bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-Hip Fracture Falls: A Missed Opportunity for Intervention
Authors: Pierrie Sarah N. , Wally Meghan K. , Churchill Christine , Patt Joshua C. , Seymour Rachel B. , Karunakar Madhav A.
Published: June 2019

Introduction:

The purpose of this study is to examine utilization of acute care services in the year prior to hip fracture to inform development and implementation of an intervention to prevent subsequent falls and hip fracture that targets high-risk patients.

Methods:

Elderly patients (age >55) with hip fractures managed at a level one trauma center during 1 year (n = 134) were included. All “preadmissions,” defined as an emergency department (ED) visit or inpatient admission within our hospital system in the year before fall with fracture, were documented. Proportion of patients with a “preadmission,” reason for “preadmission,” demographic characteristics, medical comorbidities, history of falls with fracture, cause of fracture, and time between preadmission and fracture were documented and described.

Results:

Of all, 45.5% of patients (n = 61) had a preadmission. Falls was the reason for presentation in 27.5% of the preadmission encounters, and the median interval between preadmission and fracture was 217 days. Only 8% of the patients presenting for falls in the ED received falls counseling. Patients who experienced preadmission were younger, had a higher Charlson Comorbidity Index, and were more likely to be male. Seventy-nine percent were community dwelling at the time of preadmission, and 68% were discharged home.

Discussion:

Nearly half of hip fracture patients were seen in a high acuity care environment in the year prior to fracture. A quarter presented for falls, supporting previous findings that history of falls is an important risk factor for future falls and injury. However, very few received falls counseling, documenting a major missed opportunity to address falls prevention in the acute care setting.

Conclusions:

Preventing subsequent falls and hip fractures in a targeted, high-risk population in the year prior to potential hip fracture has important implications for improving individual morbidity and mortality and population health. Community-based falls prevention programs are a viable option for this high-risk, community-dwelling population. Collaborative interventions are needed to actively link patients to evidence-based community resources.
Exploring the Construction of Adulthood and Gender Identity Among Single Childfree People in Mexico and Japan
Authors: Mandujano-Salazar Yunuen Ysela
Published: June 2019

This article presents the analysis of personal narratives of Mexican and Japanese single and childfree cisgender heterosexual individuals to explore how people who do not comply with heteronormative gender roles related to marriage and parenthood build their gender identities as adults. It draws on in-depth interviews with 24 informants who were raised and lived in these two countries, amid hegemonic discourses on adulthood, masculinity and femininity that emphasize some form of heterosexual partnership and reproduction. It is found that, men interviewed from both countries were able to narratively defend their adulthood and gender identity through other attributes that are part of hegemonic masculinity. On the contrary, women had difficulties constructing themselves congruently; they recurred to external traits of hegemonic femininity to defend their womanhood, but to personality and lifestyle qualities related to hegemonic masculinity to construct their adulthood.
Health Literacy Level of Casting Factory Workers and Its Relationship With Occupational Health and Safety Training
Authors: Güner Müberra Devrim , Ekmekci Perihan Elif
Published: June 2019

Health literacy (HL) is a stronger predictor of an individual’s health status than income, employment status, education level, and race or ethnicity. Lower levels of HL may contribute to low uptake or less adherence to occupational health and safety (OHS) training. This study was conducted among casting factory workers who received OHS training routinely. Data on sociodemographic characteristics, OHS training, and scores of the Health Literacy Survey–European Union (HLS-EU) were collected. Of the 282 of the 600 (47%) workers surveyed, 13.5% had inadequate, 47.5% problematic, 30.9% sufficient, and 8.2% excellent HL scores. There were no statistically significant differences between workers with limited and proficient HL with respect to age group or educational level. Workers with limited HL were less satisfied with OHS training content and were less likely to identify one-on-one health and safety training sessions as training. Limited HL is a universal problem both in the general and working populations, and it may be restricting the workers understanding of OHS training. Occupational health nurses should be aware of the detrimental effects of limited HL and modify their OHS training where needed for purposes of increasing the successful adoption of safe work practices.
Visual Performance and Occupational Safety Among Aging Workers
Authors: Hammond Stephanie , Bowen Pamela G. , Hallman Melanie Gibbons , Heaton Karen
Published: June 2019

With the rapid growth of the aging workforce, age-related conditions may negatively influence overall workplace safety and health among these workers and their employers. In this summary, we have outlined details about visual acuity, glare sensitivity, and contrast sensitivity, which are common age-related vision changes that can potentially affect their occupational safety. The occupational health nurse is well positioned to address these concerns by instructing aging workers about potential development of vision change and ensuring they receive the appropriate vision screening. By assisting employers to modify work environments to accommodate this population, the occupational health nurse can reduce the risk of injury, as well as positively impact the health of their aging workforce.
ODI Cannot Account for All Variation in PROMIS Scores in Patients With Thoracolumbar Disorders
Authors: Passias Peter G. , Horn Samantha R. , Segreto Frank A. , Bortz Cole A. , Pierce Katherine E. , Vasquez-Montes Dennis , Moon John , Varlotta Christopher G. , Raman Tina , Frangella Nicholas J. , Stekas Nicholas , Lafage Renaud , Lafage Virginie , Gerling Michael C. , Protopsaltis Themistocles S. , Buckland Aaron J. , Fischer Charla R.
Published: June 2019

Study Design:

Retrospective review of single institution.

