bluuebunny/crossref_metadata_2025 huggingface dataset:
Big Data Just Got Bigger: Implications of Real-World Evidence and Patient-Entered Data on Health Care and Health Care Policy
Authors: George Dana M. , George Aaron E. , George Kelly L.
Published: October 2019

Advancing care delivery in lifestyle medicine and primary care has increasingly benefited from unique data sources and points. To remain competitive and relevant in modern practice, physicians and health systems must tackle and engage the implementation of big data and advanced applications for increasingly complex care. In many cases, information is being aggregated, though barriers exist in terms of accessing, interpreting, and making it actionable. New mobile device applications have eased some barriers, yet present challenges of their own. These new applications, designed to gather patient-entered data outside of traditional clinical settings, will require new policies, systems, and workflows. From a business perspective, collecting such data has potential value to patient care and patient engagement as well as financial incentives. If handled correctly, these additional data sources, including those not previously accessible, have the potential to vastly improve patient health.
Health diagnosis of nuclear power plant
Authors: Xue Wangyu , Li Xiu , Huang Biqing
Published: October 2019

At present, nuclear power plant is developing rapidly, and its application has been involved in many aspects including life, military, industry and many other important fields, bringing benefits to people’s life. However, the nuclear power plant has a relatively special structure. Once a safety accident occurs, the consequences will be unimaginable, and the cost of its operation and maintenance will be relatively high. Therefore, how to effectively diagnose the health status of the nuclear power plant is an urgent problem to be solved. On the above-mentioned research background, we need to study nuclear power plant health diagnosis method. Considering the characteristic of the nuclear power plant system and special failure mode, both the safety and economy, a health condition diagnosis method based on analytic hierarchy process and fuzzy comprehensive evaluation method is proposed for the structural characteristics and functional characteristics of nuclear power plants. According to the special failure mode and complex system structure of nuclear power plant, the evaluation index system based on failure mode is constructed by laying the system using the hierarchical analysis method, and the system is scored by fuzzy comprehensive evaluation method. The health status makes a coarse-grained diagnosis and provides a reference for the development of the operation and maintenance strategy.
Application framework of digital twin-driven product smart manufacturing system: A case study of aeroengine blade manufacturing
Authors: Zhang Xuqian , Zhu Wenhua
Published: October 2019

In the wake of the continuous deepening of the application of new generation information technology in the manufacturing field, digital twin, as a most new active factors for smart manufacturing, has become a new research hot spot. Based on such a background, the article proposes a novel application framework of digital twin-driven product smart manufacturing system and analyzes its operation mechanism. Key enabling technologies such as digital twin mapping technology with manufacturing entity, twinning of cyber and physical manufacturing system, as well as twining data-driven machining parameter optimization are also illustrated in detail. Finally, a case of the aeroengine fan blade manufacturing is given to demonstrate the feasibility and effectiveness of the implementation method mentioned above. Meanwhile, potential industrial applications and limitations are discussed as well to provide valuable insights to aeroengine blade manufacturers.
Using contrast-enhanced ultrasound to guide a successful biopsy of a splenic sarcomatoid carcinoma
Authors: Leenknegt Benjamin , Moore Stephen , Fang Cheng , Kibriya Nabil , Gregory Stephen , Cancuri Osman , Sidhu Paul S , Yusuf Gibran
Published: October 2019

Introduction

Splenic lesions are uncommon and frequently cause a diagnostic dilemma, often with non-specific findings on both ultrasound and cross-sectional imaging with histological confirmation necessary. To reduce patient morbidity, primarily from haemorrhage and to increase diagnostic yield, precise imaging and biopsy targeting are needed.

Case

We present a case of an indeterminate complex splenic lesion, with areas of necrosis which required histological diagnosis. Contrast-enhanced ultrasound-guided percutaneous core needle biopsy was undertaken to provide real-time imaging guidance, increasing viable lesion targeting and helping to avoid areas of necrosis.

Conclusion

Contrast-enhanced ultrasound guidance of the percutaneous core needle biopsy allowed increased operator confidence in lesional targeting accuracy and reduced the number of passes required for biopsy, simultaneously maximising histological yield and minimising patient morbidity.
Brivaracetam attenuates pain behaviors in a murine model of neuropathic pain
Authors: Tsymbalyuk Solomiya , Smith Madeleine , Gore Charles , Tsymbalyuk Orest , Ivanova Svetlana , Sansur Charles , Gerzanich Volodymyr , Simard J Marc
Published: October 2019

Background

The antiseizure racetams may provide novel molecular insights into neuropathic pain due to their unique mechanism involving synaptic vesicle glycoprotein 2A. Anti-allodynic effects of levetiracetam have been shown in animal models of neuropathic pain. Here, we studied the effect of brivaracetam, which binds to synaptic vesicle glycoprotein 2A with 20-fold greater affinity, and has fewer off-target effects.

