bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting the treatment response of certolizumab for individual adult patients with rheumatoid arthritis: protocol for an individual participant data meta-analysis
Authors: Luo Yan , Chalkou Konstantina , Yamada Ryo , Funada Satoshi , Salanti Georgia , Furukawa Toshi A.
Published: June 2020

Background

A model that can predict treatment response for a patient with specific baseline characteristics would help decision-making in personalized medicine. The aim of the study is to develop such a model in the treatment of rheumatoid arthritis (RA) patients who receive certolizumab (CTZ) plus methotrexate (MTX) therapy, using individual participant data meta-analysis (IPD-MA).

Methods

We will search Cochrane CENTRAL, PubMed, and Scopus as well as clinical trial registries, drug regulatory agency reports, and the pharmaceutical company websites from their inception onwards to obtain randomized controlled trials (RCTs) investigating CTZ plus MTX compared with MTX alone in treating RA. We will request the individual-level data of these trials from an independent platform (http://vivli.org). The primary outcome is efficacy defined as achieving either remission (based on ACR-EULAR Boolean or index-based remission definition) or low disease activity (based on either of the validated composite disease activity measures). The secondary outcomes include ACR50 (50% improvement based on ACR core set variables) and adverse events. We will use a two-stage approach to develop the prediction model. First, we will construct a risk model for the outcomes via logistic regression to estimate the baseline risk scores. We will include baseline demographic, clinical, and biochemical features as covariates for this model. Next, we will develop a meta-regression model for treatment effects, in which the stage 1 risk score will be used both as a prognostic factor and as an effect modifier. We will calculate the probability of having the outcome for a new patient based on the model, which will allow estimation of the absolute and relative treatment effect. We will use R for our analyses, except for the second stage which will be performed in a Bayesian setting using .

Discussion

This is a study protocol for developing a model to predict treatment response for RA patients receiving CTZ plus MTX in comparison with MTX alone, using a two-stage approach based on IPD-MA. The study will use a new modeling approach, which aims at retaining the statistical power. The model may help clinicians individualize treatment for particular patients.

Systematic review registration

PROSPERO registration number pending (ID#157595).
Some parameterized inequalities by means of fractional integrals with exponential kernels and their applications
Authors: Zhou Tai-Chun , Yuan Zheng-Rong , Yang Hong-Ying , Du Ting-Song
Published: June 2020

We use the definition of a new class of fractional integral operators, recently introduced by Ahmad et al. in [J. Comput. Appl. Math. 353:120–129, 2019], to establish a fractional-type integral identity with one parameter. We derive some parameterized integral inequalities for convex mappings based on this identity, and provide two examples to illustrate the investigated results as well. Moreover, we present applications of our findings to special means of real numbers, and error estimations for the quadrature formula in numerical analysis.
Time-space variable-order fractional nonlinear system of thermoelasticity: numerical treatment
Authors: Assiri Taghreed A.
Published: June 2020

This paper focuses on a numerical study of the general time-space variable-order fractional nonlinear problem of thermoelasticity in one dimension using the weighted average nonstandard finite difference (WANSFD). By replacing the second order space derivative with a Riesz fractional variable-order derivative and the time derivative by Caputo fractional variable-order operator in the standard system which arises in thermoelasticity, we obtain this general system. Using a kind of John von Neumann technique, we study the stability of the designed schemes. Also, the truncation error of the introduced schemes is studied. Our numerical treatment is shown graphically. These results expose that WANSFD approach is suitable and effective for solving the proposed system; moreover, it is easy to implement.
Weighted pseudo almost periodic solutions for Clifford-valued neutral-type neural networks with leakage delays on time scales
Authors: Shen Shiping , Li Yongkun
Published: June 2020

In this paper, we consider a class of Clifford-valued neutral-type neural networks with leakage delays on time scales. We do not decompose the networks under consideration into real-valued systems, but we directly study the Clifford-valued networks. We first establish the existence of weighted pseudo almost periodic solutions of this class of neural networks by the theory of calculus on time scales and the Banach fixed point theorem. Then, we study the global exponential stability of weighted pseudo almost periodic solutions of this class of neural networks by using inequality techniques and the proof by contradiction. Finally, we give an example to illustrate the feasibility of the obtained results.
Autism Spectrum Social Stories In Schools Trial 2 (ASSSIST2): study protocol for a randomised controlled trial analysing clinical and cost-effectiveness of Social Stories™ in primary schools
Authors: Wright B. , Teige C. , Watson J. , Hodkinson R. , Marshall D. , Varley D. , Allgar V. , Mandefield L. , Parrott S. , Kingsley E. , Hargate R. , Mitchell N. , Ali S. , McMillan D. , Wang H. , Hewitt C.
Published: June 2020

