bluuebunny/crossref_metadata_2025 huggingface dataset:
The possible benefits of reporting percentage point effects
Authors: Terhanian George
Published: April 2019

Many academic researchers regard logistic regression as the preeminent analytic approach for modeling binary outcomes. It can identify and estimate the effects of actions to increase or decrease the size or proportion of the group of interest. It can also predict each case’s probability of belonging to one group instead of another, given the model’s explanatory variables. However, evidence indicates that market researchers do not use it extensively to analyze survey data, partly because of the difficulty in translating logistic regression’s standard analysis output—logits, odds, and odds ratios—into clear, action-oriented findings and recommendations. The aim here is to offer an informed view, supported by analysis of Pew Research Center survey data, of the possible benefits of reporting percentage point effects (e.g., a one-unit change in x is associated with a three-percentage-point increase in y, all else being equal), in addition to logits, odds, and odds ratios. Such reporting may help to reduce any gap between what some clients expect—particularly when they ask researchers to identify and estimate the effects of actions for increasing or decreasing a critical group’s size or proportion—and what they may receive in return. It may also create new consulting and relationship-building opportunities for market researchers.
Outcomes After Drug-Coated Balloon Treatment of Femoropopliteal Lesions in Patients With Critical Limb Ischemia: A Post Hoc Analysis From the IN.PACT Global Study
Authors: Reijnen Michel M. P. J. , van Wijck Iris , Zeller Thomas , Micari Antonio , Veroux Pierfrancesco , Keirse Koen , Lee Seung-Whan , Li Pei , Voulgaraki Despina , Holewijn Suzanne
Published: April 2019

Purpose: To report a post hoc analysis performed to evaluate 1-year safety and efficacy of the IN.PACT Admiral drug-coated balloon (DCB) for the treatment of femoropopliteal lesions in subjects with critical limb ischemia (CLI) enrolled in the IN.PACT Global study ( ClinicalTrials.gov identifier NCT01609296). Materials and Methods: Of 1535 subjects enrolled in the study, 156 participants (mean age 71.8±10.4; 87 men) with CLI (Rutherford categories 4,5) were treated with DCB angioplasty in 194 femoropopliteal lesions. This cohort was compared to the 1246 subjects (mean age 68.2±10.0 years; 864 men) with intermittent claudication (IC) treated for 1573 lesions. The CLI cohort had longer lesions (13.9±10.6 vs 11.9±9.4 cm, p=0.009) and a higher calcification rate (76.8% vs 67.7%, p=0.011). Major adverse events [MAE; composite of all-cause mortality, clinically-driven target lesion revascularization (CD-TLR), major (above-ankle) target limb amputation, and thrombosis at the target lesion site], lesion and vessel revascularization rates, and EuroQol-5D were assessed through 1 year. The Kaplan-Meier method was used to estimate survival, CD-TLR, and amputation events; estimates are presented with the 95% confidence intervals (CI). Results: Estimates of 12-month freedom from major target limb amputation were 98.6% (95% CI 96.7% to 100.0%) in subjects with CLI and 99.9% (95% CI 99.8% to 100.0%) in subjects with IC (p=0.002). Freedom from CD-TLR through 12 months was 86.3% (95% CI 80.6% to 91.9%) in CLI subjects and 93.4% (95% CI 91.9% to 94.8%) in IC subjects (p<0.001). The MAE rate through 12 months was higher in CLI subjects (22.5% vs 10.7%, p<0.001), and CLI patients had poorer overall survival (93.0%, 95% CI 88.9% to 97.2%) than IC subjects (97.0%, 95% CI 96.0% to 97.9%, p=0.011). Health status significantly improved in all domains at 6 and 12 months in both groups. Conclusion: Treatment of femoropopliteal disease with DCB in CLI patients is safe through 12-month follow-up, with a low major amputation rate of 1.4%. The rates of MAE and CD-TLR were higher in CLI subjects and reinterventions were required sooner. Additional research is needed to evaluate long-term outcomes of DCB treatment for femoropopliteal lesions in CLI patients.
Association Between Underweight Body Mass Index and In-Hospital Outcome in Patients Undergoing Endovascular Interventions for Peripheral Artery Disease: A Propensity Score Matching Analysis
Authors: Moussa Pacha Homam , Al-khadra Yasser , Darmoch Fahed , Soud Mohamad , Kaki Amir , Mamas Mamas A. , Alraies M. Chadi
Published: April 2019