Methods

Mice underwent unilateral sciatic nerve cuffing and were evaluated for mechanical sensitivity using von Frey filaments. Pain behaviors were assessed with prophylactic treatment using levetiracetam (100 or 10 mg/kg) or brivaracetam (10 or 1 mg/kg) beginning after surgery and continuing for 21 days, or with therapeutic treatment using brivaracetam (10 or 1 mg/kg) beginning on day 14, after allodynia was established, and continuing for 28 or 63 days. Spinal cord tissues from the prophylaxis experiment with10 mg/kg brivaracetam were examined for neuroinflammation (Iba1 and tumor necrosis factor), T-lymphocyte (CD3) infiltration, and synaptic vesicle glycoprotein 2A expression.

Results

When used prophylactically, levetiracetam, 100 mg/kg, and brivaracetam, 10 mg/kg, prevented the development of allodynia, with lower doses of each being less effective. When used therapeutically, brivaracetam extinguished allodynia, requiring 10 days with 10 mg/kg, and six weeks with 1 mg/kg. Brivaracetam was associated with reduced neuroinflammation and reduced T-lymphocyte infiltration in the dorsal horn. After sciatic nerve cuffing, synaptic vesicle glycoprotein 2A expression was identified in neurons, activated astrocytes, microglia/macrophages, and T lymphocytes in the dorsal horn.

Conclusion

Synaptic vesicle glycoprotein 2A may represent a novel target for neuropathic pain. Brivaracetam may warrant study in humans with neuropathic pain due to peripheral nerve injury.
The Cultural Fabric of Human Causal Cognition
Authors: Bender Andrea , Beller Sieghard
Published: October 2019

Causal cognition emerges early in development and confers an important advantage for survival. But does this mean that it is universal in humans? Our cross-disciplinary review suggests a broad evolutionary basis for core components of causal cognition but also underlines the essential role of culturally transmitted content as being uniquely human. The multiple ways in which both content and the key mechanisms of cultural transmission generate cultural diversity suggest that causal cognition in humans is not only colored by their specific cultural background but also shaped more fundamentally by the very fact that humans are a cultural species.
Fluoxetine for stroke recovery: Meta-analysis of randomized controlled trials
Authors: Mead Gillian E , Legg Lynn , Tilney Russel , Hsieh Cheng Fang , Wu Simiao , Lundström Erik , Rudberg Ann Sofie , Kutlubaev Mansur , Dennis Martin S , Soleimani Babak , Barugh Amanda , Hackett Maree L , Hankey Graeme J
Published: October 2019

Objective

To determine whether fluoxetine, at any dose, given within the first year after stroke to patients who did not have to have mood disorders at randomization reduced disability, dependency, neurological deficits and fatigue; improved motor function, mood, and cognition at the end of treatment and follow-up, with the same number or fewer adverse effects.

Methods

Searches (from 2012) in July 2018 included databases, trials registers, reference lists, and contact with experts. Co-primary outcomes were dependence and disability. Dichotomous data were synthesized using risk ratios (RR) and continuous data using standardized mean differences (SMD). Quality was appraised using Cochrane risk of bias methods. Sensitivity analyses explored influence of study quality.

Results

The searches identified 3414 references of which 499 full texts were assessed for eligibility. Six new completed RCTs (n = 3710) were eligible, and were added to the seven trials identified in a 2012 Cochrane review (total: 13 trials, n = 4145). There was no difference in the proportion independent (3 trials, n = 3249, 36.6% fluoxetine vs. 36.7% control; RR 1.00, 95% confidence interval 0.91 to 1.09, p = 0.99, I2 = 78%) nor in disability (7 trials n = 3404, SMD 0.05, −0.02 to 0.12 p = 0.15, I2 = 81%) at end of treatment. Fluoxetine was associated with better neurological scores and less depression. Among the four (n = 3283) high-quality RCTs, the only difference between groups was lower depression scores with fluoxetine.

Conclusion

This class I evidence demonstrates that fluoxetine does not reduce disability and dependency after stroke but improves depression.
Blogs’ archives and revision of the past: A case study
Authors: Urban Palina
Published: October 2019

In the beginning of the twenty-first century, the personal diary made a transition from its traditional form to the online space. This change of medium transformed the policies of subjectivity which previously structured personal journaling. One of the most profound transformations was the modified relationship of individuals with their past. Former feelings and experiences that did not fit newly constructed biographical storylines used to be discarded, rejected and, ultimately, forgotten. Personal diaries containing the testimonies of undesired past attitudes were often destroyed, but online journals allowed their authors to revisit and remould their past to bring it into alignment with their changing life story. This article presents a case study of a blogger’s practice of managing her LiveJournal archive containing biographical texts created over almost two decades. It illustrates how new life-writing technology is employed by bloggers to secure continuity of their autobiographical narrative.
Combinatory antibiotic treatment protects against experimental acute pancreatitis by suppressing gut bacterial translocation to pancreas and inhibiting NLRP3 inflammasome pathway
Authors: Jia Lingling , Chen Hao , Yang Jun , Fang Xin , Niu Wenying , Zhang Ming , Li Jiahong , Pan Xiaohua , Ren Zhengnan , Sun Jia , Pan Li-Long
Published: October 2019