Background

Interventions designed to support children with a diagnosis of Autism Spectrum Conditions (ASC) can be time consuming, needing involvement of outside experts. Social Stories™ are a highly personalised intervention aiming to give children with ASC social information or describing an otherwise difficult situation or skill. This can be delivered daily by staff in education settings. Studies examining Social Story™ use have yielded mostly positive results but have largely been single case studies with a lack of randomised controlled trials (RCTs). Despite this numerous schools are utilising Social Stories™, and a fully powered RCT is timely.

Methods

A multi-site pragmatic cluster RCT comparing care as usual with Social Stories™ and care as usual. This study will recruit 278 participants (aged 4–11) with a clinical diagnosis of ASC, currently attending primary school in the North of England. Approximately 278 school based staff will be recruited to provide school based information about participating children with approximately 140 recruited to deliver the intervention. The study will be cluster randomised by school. Potential participants will be screened for eligibility prior to giving informed consent. Follow up data will be collected at 6 weeks and 6 months post randomisation and will assess changes in participants’ social responsiveness, goal based outcomes, social and emotional health. The primary outcome measure is the Social Responsiveness Scale Second Edition (SRS-2) completed by school based staff at 6 months. Approvals have been obtained from the University of York’s Research Governance Committee, Research Ethics Committee and the Health Research Authority. Study results will be submitted for publication in peer-reviewed journals and disseminated to participating families, educational staff, local authority representatives, community groups and Patient and Participant Involvement representatives. Suggestions will be made to NICE about treatment evidence dependent on findings.

Discussion

This study addresses a much used but currently under researched intervention and results will inform school based support for primary school children with a diagnosis of ASC.

Trial registration

The trial is registered on the ISRCTN registry (registration number: ISRCTN11634810). The trial was retrospectively registered on 23rd April 2019.
Bike helmets prevent pediatric head injury in serious bicycle crashes with motor vehicles
Authors: Strotmeyer Stephen J. , Behr Christopher , Fabio Anthony , Gaines Barbara A.
Published: June 2020

Background

Approximately 75% of all bicycle-related mortality is secondary to head injuries, 85% of which could have been prevented by wearing a bicycle helmet. Younger children appear to be at greater risk than adults, yet helmet use is low despite this risk and legislation and ordinances requiring helmet use among younger riders. We sought to determine whether bicycle helmets are associated with the incidence and severity of head injury among pediatric bicyclists involved in a bicycle crash involving a motor vehicle.

Methods

We performed a retrospective review of patients age ≤ 18 years hospitalized at a level I pediatric trauma center between January 1, 2008, and December 31, 2018. Data were abstracted from the institutional trauma registry and electronic medical record. International Classification of Diseases 9th and 10th editions and external causes of injury codes were used to identify MV related bicycle crashes and determine the abbreviated injury severity (AIS) for head injury severity. Injury narratives were reviewed to determine helmet use. We calculated the incidence of head injury from bicycle vs. MV crashes utilizing descriptive statistics. We analyzed the risk and severity of injury utilizing univariate and multivariate logistic regression.

Results

Overall, 226 bicyclists were treated for injuries from being struck by a MV. The median age was 11 (interquartile range (IQR): 8 to 13) years. Helmeted bicyclists (n = 26, 27%) were younger (9.4 years versus 10.8 years, p = 0.04), and were less likely (OR 0.21, 95% CI 0.09 to 0.49) to be diagnosed with a head injury compared to unhelmeted bicyclists (n = 199). Of those with a head injury, helmeted bicyclists were less likely (OR 0.57, 95% CI 0.11–2.82) to sustain severe or higher injury using AIS. When adjusting for demographics (age, sex, race) and injury severity, helmet use predicted a reduction in head injury (OR 6.02, 95% CI 2.4–15.2).

