bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting Dynamic Workflows with Automatic Extraction of Goals from BPMN
Authors: Sabatucci Luca , Cossentino Massimo
Published: October 2019

Organizations willing to employ workflow technology have to be prepared to undertake a significant investment of time and effort due to the exceptionally dynamic nature of the business environment. Today, it is unlikely that processes are modeled once to be repeatedly executed without any changes. Goal-oriented dynamic workflows are a promising approach to provide flexibility to the execution of business processes. Many goal-oriented frameworks exist in the literature to be used for the purpose. However, modeling goals is a burden for the business analyst.

This work proposes an automatic approach for extracting goals from a business process for supporting adaptive workflows. The approach consists of a static analysis of the global workflow state. Goals derive from individual BPMN elements and their interactions.

For validating the theory, we developed the BPMN2Goals tool, which has been used for supporting a middleware for self-adaptation.
Everolimus, Letrozole, and Metformin in Women with Advanced or Recurrent Endometrioid Endometrial Cancer: A Multi-Center, Single Arm, Phase II Study
Authors: Soliman Pamela T. , Westin Shannon N. , Iglesias David A. , Fellman Bryan M. , Yuan Ying , Zhang Qian , Yates Melinda S. , Broaddus Russell R. , Slomovitz Brian M. , Lu Karen H. , Coleman Robert L.
Published: October 2019

Purpose:

Treatment for patients with recurrent endometrioid endometrial cancer (EEC) are limited as paclitaxel is the only second-line chemotherapy with a response rate >13%. Targeting PIK3/mTOR in combination with hormonal therapy has shown promise. The addition of metformin may enhance this response. We conducted a phase II study evaluating everolimus, letrozole, and metformin in advanced/recurrent EEC.

Patients and Methods:

A Simon two-stage design was employed. Women with ≤2 prior chemotherapy regimens for recurrence were eligible. Pretreatment biopsy was required, followed by everolimus 10 mg orally, letrozole 2.5 mg orally, and metformin 500 mg orally twice a day on a 4-week cycle. The primary endpoint was clinical benefit (CB), defined as complete response (CR), partial response (PR), or stable disease (SD) confirmed at 16 weeks. Patients were treated until progression or toxicity.

Results:

Sixty-two patients were enrolled. Median age was 62 years (40–77) with 401 cycles completed, median of 6 cycles (1–31). Fifty-four patients were evaluable for response with a CB rate of 50% (27/54). Best overall response (OR) was PR 28% (15/54) and SD 22% (12/54). Thirteen patients received >12 cycles. Median follow-up was 17.9 months (2–47). Median progression-free survival was 5.7 [95% confidence interval (CI), 3.0–8.1] and OS was 19.6 months (95% CI, 14.2–26.3). Positive progesterone receptor expression was associated with CB (89.5% vs. 27.3%, P = 0.001).

Conclusions:

Everolimus, letrozole, and metformin resulted in 50% CB and 28% OR in women with recurrent EEC. Progesterone receptor–positive tumors may have better response; validation studies are needed.

See related commentary by Madariaga et al., p. 523
Triglyceride Paradox Is Related to Lipoprotein Size, Visceral Adiposity and Stearoyl-CoA Desaturase Activity in Black Versus White Women
Authors: Chung Stephanie T. , Cravalho Celeste K.L. , Meyers Abby G. , Courville Amber B. , Yang Shanna , Matthan Nirupa Rachel , Mabundo Lilian , Sampson Maureen , Ouwerkerk Ronald , Gharib Ahmed M. , Lichtenstein Alice H. , Remaley Alan T. , Sumner Anne E.
Published: October 2019

Rationale:

In black women, triglycerides are paradoxically normal in the presence of insulin resistance. This relationship may be explained by race-related differences in central adiposity and SCD (stearoyl-CoA desaturase)-1 enzyme activity index.

Objective:

In a cross-sectional study, to compare fasting and postprandial triglyceride-rich lipoprotein particle (TRLP) concentrations and size in black compared with white pre- and postmenopausal women and determine the relationship between TRLP subfractions and whole-body insulin sensitivity, hepatic and visceral fat, and SCD-1 levels.

Methods and Results:

In 122 federally employed women without diabetes mellitus, 73 black (58 African American and 15 African immigrant) and 49 white; age, 44±10 (mean±SD) years; body mass index, 30.0±5.6 kg/m
2
, we measured lipoprotein subfractions using nuclear magnetic resonance. Hepatic fat was measured by proton magnetic resonance spectroscopy, insulin sensitivity index calculated by minimal modeling from a frequently sampled intravenous glucose test, and red blood cell fatty acid profiles were measured by gas chromatography and were used to estimate SCD-1 indices. Hepatic fat, insulin sensitivity index, and SCD-1 were similar in black women and lower than in whites, regardless of menopausal status. Fasting and postprandial large, medium, and small TRLPs, but not very small TRLPs, were lower in black women. Fasting large, medium, and very small TRLPs negatively correlated with insulin sensitivity index and positively correlated with visceral and hepatic fat and SCD-1 activity in both groups. In multivariate models, visceral fat and SCD-1 were associated with total fasting TRLP concentrations (adjR2, 0.39;
P
=0.001). Black women had smaller postprandial changes in large (
P
=0.005) and medium TRLPs (
P
=0.007).

