bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive radiotherapy for head and neck cancer reduces the requirement for rescans during treatment due to spinal cord dose
Authors: Belshaw Louise , Agnew Christina E. , Irvine Denise M. , Rooney Keith P. , McGarry Conor K.
Published: November 2019

Background

Patients treated with radiotherapy for head and neck (H&N) cancer often experience anatomical changes. The potential compromises to Planning Target Volume (PTV) coverage or Organ at Risk (OAR) sparing has prompted the use of adaptive radiotherapy (ART) for these patients. However, implementation of ART is time and resource intensive. This study seeks to define a clinical trigger for H&N re-plans based on spinal cord safety using kV Cone-Beam Computed Tomography (CBCT) verification imaging, in order to best balance clinical benefit with additional workload.

Methods

Thirty-one H&N patients treated with Volumetric Modulated Arc Therapy (VMAT) who had a rescan CT (rCT) during treatment were included in this study. Contour volume changes between the planning CT (pCT) and rCT were determined. The original treatment plan was calculated on the pCT, CBCT prior to the rCT, pCT deformed to the anatomy of the CBCT (dCT), and rCT (considered the gold standard). The dose to 0.1 cc (D0.1cc) spinal cord was evaluated from the Dose Volume Histograms (DVHs).

Results

The median dose increase to D0.1cc between the pCT and rCT was 0.7 Gy (inter-quartile range 0.2–1.9 Gy, p < 0.05). No correlation was found between contour volume changes and the spinal cord dose increase. Three patients exhibited an increase of 7.0–7.2 Gy to D0.1cc, resulting in a re-plan; these patients were correctly identified using calculations on the CBCT/dCT.

Conclusions

An adaptive re-plan can be triggered using spinal cord doses calculated on the CBCT/dCT. Implementing this trigger can reduce patient appointments and radiation dose by eliminating up to 90% of additional un-necessary CT scans, reducing the workload for radiographers, physicists, dosimetrists, and clinicians.
PROtective Ventilation with a low versus high Inspiratory Oxygen fraction (PROVIO) and its effects on postoperative pulmonary complications: protocol for a randomized controlled trial
Authors: Li Xue-Fei , Jiang Dan , Jiang Yu-Lian , Yu Hong , Jiang Jia-Li , He Lei-Lei , Yang Xiao-Yun , Yu Hai
Published: November 2019

Background

Postoperative pulmonary complications (PPCs) are the most common perioperative complications following surgical site infection (SSI). They prolong the hospital stay and increase health care costs. A lung-protective ventilation strategy is considered better practice in abdominal surgery to prevent PPCs. However, the role of the inspiratory oxygen fraction (FiO2) in the strategy remains disputed. Previous trials have focused on reducing SSI by increasing the inhaled oxygen concentration but higher FiO2(80%) was found to be associated with a greater incidence of atelectasis and mortality in recent research. The trial aims at evaluating the effect of different FiO2added to the lung-protective ventilation strategy on the incidence of PPCs during general anesthesia for abdominal surgery.

Methods and design

PROtective Ventilation with a low versus high Inspiratory Oxygen fraction trial (PROVIO) is a single-center, prospective, randomized controlled trial planning to recruit 252 patients undergoing abdominal surgery lasting for at least 2 h. The patients will be randomly assigned to (1) a low-FiO2(30% FiO2) group and (2) a high-FiO2(80% FiO2) group in the lung-protective ventilation strategy. The primary outcome of the study is the occurrence of PPCs within the postoperative 7 days. Secondary outcomes include the severity grade of PPCs, the occurrence of postoperative extrapulmonary complications and all-cause mortality within the postoperative 7 and 30 days.

Discussion

The PROVIO trial assesses the effect of low versus high FiO2added to a lung-protective ventilation strategy on PPCs for abdominal surgery patients and the results should provide practical approaches to intraoperative oxygen management.

Trial registration

www.ChiCTR.org.cn, identifier:ChiCTR18 00014901. Registered on 13 February 2018.
Renal epithelial cells retain primary cilia during human acute renal allograft rejection injury
Authors: Verghese Elizabeth , Martelotto Luciano G. , Cain Jason E. , Williams Timothy M. , Wise Andrea F. , Hill Prudence A. , Langham Robyn G. , Watkins D. Neil , Ricardo Sharon D. , Deane James A.
Published: November 2019

Objectives

Primary cilia are sensory organelles which co-ordinate several developmental/repair pathways including hedgehog signalling. Studies of human renal allografts suffering acute tubular necrosis have shown that length of primary cilia borne by epithelial cells doubles throughout the nephron and collecting duct, and then normalises as renal function returns. Conversely the loss of primary cilia has been reported in chronic allograft rejection and linked to defective hedgehog signalling. We investigated the fate of primary cilia in renal allografts suffering acute rejection.