Conclusions

Bicycle helmet use was associated with reduced odds of head injury and severity of injury.. These results support the use of strategies to increase the uptake of bicycle helmets wearing as part of a comprehensive youth bicycling injury prevention program.
Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature
Authors: Miura Kotaro , Kubo Naoshi , Sakurai Katsunobu , Tamamori Yutaka , Murata Akihiro , Nishii Takafumi , Kodai Shintaro , Tachimori Akiko , Shimizu Sadatoshi , Kanazawa Akishige , Inoue Toru , Nishiguchi Yukio , Maeda Kiyoshi
Published: June 2020

Background

Nonocclusive mesenteric ischemia (NOMI) has been reported to be a life-threating disease. Gastric conduit necrosis is known as a critical postoperative complication after esophagectomy for esophageal cancer. We encountered a rare case of NOMI of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy, which was successfully treated with an emergency operation.

Case presentation

A 67-year-old man presented with dysphagia. He was diagnosed with middle thoracic advanced esophageal cancer. After neoadjuvant chemotherapy, he underwent subtotal esophagectomy with lymphadenectomy and gastric conduit reconstruction. On postoperative day (POD) 2, he had diarrhea, high fever, and low blood pressure, which were treated with catecholamines. Laboratory data revealed acidosis and severe sepsis with multi-organ failure, including the kidneys. Although enhanced computed tomography did not exhibit definite findings of bowel ischemia, upper gastrointestinal endoscopy revealed necrotic mucosal changes in the whole gastric conduit. Therefore, we made a diagnosis of septic shock caused by gastric conduit necrosis and performed an emergency operation. When we explored the abdominal cavity, we found not only gastric conduit necrosis but also intermittent necrotic changes in the intestinal wall from the jejunum to the rectum. Therefore, NOMI was diagnosed. We performed an excision of the gastric conduit and 2 m of the small intestine, as well as total colectomy. After the second operation, prostaglandin E1 was administered intravenously as the treatment for NOMI, and sepsis was improved. On POD 122, he was self-discharged. He died of recurrence of lung metastasis from the esophageal cancer 9 months after the first operation.

Conclusion

When a patient has a critical status, including severe sepsis or severe acidosis, after esophagectomy, we should consider the possibility of NOMI in addition to gastric conduit necrosis and aim to diagnose and treat it immediately with an urgent operation.
Best MRI sequences for identifying axillary lymph node markers in patients with metastatic breast cancer: an inter-reader observational study
Authors: Samreen Naziya , Bhatt Asha A. , Adler Kalie , Zingula Shannon , Glazebrook Katrina N.
Published: June 2020

Background

We assessed confidence in visualization of markers within metastatic axillary lymph nodes (LNs) on magnetic resonance imaging (MRI), which were placed post-ultrasound (US)-guided biopsy.

Methods

A retrospective review was performed on 55 MRI cases between May 2015 and October 2017. Twenty-two MRIs were performed before neoadjuvant therapy, and 33 MRIs were after its initiation. There were 34/55 HydroMARK®, 10/55 Tumark®, and 11/55 other marker types. Time interval between marker placement and MRI examination was 103 ± 81 days (mean ± standard deviation). Three readers with 1–30 years of experience independently assessed four axial sequences: unenhanced fat-suppressed three-dimensional T1-weighted spoiled gradient-recalled (SPGR), first contrast-enhanced fat-suppressed SPGR, T2-weighted water-only fast spin-echo (T2-WO), and T2-weighted fat-only fast-spin-echo (T2-FO).

Results

Markers were 5.2× more likely to be visualized on T2-WO than on unenhanced images (p = < 0.001), and 3.3× more likely to be visualized on contrast-enhanced than on unenhanced sequences (p = 0.009). HydroMARK markers demonstrated a 3× more likelihood of being visualized than Tumark (p = 0.003). Markers were 8.4× more likely to be visualized within morphologically abnormal LNs (p < 0.001). After 250 days post-placement, confidence in marker brightness of HydroMARK markers on T2-WO images was less than 50% (p < 0.001). Inter-rater agreement was excellent for T2-WO and contrast-enhanced SPGR, good for unenhanced SPGR, and poor for T2-FO images.

