bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management
Authors: Park Duk-Woo , Kwon Osung , Jang Jae-Sik , Yun Sung-Cheol , Park Hanbit , Kang Do-Yoon , Ahn Jung-Min , Lee Pil Hyung , Lee Seung-Whan , Park Seong-Wook , Choi Si Wan , Lee Sang-Gon , Yoon Hyuck-Jun , Ahn Taehoon , Kim Moo Hyun , Nah Deuk Young , Lee Sung Yun , Chae Jei Keon , Park Seung-Jung ,   On behalf of the TICAKOREA Investigators
Published: September 2019

Background:

Owing to the differential propensity for bleeding and ischemic events with response to antiplatelet therapy, the safety and effectiveness of potent P2Y12 inhibitor ticagrelor in East Asian populations remain uncertain.

Methods:

In this multicenter trial, 800 Korean patients hospitalized for acute coronary syndromes with or without ST elevation and intended for invasive management were randomly assigned to receive, in a 1:1 ratio, ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (600 mg loading dose, 75 mg daily thereafter). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to PLATO (Platelet Inhibition and Patient Outcomes) criteria at 12 months.

Results:

At 12 months, the incidence of clinically significant bleeding was significantly higher in the ticagrelor group than in the clopidogrel group (11.7% [45/400] vs 5.3% [21/400]; hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.34 to 3.79;
P
=0.002). The incidences of major bleeding (7.5% [29/400] vs 4.1% [16/400],
P
=0.04) and fatal bleeding (1% [4/400] vs 0%,
P
=0.04) were also higher in the ticagrelor group. The incidence of death from cardiovascular causes, myocardial infarction, or stroke was not significantly different between the ticagrelor group and the clopidogrel group (9.2% [36/400] vs 5.8% [23/400]; HR, 1.62; 95% CI, 0.96 to 2.74;
P
=0.07). Overall safety and effectiveness findings were similar with the use of several different analytic methods and in multiple subgroups.

Conclusions:

In Korean acute coronary syndrome patients intended to receive early invasive management, standard-dose ticagrelor as compared with clopidogrel was associated with a higher incidence of clinically significant bleeding. The numerically higher incidence of ischemic events should be interpreted with caution, given the present trial was underpowered to draw any conclusion regarding efficacy.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02094963.
Association Between Occupational Exposure to Pesticides and Cardiovascular Disease Incidence: The Kuakini Honolulu Heart Program
Authors: Berg Zara K. , Rodriguez Beatriz , Davis James , Katz Alan R. , Cooney Robert V. , Masaki Kamal
Published: September 2019

Background

Previously, Kuakini Honolulu Heart Program researchers reported that occupational exposure to pesticides was significantly associated with total mortality. The current study examines occupational exposure to pesticides in relation to incident cardiovascular disease, defined as coronary heart disease or cerebrovascular accident.

Methods and Results

With the Occupational Safety Health Administration exposure scale used as an estimate of exposure, statistical analyses were performed on a cohort of 7557 Japanese‐American men from the Kuakini Honolulu Heart Program. Hazard ratios for cardiovascular disease incidence were calculated for various levels of pesticide exposure using Cox proportional hazards models. In the first 10 years of follow‐up, a positive association was observed between age‐adjusted cardiovascular disease incidence and high levels of pesticide exposure (hazard ratio=1.46, 95%
CI
=1.10‐1.95,
P
=0.009). This relationship remained significant after adjustment for other cardiovascular disease risk factors (hazard ratio=1.42, 95%
CI
=1.05‐1.92,
P
=0.021). No significant association for coronary heart disease or cerebrovascular accident incidence with pesticide exposure was observed when examined separately, possibly due to a smaller number of events.

Conclusions

These findings suggest that occupational exposure to pesticides may play a role in the development of cardiovascular diseases. The results are novel, as the association between occupational exposure to pesticides and cardiovascular disease incidence has not been examined previously in this unique cohort.
The Experience of God as Light in the Orthodox Tradition
Authors: Ladouceur Paul
Published: September 2019

This article explores the sense of John the Evangelist’s expression God is Light (1 Jn 1.5) in the Orthodox tradition, both in the experience of mystics and its theological ramifications. The article reviews the scriptural basis for the experience of God as Light and presents first-hand accounts in Symeon the New Theologian (949–1022), Seraphim of Sarov (1759–1833), Archimandrite Sophrony (Sakharov) (1896–1993), and Nicolae Steinhardt (1912–1989), and in Orthodox liturgical services. Beyond a metaphorical expression or a psychological experience, God as Light, often called the ‘Uncreated Light’, in Orthodox theology is considered an experience of the divine energies, as distinct from the divine essence, a theology elaborated notably by Gregory Palamas (1296–1359), and is a foretaste of union with God, ‘deification’ or theosis.
Knowledge from Fiction and the Challenge from Luck
Authors: Stock Kathleen
Published: September 2019

