from an unlimited choice (PUC), a limited choice (LC), or chosen by the experimenter (EC), so that comparisons could be made between groups. One-way analyses of variance (ANOVAs) identified that PUC music was significantly higher in energy and danceability, and lower in instrumentalness, compared to LC or EC music. A logit ordinal regression demonstrated that as people are given more freedom to choose music to reduce their pain, they increasingly choose music that is higher in energy and danceability, and more likely to contain lyrics. This study also demonstrates the impact of allowing patients to choose music from an unlimited range compared to choosing from a limited range of music.
Incidence of and Risk Factors for Lactational Mastitis: A Systematic Review
Authors: Wilson Emily , Woodd Susannah L , Benova Lenka
Published: April 2020

Background

Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.

Research Aim

To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research.

Methods

We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors.

Results

In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2–12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings.

Conclusions

Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.
Risk and Performance in Emerging Economies: Do Bank Diversification and Financial Crisis Matter?
Authors: Moudud-Ul-Huq Syed , Zheng Changjun , Gupta Anupam Das , Hossain S. K. Alamgir , Biswas Tanmay
Published: April 2020

This study empirically investigates the quadratic effects of bank diversification, size and global financial crisis on risk-taking behaviour and performance. To unfold those effects, it uses the generalized method of moments (GMM) estimator and also uses an unbalanced panel data set on a large sample consisting of 542 bank-year observations between 2004 and 2015. The key results for emerging economies are as follows: (a) increasingly higher non-performing loan ratio makes the bank underperforming and unstable; (b) benefits derived from bank diversification are heterogeneous and confirms portfolio diversification theory; (c) small-sized banks of Bangladesh ensure higher advantage from portfolio mix over large banks; (d) large banks of South Africa achieve higher benefit from income diversification over small-sized banks; and finally, this study evidences that during the financial crisis, emerging economies can use portfolio diversification as a mechanism for controlling risk and improve bank performance. Mainly, emerging countries can rely on income diversification and should involve this mechanism with systematic risk a great care of.
Assessing the Governance Mechanisms, Corporate Social Responsibility and Performance: The Moderating Effect of Board Independence
Authors: Karim Sitara , Manab Norlida Abdul , Ismail Rusmawati Binti
Published: April 2020

This article serves two purposes. First, it attempts to examine the joint impact of corporate governance mechanisms and corporate social responsibility (CSR) practice on firm performance. Second, the moderating role of board independence is investigated on 588 non-financial Malaysian firms listed on Bursa Malaysia during the period 2006–2017. Both accounting-based return on assets (ROA) and market-based (Tobin’s Q) performance measures have been used for measuring performance. Dynamic model using Generalized Method of Moments (GMM) has been employed on the data set to control for potential endogeneity, reverse causality and dynamic heterogeneity. Findings indicate that ROA is a better determinant of firm performance than Tobin’s Q, where ownership concentration, managerial ownership and money spent on CSR negatively affect ROA; however, an insignificant relationship is observed with Tobin’s Q. Finally, board independence negatively moderates governance-CSR and firm performance relationship. Findings of this article have implications for Bursa Malaysia and Securities Commission Malaysia to reset the limit of independent directors on board so that their unnecessary interference in operations of management may be avoided. Furthermore, companies need to reassess their CSR strategies whether they are spending on CSR activities or hiding their financial malfeasance in the name of money spent on CSR.
Interaction of a screw dislocation with a parabolic cavity and a semi-infinite crack
Authors: Wang Xu , Yang Ping , Schiavone Peter
Published: April 2020

We derive an analytic solution to the problem of a screw dislocation interacting with a parabolic cavity and a semi-infinite sharp crack using conformal mapping techniques and the method of images. Closed-form expressions for the image force acting on the screw dislocation, the mode III stress intensity factor at the crack tip and the generalized mode III stress intensity factor for the parabolic cavity are obtained. The correctness of the solution is validated by comparison with existing solutions in the literature.
Examining University Men’s Psychobiological and Behavioral Response-Recovery Profile From a Social-Evaluative Body Image Threat
Authors: Smyth Aidan P. J. , Gammage Kimberley L. , Lamarche Larkin , Muir Cameron
Published: April 2020

