bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainable improvement of HbA1c and satisfaction with diabetes care after adding telemedicine in patients on adaptable insulin regimens: Results of the TeleDiabetes randomized controlled trial
Authors: Buysse Heidi , Coremans Peter , Pouwer Frans , Ruige Johannes
Published: May 2019

This 2-year study evaluates whether tele-education adds to improvement and maintenance of good glycemic control and patient satisfaction. Adult patients were randomly assigned to study, getting immediate access to tele-education, or control group, getting this surplus education after 3 months. At several moments, clinical data were retrieved and patients completed questionnaires. Multivariate analyses of covariance and repeated measures analysis of variance were conducted. Implementation of tele-education in between face-to-face contacts improved glycemic control for both groups, which was maintained over a 2-year period. Tele-education did not have an influence on glucose measurements or on hypoglycemic events. Patients were satisfied with this tele-educational tool and appreciated use of personal messages. Further research should focus on the possible influence of “life changes” and influence on “need for more tele-educational feedback,” and consequently on the provision of (mobile) platforms adaptable to patient’s (changing life) situations.
Proportional + integral + derivative control of nonlinear full-car electrohydraulic suspensions using global and evolutionary optimization techniques
Authors: Dahunsi Olurotimi A , Dangor Muhammed , Pedro Jimoh O , Ali M Montaz
Published: May 2019

Resolving the trade-offs between suspension travel, ride comfort, road holding, vehicle handling and power consumption is the primary challenge in the design of active vehicle suspension system. Multi-loop proportional + integral + derivative controllers’ gains tuning with global and evolutionary optimization techniques is proposed to realize the best compromise between these conflicting criteria for a nonlinear full-car electrohydraulic active vehicle suspension system. Global and evolutionary optimization methods adopted include: controlled random search, differential evolution, particle swarm optimization, modified particle swarm optimization and modified controlled random search. The most improved performance was achieved with the differential evolution algorithm. The modified particle swarm optimization and modified controlled random search algorithms performed better than their predecessors, with modified controlled random search performing better than modified particle swarm optimization in all aspects of performance investigated both in time and frequency domain analyses.
Generation mechanism and remedy method of rail corrugation at a sharp curved metro track with Vanguard fasteners
Authors: Wu BW , Chen GX , Lv JZ , Zhu Q , Kang X
Published: May 2019

In Chinese metro lines, Vanguard fastener system is widely used as vibration damping fastener. However, the rails mounted with this fastener system are deeply affected by rail corrugation. The generation mechanism of corrugation wear at a metro track mounted with Vanguard fastening is revealed through the numerical simulation method. A finite element model including two rails, the track system, and a leading wheelset is set up. The parameter sensitivity analysis is conducted to identify the dominant factors affecting the rail corrugation. Then, the remedy method to suppress the corrugation wear is put forward on the basis of the parameter analysis results. The results indicate that the severe corrugation wear on the inner rail is attributed to the self-sustained vibration of the wheelset–track system aroused by the saturated wheel–rail creep force. The frequency of the rail corrugation calculated by the model is very close to the measured data. The elastic modulus and the damping coefficient of the rubber rest pad in the Vanguard fasteners have a high impact on rail corrugation. Increasing the elastic modulus and the damping coefficient can effectively restrain or even eliminate the rail corrugation. Bringing the damping coefficient of the rubber rest pad above 0.0001 can significantly alleviate the rail corrugation. The influence of the damping and stiffness of the rubber pad under the floating slab track bed is negligible.
Evaluation of approaches proposed to avoid overlap of markers in visualizations based on multidimensional projection techniques
Authors: Marcílio-Jr Wilson E , Eler Danilo M , Garcia Rogério E , Venturini Pola Ives R
Published: May 2019

Multidimensional projection techniques provide graphical representations computed based on instance similarities to enable the analysis of abstract and possibly large data sets. However, when the data set size grows these graphical representations can hardly avoid overlap among markers. To overcome this issue, while some techniques attempt to remove overlap after multidimensional projection, some projection techniques were developed considering non-overlapping constraints. In this work, we present an analysis of four overlap removal techniques and two projection techniques considering non-overlapping. The evaluation was performed according to five metrics that consider structural and similarity relations, and based on the results we provide a guide to use a technique according to the data set and analysis goals.
Temporal interplay between strategy and identity: Punctuated, subsumed, and sustained modes
Authors: Schultz Majken , Hernes Tor
Published: May 2019

Although strategy and identity are recognized as exhibiting different temporalities, research has yet to show how their temporal differences influence their mutual interplay. Based on a longitudinal case study, we make three contributions to understanding how temporal differences influence the interplay between strategy and identity. First, we articulate their temporal differences as differences in temporal structures, defined as the ordering of their past and future time horizons and the temporal depth between those horizons. Second, we show how different combinations of temporal structures lead to different modes of interplay, which we label “punctuated,” “subsumed,” and “sustained.” Third, we show how sustained interplay happens when strategy includes multiple horizons and greater temporal depth, while identity has more defined horizons and a temporal depth spanning the distant past and future. In a sustained mode of interplay, strategy is meaningfully framed by identity, while strategy serves to enact identity. These findings, we argue, have major implications for how organizations can comply with short-term business cycles while addressing long-term concerns.
Mesenchymal stem cells alleviate hypoxia-induced oxidative stress and enhance the pro-survival pathways in porcine islets
Authors: Tan Yixiong , Nie Wei , Chen Cheng , He Xuesong , Xu Yuzhi , Ma Xiaoqian , Zhang Juan , Tan Mengqun , Rong Pengfei , Wang Wei
Published: May 2019