Objective:

To assess the relationship between Patient-Reported Outcomes Measurement Information System (PROMIS) and Oswestry Disability Index (ODI) scores in thoracolumbar patients.

Methods:

Included: Patients ≥18 years with a thoracolumbar spine condition (spinal stenosis, disc herniation, low back pain, disc degeneration, spondylolysis). Bivariate correlations assessed the linear relationships between ODI and PROMIS (Physical Function, Pain Intensity, and Pain Interference). Correlation cutoffs assessed patients with high and low correlation between ODI and PROMIS. Linear regression predicted the relationship of ODI to PROMIS.

Results:

A total of 206 patients (age 53.7 ± 16.6 years, 49.5% female) were included. ODI correlated with PROMIS Physical Function ( r = −0.763, P < .001), Pain Interference ( r = 0.800, P < .001), and Pain Intensity ( r = 0.706, P < .001). ODI strongly predicted PROMIS for Physical Function ( R2 = 0.58, P < .001), Pain Intensity ( R2 = 0.50, P < .001), and Pain Interference ( R2 = 0.64, P < .001); however, there is variability in PROMIS that ODI cannot account for. ODI questions about sitting and sleeping were weakly correlated across the 3 PROMIS domains. Linear regression showed overall ODI score as accounting for 58.3% ( R2 = 0.583) of the variance in PROMIS Physical Function, 63.9% ( R2 = 0.639) of the variance in Pain Interference score, and 49.9% ( R2 = 0.499) of the variance in Pain Intensity score.

Conclusions:

There is a large amount of variability with PROMIS that cannot be accounted for with ODI. ODI questions regarding walking, social life, and lifting ability correlate strongly with PROMIS while sitting, standing, and sleeping do not. These results reinforce the utility of PROMIS as a valid assessment for low back disability, while indicating the need for further evaluation of the factors responsible for variation between PROMIS and ODI.
Unicompartmental knee arthroplasties in Hong Kong: 15 years of experience in a teaching hospital
Authors: Yung Colin Shing-Yat , Cheung Man Hong , Fu Henry Chun Him , Chan Ping Keung , Yan Chun Hoi , Chiu Kwong Yuen
Published: June 2019

Introduction:

Osteoarthritis (OA) of the knee is a growing problem in an aging population. Unicompartmental knee arthroplasties (UKA) have been used for management of isolated OA of the medial tibiofemoral joint. This is the first study on the usage of UKA in Hong Kong.

Methods:

Retrospective analysis of all patients undergoing medial compartment UKA in a tertiary referral center since 2003. Preoperative and postoperative International Knee Society Knee Scores (KSKS) and Knee Societal Functional Assessment (KSFA) scores, range of motion, flexion deformity, and lower limb mechanical alignment were measured. Statistical analysis using paired sample t-tests was performed. Revision operations, rate of revisions, and causes of failure were analyzed. Univariate and multivariate logistic regression analyses of risk factors for revision operation were performed against patient demographics, type of prosthesis, postoperative alignment, and degree of correction.

Results:

There were 94 UKA performed with an average follow-up of 4.3 years (range: 0.5–15.2 years). The KSKS and KSFA scores improved from 54.5 and 54.0 to 85.6 and 64.5 ( p < 0.01), respectively. There was no significant improvement in the range of motion ( p = 0.87) and fixed flexion deformity ( p = 0.14). Mechanical alignment improved from 172.1° to 174.9° varus postoperatively ( p < 0.01). Six cases required revision operation with a revision rate of 1.50 per 100 observed component years. Causes of revision included two cases of tibial tray loosening and one case each of progressive OA, mechanical failure, persistent pain, and infection. Logistic regression analysis for risk factors showed no statistical significance.

Conclusions:

UKA offers good functional improvement but further long-term studies are required to evaluate survivorship.
Processes of Change and Nonsuicidal Self-Injury: A Qualitative Interview Study With Individuals at Various Stages of Change
Authors: Kruzan Kaylee Payne , Whitlock Janis
Published: June 2019

Nonsuicidal self-injury (NSSI) is a pervasive and potentially lethal behavior that affects many youth and adolescents. Effective treatment and prevention efforts are critical but often lack a nuanced understanding of the behavior change process. To address this gap, this research employs a stage of change model to identify and understand the most salient and widespread processes that facilitate NSSI behavior change. Thirty-one semi-structured interviews were conducted with individuals with current or past self-injury. Individuals were recruited to represent all stages of change including those who have not thought about changing behavior to those who have been NSSI-free for years. We employ a directed content analysis to code for dimensions derived from the model and an inductive approach to surface more nuanced change levers. Four organizing dimensions emerged: relational, behavioral, self-knowledge, and barriers. Common change levers of value in clinical practice or in intervention modalities are discussed.
Understanding project mobility: The movement of King’s Cross to Brussels and Johannesburg
Authors: Brill Frances , Conte Veronica
Published: June 2019