Negative body image, which often results from social-evaluative body image threats, is common in young men and related to many harmful outcomes. Using social self-preservation theory (SSPT), the present study investigated the psychobiological (i.e., shame and cortisol) and behavioral (e.g., submission) response-recovery profile to a social-evaluative body image threat in university men. Participants ( N = 69; Mage = 20.80 years, SD = 1.84) were randomly assigned to a high-threat ( n = 34) or low-threat condition ( n = 35). Men in the high-threat condition reported greater post-threat body shame, had greater post-threat cortisol levels, and exhibited more shame-relevant behaviors than men in the low-threat condition. There were no significant differences between conditions for body shame or cortisol at the final post-threat time point (after resting for 30 min). These findings are consistent with SSPT and suggest that men respond to, and recover from, body image threats relatively efficiently.
Floristic Composition, Diversity, and Biomass of a Protected Tropical Evergreen Forest Belize
Authors: Luna-Kamyshev Nikolay M. , López-Martínez Jorge Omar , Vargas-Larreta Benedicto , Islebe Gerald A. , Villalobos-Guerrero Tulio F. , de la Rosa Andrés Vázquez , Reyes-Mendoza Oscar F. , Treviño-Garza Eduardo
Published: April 2020

A challenge in community ecology is the development of ecosystem baselines, allowing the assessment of the variation in the ecological dynamics through different temporal and spatial scales. To our best knowledge, no studies have been carried out in seasonal evergreen forests of Belize to establish a baseline for future monitoring. Hence, a floristic study of the woody plant species diversity and composition was carried out at the Billy Barquedier National Park (BBNP) to develop an ecosystemic baseline for the assessment of the originally implemented conservation strategies. A thorough floristic survey was performed from May to August 2015 in 42 rectangular plots (500 m2) randomly allocated along the 100 to 500 m elevation gradient of the BBNP. Species richness, diversity, composition, and aboveground biomass were assessed. Likewise, information of a series of indicators on protection and risk situation (e.g., IUCN Red List of threatened species, CITES categories), and restoration for each relevant species are also provided. The BBNP is an important forest with 67 woody species distributed in 30 plant families. Terminalia amazona and Corozo palm Attalea cohune are the most important species in the reserve, in terms of abundance, frequency, and biomass. A clear trend between biodiversity metrics, elevation, and aboveground biomass was noted. This study contributes to understand relevant ecological topics as well as provides key elements for the management and conservation of the BBNP area and Belize.
Safety, tolerability, and pharmacokinetics of the selective prostacyclin receptor agonist ralinepag in single and multiple dosing studies of an immediate‐release oral formulation in healthy volunteers
Authors: Grundy John S. , King Christopher D. , Adams John W. , Cabell Christopher H.
Published: April 2020

Ralinepag (APD811), an oral, potent, and selective prostacyclin receptor (IP) agonist is being developed for treatment of pulmonary arterial hypertension. Two, single‐center, randomized, double‐blind, placebo‐controlled, Phase 1 studies (single ascending dose and multiple ascending dose) evaluated an oral immediate‐release capsule formulation of ralinepag in healthy subjects. Blood samples assessed plasma pharmacokinetics and safety and tolerability data monitored adverse events, vital signs, laboratory findings, physical examination, and electrocardiograms. Eighty‐two healthy subjects (single ascending dose (n = 32) and multiple ascending dose (n = 50)) completed the studies. No clinically significant safety issues were observed, except one serious adverse event of atrial fibrillation considered moderate in intensity. In the single ascending dose study, ralinepag was tolerated up to 100 µg (single dose), but not 200 µg due to nausea and vomiting. Dose proportional mean ralinepag plasma exposure measures were observed. Maximum plasma concentrations were reached within 1.0–1.5 h post‐dose and mean terminal elimination half‐life values from 20.5–26.4 h. In the multiple ascending dose study, ralinepag tolerability decreased with increasing QD or BID dose. Dose proportional steady‐state plasma exposure measures were observed where evaluable, with mean steady‐state peak‐to‐trough ratios ranging from 3.34–4.49 (QD dosing) and 1.95–2.36 (BID dosing). Mean effective half‐life values ranged from 17.5–18.4 h, reflecting ∼1.7‐fold (QD dosing) and ∼2.6‐fold (BID dosing) accumulation in plasma exposure. Safety and tolerability of oral immediate‐release ralinepag was generally consistent with expectations for this drug class, but more individualized dose escalation appears warranted. Ralinepag exhibited favorable pharmacokinetic properties, with BID dosing producing desired minimal steady‐state peak‐to‐trough fluctuation. Overall, results supported further clinical investigation of ralinepag and guided development of an extended‐release formulation to facilitate QD dosing.
Ethical Issues in Research and Development of Epigenome-wide Technologies
Authors: Bunnik Eline M , Timmers Marjolein , Bolt Ineke LLE
Published: April 2020

