bluuebunny/crossref_metadata_2025 huggingface dataset:
Week-Long Mode Choice Behavior: Dynamic Random Effects Logit Model
Authors: Shamshiripour Ali , Golshani Nima , Shabanpour Ramin , Mohammadian Abolfazl (Kouros)
Published: June 2019

Modeling travelers’ mode choice behavior is an important component of travel demand studies. In an effort to account for day-to-day dynamics of travelers’ mode choice behavior, the current study develops a dynamic random effects logit model to endogenously incorporate the mode chosen for a day into the utility function of the mode chosen for the following day. A static multinomial logit model is also estimated to examine the performance of the dynamic model. Per the results, the dynamic random effects model outperforms the static model in relation to predictive power. According to the accuracy indices, the dynamic random effects model offers the predictive power of 60.0% for members of car-deficient households, whereas the static model is limited to 43.1%. Also, comparison of F1-scores indicates that the predictive power of the dynamic random effects model with respect to active travels is 47.1% whereas that of the static model is as low as 15.0%. The results indicate a significant day-to-day dynamic behavior of transit users and active travelers. This pattern is found to be true in general, but not for members of car-deficient households, who are found more likely to choose the same mode for two successive days.
Investigation on Improvement of Flexural Behavior of Low-Density Cellular Concrete through Fiber Reinforcement for Non-Structural Applications
Authors: Abdigaliyev Arman , Hu Jiong
Published: June 2019

During the last decades, cellular lightweight concrete (CLC), or foamed concrete, has been experiencing greater interest in geotechnical, structural, and non-structural applications. The low density and high flowability makes it a favorable construction material in relation to handling, placing, and construction costs. However, the applications of low-density cellular concrete (LDCC), the category of CLC with a unit weight less than 50 pounds per cubic foot (801 kg/m3) and generally without fine aggregates, are limited mostly to backfill applications in geotechnical engineering. The main reason lies in the brittleness of the material and low to zero resistance to flexural loads. Fiber-reinforced LDCC may be a reasonable solution to improve mechanical properties and expand the application range of the material. This study investigated the effects of adding polypropylene and hybrid fibers on physical and mechanical properties of LDCC and the feasibility of expanding LDCC utilization to non-structural applications. Results showed that although there is a slight reduction of flowability and compressive strength, the flexural behavior of LDCC can be significantly improved with the incorporation of fibers. The flexural strength and flexural toughness of LDCC was found to increase from 26.8 pounds per square inch (psi) (0.18 MPa) to 217.5 psi (1.48 MPa), and from 5.67 lb-in. (0.64 kN-mm) to 292 lb-in. (33.0 kN-mm) respectively at a 1.0% addition rate of a fibrillated polypropylene fiber selected in this study, which makes it a feasible material for non-structural applications.
Effect of Medial Open-Wedge High Tibial Osteotomy on the Patellofemoral Joint According to Postoperative Realignment
Authors: Yoon Tae-Hwan , Choi Chong Hyuk , Kim Sung-Jae , Kim Sung-Hwan , Kim Nam-Hoo , Jung Min
Published: June 2019

Background:

No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment.

Purpose:

To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR <58.3%, lowest quartile), acceptable correction (WBLR of 58.3%-66.3%, middle 2 quartiles), and overcorrection (WBLR >66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint.

Results:

Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [ P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [ P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%).

Conclusion:

The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.
Effect of chitosan incorporation on crystallinity, mechanical and rheological properties, and photodegradability of PE/TPS blends
Authors: Afkhami Ali , Rezaei Mostafa , Malmiri Hoda Jafarizadeh
Published: June 2019