This paper builds on policy mobility research to question how loosely deployed references to specific models or sites reveal how tacit and explicit knowledge are required to effectively replicate urban ideas in new places. Departing from existing analysis of policies and the public sector, we use policy mobility framing to critically engage with the strategies of the private sector. We analyse King’s Cross’ arrival in two large-scale redevelopments: Brussels’ Tour and Taxis and Johannesburg’s Modderfontein, questioning how it was referred to, the success of its deployment and the politics of urban learning. We draw three main conclusions: first, the comparison demonstrates private sector agency in their ability to shape the way expert knowledge arrives. Second, we argue that private sector actors require locally embedded practices and tacit knowledge to leverage international points of reference in their projects. Third, in placing the analytical gaze from the perspective of the project ‘arriving’ and adopting a specifically comparative approach, we reveal the myriad of possibilities developers and consultants face and the politics of what they pick from each. Theoretically, these conclusions draw from economic geography’s politics of learning and mobility research to demonstrate the benefit of analysis that traces a project, rather an idea or a policy, and from ‘arriving at’ and the subsequent assembling of different project components.
Caught in the middle? Creating and contesting intermediary spaces in low-carbon transitions
Authors: van Veelen Bregje
Published: June 2019

The distributed nature of renewable energy has given rise to new forms and scales of energy governance, in particular the emerging role of households and community organisations in generating and distributing renewable energy. Accompanying this trend has been the emergence of intermediary organisations, whose role it is to mediate between these actors cf. the market and the state, with the aim to move from local experimentation to widespread transformational change. While in recent years a significant body of research has emerged that has considered intermediary functions, less is known about intermediary spaces. By tracing how intermediary spaces are shaped, negotiated, protected, and expanded, this article makes three contributions to the literature on energy governance and low-carbon intermediaries. First, a focus on the relational nature of intermediary spaces challenges the community/state binary in energy governance. Second, it highlights the power dynamics behind these emergent relational spaces; showing such spaces are not neutral, but produced through social relations within and beyond them, affecting the functions that intermediaries seek to fulfil. Third, it provides an understanding of how the ever-changing nature of intermediary spaces can also enable new spaces for action to emerge and challenge the status quo.
Rapid Pathogen Identification With Direct Application of MALDI-TOF Mass Spectrometry on an Endophthalmitis Vitreous Sample Without Prior Culture
Authors: Chun Lindsay Y. , Dolle Molle Laura , Schneewind Olaf , Missiakas Dominique , Beavis Kathleen G. , Skondra Dimitra
Published: June 2019

Purpose:

We report a case of a 72-year-old man with bleb-related endophthalmitis (BRE) whose vitreous samples were directly analyzed with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to rapidly identify the causative organism, whereas the results from conventional microbiological techniques were negative.

Methods:

We analyzed BRE vitreous samples with MALDI-TOF MS (Vitek MS, bioMérieux) for rapid pathogen identification without prior culture. Samples were also analyzed with standard microbiological methods.

Results:

Within 1 hour of sample acquisition, MALDI-TOF MS identified Gemella sanguinis from the undiluted vitreous sample from vitrectomy without prior culture with a confidence value of 99.7%. Gram stain and cultures from aqueous and vitreous samples were negative for 28 days after acquisition. The patient’s right-eye vision improved from hand motion to 20/50 2 months later.

Conclusions:

Our findings suggest that the direct analysis of intraocular samples with MALDI-TOF MS could be a novel, promising adjuvant method of rapid endophthalmitis diagnosis.
Novel idiopathic pulmonary fibrosis susceptibility variants revealed by deep sequencing
Authors: Lorenzo-Salazar Jose M. , Ma Shwu-Fan , Jou Jonathan , Hou Pei-Chi , Guillen-Guio Beatriz , Allen Richard J. , Jenkins R. Gisli , Wain Louise V. , Oldham Justin M. , Noth Imre , Flores Carlos
Published: June 2019

Background

Specific common and rare single nucleotide variants (SNVs) increase the likelihood of developing sporadic idiopathic pulmonary fibrosis (IPF). We performed target-enriched sequencing on three loci previously identified by a genome-wide association study to gain a deeper understanding of the full spectrum of IPF genetic risk and performed a two-stage case–control association study.

Methods

A total of 1.7 Mb of DNA from 181 IPF patients was deep sequenced (>100×) across 11p15.5, 14q21.3 and 17q21.31 loci. Comparisons were performed against 501 unrelated controls and replication studies were assessed in 3968 subjects.

Results

36 SNVs were associated with IPF susceptibility in the discovery stage (p<5.0×10−8). After meta-analysis, the strongest association corresponded to rs35705950 (p=9.27×10−57) located upstream from the mucin 5B gene (MUC5B). Additionally, a novel association was found for two co-inherited low-frequency SNVs (<5%) inMUC5AC, predicting a missense amino acid change in mucin 5AC (lowest p=2.27×10−22). Conditional and haplotype analyses in 11p15.5 supported the existence of an additional contribution ofMUC5ACvariants to IPF risk.

Conclusions

This study reinforces the significant IPF associations of these loci and implicatesMUC5ACas another key player in IPF susceptibility.
A new mathematical model to identify contacts with recent and remote latent tuberculosis
Authors: Fröberg Gabrielle , Wahren Borgström Emilie , Chryssanthou Erja , Correia-Neves Margarida , Källenius Gunilla , Bruchfeld Judith
Published: June 2019

Tuberculosis (TB) elimination programmes need to target preventive treatment to groups with an increased risk of TB activation, such as individuals with a latent tuberculosis infection (LTBI) acquired recently. Current diagnostic tests for LTBI have poor predictive values for TB activation and there is, at present, no reference method to evaluate new LTBI diagnostic and prognostic tools. Thus, our objective was to develop a mathematical model, independent of currently available diagnostic tests, to estimate the individual probability of recent and/or remote LTBI.