Islet transplantation is a promising treatment for selected patients with type 1 diabetes mellitus (T1DM). Hypoxia and oxidative stress are major causes of damage to transplanted islets. Mesenchymal stem cells (MSCs) have been shown to enhance cell survival mainly through paracrine secretion. However, mechanisms of action underlying the protective effects of MSCs on islets have not been fully elucidated. In this study, we investigated whether human umbilical cord-derived MSCs (huc-MSCs) could inhibit hypoxia and ROS-related cell death of neonatal porcine islet cell clusters (NICCs) and further determined the underlying molecular mechanisms. NICCs were cultured in vitro under normoxic and hypoxic (1% O2) conditions with or without MSC-conditioned medium (MSC-CM). Apoptosis of NICCs was evaluated by the AO/EB staining and Annexin V/PI flow cytometry analysis. Total and mitochondrial ROS production was detected by fluorometric assays. Western blot and the ERK pathway inhibitor, PD98059, were used to assess the possible pathways involved. The results showed that MSC-CM suppressed hypoxia-induced oxidative stress and cell death of NICCs. MSC-CM also activated several pro-survival pathways in NICCs under hypoxic conditions. Furthermore, MSC-secreted exosomes and IL-6 partially recapitulated the multifunctional benefits of MSC-CM. This study showed that huc-MSCs protected NICCs from hypoxia-induced cell death by regulating the cell redox state and cell signaling pathways. This increased understanding may enable MSCs to become a more promising adjuvant cell therapy for islet transplantation.

Impact statement

The utilization of mesenchymal stem cells (MSCs) is a promising approach to serve as adjuvant therapy for islet transplantation. But the inability to translate promising preclinical results into sound therapeutic effects in human subjects indicates a lack of key knowledge of MSC-islet interactions that warrant further research. Hypoxia and oxidative stress are critical factors which lead to a tremendous loss of islet grafts. However, previous studies mainly focused on other aspects of MSC protection such as inducing revascularization, enhancing insulin secretion, and reducing islet apoptosis. In this study, we aim to investigate whether MSC can protect islet cells from hypoxic damage by inhibiting ROS production and the potential underlying pathways involved. We also explore the effects of MSC-derived exosomes and IL-6 on hypoxia-injured islets. Our data provide new molecular targets for developing MSC applications, and this may ultimately promote the efficiency of clinical islet transplantation.
Racial Disparities and Outcomes After Left Ventricular Assist Device Implantation as Bridge to Transplantation or Destination Therapy
Authors: Okoh Alexis K. , Chan Olivia , Schultheis Molly , Fugar Setri , Kang Nathan , Kaplon Sari , Karanam Ravindra , Russo Mark , Zucker Mark , Camacho Margarita
Published: May 2019

Objective

We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race.

Methods

Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race: Caucasian, African American (AA), and Hispanic. Postoperative outcomes including complications, discharge disposition, and survival at defined time points were compared. Cox proportional hazards were used to identify factors associated with 1-year all-cause survival.

Results

A total of 158 patients who had LVADs as BTT ( n = 63) and DT ( n = 95) were studied. Of these, 56% ( n = 89) were Caucasians, 35% ( n = 55) were AA, and 9% ( n = 14) were Hispanics. AA patients had higher BMI and lower socioeconomic status and educational level, and were more likely to be single or divorced. Operative outcomes were similar among all 3 groups. Unadjusted 30-day, 6-month, 1-year, and 2-year survival rates for Caucasians versus AA versus Hispanics were 82% versus 89% versus 93%, P = 0.339; 74% versus 80% versus 71%, P = 0.596; 67% versus 76% versus 71%, P = 0.511; and 56% versus 62% versus 68%, P = 0.797. On multivariate analysis, device-related infection, malfunction, and abnormal rhythm were factors associated with overall all-cause mortality.