To date, few scholarly discussions on ethical implications of epigenetics and epigenomics technologies have focused on the current phase of research and development, in which researchers are confronted with real and practical ethical dilemmas. In this article, a responsible research and innovation approach, using interviews and an expert meeting, is applied to a case of epigenomic test development for cervical cancer screening. This article provides an overview of ethical issues presently facing epigenomics researchers and test developers, and discusses 3 sets of issues in depth: (1) informed consent; (2) communication with donors and/or research participants, and (3) privacy and publication of data and research results. Although these issues are familiar to research ethics, some aspects are new and most require reinterpretation in the context of epigenomics technologies. With this article, we aim to start a discussion of the practical ethical issues rising in research and development of epigenomic technologies and to offer guidance for researchers working in the field of epigenetic and epigenomic technology.
Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials
Authors: Huang Jiao , Liu Jing-Chen
Published: April 2020

Background

Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.

Methods

A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.

Results

A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = − 2.18; 95% confidence interval (CI) -2.76 to − 1.61,p < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66,p = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22,p = 0.0008).

Conclusions

Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.
Correction to: Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice
Authors: Walter Stephen D. , Turner Robin M. , Macaskill Petra , McCaffery Kirsten J. , Irwig Les
Published: April 2020

In the original publication of this article [1], the number “− 0.49” in the below sentence in the Results section should be changed to “-3.23”, and this typo does not affect the wider conclusions.
Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data
Authors: Tahkola Aapo , Korhonen Päivi , Kautiainen Hannu , Niiranen Teemu , Mäntyselkä Pekka
Published: April 2020

Background

In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.

Methods

In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.

Results

More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men).

Conclusions

Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study
Authors: Pan Xiding , Zhou Feng , Shen Rui , Zhu Yubing , Arima Hisatomi , Yang Jie , Zhou Junshan
Published: April 2020

Background

For acute ischemic stroke (AIS) patient receiving mechanical thrombectomy (MT), renal dysfunction was an independent risk factor of contrast-induced nephropathy which may affect clinical outcomes. However, the influence of renal function on stroke outcomes is still controversial. Thus, we aim to investigate the association between renal function and outcomes of AIS patients receiving MT.

Methods

All consecutive stroke patients receiving MT were included in a prospective stroke registry in China from April 2015 to February 2019. Estimated glomerular filtration rate (eGFR) was measured on admission and categorized into G1 (≥ 90 ml/min/1.73 m2), G2 (60–89 ml/min/1.73 m2), G3a (45–59 ml/min/1.73 m2) and G3b-5 (≤44 ml/min/1.73 m2). Multivariable logistic regression analysis was performed to evaluate the association between eGFR and recanalization rate (thrombolysis in cerebral infarction scale 2b-3), symptomatic intracranial hemorrhage (sICH), death in hospital, death at 3 months and poor functional outcome (modified Rankin Scale 3–6 at 3 months).