Estimations of recent LTBI were based on the contagiousness of index case, proximity and time of exposure, and environmental factors. Estimation of remote LTBI was based on country of origin, previous stays in high-risk environments or known exposure to TB. Individual probabilities were calculated and compared with tuberculin skin test (TST) and interferon-γ release assay results for 162 contacts of 42 index TB cases.

Probabilities of remote LTBI were 16% for European/American contacts and 38% for African/Asian contacts. The probability of recent LTBI was 35% for close contacts to smear microscopy positive index cases. A higher probability of remote LTBI was seen among TST-positive contacts.

This model may, with further validation, be used as an independent tool to evaluate new diagnostic markers for recent LTBI.
Dealing with headquarters in the multinational corporation: a subsidiary perspective on organizing costs
Authors: Lunnan Randi , Tomassen Sverre , Andersson Ulf , Benito Gabriel R. G.
Published: June 2019

This study examines how subsidiaries in multinational corporations (MNCs) experience interactions with corporate headquarters. We conceptualize such interactions in terms of organizing costs, focusing on two key types of costs: bargaining costs and information costs. Specifically, we examine how distance, coordination mechanisms, and atmosphere influence the level of organizing costs in the headquarter-subsidiary relationship. Using survey data collected among 104 subsidiary managers in two MNCs, we show that relationship atmosphere significantly reduces both types of organizing costs, whereas distance increases bargaining costs. We also find that centralization and formalization reduce information costs, whereas social integration, contrary to our hypothesis, increases bargaining costs.
An attempt to explain the bidirectional association between ischaemic heart disease, stroke and depression: a cohort and meta-analytic approach
Authors: Wium-Andersen Marie Kim , Wium-Andersen Ida Kim , Prescott Eva Irene Bosano , Overvad Kim , Jørgensen Martin Balslev , Osler Merete
Published: June 2019

Background

Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner.

Aims

To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response.

Method

A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017–2018. Exposures were physicians’ diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables.

Results

IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43–2.23 and HR for stroke: 2.62, 95% CI 2.09–3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36–1.95) and stroke (HR = 1.94, 95% CI 1.63–2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders.

Conclusions

The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.
Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update
Authors: Khorana Alok A. , McKernin Shannon E. , Berlin Jordan , Hong Theodore S. , Maitra Anirban , Moravek Cassadie , Mumber Matthew , Schulick Richard , Zeh Herbert J. , Katz Matthew H.G.
Published: June 2019

PURPOSE

The purpose of this guideline update is to incorporate recently reported practice-changing evidence into ASCO’s recommendations on potentially curable pancreatic adenocarcinoma.

METHODS

ASCO convened an Expert Panel to evaluate data from PRODIGE 24/CCTG PA.6, a phase III, multicenter, randomized clinical trial of postoperative leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX) versus gemcitabine alone, presented at the 2018 ASCO Annual Meeting. In addition, PubMed was searched for additional papers that may influence the existing recommendations.

RECOMMENDATIONS

The Expert Panel only updated Recommendation 4.1 as a result of the practice-changing data. Recommendation 4.1 states that all patients with resected pancreatic adenocarcinoma who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of medical or surgical contraindications. The modified combination regimen of 5-fluorouracil, oxaliplatin, and irinotecan (mFOLFIRINOX; oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 D1, and 5-fluorouracil 2.4 g/m2 over 46 hours every 14 days for 12 cycles) is now preferred in the absence of concerns for toxicity or tolerance; alternatively, doublet therapy with gemcitabine and capecitabine or monotherapy with gemcitabine alone or fluorouracil plus folinic acid alone can be offered. Additional information can be found at www.asco.org/gastrointestinal-cancer-guidelines .
Collagen vitrigel promotes hepatocytic differentiation of induced pluripotent stem cells into functional hepatocyte-like cells
Authors: Nakai Shun , Shibata Ima , Shitamichi Takahiro , Yamaguchi Hiroyuki , Takagi Nobuyuki , Inoue Tomoaki , Nakagawa Toshito , Kiyokawa Jumpei , Wakabayashi Satoshi , Miyoshi Tomoya , Higashi Eriko , Ishida Seiichi , Shiraki Nobuaki , Kume Shoen
Published: June 2019

Differentiation of stem cells to hepatocytes provides an unlimited supply of human hepatocytes and therefore has been vigorously studied. However, to date, the stem cell-derived hepatocytes were suggested to be of immature features. To obtain matured hepatocytes from stem cells, we tested the effect of culturing iPS cell-derived endoderm cells on collagen vitrigel membrane and compared with our previous reported nanofiber matrix.

We cultured hiPS cell-derived endoderm cells on a collagen vitrigel membrane and examined the expression profiles, and tested the activity of metabolic enzymes. Gene expression profile analysis of hepatocytic differentiation markers revealed that upon culture on collagen vitrigel membrane, immature markers of AFP decreased, with a concomitant increase in the expression of mature hepatocyte transcription factors and mature hepatocyte markers such as ALB, ASGR1. Mature markers involved in liver functions, such as transporters, cytochrome P450 enzymes, phase II metabolic enzymes were also upregulated. We observed the upregulation of the liver markers for at least 2 weeks. Gene array profiling analysis revealed that hiPS cell-derived hepatocyte-like cells (hiPS-hep) resemble that of the primary hepatocytes. Functions of the CYP enzyme activities were tested in multi-institution and all revealed high CYP1A, CYP2C19, CYP2D6, CYP3A activity, which could be maintained for at least 2 weeks in culture.