Conclusion

AA patients who undergo LVAD implantation as BTT or DT have lower socioeconomic status and educational level compared to their Caucasian or Hispanic counterparts. These differences, however, do not translate into postimplant survival outcomes.
The role of character in talent identification and development in New Zealand rugby union
Authors: Rosevear Ryan , Cassidy Tania
Published: May 2019

The purpose of the study was to gain understanding of how character is understood in the New Zealand Rugby (NZR) ecology and how the Player Development Manager (PDM) in one Provincial Union (PU) negotiates, constructs and operationalizes interpretations of character within talent identification and development practices. The study design was informed by Bronfenbrenner’s ecological systems model of development and the methodology was case study. The participant in the study was the PDM who worked for one provincial rugby union and NZR. Data was gained using; interviews, document analysis and observations. An iterative strategy was employed when adopting the deductive and inductive analysis. The study found that across the NZR ecology there was no universal definition of character, or set of criteria used to assess players’ character. Within the NZR macrosystem there were formal policies that explicitly identified character as a value to be assessed. Yet, implicit understandings and assessment of character also existed. The PDM working in a microsystem constructed his understanding and assessment of character based on his experiences working with, and for, NZR (macrosystem) and the PU (exosystem) respectively, as well as drawing on his personal value set. The findings of this study are significant not only for rugby, in New Zealand and elsewhere, but they are relevant and topical for any selector, recruitment agent or coach who implicitly and explicitly (de)selects participants based on character.
Surgical management of urachal tumors: Can the umbilicus be sparred in localized disease?
Authors: Pavelescu Cristian , Pavelescu Alexandra , Surcel Cristian , Mirvald Cristian , Alvarez-Maestro Mario , Najjar Salam , Mihai Victor , Multescu Razvan , Savu Carmen Mariana , Sinescu Ioanel
Published: May 2019

Urachal adenocarcinoma represents the third most common histological type of non-urotelial bladder cancer. A very low incidence of this disease and the lack of prospective studies have led to a rich and heterogeneous treatment history. Currently, the standard of care for these patients is represented by partial cystectomy en bloc with resection of the urachal ligament and total omphalectomy. The aim of this article is to present our experience and results in the management of patients with urachal adenocarcinoma. Between 2005 and 2015, 16 patients have undergone surgical treatment for urachal adenocarcinoma in “Fundeni” Clinical Institute and Madrid University Hospital “Infanta Sofia.” Partial cystectomy was performed in 11 (68.76%) patients, while radical cystectomy en bloc with omphalectomy was performed in 5 (31.25%) patients, which were not amendable to a limited resection. The Sheldon classification was used, as it provides appropriate disease staging and is the most commonly utilized. Postoperative pathological results showed that 7 (43.75%) patients had localized tumors, and more than one-third (37.5%) of the patients had locally advanced Sheldon III disease, while 3 patients had distant metastasis at the time of surgery. Lymph node involvement was present in 3 patients (18.75%). Mean follow-up time was 2.5 years, ranging from 4 months to 7.6 years. Three patients (18.75%) were lost to follow-up, without any documented signs of local or systemic recurrence and were cancer free at the time of the last evaluation. In cases with lymph node involvement, local recurrence or distant metastasis, patients underwent cisplatin- or 5-fluorouracil-based salvage chemotherapy. Surgical treatment represents the gold standard, while adjuvant chemotherapy has a limited impact on overall survival. The utility of navel resection is questionable due to the rarity of direct invasion or local recurrence.
From Promoting Healthy Sexual Functioning to Managing Biomedical Sexual Dysfunction: Health Professional Views of Youth Sexual Health
Authors: O'Sullivan Lucia F. , Majerovich Jo Ann , Wuest Judith
Published: May 2019

A body of work emerging in the last few years has expanded the focus of youth sexual health to include problems in sexual functioning. Recent surveys show that rates of youth sexual functioning problems are similar to those of adults. Physicians' lack of awareness about problems of sexual functioning has been identified as a major obstacle in treatment. Yet little is known about health-care provider (HCP) perspectives on youth sexual functioning. We conducted a descriptive qualitative study with HCPs to learn about their perceptions of adolescent sexual problems and HCP roles in managing these issues including sexual functioning. Nineteen HCPs: Family physicians, nurse practitioners, and public health nurses working primarily with youth in universities, schools, or sexual health clinics were recruited to draw on their expert knowledge and experience. All completed in-depth individual interviews. Data were analyzed using directed qualitative content analysis. Our findings illuminate inconsistent views. Some HCPs, particularly those in youth-focused services, adopt a holistic role in promoting healthy sexual functioning, and others, commonly those in general practice, attend only to biomedical issues related to sexual dysfunction. All HCPs in our study were challenged by a paucity of sexual health preparation in their formal education. HCP interest in youth sexual health affected their efforts to acquire new information and training and, along with the structure of their practice setting, influenced whether they framed their role in youth sexual health holistically within a context of social determination or constrained their role to a medical model. These findings draw attention to the need for new approaches for strengthening knowledge, training, and resources to foster HCP promotion of healthy sexual functioning and prevention of lifelong sexual health problems.
Synthesis of the Literature: Variables Influencing Caregiver Use or Nonuse of Supportive Services
Authors: Childers Kristina M.
Published: May 2019