Conclusion

T2-WO and contrast-enhanced images should be used for marker identification. HydroMARK was the best visualized marker. Markers were easier to identify when placed in abnormal LNs. The visibility of HydroMARK markers was reduced with time.
Estimation of the top of the saturated zone from airborne electromagnetic data
Authors: Dewar Noah , Knight Rosemary
Published: June 2020

In an airborne electromagnetic (AEM) data set acquired in unsaturated and saturated zones, the depth of the top of the saturated zone (TSZ) at the time of data acquisition should be accounted for in the resistivity-to-lithology transform. We have developed and tested a methodology for estimating the TSZ from AEM data, using data collected in three survey areas in the Central Valley of California and water-table elevation (WTE) measurements from nearby wells. The methodology is based on the difference in the distribution of resistivity values above and below the TSZ, using the WTE measurements to optimize two components of the general workflow. From the AEM data acquired in Tulare County, in the southern portion of the Central Valley, where the WTE measurements were acquired two to four weeks before the AEM data acquisition, we have found estimates of the TSZ with a root-mean-square (rms) error of 10.6 m when compared to the WTE measurements. From the two survey areas in Butte and Glenn counties, in the northern portion of the Central Valley, where WTE measurements were available at the time of, and closer to the locations of, AEM data acquisition, we have found estimates of the TSZ with an rms error ranging from 3.8 to 5.3 m, depending on the form of inversion. The level of error found in the three survey areas is comparable to the thickness of the layers in the resistivity models at the depths of the TSZ. Because the intended use of these estimates is to locate the TSZ for use in developing and applying the resistivity-to-lithology transform, the level of error associated with this new methodology is acceptable.
Is Advance Care Planning Associated With Decreased Hope in Advanced Cancer?
Authors: Cohen Michael G. , Althouse Andrew D. , Arnold Robert M. , Bulls Hailey W. , White Douglas , Chu Edward , Rosenzweig Margaret , Smith Kenneth , Schenker Yael
Published: June 2020

PURPOSE:

Providers have cited fear of taking away hope from patients as one of the principal reasons for deferring advance care planning (ACP). However, research is lacking on the relationship between ACP and hope. We sought to investigate the potential association between ACP and hope in advanced cancer.

METHODS:

This is a cross-sectional analysis of baseline data from a primary palliative care intervention trial. All patients had advanced solid cancers. Three domains of ACP were measured using validated questions to assess discussion with oncologists about end-of-life (EOL) planning, selection of a surrogate decision maker, and completion of an advance directive. Hope was measured using the Hearth Hope Index (HHI). Multivariable regression was performed, adjusting for variables associated with hope or ACP.

RESULTS:

A total of 672 patients were included in this analysis. The mean age was 69.3 ± 10.2 years; 54% were female, and 94% were White. Twenty percent of patients (132 of 661) reported having a discussion about EOL planning, 51% (342 of 668) reported completing an advance directive, and 85% (565 of 666) had chosen a surrogate. There was no difference in hope between patients who had and had not had an EOL discussion (adjusted mean difference in HHI, 0.55; P = .181 for adjusted regression), chosen a surrogate (adjusted HHI difference, 0.31; P = .512), or completed an advance directive (adjusted HHI difference, 0.11; P = .752).

CONCLUSION:

In this study, hope was equivalent among patients who had or had not completed 3 important domains of ACP. These findings do not support concerns that ACP is associated with decreased hope for patients with advanced cancer.
A Quantitative Systems Pharmacology Model of T Cell Engager Applied to Solid Tumor
Authors: Ma Huilin , Wang Hanwen , Sove Richard J. , Jafarnejad Mohammad , Tsai Chia-Hung , Wang Jun , Giragossian Craig , Popel Aleksander S.
Published: June 2020

Cancer immunotherapy has recently drawn remarkable attention as promising results in the clinic have shown its ability to improve the overall survival, and T cells are considered to be one of the primary effectors for cancer immunotherapy. Enhanced and restored T cell tumoricidal activity has shown great potential for killing cancer cells. Bispecific T cell engagers (TCEs) are a growing class of molecules that are designed to bind two different antigens on the surface of T cells and cancer cells to bring them in close proximity and selectively activate effector T cells to kill target cancer cells. New T cell engagers are being investigated for the treatment of solid tumors. The activity of newly developed T cell engagers showed a strong correlation with tumor target antigen expression. However, the correlation between tumor-associated antigen expression and overall response of cancer patients is poorly understood. In this study, we used a well-calibrated quantitative systems pharmacology (QSP) model extended to bispecific T cell engagers to explore their efficacy and identify potential biomarkers. In principle, patient-specific response can be predicted through this model according to each patient’s individual characteristics. This extended QSP model has been calibrated with available experimental data and provides predictions of patients’ response to TCE treatment.
Exploratory behaviour, memory and neurogenesis in the social Damaraland mole-rat (Fukomys damarensis).
Authors: Oosthuizen Maria K.
Published: June 2020