Chitosan is a well-known biodegradable biopolymer, which possesses antimicrobial properties. In this study, the effect of chitosan incorporation on the morphology; thermal, mechanical, and rheological properties; and antibacterial and photodegradation behaviors of polyethylene (PE)/thermoplastic starch (TPS) blends were examined. PE/TPS blends were compatibilized with low-density PE-grafted maleic anhydride copolymer (PE- g-MA) compatibilizer. Scanning electron microscopy (SEM) and tensile test indicated that the addition of chitosan in powder form has a devastating effect on both mechanical and morphological properties of the blends. Therefore, chitosan was plasticized with acetic acid and glycerol (2 wt% chitosan dissolved in acetic acid/glycerol solution) prior to addition to the blends, which considerably improved the mechanical properties of the blends. Dynamic rheological experiments revealed a decrease in the complex viscosity of the blends with the addition of plasticized chitosan compared with unplasticized chitosan. SEM micrographs demonstrated more homogenous microstructure for the blends containing plasticized chitosan and PE- g-MA compatibilizer. Differential scanning calorimetry results indicated that unplasticized chitosan acts as a nucleation agent for PE crystallization. Antibacterial analysis indicated that the incorporation of chitosan had a significant effect on preventing from bacterial population growth. The major part of this article was to study the effect of ultraviolet (UV) exposure on the chemical structure and mechanical properties of the blends, using Fourier transform infrared spectroscopy and tensile properties examination. The results indicated that the slight amount of chitosan may significantly improve the photostability of PE/TPS blends against UV degradation. However, PE- g-MA compatibilizer dramatically decreased the UV resistance of the blends.
Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort
Authors: Daly Michael , Sutin Angelina R. , Robinson Eric
Published: June 2019

Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults—that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.
Learning What to Learn Across the Life Span: From Objects to Real-World Skills
Authors: Wu Rachel
Published: June 2019

One of the most difficult and important problems that all learners face across the life span is learning what to learn. Understanding what to learn is difficult when both relevant and irrelevant information compete for attention. In these situations, the learner can rely on cues in the environment, as well as prior knowledge. However, these sources of information sometimes conflict, and the learner has to prioritize some sources over others. Determining what to learn is important because learning relevant information helps the learner achieve goals, whereas learning irrelevant information can waste time and energy. A new theoretical approach posits that adaptation is relevant for all age groups because the environment is dynamic, suggesting that learning what to learn is a problem relevant across the life span instead of only during infancy and childhood. In this article, I review new research demonstrating the importance and ways of learning what to learn across the life span, from objects to real-world skills, before highlighting some unresolved issues for future research.
Improvement in inflammation and airway remodelling after acupuncture at BL13 and ST36 in a mouse model of chronic asthma
Authors: Nurwati Ida , Purwanto Bambang , Mudigdo Ambar , Saputra Koosnadi , Prasetyo Diding Heri , Muthmainah Muthmainah
Published: June 2019

Background:

Asthma is a chronic inflammatory disease that affects millions of people worldwide. Chronic asthma is commonly resistant to steroid therapy. Acupuncture has an anti-inflammatory effect and has been widely used as an add-on therapy for asthma.

Objective:

To evaluate the effects of acupuncture on the inflammatory response and airway remodelling in the bronchioles of an asthma mouse model.

Methods:

A chronic asthma model was produced in female BALB/c mice by ovalbumin (OVA) sensitisation. 32 mice were randomised into four groups: control; asthma (OVA); OVA+BL13; and OVA+BL13+ST36. OVA was administered by intraperitoneal injection on days 0 and 14 followed by aerosol exposure of 1% OVA three times a week for 6 weeks. Manual acupuncture (MA) was performed three times a week for 6 weeks at BL13 alone, or BL13 in combination with ST36, in the two MA-treated groups. At the end of the experiment, blood samples were collected to determine eosinophil and neutrophil counts and lung tissue was prepared for histological examination.

Results:

A pronounced reduction in the neutrophil count was achieved after MA at BL13+ST36 (P=0.005) while the eosinophil count was lowered after MA both at BL13 (P=0.007) and BL13+ST36 (P=0.006). Reduction in the bronchiolar epithelial and smooth muscle thickness and the number of goblet cells was observed after MA at BL13 (P=0.001, P=0.001 and P=0.002, respectively) and BL13+ST36 (P=0.001, P=0.002 and P=0.001, respectively).

Conclusion:

Acupuncture can reduce the inflammatory response and prevent airway remodelling in a chronic asthma mouse model.
Signal Failure: Communications in the British Expeditionary Force, September 1939–June 1940
Authors: Smalley Edward
Published: June 2019

The article examines the communication difficulties faced by the British Expeditionary Force during the France campaign of 1939–40 and determines the extent to which they were self-inflicted. Among the many assessments of the German invasion of May 1940 and associated collapse of the French, the British acceptance of long-standing deficiencies in vital systems has been overlooked. The Phoney War encouraged unrealistic expectation and insatiable demand, which compounded flawed equipment, personnel, and procedure. Opportunities to ease vulnerabilities, via efficiencies and best practice, were missed. Combat and, in particular, mobile operations, were the final straw, prompting immediate collapse and, eventually, evacuation.
Fixing One’s History: George S. Patton’s Changes in his Personal Diary
Authors: Feldmann Daniel
Published: June 2019

