bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource implications of bortezomib therapy in a large UK cohort: An evaluation study
Authors: Djebbari Faouzi , Tatarczuch Maciej , Panitsas Fotios , Vallance Grant , Sultanova Manuela , Kothari Jaimal , Ramasamy Karthik , Peniket Andy
Published: August 2019

Background

Bortezomib is a cornerstone in the management of multiple myeloma. It remains an attractive treatment option because it is efficacious, reasonably well tolerated and easy to administer. However, data on resource implications in the UK for both patients and healthcare providers are limited.

Methods

We conducted a retrospective study of 127 patients to assess implications of bortezomib therapy on patients and healthcare resources. A patient-episode was defined as a patient attending the chemotherapy day treatment unit solely for bortezomib administration. Data were collected for the duration of therapy as follows: cost of drug calculated using the UK’s bortezomib indicative price as per British National Formulary, cost of drug administration in the chemotherapy day treatment unit calculated using the National Health Service’s schedule of service cost, time from check-in to drug administration, patient travel time and distance calculated using Google maps, and cost of travel.

Results

Median drug cost and administration cost per patient were £8336 (£2084–£108,368) and £4640 (£290–£15,080), respectively. Median time from check-in to administration was 63 min (range 5–433), median travel time was 90 min (range 8–270) and 80 min (range 8–280) during peak and off-peak periods, respectively. Median return travel distance was 33.4 miles (range 1.2–224) for travel cost per patient per trip was £8.35–£13.20.

Conclusions

Our real-world resource analysis demonstrated that delivering bortezomib therapy can be associated with significant cost and time implications for patients and healthcare providers. Our study method sets a basis for evaluating resource implications of other novel approaches to myeloma therapy.
Statement From the Society for the Advancement of Transplant Anesthesia: White Paper Advocating Desirable Milestones and Competencies for Anesthesiology Fellowship Training in the Field of Lung Transplantation
Authors: Wilkey Barbara J. , Abrams Benjamin A. , Del Rio J. Mauricio , Kertai Miklos D. , Subramaniam Kathirvel , Srinivas Coimbatore , Peng Yong G. , Berrio-Valencia Marta , Martin Archer K.
Published: August 2019

The clinical, educational, and research facets of lung transplantation have advanced significantly since the first lung transplant in 1963. The formation of the International Society for Heart and Lung Transplantation (ISHLT) and subsequent Registry has forged a precedent of collaborative teamwork that has significantly affected current lung transplantation outcomes. The Society for the Advancement of Anesthesia (SATA) is dedicated to developing educational platforms for all facets of transplant anesthesia. Additionally, we believe that the anesthetic training for lung transplantation has not kept pace with other advances in the field. As such, SATA presents for consideration these educational milestones and competencies for anesthetic fellowship training in the field of lung transplantation. The proposed milestones were designed on the framework of 6 core competencies created by the Accreditation Council on Graduate Medical Education. The milestones were identified by combining the expert opinion of our Thoracic Transplant Committee, our experience as educators, and literature review. We offer this White Paper to the anesthesiology and transplant communities as a starting point for the discussion and evolution of perioperative anesthetic care in the field of lung transplantation.
“Mummy, my eyelids are heavy”: A case series of juvenile myasthenia gravis
Authors: Krishna Logeswari , Abdul Jalil Nor Fadzillah , Lott Pooi Wah , Singh Sujaya , Choo May May
Published: August 2019

Purpose:

To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation.

Method:

A case series.

Results:

We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis.

Conclusion:

Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.
Brain Injury in Neonatal Hypoglycemia: A Hospital-Based Cohort Study
Authors: Gu Mei-Hong , Amanda Fanny , Yuan Tian-Ming
Published: August 2019

Background:

Neonatal hypoglycemia is more prevalent and can cause severe neurological sequelae. The objective of this study was to assess the patterns of neuroradiologic changes in neonatal hypoglycemia.