Both exploratory behaviour and spatial memory are important for survival in dispersing animals. Exploratory behaviour is triggered by novel environments and having a better spatial memory of the surroundings provides an adaptive advantage to the animals. Spatial challenges can also affect neurogenesis in the hippocampus by increasing cell proliferation and enhancing survival of young neurons. In social Damaraland mole-rat colonies, the social hierarchy is largely based on the size. Individuals with different social statuses in these colonies display different dispersal behaviours and since behavioural differences have been linked dispersal behaviour, I investigated the exploratory behaviour, memory and hippocampal neurogenesis in wild captured Damaraland mole-rats. Dispersal behaviour renders differential exploratory behaviour in Damaraland mole-rats, they readily explored in a novel environment, but resident, worker mole-rats explored slower. In the Y-maze, animals entered the escape hole significantly faster by the second day, however they did not make fewer wrong turns with successive days of the experiment. Female dispersers did not show any improvement in time to reach the escape hole, or the number of wrong turns, over the 4-day experimental period. Damaraland male and female dispersers employ different dispersal strategies, and this is evident in their approach to the learning task. Females are less motivated to complete the task, leading to a difference in behaviour, and this has important survival implications for the different sexes. Finally, in the context of memory, adult neurogenesis does not seem to be a good marker in mole-rats as it is generally low and has not been investigated thoroughly enough to determine which and how other factors can influence it in these animals.
Flavor perception of wine is unchanged during commercial flight: a comparative field study
Authors: Gram-Hanssen Anders , Bøge Paulsen Cecilie , Rosenberg Jacob
Published: June 2020

Background: It is generally accepted that the human perception of flavor and odor is altered in low-pressure environments such as airplane cabins. This has been demonstrated in several simulation studies, but never in a field study conducted in an authentic environment, and never using wine as the object of study.

Methods: We performed a comparative field study composed of two wine tastings. The first tasting was conducted on board an aircraft flying at standard cruising altitude and the second tasting was conducted at ground level. Subjective taste experience and current mood were evaluated through a validated questionnaire. The study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.

Results: The study included 22 participants, none of whom had any special training in wine tasting. No statistically significant difference in experienced flavor intensity was found between the high and low altitude tests, with median aromatic intensities of 5 (interquartile range 3.5-6.0) and 5 (interquartile range 4.0-6.5) respectively, measured on a 9-point hedonic scale. Additionally, there was no detectable difference in several other taste parameters.

Conclusions: These findings suggest that even though experimental studies have demonstrated that senses of taste and smell may be suppressed on commercial flights, the subjective wine tasting experience of non-professionals in real life testing may not be affected.
Online Demand Fulfillment Under Limited Flexibility
Authors: Xu Zhen , Zhang Hailun , Zhang Jiheng , Zhang Rachel Q.
Published: June 2020

We study online demand fulfillment in a class of networks with limited flexibility and arbitrary numbers of resources and request types. We show analytically that such a network is both necessary and sufficient to guarantee a performance gap independent of the market size compared with networks with full flexibility, extending the previous literature from the long chains to more general sparse networks. Inspired by the performance bound, we develop simple inventory allocation rules and guidelines for designing such network structures. Numerical experiments including one using some real data from Amazon China are conducted to confirm our findings as well as some of the flexibility principles conjectured in the literature.