Results

Here we observed that in renal allografts undergoing acute rejection, primary cilia were retained, with their length increasing 1 week after transplantation and remaining elevated. We used a mouse model of acute renal injury to demonstrate that elongated renal primary cilia in the injured renal tubule show evidence of smoothened accumulation, a biomarker for activation of hedgehog signalling. We conclude that primary cilium-mediated activation of hedgehog signalling is still possible during the acute phase of renal allograft rejection.
Analysis of the clinical significance of DNA methylation in gastric cancer based on a genome-wide high-resolution array
Authors: Fang Wen-Liang , Chen Ming-Huang , Huang Kuo-Hung , Chang Shih-Ching , Lin Chien-Hsing , Chao Yee , Lo Su-Shun , Li Anna Fen-Yau , Wu Chew-Wun , Shyr Yi-Ming
Published: November 2019

Background

Aberrant DNA methylation is involved in gastric carcinogenesis and may serve as a useful biomarker in the diagnosis and detection of gastric cancer (GC) recurrence.

Results

A total of 157 patients who received surgery for GC were enrolled in the present study. A genome-wide methylation analysis was performed in tumor and adjacent normal tissues for the discovery set of 16 GC patients; the top three hypermethylated CpG sites of DNA promoters were selected for validation in tissue and plasma samples for the validation set of 141 GC patients. The frequencies of the top three hypermethylated genes in available patient tissues (n = 141) and plasma samples (n = 106) were 41.8% and 38.7%, respectively, for ADAM19; 40.4% and 42.5%, respectively, for FLI1; and 56.7% and 50.9%, respectively, for MSC. In both tissue and plasma samples, FLI1 hypermethylation was associated with more advanced GC and liver and distant lymphatic metastasis, and ADAM19 hypermethylation was associated with more stage IV GC. In plasma samples, MSC hypermethylation was more common in non-superficial type GC than samples without MSC hypermethylation. In both tissue and plasma samples, patients with methylation of all the three genes had significantly more liver metastases, distant lymphatic metastases, and paraaortic lymph node metastases than patients with two or fewer hypermethylated genes. The survival analysis showed that only for stage III GC, patients with hypermethylation of two or three genes had a worse 5-year disease-free survival rate than those with hypermethylation of one or none of the three genes. Subgroup analysis showed that FLI1 hypermethylation in both tissue and plasma samples was associated with liver metastasis in MSI−/EBV− GC, and MSC hypermethylation in tissue samples was correlated with liver metastasis in MSI+ or EBV+ GC. Patients with FLI1 hypermethylation in plasma samples had a significantly worse 5-year disease-free survival rate than those without FLI1 hypermethylation in MSI−/EBV− GC. FLI1 hypermethylation was an independent prognostic factor affecting the overall survival and disease-free survival in both tissue and plasma samples.

Conclusions

DNA methylation is a useful biomarker for predicting tumor recurrence patterns and GC patient survival.
Satisfaction of Nigerian patients with health services: a protocol for a systematic review
Authors: Akunne Maureen O. , Okonta Mathew J. , Ukwe Chinwe V. , Heise Thomas L. , Ekwunife Obinna I.
Published: November 2019

Background

Patient-based assessment of health services is becoming popular in measuring the standard of care. Both quantitative and qualitative methods are available. Patient satisfaction surveys are commonly used to record the experiences of patients in hospitals, whereas qualitative designs (e.g., interviews and focus group discussions) are used less frequently. To date, there has been no systematic review published devoted to patient satisfaction with health services in Nigeria. We aim to (1) systematically analyze relevant quantitative studies to pinpoint excellent procedures in measuring patient satisfaction with health services, (2) to investigate if a reference method (gold standard method) exists, and (3) to identify relevant topics which are recognized by patients as important for the delivery of a high-quality health service in Nigeria.

Methods

Searches of eight electronic journal databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, AJOL, CDSR, DARE, and HTA will be conducted to identify studies assessing patient satisfaction with health services in Nigeria. The searches will be supported by manual searches in reference lists of relevant primary studies and systematic reviews. The review will be limited to studies published since 2007. After a stepwise screening process by two reviewers, data from included studies will be extracted and reviewed. The COSMIN RoB checklist will be used to critically appraise included studies. We will carry out an extensive data synthesis to answer the review questions.

Discussion

The intended systematic review will provide information on how the satisfaction of patients with health services has earlier been described and assessed in Nigerian studies. It will establish if a gold standard method exists and synthesize information on topics which might be of special interest to patients. Review findings will enrich the debate on patient-centered care and overall performance of health quality standards in Nigeria.