Conclusions:

Lower visceral fat and SCD-1 activity may contribute to the paradoxical association of lower fasting and postprandial TRLP subfractions despite insulin resistance in black compared with white pre- and postmenopausal women. Similar concentrations of very small TRLPs are related to insulin resistance and could be important mediators of cardiometabolic disease risk in women.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01809288.
Sixteen‐Week Physical Activity Intervention in Subjects With Increased Cardiometabolic Risk Shifts Innate Immune Function Towards a Less Proinflammatory State
Authors: Noz Marlies P. , Hartman Yvonne A. W. , Hopman Maria T. E. , Willems Peter H. G. M. , Tack Cees J. , Joosten Leo A. B. , Netea Mihai G. , Thijssen Dick H. J. , Riksen Niels P.
Published: October 2019

Background

Low‐grade inflammation, largely mediated by monocyte‐derived macrophages, contributes to atherosclerosis. Sedentary behavior is associated with atherosclerosis and cardiovascular diseases (CVD). We examined whether reducing sedentary behavior and improving walking time improves monocyte inflammatory phenotype in subjects with increased cardiovascular risk.

Methods and Results

Across 2 waves, 16 individuals with increased
cardiovascular
risk performed a 16‐week intervention study (age 64±6 years, body mass index 29.9±4.3 kg/m
2
), using a device with vibration feedback to promote physical activity. Before and after intervention, we objectively examined physical activity (Activ
PAL
), cytokine production capacity after ex vivo stimulation in peripheral blood mononuclear cells, metabolism of peripheral blood mononuclear cells, circulating cytokine concentrations, and monocyte immunophenotype. Overall, no significant increase in walking time was found (1.9±0.7 to 2.2±1.2 h/day,
P
=0.07). However, strong, inverse correlations were observed between the change in walking time and the change in production of interleukin (
IL
)‐1β,
IL
‐6,
IL
‐8, and
IL
‐10 after lipopolysaccharide stimulation (
r
s
=−0.655, −0.844, −0.672, and −0.781, respectively, all
P
<0.05). After intervention optimization based on feedback from wave 1, participants in wave 2 (n=8) showed an increase in walking time (2.2±0.8 to 3.0±1.3 h/day,
P
=0.001) and attenuated cytokine production of
IL
‐6,
IL
‐8, and
IL
‐10 (all
P
<0.05). Glycolysis (
P
=0.08) and maximal
OXPHOS
(
P
=0.04) of peripheral blood mononuclear cells decreased after intervention. Lower
IL
‐6 concentrations (
P
=0.06) and monocyte percentages (
P
<0.05), but no changes in monocyte subsets were found.

Conclusions

Successfully improving walking time shifts innate immune function towards a less proinflammatory state, characterized by a lower capacity to produce inflammatory cytokines, in individuals with increased
cardiovascular
risk.

Clinical Trial Registration Information

URL:
http://www.trialregister.nl
. Unique identifier:
NTR
6387.
Metabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation
Authors: Decker Joseph J. , Norby Faye L. , Rooney Mary R. , Soliman Elsayed Z. , Lutsey Pamela L. , Pankow James S. , Alonso Alvaro , Chen Lin Y.
Published: October 2019

Background and Purpose—

Metabolic syndrome (MetS), a prothrombotic state, is associated with an increased risk of atrial fibrillation (AF) and stroke. The CHA
2
DS
2
-VASc score does not account for the MetS components of prehypertension, prediabetes mellitus, abdominal obesity, elevated triglycerides, and low HDL (high-density lipoprotein). Data are limited on the association of MetS with stroke in AF, independent of CHA
2
DS
2
-VASc variables. Our aim was to identify MetS components associated with ischemic stroke in participants with AF in the ARIC study (Atherosclerosis Risk in Communities).

Methods—

We included 1172 participants with incident AF within 5 years of measurement of MetS components. MetS was defined by ATP criteria and International Diabetes Federation criteria. Incident ischemic stroke was physician adjudicated. Multivariable Cox proportional hazards regression was used to assess the association of MetS components with stroke.