Methods:

A retrospective cohort study was conducted on 66 neonatal hypoglycemia patients, and the magnetic resonance imaging (MRI) and clinical records were reviewed.

Results:

Magnetic resonance imaging showed evidences of abnormality in 54.54% (36 of 66) of hypoglycemic infants. The most common abnormal findings were located on the parietal and occipital lobes of the brains. The number of days with hypoglycemia was significantly higher for abnormal MRI infants ( P < .001), and prolonged/recurrent hypoglycemia was remarkably distinguished for abnormal MRI infants ( P < .001). Patients with abnormal MRI findings did not have a lower blood glucose than infants without abnormal MRI findings ( P > .05), but the lowest blood glucose was significantly lower for the patients with seizures ( P < .01).

Conclusions:

The pattern of bilateral occipital cortical injury is the most common abnormality for neonatal hypoglycemia. The number of days with hypoglycemia, not the lower blood glucose, was significantly related to abnormal MRI infants.
Subclinical neurodegeneration in multiple sclerosis and neuromyelitis optica spectrum disorder revealed by optical coherence tomography
Authors: Pisa Marco , Ratti Francesco , Vabanesi Marco , Radaelli Marta , Guerrieri Simone , Moiola Lucia , Martinelli Vittorio , Comi Giancarlo , Leocani Letizia
Published: August 2019

Background:

Neuroretinal atrophy is associated with whole-brain atrophy and disease activity in multiple sclerosis (MS). Recent findings support that subclinical visual pathway involvement might also occur in neuromyelitis optica spectrum disorders (NMOSDs).

Objective:

The objective of this study is to assess retinal thinning in MS and NMOSD and its association with disease activity.

Methods:

In total, 27 NMOSD and 54 propensity-score-matched MS patients underwent optical coherence tomography, visual acuity, and visual-evoked potentials at 2.4 years apart, in addition to routine clinical and magnetic resonance imaging (MRI) assessment. We excluded eyes with acute optic neuritis.

Results:

In NMOSD, we detected peripapillary retinal nerve fiber layer (pRNFL) thinning in patients with disease activity during follow-up (−0.494 µm/year), but not in stable patients (−0.012 µm/year). Macular ganglion cell-inner plexiform layer (GCIPL) thinning occurred instead in all patients (−0.279 µm/year). Relapsing–remitting multiple sclerosis (RRMS) meeting NEDA-3 criteria had no pRNFL or GCIPL thinning during follow-up. Active-disease RRMS and progressive MS, both active and stable, displayed pRNFL (−0.724, −0.586, −0.556 µm/year, respectively) and GCIPL loss.

Conclusion:

In MS, neuroretinal atrophy was associated with disease activity but occurred in progressive MS even when achieving NEDA-3 criteria. In NMOSD, pRNFL thinning was associated with non-ocular relapses due to a spreading of inflammatory activity. GCIPL thinning was found in all patients, supporting a primary retinal pathology targeting AQP4-rich structures.
Responsibility versus responsiveness…to whom? A theory of party behavior
Authors: Lefkofridi Zoe , Nezi Roula
Published: August 2019

Late Peter Mair argued that, in the contemporary multilevel institutional setting of global governance, parties are faced with a dilemma between Responsiveness and Responsibility (RR dilemma). However, Mair did not theorize variation in how different parties experience the RR dilemma (degrees of tension) and how they manage it (strategies). We develop his work in three ways: first, we advance variants of the RR dilemma, where the tension party leaders face differs, and elucidate how viable contenders for executive office are likely to behave in each of these scenarios, and why. Second, we highlight domestic institutional factors (electoral rules and leadership autonomy) that regulate the pressure for being responsive to public opinion and to partisans. Third, we place the RR dilemma in the context of multidimensional issue competition, which helps identify strategies for managing it. Finally, we provide an empirical illustration of our arguments using data on public opinion and partisans. We show that although responsibility can be combined with (some) voters’ representation, tension is high when leaders are constrained and partisans oppose responsibility even if the public endorses it; this is also the case under disproportional electoral rules when the public opposes responsibility, even if party supporters endorse it.
Examining the effects of activities of daily living on informal caregiver strain
Authors: Walsh Edel , Murphy Aileen
Published: August 2019

Objectives

This study examines the factors associated with caregiver strain experienced by informal caregivers of older people, using data from Ireland.