Systematic review registration

PROSPEROCRD42018108140
An automated fruit harvesting robot by using deep learning
Authors: Onishi Yuki , Yoshida Takeshi , Kurita Hiroki , Fukao Takanori , Arihara Hiromu , Iwai Ayako
Published: November 2019

Automation and labor saving in agriculture have been required recently. However, mechanization and robots for growing fruits have not been advanced. This study proposes a method of detecting fruits and automated harvesting using a robot arm. A highly fast and accurate method with a Single Shot MultiBox Detector is used herein to detect the position of fruit, and a stereo camera is used to detect the three-dimensional position. After calculating the angles of the joints at the detected position by inverse kinematics, the robot arm is moved to the target fruit’s position. The robot then harvests the fruit by twisting the hand axis. The experimental results showed that more than 90% of the fruits were detected. Moreover, the robot could harvest a fruit in 16 s.
Brittle to quasi-brittle transition and crack initiation precursors in crystals with structural Inhomogeneities
Authors: Papanikolaou S. , Shanthraj P. , Thibault J. , Woodward C. , Roters F.
Published: November 2019

Crack initiation emerges due to a combination of elasticity, plasticity, and disorder, and it displays strong dependence on the material’s microstructural details. The characterization of the structural uncertainty in the original microstructure is typically empirical and systematic characterization protocols are lacking. In this paper, we propose an investigational tool in the form of the curvature of an ellipsoidal notch: As the radius of curvature at the notch increases, there is a dynamic phase transition from notch-induced crack initiation to disorder-induced crack nucleation. We argue that the this transition may unveil the characteristic length scale of structural disorder in the material. We investigate brittle but elastoplastic metals with continuum, microstructural disorder that could originate in a manufacturing process, such as alloying. We perform extensive and realistic simulations, using a phase-field approach coupled to crystal plasticity, where microstructural disorder and notch width are systematically varied. We identify the brittle-to-quasi-brittle transition for various disorder strengths in terms of the damage and stress evolution. Moreover, we investigate precursors to crack initiation that we quantify in terms of the expected stress drops during displacement control loading.
Correction to: Comparison of rodent community between natural and modified habitats in Kafta-Sheraro National Park and its adjoining villages, Ethiopia: implication for conservation
Authors: Assefa Alembrhan , Chelmala Srinivasulu
Published: November 2019

In the original version of this article (Assefa & Chelmala, 2019), published on 5 September 2019, there was 1 incorrect author name.
Outcome evaluation by patient reported outcome measures in stroke clinical practice (EPOS) protocol for a prospective observation and implementation study
Authors: Rimmele D. Leander , Lebherz Lisa , Frese Marc , Appelbohm Hannes , Bartz Hans-Jürgen , Kriston Levente , Gerloff Christian , Härter Martin , Thomalla Götz
Published: November 2019

Introduction

The impact of stroke-related impairment on activities of daily living may vary between patients, and can only be estimated by applying patient-reported outcome measures. The International Consortium for Health Outcome Measurement has developed a standard set of instruments that combine clinical and longitudinal patient-reported outcome measures for stroke. The present study was designed (1) to implement and evaluate the feasibility of the use of it as a consistent outcome measure in clinical routine at the stroke center of a German university hospital, (2) to characterize impairment in everyday life caused by stroke, and (3) to identify predictive factors associated with patient-relevant outcomes.

Methods

We plan to enroll 1040 consecutive patients with the diagnosis of acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage in a prospective observational study. Demographics, cardiovascular risk factors, and living situation are assessed at inpatient surveillance. At 90 days and 12 months after inclusion, follow-up assessments take place including the Patient-reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10), the Patient- Health Questionnaire-4, and the simplified modified Ranking Scale questionnaire. The acceptance and feasibility (1) will be assessed by a process evaluation through qualitative semi-structured interviews with clinical staff and patients and quantitative analyses of the data quality evaluating practicability, acceptance, adoption, and fidelity to protocol. The primary outcome of objective 2 and 3 is health-related quality of life measured with the PROMIS-10. Additional outcomes are depressive and anxiety symptoms and patient participation in their social roles. Patient-reported outcomes will be assessed in their longitudinal course using (generalized) mixed regressions. Exploratory descriptive and inference statistical analyses will be used to find patterns of patient characteristics and predictive factors of the outcome domains.

Perspective

The results will describe and further establish the evaluation of stroke patients of a stroke center by standardized PROMs in everyday life.