Results—

After a median follow-up of 14.8 years, there were 113 ischemic stroke cases. Of the individual MetS components, low HDL was borderline associated with increased stroke risk (hazard ratio, 1.48 [95% CI, 0.99–2.21]) after adjustment for CHA
2
DS
2
-VASc variables while the remaining MetS variables were not associated with stroke risk. The presence of ≥3 components of MetS was not significantly associated with ischemic stroke after adjustment for CHA
2
DS
2
-VASc variables (hazard ratio, 1.38 [95% CI, 0.91–2.11]). The risk of stroke increased by 13% for each additional component of MetS; however, this association was borderline significant (hazard ratio, 1.13 [95% CI, 0.99–1.28]).

Conclusions—

The presence of MetS was not significantly associated with ischemic stroke after adjustment for CHA
2
DS
2
-VASc variables. Consideration of MetS is unlikely to improve stroke prediction in AF.
Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke
Authors: Lee Hwang-Jae , Lee Su-Hyun , Seo Keehong , Lee Minhyung , Chang Won Hyuk , Choi Byung-Ok , Ryu Gyu-Ha , Kim Yun-Hee
Published: October 2019

Background and Purpose—

The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke.

Methods—

Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter.

Results—

Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention (
P
<0.05). The net cardiopulmonary metabolic energy cost (mL·kg
−1
·min
−
1
) was also reduced by 14.71% in the experimental group after the intervention (
P
<0.01). Significant group×time interactions were observed for all parameters (
P
<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (
P
<0.01).

Conclusions—

Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders.

Clinical Trial Registration—

URL:
https://clinicaltrials.gov
. Unique identifier: NCT02843828.
In the Service of World Revolution: Vietnamese Communists’ Radical Ambitions through the Three Indochina Wars
Authors: Vu Tuong
Published: October 2019

The terms “decolonization” and “Cold War” refer to specific processes and periods in the international system, but they do not capture the full agency of local actors such as Vietnamese Communists. Based on recently available archival materials from Hanoi, this article maps those terms onto Vietnamese Communist thinking through four specific cases. The declassified materials underscore the North Vietnamese leaders’ deep commitment to a radical worldview and their occasional willingness to challenge Moscow and Beijing for leadership of world revolution. The article illuminates the connections (or lack thereof) between global, regional, and local politics and offers a more nuanced picture of how decolonization in Southeast Asia in the 1950s–1980s sparked not only a Cold War confrontation but also a regional war.
South Africa’s Proposed Exit from the Rome Statute: Alternative Perspectives
Authors: Wabwile Michael Nyongesa
Published: October 2019

In the aftermath of the Omar al Bashir case, South Africa’s engagement with the International Criminal Court (hereafter the ICC) is at an anti-climax. Conventional perspectives from the decisions of the ICC assert the sanctity of treaty obligations. However, alternative perspectives can be explored. There is a need to address continuing dissatisfaction with and limitations of the Rome Statute. Dissent by States parties may signal need for review of the treaty and introduction of new procedures for conducting consultations with States to improve compliance. The Rome Statute does not deal with resolving on-going armed conflicts and should be complemented by alternative processes for addressing such threats to peace and security. Withdrawal from treaties is a normal fact of life in the international legal system. States exit from treaties when changed circumstances, shifting domestic priorities, or dissatisfaction with treaty-based institutions create tensions between national interests and international commitments. This would not necessarily be regarded as retrogressive. Exit by a significant number of important states may be the catalyst required for reform of contentious aspects of the treaty system. Therefore, South Africa’s proposed exit from the Rome Statute can be a potentially positive development.
Towards Effective Implementation of the African Charter on the Rights and Welfare of the Child in Egypt
Authors: Gyan Nyarko Michael
Published: October 2019

The adoption of the Convention on the Rights of the Child (CRC) in 1989 marked an important step towards the ‘legal recognition and protection of the rights of children’. The inadequacies of the CRC regarding some issues peculiar to the African child, however, led to the adoption of the African Charter on the Rights and Welfare of the Child (ACRWC or African Children’s Charter) in 1990, to complement the CRC and provide protection to children in peculiar African realities. The desired effects of the Charter will, however, only be achieved if its provisions are diligently implemented. Based on desk research and semi-structured interviews, this article discusses the implementation of the ACRWC in Egypt, highlighting the legislative and other measures adopted by Egypt to implement the provisions of the ACRWC. It also considers the role of the African Committee of Experts on the Rights and Welfare of the Child (African Children’s Committee) in ensuring implementation of the ACRWC in Egypt through the state reporting and complaint mechanisms and considers the measures adopted by Egypt towards the implementation of concluding observations of the African Children’s Committee. It concludes with recommendations on how Egypt can better implement the provisions of the ACRWC.
Efficient Standard Errors in Item Response Theory Models for Short Tests
Authors: Ippel Lianne , Magis David
Published: October 2019