In order for true beliefs acquired from reading fiction to count as knowledge proper, they must survive ‘the challenge from luck’. That is, it must be established that such beliefs are neither luckily true, nor luckily believed by readers. The author considers three kinds of true belief a reader may, she assumes, get from reading fiction: a) those based on testimony about empirical facts; b) those based on ‘true in passing’ sentences; and c) those beliefs about counterfactuals one may get from reading a ‘didactic’ fiction. The first group escape the challenge from luck relatively easily, she argues. However, things turn out to be more complicated with the second group. The author examines Mitchell Green’s suggestion, effectively, that knowledge of fictional genre may see off the challenge from luck here, but rejects this in the form presented by Green, adapting it substantially to offer beliefs of this kind a more promising escape route. The author finishes by following Green’s lead once again, and discussing the category of ‘didactic’ fiction, as he calls it. She argues that any true beliefs about counterfactuals gained from such fictions are likely to be lucky. The author concludes however that things are much more promising for any true beliefs gained about oneself as a result of engaging with what Green calls an ‘interrogative’ fiction.
Factors Affecting Environmental Activism, Nonactivist Behaviors, and the Private Sphere Green Behaviors of Thai University Students
Authors: Piyapong Janmaimool
Published: September 2019

University students are expected by the general public to be active in pro-environmental behaviors due to their environmental knowledge and relevant education. However, it is still unclear whether students only educated in environmental knowledge will decide to engage in green behaviors. This study investigates factors that determine university students’ pro-environmental behaviors, which include environmental activism, nonactivism, and private sphere environmental activities. A proposed model for investigating such factors, which include environmental knowledge and attitudes, self-efficacy, self-obligation, behavioral control, and sociodemographic characteristics, was developed. Questionnaire surveys with 337 students enrolled at King Mongkut’s University of Technology Thonburi in the city of Bangkok, Thailand, were carried out. Multiple regression analyses were performed to test the effect of these potential factors on each type of behavior. The results showed that providing only environmental knowledge at a university may not contribute to any kind of pro-environmental behavior. It was found that environmental knowledge and attitudes had a significant effect on students’ nonactivist behaviors. Without positive environmental attitudes, but with environmental knowledge and self-efficacy, students decided to engage in environmental activism. In addition, male students were more likely to engage in environmental activism than female students. Finally, students’ engagement in private sphere green behaviors was attributed to self-obligation, environmental knowledge, and environmental attitudes, as well as grade point average (GPA). Students with a higher GPA were more likely to act environmentally. Therefore, to promote each type of environmental behavior, different environmental education strategies should be developed.
Motives for Classical and Novel Psychoactive Substances Use in Psychedelic Polydrug Users
Authors: Kettner Hannes , Mason Natasha L. , Kuypers Kim P. C.
Published: September 2019

Novel psychoactive substances (NPS) are compounds designed to mimic the effects of existing recreational drugs (classical psychoactive substances [CPS]), while eluding established legal frameworks. Little is known about their effects and potential harms, rendering the increasing number of NPS a challenge to policy makers and researchers alike. Quantitative studies on the motives underlying NPS use are limited, though understanding them is crucial for the design of effective harm prevention strategies. The present study therefore aimed to compare motivational patterns for NPS, CPS, and legal psychoactive substance (LPS) use. An online survey including questions about lifetime drug use, demographics, and motives for use was completed by 2,319 participants of which 1,967 consented and were 18 years or older. Data on lifetime use and endorsed motives are presented for 12 psychoactive substances classified into LPS (alcohol, nicotine), CPS (cannabis, MDMA/ecstasy, amphetamines, cocaine, psilocybin, LSD, ayahuasca), and NPS (synthetic cannabinoids, stimulant, and hallucinogenic) and compared between classes. Across substances, the most frequently endorsed motives were to feel euphoric (58.0%), enhance an activity (52.3%), and broaden consciousness (48.1%). Motives for use were found to differ by substance and gender, with coping-related reasons being more frequent among female participants compared to males who indicated to use for a broad range of reasons. Motivational patterns of CPS and NPS use were largely similar to their classical analogues, this was not the case for synthetic cannabinoids, which had as main endorsed motive getting intoxicated, indiscriminate of specific qualities. This information can feed into tailoring of educational campaigns and prevention strategies.
The politics of Japan’s immigration and alien residence control
Authors: Endoh Toake
Published: September 2019