George S. Patton is a well-known American Army commander of the Second World War. The personal diary he kept from 1942 to 1945 is a must-read source to understand the history and the performance of the US Army in the war. However, the conflicting versions of this diary and the many after-the-fact additions can lead to significant misinterpretations of Patton’s performance. This article examines the editorial evolutions of the diary, details what were the most significant modifications, and shows how they distorted what Patton thought of fellow officers as well as his role in the Normandy campaign and the Battle of the Bulge.
Does the Five-Factor Asset Pricing Model Have Sufficient Power?
Authors: Dutta Anupam
Published: June 2019

The central purpose of this article is to assess whether the newly developed five-factor model of Fama and French (2015) has sufficient power to identify the long-term abnormal performance of firms experiencing major corporate events. In order to check the robustness of the five-factor model, power of the Fama–French three-factor model (1993) has also been investigated. Simulations show that although the five-factor specification is more powerful than the three-factor specification, the extended model still lacks power. The findings further suggest that if the book-to-market factor is excluded from the five-factor model, the four-factor model documents almost similar power like the five-factor model. In addition, the power is found to be substantially reduced as the event period advances.
The Influence of Internal Corporate Governance on Bank Credit Risk: An Empirical Analysis for Tunisia
Authors: Moussa Fatma Ben
Published: June 2019

Bank governance has received special attention after the financial crises of 2008 that have occurred. Nevertheless, the literature presents seemingly conflicting evidence on the implications of governance for bank credit risk quality. The purpose of this article is to examine the impact of corporate governance variables of board size, board composition and board gender diversity on credit risk. Panel data regression analysis is applied to a sample of listed banks from the Tunisia during the 2000–2014 period. We improve the robustness of our results by employing four measures of credit risk commonly used in the literature as the dependent variable in our study. Our results show that the higher the number of board members, the lower the quality of credit is and, consequently, the credit risk increases. The concentration of power within the board of directors may increase bank risks when the cumulative functions of CEO and chairman negatively affect the weight of the board and make it less effective. Also, our findings highlight the importance of board independence and the presence of foreign directors in enhancing credit quality. Nevertheless, we document that the NPLs ratio increases and NPL coverage ratio decreases in the presence of state directors. Finally, we find evidence that the presence of a woman on board influences credit risk, as it is argued that female directors may differ from male directors with regard to their risk attitude, and this, in turn, may influence board’s monitoring ability and its decision-making process. Therefore, this evidence provides beneficial information for supervising authorities, stakeholders and academics, and banks should take this into account during the composition of their board of directors.
Spillover Effect of M&A Announcements on Acquiring Firms’ Rivals: Evidence from India
Authors: Ranju P. K. , Mallikarjunappa T.
Published: June 2019

Motivated by the paucity of empirical studies examining the impact of mergers and acquisition (M&A) announcements on the acquiring firms’ rivals, we made an attempt to uncover the spillover effect of M&A announcements on the stock market reaction of acquiring firms’ rivals. Using a sample of 97 M&A announcements during the period from April 2014 to March 2016 and 179 rivals of acquirers, we found that acquiring firms and acquiring firms’ rivals react positively to the announcement of M&As. The results of the disaggregated analysis suggest that horizontal M&As do not result in a significant positive reaction of acquiring firms’ rivals. Therefore, this study does not support the collusion theory. We also found negative (insignificant) stock market reaction of acquiring firms’ rivals upon the announcement of cross-border M&As. However, overall results show that acquiring firms’ rivals react positively to the announcement of M&As. This significant positive reaction of acquiring firms’ rivals goes in line with signalling theory. Thus, we argue that M&A announcements signal information regarding the growth potential of rivals, which results in positive stock market reaction of acquiring firms’ rivals upon the M&A announcements.
Reproductive Correlates of Natural Age at Menopause: A Study on the Minyong of Arunachal Pradesh
Authors: Sharma Maitreyee
Published: June 2019

This cross-sectional study attempts to determine the median age at menopause of 154 ever-married menopausal women belonging to the Minyong tribal community of Arunachal Pradesh. The study further attempts to see whether there is any significant association between age at menopause and the reproductive variables. The results of this study reject the association between age at menarche and menopause. Cox univariate regression of proportional risks analysis shows that the age at menopause is significantly related with age at marriage, nature of lifetime menstrual cycle, length between consecutive menstrual cycles, parity, age at last delivery, and postpartum amenorrhea (PPA). A less-studied variable, PPA, is undertaken, and a significant association is observed between the duration of PPA and the age at natural menopause. Multiparous women and later age at last delivery reported late age at natural menopause.
Shared Decision Making and Treatment for Minority Children With ADHD
Authors: Hinojosa Melanie Sberna , Hinojosa Ramon , Nguyen Jenny
Published: June 2019