In dichotomous item response theory (IRT) framework, the asymptotic standard error (ASE) is the most common statistic to evaluate the precision of various ability estimators. Easy-to-use ASE formulas are readily available; however, the accuracy of some of these formulas was recently questioned and new ASE formulas were derived from a general asymptotic theory framework. Furthermore, exact standard errors were suggested to better evaluate the precision of ability estimators, especially with short tests for which the asymptotic framework is invalid. Unfortunately, the accuracy of exact standard errors was assessed so far only in a very limiting setting. The purpose of this article is to perform a global comparison of exact versus (classical and new formulations of) asymptotic standard errors, for a wide range of usual IRT ability estimators, IRT models, and with short tests. Results indicate that exact standard errors globally outperform the ASE versions in terms of reduced bias and root mean square error, while the new ASE formulas are also globally less biased than their classical counterparts. Further discussion about the usefulness and practical computation of exact standard errors are outlined.
Is unemployment less important than expected for suicide attempted in developing regions? Occupational profile of suicide attempts in Jujuy, north westernmost Argentina
Authors: López Steinmetz Lorena Cecilia , López Steinmetz Romina Lucrecia , Godoy Juan Carlos
Published: October 2019

Background:

Mental health practices consider unemployment as a suicide main risk factor, based on models built for populations of developed countries.

Aim:

This study assesses the association between the occupational risk factor and suicidal behaviors, by considering sex, age and temporal distribution, in a Latin American Andean population from north westernmost Argentina.

Methods:

Data include 481 suicide attempt cases assisted by emergency service psychologists at a head hospital in the Jujuy Province, northern Argentina, during two biennials. General categories and specific types of occupational situation, sex, age and temporal distribution were analyzed.

Results:

83.58% of cases corresponded to the with occupation category, but without occupation characterized male cases ( p-value = .01). The type no referred occupation (19.15%) mainly contributed to this association ( p-value = .02). Unemployed only represented 1.6%. These features revealed independent from the biennial period of assistance ( p-value = .96 (general), p-value = .86 (specific)). Associations by age ranges did not seem to be specific of suicidal attempts.

Conclusion:

The present contribution provides an occupational characterization of suicide attempts in an Andean population from north westernmost Argentina. Unemployment is not associated with suicidal behavior in this population, suggesting that dissimilar patterns underlie suicidal behavior of populations from developed and developing regions.
Transcriptomic and Single-Cell Analysis of the Murine Parotid Gland
Authors: Oyelakin A. , Song E.A.C. , Min S. , Bard J.E. , Kann J.V. , Horeth E. , Smalley K. , Kramer J.M. , Sinha S. , Romano R.A.
Published: October 2019

The salivary complex of mammals consists of 3 major pairs of glands: the parotid, submandibular, and sublingual glands. While the 3 glands share similar functional properties, such as saliva secretion, their differences are largely based on the types of secretions they produce. While recent studies have begun to shed light on the underlying molecular differences among the glands, few have examined the global transcriptional repertoire over various stages of gland maturation. To better elucidate the molecular nature of the parotid gland, we have performed RNA sequencing to generate comprehensive and global gene expression profiles of this gland at different stages of maturation. Our transcriptomic characterization and hierarchical clustering analysis with adult organ RNA sequencing data sets has identified a number of molecular players and pathways that are relevant for parotid gland biology. Moreover, our detailed analysis has revealed a unique parotid gland–specific gene signature that may represent important players that could impart parotid gland–specific biological properties. To complement our transcriptomic studies, we have performed single-cell RNA sequencing to map the transcriptomes of parotid epithelial cells. Interrogation of the single-cell transcriptomes revealed the degree of molecular and cellular heterogeneity of the various epithelial cell types within the parotid gland. Moreover, we uncovered a mixed-lineage population of cells that may reflect molecular priming of differentiation potentials. Overall our comprehensive studies provide a powerful tool for the discovery of novel molecular players important in parotid gland biology.
Disciplinary Segregation and Its Effects on In-Prison Outcomes
Authors: Salerno Laura M. , Zgoba Kristen M.
Published: October 2019

The present study explored the effects of solitary confinement on in-prison outcomes among inmates housed in disciplinary segregation in a northeast state ( N = 398). The deterrent effects of segregation and program participation on future in-prison behaviors were examined. Differences among samples of inmates housed in disciplinary segregation before and after the enactment of policy revisions were also assessed. Findings from bivariate and multivariate analyses indicate most inmates did not have a new infraction; however, certain inmates were more likely to receive a future discipline. Furthermore, completing programming while in disciplinary segregation did not have an effect on future infractions or programming participation. The implications of the research findings are discussed.
Social mixing in urban schools: Class, race and exchange-value friendships
Authors: Hollingworth Sumi
Published: October 2019