Since the 1990s, the Japanese state has tried to balance easing immigration for some categories of immigrants while tightening restrictions for others through immigration and alien residence control. Using qualitative and data-driven analysis, this paper examines the political implications of Japan’s recent policy of accepting less-skilled migrant workers by providing a systemic explanation of the institutional changes in immigration management. The state uses alien residence control in order to curb the social costs of immigrant integration while pursuing a selective worker acceptance policy. Despite the policy shift, it seems likely that Japan will maintain this essentially illiberal means of temporary labor inclusion with long-term social exclusion.
Notes From the Field: Creating a Typology of Childhood Obesity Intervention Strategies
Authors: Robles Brenda , Jiang Linghui , Prelip Michael , Nobari Tabashir Z. , Wang Amy , Kuo Tony , Wang May C.
Published: September 2019

Classification systems can be useful for evaluating and communicating the impact of interventions. We describe how a typology was created to inform the development of a community intervention dose index (CIDI) intended to measure the strength of impacts attributed to multiple childhood obesity intervention strategies implemented in a large, diverse urban jurisdiction in the United States during 2000–2016. The categorization system was constructed via a three-stage process: (Stage 1) identify relevant constructs for categorizing intervention strategies; (Stage 2) review peer-reviewed literature and program requests for proposals to identify and integrate common attributes of intervention strategies based on Stage 1 constructs; and (Stage 3) vet the results from prior stages to develop a final version of the typology, slated for research application and for use in program improvement. The final system grouped strategies into four macrolevel and five microlevel categories. Macrolevel strategies included government/public institutional policies, infrastructure investments, and business practices. Microlevel strategies included group education, counseling, health communication and social marketing, home visitation, and screening and referral. Grouping intervention strategies in a purposeful, classified manner facilitated communications among researchers and practitioners during the gathering and quantifying of intervention data for the CIDI project and may be used to guide scarce public health resource allocation decisions.
Cluster-specific nonignorably missing, endogenous, and continuous regressors in multilevel model for binary outcome
Authors: Kim Gi-Soo , Lee Youngjo , Kim Hongsoo , Paik Myunghee Cho
Published: September 2019

In multilevel regression models for observational clustered data, regressors can be correlated with cluster-level error components, namely endogenous, due to omitted cluster-level covariates, measurement error, and simultaneity. When endogeneity is ignored, regression coefficient estimators can be severely biased. To deal with endogeneity, instrument variable methods have been widely used. However, the instrument variable method often requires external instrument variables with certain conditions that cannot be verified empirically. Methods that use the within-cluster variations of the endogenous variable work under the restriction that either the outcome or the endogenous variable has a linear relationship with the cluster-level random effect. We propose a new method for binary outcome when it follows a logistic mixed-effects model and the endogenous variable is normally distributed but not linear in the random effect. The proposed estimator capitalizes on the nested data structure without requiring external instrument variables. We show that the proposed estimator is consistent and asymptotically normal. Furthermore, our method can be applied when the endogenous variable is missing in a cluster-specific nonignorable mechanism, without requiring that the missing mechanism be correctly specified. We evaluate the finite sample performance of the proposed approach via simulation and apply the method to a health care study using a San Diego inpatient dataset. Our study demonstrates that the clustered structure can be exploited to draw valid analysis of multilevel data with correlated effects.
Safety and efficacy of high-intensity focused ultrasound in severe or refractory glaucoma
Authors: Hugo Juliette , Matonti Frederic , Beylerian Marie , Zanin Emilie , Aptel Florent , Denis Danièle
Published: September 2019

Purpose:

The aim of this study was to evaluate the efficacy and safety of ultrasonic cyclocoagulation in severe or refractory glaucoma, and to analyze the procedure-related inflammation.

Patients and Methods:

In this retrospective study, 15 eyes of 13 patients suffering from severe or refractory glaucoma with uncontrolled intraocular pressure of ⩾21 mmHg underwent 8-s ultrasonic cyclocoagulation. A complete ophthalmic evaluation, quality of life assessment using Glau-Qol-17, endothelial cell count, and flare measurement were performed. Primary outcome was qualified surgical success (defined as intraocular pressure reduction from baseline ⩾20% and intraocular pressure >5 mmHg without hypotensive medication adjunction). Secondary outcomes were flare, endothelial cell loss, and quality of life.