Two out of three caregivers (CGs) of persons with dementia (PWD) living in the community do not use supportive services or resources, and three out of four underutilize available support. These findings are troubling because CGs report many unmet needs in providing support to PWD. What predisposing, enabling, and need variables influence CGs to use or not use support services are poorly understood. This article reviews the literature on CG of PWD to find characteristic variables that are related to CG's decisions to use or not use support services. Instruments used in research studies were named to determine recommendations for future studies. The article organizes the variables following Anderson's model of predisposing, enabling, and need characteristics. It also supports future research to examine CG use or nonuse of resources that could inform practice, funding of programs, and policy.
School Nurses' Experiences Working With Unaccompanied Refugee Children and Adolescents: A Qualitative Study
Authors: Musliu Ermira , Vasic Snezana , Clausson Eva K. , Garmy Pernilla
Published: May 2019

School nurses are one of the first health-care professionals to meet unaccompanied refugee children and adolescents and therefore have an important impact on health outcomes. The aim of this study was to describe school nurses' experiences working with unaccompanied refugee children and adolescents. Semistructured interviews were conducted with school nurses ( n = 14) who worked with unaccompanied refugee children and adolescents. The interviews were analyzed via qualitative content analysis. The results fell into three themes: (a) knowledge of trauma-informed care, (b) knowledge of intercultural nursing, and (c) importance of self-awareness. School nurses require the development of tailor-made skills that focus on crisis, trauma, and cultural awareness to meet the complex needs associated with working with unaccompanied refugee children and adolescents.
Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria
Authors: Cuvelier Geoffrey D. E. , Nemecek Eneida R. , Wahlstrom Justin T. , Kitko Carrie L. , Lewis Victor A. , Schechter Tal , Jacobsohn David A. , Harris Andrew C. , Pulsipher Michael A. , Bittencourt Henrique , Choi Sung Won , Caywood Emi H. , Kasow Kimberly A. , Bhatia Monica , Oshrine Benjamin R. , Flower Allyson , Chaudhury Sonali , Coulter Donald , Chewning Joseph H. , Joyce Michael , Savaşan Süreyya , Pawlowska Anna B. , Megason Gail C. , Mitchell David , Cheerva Alexandra C. , Lawitschka Anita , West Lori J. , Pan Bo , Al Hamarneh Yazid N. , Halevy Anat , Schultz Kirk R.
Published: May 2019

Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versus-host disease (GVHD) syndromes but have not been validated in patients <18 years of age. The objectives of this prospective multi-institution study were to determine: (1) whether the NIH-CC could be used to diagnose pediatric cGVHD and whether the criteria operationalize well in a multi-institution study; (2) the frequency of cGVHD and L-aGVHD in children using the NIH-CC; and (3) the clinical features and risk factors for cGVHD and L-aGVHD using the NIH-CC. Twenty-seven transplant centers enrolled 302 patients <18 years of age before conditioning and prospectively followed them for 1 year posttransplant for development of cGVHD. Centers justified their cGVHD diagnosis according to the NIH-CC using central review and a study adjudication committee. A total of 28.2% of reported cGVHD cases was reclassified, usually as L-aGVHD, following study committee review. Similar incidence of cGVHD and L-aGVHD was found (21% and 24.7%, respectively). The most common organs involved with diagnostic or distinctive manifestations of cGVHD in children include the mouth, skin, eyes, and lungs. Importantly, the 2014 NIH-CC for bronchiolitis obliterans syndrome perform poorly in children. Past acute GVHD and peripheral blood grafts are major risk factors for cGVHD and L-aGVHD, with recipients ≥12 years of age being at risk for cGVHD. Applying the NIH-CC in pediatrics is feasible and reliable; however, further refinement of the criteria specifically for children is needed.
Patterns of substrate affinity, competition, and degradation kinetics underlie biological activity of thalidomide analogs
Authors: Sperling Adam S. , Burgess Michael , Keshishian Hasmik , Gasser Jessica A. , Bhatt Shruti , Jan Max , Słabicki Mikołaj , Sellar Rob S. , Fink Emma C. , Miller Peter G. , Liddicoat Brian J. , Sievers Quinlan L. , Sharma Rohan , Adams Dylan N. , Olesinski Elyse A. , Fulciniti Mariateresa , Udeshi Namrata D. , Kuhn Eric , Letai Anthony , Munshi Nikhil C. , Carr Steven A. , Ebert Benjamin L.
Published: May 2019

Pharmacologic agents that modulate ubiquitin ligase activity to induce protein degradation are a major new class of therapeutic agents, active in a number of hematologic malignancies. However, we currently have a limited understanding of the determinants of activity of these agents and how resistance develops. We developed and used a novel quantitative, targeted mass spectrometry (MS) assay to determine the relative activities, kinetics, and cell-type specificity of thalidomide and 4 analogs, all but 1 of which are in clinical use or clinical trials for hematologic malignancies. Thalidomide analogs bind the CRL4CRBN ubiquitin ligase and induce degradation of particular proteins, but each of the molecules studied has distinct patterns of substrate specificity that likely underlie the clinical activity and toxicities of each drug. Our results demonstrate that the activity of molecules that induce protein degradation depends on the strength of ligase-substrate interaction in the presence of drug, the levels of the ubiquitin ligase, and the expression level of competing substrates. These findings highlight a novel mechanism of resistance to this class of drugs mediated by competition between substrates for access to a limiting pool of the ubiquitin ligase. We demonstrate that increased expression of a nonessential substrate can lead to decreased degradation of other substrates that are critical for antineoplastic activity of the drug, resulting in drug resistance. These studies provide general rules that govern drug-dependent substrate degradation and key differences between thalidomide analog activity in vitro and in vivo.
Dysregulated megakaryocyte distribution associated with nestin+ mesenchymal stem cells in immune thrombocytopenia
Authors: Wang Min , Feng Ru , Zhang Jia-min , Xu Lin-lin , Feng Fei-er , Wang Chen-cong , Wang Qian-ming , Zhu Xiao-lu , He Yun , Xue Jing , Fu Hai-xia , Lv Meng , Kong Yuan , Chang Ying-jun , Xu Lan-ping , Liu Kai-yan , Huang Xiao-jun , Zhang Xiao-hui
Published: May 2019