Gut bacterial translocation following impaired gut barrier is a critical determinant of initiating and aggravating acute pancreatitis (AP). Antibiotic combination (ABX; vancomycin, neomycin and polymyxin b) is capable of reducing gut bacteria, but its efficacy in AP prevention and the underlying mechanism have not been investigated yet. AP was induced in BALB/c mice by caerulein (CAE) hyperstimulation. We found that ABX supplementation attenuated the severity of AP as evidenced by reduced pancreatic oedema and myeloperoxidase activity. The protective effect was also confirmed by improved histological morphology of the pancreas and decreased pro-inﬂammatory markers (IL-1β, TNF-α, MCP-1) in pancreas. ABX administration inhibits the activation of colonic TLR4/NLRP3 inflammasome pathway. Subsequently, down-regulated NLRP3 resulted in decreased colonic pro-inflammation (IL-1β, IL-6, MCP-1) and enhanced gut physical barrier as evidenced by up-regulation of tight junction proteins including occludin, claudin-1 and ZO-1, as well as improved histological morphology of the colon. Together, combinatory ABX therapy inhibited the translocation of gut bacteria to pancreas and its amplification effects on pancreatic inflammation by inhibiting the pancreatic NLRP3 pathway, and inhibiting intestinal-pancreatic inflammatory responses. The current study provides the basis for potential clinical application of ABX in AP.
KUBeetle-S: An insect-like, tailless, hover-capable robot that can fly with a low-torque control mechanism
Authors: Phan Hoang Vu , Aurecianus Steven , Kang Taesam , Park Hoon Cheol
Published: October 2019

For an insect-like tailless flying robot, flapping wings should be able to produce control force as well as flight force to keep the robot staying airborne. This capability requires an active control mechanism, which should be integrated with lightweight microcontrol actuators that can produce sufficient control torques to stabilize the robot due to its inherent instability. In this work, we propose a control mechanism integrated in a hover-capable, two-winged, flapping-wing, 16.4 g flying robot (KUBeetle-S) that can simultaneously change the wing stroke-plane and wing twist. Tilting the stroke plane causes changes in the direction of average thrust and the wing twist distribution to produce control torques for pitch and roll. For yaw (heading change), root spars of left and right wings are adjusted asymmetrically to change the wing twist during flapping motion, resulting in yaw torque generation. Changes in wing kinematics were validated by measuring wing kinematics using three synchronized high-speed cameras. We then performed a series of experiments using a six-axis force/torque load cell to evaluate the effectiveness of the control mechanism via torque generation. We prototyped the robot by integrating the control mechanism with sub-micro servos as control actuators and flight control board. Free flight tests were finally conducted to verify the possibility of attitude control.
Fresh Osteochondral Allograft Transplantation in the Knee: A Viability and Histologic Analysis for Optimizing Graft Viability and Expanding Existing Standard Processed Graft Resources Using a Living Donor Cartilage Program
Authors: Hevesi Mario , Denbeigh Janet M. , Paggi Carlo A. , Galeano-Garces Catalina , Bagheri Leila , Larson A. Noelle , Stuart Michael J. , Saris Daniel B. F. , van Wijnen Andre J. , Krych Aaron J.
Published: October 2019

Objective

This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts.

Design

Using healthy cartilage from well-preserved contralateral compartments in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability.

Results

Osteochondral samples demonstrated a consistent decrease in viability and histologic quality over the first 3 weeks of storage at 37°C, supporting the utility of an OCA paradigm shift toward early implantation, as was the clinical standard up until recent adoption of transplantation at 14 to 35 days following donor procurement. Samples from the 10 clinical-grade OCAs, implanted at an average of 23 days following graft harvest demonstrated a mean viable cell density of 45.6% at implantation, significantly lower ( P < 0.01) than the 93.6% viability observed in living donor allograft tissues.

Conclusions

Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program.
Psychotic disorders in late life: a narrative review
Authors: Tampi Rajesh R. , Young Juan , Hoq Rakin , Resnick Kyle , Tampi Deena J.
Published: October 2019

Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
A mHealth Support Program for Australian Young Adults with Type 1 Diabetes: A Mixed Methods Study
Authors: Ng Ashley H , Crowe Timothy C , Ball Kylie , Rasmussen Bodil
Published: October 2019

Aims and Objectives

Young adulthood is a life stage comprised of many turning points. For young adults with type 1 diabetes (T1DM), diabetes self-management support is crucial during this period. There is a lack of diabetes education programs and services tailored to this population. This paper presents the findings, according to the STROBE guidelines, on the usability and acceptability of a patient-informed mHealth support program (Diabetes YES) that was developed for young adults with T1DM.

Methods

A total of 34 young adults aged 18–35 years with T1DM participated in the Diabetes YES program over 12 weeks. Google analytics was used to tracked website use, while a website usability survey measured ease of use. Facebook analytics was used to measure peer support engagement. Evaluation of the program was completed using Likert scales and open-ended questions.

Results

Participants rated the website favourably for its ease of navigation and easy to understand information. Web page visits declined sharply while peer support group engagement through Facebook remained consistent throughout the intervention period. Participants utilised weekly discussion topics to generate conversation within the peer support group. Emotional support from peers was the highest regarded benefit reported by participants.