Methods

The analysis is based on a sample of 1394 informal caregivers obtained from Ireland’s Quarterly National Household Survey (2009). The Caregiver Strain Index is used to measure caregiver strain on a scale from 0 to 13. The analysis focuses on estimating the association between caregiving activities (measured using Activities of Daily Living) and caregiver strain, using multivariate regression analysis.

Results

Overall, 60% of informal caregivers report feeling strained. The results suggest that different types of caregiving assistance are associated with increasing caregiver strain, in line with Pearlin’s conceptual model of Stress Process theory and Process Utility theory of informal care. Female caregivers have significantly higher levels of strain. Moreover, caregiver strain amongst co-residential caregivers is 0.8 points higher compared to those who are non-resident. Conversely, caregivers over 65 years are less prone to strain than younger caregivers. The condition of the dependent is also a statistically significant factor: caring for someone with a physical condition, a mental condition or both a physical and mental condition, increases caregiver strain.

Conclusions

As Ireland and Europe’s populations are ‘greying’, sustainable systems and supports need to be designed to meet demand for care that limit strain for caregivers. In doing so, policymakers and their advisors need to better understand the impact of informal caring on caregivers.
Endovascular therapy for anterior circulation large vessel occlusion in telestroke
Authors: Moustafa Haidar , Barlinn Kristian , Prakapenia Alexandra , Winzer Simon , Gerber Johannes , Pallesen Lars-Peder , Siepmann Timo , Haedrich Kevin , Wojciechowski Claudia , Reichmann Heinz , Linn Jennifer , Puetz Volker , Barlinn Jessica
Published: August 2019

Introduction

Recent exploratory analysis suggested comparable outcomes among stroke patients undergoing endovascular therapy (EVT) for anterior circulation large vessel occlusion, whether selected via the telestroke network or admitted directly to an EVT-capable centre. We further studied the role of telemedicine in selection of ischaemic stroke patients potentially eligible for EVT.

Methods

We prospectively included consecutive ischaemic stroke patients with anterior circulation large vessel occlusion who underwent EVT at our neurovascular centre (January 2016 to March 2018). We compared safety and efficacy including symptomatic intracerebral haemorrhage (sICH), successful reperfusion (mTICI 2b/3), 90-day favourable outcome (mRS ≤ 2) and 90-day survival between patients transferred from telestroke hospitals and patients directly admitted.

Results

Of 280 potentially EVT-eligible patients, 72/129 (56%) telestroke and 91/151 (60%) direct admissions eventually underwent EVT (age 76 (66–82) years, median (interquartile range), 46% men, NIHSS score 17 (13–20)). Telestroke patients had larger pre-EVT infarct cores (ASPECTS: 7 (6–8) vs. 8 (7–9); p < 0.0001) and shorter door-to-groin puncture times (71 (56–84) vs. 101 (79–133) min; p < 0.0001) than directly admitted patients. sICH (2.8% vs. 1.1%; p = 0.58), successful reperfusion (81% vs. 77%; p = 0.56), 90-day favourable outcome (25% vs. 29%; p = 0.65) and 90-day survival (73% vs. 67%; p = 0.39) rates were comparable among telestroke and direct admissions.