Impaired megakaryocyte (MK) maturation and reduced platelet production are important causes of immune thrombocytopenia (ITP). However, MK distribution and bone marrow (BM) niche alteration in ITP are unclear. To investigate the maturation and distribution of MKs in the BM niche and examine the components of BM niche regulation of MK migration, BM and peripheral blood were obtained from 30 ITP patients and 28 healthy donors. Nestin+ mesenchymal stem cells (MSCs) and CD41+ MKs were sorted by fluorescence-activated cell sorting. The components of the BM niche and related signaling were analyzed via immunofluorescence, flow cytometry, enzyme-linked immunosorbent assay, reverse transcription polymerase chain reaction, and western blot analysis. The number of MKs in the BM vascular niche was reduced in ITP. Moreover, the concentrations of CXCL12 and CXCR4+ MKs in the BM were decreased in ITP. Further investigation demonstrated that nestin+ MSCs and CXCL12 messenger RNA (mRNA) in nestin+ MSCs were both reduced whereas the apoptosis of nestin+ MSCs was significantly increased in ITP. Sympathetic nerves, Schwann cells, the proportion of β3-adrenoreceptor (β3-AR)+ nestin+ MSCs, and β3-AR mRNA in nestin+ MSCs were all markedly reduced in ITP. Moreover, matrix metalloproteinase 9, vascular endothelial growth factor (VEGF), and VEGF receptor 1 were significantly reduced in ITP. Our data show that impaired MK distribution mediated by an abnormal CXCL12/CXCR4 axis is partially involved in reduced platelet production in ITP. Moreover, sympathetic neuropathy and nestin+ MSC apoptosis may have an effect on the alterations of BM CXCL12 in ITP.
Geo-consistent depth trends: Honoring geology in siliciclastic rock-physics depth trends
Authors: Dræge Anders
Published: May 2019

A new method for modeling rock-physics depth trends called “geo-consistent depth trend modeling” is presented. No new rock-physics models are developed in this work, but existing models are put together in a new workflow. The workflow integrates rock-physics modeling with petrologic porosity models that account for burial, pressure, and temperature history. The new approach honors geologic trends, patterns, and cyclicity in the rocks. Examples based on well data are given to show how depositional trends can influence seismic response and depth trends. Geo-consistent depth trends are compared with the standard method for rock-physics depth trends, and differences are discussed. Geo-consistent depth trends can contribute to increased understanding of the subsurface and give input to risking of targets in exploration.
Prospective, Multicenter, Randomized Phase III Trial Evaluating the Impact of Lymphoscintigraphy as Part of Sentinel Node Biopsy in Early Breast Cancer: SenSzi (GBG80) Trial
Authors: Kuemmel Sherko , Holtschmidt Johannes , Gerber Bernd , Von der Assen Albert , Heil Joerg , Thill Marc , Krug David , Schem Christian , Denkert Carsten , Lubitz Juliane , Blohmer Jens Uwe , Reinisch Mattea , Hötzeldt Michael , Seither Fenja , Nekljudova Valentina , Schwidde Ilka , Uhrhan Klara , Von Minckwitz Gunter , Rezai Mahdi , Mulowski Jana , Loibl Sibylle , Kuehn Thorsten
Published: May 2019

PURPOSE

The aim of the current work was to clarify whether a preoperative lymphoscintigraphy (LSG) enhances staging accuracy of sentinel lymph node biopsy (SLNB).

PATIENTS AND METHODS

In a prospective, multicenter, randomized phase III trial, patients with cN0 early breast cancer or extensive/high-grade ductal carcinoma in situ planned for standard radioactive-labeled colloid LSG with subsequent SLNB were randomly assigned 1:1 to receive SLNB either with knowledge of the LSG findings or without. As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary end point was the mean number of histologically detected SLNs per patient. One thousand one hundred two evaluable patients were necessary to demonstrate noninferiority of SLNB without LSG. Stratified one-sided 95% CI for the difference (without LSG − with LSG) in the mean number of histologically detected SLNs had to be greater than −0.27 (10% noninferiority margin). Stratification was performed according to tumor focality and trial site. Additional predefined secondary end points (rates of node-positive patients and of completion axillary lymph node dissection) were analyzed to rule out differences in the reliable detection of nodal metastases.