Based on empirical, qualitative research on ‘social mixing’ in multi-ethnic London schools, this article argues for a conceptualisation of social mixing as an exchange of the self. Through analysis of three working-class, minority ethnic students who attempt to ‘cross borders’ into White middle-class subcultures, I explore the differing capital value embodied in their raced, classed and gendered identity positions. Friendships across this border are characterised by ‘semi-investments’ on both sides, and promise only partial possibilities for social mobility via social mixing, through limited access to academic capital and embodied Whiteness.
Factors Associated With Fast Recovery of Bell Palsy in Children
Authors: Lee Yeseul , SooYoon Hoi , Yeo Seung Geun , Lee Eun Hye
Published: October 2019

The purpose of this study was to identify the clinical characteristics and factors affecting the prognosis of children with Bell palsy. We retrospectively reviewed the medical records of 53 pediatric patients diagnosed with Bell palsy. After a mean follow-up period of 30 days, 30 patients (56%) were completely recovered, 21 patients (40%) were partially recovered, and 2 patients (4%) had not recovered. The patients in the complete recovery group were significantly younger than those in the partial and nonrecovery groups (8.8 ± 4.2 years vs 12.2 ± 3.0 years, P = .003). Patients <8 years old had a higher complete recovery rate than was found in patients >8 years old (80% vs 47%, P = .031). Sex, affected side, and early or late treatment did not influence the recovery rate. These results suggest that younger age may be a good prognostic factor affecting the fast recovery of children with Bell palsy.
AmericanVogueand Sustainable Fashion (1990–2015): A Multimodal Critical Discourse Analysis
Authors: Jones Katie Baker
Published: October 2019

Discursive practices employed by American Vogue to recontextualize sustainable fashion between 1990 and 2015 were explored through the lens of a discourse-historical approach and multimodal critical discourse analysis. References to sustainably minded values and actions were found throughout the 26 years studied with notable peaks and valleys in coverage that, at times, contradicted changing social interest in the subject. Over time, Vogue recontextualized sustainable fashion discourses and encouraged a passive revolution by moving from a contentious positioning of either/or sustainable fashion to one that embraced a both/and positionality by narrowing focus to lifestyle and product features. Additionally, Vogue celebrated social actors engaged in sustainable behaviors though these were increasingly positioned as lifestyle choices rather than revolutionary collective action. Vogue continuously recontextualized the sustainable fashion discourse as “new” and desirable while neutralizing most negative considerations of fashion consumption through a variety of articulations and by drawing on well-established semiotic resources.
A Cross-Cultural Study of Calling and Life Satisfaction in the United States and South Korea
Authors: Ahn Jina , Kim Hye-Weon , Lee Jee-Yon
Published: October 2019

This study examined how a career calling is linked to life satisfaction among undergraduate students in the United States and South Korea. Using structural equation modeling, we tested the mediating role of core self-evaluations, work volition, and work hope on the calling-satisfaction link. Supporting prior research, perceiving a calling was positively correlated with life satisfaction in both groups. However, we found that work volition was a dominant mediator for South Koreans, whereas work hope was a significant mediator for Americans. These findings suggest that a sense of calling links to well-being, but the underlying mechanism of how a calling beneficially functions may differ across culture and situational contexts. Practical implications are suggested for each group and recommendations are provided for further cross-cultural research.
Synergistic solution of CO2 capture by novel lanthanide-based MOF-76 yttrium nanocrystals in mixed-matrix membranes
Authors: Bano Sadia , Tariq Saadia R , Ilyas Ayesha , Aslam Muhammad , Bilad Muhammad R , Nizami Abdul-Sattar , Khan Asim L
Published: October 2019

A porous and thermally stable metal organic framework (MOF) of yttrium and 1,3,5-benzenetricarboxylate was synthesized, which belongs to the family of lanthanide-based MOF-76. Mixed-matrix membranes were developed by incorporating MOF-76 yttrium nanocrystals into Matrimid® 5218. The structure, composition, and morphology of synthesized lanthanide-based MOF-76 yttrium nanocrystals and mixed-matrix membranes were characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, and thermogravimetric analysis. The characterizations and gas permeation results of the prepared mixed-matrix membranes confirmed better adhesion and distribution of filler particles in the polymer. The results demonstrated that the addition of MOF-76 yttrium nanocrystals to the polymer matrix improved both the gas selectivity and permeability of mixed-matrix membranes compared to pure Matrimid membranes. Permeability of CO2 increased from 7.24 to 27.29 Barrer by increasing the particle content from 0 to 30% in pure gas experiments. Whereas with 30 wt% concentration of MOF-76(Y) at 50:50 feed compositions, the selectivity increased for CO2/CH4 and CO2/N2 was 67% and 68%, respectively. The rise in temperature from 298 to 338 K decreased the ideal selectivity up to 25% for both gas pairs due to polymer chain relaxations at elevated temperatures. The commercial importance of membranes was evaluated at different feed compositions and operating temperatures.
Efficacy and Safety of Vasopressin as First-Line Treatment of Distributive and Hemorrhagic Shock States
Authors: Haan Bradley J. , Cadiz Megan L. , Natavio Allycia M.
Published: October 2019