Conclusions

Diabetes YES is an example of an mHealth support program that was readily accepted by young adults living with T1DM. Feasibility studies are an important formative step in the implementation of mHealth programs within mainstream healthcare. Future work should focus on the adaptability of such programs to fit within larger consumer or healthcare organisations.
Investigation of dielectric elastomer human energy harvesting to reduce knee joint torque deviation due to bracing
Authors: Lai Heather , Reid Kristina
Published: October 2019

Introduction

The use of a smart electromechanical material, dielectric elastomer, is investigated for the development of an active bracing technique, which modifies the stiffness and damping of the knee brace during energy harvesting so as to reduce knee joint torque deviation during late swing in braced walking.

Methods

The bracing technique considered involves a dielectric elastomer energy harvesting cycle, which activates only when the knee flexor muscles are contracting eccentrically during late swing. The brace reduces the leg extension deviation during late swing in braced walking by transforming a portion of the mechanical stored energy into electrical energy, reducing the required internal work performed within the body.

Results

Simulated behavior of the dielectric elastomer brace worn across the knee joint demonstrates that when properly activated, the dielectric elastomer brace’s reduction in stiffness and increase in damping minimize the added energy expenditure of knee joint bracing during late swing.

Conclusions

The modeling results demonstrate the effective application of a soft, circumferential, dielectric elastomer energy harvesting knee brace, which utilizes the changes in the dynamic behavior of the knee joint occurring during energy harvesting in order to reduce the added demand placed on the knee joint under braced conditions.
Empowering Leadership in a University Spin-off Project: A Case Study of Team Building
Authors: Turunen Pauli , Hiltunen Esa
Published: October 2019

This case study explores university spin-off (USO) team building from leadership and intrapreneurship perspectives. The study sheds light on a USO team member’s view of team building, examining the inherent tensions and challenges, but also the best practices of team building in general. Thus, the case is based on narrative study and evocative autoethnography, providing knowledge from an insider´s perspective of USO team building and also team leadership, especially for supporting intrapreneurship. The intrapreneurship allows an employee to act like an entrepreneur—in this case, within a USO project team. Instead of considering team building as a completely rational process, the case stresses the need to take into account soft aspects, like emotions, in USO team building. This case study should assist other innovative teams in the future to process narratively different factors, relationships and team behaviour within innovation project teams.
Building Intercultural Competence Through Virtual Team Collaboration Across Global Classrooms
Authors: Swartz Stephanie , Barbosa Belem , Crawford Izzy
Published: October 2019

By means of a cross-cultural virtual teams project involving classrooms in Scotland, Germany, and Portugal, students were exposed to the challenges of collaborating internationally with the intention of increasing their intercultural competency. Intercultural sensitivity and intercultural communication competency were measured using responses to surveys before and after the 6-week project. Students reported, among other aspects, a heightened awareness of the difficulties of intercultural communication. Despite a general appreciation of the project and its outcomes, negative results, such as an increased dislike of intercultural interaction, emerged. Contradictory results warrant further investigation with data from future collaborations.
Goal-Based Shared Decision-Making: Developing an Integrated Model
Authors: Elwyn Glyn , Vermunt Neeltje Petronella Catharina Anna
Published: October 2019

Objective:

Definitions of shared decision-making (SDM) have largely neglected to consider goal setting as an explicit component. Applying SDM to people with multiple long-term conditions requires attention to goal setting. We propose an integrated model, which shows how goal setting, at 3 levels, can be integrated into the 3-talk SDM model.

Method:

The model was developed by integrating 2 published models.

Results:

An integrated, goal-based SDM model is proposed and applied to a patient with multiple, complex, long-term clinical conditions to illustrate the use of a visualization tool called a Goal Board. A Goal Board prioritizes collaborative goals and aligns goals with interventional options.

Conclusion:

The model provides an approach to achieve person-centered decision-making by not only eliciting and prioritizing goals but also by aligning prioritized goals and interventions.

Practice Implications:

Further research is required to evaluate the utility of the proposed model.
Religious Freedom: Freedom of Conversion or Freedom from Conversion?
Authors: John Aruthuckal Varughese
Published: October 2019

The orthodox Hindu objection to the classic formulation of religious freedom, as seen in the UN Universal Declaration of Human Rights and other charters, is with the Judeo-Christian origin or bias in these secular frameworks. It argues that in the application of laws protecting religious freedom, the secular framework erroneously presupposes a similarity between Semitic religions and Hinduism. Consequently, the secular framework applies Judeo-Christian anthropological assumptions that favor conversionary religions, which function against the interests of Asiatic religions.
Diffuse Pigmented Lesions in the Outer Retina: An Unusual Fundus Appearance
Authors: Benson Matthew D. , Rubin Uriel , Cheema Marvi , MacDonald Ian M. , Tennant Matthew T.S. , Hinz Brad J. , Somani Rizwan
Published: October 2019

Purpose:

This report describes and provides a differential diagnosis for a patient with unusual bilateral retinal pigmented lesions.