Taken together, the present approach identified that collagen vitrigel membrane provides a suitable environment for the generation of hepatocytes from hiPS cells that resemble many characteristics of primary human hepatocytes.
Periconceptional alcohol exposure causes female-specific perturbations to trophoblast differentiation and placental formation in the rat
Authors: Kalisch-Smith Jacinta I. , Steane Sarah E. , Simmons David G. , Pantaleon Marie , Anderson Stephen T. , Akison Lisa K. , Wlodek Mary E. , Moritz Karen M.
Published: June 2019

The development of pathologies during pregnancy, including pre-eclampsia, hypertension and fetal growth restriction (FGR), often originates from poor functioning of the placenta. In vivo models of maternal stressors, such as nutrient deficiency, and placental insufficiency often focus on inadequate growth of the fetus and placenta in late gestation. These studies rarely investigate the origins of poor placental formation in early gestation, including those affecting the pre-implantation embryo and/or the uterine environment. The current study characterises the impact on blastocyst, uterine and placental outcomes in a rat model of periconceptional alcohol exposure, in which 12.5% ethanol is administered in a liquid diet from 4 days before until 4 days after conception. We show female-specific effects on trophoblast differentiation, embryo-uterine communication, and formation of the placental vasculature, resulting in markedly reduced placental volume at embryonic day 15. Both sexes exhibited reduced trophectoderm pluripotency and global hypermethylation, suggestive of inappropriate epigenetic reprogramming. Furthermore, evidence of reduced placental nutrient exchange and reduced pre-implantation maternal plasma choline levels offers significant mechanistic insight into the origins of FGR in this model.
Centrin2 from the human parasite Toxoplasma gondii is required for its invasion and intracellular replication
Authors: Leung Jacqueline M. , Liu Jun , Wetzel Laura A. , Hu Ke
Published: June 2019

Centrins are EF-hand containing proteins ubiquitously found in eukaryotes and are key components of centrioles/basal bodies as well as certain contractile fibers. We previously identified three centrins in the human parasite Toxoplasma gondii, all of which localized to the centrioles. However, one of them, T. gondii (Tg) Centrin2 (CEN2), is also targeted to structures at the apical and basal ends of the parasite, as well as to annuli at the base of the apical cap of the membrane cortex. The role(s) that CEN2 play in these locations were unknown. Here, we report the functional characterization of CEN2 using a conditional knockdown method that combines transcriptional and protein stability control. The knockdown resulted in an ordered loss of CEN2 from its four compartments, due to differences in incorporation kinetics and structural inheritance over successive generations. This was correlated with a major invasion deficiency at early stages of CEN2 knockdown, and replication defects at later stages. These results indicate that CEN2 is incorporated into multiple cytoskeletal structures to serve distinct functions that are required for parasite survival.
Does evidence support the high expectations placed in precision medicine? A bibliographic review
Authors: Cortés Jordi , González José Antonio , Medina María Nuncia , Vogler Markus , Vilaró Marta , Elmore Matt , Senn Stephen John , Campbell Michael , Cobo Erik
Published: June 2019

Background: Precision medicine is the Holy Grail of interventions that are tailored to a patient’s individual characteristics. However, conventional clinical trials are designed to find differences in averages, and interpreting these differences depends on untestable assumptions. Although only an ideal, a constant effect of treatment would facilitate individual management. A direct consequence of a constant effect is that the variance of the outcome measure would be the same in the treated and control arms. We reviewed the literature to explore the similarity of these variances as a foundation for examining whether and how often precision medicine is definitively required.

Methods: We reviewed parallel clinical trials with numerical primary endpoints published in 2004, 2007, 2010 and 2013. We collected the baseline and final standard deviations of the main outcome measure. We assessed homoscedasticity by comparing the variance of the primary endpoint between arms through the outcome variance ratio (treated to control group).

Results: The review provided 208 articles with enough information to conduct the analysis. One out of five studies (n = 40, 19.2%) had statistically different variances between groups, implying a non-constant-effect. The adjusted point estimate of the mean outcome variance ratio (treated to control group) is 0.89 (95% CI 0.81 to 0.97).

Conclusions: The mean variance ratio is significantly lower than 1 and the lower variance was found more often in the intervention group than in the control group, suggesting it is more usual for treated patients to be stable. This observed reduction in variance might also imply that there could be a subgroup of less ill patients who derive no benefit from treatment. This would require further study as to whether the treatment effect outweighs the side effects as well as the economic costs. We have shown that there are ways to analyze the apparently unobservable constant effect.
de.NBI Cloud federation through ELIXIR AAI
Authors: Belmann Peter , Fischer Björn , Krüger Jan , Procházka Michal , Rasche Helena , Prinz Manuel , Hanussek Maximilian , Lang Martin , Bartusch Felix , Gläßle Benjamin , Krüger Jens , Pühler Alfred , Sczyrba Alexander
Published: June 2019

The academic de.NBI Cloud offers compute resources for life science research in Germany. 