Results

A total of 373 patients were included in the study. Of them, 130 (34.9%) patients were in the eGFR group G1, 170 (45.6%) in G2, 46 (12.3%) in G3a, 27 (7.2%) in G3b–5. In multivariable logistic regression analysis, reduced eGFR was associated with increased risk of sICH (G3a, p = 0.016) and 3-month death (G3b–5, p = 0.025). However, no significant effects were observed between reduced eGFR and the risk of recanalization rate (p = 0.855), death in hospital (p = 0.970), and poor functional outcome (p = 0.644).

Conclusions

For AIS patients underwent MT, reduced eGFR was associated with increased risk of sICH and 3-month death. However, there were no appreciable effects of reduced eGFR on recanalization rate, death in hospital and 3-month functional outcome.
Ribosomal RNA fragmentation into short RNAs (rRFs) is modulated in a sex- and population of origin-specific manner
Authors: Cherlin Tess , Magee Rogan , Jing Yi , Pliatsika Venetia , Loher Phillipe , Rigoutsos Isidore
Published: April 2020

Background

The advent of next generation sequencing (NGS) has allowed the discovery of short and long non-coding RNAs (ncRNAs) in an unbiased manner using reverse genetics approaches, enabling the discovery of multiple categories of ncRNAs and characterization of the way their expression is regulated. We previously showed that the identities and abundances of microRNA isoforms (isomiRs) and transfer RNA-derived fragments (tRFs) are tightly regulated, and that they depend on a person’s sex and population origin, as well as on tissue type, tissue state, and disease type. Here, we characterize the regulation and distribution of fragments derived from ribosomal RNAs (rRNAs). rRNAs form a group that includes four (5S, 5.8S, 18S, 28S) rRNAs encoded by the human nuclear genome and two (12S, 16S) by the mitochondrial genome. rRNAs constitute the most abundant RNA type in eukaryotic cells.

Results

We analyzed rRNA-derived fragments (rRFs) across 434 transcriptomic datasets obtained from lymphoblastoid cell lines (LCLs) derived from healthy participants of the 1000 Genomes Project. The 434 datasets represent five human populations and both sexes. We examined each of the six rRNAs and their respective rRFs, and did so separately for each population and sex. Our analysis shows that all six rRNAs produce rRFs with unique identities, normalized abundances, and lengths. The rRFs arise from the 5′-end (5′-rRFs), the interior (i-rRFs), and the 3′-end (3′-rRFs) or straddle the 5′ or 3′ terminus of the parental rRNA (x-rRFs). Notably, a large number of rRFs are produced in a population-specific or sex-specific manner. Preliminary evidence suggests that rRF production is also tissue-dependent. Of note, we find that rRF production is not affected by the identity of the processing laboratory or the library preparation kit.

Conclusions

Our findings suggest that rRFs are produced in a regimented manner by currently unknown processes that are influenced by both ubiquitous as well as population-specific and sex-specific factors. The properties of rRFs mirror the previously reported properties of isomiRs and tRFs and have implications for the study of homeostasis and disease.
Ovarian mucinous tumors with mural nodules: immunohistochemical and molecular analysis of 3 cases
Authors: Shao Ying , Liu Qin , Shi Haiyan , Lu Bingjian
Published: April 2020

Background

Primary ovarian mucinous tumors with mural nodules are very rare. The histogenesis of the mural nodules remains unclear.

Methods

We investigated the clincopathological and molecular features in 3 cases with mural nodules.

Results

Patient 1 was diagnosed as mucinous carcinoma with mural nodules of anaplastic carcinoma that was composed of CK+ and CK7+ spindled cells and polygonal cells with marked pleomorphism. Aberrant p53 staining was found in the mural nodules rather than in the mucinous components. A concordant KRAS mutation (c.35G > A p.G12A) was identified in both mucinous tumors and mural nodules. She died of disease at 44 months. The mural nodule in patient 2 was interpreted as a sarcoma, no other specified. The uniform short spindle cells were separated by abundant myxoid matrix. They were CD10 + , CCND1-, SMA-, and negative for break-apart BCOR, PHF1, and JAZF1 FISH assay. The adenocarcinomatous component harbored LOH at D18S51 and FGA loci while the sarcomatous component had LOH at D19S433. She had lung metastasis at 18 months and was alive without evidence of disease for 40 months. Patient 3 harbored multiple mural nodules that were composed of vimentin+, focal CK+, atypical spindle cells. A diagnosis of sarcoma-like mural nodules was rendered. She was alive with no evidence of disease for 13 months. No hotspot mutant AKT1, KRAS, HRAS, and PI3KCA alleles were found in patients 2 and 3.