Background: Norepinephrine remains the first-line option to manage patients with circulatory shock. Limited evidence exists evaluating noncatecholamine compounds as first-line monotherapy for managing noncardiogenic shock. Objective: To compare vasopressin monotherapy with norepinephrine monotherapy for reversal of distributive and hemorrhagic shock. Methods: This was a retrospective cohort study including adult patients who were diagnosed with hypovolemic or septic shock, received fluids, and received norepinephrine or vasopressin monotherapy for at least 1 hour. Patients excluded lacked a clear diagnosis, were initiated on 2 or more vasopressors at once, or underwent cardiac surgery. The primary outcome was time to shock reversal. Secondary outcomes included mortality, lengths of stay, and safety end points. A multivariable Cox proportional hazards model was performed incorporating baseline and treatment variables. Results: A total of 85 and 160 patients were treated with vasopressin and norepinephrine, respectively. A decrease in time to shock reversal was observed in the vasopressin group (58.32 hours [95% CI, 50.88-66.00] vs 74.64 hours [95% CI, 60.96-88.32], P = 0.004). Mortality was lower in the vasopressin group (25% vs 41%, P = 0.01), and intensive care unit length of stay was longer (13 days [interquartile range, IQR = 7-19] vs 7 days [IQR = 5-9], P = 0.006). Remaining secondary outcomes were similar. The multivariable analysis revealed no difference in time to shock reversal. Conclusion and Relevance: First-line vasopressin exhibited faster time to distributive shock reversal in the unadjusted analysis but failed to maintain this difference in the multivariable analysis. These findings support safe use of vasopressin as first-line therapy or as an alternative to norepinephrine in distributive shock.
Practical Significance of Longitudinal Measurement Invariance Violations in the Dutch–Flemish PROMIS Item Banks for Depression and Anxiety: An Illustration With Ordered-Categorical Data
Authors: Flens Gerard , Smits Niels , Terwee Caroline B. , Pijck Liv , Spinhoven Philip , de Beurs Edwin
Published: October 2019

We investigated longitudinal measurement invariance in the Dutch–Flemish PROMIS adult v1.0 item banks for Depression and Anxiety using two clinical samples with mood and anxiety disorders ( n = 640 and n = 528, respectively). Factor analysis was used to evaluate whether the item banks were sufficiently unidimensional at two test-occasions and whether the measured constructs remained the same over time. The results indicated that the item banks were sufficiently unidimensional, but the thresholds and residual variances of the constructs changed over time. However, using tentative rules of thumb, these invariance violations did not substantially affect the endorsement of a specific response category of a specific item at a specific test-occasion. Furthermore, the impact on the mean latent change scores of the item banks remained below the proposed cutoff value for substantial bias. These findings suggest that the invariance violations lacked practical significance for test-users, meaning that the item banks provide sufficiently invariant latent factor scores for use in clinical practice.
Folding deformation modeling and simulation of 4D printed bilayer structures considering the thickness ratio
Authors: Liu Zhenyu , Liu Han , Duan Guifang , Tan Jianrong
Published: October 2019

This paper addresses the problem of deformation modeling and simulation of 4D printed polymeric bilayer structures considering the thickness ratio. Through an equivalent transformation, the folding deformation model is transformed into two simpler deformation models, stretching and bending, which greatly reduces the complexity of the modeling problem. The stretching deformation model is developed by Hooke’s law, and based on the final strain of the stretching deformation, which is determined by the thickness ratio, a new hyperelastic energy density function considering the thickness ratio is defined to calculate the energy of the bilayer structure during the bending deformation. According to the new energy density function, the bending deformation model considering the thickness ratio is developed by minimizing the energy of the bilayer structure during the bending deformation. Numerical simulations show encouraging results obtained by the proposed model.
Validation of a method to measure three-dimensional hip joint kinematics in subjects with femoroacetabular impingement
Authors: Ward Thomas R , Hussain Mafruha M , Pickering Mark , Perriman Diana , Burns Al , Scarvell Jennie , Smith Paul N
Published: October 2019

Introduction:

A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI).

Methods:

3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D–2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images.

Results:

Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D–2D registration demonstrated maximums of 1.64° and 3.96°, respectively. However, if the single outlier was removed, bias and precision were 0.55° and 1.38°. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively.