Purpose: To investigate in-hospital outcomes after endovascular therapy (EVT) in patients with severe peripheral artery disease (PAD) who had a low body mass index (BMI, kg/m2) compared to those with normal BMI. Materials and Methods: Using weighted data from the National Inpatient Sample (NIS) database between 2002 and 2014 and ICD-9 codes, 2614 patients were identified who were aged ≥18 years and underwent EVT for PAD in the lower limb vessels. EVT was defined as angioplasty, atherectomy, and/or stenting. After excluding individuals with BMI >24, there were 807 (31%) normal-weight (BMI 19–24) patients and 1807 (69%) underweight (BMI <19) individuals. All patients in both groups were matched for baseline demographic and clinical characteristics and critical limb ischemia in a 1:1 propensity score matching analysis using the nearest neighbor method. Results: Propensity score matching produced 2 groups of 685 patients that differed only in the incidence of chronic lung disease, which was more frequent in low-BMI patients (p=0.04). Patients with low BMI had a higher incidence of in-hospital mortality (4.8% vs 1.2%, p<0.001), major adverse cardiovascular events (composite of death, myocardial infarction, or stroke) (7.9% vs 4.1%, p=0.003), open bypass surgery (9.1% vs 6.0%, p=0.03), and infection (14.6% vs 10.5%, p=0.02) compared with the normal-BMI group. There was no significant difference in the incidence of vascular complications (p=0.31), major bleeding (p=0.17), major amputation (p=0.35), or acute kidney injury (p=0.09) between the low- and normal-BMI groups. Conclusion: Low-BMI patients with PAD have worse in-hospital survival and more adverse outcomes after EVT.
Knitted piezoresistive strain sensor performance, impact of conductive area and profile design
Authors: Raji Rafiu K , Miao Xuhong , Zhang Shu , Li Yutian , Wan Ailan , Boakye Andrews
Published: April 2019

While many of the factors influencing strain sensor properties have been explained in literature, other very important parameters that influence actual design performance of sensors remain obscure. This paper investigates the impact of conductive profile and area design including post fabric treatments such as dyeing and washing on sensor performance. 1 × 1 mock rib was the fabric structure of choice, and silver-plaited nylon was the conductive yarn used in knitting all the samples. Six main polygonal shapes including ellipse, diamond shape, corrugated rectangular shape, rectangular horse shoe, rectangular dough roller shape, and plain rectangular shape were designed and knitted. Plain rectangular profile has been found to deliver the best results characterized by noiseless signals, highest gauge factor, and good result repeatability. The analysis of results also reveals a positive linear correlation between conductive path and initial electrical resistance of a sensor. The inverse is true for the relation between the conductive width values and their corresponding initial resistances. Higher conductive widths led to low initial resistance, and values less than 20 Ω for a sensor could lead to inferior sensor sensitivity. High conductive paths produced high initial resistances, and values within the range of 40–120 Ω could deliver higher sensitivity. This study thus concludes that the optimum aspect ratio range for conductive area to deliver satisfactory sensitivity results is approximately between 24:1 and 77:1 cm. Laundry and dyeing have also been found to result in reduced sensor dimensions, resistance, and sensitivity levels.
Lower Extremity Necrotizing Fasciitis in Diabetic and Nondiabetic Patients: Mortality and Amputation
Authors: Ahn Junho , Raspovic Katherine M. , Liu George T. , Lavery Lawrence A. , La Fontaine Javier , Nakonezny Paul A. , Wukich Dane K.
Published: April 2019

Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality ( P = .004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respiratory distress syndrome (aOR = 5.24, 95% CI = 2.04-14.4), and postoperative septic shock (aOR = 5.14, 95% CI = 1.94-14.1). Amputation was independently associated with DM (aOR = 4.35, 95% CI = 2.63-7.35) but not mortality. Although DM was associated with more amputations for lower extremity NF, patients with DM had lower mortality than non-DM patients in the bivariate analysis. Further research is needed to investigate outcomes among DM and non-DM patients in the context of lower extremity NF.
The Silk Vista Baby: Initial experience and report of two cases
Authors: Bhogal Pervinder , Wong Ken , Uff Christopher , Wadley John , Makalanda Hegoda LD
Published: April 2019

In this report, we present two cases using a novel flow diverter, the Silk Vista Baby, to treat aneurysms successfully, both ruptured and unruptured, that would have been difficult to treat using alternative flow diverters. We describe the clinical and radiological features, outcome and the unique features of the Silk Vista Baby flow diverter.
The emergence of the Netherlands as a ‘democratic’ country
Authors: te Velde Henk
Published: April 2019

This contribution sketches the emergence of democratic self-definitions in the Netherlands, from the end of the 18th century until the post-war period, when it had become commonplace to define the country as democratic. Its point of departure is the use of the word and concept of democracy by contemporaries and Dutch and foreign historians, and it argues that the history of Dutch ‘democracy’ has been characterized by an emphasis on freedom, self-government by a broadly defined elite and a strong civil society, rather than by participation of the population at large. Democracy only became really popular after the Second World War when it could be defined as protection against dictatorship. The Dutch case shows that we should be careful about equating a strong civil society or even the rule of law with democracy in the sense of the power of the people at large. Democracy was definitely accepted as a label to characterize the Netherlands after it had been redefined as in essence the opposite of dictatorship instead of the opposite of aristocracy. The Dutch case also shows that a highly developed, civil society can even confine rather than promote the need for political democracy and for a vibrant independent political sphere.
Narratives of democracy in post-war France
Authors: Nord Philip G
Published: April 2019