At the beginning of 2017, de.NBI Cloud started to implement a federated cloud consisting of five compute centers, with the aim of acting as one resource to their users. A federated cloud introduces multiple challenges, such as a central access and project management point, a unified account across all cloud sites and an interchangeable project setup across the federation. In order to implement the federation concept, de.NBI Cloud integrated with the ELIXIR authentication and authorization infrastructure system (ELIXIR AAI) and in particular Perun, the identity and access management system of ELIXIR. The integration solves the mentioned challenges and represents a backbone, connecting five compute centers which are based on OpenStack and a web portal for accessing the federation.This article explains the steps taken and software components implemented for setting up a federated cloud based on the collaboration between de.NBI Cloud and ELIXIR AAI. Furthermore, the setup and components that are described are generic and can therefore be used for other upcoming or existing federated OpenStack clouds in Europe.
Likelihood Ratio Gradient Estimation for Steady-State Parameters
Authors: Glynn Peter W. , Olvera-Cravioto Mariana
Published: June 2019

We consider a discrete-time Markov chain Φ on a general state-space X, whose transition probabilities are parameterized by a real-valued vector θ. Under the assumption that Φ is geometrically ergodic with corresponding stationary distribution π(θ), we are interested in using Monte Carlo simulation for estimating the gradient ∇α(θ) of the steady-state expectation α(θ) = π(θ) To this end, we first give sufficient conditions for the differentiability of α(θ) and for the calculation of its gradient via a sequence of finite horizon expectations. We then propose two different likelihood ratio estimators and analyze their limiting behavior.
Logistical gazes: introduction to a special issue of Work Organisation, Labour and Globalisation
Authors: Benvegnù Carlotta , Cuppini Niccolò , Frapporti Mattia , Milesi Floriano , Pirone Maurilio
Published: June 2019

This article introduces this special issue of Work Organisation, Labour and Globalisation on logistics. First of all, it furnishes a brief genealogy of logistics in the modern era. Then, it frames some of the main issues in current critical debates on logistics. Finally, it presents the contents of the special issue in detail, connecting them with more general attempts to develop a ‘logistical gaze’ as a methodological perspective on the different and multiple transformations of contemporary capitalism.
The Georgian logistics revolution: questioning seamlessness across the New Silk Road
Authors: Gambino Evelina
Published: June 2019

Georgia, the post-Soviet republic in the South Caucasus, is undergoing its own logistics revolution. The government has pledged to complete by 2020 a spatial plan which aims to turn the country into a transit corridor for the New Silk Road. While this development is still underway, logistics zones - infrastructural hubs, free industrial zones (FIZ), manufacturing areas and malls - are emerging across the Georgian space. The New Silk Road initiative is promoting a perspective of a world without barriers, where logistics is not a means but an end: a world in which connectivity is productive in itself and where geopolitical reasoning has succumbed to geoeconomic calculations. This article aims at problematising this view by providing a grounded analysis of the workings of logistical spaces in Georgia, exploring the discourses, frictions and histories which engender capital accumulation within and beyond the Georgian space.
Antigen of 49.6-kDa subunit pili protein of Helicobacter pylori as a potential biomarker for early and rapid detection of the infection
Authors: Suharsono Hamong , Muttaqin Zainul , Tenaya I Wayan Masa , Agustina Kadek Karang , Prawiro Sumarno Retro
Published: June 2019

Background and Aim: Helicobacter pylori infection has been identified as a major cause of peptic ulcer diseases, including gastric and duodenal ulcers, gastritis, chronic and gastric carcinoma, and even gastric lymphoma. In vitro studies using Western blotting analysis, hemagglutination test, adherence inhibition assays, and immunocytochemical staining revealed that the 49.6-kDa subunit pili protein of H. pylori was considered an immunogenic protein. This study aimed to develop a serological diagnostic test using 49.6 kDa for detecting antibodies against H. pylori proteins in an early phase of the infection. Materials and Methods: An in-house immunochromatographic test (ICT) kit was developed and used to test a panel of sera sample obtained from a randomly selected symptomatic patient, in which 40 sera were H. pylori positive and 40 sera were H. pylori negative. Results: The results showed that ICT with 49.6 kDa as an antigen was highly sensitive and specific for detecting anti-H. pylori immunoglobulin G antibodies in human serum, with a high negative predictive value. Conclusion: The developed test could be used to exclude H. pylori infection in symptomatic patients.
Análise do nível de sustentabilidade da rede hoteleira de Foz do Iguaçu – PR
Authors: Ferreira Júlio César , Bertolini Geysler Rogis Flor , Brandalise Loreni Teresinha
Published: June 2019