Results:

Qualified success was achieved in 67% of eyes at 6 months (mean intraocular pressure reduction = 42% in these eyes). During the first month after the procedure, the mean flare reached its maximum value when the intraocular pressure was minimal; the flare slowly decreased until normalization at month 3 when the maximal intraocular pressure was noted. At month 3, there was moderate but significant endothelial cell loss (11%), and no significant alteration in quality of life was demonstrated.

Conclusion:

The efficacy of ultrasonic cyclocoagulation in the present study is comparable to that reported in the literature. The kinetics of intraocular pressure and flare suggest that postoperative inflammation could be partly responsible for the early intraocular pressure decrease. The moderate endothelial cell loss, which could be caused by localized heating, and the preservation of quality of life confirm the safety of ultrasonic cyclocoagulation.
Heat transfer characteristics of a composite radiant wall under cooling/heating conditions
Authors: Qin S. Y. , Wang Y. A. , Gao S. , Xu D. G. , Cui X. , Zhao M. , Jin L. W.
Published: September 2019

The radiant wall composited with capillary tubes has been widely applied in heating or cooling systems due to its large heat transfer area, low-temperature heating and high-temperature cooling. In this study, a ratio model of heat transfer in steady-state condition was established, which explores heat transfer capacity from the capillary layer (active layer) towards the indoor and outdoor sides. The experimental data including the radiant surface temperature, the capillary layer temperature and the heat flux distribution were collected in cooling and heating conditions. The proposed ratio model was validated. The results show that the fluctuation of indoor air temperature is relatively small, suggesting that the radiant system possesses higher stability. Results showed that thermal resistances of the composite radiant wall in summer and winter conditions vary greatly due to different moisture contents. With the continuation of the system operation, the calculated values from the ratio model under the steady-state condition were more consistent with average values obtained from experiments under unsteady-state conditions, indicating that the overall heat transfer performance of the composite radiant wall could be properly evaluated by the proposed model in engineering applications.
Which doctors do we trust? A vignette experiment of how gender and ethnicity influence trust
Authors: Alecu Andreea I
Published: September 2019

Is people’s trust in doctors affected by their ethnicity or gender? It is often assumed that highly skilled migrants are protected from the worst effects of discrimination. Yet, they also report high degrees of discrimination. This study examines whether ethnic and gendered stereotypes influence trust in general practitioners in Norway. The question is investigated using a survey experiment. Respondents receive a brief resume of a general practitioner where the ethnicity and gender of the physician are randomly varied. Thereafter, the study focuses on investigating the interaction between the respondents' and fictive GPs' ethnicity and gender. The results show that while the majority population is indifferent to the ethnicity of the physicians, they prefer females. Non-Western minorities have a bias in favour of Pakistani-named GPs but are indifferent to the GP's gender.
Is One Study as Good as Three? College Graduates Seem to Think So, Even if They Took Statistics Classes
Authors: Thompson W Burt , Garry Amanda , Taylor John , Radell Milen L.
Published: September 2019

When people interpret the outcome of a research study, do they consider other relevant information such as prior research? In the current study, 251 college graduates read a single brief fictitious news article. The article summarized the findings of a study that found positive results for a new drug. Three versions of the article varied the amount and type of previous research: (a) two prior studies that found the drug did not work, (b) no prior studies of the drug, or (c) two prior studies that found the drug had a positive effect. After reading the article, participants estimated the probability the drug is effective. Average estimates were similar for the three articles, even for participants who reported more statistics experience. Overall, just 4% of participants appeared to use prior research to make probability estimates—most seemed to focus on the latest study, while ignoring or discounting prior studies. Implications for statistics education and reporting are discussed.
Optimization of plasma process parameters for surface modification of bamboo spunlace nonwoven fabric using glow discharge oxygen plasma
Authors: Manjula S , Shanmugasundaram OL , Ponappa K
Published: September 2019

In this study, Box–Behnken design was used to study the effect of optimization of plasma treatment on surface modification of bamboo spunlace nonwoven fabric. The effect and interaction of the process variables of glow discharge oxygen plasma treatment, i.e. discharge power, exposure duration and inter-electrode spacing on fabric characteristics such as mass per unit area, thickness, breaking force and elongation, air permeability, water vapour permeability and wicking were analysed. The optimum conditions of discharge power 650 W, exposure duration 55 s, and inter-electrode spacing 4 cm were arrived using response optimizer tool of Minitab software. The fabrics showed better characteristics in terms of air permeability, water vapour permeability, wicking and elongation and showed slight reduction in terms of fabric weight, thickness and breaking force. Fourier-transform infrared spectroscopy spectra analysis confirmed the increased functionality of the material after plasma treatment.
Negative Affect,SCUM, and the Politics of Possibility
Authors: Rowe Desirée D.
Published: September 2019