Conclusions:

This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10° of rotation represent a clinically significant difference in hip kinematics, the method’s accuracy of approximately 1 mm displacement and 1° rotation should enable detection of significant clinical differences.
The relationship between living with a spouse and mental health in the elderly population: Moderated mediation effects of loneliness and perceived problems
Authors: Soh Lin Ken , Pang Joyce S.
Published: October 2019

Objectives:

Study 1 investigated if the elderly’s perception of experiencing life problems moderates the effect of spousal living arrangements on their mental health, while study 2 first assessed loneliness as a mediator on the spousal living arrangements and mental health relationship, and then tested 2 moderated-mediation models whereby perceived problems moderates the mediation.

Methods:

Study 1 involved 135 participants aged 60 years and above (mean = 70.96; SD = 6.16); Study 2 involved 122 participants aged 65 years and above (mean = 74.85; SD = 6.91).

Results:

This study found simple moderation and mediation effects of perceived problems and loneliness, respectively, on the spousal living arrangements and mental health relationship. Furthermore, results showed that perceived problems moderate the loneliness and mental health link in a moderated-mediation model.

Discussion:

Findings inform potential interventions for elderly mental health. Interventions could focus on reducing loneliness and problems faced by the elderly, especially those with nonspousal living arrangements.
Static and stability analysis of partial slip texture multi-lobe journal bearings
Authors: Rao TVVLN , A Rani Ahmad M , Mohamed Norani M , Ya Hamdan H , Awang Mokhtar , M Hashim Fakhruldin
Published: October 2019

This paper presents one-dimensional analysis of modified dynamic Reynolds equation derived for partial slip texture multi-lobe journal bearings. The novelty included in this study is the configuration of partial slip texture region on the bottom bearing lobe surface of a multi-lobe journal bearing under a constant vertical load. The nondimensional pressure and shear stress for steady-state and nondimensional pressure gradients for dynamic coefficients for each lobe with partial slip texture configuration are derived based on narrow groove theory. Linearized stability analysis is evaluated using infinitesimal perturbation method. Results of static and stability characteristics of partial slip texture multi-lobe (two-axial groove, elliptical, three-lobe and offset) journal bearings are presented. Partial slip texture configuration significantly enhances load capacity, coefficient of friction, and stability of two-lobe journal bearing.
Party ownership or individual specialization? A comparison of politicians’ individual issue attention across three different agendas
Authors: Peeters Jeroen , Van Aelst Peter , Praet Stiene
Published: October 2019

Studies have shown that parties selectively emphasize different issues to compete with each other to raise the salience for their preferred issues and to appear competent in handling them. This study applies the selective emphasis framework to individual politicians. We argue that politicians compete with both politicians from different parties and with their party members. We expect that issue ownership matters to competition with politicians from different parties and issue specialization to competition with politicians from their own party. We studied the individual issue agendas of 144 Belgian politicians for a period of 9 months on Twitter, in the news and in parliament. Our results show that issue specialization is a consistent driver of the three issue agendas of politicians, while the effect of issue ownership varies across agendas. This means that both factors are not mutually exclusive and that combining them can be an opportune strategy for politicians.
Sensitivity and specificity of an algorithm based on medico-administrative data to identify hospitalized patients with major bleeding presenting to an emergency department
Authors: Oger Emmanuel , Botrel Marie-Anne , Juchault Catherine , Bouget Jacques
Published: October 2019

Background

Validation studies on an ICD-10-based algorithm to identify major bleeding events are scarce, and mostly focused on positive predictive values.

Objective

To evaluate the sensitivity and specificity of an ICD-10-based algorithm in adult patients referred to hospital.

Methods

This was a cross-sectional, retrospective analysis. Among all hospital stays of adult patients referred to Rennes University Hospital, France, through the emergency ward in 2014, we identified major bleeding events according to an index test based on a list of ICD-10 diagnoses. As a reference, a two-step process was applied: firstly, a computerized request for electronic health records from the emergency ward, using several hemorrhage-related diagnostic codes and specific emergency therapies so as to discard stays with a very low probability of bleeding; secondly, a chart review of selected records was conducted by a medical expert blinded to the index test results and each hospital stay was classified into one of two exclusive categories: major bleeding or no major bleeding, according to pre-specified criteria.

Results

Out of 16,012 hospital stays, the reference identified 736 major bleeding events and left 15,276 stays considered as without the target condition. The index test identified 637 bleeding events: 293 intracranial hemorrhages, 197 gastrointestinal hemorrhages and 147 other bleeding events. Overall, sensitivity was 65% (95%CI, 62 to 69), and specificity was 99.0%. We observed differential sensitivity and specificity across bleeding types, with the highest values for intracranial hemorrhage. Positive predictive values ranged from 59% for “other” bleeding events, to 71% (95%CI, 65 to 78) for gastrointestinal hemorrhage, and 96% for intracranial hemorrhage.