RESULTS

Between May 2014 and October 2015, 1,198 patients were randomly assigned in 23 German and Swiss breast centers. Modified intention-to-treat analysis (n = 1,163) showed a mean number of histologically detected SLNs of 2.21 with LSG and 2.26 without LSG (difference 0.05; stratified 95% CI, −0.18 to infinity), thus establishing noninferiority of omitting preoperative LSG. Secondary end points displayed no statistically significant differences.

CONCLUSION

We show that SLNB is equally effective irrespective of the surgeon’s knowledge of preoperative LSG results. SLNB without LSG will speed up the preoperative workflow and reduce cost.
Impact of Consensus Molecular Subtype on Survival in Patients With Metastatic Colorectal Cancer: Results From CALGB/SWOG 80405 (Alliance)
Authors: Lenz Heinz-Josef , Ou Fang-Shu , Venook Alan P. , Hochster Howard S. , Niedzwiecki Donna , Goldberg Richard M. , Mayer Robert J. , Bertagnolli Monica M. , Blanke Charles D. , Zemla Tyler , Qu Xueping , Wirapati Pratyaksha , Tejpar Sabine , Innocenti Federico , Kabbarah Omar
Published: May 2019

PURPOSE

To determine the predictive and prognostic value of the consensus molecular subtypes (CMSs) of colorectal cancer (CRC) that represent a merging of gene expression–based features largely in primary tumors from six independent classification systems and provide a framework for capturing the intrinsic heterogeneity of CRC in patients enrolled in CALGB/SWOG 80405.

PATIENTS AND METHODS

CALGB/SWOG 80405 is a phase III trial that compared the addition of bevacizumab or cetuximab to infusional fluorouracil, leucovorin, and oxaliplatin or fluorouracil, leucovorin, and irinotecan as first-line treatment of advanced CRC. We characterized the CMS classification using a novel NanoString gene expression panel on primary CRCs from 581 patients enrolled in this study to assess the prognostic and predictive value of CMSs in these patients.

RESULTS

The CMSs are highly prognostic for overall survival (OS; P < .001) and progression-free survival (PFS; P < .001). Furthermore, CMSs were predictive for both OS ( P for interaction < .001) and PFS ( P for interaction = .0032). In the CMS1 cohort, patients treated with bevacizumab had a significantly longer OS than those treated with cetuximab ( P < .001). In the CMS2 cohort, patients treated with cetuximab had a significantly longer OS than patients treated with bevacizumab ( P = .0046).

CONCLUSION

These findings highlight the possible clinical utility of CMSs and suggests that refinement of the CMS classification may provide a path toward identifying patients with metastatic CRC who are most likely to benefit from specific targeted therapy as part of the initial treatment.
Real-World Treatment Patterns and Clinical Outcomes in Patients Receiving Palbociclib for Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Advanced or Metastatic Breast Cancer in Argentina: The IRIS Study
Authors: Waller John , Mitra Debanjali , Mycock Katie , Taylor-Stokes Gavin , Milligan Gary , Zhan Lin , Iyer Shrividya
Published: May 2019

PURPOSE

The selective cyclin-dependent kinase 4/6 inhibitor palbociclib was approved in Argentina in 2015 for postmenopausal women with hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative advanced breast cancer (ABC) or metastatic breast cancer (MBC) based on phase III study results. The Ibrance Real World Insights (IRIS) study aims to evaluate palbociclib in patients with HR-positive/HER2-negative ABC or MBC in the real-world setting in multiple countries globally. Here we report results from patients enrolled in the IRIS study in Argentina.

PATIENTS AND METHODS

This retrospective medical chart review study included postmenopausal women with confirmed HR-positive/HER2-negative ABC or MBC who were treated with palbociclib plus letrozole as first-line endocrine-based therapy or with palbociclib plus fulvestrant in women with disease progression after endocrine therapy. Participating physicians reviewed medical records of up to six patients each, collecting demographic and clinical data. Outcomes included progression-free and overall survival rates.

RESULTS

Records were extracted for 162 patients in Argentina (palbociclib plus letrozole, n = 105 [65%]; palbociclib plus fulvestrant, n = 57 [35%]). The 6-month progression-free survival rate was 94% for patients treated with palbociclib plus letrozole and 95% for patients treated with palbociclib plus fulvestrant; 85% and 80% of patients treated with palbociclib plus letrozole were progression free at 12 and 18 months, respectively. Six-month survival rates were 98% for palbociclib plus letrozole and 98% for palbociclib plus fulvestrant; 93% and 89% of patients treated with palbociclib plus letrozole were alive at 12 and 18 months, respectively.