Negativity has been widely framed through Edelman’s “no future” orientation. While being productive, this orientation forecloses the potential negativity to foster coalitional alliances. Building off previous works about Valerie Solanas, I turn toward an investigation of the negative affective traces of her SCUM Manifesto to create paths of meaning-making beyond Edelman’s accounting. First, I examine how Solanas uses negative affect in her work. Second, I build from contemporary re-framings of negativity to imagine a possible reparative reading of SCUM. I argue that through her use of lived experience—specifically her narratives of violence, SCUM challenges the reader’s engagement with negativity. Within SCUM, there is a potential path of meaning-making through Solanas’ invocation of her own lived experience.
Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer
Authors: Gao Zhenzhen , Hua Beibei , Ge Xiaolin , Liu Jinyuan , Xue Lei , Zhen Fuxi , Luo Jinhua
Published: September 2019

Background:

Our objective is to explore the accuracy of magnetic resonance imaging in determining the preoperative T and N staging, pathological stage, and the length of esophageal tumor in patients with esophageal cancer.

Methods:

This retrospective analysis included 57 patients admitted to the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University between January 2015 and December 2016. Postoperative pathological results were used as the reference to verify the accuracy of magnetic resonance imaging in evaluating tumor T and N staging, pathological stage, and tumor length. The correlation between tumor lengths—measured using magnetic resonance imaging and the surgical specimen measurements—was evaluated.

Results:

The mean age of the patients was 64.6 ± 7.2 years, with a range of 47 to 77 years. The overall accuracy rate of magnetic resonance imaging in T staging of esophageal cancer was 63.2%; magnetic resonance imaging was generally consistent in the N staging of esophageal cancer. Magnetic resonance imaging and surgical evaluation of tumor length were in excellent agreement (κ = .82, P < .001), while that of gastroscopy and postoperative pathology was moderate (κ = .63, P < .001).

Conclusion:

Magnetic resonance imaging is highly accurate in determining the preoperative T and N staging, pathologic stage, and tumor length in patients with esophageal cancer, which is important in deciding the choice of preoperative treatment and the surgical approach.
Influence of Postoperative Finasteride Therapy on Recurrence of Gynecomastia After Mastectomy in Men Taking Finasteride for Alopecia
Authors: Lee Seung Geun , Park Pyoung Jae , Lee Sung Ryul , Koo Bum Hwan , Byun Geon Young , Kim Myoung Jin , Kang Hyok Jo , Kim Sarang , Oh Beom Seok , Lee Young Hyun
Published: September 2019

Finasteride is commonly used for treatment of alopecia. Because finasteride is a cause of gynecomastia, there is concern regarding the continuation of finasteride therapy after mastectomy. No studies have been performed to determine whether finasteride should be continued after mastectomy when gynecomastia occurs in patients taking finasteride for the treatment of alopecia. The researchers studied the effects of finasteride on gynecomastia recurrence after mastectomy in men with gynecomastia taking finasteride for alopecia. The researchers retrospectively evaluated 1,673 patients with gynecomastia who underwent subcutaneous mastectomy with liposuction at Damsoyu Hospital from January 2014 to December 2016. In total, 52 of the patients were taking finasteride for alopecia before surgery and continued to use it in the same manner after mastectomy. Ultrasonography was performed 1 year after mastectomy. The patients’ median age was 26.5 (24.75–30) years. All 52 patients had bilateral gynecomastia. The median duration of finasteride therapy before and after surgery was 12 (5–25.75) and 33 (27.5–40.5) months, respectively. There were no statistically significant differences between the groups with and without the use of finasteride in relation to postoperative complications and recurrence rates. Taking finasteride seems to have little effect on recurrence in patients with alopecia who have undergone surgical treatment of gynecomastia. Surgeons may recommend continuous finasteride therapy in patients with alopecia who wish to take finasteride after mastectomy.
Only the wearer knows where the shoe pinches? Deontics and epistemics in discussions of health and well-being in participatory workplace settings
Authors: Wåhlin-Jacobsen Christian Dyrlund , Abildgaard Johan Simonsen
Published: September 2019

In participatory activities in the workplace, employees are invited to raise problems and suggest improvements to the management. Although it is widely acknowledged that employees rarely control decisions in these settings, little is known about the interactional resources that employees and managers draw upon when negotiating consensus about which initiatives to pursue in the future. We analyse interactions from participatory meetings in an industrial setting in relation to the topic of work shoes, showing how the participants orient to both their relative deontic rights (e.g. who can suggest and decide on initiatives) and epistemic rights (e.g. who can define a situation as problematic and assert what can be done about it). The analysis suggests that besides their low deontic status, employees’ fragile epistemic status constitutes an important but overlooked challenge to achieving improved working conditions through the participatory activities.
Outcomes of ulnotriquetral split tear repair: a report of 96 patients
Authors: Clark Nicholas J. , Munaretto Nicholas , Ivanov David , Berger Richard A. , Kakar Sanjeev
Published: September 2019

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6–112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores.