Methods:

A 40-year-old woman was found to have multiple flat, gray lesions scattered across her fundi, becoming larger and more confluent toward the periphery. There were small drusenlike deposits in her foveae. The hyperpigmented lesions demonstrated hypoautofluorescence with thickening of the retinal pigment epithelium and disruption of the overlying layers on optical coherence tomography (OCT). Full-field electroretinography revealed generalized reduced a- and b-wave amplitudes.

Results:

Chest x-ray, breast ultrasound, mammography, and pelvic ultrasound findings were negative for malignant etiologic factors. Panel testing results for hereditary retinal dystrophy were negative.

Conclusions:

Although the clinical and OCT appearance of the lesions is similar to congenital grouped pigmentation, the symmetric and bilateral nature of ocular findings coupled with electroretinographic changes suggest a possible retinal dystrophy. This case adds to the phenotypic diversity of pigmented fundus lesions.
The art of rent: The making of edamame monopoly rents in East Asia
Authors: Wang Kuan-Chi
Published: October 2019

Drawing on the monopoly rent concept in the Marxist tradition, this study examines recent transformations in East Asian agriculture through a case study of edamame. The analysis develops rent as an analytical framework—edamame monopoly rents—by incorporating recent literature of “technoscience rent” and “value grabbing.” Based on empirical research of edamame industries in Taiwan and China, I conclude that before edamame industries adopted the World Trade Organization legal frameworks on patenting and intellectual property rights, edamame monopoly rents acquired more characteristics of value grabbing of heterogeneous edamame nature. After the World Trade Organization patented and established legal frameworks in the edamame sector, edamame monopoly rents acquired more characteristics of technoscience rent. Overall, this study identifies value politics and edamame rent regimes through which socio-ecological-technological breakthroughs under rentier capital accumulation have been paving new ways to internalize new commons and terrains in East Asian agriculture.
Untapped CHRO Potential: From Partnering to Chairing the Board
Authors: Dwarakanath P.
Published: October 2019

In the changing business landscape most shareholders and investors when making their investment decisions not just look at a firm’s profitability but also consider its corporate citizenship model through its governance practices, leadership talent, ethical behaviour and environmental awareness.

Over the years the role of human resource function has transformed from focusing on just ‘hatch, match and dispatch’ to becoming an active partner in business decisions and serving the interests of not just employees but also investors, shareholders and community at large.

Increasingly the focal point of regulators is on the nomination and remuneration committee (NRC). This further emphasises the need of HR to act as not only the eyes and ears of the NRC but also as its heart to guide and influence on key people matters. To gain the trust of board members, HR professionals must parallel the vision of the CEO and develop a strong business acumen and customer-focused mindset. It also calls for the HR professionals to act as ‘Credible Activists’ in creating the right culture, candour and openness in engaging and partnering with the board/committee members and key stakeholders. In addition to the board and NRC, HR also needs to gain the confidence of the audit committee, corporate social responsibility (CSR) committee and its shareholders.

The time perhaps has come to include chief human resource officer (CHRO) as a key management personnel in the organisation and ‘earn a seat at the board’. Hence it is vital for HR professionals to be future ready and develop their skills such that their contribution in the organisational growth is amplified.
Portal Hypertensive Cholangiopathy, Which Masquerades as an Acute Portal Vein Thrombosis
Authors: Cisak Kamila I. , Macedo Thanila A. , Sheedy Shannon P. , Kamath Patrick S. , Ashrani Aneel A.
Published: October 2019

Portal hypertensive cholangiopathy is a rare complication of extrahepatic portal vein obstruction and portal cavernoma. It is usually asymptomatic but may be associated with jaundice, biliary colic, and fever. Abdominal sonography and Doppler are ideal initial diagnostic modalities, followed by magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography. These imaging modalities are important if an intervention is planned for the management of portal hypertension and for relieving biliary obstruction. If computed tomography (CT) is performed in isolation, it may be challenging to distinguish this entity from acute on chronic portal vein thrombosis. The diagnostic results should be interpreted cautiously. This case report of an abdomen CT performed on a patient with a history of portal vein thrombosis masqueraded as an acute on chronic portal vein thrombosis with cavernous collaterals. Doppler confirmed the diagnosis of portal hypertensive cholangiopathy. Correlation with clinical symptoms and Doppler may be necessary to distinguish portal hypertensive cholangiopathy from acute portal vein thrombus.
Changing Lives on the Border: Preparing Rural, Culturally Responsive Special Educators
Authors: Peterson Patricia J. , Sandigo Alma M. , Stoddard Susan E. , Abou-Rjaily Kathleen , Ulrich Judith
Published: October 2019