CONCLUSION

Results from this first real-world evaluation of clinical outcomes in Argentina suggest that palbociclib plus letrozole or fulvestrant delivers favorable effectiveness, as measured by progression-free and overall survival rates.
Why Lucy Doesn't Care: Migration and Emotional Labor inVillette
Authors: Schaffer Talia
Published: May 2019

In this essay I argue that Lucy's traumatic condition comes from her experience navigating an emerging economic phenomenon. She is an early participant in global migrant caregiving. Initially involved in an intensive, all-engrossing care dyad, she then moves into what Arlie Russell Hochschild calls “emotional labor,” the act of performing an inauthentic feeling publicly for money. Like modern caregivers, Lucy Snowe expresses a sense of invisibility and stress over her cultural alterity. When Madame Beck's surveillance forces Lucy to enact her teacherly persona constantly, Lucy fetishizes her inner truth and develops a disastrous split between these two versions of herself—a split that the novel represents both by her two love interests and by the costume of the nun. In Villette, moreover, Brontë invents specific narrative tropes that would be picked up by later writers on migration including Jamaica Kincaid. Although Lucy Snowe is the first protagonist to suffer from emotional labor, analyzing Lucy's condition helps us notice that throughout Victorian fiction, a host of minor characters—companions, governesses, nurses—share some of these characteristic traits. Villette therefore gives us an alternative way of understanding Victorian working women in fiction, and the effort to depict the inner life of a person whose work profoundly alienates her from her inner self accounts for the extraordinary literary innovations of Brontë's last novel.
Thomas Hardy's Modern Peasant
Authors: Ramizi Erag
Published: May 2019

This article reads Thomas Hardy's 1891 novel Tess of the d'Urbervilles as one instance of the way literary engagements with the peasant question in late nineteenth-century Europe at once shed light onto the lived experiences of rural populations and elaborated the theoretical preoccupations pertaining to peasants' status in their contemporary society. It makes a case for Hardy's lucid awareness of the continuing nature of primitive accumulation in England and demonstrates that the text aptly explores its effects on various rural social classes. To do so, the article closely examines the chronopolitics that underpin the troubled encounter between Tess and Angel to argue that their divergent temporal orders both enable and preclude an alliance between the two worlds they stem from. Ultimately, the article investigates the dynamic between modernity and peasanthood to argue for their metonymic, as opposed to antonymic, relationship.
Are Local Tax Rates Strategic Complements or Strategic Substitutes?
Authors: Parchet Raphaël
Published: May 2019

The identification of strategic interactions among local governments is typically plagued by endogeneity problems. I exploit the fact that local jurisdictions located close to a state border have some neighbors in another state and instrument the tax rate of neighbor jurisdictions with the state-level tax rate of the neighboring state. I use this instrument to identify strategic personal income tax setting by local jurisdictions in Switzerland and find that tax rates are strategic substitutes. I then develop a residence-based personal income tax competition model and show that tax rates are strategic substitutes if the elasticity of the marginal utility of the public good with respect to the tax rate is above one. This is notably the case in the presence of economies of scale in the public good provision. (JEL H24, H71, H73, H77)
Financial Incentives and Earnings of Disability Insurance Recipients: Evidence from a Notch Design
Authors: Ruh Philippe , Staubli Stefan
Published: May 2019

Most countries reduce disability insurance (DI ) benefits for beneficiaries earning above a specified threshold. Such an earnings threshold generates a discontinuous increase in tax liability—a notch—and creates an incentive to keep earnings below the threshold. Exploiting such a notch in Austria, we provide transparent and credible identification of the effect of financial incentives on DI beneficiaries’ earnings. Using rich administrative data, we document large and sharp bunching at the earnings threshold. However, the elasticity driving these responses is small. Our estimate suggests that relaxing the earnings threshold reduces fiscal cost only if program entry is very inelastic. (JEL H55, J14, J31)
Snapping Back: Food Stamp Bans and Criminal Recidivism
Authors: Tuttle Cody
Published: May 2019

I estimate the effect of access to food stamps on criminal recidivism. In 1996, a federal welfare reform imposed a lifetime ban from food stamps on convicted drug felons. Florida modified this ban, restricting it to drug traffickers who commit their offense on or after August 23, 1996. I exploit this sharp cutoff in a regression discontinuity design and find that the ban increases recidivism among drug traffickers. The increase is driven by financially motivated crimes, suggesting that the cut in benefits causes ex-convicts to return to crime to make up for the lost transfer income. (JEL H75, I38, K42)
Early School Exposure, Test Scores, and Noncognitive Outcomes
Authors: Cornelissen Thomas , Dustmann Christian
Published: May 2019

We estimate the effects of receiving additional schooling before age five on cognitive and noncognitive outcomes, exploiting unique school entry rules in England that cause variation in the age at school entry and the effective length of the first school year, and combining survey data with administrative school records up to six years after exposure. We find significant effects on both cognitive and noncognitive outcomes at ages five and seven, particularly so for boys with a disadvantaged parental background. At age 11, effects on cognitive outcomes have disappeared, while there is still evidence for effects on noncognitive outcomes. (JEL I21, J13)
Student Loan Nudges: Experimental Evidence on Borrowing and Educational Attainment
Authors: Marx Benjamin M. , Turner Lesley J.
Published: May 2019