This paper was accepted by Chung Piaw Teo, optimization.
The Value of Insight
Authors: Ernst Philip A. , Rogers L. C. G.
Published: June 2020

An investor may invest in a riskless bank account and in a stock that is a standard Black–Scholes asset with occasional Gaussian jumps of the log price, as proposed by Merton [Merton RC ( 1976 ) Option pricing when underlying stock returns are discontinuous. J. Financial Econom. 3(1):125–144.]. It is well known how to solve the standard running consumption problem for this investor, which we take as a benchmark for comparing the performance of two different insiders, one who knows in advance of each jump exactly when the jump will happen, and the other who has information in advance of each jump about the size of the jump but no information about the time. These considerations give rise to two novel and concrete stochastic control problems. For each problem, rigorous verification proofs for optimality are presented.
Distal radius fractures: an evidence-based approach to assessment and management
Authors: Vaghela Kalpesh R , Velazquez-Pimentel Diana , Ahluwalia Aashish K , Choraria Anika , Hunter Alistair
Published: June 2020

Distal radius fractures account for one in five bony injuries in both primary and secondary care. These are commonly the result of a fall on outstretched hands or high-energy trauma. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Non-operative management in select patients can give good results, especially in older adults. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.
Everything you need to know about deprivation of liberty safeguards
Authors: Callaghan Harriet , Illsley Amy
Published: June 2020

Established as an amendment to the Mental Capacity Act 2005 , the deprivation of liberty safeguards were introduced to ensure that anyone who lacks capacity to consent to their care, and was being deprived of their liberty, has rights equivalent to those held under the Mental Health Act 1983 . These rights include someone to oversee any deprivation of liberty, the right of appeal and the guarantee of review of appeal in a timely manner. This article outlines how deprivation of liberty safeguards work, how a deprivation of liberty safeguards is applied for and obtained, what to discuss with the next of kin, and some special circumstances to consider. It also provides information about the criteria by which deprivation of liberty safeguards applications are assessed and the process by which this is done. This provides an overview for junior doctors working in secondary care, to increase their knowledge and confidence when patients require a deprivation of liberty safeguards application.
Medical leadership in the NHS during the COVID-19 pandemic
Authors: Warraich Sara , Olabi Bayanne , Azhar Bilal , Tanzeem S Fizza , Fischer Martin
Published: June 2020

Amid the global COVID-19 pandemic, adaptation of healthcare systems, with strong medical leadership, has been integral to coping with the ever-changing situation. This article is based on the personal experiences of doctors in the NHS and insights into the frontline response to this situation. It reflects on leadership dilemmas and strategies implemented to overcome them, with a focus on systems thinking and adaptive leadership.
Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency
Authors: Moore Zena , Patton Declan , Avsar Pinar , McEvoy Natalie L , Curley Gerard , Budri Aglecia , Nugent Linda , Walsh Simone , O'Connor Tom
Published: June 2020

Objective:

Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery.

Method:

Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only.

Results:

The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown.

Conclusion:

Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.
Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review
Authors: McNamara Stephanie A , Hirt Penelope A , Weigelt Maximillian A , Nanda Sonali , de Bedout Valeria , Kirsner Robert S , Schachner Lawrence A
Published: June 2020

Objective:

Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously.

Method:

Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included ‘wound care’, ‘wound management’, ‘paediatrics’, ‘children’, ‘skin substitutes’, and ‘grafts’. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: ‘Apligraf’, ‘dermagraft’, ‘Manuka honey’, ‘antibiotic’, ‘timolol’, and ‘negative pressure wound therapy’ (NPWT).

Results:

Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount.

Conclusion:

Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
Surgical treatment of midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes: a systematic review
Authors: Ramanujam Crystal L. , Stuto Alan C. , Zgonis Thomas
Published: June 2020

Objective:

A wide range of clinical presentations of Charcot neuroarthropathy of the foot with concomitant osteomyelitis in patients with diabetes has been described. Existing literature provides an equally diverse list of treatment options. The purpose of this systematic review was to assess the outcomes specifically for the surgical management of midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes.

Method:

A systematic review was conducted by three independent reviewers using the following databases and search engines: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica dataBASE), Google Scholar, Ovid, PubMed and Scopus. Search terms used were: Charcot neuroarthropathy, osteoarthropathy, neuro-osteoarthropathy, neurogenic arthropathy, osteomyelitis, midfoot, foot, ankle, diabetes mellitus, ulceration, wound, infection, surgical offloading, diabetic reconstruction, internal fixation, external fixation. Studies meeting the following criteria were included: English language studies, studies published from 1997–2017, patients with diabetes mellitus surgically treated for Charcot neuroarthropathy of the midfoot (specified location) with concomitant osteomyelitis, with or without internal and/or external fixation, follow-up period of six months or more postoperatively, documentation of healing rates, complications, and need for revisional surgery. Studies which were entirely literature reviews, descriptions of surgical-only technique and/or cadaveric studies, patients without diabetes, studies that did not specify location of osteomyelitis and Charcot neuroarthropathy, and treatment proximal to and including Chopart's/midtarsal joint specifically talonavicular, calcaneocuboid, subtalar, ankle were excluded.