Loyalists of France’s Third Republic presented the regime as heir to France’s revolutionary tradition and as such the bearer of a set of undying principles: liberty, equality, and fraternity. This narrative came under crippling pressure in the 20th century, and in the aftermath of the Second World War, a new set of narratives began to crystallize that rethought the meaning of republican democracy. Under the Third Republic, it was the venerable Parti Radical, dating back to Dreyfusard days, that had been the mainstay of the democratic idea, but in the Liberation era, the party was sidelined, and successors emerged, Socialist and Christian-democratic, which tendered new visions of democracy’s future. The place of the State in French life was also reconsidered. It ceased to be an object of democratic suspicion but came to be seen rather as an indispensable vehicle for effecting the nation’s reconstruction. France’s place in the world came in for a major rethinking at the same time. The nation remained as ever the bearer of the democratic idea, but it now expressed that commitment as a European power and not an imperial one, as a founding member of a brotherhood of democracies and not as a unilateral actor propelled by a self-appointed civilizing mission. In today’s post-colonial, post-industrial, and globalizing world, however, these narratives no longer have the same purchase as in decades past.
A time-dependent reliability estimation method based on surrogate modeling and data clustering
Authors: Peng Wei , Huang Xiesi , Zhang Xiaoling , Ni Liyong , Zhu Shengguang
Published: April 2019

Due to the complex uncertainty of working loads and design parameters, time-dependent reliability estimation is time-consuming. Various works aim to improve the accuracy and efficiency of time-dependent reliability estimation methods with a known time-dependent response of the mechanical system. Time-dependent reliability calculation with complex uncertainty and unknown limit state function are more complex. In this article, surrogate modeling and data clustering technology are utilized to estimate the time-dependent reliability of mechanical structure. First, the physics of failure with respect to time for a mechanical structure is analyzed, and BP neural network is introduced to build the surrogate model of time-dependent response for mechanical structure. Second, data clustering technique is used to find the most probable failure domains. Furthermore, the Genetic Algorithm is utilized to search the extreme values of the response at the most probable failure points during the given time interval. Then, the surrogate model for the extreme values at the most probable failure points is approximately established using BP neural network and Monte Carlo simulation is used for time-dependent reliability estimation. Finally, two examples are presented to verify the accuracy and efficiency of the proposed method.
Spatial–numerical associations: Shared symbolic and non-symbolic numerical representations
Authors: Buijsman Stefan , Tirado Carlos
Published: April 2019

During the last decades, there have been a large number of studies into the number-related abilities of humans. As a result, we know that humans and non-human animals have a system known as the approximate number system that allows them to distinguish between collections based on their number of items, separately from any counting procedures. Dehaene and others have argued for a model on which this system uses representations for numbers that are spatial in nature and are shared by our symbolic and non-symbolic processing of numbers. However, there is a conflicting theoretical perspective in which there are no representations of numbers underlying the approximate number system, but only quantity-related representations. This perspective would then suggest that there are no shared representations between symbolic and non-symbolic processing. We review the evidence on spatial biases resulting from the activation of numerical representations, for both non-symbolic and symbolic tests. These biases may help decide between the theoretical differences; shared representations are expected to lead to similar biases regardless of the format, whereas different representations more naturally explain differences in biases, and thus behaviour. The evidence is not yet decisive, as the behavioural evidence is split: we expect bisection tasks to eventually favour shared representations, whereas studies on the spatial–numerical association of response codes (SNARC) effect currently favour different representations. We discuss how this impasse may be resolved, in particular, by combining these behavioural studies with relevant neuroimaging data. If this approach is carried forward, then it may help decide which of these two theoretical perspectives on number representations is correct.
Risks and risk management in modern multiple sclerosis immunotherapeutic treatment
Authors: Klotz Luisa , Havla Joachim , Schwab Nicholas , Hohlfeld Reinhard , Barnett Michael , Reddel Stephen , Wiendl Heinz
Published: April 2019

In recent years, there has been a paradigm shift in the treatment of multiple sclerosis (MS) owing to the approval of a number of new drugs with very distinct mechanisms of action. All approved disease-modifying drugs primarily work directly on the immune system. However, the identification of an ‘optimal choice’ for individual patients with regard to treatment efficacy, treatment adherence and side-effect profile has become increasingly complex including conceptual as well as practical considerations. Similarly, there are peculiarities and specific requirements with regard to treatment monitoring, especially in relation to immunosuppression, the development of secondary immune-related complications, as well as the existence of drug-specific on- and off-target effects. Both classical immunosuppression and selective immune interventions generate a spectrum of potential therapy-related complications. This article provides a comprehensive overview of available immunotherapeutics for MS and their risks, detailing individual mechanisms of action and side-effect profiles. Furthermore, practical recommendations for patients treated with modern MS immunotherapeutics are provided.
Impact of Medicare Continuous Subcutaneous Insulin Infusion Policies in Patients With Type 1 Diabetes
Authors: Argento Nicholas B. , Liu Jingwen , Hughes Allyson S. , McAuliffe-Fogarty Alicia H.
Published: April 2019