Trial registration

The trial is registered atClinicalTrials.gov(NCT03795948). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg) has been obtained.
Heat shock protein 70 increases cell proliferation, neuroblast differentiation, and the phosphorylation of CREB in the hippocampus
Authors: Kwon Hyun Jung , Kim Woosuk , Jung Hyo Young , Kang Min Soo , Kim Jong Whi , Hahn Kyu Ri , Yoo Dae Young , Yoon Yeo Sung , Hwang In Koo , Kim Dae Won
Published: November 2019

In the present study, we investigated the effects of heat shock protein 70 (HSP70) on novel object recognition, cell proliferation, and neuroblast differentiation in the hippocampus. To facilitate penetration into the blood–brain barrier and neuronal plasma membrane, we created a Tat-HSP70 fusion protein. Eight-week-old mice received intraperitoneal injections of vehicle (10% glycerol), control-HSP70, or Tat-HSP70 protein once a day for 21 days. To elucidate the delivery efficiency of HSP70 into the hippocampus, western blot analysis for polyhistidine was conducted. Polyhistidine protein levels were significantly increased in control-HSP70- and Tat-HSP70-treated groups compared to the control or vehicle-treated group. However, polyhistidine protein levels were significantly higher in the Tat-HSP70-treated group compared to that in the control-HSP70-treated group. In addition, immunohistochemical study for HSP70 showed direct evidences for induction of HSP70 immunoreactivity in the control-HSP70- and Tat-HSP70-treated groups. Administration of Tat-HSP70 increased the novel object recognition memory compared to untreated mice or mice treated with the vehicle. In addition, the administration of Tat-HSP70 significantly increased the populations of proliferating cells and differentiated neuroblasts in the dentate gyrus compared to those in the control or vehicle-treated group based on the Ki67 and doublecortin (DCX) immunostaining. Furthermore, the phosphorylation of cAMP response element-binding protein (pCREB) was significantly enhanced in the dentate gyrus of the Tat-HSP70-treated group compared to that in the control or vehicle-treated group. Western blot study also demonstrated the increases of DCX and pCREB protein levels in the Tat-HSP70-treated group compared to that in the control or vehicle-treated group. In contrast, administration of control-HSP70 moderately increased the novel object recognition memory, cell proliferation, and neuroblast differentiation in the dentate gyrus compared to that in the control or vehicle-treated group. These results suggest that Tat-HSP70 promoted hippocampal functions by increasing the pCREB in the hippocampus.
Enhancing ecological-economic efficiency of intensive shrimp farm through in-out nutrient budget and feed conversion ratio
Authors: Chaikaew Pasicha , Rugkarn Natcha , Pongpipatwattana Varot , Kanokkantapong Vorapot
Published: November 2019

In aquaculture systems, insufficient nutrients impede shrimp growth while excessive amounts of nutrient inputs lead to environmental degradation and unnecessary high investment. A study of in-out nutrient budgets in an intensive Litopenaeus vannamei farm was conducted in this work to measure the amount of nitrogen (N) and phosphorus (P) input and output from the system. The feed conversion ratio (FCR) was obtained to determine the level of nutrient input performance. Between September and December 2017, monthly water and sediment samples were taken within one crop cycle. Nutrient concentrations in sediment and water increased over 90 days. The total nitrogen concentration in the pond water and effluents were in accordance with wastewater quality control for aquaculture; however, the total phosphorus concentration failed to meet the water quality control from the water input through the end of the crop cycle. The nutrient budget model showed that the input/output contained 107.8 kg N and 178.4 kg P. Most of the N input came from shrimp diets (80%) while most of the P came from fertilizer (57%). Both N (46%) and P (54%) mainly deposited in the sediment as an output process. The FCR of this farm is 2.0. Based on the 1.8 FCR scenario, this farm could reduce 147 kg of feed in total, which accounts for 9.04 kg N and 2.21 kg P reduction. The farmer could save $1027 USD crop− 1 ($1 USD = 32.7 baht), as well as reducing uneaten food at the bottom of the pond. This study offers a simple and straightforward model that can practically reduce environmental impacts and increase the profitability of farms.
Association between dietary sodium, calcium, saturated fat and blood pressure in obese Egyptian adolescents
Authors: Hassana Nayera E. , El Shebinib Salwa M. , El-Masrya Sahar A. , Ahmedb Nihad H. , Alia Manal M. , El-Saeedc Gamila S. M. , El-Lebedyd Dalia
Published: November 2019

Background

Overweight/obesity, high dietary fat, sodium and low calcium intake are recognized as risk factors for primary hypertension in obese adults, children and adolescents.

Aim

The aim of this work was to assess the association between some dietary factors (fat, sodium, calcium) and blood pressure (BP) among obese Egyptian adolescents.

Subjects and methods

Seventy-seven adolescents shared in this study. Their height and weight were reported. Body mass index (BMI) was calculated. Blood pressure was measured; the mean values were corrected for age and sex in the form of centile. Dietary interview consisting of 24 h recall was performed. Fasting blood glucose and serum lipid profile were determined.

Results

Data revealed that, the percent of the prehypertensive was 42.86% and 38.80%, for boys and girls, no hypertensive cases were recorded. The mean values of their weight, DBP, and the serum lipid parameters were high compared to their controls; significant differences were found between the daily intake of calories, protein, carbohydrate, dietary fiber and cholesterol at p ≤ 0.05. The mean values of the daily intake of the vitamins and minerals were low in all groups compared to the RDAs, except sodium intake which was high in the prehypertensive boys and normal and prehypertensive girls.