A sustentabilidade tem sido questão relevante para os meios de hospedagem. A adesão à sustentabilidade na gestão hoteleira pode ser considerada como um vetor, capaz de gerar ganhos de ordem econômicos, sociais e ambientais para os negócios e para a sociedade em geral. Este artigo tem por objetivo analisar o nível de gestão da sustentabilidade dos hotéis de Foz do Iguaçu, Paraná. Para tanto, foram selecionados os 23 hotéis associados à Associação Brasileira da Indústria de Hotéis (ABIH) para compor a amostra. Foi empregado para análise o modelo (GSE) Grid de Sustentabilidade Empresarial. A pesquisa caracterizou-se, quanto aos objetivos, como exploratória e descritiva e, quanto aos procedimentos técnicos, classificou-se em bibliográfica e de levantamento. Os resultados apontaram que a maioria dos hotéis investigados não apresentam desempenhos sustentáveis satisfatórios nas três dimensões. A pesquisa contribuiu com importantes informações sobre o perfil da gestão hoteleira, tanto para o desenvolvimento sustentável nos aspectos ambiental, econômico e social, quanto para a eficiência na gestão de seus empreendimentos em busca da Sustentabilidade Empresarial.
Produtos turísticos para demandantes de experiências da dimensão entretenimento de Pine & Gilmore: novas características e tendências para o Paraná
Authors: Alencar Débora Gonçalves , Santos Marina Lima dos , Souza Adriely Andrade e , Gândara José Manoel Gonçalves
Published: June 2019

Atualmente, a atividade turística tem recebido novos perfis de demanda e, mediante a este fato, os responsáveis pela gestão do turismo buscam aperfeiçoar como seus produtos são conformados no mercado e entregues ao consumidor. Este artigo tem como objetivo diagnosticar atrativos que se relacionam com a dimensão de entretenimento de Pine & Gilmore (1999) no estado do Paraná. Para tanto, adota-se uma pesquisa bibliográfica exploratória em conjunto com a análise documental do Plano Paraná Turístico 2026 - pacto para um destino inteligente. Em primeiro momento foi realizado um levantamento de dados quantitativos relacionados ao potencial do turismo no estado do Paraná, seguido de uma análise qualitativa em relação a atrativos. A investigação possibilita visualizar a forma com que o estado do Paraná está organizando a atividade turística por meio de estratégias de gestão pautadas na economia da experiência. Conclui-se que o modelo dimensional de consumo de Pine & conformação de produtos experiências para o turismo. Desta forma, o destino turístico consegue atender a consumidores específicos, uma vez que as dimensões construídas pelos referidos autores permitem adquirir conhecimento em relação à oferta e demanda.
Successful Treatment of Hereditary Hemorrhagic Telangiectasia With Octreotide
Authors: Houghton Kimberly D. , Umar Beena , Schairer Jason
Published: June 2019

Hereditary hemorrhagic telangiectasia (HHT) is a disorder characterized by telangiectasias and arteriovenous malformations. We present a case report of a 74-year-old man diagnosed with HHT having a favorable response to a somatostatin analogue for treatment. This patient had been suffering from chronic anemia from recurrent gastrointestinal bleeding, requiring oral/intravenous iron replacement, frequent endoscopic ablations, and blood transfusions. Due to insufficient treatment, he was started on subcutaneous octreotide, with significant improvement as evidenced by a steady increase in the hemoglobin level, decreased endoscopic interventions, and decreased blood transfusions, making this the first case of HHT successfully treated with octreotide.
EXPERIENCIAS ESTUDIANTILES Y DIFICULTADES MÁS ACUCIANTES EN EL INGRESO UNIVERSITARIO.
Authors: Fascendini Paola Yanina
Published: June 2019

Son numerosas las referencias que evidencian las  dificultades y obstáculos que los estudiantes manifiestan al momento del ingreso, como así también los motivos por los cuales, algunos de ellos, abandonan sus estudios.Los objetivos de este trabajo son visibilizar las problemáticas vivenciadas por los estudiantes en relación con las habilidades y estrategias para aprender, como así también conocer las experiencias acaecidas en la escuela secundaria y el inicio en esta formación profesional. Los resultados obtenidos nos indican que los estudiantes no cuentan con el bagaje instrumental necesario para hacer frente a los desafíos que implica una educación superior, viéndose obnubilados por las demandas académicas existentes, como así también, por la pérdida de referentes anteriores, que implican el desafío de volver a construir el oficio de  estudiante. Otros aspectos dignos de destacar, son las dificultades orales que refieren a la hora de expresarse y las interferencias acontecidas en la construcción de vínculos interpersonales que tienen que generar ante un  nuevo mundo de coetáneos (factor psicosocial). El aporte y beneficio de la investigación radica, en propiciar espacios y oportunidades a los estudiantes donde no sólo se conozcan a sí mismos sino también puedan construir las herramientas faltantes, tan reclamadas y poco trabajadas.
Nutrisi Pada Pasien Cedera Kepala
Authors: Debora Yusnita , Villyastuti Yulia Wahyu , Harahap Mohamad Sofyan
Published: June 2019

Status hipermetabolik sering ditemukan pada pasien-pasien stroke ataupun cedera kepala, sehingga tidak jarang keadaan ini akan memperburuk keadaan pasien. Laju hipermetabolik ini dipercepat dengan puasa yang lama sehingga tubuh akan memobilisasi lemak dan protein yang nantinya akan digunakan sebagai untuk energi. Keadaan ini dapa t dicegah dengan pemberian nutrisi secara dini dan pada keadaan ini lebih terpilih pemberian enteral nutrisi. Pemberian enteral nutrisi ini dapat melalui berbagai jalur, seperti melalui gaster, jejunum, ataupun dudenum dengan pemasangan “ feeding tube “ Untuk suksesnya suatu terapi nutrisi diperlukan penyaringan dan penilaian status gizi pasien-pasien tersebut.
Perbedaan Tekanan Balon Pipa Endotrakeal Setelah Perubahan Posisi Supine ke Lateral Decubitus
Authors: Handayanto Anton Wuri , Bagianto Hari , Isngadi Isngadi
Published: June 2019