Background:

The Centers for Medicare and Medicaid Services (CMS) has numerous requirements for coverage of continuous subcutaneous insulin infusion (CSII; insulin pump). Due to recent improvements in diabetes treatment, people with type 1 diabetes are living longer, resulting in an increase in the number of individuals who are eligible for Medicare and are impacted by CMS policies regarding CSII.

Methods:

Two hundred forty-one adults with type 1 diabetes who had been on CSII with CMS coverage for at least 6 months were surveyed. Median age was 67 years, mean A1c was 7.0%, 64% were women, 93% were white, and the median type 1 diabetes duration was 42 years. Participants reported median CSII use of 15 years and 82% were on CSII before starting CMS.

Results:

Of those starting CSII while on CMS, challenges included cost of supplies (29%) or the insulin pump (24%). The majority (57.5%) reported issues with obtaining supplies, the most common problems being delays in release of supplies (29%), difficulty getting paperwork completed (23.5%), and seeing a health care provider every 90 days (18%). Participants reported changing their CSII behaviors because of supply delays (39%) including leaving site in place >3 days (64%), and reusing pump supplies (34%). Consequently, participants reported adverse outcomes including more erratic (48%) or higher (42%) blood glucose and pain or irritation at sites (34%).

Conclusion:

This study concluded that current CMS CSII policies promote adverse CSII behaviors and outcomes in type 1 diabetes and thus call for changes in the CMS CSII policies.
Quality of Life and Impact of Endoscopic Sinus Surgery in Adult Patients With Cystic Fibrosis
Authors: Lazio Maria S. , Luparello Paolo , Mannelli Giuditta , Santoro Giovanni P. , Bresci Silvia , Braggion Cesare , Gallo Oreste , Maggiore Giandomenico
Published: April 2019

Background

Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasian population. Due to its pathological mechanism, chronic rhino sinusitis (CRS) associated or not with nasal polyposis usually occurs in adults and affects close to one-half of all CF patients. The goal of our work was to evaluate the impact of endoscopic sinus surgery (ESS) in the quality of life (QoL) of the CF patients and demonstrate an improvement of the functional outcomes in the patients undergoing the surgical procedure rather than in the not treated ones. Methodology: We studied 54 adult patients affected by CF. Lund–Kennedy, Lund–Mackay scores, and Sino-Nasal Outcome Test-22 (SNOT-22) were analyzed.

Results

Twenty-two (40.7%) of the 54 CF patients underwent ESS. This group presented more likely complaints consistent with CRS. Lund–Kennedy and Lund–Mackay scores appeared higher in the ESS group: 10 (range of 6–12) and 16 (range of 12–20), respectively. SNOT-22 showed median values for non-ESS and ESS group of 17.5 (range of 3–68) and 44 (range of 10–73), respectively.

Conclusions

ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy.
Mobile-based insulin dose adjustment for type 2 diabetes in community and rural populations: study protocol for a pilot randomized controlled trial
Authors: Menon Anish , Gray Leonard , Fatehi Farhad , Bird Dominique , Darssan Darsy , Karunanithi Mohan , Russell Anthony
Published: April 2019

Background: Insulin initiation and/or titration for type 2 diabetes (T2DM) is often delayed as it is a resource-intensive process, often requiring frequent exchange of information between a patient and their diabetes healthcare professional, such as a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). Existing models of IDA are unlikely to meet the increasing service demand unless efficiencies are increased. Mobile health (mHealth), a subset of Ehealth, has been shown to improve glycaemic control through enhanced self-management and feedback leading to improved patient satisfaction and could simultaneously reduce costs. Considering the potential benefits of mHealth, we have developed an innovative mHealth-based care model to support patients and clinicians in diabetes specialist community outreach and telehealth clinics, that is, REthinking Model of Outpatient Diabetes care utilizing EheaLth – Insulin Dose Adjustment (REMODEL-IDA). This model primarily aims to improve the glycaemic management of patients with T2DM on insulin, with the secondary aims of improving healthcare service delivery efficiency and the patients’ experience. Methods/Design: A two-arm pilot randomized controlled trial (RCT) will be conducted for 3 months with 44 participants, randomized at a 1:1 ratio to receive either the mHealth-based model of care (intervention) or routine care (control), in diabetes specialist community outreach and telehealth clinics. The intervention arm will exchange information related to blood glucose levels via the Mobile Diabetes Management System developed for outpatients with T2DM. They will receive advice on insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their blood glucose levels and frequency of blood glucose testing. The routine care arm will be followed up via telephone calls by the CDE as per usual practice. The primary outcome is change in glycated haemoglobin, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required to perform IDA by healthcare providers in both arms will be collected. This pilot study will guide the conduct of a large-scale pragmatic RCT in regional Australia.
Acute pulmonary embolism following endoscopic sclerotherapy for gastroesophageal variceal hemorrhage: A case report and literature review
Authors: Tangcheewinsirikul Nuanrat , Suankratay Chusana
Published: April 2019