Conclusions

Low sensitivity and differential measures of accuracy across bleeding types support the need for specific data collection and medical validation rather than using an ICD-10-based algorithm for assessing the incidence of major bleeding.
Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study
Authors: Ulbricht Sabina , Beyer Angelika , John Ulrich
Published: October 2019

Background

To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered.

Methods

We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression.

Results

There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model.

Conclusions

Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.
Insights into student assessment outcomes in rural clinical campuses
Authors: Shulruf Boaz , Velan Gary , Forster Lesley , O’Sullivan Anthony , Harris Peter , Taylor Silas
Published: October 2019

Background

There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs.

Methods

Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes.

Results

The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled.

Conclusion

It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.
The History of Enterovirus A71 Outbreaks and Molecular Epidemiology in the Asia-Pacific Region
Authors: Puenpa Jiratchaya , Wanlapakorn Nasamon , Vongpunsawad Sompong , Poovorawan Yong
Published: October 2019

Enterovirus A71 (EV-A71) is one of the common causative pathogens for hand foot and mouth disease (HFMD) affecting young children. HFMD outbreak can result in a substantial pediatric hospitalization and burden the healthcare services, especially in less-developed countries. Since the initial epidemic of predominantly EV-A71 in California in 1969, the high prevalence of HFMD in the Asia-pacific region and elsewhere around the world represents a significant morbidity in this age group. With the advent of rapid and accurate diagnostic tools, there has been a dramatic increase in the number of laboratory-confirmed EV-A71 infection over the past two decades. The population, cultural, and socioeconomic diversity among countries in the Asia-Pacific region all influence the transmission and morbidity associated with HFMD. This review summarizes the current state of epidemiology of EV-A71 in Asia-Pacific countries based on the most recent epidemiological data and available information on the prevalence and disease burden. This knowledge is important in guiding the prevention, control and future research on vaccine development of this highly contagious disease of significant socioeconomic implications in public health.
Beverage consumption and energy intake among Canadians: analyses of 2004 and 2015 national dietary intake data
Authors: Jones Amanda C. , Kirkpatrick Sharon I. , Hammond David
Published: October 2019

Background

Among adults and children consuming Western diets, beverages are significant sources of free sugars, saturated fats, excess calories, and alcohol, with relevance to chronic disease risk. The impact of recent healthy eating policies and beverage market evolutions on population-level consumption patterns in Canada is unknown. The current study examined trends in intake of a range of beverage types among a nationally-representative sample of Canadians, with stratification by socio-demographic characteristics.

Methods

The 2004 (n = 34,775) and 2015 (n = 20,176) nutrition-focused cycles of the Canadian Community Health Surveys are cross-sectional surveys representative of the population of the 10 Canadian provinces. Based on a single multiple-pass 24-h dietary recall for each participant, fluids consumed as beverages were grouped into seven categories. Using linear regression, reported intake (volume, ml and energy, kcal) of each category was characterized over time and in relation to sex, age, ethnicity, income, body mass index (BMI), and province of residence.

Results

In 2015, Canadians reported consuming an average of 1806 ml (275 kcal) fluids as beverages per day, including: plain water 867 ml (0 kcal); other unsweetened beverages, e.g. coffee, 364 ml (6 kcal); sugar-sweetened beverages (SSBs) 204 ml (99 kcal); plain milk 132 ml (64 kcal); alcoholic drinks 120 ml (71 kcal); 100% juice 74 ml (34 kcal); and diet or low calorie beverages 44 ml (2 kcal). Differential consumption was observed across socio-demographic groups, with high consumption of sugary drinks (i.e., SSBs and 100% juice) and alcohol across groups. From 2004 to 2015, the reported volumes of beverages consumed decreased by 10% (energy: − 24%). With adjustment for socio-demographic characteristics, there were significant changes (p < 0.001) over time in intake of: 100% juice − 40% (− 38%); plain milk − 37% (− 35%); SSBs − 26% (− 20%); diet or low calorie beverages (− 46%); and other unsweetened beverages − 11% (− 42%). The volume of plain water consumed increased by 10% (p < 0.0001). Intake of alcoholic (volume and energy) and diet or light beverages did not change significantly.

Conclusions

Lower intake of beverages was reported by Canadians in 2015 versus 2004, with a shift towards plain water. Consumption of sugary drinks decreased, but these beverages continue to contribute substantially to Canadians' overall energy intake. The findings underscore the need for policies to further reduce the consumption of sugary and alcoholic beverages, as well as calories from beverages.