Discussion

Our data underpins the important role of telemedicine in identifying acute ischaemic stroke patients lacking immediate access to EVT-capable stroke centres. Stroke patients selected via telemedicine and those directly admitted had comparable chances of favourable outcomes after EVT for large vessel occlusion.
Popular imaginary and cultural constructions of the Nonya in Peranakan Chinese culture of the Straits Settlements
Authors: Neo David HJ , Ngo Sheau-Shi , Heng Jenny Gek Koon
Published: August 2019

The Peranakan Chinese is a Chinese diasporic community with a unique hybrid culture of Chinese, Malay, and European influences concentrated in the Straits Settlements (Malacca, Penang, and Singapore) of Malaya (before the independence of Singapore). It has inherited the Chinese patrilineal system but Nonyas within the Peranakan Chinese (also known as Baba-Nonya) culture fill an interesting space in Chinese patriarchy. This article explores the world of the Nonyas and identifies three cultural constructions of the Nonya: garang/li hai (feisty/crafty and manipulative), poonsu (resourceful), and toh tiap (victimized), specifically drawn out from the television serial, The Little Nonya; but these constructions have also been widely represented and documented in the arts and cultural expressions, particularly through the existing literature and portrayal of Nonyas in popular culture. We explore the cultural meanings of the Nonya through gendered patterns and identities which come out of a specific historical context of the Straits Settlements at the turn of the 20th century—the Peranakan Golden Age, where colonialism, wealth, and education shaped its matrifocal Peranakan culture. We employ Sylvia Walby’s theoretical framework of private and public patriarchy, specifically through the structures of household production and culture to analyze the situation of the Nonyas, arguing that Nonyas were not so much oppressed by men but by women; and yet, they were also privileged and valued in the Peranakan culture. Their privileged position allowed them to negotiate and challenge Chinese patriarchy.
Notions of agency in early literacy classrooms: Assemblages and productive intersections
Authors: Daniels Karen
Published: August 2019

Agency and its role in the early literacy classroom has long been a topic for debate. While sociocultural accounts often portray the child as a cultural agent who negotiates their own participation in classroom culture and literacy learning, more recent framings draw attention from the individual subject, instead seeing agency as dispersed across people and materials. In this article, I draw on my experiences of following children as they followed their interests in an early literacy classroom, drawing on the concepts of assemblage and people yet to come, as defined by Deleuze and Guattari and Spinoza’s common notion. I provide one illustrative account of moment-by-moment activity and suggest that in education settings it is useful to see activity as a direct and ongoing interplay of three dimensions: children’s moving bodies; the classroom; and its materials. I propose that children’s ongoing movements create possibilities for ‘doing’ and ‘being’ that flow across and between children. I argue that thinking with assemblages can draw attention to both the potentiality and the power dynamics inherent in the ongoing present and also counter preconceived notions of individual child agency and linear trajectories of literacy development, and the inequalities that these concepts can perpetuate within early education settings.
How does interactivity of online media hamper ad effectiveness
Authors: Pleyers Gordy , Vermeulen Nicolas
Published: August 2019

The development of the Internet has increasingly led to advertisements presented on rich and interactive websites offering users a high level of control over the contents they are exposed to—sometimes to the extent of allowing them to skip “unwanted” ads preceding the desired content. While previous studies have shown that such interactivity and control can positively impact users’ subjective experience and attitude toward the advertisements, the present study examined their impact on users’ attention to the ad (using eye-tracking) and actual ad effectiveness (ad memory). It relied on an experimental design allowing for comparing the effectiveness of similar ads that were presented by realistic interfaces simulating common types of online media (in addition to “traditional television” as a form of passive baseline comparison condition). The interfaces consisted of a news website (including many stimuli surrounding the ads and an “ad countdown timer,” that might detract users’ attention from the ads) and YouTube (also including the “skip ad” option). Ad memory correlated positively (negatively) with gaze direction to the ad area (outside the ad area) and was particularly low when users had the opportunity to stop the ad after a few seconds. These results emphasize the scale of ad effectiveness decrease that may occur when the media interfaces offer users easy ways of avoiding video ads by gazing toward surrounding stimuli and by skipping the ads. The implications of these findings for advertisers are addressed, and it is suggested that future studies on the topic should include other measures of ad effectiveness and other distracting factors that might further detract users from online ad video content in real-life contexts.
Smashing the state gently: Radical realism and realist anarchism
Authors: Brinn Gearóid
Published: August 2019