Gastroesophageal variceal hemorrhage is a substantial cause of death in patients with portal hypertension. Cyanoacrylate injection is a widely used endoscopic treatment for variceal hemorrhage. We report herein the case of a 49-year-old male with decompensated alcoholic cirrhosis, who received endoscopic sclerotherapy to stop gastroesophageal variceal hemorrhage during hospitalization. The following day, he developed acute progressive dyspnea, and computed tomogram of pulmonary artery revealed acute pulmonary embolism at the right lower pulmonary artery. A final diagnosis of sclerotherapy-associated pulmonary embolism was made, and he gradually improved conservatively without anticoagulant treatment 2 weeks after hospitalization.
Incidental findings in pancreas screening programs for high‐risk individuals: Results from three European expert centers
Authors: Ibrahim Isaura S , Brückner Catharina , Carrato Alfredo , Earl Julie , Inderson Akin , de Vos tot Nederveen Cappel Wouter H , Mintziras Ioannis , Matthäi Elvira , Figiel Jens , Wasser Martin , Moreau Hans , Bonsing Bert , Slater Emily P , Bartsch Detlef K , Vasen Hans FA
Published: April 2019

Background

Widespread abdominal imaging has led to a substantial increase in the detection of incidentalomas. Currently, an increasing number of centers offer surveillance of the pancreas to individuals at high risk (IARs) of pancreatic ductal adenocarcinoma (PDAC).

Objective

The aims of this study were to evaluate the frequency and type of incidental findings in a magnetic resonance imaging (MRI)‐based surveillance program for IARs for PDAC, and to discuss the benefit of detecting these lesions.

Methods

The outcome of MRI screening was reviewed in 568 individuals from three long‐term pancreas surveillance programs conducted at three large European expert centers. All MRIs were studied in detail for the presence of incidental lesions.

Results

The most common lesions were liver cysts, renal cysts and liver hemangioma, which together comprised 75% of all lesions. Only five (0.9%) patients underwent surgery for a benign lesion. Cancer was detected in 11 patients (1.9%); early detection of tumors was beneficial in at least five cases.

Conclusion

The present study demonstrates that extrapancreatic incidentaloma is a common finding in IARs for PDAC, but rarely requires additional treatment. CDKN2A‐p16‐Leiden mutation carriers were the only patient group found to harbor a substantial number of cancers, and detection resulted in benefit in several cases.
Healthcare staff perceptions of integrated care in a programme for complex chronic patients admitted to hospital because of heart failure (ProMIC)
Authors: Domingo Cristina , Regidor Iratxe , Alonso Edurne , Besga Ariadna , Orozco Domingo , Nuño Roberto
Published: April 2019

Introduction

Patients with heart failure are usually a frail population characterised by complex care needs. To ensure an integrated care approach, it is necessary to work collaboratively across organisational boundaries. The purpose of this study is to measure and understand the perception of collaboration between clinicians participating in a comprehensive care programme for patients with heart failure, known as PROMIC.

Methods

A sequential mixed-method study design was used. A sample of PROMIC clinicians completed a survey in which they evaluated 10 dimensions of collaboration in 2010 and in 2014. The perspectives of clinicians were studied more in depth in a focus group in 2012, which was analysed using content analysis. Outcomes: Professionals’ perception of collaboration showed an improvement by 1.18 points (53%) over the period 2010–14. The comprehensive programme proved to be of major support to the professionals. Sometimes, the study participants did not feel prepared to manage cases due to the complexity of the situations with regard to patients’ care. Both, the quantitative and the qualitative methods, showed up a congruent information about the positive perception of participants of the programme itself and the collaboration.