Conclusion

This study showed a high incidence of pre-hypertension among obese Egyptian adolescents, which is associated with high intake of sodium, saturated fat and cholesterol, along with low intake of calcium.
Expert–Novice Comparison Reveals Pedagogical Implications for Students’ Analysis of Primary Literature
Authors: Nelms April A. , Segura-Totten Miriam
Published: November 2019

Student engagement in the analysis of primary scientific literature increases critical thinking, scientific literacy, data evaluation, and science process skills. However, little is known about the process by which expertise in reading scientific articles develops. For this reason, we decided to compare how faculty experts and student novices engage with a research article. We performed think-aloud interviews of biology faculty and undergraduates as they read through a scientific article. We analyzed these interviews using qualitative methods. We grounded data interpretation in cognitive load theory and the ICAP (interactive, constructive, active, and passive) framework. Our results revealed that faculty have more complex schemas than students and that they reduce cognitive load through two main mechanisms: summarizing and note-taking. Faculty also engage with articles at a higher cognitive level, described as constructive by the ICAP framework, when compared with students. More complex schemas, effectively lowering cognitive load, and deeper engagement with the text may help explain why faculty encounter fewer comprehension difficulties than students in our study. Finally, faculty analyze and evaluate data more often than students when reading the text. Findings include a discussion of successful pedagogical approaches for instructors wishing to enhance undergraduates’ comprehension and analysis of research articles.
DAS observations and modeling of perforation-induced guided waves in a shale reservoir
Authors: Lellouch Ariel , Horne Steve , Meadows Mark A. , Farris Stuart , Nemeth Tamas , Biondi Biondo
Published: November 2019

Perforation shots can be recorded by downhole distributed acoustic sensing (DAS) arrays. In this study, we demonstrate that guided waves induced by perforation shots propagate in a low-velocity shale reservoir layer. Such guided waves have a high frequency content of up to 700 Hz and are dispersive, with lower frequencies propagating faster than higher frequencies. They can propagate as P- and S-waves, and their group velocity is higher than their phase velocity. The high temporal and spatial resolution of the DAS array enables unaliased recording despite short wavelengths. The guided waves disappear from the records when the well exits the shale formation. Synthetic modeling predicts their existence for acoustic and elastic cases in simple velocity models. We show that perforation shots from an offset well at a distance of about 270 m can be recorded by the DAS array. Induced guided S-waves undergo significant disturbances while propagating through previously stimulated zones. These disturbances manifest as kinematic and dynamic changes of the recorded wavefield and as scattered events. The nature of the stimulation-induced changes is interpreted as a combination of unknown spatial and temporal effects linked to fluid-filled fractures. Guided waves hold tremendous potential for high-resolution reservoir imaging and should be used in conjunction with conventional DAS arrays and state-of-the-art DAS interrogators.
IPTC 2020: A first for Saudi Arabia
Authors: Reilly Joseph , Badri Mohammed
Published: November 2019

In a first since its founding in 2005, the International Petroleum Technology Conference (IPTC) is coming to the Kingdom of Saudi Arabia, 13–15 January 2020, with Saudi Aramco as the exclusive host. Beyond the location in Dhahran, Saudi Arabia, being a first for IPTC, it is also the first international multidisciplinary, multisociety oil and gas conference and expo ever to be held in Saudi Arabia. The conference is especially welcomed since the last IPTC conference in the Middle East was in December 2015 in Doha. The conference's executive committee included more than 45 top company executives and managers, positioning the event for remarkable success. Saudi Arabia has seen significant changes in recent years, making it a perfect place for this oil and gas conference that will attract many professionals to visit the kingdom and learn about its oil industry.
The Soviet Project of the 1930s to Found a “World Literature” and British Literary Internationalism
Authors: Clark Katerina
Published: November 2019

A major lacuna in Pascale Casanova’s account of world literature in her World Republic of Letters is the Soviet venture into establishing a “world literature” (mirovaia literatura) to be centered not in Paris but in Moscow. This aim was most actively pursued between the wars, when many writers were implicated in its international network. This moment in literary history provides a missing link in the progression from the more elitist world literature as conceived by Goethe and others in the early nineteenth century to world literature in our postcolonialist present and era of globalization. This article outlines the networks that sought to foster such a world literature and the main aesthetic controversies within the movement. In particular, the article looks at the efforts of such official spokesmen as Andrei Zhdanov, Karl Radek, and Georg Lukács to proscribe “bourgeois” modernism. It takes members of the British Writers’ International and their associated journals the Left Review and New Writing as case studies in the interplay between Moscow as putative “metropole” and the “periphery.”
Literary History after Literary Dominance
Authors: Hayot Eric
Published: November 2019