Shared decision making (SDM) involves the patient and family in medical decisions regarding treatment. The purpose of this article is to utilize the 2016 National Survey of Children’s Health to explore whether family engagement in SDM increases the odds of treatment for children with ADHD, and more specifically, if the presence of SDM is associated with the reduction of racial and ethnic disparities in treatment. Multivariate logistic regression was used to model the odds of treatment for each racial/ethnic group controlling for sociodemographic and health-related variables. Results indicated that White and Multiracial families engaged in SDM were twice as likely to report treatment for ADHD. Black and Latinx families, however, showed no difference in treatment for ADHD when SDM was present. Based on these findings, we conclude that SDM may be less important for Black and Latinx families when making treatment decisions for children with ADHD.
What Do U.K. Orthopedic Surgery Patients Think About PROMs? Evaluating the Evaluation and Explaining Missing Data
Authors: Rowland Christine , Walsh Lauren , Harrop Rebecca , Roy Bibhas , Skevington Suzanne M.
Published: June 2019

The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.
Exploring Attachment Incoherence in Bereaved Families’ Therapy Narratives: An Attachment Theory-Informed Thematic Analysis
Authors: Willcox Rachel , Moller Naomi , Clarke Victoria
Published: June 2019

Attachment theory predicts that family bereavement leads even securely attached individuals to experience temporary attachment insecurity. This article explores how incoherence, a narrative marker of attachment insecurity, is displayed in the talk of families undergoing bereavement family therapy. This study uses the lens of attachment theory, and specifically the Adult Attachment Interview (AAI), to explore how members of five families talked about the loss of a close family member and how interactions between therapist and family members could hinder a coherent dialogue about the death. The families were recruited through Winston’s Wish, a UK-based family bereavement charity. The analysis centers on the “Telling the story” intervention, used at the start of therapy, in which family members together tell the story of the death. Families also retold the story in an extra family session toward the end of the therapy for the purposes of this research. Transcripts of the therapy sessions were analyzed using thematic analysis, with some codes developed directly from the unresolved loss codes of the AAI and other codes generated from analyzing the transcripts through the lens of attachment theory. Through a micro focus on therapy process, the study provides tentative support for suppositions in attachment theory about the psychological importance of (fostering) coherent speech as well as information about potentially helpful versus unhelpful therapist actions in family bereavement therapy. The findings have relevance for bereavement therapy interventions, therapy training, and research practice.
Adherence to human epidermal growth factor receptor-2 testing and adjuvant trastuzumab treatment guidelines in Ontario
Authors: Marshall Deborah A , Ferrusi Ilia L , Trudeau Maureen , Leighl Natasha B , Hoch Jeffrey S , Grazziotin Luiza R , Khong Hoa , Pullenayegum Eleanor , Earle Craig C
Published: June 2019

Objectives

We evaluated adherence of human epidermal growth factor receptor-2 testing using immunohistochemistry and fluorescence in situ hybridization, as well as adjuvant trastuzumab treatment according to Canadian guidelines, and predictors of trastuzumab use in early-stage breast cancer in Ontario.

Methods

Retrospective cohort of early-stage breast cancer patients identified in the Ontario Cancer Registry. Human epidermal growth factor receptor-2 test type, sequence, result(s), tumor grade, and hormone receptor status were abstracted from Ontario Cancer Registry pathology reports. Trastuzumab treatment was determined from provincial cancer agency records. Other variables were determined from administrative data sources. Logistic regression models were used to estimate adjusted odds ratios for factors associated with guideline adherence.

Results

The first human epidermal growth factor receptor-2 test result was the strongest predictor of confirmatory testing ( p < 0.05). Human epidermal growth factor receptor-2 testing by immunohistochemistry accounted for the majority of documented first tests (94%; n = 8249). Overall, 27% ( n = 2360) of tested patients received a second test by fluorescence in situ hybridization (46%) or immunohistochemistry (49%) assay. Most human epidermal growth factor receptor-2 equivocal patients (89%; n = 784) received a confirmatory test. Among human epidermal growth factor receptor-2-positive patients, only 57% ( n = 385) received trastuzumab treatment within the study period. Human epidermal growth factor receptor-2 status was the strongest predictor of trastuzumab use. Younger patients (<70 years at diagnosis) and negative hormone receptor status had higher odds of trastuzumab treatment ( p < 0.05) compared to older and positive hormone receptor status patients.