Discussion

The complexity of care processes and the need for continuity of care mean that large-scale collaboration is necessary between care levels as well as major interdisciplinary teamwork, to achieve the best possible outcomes in terms of health. ProMIC intervention has helped to improve professionals’ perception in terms of collaboration between levels.
Psychological intervention based on psychoneuroimmunology improves clinical evolution, quality of life, and immunity of children with leukemia: A preliminary study
Authors: Chacin-Fernández Josymar , Chacin Fuenmayor Margarita , Piñerua-Shuhaibar Lorena , Suarez-Roca Heberto
Published: April 2019

We conducted a non-randomized, open-label clinical trial to assess whether a psychoneuroimmunology-based intervention enhanced immunity in children with acute lymphoblastic leukemia undergoing chemotherapy. In total, 16 children (44% female) received psychoneuroimmunology-based intervention, whereas 12 (50% female) received health psychoeducation (controls). The primary outcome was immunity markers, being clinical conditions the secondary outcome. Psychoneuroimmunology-based intervention increased immune markers (CD8+ T, B, and natural killer cells, serum immunoglobulin A, and immunoglobulin M) and quality of life, whereas it shortens the duration of fever and use of antipyretics, antibiotics, analgesics, and respiratory therapy. Immunity markers correlated with clinical conditions. Thus, psychoneuroimmunology-based intervention could reduce hospital cost and increase patient well-being.
‘It’s nice to just be you’: The influence of the employment experiences of UK military spouses during accompanied postings on well-being
Authors: Gribble Rachael , Goodwin Laura , Oram Sian , Fear Nicola T
Published: April 2019

Repeated military relocations (accompanied postings) can have a detrimental effect on employment and well-being among the spouses and partners of military personnel. Semi-structured telephone interviews were conducted with 19 spouses of British Army/Royal Air Force personnel with recent experience of accompanied postings to explore this issue through the lens of self-determination theory; all were married women with at least one child. Participants explained how employment contributed to an independent identity, enabling social connectedness, providing a sense of self-confidence and value but limiting agency over employment decisions. Spouse employment, and therefore, well-being could be improved by the provision of better childcare access or additional support in finding employment and training opportunities.
Relationship Between Organizational Injustice and Work Interference with Family: The Role of Social Support
Authors: Kumar Aneel , Ali Arain Ghulam , Ahmed Channa Khalil
Published: April 2019

This study investigates the moderating role of social support (i.e., supervisor, co-workers and the family) in the relationship between organizational injustice (i.e., distributive and procedural) and work interference with family (WIF; i.e., strain and behaviour based). Quantitative data were collected from employees working in public sector health-care organizations of Pakistan through survey questionnaires ( N = 255). This study finds significant effects of distributive and procedural injustice in engendering the negative experiences of strain- and behaviour-based WIF, in the employees of health-care organizations. The moderating effect of co-worker and family support provided mixed results. The supervisory social support was not found as a moderator.

Findings of this study suggest that health-care organizations should pay serious attention to the ineffective work family policies and procedure to develop a family-friendly work environment. The supervisors should be given a role in work family policies and procedure development. The mitigating effect of co-workers’ support showed that the employees should be provided with proper knowledge on the policies and procedures of their organizations. The support of family members can also be either benign or harmful.
ERCC6L2 defines a novel entity within inherited acute myeloid leukemia
Authors: Douglas Suvi P. M. , Siipola Pihla , Kovanen Panu E. , Pyörälä Marja , Kakko Sakari , Savolainen Eeva-Riitta , Salmenniemi Urpu , Orte Katri , Kytölä Soili , Pitkänen Esa , Porkka Kimmo , Kilpivaara Outi , Wartiovaara-Kautto Ulla
Published: April 2019

There is a Blood Commentary on this article in this issue.
von Willebrand factor self-association is regulated by the shear-dependent unfolding of the A2 domain
Authors: Zhang Changjie , Kelkar Anju , Neelamegham Sriram
Published: April 2019

von Willebrand factor (VWF) self-association results in the homotypic binding of VWF upon exposure to fluid shear. The molecular mechanism of this process is not established. In this study, we demonstrate that the shear-dependent unfolding of the VWF A2 domain in the multimeric protein is a major regulator of protein self-association. This mechanism controls self-association on the platelet glycoprotein Ibα receptor, on collagen substrates, and during thrombus growth ex vivo. In support of this, A2-domain mutations that prevent domain unfolding due to disulfide bridging of N- and C-terminal residues (“Lock-VWF”) reduce self-association and platelet activation under various experimental conditions. In contrast, reducing assay calcium concentrations, and 2 mutations that destabilize VWF-A2 conformation by preventing coordination with calcium (D1498A and R1597W VWD type 2A mutation), enhance self-association. Studies using a panel of recombinant proteins that lack the A1 domain (“ΔA1 proteins”) suggest that besides pure homotypic A2 interactions, VWF-A2 may also engage other protein domains to control self-association. Addition of purified high-density lipoprotein and apolipoprotein-A1 partially blocked VWF self-association. Overall, similar conditions facilitate VWF self-association and ADAMTS13-mediated proteolysis, with low calcium and A2 disease mutations enhancing both processes, and locking-A2 blocking them simultaneously. Thus, VWF appears to have evolved 2 balancing molecular functions in a single A2 functional domain to dynamically regulate protein size in circulation: ADAMTS13-mediated proteolysis and VWF self-association. Modulating self-association rates by targeting VWF-A2 may provide novel methods to regulate the rates of thrombosis and hemostasis.
Trauma-focused group intervention for unaccompanied young refugees: “Mein Weg”—predictors of treatment outcomes and sustainability of treatment effects
Authors: Pfeiffer Elisa , Sachser Cedric , Tutus Dunja , Fegert Joerg M. , Plener Paul L.
Published: April 2019