We provide the first experimental evidence on the effect of student loans on educational attainment. Loan amounts listed in financial aid award letters (“offers”) do not alter students’ choice sets but significantly affect borrowing. Students randomly receiving a nonzero offer were 40 percent more likely to borrow than those who received a $0 offer. Per additional borrower, loans increased by $4,000, GPA and completed credits increased by 30 percent, and transfers to four-year public colleges increased by 11 percentage points. Cost-benefit and theoretical analyses suggest nonzero offers enhance welfare, yet over five million students are not currently offered loans. (JEL D14, D91, I22, I23)
Changes of serum IGF-1 and ET-1 levels in patients with osteoporosis and its clinical significance
Authors: Sun Lei , Su Jin , Wang Mingming
Published: May 2019

Objective: To investigate the correlations of levels of serum insulin-like growth factor-1 (IGF-1) and endothelin-1 (ET-1) with cytokines including interleukin (IL)-18, IL-6 and high-sensitivity C-reactive protein (hs-CRP) and bone material density in patients with osteoporosis d.

Methods: Eighty patients with osteoporosis who were treated in our hospital from April 2016 to October 2017 were selected as observation group, and 60 healthy elderly people who received physical examination in our hospital in the same period were selected as control group. The serum levels of IGF-1 and ET-1 were detected using enzyme-linked immunosorbent assay. The bone material density of the lumbar vertebra, tibial neck and Ward’s triangle of every research subject was measured using dual-energy x-rays absorptiometry. The correlations between variables were analyzed using Pearson correlation analysis.

Results: The level of IGF-1 in the observation group was lower than that in the control group, and the level of ET-1 in the observation group was higher than that in the control group (P<0.05). The levels of interleukin (IL)-18, IL-6 and high-sensitivity C-reactive protein (hs-CRP) in the observation group were significantly higher than those in the control group (P<0.05). Bone mineral density of lumbar vertebra, tibial neck and Ward triangle in the observation group was significantly lower than that in the control group (P<0.05); the IGF-1 level of osteoporosis patients was negatively correlated with IL-18, IL-6, hs-CRP levels and positively correlated with bone mineral density; the ET-1 level was positively correlated with IL-18, IL-6, hs-CRP levels and negatively correlated with bone mineral density.

Conclusion: Patients with osteoporosis have decreased level of IGF-1 but increased level of ET-1, and they are closely related to cytokines and bone mineral density and may participate in the pathogenesis of osteoporosis.

doi: https://doi.org/10.12669/pjms.35.3.84

How to cite this:Sun L, Su J, Wang M. Changes of serum IGF-1 and ET-1 levels in patients with osteoporosis and its clinical significance. Pak J Med Sci. 2019;35(3):691-695. doi: https://doi.org/10.12669/pjms.35.3.84

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Knowledge management awareness assessment in Nigerian tertiary institutions
Authors: Ogunbanwo Afolakemi Simbo , Okesola Julius Olatunji , Buckley Sheryl
Published: May 2019

Background: Knowledge management (KM) is a recipe for increasing performance and promoting innovation in tertiary institutions. However, some scholars argue that the Nigerian educational sector is yet to fully appreciate the importance of KM as their KM awareness level is still low. Since measurement is the basic foundation to accomplish success, this paper assesses the KM awareness level in tertiary institutions of south-west Nigeria.

Methods: We applied a survey method using a closed ended questionnaire administered to 50 participants from each of the 10 institutions measured by Likert scaling. Employing SPSS for data analysis, frequency count and percentage score were adopted to analyse the demographic data, and the research hypotheses were analysed with chi square test, Pearson chi square and bivariate correlation (Pearson) analysis.

Results: A positive relationship between awareness, current status and level of familiarity was noted. KM awareness level in the institutions is high even though there is a significant difference between the public and private universities, as well as between the students and academic staff.

Conclusions: Since an increase in the awareness level increases both current status and level of familiarity which often account for KM success, it is recommend that KM awareness level should continuously be improved upon in Nigerian tertiary institutions.
Modifiable factors associated with weight regain after bariatric surgery: a scoping review
Authors: Kaouk Lisa , Hsu Amy T. , Tanuseputro Peter , Jessri Mahsa
Published: May 2019

Background: Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight regain after bariatric surgery.

Methods: A systematic search was conducted in Medline, Google Scholar, Cochrane, National Collaborating Centre for Methods and Tools (NCCMT) and Practice-based Evidence in Nutrition (PEN) which included articles published between January 1990 and February 2 2017, for studies examining “weight regain” after bariatric surgery. A total of 293 citations were retrieved. Eligible articles must have examined modifiable factors and addressed weight regain, or a long-term post-operative phase in which weight regain may occur. After removing duplicates, 22 studies were included for thematic analysis.

Results: Key modifiable factors associated with weight regain were identified and categorized under the following themes: poor dietary adherence (e.g. excessive calorie, carbohydrate, and alcohol intake), maladaptive eating behaviors (e.g. grazing, binging), lack of on-going follow-up with the bariatric team and insufficient physical activity.

Conclusions:  Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change.