Conclusions

Immunohistochemistry use as a first test was largely consistent with Canadian guidelines; however, immunohistochemistry was frequently used as a confirmatory test, which is not guideline-concordant. Monitoring these testing and treating patterns is necessary to optimize health outcomes associated with trastuzumab.
The incidence and risk factors of thrombosis and the need for thromboprophylaxis in lymphoma and leukemia patients: A 9-year single-center experience
Authors: Yıldız Abdulkerim , Albayrak Murat , Pala Çiğdem , Afacan Öztürk Hacer B , Maral Senem , Şahin Osman , Cömert Pınar
Published: June 2019

Background

Patients with cancer are at increased risk of thromboembolic complications. There is no evidence-based guideline on the use of routine prophylaxis in hematological malignancies except in patients with multiple myeloma. The purpose of this study was to determine the incidence and risk factors of thrombosis and suggest a rationale for primary thromboprophylaxis in acute leukemia and lymphoma patients.

Patients and methods

A retrospective study was conducted on newly-diagnosed acute leukemia and lymphoma patients who presented at our institution from November 2009 to March 2018. The study included a total of 157 patients with acute leukemia and 238 patients with lymphoma. The groups were analyzed to determine the incidence and risk factors of thromboembolic complications.

Results

The incidence of all thrombotic complications was 10.12% (40/395) including 11.4% (18/157) in patients with acute leukemia and 9.2% (22/238) in patients with lymphoma. The majority of events occurred in the first 6 months. Acute leukemia patients with thrombosis had a higher number of comorbidities than those without thrombosis ( p < 0.05). Lymphoma patients with thrombotic complications had significantly higher beta-2-microglobulin and lactate dehydrogenase levels compared to those without thrombosis ( p < 0.05). Major bleeding events developed in five (3.1%) acute leukemia patients and two (0.8%) lymphoma patients. All the major bleeding events occurred when the patients were thrombocytopenic (platelet < 50,000/mm3).

Conclusions

Acute leukemia patients with any comorbidity and lymphoma patients with higher lactate dehydrogenase and beta-2-microglobulin are at high risk of developing thromboembolic complications. The prophylactic use of anticoagulant should be considered for those patients especially in the first 6 months.
Experience with ambulatory high-dose methotrexate administration as CNS prophylaxis in patients with non-Hodgkin lymphoma
Authors: Pampín Rubén , Labeaga Yoar , Rodríguez Belén , Fernández Beatriz , Fernández Rubén , Carbajales Mónica
Published: June 2019

Background

We describe the feasibility and safety of an oral administration schedule of hydration, alkalinization and leucovorin rescue with an ambulatory high-dose methotrexate regimen.

Methods

Single-centre prospective observational study conducted within a tertiary hospital where all patients have received systemic high-dose methotrexate (3.5 g/m2). Patients were instructed to keep an adequate ambulatory oral hydration and alkalinization to monitor urine pH and to adjust bicarbonate according to our institution's treatment protocol. High-dose methotrexate was infused over 4 h. Urine pH was checked before high-dose methotrexate administration, and for any value less than 7 a sodium bicarbonate bolus was given. Leucovorin at a standard dose was begun 24 h after high-dose methotrexate. methotrexate serum concentrations were monitored daily from 24 h after administration until clearance (level ≤ 0.1 µmol/L).

Results

From January 2016 to June 2018, 49 ambulatory high-dose methotrexate courses were given to 18 patients. No dose reduction was required afterwards. All patients completed succesfully the planned three doses in an outpatient basis, except four patients, one of them due to pneumonitis. Previous to methotrexate infusion, urinary pH > 7 was achieved in 35 (79.5%) cycles. Methotrexate clearance was achieved by 72 h in 35 courses (71.4%), and by 96 h in 100%. Neutropenia/trombocytopenia grades III/IV were observed in four cycles (8.16%) and two (4.08%) cycles, respectively. Around 20.40% were associated with stomatitis, 14.20% vomiting, 10.20% asthenia, 8.16% diarrhea and 6.12% with renal toxicity.