The various pronouncements of the nation’s dissolution seem to have been premature. Literary history is still very much within the nation, especially if one considers the realm of the middle- and lowbrow, or indeed the vast swaths of genre fiction. What has changed in literary history is the position of literature itself. The discipline of literary study (whether one thinks of it as literary history or literary criticism) institutionalized itself during a period of literary dominance. Now that that dominance is over—now that the field of narrative aesthetic culture includes television, film, and video games, and now that those genres dominate not only markets but the forms of representativity that used to belong almost exclusively to literature—what is the future for literary studies, either as a scholarly discipline or as an institutional field?
When More Is Not Better: Three Common Mistakes in Health Messaging Interventions
Authors: Farrow Katherine , Grolleau Gilles , Mzoughi Naoufel
Published: November 2019

Health messaging interventions frequently make three well-intentioned but mistaken choices in their communications strategies. To increase their persuasiveness, these messages frequently call attention to the greatest possible numbers of people engaging in undesirable behavior, victims of this behavior, and reasons why one should change the behavior. We raise recent research suggesting how and why the intuitively attractive more-is-better heuristic can be unproductive, and suggest ways to overcome these pitfalls.
Model systems for regeneration: Hydra
Authors: Vogg Matthias C. , Galliot Brigitte , Tsiairis Charisios D.
Published: November 2019

The freshwater polyp Hydra provides a potent model system for investigating the conditions that promote wound healing, reactivation of a developmental process and, ultimately, regeneration of an amputated body part. Hydra polyps can also be dissociated to the single cell level and can regenerate a complete body axis from aggregates, behaving as natural organoids. In recent years, the ability to exploit Hydra has been expanded with the advent of new live-imaging approaches, genetic manipulations that include stable transgenesis, gene silencing and genome editing, and the accumulation of high-throughput omics data. In this Primer, we provide an overview of Hydra as a model system for studying regeneration, highlighting recent results that question the classical self-enhancement and long-range inhibition model supposed to drive Hydra regeneration. We underscore the need for integrative explanations incorporating biochemical as well as mechanical signalling.
New insights into transcriptional reprogramming during cellular stress
Authors: Himanen Samu V. , Sistonen Lea
Published: November 2019

Cellular stress triggers reprogramming of transcription, which is required for the maintenance of homeostasis under adverse growth conditions. Stress-induced changes in transcription include induction of cyto-protective genes and repression of genes related to the regulation of the cell cycle, transcription and metabolism. Induction of transcription is mediated through the activation of stress-responsive transcription factors that facilitate the release of stalled RNA polymerase II and so allow for transcriptional elongation. Repression of transcription, in turn, involves components that retain RNA polymerase II in a paused state on gene promoters. Moreover, transcription during stress is regulated by a massive activation of enhancers and complex changes in chromatin organization. In this Review, we highlight the latest research regarding the molecular mechanisms of transcriptional reprogramming upon stress in the context of specific proteotoxic stress responses, including the heat-shock response, unfolded protein response, oxidative stress response and hypoxia response.
Randomized Safety Inspections and Risk Exposure on the Job: Quasi-experimental Estimates of the Value of a Statistical Life
Authors: Lee Jonathan M. , Taylor Laura O.
Published: November 2019

The value of a statistical life (VSL) is a critical driver of estimated benefits for federal policies designed to improve human health, safety, and environmental exposures. The vast majority of empirical evidence on the magnitude of the VSL arises from hedonic wage models that have been plagued by measurement error and omitted variables. To address these limitations, this paper employs randomly assigned workplace safety inspections to instrument for plant-level risks in a quasi-experimental design. We provide credible causal evidence for the existence of compensating wages for fatality risks and estimate a VSL between $(2016)8 million and $(2016)10 million. (JEL J17, J28, J31, K32)
Price Regulation, Price Discrimination, and Equality of Opportunity in Higher Education: Evidence from Texas
Authors: Andrews Rodney J. , Stange Kevin M.
Published: November 2019

We assess the importance of price regulation and price discrimination to low-income students’ access to opportunities in public higher education. In 2003, Texas shifted tuition-setting authority away from the state legislature to public universities themselves. In response, most institutions raised sticker prices and many began charging more for high-earning majors, such as business and engineering. We find that poor students actually shifted toward higher earning programs following deregulation, relative to non-poor students. Deregulation facilitated more price discrimination through increased grant aid and enabled supply-side enhancements, which may have partially shielded poor students from higher sticker prices. (JEL D63, H75, I22, I23, I24, I28, I32)
Peer Preferences, School Competition, and the Effects of Public School Choice
Authors: Barseghyan Levon , Clark Damon , Coate Stephen
Published: November 2019