The revival of realism in political theory has included efforts to challenge realism’s conservative reputation and argue that radical forms are possible. Nonetheless these efforts have been criticised as insufficient to overcome realism’s inherent conservatism. This article argues that radical forms of realism can be better appreciated by considering the application of the realist perspective within an existing radical ideology: anarchism. This may seem an unusual choice, considering anarchism’s standard representation as naïvely idealistic and paradigmatically non-realist. However, attention to the breadth of diversity in anarchist theory reveals a collection of positions that together represent a ‘realist anarchism’ which not only challenges anarchism’s reputation as uniformly committed to unrealistic and idealistic utopianism but also demonstrates the existence of genuinely radical forms of realism.
Community dance as a democratic dialogue
Authors: Wise Serenity , Buck Ralph , Martin Rose , Yu Longqi
Published: August 2019

This article explores the values that bridge democracy and community dance. Policymakers show an interest in promoting democracy, including the very values shared between community dance and democracy. Observing this, we propose that policy may benefit from examining the pedagogy and practices of community dance, and incorporate relevant aspects of community dance’s ability to teach democratic values, into education policy. Through personal accounts and references, it highlights the ways in which community dance could have democratizing effects on its participants, encouraging people to actively create inclusive, participatory, and empowering spaces. Democracy takes practice, and recent, ongoing violent events show us the need for greater civic education in society: education that disseminates the values of democracy, as well as the everyday work of practicing, supporting, and existing in a democracy. As community dancers, we are compelled to explore the ways in which our discipline might intersect with policy, and wider social and political issues. We approach this exploration by raising the question, how might community dance play a role in education policy, as a means of fostering democracy within our world? To address this question, we delve into our mutually held values of inclusion, participation, and empowerment, to further understand the ways they are apparent within the community dance field and the ways they are apparent in defining democracy. Serving as a starting point to larger discussions, we illustrate that democracy and community dance share certain values, that community dance has the potential to teach people how to embody these values, and that these values are conducive to education policy.
“Tell Me About Your Picture”: Using Drawings to Support Expressive Language in Children With Autism Spectrum Disorder
Authors: Wright Bridget M. , Benigno Joann P. , Boster Jamie B. , McCarthy John W. , Coologhan Bridget K.
Published: August 2019

Thirty-one children with and without autism spectrum disorder were asked to draw the meaning of 10 basic concepts. Following each drawing, children explained their drawing to the experimenter. Transcripts of the drawing task were coded for children’s use of personal pronouns and internal state terms. Children’s use of on- and off-task comments while explaining each drawing was examined. Both groups of children had a longer mean length of utterance when prompted to explain their drawings than while they were drawing. Analyses revealed no significant differences between children with and without autism in their use of internal state terms, pronouns, or their use of on- and off-task language during the drawing task. Clinical implications for the use of drawings as expressive language supports for children with autism are discussed.
Transference and the Gateless Barrier: A Relational Approach to Contemplative Education
Authors: Saari Antti
Published: August 2019

While contemplative approaches have recently garnered much attention in different areas of transformative education, the interpersonal and relational aspects of contemplative training have received less scrutiny. This article examines the relational dynamics involved in contemplative education from a Lacanian viewpoint. The concept of transference is used to unpack the fantasies, desires, and errors involved in contemplation, a process aimed at deep existential realization. Transcripts of Zen Buddhist kōan training from Philip Kapleau’s classic book The Three Pillars of Zen are used as a case in point.
Muslim transplant recipients’ family experiences following organ transplantation
Authors: Sheikhalipour Zahra , Zamanzadeh Vahid , Borimnejad Leili , Newton Sarah E , Valizadeh Leila
Published: August 2019

Background

Despite the importance of family and its relationship to positive transplant outcomes, little is known about family experiences following organ transplantation from the perspective of the transplant recipients. The literature is also devoid of information that describes the family experiences of Muslim transplant recipients.