Conclusions

Ambulatory administration of high-dose methotrexate as CNS prophylaxis is safe and feasible following the described approach, allowing us to optimize healthcare resources.
Successful treatment of refractory metastatic neuroblastoma with panobinostat in combination with chemotherapy agents and iodine-131-meta-iodobenzylguanidine therapy
Authors: Zareifar Soheila , Shakibazad Nader , Zekavat Omid Reza , Bordbar Mohammadreza , Shahriari Mahdi
Published: June 2019

Introduction

Neuroblastoma commonly required multimodal therapy containing surgery, chemotherapy, radiotherapy, and immunotherapy.

Case report

In our case, who had refractory metastatic neuroblastoma, we use histone deacetylase inhibitor (panobinostat) in combination with chemotherapy agents and iodine-131-meta-iodobenzylguanidine (MIBG) therapy.

Management and outcome

This approach leads to successfully treat the patient. MIBG scan and bone marrow examination after therapy revealed no evidence of tumor. Now, she underwent autologous transplantation six months ago and free of tumor.

Conclusion

Panobinostat can cause apoptosis induction in refractory metastatic neuroblastoma in combination with MIBG therapy and chemotherapy.
Endophthalmitis after dropless (Tri-Moxi injection) cataract surgery
Authors: Ng Caleb , Chalam Kakarla V
Published: June 2019

Introduction:

A case of endophthalmitis after dropless cataract surgery with intravitreal Tri-Moxi associated with severe vision loss.

Case summary:

An 82-year-old male developed severe vision loss in the left eye 24 days after dropless cataract surgery with intravitreal Tri-Moxi injection. Best corrected visual acuity was hand motion in the left eye. Intraocular pressure was 13, with inferior keratic precipitates, 4 + cell with 1 mm layered hypopyon, and a plaque on the posterior capsule that blocked direct exam of the posterior segment. Ultrasonography revealed extensive vitritis without retinal or choroidal detachments.

Conclusion:

Endophthalmitis resolved and vision improved after management with vitreous tap, intravitreal and fortified topical antibiotics, and subsequent prompt pars plana vitrectomy. Vitreous sample grew fluoroquinolone-resistant staphylococcus epidermidis.
Dissociated optic nerve fiber layer in a case of Terson syndrome
Authors: Tripathy Koushik
Published: June 2019

Purpose:

To report a case of Terson syndrome who developed dissociated optic nerve fiber layer appearance after pars plana vitrectomy.

Case report:

The author reports a young male patient with Terson syndrome who developed bilateral vitreous hemorrhage and sub-internal limiting membrane hemorrhage after road traffic accident. He underwent pars plana vitrectomy and removal of the already detached internal limiting membrane and the sub-internal limiting membrane hemorrhage in both eyes. In both eyes, dissociated optic nerve fiber layer was appreciated and left eye had a peculiar resemblance to the appearance of cystoid macular edema.

Conclusions:

Dissociated optic nerve fiber layer appearance may be noted following vitrectomy and removal of detached internal limiting membrane in patients with vitreous hemorrhage and sub-internal limiting membrane bleed due to Terson syndrome.
Anti-osteoporosis Medication Use in a High Fracture-Risk Population: Contemporary Trends in Australian Residential Aged Care Facilities
Authors: Lind Kimberly E , Jorgensen Mikaela L , Gray Leonard C , Georgiou Andrew , Westbrook Johanna I
Published: June 2019

Osteoporotic fractures impose substantial morbidity and mortality among older adults. Undertreatment is an ongoing concern; treatment rates declined following reports of adverse effects of guideline-recommended bisphosphonates, but new antiresorptives have since become available. Our goal was to identify contemporary trends in osteoporosis treatment guideline adherence in a high fracture-risk population. We conducted a secondary data analysis using electronic health record data of adults aged ⩾65 years from 68 residential aged care facilities in Australia during 2014-2017 (n = 9094). Using medication administration data, we identified antiresorptive (bisphosphonates and denosumab) and vitamin D supplement use among residents with osteoporosis. Regression was used to evaluate temporal trends, and resident and facility characteristics associated with antiresorptive use and vitamin D use. In 2014, 34% of women and 42% of men with osteoporosis used antiresorptives; this decreased 8 percentage points by 2017. Antiresorptive use was higher among those with a history of fracture and lower in the last year of life. Denosumab use increased but did not substitute for the continued decline in bisphosphonate use. Vitamin D was consistently used by more than 60% of residents and was higher among those with fracture history. Greater attention to the treatment of osteoporosis treatment rates among this high fracture-risk population is warranted.
Analysis of written resources for parents of children discharged from a paediatric emergency department
Authors: Phonpruk Kodchanipa , Flowers Karen , Naughton Geraldine , Fulbrook Paul
Published: June 2019