Latar belakang: Tekanan balon pipa endotrakeal (ETT) akan menimbulkan komplikasi bila diberikan lebih atau kurang dari batas aman yang direkomendasikan. Perubahan tekanan ini, dapat disebabkan oleh perubahan posisi.Tujuan: Penelitian ini bertujuan mengetahui perbedaan tekanan balon ETT setelah perubahan posisi supine ke lateral decubitus.Metode: Penelitian ini merupakan uji klinis eksperimental untuk mengetahui perbedaan tekanan balon ETT setelah perubahan posisi supine ke lateral decubitus pada pasien yang menjalani anestesi umum. Sampel diambil dengan cara consecutive sampling dalam satu kelompok (n=40). Variabel yang diukur pada penelitian ini adalah tekanan balon ETT pada saat posisi supine dan pada saat setelah posisi lateral decubitus.Hasil: Didapatkan sampel sebanyak 40 subjek. Rerata tekanan balon ETT pada posisi supine adalah 25±0,00 mmHg dan pada posisi lateral decubi tus 31,3±2,88 mmHg. T erdapat perbedaan yang signifikan pada tekanan balon ETT saat diposisikan supine dan lateral decubitus (p=0,00), dimana pada saat diposisikan lateral decubitus tekanan balon ETT lebih tinggi daripada tekanan balon ETT saat diposisikan supine.Simpulan: Terdapat perbedaan yang signifikan pada tekanan balon ETT setelah perubahan posisi pasien dari supine ke lateral decubitus. Perubahan posisi ini terbukti dapat meningkatkan tekanan balon ETT. Berdasarkan penelitian ini, disarankan perlu penggunaan alat pengukur tekanan balon ETT pada setiap tindakan anestesi umum dengan intubasi ETT khususnya untuk operasi yang memerlukan posisi pasien lateral decubitus, guna memastikan tekanan balon ETT selalu dalam batas aman. Sehingga komplikasi akibat tekanan balon ETT diluar batas aman tidak terjadi dan keamanan pasien tetap terjaga.
Anestesi Epidural Thorakal pada Tumor Phyllodes
Authors: Hadinata Yudi , Basuki Djudjuk Rahmad , Bagianto Hari
Published: June 2019

Latar Belakang: Perkembangan teknik anestesi neuroaksial telah memberikan kontribusi yang bermanfaat untuk prosedur anestesi dan analgesia, baik selama prosedur operasi maupun tatalaksana nyeri pasca operasi. Anestesi epidural merupakan salah satu teknik anestesi yang telah digunakan secara umum. Teknik anestesi tersebut bisa dilakukan dengan melihat dermatom area operasi yang dipersarafi sesuai regio servikal, torakal, lumbal maupun caudal.Kasus: Pada kasus ini kami melaporkan penggunaan anestesi epidural mid-thorakal dengan insersi pada ruang intervertebra torakal 7-8 untuk mengakomodasi prosedur operasi mastektomy pasien wanita ASA II dengan tumor payudara phyllodes kiri.
Efek Dexmedetomidine 0,2 ug/kgbb Intravena terhadap Insiden Delirium saat Pulih Sadar dari Anestesi Umum pada Pasien Pediatrik
Authors: Hendrawan Cahya , Arif Syafri Kamsul
Published: June 2019

Latar Belakang : Dexmedetomidine memberikan efek sedasi, analgesia, dan anxiolitiksetelah pemberian intravena. Isofluran dan sevofluran dihubungkan dengan angkakejadian delirium saat pulih sadar dari anestesi umum pada pasien pediatrik. Padapenelitian dengan menggunakan placebo sebagai kontrol, kami mengevaluasi efek daridosis tunggal dexmedetomidine pada delirium saat pulih sadar dari anestesi umumpada pasien pediatrik yang menjalani pembedahan elektif menggunakan anestesiumum dengan isofluran.Metode : Pada penelitian acak tersamar ganda ini , 46 anak (usia 3-10 tahun) dipilihsecara acak mendapatkan dexmedetomidin 0,2ug/kgBB atau placebo pada akhirpembedahan. Semua pasien mendapatkan obat anestesi yang standar. Setelahpembedahan, nilai delirium saat pulih sadar dari anestesi umum diukur sampai 1 jampascabedah. Waktu ekstubasi, waktu pulih sadar, dan efek samping daridexmedetomidine dicatat. Setelah pembedahan nyeri pasien diukur denganmenggunakan objective pain scale (OPS) .Hasil : Nilai delirium saat pulih sadar dari anestesi umum pada kelompokdexmedetomidine lebih baik daripada kelompok placebo (P<0,05). Nilai nyeri samapada kedua kelompok (P>0,05). Waktu ekstubasi dan waktu pulih sadar lebih panjangpada kelompok dexmedetomidin tetapi tidak bermakna secara statistik (P>0,05). Tidakada efek samping (hipotensi dan bradikardi) pada kedua kelompok.Kesimpulan : Kami menyimpulkan bahwa Dexmedetomidine 0,2ug/kgBB intravenadapat mengurangi insiden delirium saat pulih sadar dari anestesi umum denganisofluran pada anak yang menjalani pembedahan elektif.