Level of evidence: IV
Net benefit of statins for primary prevention of cardiovascular disease in people 75 years or older: a benefit–harm balance modeling study
Authors: Yebyo Henock G. , Aschmann Hélène E. , Menges Dominik , Boyd Cynthia M. , Puhan Milo A.
Published: September 2019

Background:

We determined the risk thresholds above which statin use would be more likely to provide a net benefit for people over the age of 75 years without history of cardiovascular disease (CVD).

Methods:

An exponential model was used to estimate the differences in expected benefit and harms in people treated with statins over a 10-year horizon versus not treated. The analysis was repeated 100,000 times to consider the statistical uncertainty and produce a distribution of the benefit–harm balance index from which we determined the 10-year CVD risk threshold where benefits outweighed the harms. We considered treatment estimates from trials and observational studies, baseline risks, patient preferences, and competing risks of non-CVD death, and statistical uncertainty.

Results:

Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75–79 years and 80–84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21–33% and 23–36% for men aged 75–79 years and 80–84 years, respectively, as well as 20–32% and 21–32% for women aged 75–79 years and 80–84 years, respectively.

Conclusions:

Statins would more likely provide a net benefit for primary prevention in older people taking the average preferences if their CVD risk is well above 20%. However, the thresholds could be much higher or lower depending on preferences of individual patients, which suggests more emphasis should be placed on individual-based decision-making, instead of recommending statins for everyone based on a single or a small number of thresholds.
Adrift in the etheric ocean
Authors: Engelmann Sasha
Published: September 2019

In this commentary, I explore Peters and Steinberg’s use of extension, entanglement and excess as operative terms for their ‘more-than-wet’ ontology. I ask whether the elemental ocean so vividly expressed in their article is commensurable with these terms. In doing so, I suggest that elemental geographies may require further experimentation beyond analytical and grammatical description, and towards poetic, aesthetic and creative gestures that convey the force and complexity of the elements.
Pediatric Hand Fracture Referring Practices: A Scoping Review
Authors: Hartley Rebecca L. , Todd Anna R. , Harrop Alan R. , Fraulin Frankie O. G.
Published: September 2019

Background:

Pediatric hand fractures are common, but few require surgery; therefore, these fractures are often perceived to be overreferred. Our objective is to systematically identify and describe pediatric hand fracture referring practices.

Method:

A scoping review was performed, searching electronic databases and grey literature up to January 2018 to identify referring practices for children (17 years and younger) with hand fractures (defined as radiographically confirmed fractures distal to the carpus) to hand surgeons. All study designs were included, and study selection and data extraction were independently performed in duplicate by 2 reviewers. Outcomes included referring rates, necessity of referral, referring criteria, and management of fractures.

Results:

Twenty (10 cross-sectional, 7 prospective cohorts, and 3 narrative reviews) studies reporting on referring practices or management of 21,624 pediatric hand fractures were included. Proportion of pediatric hand fractures referred to hand surgeons ranged from 6.5% to 100%. Unnecessary referral, defined as those fractures within the scope of primary care management, ranged from 27% to 78.1%. Ten studies reported referring criteria, with 14 unique criteria identified. The most common referring criteria were displacement (36.4%), loss of joint congruity (36.4%), and instability (36.4%). The most common justification for these criteria was increased likelihood of requiring surgery. The most common initial management was immobilization (66%-100%). Final management was provided by orthopedic or plastic hand surgeons with 0% to 32.9% of fractures requiring surgery.