Conclusions

Mural nodules with anaplastic carcinoma or with true sarcomas may represent the dedifferentiation form of mucinous tumors or collision tumors, respectively. The worrisome histology in sarcoma-like mural nodules necessitates meticulous treatment for these patients.
High-intensity interval training accelerates oxygen uptake kinetics and improves exercise tolerance for individuals with cystic fibrosis
Authors: Reuveny Ronen , DiMenna Fred J. , Gunaratnam Cedric , Arad Avigdor D. , McElvaney Gerry N. , Susta Davide , Peled Michael , Moyna Niall M.
Published: April 2020

Background

Exercise training provides benefits for individuals with cystic fibrosis; however, the optimal program is unclear. High-intensity interval training is safe and effective for improving ‘functional capacity’ in these individuals with peak rate of O2uptake typically referenced. The ability to adjust submaximal rate of oxygen uptake (V̇O2kinetics) might be more important for everyday function because maximal efforts are usually not undertaken. Moreover, the ability of high-intensity training to accelerate V̇O2kinetics for individuals with cystic fibrosis could be enhanced with O2supplementation during training.

Methods

Nine individuals with cystic fibrosis completed incremental cycling to limit of tolerance followed by 8 weeks of high-intensity interval cycling (2 sessions per week x ~ 45 min per session) either with (n = 5; O2+) or without (AMB) oxygen supplementation (100%). Each session involved work intervals at 70% of peak work rate followed by 60 s of recovery at 35%. For progression, duration of work intervals was increased according to participant tolerance.

Results

Both groups experienced a significant increase in work-interval duration over the course of the intervention (O2+, 1736 ± 141v. 700 ± 154 s; AMB, 1463 ± 598v. 953 ± 253 s;P = 0.000); however, the increase experienced by O2+ was greater (P = 0.027). During low-intensity constant-work-rate cycling, the V̇O2mean response time was shortened post compared to pre training (O2+, 34 ± 11v. 44 ± 9 s; AMB, 39 ± 14v. 45 ± 17 s;P = 0.000) while during high-intensity constant-work-rate cycling, time to exhaustion was increased (O2+, 1628 ± 163v. 705 ± 133 s; AMB, 1073 ± 633v. 690 ± 348 s;P = 0.002) and blood [lactate] response was decreased (O2+, 4.5 ± 0.9v. 6.3 ± 1.4 mmol.L− 1; AMB, 4.5 ± 0.6v. 5.2 ± 1.4 mmol.L− 1;P = 0.003). These positive adaptations were similar regardless of gas inspiration during training.

Conclusion

Eight weeks of high-intensity interval training for patients with cystic fibrosis accelerated V̇O2kinetics and increased time to exhaustion. This provides some evidence that these patients may benefit from this type of exercise.

Trial registration

This study was retrospectively registered in the ISRTCN registry on 22/06/2019 (#ISRCTN13864650).
The Effect of Fly Ash and Recycled Aggregate on the Strength and Carbon Emission Impact of FRCCs
Authors: Lee Jong-Won , Jang Young-Il , Park Wan-Shin , Yun Hyun-Do , Kim Sun-Woo
Published: April 2020