Arizona teacher education programs are largely concentrated in urban or suburban areas, with the majority of practicum experiences and student teaching placements located in the same metropolitan areas. However, in Arizona, 35% of K–12 students are served by the 135 school districts that qualify as “rural.” In the extreme southwest corner of Arizona bordering Mexico, 70% of these rural K–12 students are of Hispanic background with Spanish as their first language, and 26.7% of these Hispanic families are living below the poverty line. The “Grow Your Own” programs described here, developed through university–school district partnerships, are specifically designed to prepare culturally responsive educators to meet the needs and ultimately improve the lives of students with disabilities in southwestern Arizona rural border communities.
Real-world experience of venetoclax with azacitidine for untreated patients with acute myeloid leukemia
Authors: Winters Amanda C. , Gutman Jonathan A. , Purev Enkhtsetseg , Nakic Molly , Tobin Jennifer , Chase Stephanie , Kaiser Jeff , Lyle Lindsey , Boggs Chelsey , Halsema Keri , Schowinsky Jeffrey T. , Rosser Julie , Ewalt Mark D. , Siegele Bradford , Rana Vishal , Schuster Steven , Abbott Diana , Stevens Brett M. , Jordan Craig T. , Smith Clayton , Pollyea Daniel A.
Published: October 2019

Key Points

Responses and survival with venetoclax for “real-world” AML patients were promising but inferior to those treated in a clinical trial. Compared with induction, response rates are as high as would be predicted and venetoclax patients had a lower than expected early death rate.
Targeting chronic lymphocytic leukemia with N-methylated thrombospondin-1–derived peptides overcomes drug resistance
Authors: Pramil Elodie , Herbi Bastian Linda , Denèfle Thomas , Nemati Fariba , Xiao Malina , Lardé Eva , Maloum Karim , Roos-Weil Damien , Chapiro Elise , Le Garff-Tavernier Magali , Davi Frédéric , Decaudin Didier , Sarfati Marika , Nguyen-Khac Florence , Merle-Béral Hélène , Karoyan Philippe , Susin Santos A.
Published: October 2019

Key Points

N-methylated thrombospondin-1 mimetic peptides selectively kill the leukemic CD5+ B cells, sparing mature and precursor nontumor cells. CD47 peptide triggering eliminates drug-resistant CLL cells by inducing an original form of cell death regulated by G proteins.
Properties of low-density cement-bonded composite panels manufactured from polystyrene and jute stick particles
Authors: Rana Md Nasim , Islam Md Nazrul , Nath Suresh Kumar , Das Atanu Kumar , Ashaduzzaman Md , Shams Md Iftekhar
Published: October 2019

This study was conducted to evaluate the properties of cement-bonded composite (CBC) manufactured using jute stick particles and expanded polystyrene (EPS) beads to reduce the density of CBC for mitigating the main limitation of CBC in its applications. The CBCs were manufactured by using cement, jute stick particle, EPS and jute fiber by cold pressing having the pressure of 5 MPa and pressing time of 24 h. CBCs were also manufactured by replacing the jute stick particles with EPS beads, the processing conditions remaining the same. There were at least 5 replications for each type of board. Waste jute fibers were added for improving the degenerated mechanical properties of CBC caused by the addition of EPS beads. Important physical properties, i.e., density, water absorption (WA) and thickness swelling (TS) and mechanical properties, i.e., modulus of elasticity (MOE) and modulus of rupture (MOR) of the manufactured CBCs were tested following the Malaysian Standards. Higher percentage of EPS beads significantly reduced the density of CBCs and the lowest density (0.91 ± 0.02 g/cm3) was found when the EPS beads replaced 30% jute stick particles. As expected, mechanical properties decreased with the gradual replacement of jute stick particles by EPS beads. However, the degraded mechanical properties significantly increased when waste jute fibers were added in the CBCs. Addition of EPS beads in CBCs reduced the density, which might increase the potentiality for the utilization of cement-bonded composites for various applications.
blaVIM- and blaOXA-mediated carbapenem resistance among Acinetobacter baumannii and Pseudomonas aeruginosa isolates from the Mulago hospital intensive care unit in Kampala, Uganda
Authors: Aruhomukama Dickson , Najjuka Christine F. , Kajumbula Henry , Okee Moses , Mboowa Gerald , Sserwadda Ivan , Mayanja Richard , Joloba Moses L. , Kateete David P.
Published: October 2019

Background

Between January 2015 and July 2017, we investigated the frequency of carbapenem resistant Acinetobacter baumannii (CRAB) and carbapenem resistant Pseudomonas aeruginosa (CRPA) at the Mulago Hospital intensive care unit (ICU) in Kampala, Uganda. Carbapenemase production and carbapenemase gene carriage among CRAB and CRPA were determined; mobility potential of carbapenemase genes via horizontal gene transfer processes was also studied.

Methods

Clinical specimens from 9269 patients were processed for isolation of CRAB and CRPA. Drug susceptibility testing was performed with the disk diffusion method. Carriage of carbapenemase genes and class 1 integrons was determined by PCR. Conjugation experiments that involved blaVIM positive CRAB/CRPA (donors) and sodium azide resistant Escherichia coli J53 (recipient) were performed.