Background

Current research on treatment predictors and long-term effects of trauma-focused interventions for (unaccompanied) refugee minors is limited. This secondary analysis of a recent randomised controlled trial (RCT), evaluating the trauma-focused group intervention “Mein Weg” (English “My Way”) compared to usual care, investigated several refugee-specific factors such as treatment predictors and sustainability of treatment gains.

Methods

In total N = 50 participants (Mage = 17.00, 94% male) were included in this analysis. Evaluation of 3-month follow-up data included: posttraumatic stress symptoms [(PTSS) CATS-Self, CATS-Care], depression (PHQ-8), and dysfunctional posttraumatic cognitions (CPTCI-S). Baseline symptom severity of the above-mentioned measures, trauma load and socio-demographic factors were investigated as the treatment predictors.

Results

Intention-to-treat-analyses (ITT) revealed the sustainability of treatment effects in self-reported PTSS (pre to post change: 6.48 ± 1.60, d = 0.62, p < 0.001; post to 3-month follow-up change: 1.41 ± 1.96, d = 0.11, p = 0.47) and depression (pre to post change: 7.82 ± 2.09, d = 0.64, p < 0.001; post to 3-month follow-up change: 1.35 ± 2.17, d = 0.05, p = 0.54). Country of origin alone was a significant predictor of the change in PTSS (b = − 8.22 ± 3.53, t(30) = − 2.33, p = 0.027), and baseline levels of depression were a significant predictor of the change in depression (b = 0.83 ± 0.19, t(33) = 4.46, p < 0.001).

Conclusion

This group intervention can serve as a valuable component in a stepped care approach with promising long-term effects for young refugees.

Trial registration DRKS, #DRKS00010915. Registered 15 September 2016, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010915
Hypoxia as a barrier to immunotherapy in pancreatic adenocarcinoma
Authors: Daniel S. K. , Sullivan K. M. , Labadie K. P. , Pillarisetty V. G.
Published: April 2019

Pancreatic ductal adenocarcinoma (PDA) is a lethal disease with limited response to cytotoxic chemoradiotherapy, as well as newer immunotherapies. The PDA tumor microenvironment contains infiltrating immune cells including cytotoxic T cells; however, there is an overall immunosuppressive milieu. Hypoxia is a known element of the solid tumor microenvironment and may promote tumor survival. Through various mechanisms including, but not limited to, those mediated by HIF‐1α, hypoxia also leads to increased tumor proliferation and metabolic changes. Furthermore, epithelial to mesenchymal transition is promoted through several pathways, including NOTCH and c‐MET, regulated by hypoxia. Hypoxia‐promoted changes also contribute to the immunosuppressive phenotype seen in many different cell types within the microenvironment and thereby may inhibit an effective immune system response to PDA. Pancreatic stellate cells (PSCs) and myofibroblasts appear to contribute to the recruitment of myeloid derived suppressor cells (MDSCs) and B cells in PDA via cytokines increased due to hypoxia. PSCs also increase collagen secretion in response to HIF‐1α, which promotes a fibrotic stroma that alters T cell homing and migration. In hypoxic environments, B cells contribute to cytotoxic T cell exhaustion and produce chemokines to attract more immunosuppressive regulatory T cells. MDSCs inhibit T cell metabolism by hoarding key amino acids, modulate T cell homing by cleaving L‐selectin, and prevent T cell activation by increasing PD‐L1 expression. Immunosuppressive M2 phenotype macrophages promote T cell anergy via increased nitric oxide (NO) and decreased arginine in hypoxia. Increased numbers of regulatory T cells are seen in hypoxia which prevent effector T cell activation through cytokine production and increased CTLA‐4. Effective immunotherapy for pancreatic adenocarcinoma and other solid tumors will need to help counteract the immunosuppressive nature of hypoxia‐induced changes in the tumor microenvironment. Promising studies will look at combination therapies involving checkpoint inhibitors, chemokine inhibitors, and possible targeting of hypoxia. While no model is perfect, assuring that models incorporate the effects of hypoxia on cancer cells, stromal cells, and effector immune cells will be crucial in developing successful therapies.
Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana
Authors: Adom Theodosia , De Villiers Anniza , Puoane Thandi , Kengne André Pascal
Published: April 2019

Background

There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods

Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results

The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.