Concrete is the most widely used construction material in the world. In particular, cementitious composites that contain reinforced fibers have a relatively large amount of cement. Therefore, in this study, the target is to maintain at least 90% of the performance along with a reduction of CO2 emissions from the material stage during fiber-reinforced cementitious composites (FRCCs) production by applying fly ash (FA) and recycled sand (RS). To calculate the amount of CO2 emission at the stage of manufacturing the FRCCs, life cycle inventory database (LCI DB) were referenced from domestic and Japan. As the performance efficiency indicators, simple equations to evaluate the amount of CO2 emission of FRCCs were then formulated as a function of the replacement ratio of FA and RS. And binder and CO2 intensities were analyzed by FRCCs strength. Based on the results for the test, a mix of FA 25% and RS 25% of W/B 0.45, is considered most suitable in terms of performance of FRCCs and reduction of CO2 emissions.
Evaluating the effectiveness of traumatic brain injury state laws among high school athletes
Authors: Arakkal Alan T. , Barón Anna E. , Lamb Molly M. , Fields Sarah K. , Comstock R. Dawn
Published: April 2020

Background

Traumatic brain injury legislation varies across states. A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation’s language affected the observed trends.

Methods

In this retrospective ecological study of a large national sample of US high schools from 2005/06 through 2017/18, piecewise regression models along with a profile likelihood approach were utilized to examine longitudinal trends in incident and recurrent concussion rates.

Results

Overall incident concussion rates increased by an additional 1.85%/standardized month (STDM) (95% confidence interval (CI): 1.14, 2.56%) prior to law passage and decreased by an additional 1.08%/ STDM (95%CI: − 1.43, − 0.72%) after law passage. Similar trends were observed for overall recurrent concussion rates. Among states that specified the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased on average by an additional 1.59%/STDM (95%CI: − 3.42, 0.22%) compared to states that did not specify the category of healthcare provider.

Conclusions

The passage of state level traumatic brain injury laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Although not statistically significant, states with traumatic brain injury laws specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussion rates compared to states not specifying the category of healthcare provider. The findings suggest that state traumatic brain injury laws may benefit from specifying the category of healthcare provider allowed to provide return to play clearance, if they do not already include such language.
Endovascular treatment of aortic stump blow-out after extra-anatomical repair of aortoduodenal fistula: a case report and review of literature
Authors: Beijer E. , Scholtes V. P. W. , Moerbeek P. , Coveliers H. M. E. , Lely R. J. , Hoksbergen A. W. J.
Published: April 2020

Background

An aortoduodenal fistula (ADF) is an unusual, but serious complication following surgical or endovascular aortic repair. The optimal treatment for ADF consists of removal of the infected graft with in situ or extra-anatomical repair and is associated with high mortality. Part of this mortality is caused by re-bleeding or aortic stump ruptures. Classical treatment of an aortic stump rupture involves immediate re-laparotomy, removal of infected tissue, aortic stump formation and reinforcement with soft tissue flaps.

However, this invasive treatment is often difficult to perform and the condition of the patient frequently requires a more rapid response. We describe a case in which an aortic stump rupture was treated endovascularly by using an Amplatzer® Vascular Plug, which successfully stopped the bleeding.

Case presentation

This report describes a 67-year-old man who was presented with persistent duodenal leakage (due to secondary duodenal perforation) after resection and open in-situ repair of an infected aorto-bi-femoral prosthetic graft. An extra-anatomical reconstruction was performed with an axillo-bi-femoral bypass, followed by excision of the prosthesis, aortic stump formation, partial duodenal resection and duodenojejunal reconstruction. Twelve weeks later, sudden severe hematemesis with severe hemodynamic instability occurred. Computed tomography angiography showed extravasation of blood from the aortic stump into the duodenal loop. Endovascular treatment of the aortic stump blow-out with an Amplatzer® Vascular Plug was performed, which successfully stopped the bleeding and stabilized the patient. The duodenal fistula was treated conservatively. Three months later, the patient was discharged to a rehabilitation clinic in a good clinical condition. The patient was still alive after a follow-up of 4 years.

Conclusions

Rapid treatment is requested in cases of aortic stump rupture. Re-laparotomy is practically never the most suitable solution and most of these aortic stump ruptures are fatal. Endovascular treatment could be a suitable alternative. Whether the endovascular treatment of aortic stump rupture is a definitive treatment or a bridge to surgery remains to be elucidated.
Outcome of late preterm newborns in Upper Egypt
Authors: Algameel Alkassem , Elhawary Manal , Amin Sayed , Abd Elmenem Marwa
Published: April 2020

Background

The incidence of preterm births is increasing and has become a global health concern. This study aimed to compare the outcome of late preterm (LPT) to full term (FT) neonates at two large hospitals in Upper Egypt.