Conclusion:

Referring practices vary widely in the literature. Major gaps in the literature include objective measures and justification for referring criteria and primary care education on hand fracture referring practices.
Digital or Print? A Comparison of Preschoolers’ Comprehension, Vocabulary, and Engagement From a Print Book and an e-Book
Authors: Reich Stephanie M. , Yau Joanna C. , Xu Ying , Muskat Tallin , Uvalle Jessica , Cannata Daniela
Published: September 2019

Increasingly, children are engaging in early literacy experiences through digital devices. This raises questions about how electronic reading compares to print reading. To assess this, we randomly assigned 200 children (3–5 years) to be read the same book (1) with auto-narration on a tablet or 2) by a researcher from a print book. Reading was recorded and coded for behavioral and emotional engagement and vocalizations. Children were also tested on their story comprehension and vocabulary. Children had slightly higher posttest scores in the print condition. Older children and females also scored higher. There was an interaction between weekly tablet use and book platform. Children were equally engaged with the e-book and print book, but vocalized more about the device in the e-book condition. Findings suggest that e-books offer many of the same, but not all, of the educational affordance as print books. Additionally, novelty might be important in supporting comprehension.
Seasonal influenza vaccination: knowledge, attitude and practice in Varna, Bulgaria
Authors: Ermenlieva Neli M. , Tsankova Gabriela S. , Todorova Tatina T.
Published: September 2019

Background:

Seasonal influenza vaccination is recommended for certain at-risk groups in Bulgaria, but vaccine coverage and the population’s perception of vaccination are currently unknown. The objective of this study was to assess the level of seasonal influenza vaccination in Varna Region, Bulgaria. It also aimed to investigate the status of knowledge and the attitude towards the reliability, safety, and other aspects associated with the use of influenza vaccines.

Methods:

A cross-sectional survey was conducted among 120 responders in Varna Region, Bulgaria. They completed a questionnaire assessing the practice, knowledge, and attitude towards seasonal influenza vaccination.

Results:

Nearly 70% of all responders have never been vaccinated against seasonal influenza in their lives. The main reason indicated was a lack of confidence in the vaccine in general (53.7% of nonvaccinated responders). Individuals with insufficient knowledge, or with a negative perception, were more likely to not be vaccinated: being poorly informed and having a negative attitude towards influenza vaccination also decreased the chance of being vaccinated by 29% and 36%, respectively.

Conclusions:

This study indicates that efforts should be made towards achieving better understanding and knowledge of the vaccine’s mechanism of prevention and effectiveness among the Bulgarian population.
The genetics of interstitial lung diseases
Authors: Borie Raphael , Le Guen Pierre , Ghanem Mada , Taillé Camille , Dupin Clairelyne , Dieudé Philippe , Kannengiesser Caroline , Crestani Bruno
Published: September 2019

Interstitial lung diseases (ILDs) are a set of heterogeneous lung diseases characterised by inflammation and, in some cases, fibrosis. These lung conditions lead to dyspnoea, cough, abnormalities in gas exchange, restrictive physiology (characterised by decreased lung volumes), hypoxaemia and, if progressive, respiratory failure. In some cases, ILDs can be caused by systemic diseases or environmental exposures. The ability to treat or cure these ILDs varies based on the subtype and in many cases lung transplantation remains the only curative therapy. There is a growing body of evidence that both common and rare genetic variants contribute to the development and clinical manifestation of many of the ILDs. Here, we review the current understanding of genetic risk and ILD.
Update on oral appliance therapy
Authors: Marklund Marie , Braem Marc J.A. , Verbraecken Johan
Published: September 2019

Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea–hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.
Pattern of lung function decline in patients with amyotrophic lateral sclerosis: implications for timing of noninvasive ventilation
Authors: Panchabhai Tanmay S. , Mireles Cabodevila Eduardo , Pioro Erik P. , Wang Xiaofeng , Han Xiaozhen , Aboussouan Loutfi S.
Published: September 2019

Background

The course of lung function decline in amyotrophic lateral sclerosis (ALS) and the effect of noninvasive positive-pressure ventilation (NIPPV) on that decline are uncertain. We sought to model lung function decline, determine when NIPPV is initiated along that course, and assess its impact on the course of decline.

Methods

An observed sigmoid pattern of forced vital capacity decline was reproduced with a four-parameter nonlinear mixed-effects logistic model.

Results

Analyses were performed on 507 patients overall and in 353 patients for whom a determination of adherence to NIPPV was ascertained. A sigmoid bi-asymptotic model provided a statistical fit of the data and showed a period of stable vital capacity, followed by an accelerated decline, an inflection point, then a slowing in decline to a plateau. By the time NIPPV was initiated in accordance with reimbursement guidelines, vital capacity had declined by ≥85% of the total range. Nearly half of the total loss of vital capacity occurred over 6.2 months centred at an inflection point occurring 17 months after disease onset and 5.2 months before initiation of NIPPV at a vital capacity of about 60%. Fewer bulbar symptoms and a faster rate of decline of lung function predicted adherence to NIPPV, but the intervention had no impact on final vital capacity.