Conclusions

A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.
Pilot Line Kinking Prevents Cuff Deflation: A Case Report
Authors: Toyosato Akira , Sugita Takeo , Umezawa Nobuo , Matsumoto Akiko , Arisaka Hirofumi
Published: April 2019

We report kinking of the pilot line of an endotracheal tube (ETT). The anesthesiologist found it difficult to deflate the ETT cuff after performing test inflation with air before intubation. We subsequently filled the pilot line with red dye and examined it from the connection with the pilot balloon to the site of entry into the ETT wall. This examination revealed stenosis of the pilot line at the entry into the ETT, making it too narrow for air to flow freely during cuff deflation. The present case emphasizes that preanesthetic checking of the ETT cuff is very important.
Provisional Notes on Hydrocolonialism
Authors: Hofmeyr Isabel
Published: April 2019

This article discusses the meanings and applications of the rubric hydrocolonialism. Starting with a South African poem as an example, the piece sets out a definition of the term before outlining the existing literary scholarship that could fall under its umbrella. The article then turns to discuss hydrocolonial book history and what we might learn by tracing books on their oceanic journeys. One important node in these journeys was the port city, where customs and excise officials examined texts to see whether they were pirated, seditious, or obscene. These inspectors in effect functioned as censors and adjudicators of copyright. The article examines how these protocols worked in practice and concludes by discussing this dockside mode of reading as a hydrocolonial literary formation.
The Oceanic South
Authors: Samuelson Meg , Lavery Charne
Published: April 2019

This essay proposes the category of the oceanic South. It presents the Southern Hemisphere’s blue expanses as one of its defining features and elaborates from this a framework that brings into agitated contention the extractive economies of the North, the persistent legacies of settler colonialism in the South, and other interlocking human and more-than-human itineraries. Tracking a drift into the Southern Ocean in the fiction of J. M. Coetzee, the essay takes this “most neglected of oceans” as a vantage point from which to draw the contours of the oceanic South and engage its troubled surfaces and lively depths. Thinking through the roiling and hostile, fecund, and unbounded nature of this ocean, the essay follows “the lives of whales” in novels by Witi Ihimaera and Zakes Mda. Sounding the ocean’s imaginative depths, these fictions offer illuminating ways of thinking the South while maintaining an unsettling planetarity.
Mexican Manuscripts and the First Images of Africans in the Americas
Authors: Sifford Elena FitzPatrick
Published: April 2019

Africans in the Americas were first visually recorded by tlacuiloque, or indigenous artist-scribes, in mid-sixteenth-century Central Mexican manuscripts such as Diego Durán’s History, the Codex Telleriano-Remensis, and the Codex Azcatitlan. These figures, while often peripheral to the central narrative and never mentioned specifically by name, are nevertheless rendered as active agents in the shaping of a new colonial society. The article examines these images of Africans to reveal their ethnographic complexity and the development of concepts of alterity in the early contact period.
Across Archival Limits: Colonial Records, Changing Ethnonyms, and Geographies of Knowledge
Authors: Erbig Jeffrey A. , Latini Sergio
Published: April 2019

This article examines relationships between archival records produced in borderland spaces and the histories of autonomous (non-subjugated and non-missionized) Indigenous peoples. Focusing on the Banda Oriental region of Southeastern South America, it argues that the geographical content, dispersion, and curation of colonial records have served to silence Native pasts. As Portuguese, Spanish, and Jesuit administrators sought possession of this borderland, they overstated the reach of their own settlements and strategically ascribed ethnic labels to Indigenous neighbors to appropriate their lands or delegitimize their sovereignty. The geographical dispersion of colonial records over time has masked the inconsistencies of such claims, and colonial ethnogeographic imaginations thus persist. By reading colonial sources from multiple settlements against one another, this article identifies contradictions in the geographic and ethnographic information they provide, laying a foundation for new ethnogeographic imaginations that center the spaces and agency of autonomous Indigenous communities.
Ch’orti’, Lenca, and Pipil: An Onomastic Approach to Redefining the Sixteenth-Century Southeastern Maya Frontier
Authors: Johnson Erlend M. , Zúñiga Pastor Gómez , Kelly Mary Kate
Published: April 2019

Scholars argue that western Honduras was occupied by Ch’orti’ speakers in the sixteenth century. These reconstructions conform to nationalist pressures to present Honduras as Maya, by using Classic period (AD 200–900) archaeological remains together with sparsely available sixteenth-century documentation. Drawing on existing and newly discovered sources, this article uses an onomastic approach to interpret glossonyms (language names), anthroponyms (personal names), and toponyms (place-names) in order to reconstruct past linguistic territories. The results of the analysis suggest greater Lenca- and Pipil- and smaller Ch’orti’-speaking populations than once thought, and emphasize the multilinguistic and frontier nature of societies in western Honduras. This study also highlights the viability of onomastic approaches in reconstructing linguistic boundaries when source documents provide either vague or contradictory information about languages spoken.