Results

Out of 250 newborns included in the study, 180 (72%) were FT and 70 (28%) were LPT. More than half of the LPT newborns (52.9%) were admitted to the neonatal intensive care unit (NICU), compared with 26.7% of FT newborns. Delivery of LPT was associated with an increased risk of neonatal morbidity, including jaundice requiring phototherapy (34.3% vs. 7.8%), respiratory morbidities (32.9% vs. 13.9%), hypoglycemia (8.6% vs. 1.7 %), and convulsions (4.3% vs. 0.6%).

Conclusions

LPT neonates were more susceptible to suffer from jaundice and respiratory distress among other morbidities. They also had a higher rate of NICU admission, longer duration of NICU stay, as well as a higher mortality rate. The best treatment of late prematurity is to prevent it. Public and professional awareness of the problems associated with late prematurity should be highlighted. Follow-up programs for early detection and intervention for long term complications are recommended.
Post-treatment benign changes versus recurrence in non-lymphoid head and neck malignancies: can diffusion-weighted magnetic resonance imaging end up the diagnostic challenge?
Authors: Serour Dalia K. , Adel Khaled M. , Osman Ayman M. A.
Published: April 2020

Background

The aim of this prospective cohort study is to substantiate the added value of diffusion-weighted magnetic resonance imaging (DW-MRI) over conventional MRI assessment in the differentiation between locoregional recurrence/residual tumour and post-treatment benign changes in patients with non-lymphoid head and neck malignancies.

Thirty adult patients, each with a suspicious lesion on post-treatment imaging scans at the primary site of a previously treated non-lymphoid head and neck malignancy, were evaluated by MRI and diffusion-weighted imaging (DWI). The apparent diffusion coefficient (ADC) values of the lesions were calculated.

Results

Diffusion-weighted MRI yielded an accuracy of 90%, a sensitivity of 88.9%, a specificity of 91.7%, a positive predictive value of 94.1% and a negative predictive value of 84.6%. The mean ADC value of the lesions was lower in the “locoregional recurrence/residual tumour” group (1.08 × 10−3 mm2/s) compared to the “post-treatment benign changes” group (1.95 × 10−3 mm2/s); P < 0.001. An ADC cutoff value of 1.43 × 10−3 mm2/s achieved the same accuracy as the visual assessment by DW-MRI.

Conclusion

Incorporating the DWI sequence into the post-treatment imaging assessment protocol brings a substantial added value to conventional MRI assessment in patients with non-lymphoid head and neck malignancies. This valuable merit of DW-MRI can help avoid or, at least, largely minimize unnecessary or unfeasible tissue sampling. An ADC cutoff value of 1.43 × 10−3 mm2/s can also be utilized to aid in the assessment process.
An Automated Algorithm Incorporating Poincaré Analysis Can Quantify the Severity of Opioid-Induced Ataxic Breathing
Authors: Ermer Sean C. , Farney Robert J. , Johnson Ken B. , Orr Joseph A. , Egan Talmage D. , Brewer Lara M.
Published: April 2020

BACKGROUND:

Opioid-induced respiratory depression (OIRD) is traditionally recognized by assessment of respiratory rate, arterial oxygen saturation, end-tidal CO2, and mental status. Although an irregular or ataxic breathing pattern is widely recognized as a manifestation of opioid effects, there is no standardized method for assessing ataxic breathing severity. The purpose of this study was to explore using a machine-learning algorithm for quantifying the severity of opioid-induced ataxic breathing. We hypothesized that domain experts would have high interrater agreement with each other and that a machine-learning algorithm would have high interrater agreement with the domain experts for ataxic breathing severity assessment.