This paper develops a new economic model of public school choice. The key innovation is to model competition between schools in an environment in which parents have peer preferences. The analysis yields three main findings. First, peer preferences dampen schools’ incentives to exert effort in response to competitive pressure. Second, when peer preferences are sufficiently strong, choice can reduce social welfare. This is because choice is costly to exercise but aggregate peer quality is fixed. Third, given strong peer preferences, choice can reduce school quality in more affluent neighborhoods. We conclude that peer preferences weaken the case for choice. (JEL H73, H75, I21, I28, R23)
Incentives and Unintended Consequences: Spillover Effects in Food Choice
Authors: Angelucci Manuela , Prina Silvia , Royer Heather , Samek Anya
Published: November 2019

Little is known about how peers influence the impact of incentives. We study how peers’ actions and incentives can lead to peer spillover effects. Using a field experiment on snack choice in the school lunchroom (choice of grapes versus cookies), we randomize who receives incentives, the fraction of peers incentivized, and whether or not it can be observed that peers’ choices are incentivized. We show that, while peers’ actions of picking grapes have a positive spillover effect on children’s take-up of grapes, seeing that peers are incentivized to pick grapes has a negative spillover effect on take-up. When incentivized choices are public, incentivizing all children to pick grapes, relative to incentivizing none, has no statistically significant effect on take-up, as the negative spillover offsets the positive impacts of incentives. (JEL C93, D12, I21, J13)
Sustaining Honesty in Public Service: The Role of Selection
Authors: Barfort Sebastian , Harmon Nikolaj A. , Hjorth Frederik , Olsen Asmus Leth
Published: November 2019

We study the role of self-selection into public service in sustaining honesty in the public sector. Focusing on the world’s least corrupt country, Denmark, we use a survey experiment to document strong self-selection of more honest individuals into public service. This result differs sharply from existing findings from more corrupt settings. Differences in pro-social versus pecuniary motivation appear central to the observed selection pattern. Dishonest individuals are more pecuniarily motivated and self-select out of public service into higher-paying private sector jobs. Accordingly, we find that increasing public sector wages would attract more dishonest candidates to public service in Denmark. (JEL D73, H83, J31, J45)
New Evidence on Information Disclosure through Restaurant Hygiene Grading: Reply
Authors: Jin Ginger Zhe , Leslie Phillip
Published: November 2019

Ho, Ashwood, and Handan-Nader (forthcoming) replicates table VI of Jin and Leslie (2003) but questions its research design. Robustness checks support our original conclusion—foodborne hospitalizations, as defined in JL, declined in Los Angeles County (LA) relative to the rest of California (CA) after LA adopted restaurant hygiene grade cards in 1998. More precisely, the decline in LA is pronounced against central and Northern CA, but insignificant when compared with the rest of Southern CA. One possible explanation is that the LA regulation has generated spillovers in Southern CA. (JEL D83, H75, I12, I18, L83, L88)
A New Branch-and-Price-and-Cut Algorithm for One-Dimensional Bin-Packing Problems
Authors: Wei Lijun , Luo Zhixing , Baldacci Roberto , Lim Andrew
Published: November 2019

In this paper, a new branch-and-price-and-cut algorithm is proposed to solve the one-dimensional bin-packing problem (1D-BPP). The 1D-BPP is one of the most fundamental problems in combinatorial optimization and has been extensively studied for decades. Recently, a set of new 500 test instances were proposed for the 1D-BPP, and the best exact algorithm proposed in the literature can optimally solve 167 of these new instances, with a time limit of 1 hour imposed on each execution of the algorithm. The exact algorithm proposed in this paper is based on the classical set-partitioning model for the 1DBPPs and the subset row inequalities. We describe an ad hoc label-setting algorithm to solve the pricing problem, dominance, and fathoming rules to speed up its computation and a new primal heuristic. The exact algorithm can easily handle some practical constraints, such as the incompatibility between the items, and therefore, we also apply it to solve the one-dimensional bin-packing problem with conflicts (1D-BPPC). The proposed method is tested on a large family of 1D-BPP and 1D-BPPC classes of instances. For the 1D-BPP, the proposed method can optimally solve 237 instances of the new set of difficult instances; the largest instance involves 1,003 items and bins of capacity 80,000. For the 1D-BPPC, the experiments show that the method is highly competitive with state-of-the-art methods and that it successfully closed several open 1D-BPPC instances.
Development and delivery of a clinical leadership programme for integrated community teams
Authors: Roberson Carole
Published: November 2019

Neighbourhood teams were formed throughout Worcestershire in early 2018, which led to a change in staff roles and responsibilities, as these are multidisciplinary community teams. It became apparent during the transition that many of the staff in band 6 roles required additional support and education to enable them to develop their knowledge and skills. Therefore, a clinical leadership programme was developed specifically for these staff. The programme followed the principles of the NHS Leadership Framework and consisted of six full-day training sessions. During the programme, staff identified issues within their team and developed a plan to address these issues over the following 6–12 months. The next two cohorts of the programme included staff from out-of-hours community nursing teams. The feedback from all delegates and managers was overwhelmingly positive, and delegates continue to implement their plans.
Understanding indemnity in practice nursing: part 1
Authors: Finch John
Published: November 2019