The aim of this study was to profile the information and readability of parent-focused resources to support care at home following a child’s discharge from a paediatric emergency department (ED). Analysis included recording the scope, source, readability scores and benchmarking the contents against previous recommendations for discharge information. Information from 46 resources (on 41 conditions) from three separate sources was analysed. Overall, a wide range of resources was available. Inconsistency was evident in the framework and design of resources available. Approximately two-thirds of resources provided information about referral to community resources, and most had links to community health providers. Assessment of readability levels showed a predominant pitch towards a relatively high level of schooling. Existing written resources available for parents to use in caring for their child following discharge from an ED could improve with more streamlined designs as well as consistent references to community resources and additional health providers. Parents with low reading capacity may not be able to make the most of existing resources to care for their child at home following ED discharge. This framework was developed for reviewing the resources that could be useful for quality assessment of other parent-focused discharge information.
On humanitarian virality: Kony 2012, or, the rise and fall of a pictorial artifact in the digital age
Authors: Kurasawa Fuyuki
Published: June 2019

This article adopts a socio-visual constructivist approach to explain how the Kony 2012 video became a site of intense symbolic struggle regarding how to represent humanity in the digital age and, in the process, one of the most viral and intensely contested cultural artifacts of the last few years. The first section demonstrates that the video employs the visual conventions of personification and rescue, which form part of an iconographic repertoire coding certain events as humanitarian crises recognizable as such by Euro-American audiences. Conversely, the author examines how these tropes drew upon a neocolonial framing of humanitarianism, one that Ugandan and Western critics questioned and against which they offered an alternative vision of the post-civil war realities of northern Uganda. However, to avoid pictorial reification, the article’s second section retraces the institutional and actor-based networks through which still and moving images from Kony 2012 and its associated campaign circulated. The concept of pictorial exponentiality is introduced to explain how these images multiplied in digital public spaces through the accelerating digital cycles. This section also examines the concept of digital feedback loops to make sense of the non-linear and institutionally ‘flattened’ social relations binding pictorial actors debating the video’s representational content and responding to each other via social media- and web-based exchanges. Kony 2012 was a key marker of an era during which the visual politics and ethics of portrayal of the human unfold digitally, through social media and online video platforms as much as conventional institutions of image production and dissemination. By treating the video as a cultural artifact whose viral rise and fall are attributable to the pictorial conventions upon which it drew and the structure of the networks through which it circulated, the article reveals how understandings of humanity are visually constituted, contested, and undone in the digital age.
Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by Pseudomonas sp: A Pilot Study
Authors: Fejfarová Vladimíra , Tibenská Hana , Niklová Jitka , Bém Robert , Dubský Michal , Wosková Veronika , Němcová Andrea , Jirkovská Alexandra , Jude Edward , Lánská Věra
Published: June 2019

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.
The “Standing Cone” Flap for Thumb: A Spinoff the Hypogastric Flap in Combined Defects of Dorsum of Hand and Thumb
Authors: Garg Akhil , Sharma Ramesh K. , John J. R.
Published: June 2019

Background: The management of combined defects of the dorsum of the hand and the thumb can be quite challenging. The conventional teaching has been to use more than 1 flap for such discontinuous defects of the hand. Methods: We present a novel technique to provide a reliable skin cover to a concomitant second defect over thumb, which otherwise would require an additional flap, by recruiting the excess skin available after closure of the primary flap donor site of the hypogastric flap being used for the defect on the dorsum of hand. We report a case series of 5 patients wherein this technique has been used successfully. Results: The modified technique was able to successfully manage the concomitant defects of the dorsum of hand and the thumb in 1 stage. Conclusions: We find this innovation can help cover 2 separate defects on dorsum of hand and the thumb in 1 stage by utilizing just 1 flap instead of the conventional method of raising 2 flaps for such defects
The PROMIS Upper Extremity Computer Adaptive Test Correlates With Previously Validated Metrics in Patients With Carpal Tunnel Syndrome
Authors: Phillips Jessica L. H. , Freedman Mitchell K. , Simon Jeremy I. , Beredjiklian Pedro K.
Published: June 2019