METHODS:

We administered target-controlled infusions of propofol and remifentanil to 26 healthy volunteers to simulate light sleep and OIRD. Respiration data were collected from respiratory inductance plethysmography (RIP) bands and an intranasal pressure transducer. Three domain experts quantified the severity of ataxic breathing in accordance with a visual scoring template. The Krippendorff alpha, which reports the extent of interrater agreement among N raters, was used to assess agreement among the 3 domain experts. A multiclass support vector machine (SVM) was trained on a subset of the domain expert-labeled data and then used to quantify ataxic breathing severity on the remaining data. The Vanbelle kappa was used to assess the interrater agreement of the machine-learning algorithm with the grouped domain experts. The Vanbelle kappa expands on the Krippendorff alpha by isolating a single rater—in this case, the machine-learning algorithm—and comparing it to a group of raters. Acceptance criteria for both statistical measures were set at >0.8. The SVM was trained and tested using 2 sensor inputs for the breath marks: RIP and intranasal pressure.

RESULTS:

Krippendorff alpha was 0.93 (95% confidence interval [CI], 0.91–0.95) for the 3 domain experts. Vanbelle kappa was 0.98 (95% CI, 0.96–0.99) for the RIP SVM and 0.96 (0.92–0.98) for the intranasal pressure SVM compared to the domain experts.

CONCLUSIONS:

We concluded it may be feasible for a machine-learning algorithm to quantify ataxic breathing severity in a manner consistent with a panel of domain experts. This methodology may be helpful in conjunction with traditional measures to identify patients experiencing OIRD.
Parsimony of Hemodynamic Monitoring Data Sufficient for the Detection of Hemorrhage
Authors: Pinsky Michael R. , Wertz Anthony , Clermont Gilles , Dubrawski Artur
Published: April 2020

BACKGROUND:

Individualized hemodynamic monitoring approaches are not well validated. Thus, we evaluated the discriminative performance improvement that might occur when moving from noninvasive monitoring (NIM) to invasive monitoring and with increasing levels of featurization associated with increasing sampling frequency and referencing to a stable baseline to identify bleeding during surgery in a porcine model.

METHODS:

We collected physiologic waveform (WF) data (250 Hz) from NIM, central venous (CVC), arterial (ART), and pulmonary arterial (PAC) catheters, plus mixed venous O2 saturation and cardiac output from 38 anesthetized Yorkshire pigs bled at 20 mL/min until a mean arterial pressure of 30 mm Hg following a 30-minute baseline period. Prebleed physiologic data defined a personal stable baseline for each subject independently. Nested models were evaluated using simple hemodynamic metrics (SM) averaged over 20-second windows and sampled every minute, beat to beat (B2B), and WF using Random Forest Classification models to identify bleeding with or without normalization to personal stable baseline, using a leave-one-pig-out cross-validation to minimize model overfitting. Model hyperparameters were tuned to detect stable or bleeding states. Bleeding models were compared use both each subject’s personal baseline and a grouped-average (universal) baseline. Timeliness of bleed onset detection was evaluated by comparing the tradeoff between a low false-positive rate (FPR) and shortest time to bleed detection. Predictive performance was evaluated using a variant of the receiver operating characteristic focusing on minimizing FPR and false-negative rates (FNR) for true-positive and true-negative rates, respectively.

RESULTS:

In general, referencing models to a personal baseline resulted in better bleed detection performance for all catheters than using universal baselined data. Increasing granularity from SM to B2B and WF progressively improved bleeding detection. All invasive monitoring outperformed NIM for both time to bleeding detection and low FPR and FNR. In that regard, when referenced to personal baseline with SM analysis, PAC and ART + PAC performed best; for B2B CVC, PAC and ART + PAC performed best; and for WF PAC, CVC, ART + CVC, and ART + PAC performed equally well and better than other monitoring approaches. Without personal baseline, NIM performed poorly at all levels, while all catheters performed similarly for SM, with B2B PAC and ART + PAC performing the best, and for WF PAC, ART, ART + CVC, and ART + PAC performed equally well and better than the other monitoring approaches.

CONCLUSIONS:

Increasing hemodynamic monitoring featurization by increasing sampling frequency and referencing to personal baseline markedly improves the ability of invasive monitoring to detect bleed.