Results:

A total of 13 selected studies, with a total of 114 patients with diabetes of which 56 had surgical treatment for midfoot Charcot neuroarthropathy with osteomyelitis, met the above inclusion criteria and were used for data extraction.

Conclusion:

Surgical intervention for midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes demonstrated a relatively high success rate for a range of procedures including debridement with simple exostectomy, arthrodesis with or without internal or external fixation, and advanced soft tissue reconstruction. However, this systematic review emphasises the need for larger, better designed studies to investigate the efficacy and failure rates of surgical treatment in this group of patients.
Multiplexable high-temperature stable and low-loss intrinsic Fabry-Perot in-fiber sensors through nanograting engineering
Authors: Wang Mohan , Yang Yang , Huang Sheng , Wu Jingyu , Zhao Kehao , Li Yuqi , Peng Zhaoqiang , Zou Ran , Lan Hui , Ohodnicki Paul R. , Lu Ping , Buric Michael P. , Liu Bo , Yu Qingxu , Chen Kevin P.
Published: June 2020

This paper presents a method of using femtosecond laser inscribed nanograting as low-loss– and high-temperature–stable in-fiber reflectors. By introducing a pair of nanograting inside the core of a single-mode optical fiber, an intrinsic Fabry-Perot interferometer can be created for high-temperature sensing applications. The morphology of the nanograting inscribed in fiber cores was engineered by tuning the fabrication conditions to achieve a high fringe visibility of 0.49 and low insertion loss of 0.002 dB per sensor. Using a white light interferometry demodulation algorithm, we demonstrate the temperature sensitivity, cross-talk, and spatial multiplexability of sensor arrays. Both the sensor performance and stability were studied from room temperature to 1000°C with cyclic heating and cooling. Our results demonstrate a femtosecond direct laser writing technique capable of producing highly multiplexable in-fiber intrinsic Fabry-Perot interferometer sensor devices with high fringe contrast, high sensitivity, and low-loss for application in harsh environmental conditions.
El archivo general de Villafranca durante la Guerra de Independencia Española
Authors: Beltrán Corbalán Domingo , Izquierdo Francisco Precioso
Published: June 2020

As funções do arquivo geral da casa de Villafranca foram interrompidas pela apreensão francesa da propriedade do marquês durante a Guerra da Independência. Esse facto constituiu uma grave violação dos interesses da casa do marquês, uma vez que a privação da documentação dificultou os governos senhoriais. Neste artigo, analisamos a maneira pela qual esses eventos ocorreram, prestando atenção especial à série de práticas de reorganização de arquivos, bem como aos projetos de transferência tentados pelo proprietário da casa após a recuperação de seus fundos documentais.
Propuesta de un método de evaluación del patrimonio cultural y su aplicación en Cortes de Pallás (Valencia)
Authors: Mayordomo Maya Sandra , Hermosilla Pla Jorge
Published: June 2020

Las áreas rurales han experimentado significativas transformaciones socioeconómicas en las últimas décadas, en las cuales ha sido común la competencia de los ámbitos urbanos. Actualmente constituyen espacios multifuncionales caracterizados por el desempeño de nuevas actividades, donde el patrimonio se configura como un recurso esencial en las estrategias de desarrollo territorial (local). No obstante, el diseño de proyectos de valorización requiere la identificación del valor de cada bien. El propósito del estudio es la propuesta de un método de evaluación del patrimonio cultural, conformado por tres sistemas específicos que permiten cuantificar el interés patrimonial de los bienes inmuebles, inmateriales y los paisajes. La metodología posee una estructura jerarquizada basada en múltiples indicadores, y contempla la implementación de acciones de participación. La comprobación de la aplicabilidad del método se efectúa en una treintena de bienes emplazados en la Huerta de Cortes de Pallás, un municipio rural del interior valenciano. Entre los resultados técnicos y participativos destaca la presencia de un patrimonio valioso, y se constata la creciente consideración social hacia el medio rural y agrario. La aplicación íntegra del método confirma su validez y con ello la disponibilidad de un instrumento eficaz de gestión patrimonial que puede ser asumido por las instituciones.
Amazon in flames: for a multilevel environmental transnational governance
Authors: Cruz Paulo Márcio , Bodnar Zenildo , Staffen Márcio Ricardo
Published: June 2020