In the first article of a two-part series, John Finch looks at accident indemnity in practice nursing. He examines precisely what a practice nurse is indemnified against, and what that means in practical terms
Could mandatory vaccinations increase uptake in children?
Authors: Sisson Helen
Published: November 2019

Since the UK lost its measles-free status, mandatory vaccination for children has been considered as a method to increase uptake. Helen Sisson discusses the pros and cons of this approach
In vivo wear measurement in a modern total knee arthroplasty with model-based radiostereometric analysis
Authors: Gascoyne Trevor , Parashin Sara , Teeter Matthew , Bohm Eric , Laende Elise , Dunbar Michael , Turgeon Thomas
Published: November 2019

Aims

A retrospective study was conducted to measure short-term in vivo linear and volumetric wear of polyethylene (PE) inserts in 101 total knee arthroplasty (TKA) patients using model-based radiostereometric analysis (MBRSA).

Patients and Methods

Nonweightbearing supine RSA exams were performed postoperatively and at six, 12, and 24 months. Weightbearing standing RSA exams were performed on select patients at 12 and 24 months. Wear was measured both linearly (joint space) and volumetrically (digital model overlap) at each available follow-up. Precision of both methods was assessed by comparing double RSA exams. Patient age, sex, body mass index, and Oxford Knee Scores were analyzed for any association with PE wear.

Results

Linear wear occurred at 0.015 mm/year (supine) and 0.220 mm/year (standing). Volumetric wear occurred at 10.3 mm3/year (supine) and 39.3 mm3/year (standing). Wear occurred primarily on the medial side of the joint. Weightbearing imaging greatly improved the reliability of measurement. Clinical precision of volumetric wear was 34 mm3. No significant associations were found between patient demographics or function scores and measured wear.

Conclusion

In vivo volumetric wear of TKAs can be assessed at short-term follow-up using MBRSA. Cite this article: Bone Joint J 2019;101-B:1348–1355.
Antibiotic-loaded bone cement is associated with a lower risk of revision following primary cemented total knee arthroplasty
Authors: Jameson Simon S. , Asaad Asaad , Diament Marina , Kasim Adetatyo , Bigirumurame Theophile , Baker Paul , Mason James , Partington Paul , Reed Mike
Published: November 2019

Aims

Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients.

Materials and Methods

Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients.

Results

Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group.

Conclusion

After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331–1347.
Knee Fix or Replace Trial (KFORT): a randomized controlled feasibility study
Authors: Hull Peter D. , Chou Daud T. S. , Lewis Sophie , Carrothers Andrew D. , Queally Joseph M. , Allison Annabel , Barton Gary , Costa Matthew L.
Published: November 2019

Aims

The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients.

Patients and Methods

Seven centres recruited patients into the study. Patients were eligible if they were greater than 65 years of age with a distal femoral fracture, and if the surgeon felt that they were suitable for either form of treatment. Outcome measures included the patients’ willingness to participate, clinicians’ willingness to recruit, rates of loss to follow-up, the ability to capture data, estimates of standard deviation to inform the sample size calculation, and the main determinants of cost. The primary clinical outcome measure was the EuroQol five-dimensional index (EQ-5D) at six months following injury.

Results

Of 36 patients who met the inclusion criteria, five declined to participate and eight were not recruited, leaving 23 patients to be randomized. One patient withdrew before surgery. Of the remaining patients, five (23%) withdrew during the follow-up period and six (26%) died. A 100% response rate was achieved for the EQ-5D at each follow-up point, excluding one missing datapoint at baseline. In the DFR group, the mean cost of the implant outweighed the mean cost of many other items, including theatre time, length of stay, and readmissions. For a powered RCT, a total sample size of 1400 would be required with 234 centres recruiting over three years. At six months, the EQ-5D utility index was lower in the DFR group.

Conclusion

This study found that running a full-scale trial in this country would not be feasible. However, it may be feasible to undertake an international multicentre trial, and our findings provide some guidance about the power of such a study, the numbers required, and some challenges that should be anticipated and addressed. Cite this article: Bone Joint J 2019;101-B:1408–1415.
Surgical treatment of Vancouver type B periprosthetic femoral fractures
Authors: Chatziagorou Georgios , Lindahl Hans , Kärrholm Johan
Published: November 2019

Aims

We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis.

Patients and Methods

The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR.

Results

Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures.

Conclusion

In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed. Cite this article: Bone Joint J 2019;101-B:1447–1458.