Results

The 9269 specimens processed yielded 1077 and 488 isolates of Acinetobacter baumannii and Pseudomonas aeruginosa, respectively. Of these, 2.7% (29/1077) and 7.4% (36/488) were confirmed to be CRAB and CRPA respectively, but 46 were available for analysis (21 CRAB and 25 CRPA). Majority of specimens yielding CRAB and CRPA were from the ICU (78%) while 20 and 2% were from the ENT (Ear Nose & Throat) Department and the Burns Unit, respectively. Carbapenemase assays performed with the MHT assay showed that 40 and 33% of CRPA and CRAB isolates respectively, were carbapenemase producers. Also, 72 and 48% of CRPA and CRAB isolates respectively, were metallo-beta-lactamase producers. All the carbapenemase producing isolates were multidrug resistant but susceptible to colistin. blaVIM was the most prevalent carbapenemase gene, and it was detected in all CRAB and CRPA isolates while blaOXA-23 and blaOXA-24 were detected in 29 and 24% of CRAB isolates, respectively. Co-carriage of blaOXA-23 and blaOXA-24 occurred in 14% of CRAB isolates. Moreover, 63% of the study isolates carried class 1 integrons; of these 31% successfully transferred blaVIM to E. coli J53.

Conclusions

CRAB and CRPA prevalence at the Mulago Hospital ICU is relatively low but carbapenemase genes especially blaVIM and blaOXA-23 are prevalent among them. This requires strengthening of infection control practices to curb selection and transmission of these strains in the hospital.
Impact of metformin on the risk and treatment outcomes of tuberculosis in diabetics: a systematic review
Authors: Yu Xinyu , Li Ling , Xia Liangtao , Feng Xin , Chen Fan , Cao Shiyi , Wei Xiang
Published: October 2019

Background

Tuberculosis (TB) remains one of the infectious diseases with a leading cause of death among adults worldwide. Metformin, a first-line medication for the treatment of type 2 diabetes, may have potential for treating TB. The aims of the present systematic review were to evaluate the impact of metformin prescription on the risk of tuberculosis diseases, the risk of latent TB infection (LTBI) and treatment outcomes of tuberculosis among patients with diabetic mellitus.

Methods

Databases were searched through March 2019. Observational studies reporting the effect of metformin prescription on the risk and treatment outcomes of TB were included in the systematic review. We qualitatively analyzed results of included studies, and then pooled estimate effects with 95% confidence intervals (CIs) of different outcome using random-effect meta-analyses.

Results

This systematic review included 6980 cases from 12 observational studies. The meta-analysis suggested that metformin prescription could decrease the risk of TB among diabetics (pooled odds ratio [OR], 0.38; 95%CI, 0.21 to 0.66). Metformin prescription was not related to a lower risk of LTBI (OR, 0.73; 95%CI, 0.30 to 1.79) in patients with diabetes. Metformin medication during the anti-tuberculosis treatment is significantly associated with a smaller TB mortality (OR, 0.47; 95%CI, 0.27 to 0.83), and a higher probability of sputum culture conversion at 2 months of TB disease (OR, 2.72; 95%CI, 1.11 to 6.69) among patients with diabetes. The relapse of TB was not statistically reduced by metformin prescription (OR, 0.55; 95%CI, 0.04 to 8.25) in diabetics.

Conclusions

According to current observational evidence, metformin prescription significantly reduced the risk of TB in patients with diabetes mellitus. Treatment outcomes of TB disease could also be improved by the metformin medication among diabetics.
Uridine diphosphate glucuronosyl transferase 1A (UGT1A1) promoter polymorphism in young patients with sickle cell anaemia: report of the first cohort study from Nigeria
Authors: Olatunya Oladele Simeon , Albuquerque Dulcineia Martins , Akanbi Ganiyu Olusola , Aduayi Olufunso Simisola , Taiwo Adekunle Bamidele , Faboya Opeyemi Ayodeji , Kayode Tolorunju Segun , Leonardo Daniela Pinheiro , Adekile Adekunle , Costa Fernando Ferreira
Published: October 2019

Background

(TA) n repeat sequence (rs8175347) of UGT1A1 gene promoter polymorphism is associated with serum bilirubin levels and gallstones among different sickle cell anaemia (SCA) populations. There are no data on UGT1A1 polymorphisms and their impact on Nigerian SCA patients. In this study, we determined the distribution of the UGT1A1 (TA) n genotypes among a group of young Nigerian SCA patients and healthy controls. In addition, the influence of UGT1A1 (TA) n genotypes on the laboratory and clinical events among the patients was determined.

Methods

The distribution of the UGT1A1 (TA) n genotypes among 101 young Nigerian SCA patients and 64 normal appropriate controls were determined and studied. The UGT1A1 (TA) n genotypes were further classified into subgroups and used to differentiate the clinical events and laboratory parameters of the patients.