Background: The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) computer adaptive test was developed to improve precision and reduce question burden. We hypothesized that in patients with carpal tunnel syndrome (CTS): (1) PROMIS UE would correlate with established patient-reported outcome measures (PROs); (2) the time and number of questions required would be lower than current metrics; (3) there would be no floor or ceiling effects; and (4) PROMIS UE would not correlate with disease severity. Methods: Patients undergoing electrodiagnostic evaluation found to have a primary diagnosis of unilateral CTS prospectively completed PROMIS UE, Quick Disabilities of the Arm, Shoulder and Hand (qDASH), and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrophysiologic and clinical severity was recorded. The relationships among PROs were described with Spearman coefficients. A floor or ceiling effect was confirmed if >15% of patients achieved the lowest or highest possible score, respectively. Results: Fifty-one patients (average, 53.9 years) were enrolled. An excellent correlation was identified between PROMIS UE and qDASH ( R = −0.76, P < .001). There was a good correlation between PROMIS UE and BCTQ ( R = −0.58, P < 0.001). The PROMIS UE required less time and fewer questions than qDASH and BCTQ ( P = .02 and P < .001). There were no floor or ceiling effects. Neither neurophysiologic nor clinical severity correlated with PROMIS UE ( R = 0.24, P > .05 and R = −0.18, P > .05). Conclusions: The PROMIS UE has an excellent correlation with qDASH and a good correlation with BCTQ in patients with CTS. Furthermore, PROMIS UE required less time and fewer questions than established PROs. Used as a single PRO, PROMIS UE represents a practical alternative to current metrics in patients with CTS.
Evaluation of Tension at Median and Ulnar Nerve Repairs at the Wrist in a Cadaveric Model
Authors: Usmani Rashad H. , Rainville Aundrea , Botkin Deana , Merrell Gregory A.
Published: June 2019

Background: Median and ulnar nerve lacerations at the wrist are often combined with zone 5 tendon injury. The inability to provide early range of motion leads to increased adhesions. Current therapy protocols recommend the wrist be held in 30° of flexion post operatively to protect the nerve repair. However, if tension and elongation across the nerve repair stay under a critical level in less wrist flexion, postoperative splinting in more extension could allow for better tendon excursion and less adhesions. Methods: Six cadaveric specimens were used. After appropriate dissection, the median and ulnar nerves were transected and repaired with a single 10-0 nylon suture. The wrist was ranged from 30° flexion to 45° extension to see if the repair would fail. Next, an epineural repair was accomplished with 9-0 nylon suture. The percent elongation along the nerve repair was measured at set increments from 30° flexion to 45° extension. Results: In all 6 specimens, median and ulnar nerve repairs with a single 10-0 nylon suture did not fail with wrist range of motion from 30° flexion to 45° extension. Mean percent elongation stayed under critical levels in up to 30° of extension. Conclusions: Both median and ulnar nerve repairs stayed under critical levels of tension and elongation in up to 30° of wrist extension. We believe it is possible to be more aggressive with wrist positioning in wrist level median and ulnar nerve repairs.
Risk factors for Barrett’s esophagus in young adults who underwent upper gastrointestinal endoscopy in a health examination center
Authors: Wu Pin-Chieh , Chen Yan-Hua , Wu Fu-Zong , Lin Kung-Hung , Hsu Chiao-Lin , Chen Chi-Shen , Chen Yu-Hsun , Lin Po-Hsiang , Mar Guang-Yuan , Yu Hsien-Chung
Published: June 2019

Background:

Barrett’s esophagus (BE) is a premalignant condition with increased incidence worldwide both in old and young individuals. However, the role of certain potential risk factors remains unclear in young adults (< 50 years). We aimed to determine the risk factors of BE in young adults.

Methods:

A total of 4943 young adults who underwent upper gastrointestinal endoscopy at our health check-up center were enrolled. The diagnosis of BE was based on histological confirmation. We analyzed demographic factors, laboratory data, potential risk factors such as smoking, alcohol consumption, presence of gastroesophageal reflux disease (GERD) symptoms, and metabolic syndrome for the risk of BE by using binary logistic regression analysis.

Results:

The prevalence of BE was 1.8% (88/4943). Male sex, the presence of GERD symptoms, and smoking were three significant risk factors related to BE. Furthermore, participants who had smoked for 10 pack-years or more had increased risk of BE with dose-dependent phenomenon ( p trend < 0.001). The proportion of BE in male participants with both GERD symptoms and a smoking history of 10 pack-years or more was as high as 10.3% (16/155).

Conclusions:

Significant risk factors of BE in young adults are male sex, the presence of GERD symptoms, and smoking. The risk also increases with an increase in cumulative exposure to smoking.