This paper allows an analysis of transnational governance perspectives for the protection, defense and management of natural resources of planetary dimensions, such as the Amazon, which has been strongly impacted by the recent burnings of widespread media dissemination, heated diplomatic debates and the performance of non-state actors. The problem that is analyzed is the adequate understanding of the meaning of nation state and sovereignty, as well as its reflexes in the effective protection of juridical goods with planetary dimension. The approach starts from an analysis of Amazonian burning and the challenges of good environmental governance; discusses the state crisis and state sovereignty as concepts that demand redefinition. Finally, it argues for the need for multilevel environmental transnational governance, as a joint strategy to promote sustainability in a global perspective and to defend and protect the Amazonian natural resources. The research consists of bibliographic research produced from inductive logic-based methodology.
Assessment of water source availability and quality for small ruminant consumption in the Northern Badia region of Jordan
Authors: Al-Khaza'leh J. , Abdelqader A. , Abuajamieh M. , Hayajneh F. M. F.
Published: June 2020

Background and Aim: Water is the most important nutrient for the production of healthy livestock. Water scarcity bottlenecks livestock production in arid and semi-arid regions, particularly during the dry season. This study aimed to assess water availability and quality for small ruminants, and to identify major challenges of meeting their water requirements in two major small ruminant production systems in Jordan.

Materials and Methods: Transhumant and sedentary production systems in the Northern Badia region of Jordan were the focus of this study. A questionnaire was distributed to 120 sheep and goat farmers (62 transhumant farmers and 58 sedentary farmers) and a water quality assessment was completed.

Results: Results showed that the two production systems varied their water source use seasonally. Water provision was perceived as one of the major constraints for Bedouins, particularly during the dry season in transhumant production systems, when longer distances to water sources and the high costs of fetching water daily aggravated the problem. The mean distance and travel times to the boreholes were less in the sedentary system. Watering frequency was significantly lower in the transhumant system compared to the sedentary system (p<0.05). Although the values of water quality parameters complied with guidelines for livestock consumption, low water quality was the main concern expressed by some of the survey households.

Conclusion: Technical support to properly design, manage, and rehabilitate surface water harvesting systems is required for the sustainable use of water resources in the study region. Moreover, systematic water quality monitoring is necessary to ensure its suitability for livestock use. Further investigations on the microbiological quality of water and its effect on the health and performance of livestock are recommended.
Relationship between Maternal and Children Body Mass Index in four Educational Systems in Hidalgo, Mexico
Authors: García Meraz Melissa , Guzmán Saldaña Rebeca María Elena , López-Rodríguez Guadalupe , Galván Marcos
Published: June 2020

Introduction: While the prevalence of overweight and obesity is pervasive in adults and children in Mexico, differences and relationships among children and their mothers from different ethnic groups, educational systems, and environmental settings in Mexico is understudied. Objective: The present study tested the relationship between Maternal Body Mass Index (MBMI) and Children’s Z-score Body Mass Index for Age (ZBFA) from indigenous, private, public and CONAFE (community schools in marginalized rural areas) schools representing four distinct educational systems in Hidalgo, Mexico.Material and methods: A survey-type study was carried out in a random sample of school children and their mothers. The weight and height of the children and their mothers was evaluated with standardize anthropometric techniques. Mothers’ and children’s scores were evaluated following the recommendations by the World Health Organization (WHO).Results: Prevalence of overweight was very high in mothers (55.8%), without signiﬁcant differences in MBMI across the four different educational systems. Children from private schools showed higher Body Mass Index, being the girls with the highest scores. Our initial model only included MBMI and Children’s ZBFA, this relationship provided us with a model that explained only 7% of the variance. However, when school type was added as covariate in models for boys and girls, the explained variance increased (17% and 33% respectively).Conclusions: It was found evidence of a low relationship between Maternal Body Mass Index and Child Body Mass Index. This relationship was stronger when the type of school was added as a covariate. The evidence revealed differences between the environment of rural and urban schools, between mestizo populations and indigenous groups.