Results

Four (TA) n alleles:(TA)5, 6, 7, and 8 were found. These were associated with 10 genotypes: TA5/5, 5/6, 5/7, 5/8, 6/6, 6/7, 6/8, 7/7, 7/8, 8/8. The normal (wild-type)-(TA) 6/6), low- (TA) 7/7, 7/8, 8/8), intermediate- (TA) 5/7, 5/8, 6/7, 6/8), and high-activity (TA) 5/5, 5/6,) genotypes were found in 24.8, 24.8, 41.5, and 8.9% patients and 20.3, 15.6, 61, and 3.1% controls respectively. The general genotype distribution of the patients and control group were not significantly different. There were significant differences in serum bilirubin and lactate dehydrogenase (LDH) of the patients when differentiated by the UGT1A1 (TA) n genotypes (p<0.05). Asymptomatic gallstones were found in 5.9% of patients and were significantly of the low-activity genotypes sub-group 5 (20%) vs 1(1.3%) p = 0.0033. Although, bilirubin and fetal hemoglobin (HbF) of patients with gallstones were significantly different from those without gallstone, only the serum bilirubin was associated with UGT1A1 (TA) n genotypes on multivariate analysis (p < 0.0001).

Conclusion

This study highlights the contribution of UGT1A1 polymorphisms, a non-globin genetic factor, to the laboratory and clinical manifestations of young Nigerian SCA patients for the first time. It also shows that children with co-inheritance of low UGT1A1 (TA) n affinity genotypes may be at risk of gallstone, hence the need to follow them up.
Association of medication non-adherence with short-term allograft loss after the treatment of severe acute kidney transplant rejection
Authors: Al-Sheyyab Ahmed , Binari Laura , Shwetar Mohammed , Ramos Everly , Kapp Meghan E. , Bala Stefanie , Wilson Nikita , Forbes Rachel C. , Helderman J. Harold , Abdel-Kader Khaled , Concepcion Beatrice P.
Published: October 2019

Background

Medication non-adherence is a risk factor for acute kidney transplant rejection. The association of non-adherence with short-term allograft loss in patients who develop acute rejection and are subsequently treated with maximal therapy is unknown.

Methods

We conducted a retrospective single center cohort study of adult patients who developed acute rejection from January 2003 to December 2017 and were treated with lymphocyte depletion. Clinicopathologic characteristics including adherence status were collected and descriptive statistics utilized to compare groups. The primary outcome was all-cause graft loss at 6 months after acute rejection treatment. A multivariable logistic regression quantified the association of non-adherence with the outcome.

Results

A total of 182 patients were included in the cohort, of whom 71 (39%) were non-adherent. Compared to adherent patients, non-adherent patients were younger (mean age 37y vs 42y), more likely to be female (51% vs 35%) and developed acute rejection later (median 2.3y vs 0.5y from transplant). There were no differences in estimated glomerular filtration rate or need for dialysis on presentation, Banff grade, or presence of antibody mediated rejection between the 2 groups. Overall, 48 (26%) patients lost their grafts at 6 months after acute rejection treatment. In adjusted analysis, non-adherence was associated with all-cause graft loss at 6 months after acute rejection treatment [OR 2.64 (95% CI 1.23–5.65,p = 0.012].

Conclusions

After adjusting for common confounders, non-adherent patients were at increased risk for short-term allograft loss after a severe acute rejection despite lymphocyte depletion. This finding may aid clinicians in risk stratifying patients for poor short-term outcomes and treatment futility.
Developing nephrology services in low income countries: a case of Tanzania
Authors: Furia Francis F. , Shoo Jacqueline , Ruggajo Paschal J. , Kilonzo Kajiru , Basu Gopal , Yeates Karen , Varughese Santosh , Svarstad Einar , Kisanga Onesmo
Published: October 2019

Background

The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services.

Methods

This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services.

Results

Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania.

Conclusion

Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.
Non-survivor patients with malignant middle cerebral artery infarction showed persistently high serum malondialdehyde levels
Authors: Lorente Leonardo , Martín María M. , Abreu-González Pedro , Sabatel Rafael , Ramos Luis , Argueso Mónica , Solé-Violán Jordi , Cáceres Juan J. , Jiménez Alejandro , García-Marín Victor
Published: October 2019

Objective

Previously there have been found higher circulating malondialdehyde levels during the first week of ischemic stroke in patients with worst neurological functional outcome, and at moment of ischemic stroke in non-survivor patients. Thus, the aim of our study was to determine the potential role of serum malondialdehyde levels during the first week of a severe cerebral infarction to mortality prediction.

Methods

This study was observational, prospective, and multicenter. We included patients with a severe malignant middle cerebral artery infarction (MMCAI) defined as patients with computed tomography showing acute infarction in more than of 50% of the territory and Glasgow Coma Scale (GCS) lower than 9. We determined serum concentrations of malondialdehyde on days 1, 4 and 8 of MMCAI.

Results

Serum malondialdehyde concentrations at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.001) of MMCAI in non-survivor patients (n = 34) were higher than in survivor patients (n = 34). ROC curve analyses showed that serum malondialdehyde concentrations at days 1, 4, and 8 of MMCAI had an AUC (95% CI) to predict 30-day mortality of 0.77 (0.65–0.86; p < 0.001), 0.82 (0.69–0.91; p < 0.001) and 0.84 (0.70–0.93; p < 0.001) respectively.

Conclusions

The new findings of our study were that serum malondialdehyde levels during the first week of MMCAI could be used as biomarkers to mortality prediction.