Conclusions

In patients with ALS, vital capacity decline is rapid but slows after an inflection point regardless of NIPPV. Initiating NIPPV along reimbursement guidelines occurs after ≥85% of vital capacity loss has already occurred.
Subjective swallowing symptoms and related risk factors in COPD
Authors: Gonzalez Lindh Margareta , Malinovschi Andrei , Brandén Eva , Janson Christer , Ställberg Björn , Bröms Kristina , Blom Johansson Monica , Lisspers Karin , Koyi Hirsh
Published: September 2019

Objectives

This study aimed to investigate the prevalence of subjective (i.e.self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors.

Methods

A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test.

Results

In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46%versus22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40%versus19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28).

Conclusion

Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review
Authors: Chen Ying-Chun , Zhang Lin , Li Er-Nan , Ding Li-Xiang , Zhang Gen-Ai , Hou Yu , Yuan Wei
Published: September 2019

Background

Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1–1.6% of early and late postoperative infection have been reported although the rate of late infection is very low.

Case presentation

Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient’s deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame.

Conclusions

This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.
Arthropod segmentation
Authors: Clark Erik , Peel Andrew D. , Akam Michael
Published: September 2019

There is now compelling evidence that many arthropods pattern their segments using a clock-and-wavefront mechanism, analogous to that operating during vertebrate somitogenesis. In this Review, we discuss how the arthropod segmentation clock generates a repeating sequence of pair-rule gene expression, and how this is converted into a segment-polarity pattern by ‘timing factor’ wavefronts associated with axial extension. We argue that the gene regulatory network that patterns segments may be relatively conserved, although the timing of segmentation varies widely, and double-segment periodicity appears to have evolved at least twice. Finally, we describe how the repeated evolution of a simultaneous (Drosophila-like) mode of segmentation within holometabolan insects can be explained by heterochronic shifts in timing factor expression plus extensive pre-patterning of the pair-rule genes.
Application of RF (13.56 MHz) Arc Discharge for Plasma Chemical Conversion of Volatile Chlorides of Silicon and Germanium.
Authors: Kornev R. , Sennikov P. , Nazarov V. , Sukhanov A. , Shabarova L.
Published: September 2019

The processes of hydrogen reduction of silicon and germanium chlorides are studied under RF conditions (40.68 MHz) of contracted atmospheric pressure arc discharge stabilized between two rod electrodes. The main gas-phase and solid products of plasma-chemical transformations are determined. Using the hydrogen reduction of SiCl4 as an example, the numerical simulation of gas-dynamic and heat exchange processes for this type of discharge was performed. The studies were carried out for the optimal conditions for obtaining trichlorosilane using modern computational technologies of fluid dynamics which made it possible to detail the velocity and temperature fields, the gas flow rates in the plasma region, and also determine the main temperature zones affecting the hydrogen reduction process.
Plasma Peculiarities of Arc Discharge Between Carbon-Copper Electrodes
Authors: Veklich A. , Fesenko S. , Boretskij V.
Published: September 2019

Composite materials on carbon-copper base have advanced electric and exploitation characteristics. They usually used as materials for sliding contacts for high-speed railway. Arc discharges appear during pantograph lowering process in pantograph-catenary system, so injection of contact material into discharge gap has place. Therefore, investigations of electric arc plasma between such composite electrodes can be useful for further optimization of materials. It would be very useful as well to examine the peculiarities of electric arc plasma and contacts’ working surface interaction. So, the aim of this work is spectroscopy investigations of electric arc discharge plasma between C-Cu composite electrodes. The mutual correlation of plasma properties and composition of contacts’ was found.
Calculation of OPGW Strands Melting due to DC Arc Discharge Simulating High-Energy Lightning Strike
Authors: Iwata M. , Nakano T. , Kotari M. , Ohtaka T. , Goda Y.
Published: September 2019

Metal strands of OPGWs (composite fiber-optic ground wires) installed in overhead power transmission lines are sometimes melted and broken when struck by high-energy lightning. This paper presents the calculation results regarding OPGW strands melting behavior when struck by DC arcs simulating high-energy lightning. The calculations revealed that the melted volume of the strand was 26% of the strand volume before the arc test, i.e. the rate of the non-melted volume of the strand was 74%. On the other hand, the residual tensile strength of the melted strand was 69% of the other non-melted strands after DC arc test. These results suggest there is a strong correlation between the calculated non-melted volume of the strand and the measured residual tensile strength of the melted strand.