Aims

The purpose of this study was to describe Muslim transplant recipients’ family experiences following organ transplantation.

Methods

A hermeneutical phenomenological approach was employed to determine the emergent themes present in the data. The sample was composed of 12 Muslim organ transplant recipients (heart, kidney and liver) living in Iran. Semi-structured interviews were conducted with each participant.

Results

The primary constitutive pattern that emerged from the interview data was ‘Altered Family Relationships’ and three themes: fear in relationships, abnormal relationships, and the family at the centre of organ transplant issues.

Conclusions

There are several important findings in this study, notably that Muslim transplant recipients describe their family experiences following organ transplantation as ‘altered’ and not as they were pre-transplant. More research is needed that focuses on the family experience post-transplant, and how Muslim transplant recipient families are impacted by the transplant experience.
Association between tumor necrosis factor-α and chronic obstructive pulmonary disease: a systematic review and meta-analysis
Authors: Yao Yang , Zhou Jing , Diao Xin , Wang Shengyu
Published: August 2019

Background:

Patients diagnosed with chronic obstructive pulmonary disease (COPD) have increased risks for a series of physical and mental illnesses. Tumor necrosis factor-α (TNF-α) has been reported to participate in the development of COPD and its complications. However, the values of blood TNF-α level used in the diagnosis of COPD remains controversial. In view of this, we performed a systematic review and meta-analysis to evaluate the correlation between TNF-α level and COPD.

Methods:

We searched PubMed, Web of Science, Embase and CNKI up to May 2018. The selection criteria were set according to the PICOS framework. A random-effects model was then applied to evaluate the overall effect sizes by calculating standard mean difference (SMD) and its 95% confidence intervals (CIs).

Results:

A total of 40 articles containing 4189 COPD patients and 1676 healthy controls were included in this meta-analysis. The results indicated a significant increase in TNF-α level in the COPD group compared with the control group (SMD: 1.24, 95% CI: 0.78–1.71, p < 0.00001). According to the subgroup analyses, we noted that TNF-α level was associated with predicted first second of forced expiration (FEV1) (%) and study region. However, no association between TNF-α level and COPD was found when the participants were nonsmokers, and the mean age was less than 60 years.

Conclusions:

Our results indicated that TNF-α level was increased in COPD patients when compared with healthy controls. Illness progression and a diagnosis of COPD might contribute to higher TNF-α levels. However, the underlying mechanism still remains unknown and needs further investigation. The reviews of this paper are available via the supplemental material section.
Prediction of Nocturnal Hypoglycemia From Continuous Glucose Monitoring Data in People With Type 1 Diabetes: A Proof-of-Concept Study
Authors: Jensen Morten H. , Dethlefsen Claus , Vestergaard Peter , Hejlesen Ole
Published: August 2019

Background:

Intensive insulin therapy has documented benefits but may also come at the expense of a higher risk of hypoglycemia. Hypoglycemia is associated with higher all-cause mortality and nocturnal hypoglycemia has been associated with the sudden dead-in-bed syndrome. This proof-of-concept study sought to investigate if nocturnal hypoglycemia can be predicted.

Method:

Continuous glucose monitoring, meal, insulin, and demographics data from 463 people with type 1 diabetes were obtained from a clinical trial. A total of 4721 nights without or with hypoglycemia (429) were available including data from three consecutive days before the night. Thirty-two features were calculated based on these data. Data were split into 20% participants for evaluation and 80% for training. The optimal feature subset was found from forward selection of the 80% participants with linear discriminant analysis as basis for the classifier.

Results:

The forward selection resulted in a feature subset of four features. The evaluation resulted in an area under the receiver operating characteristics curve (ROC-AUC) of 0.79 leading to a sensitivity and a specificity of, e.g., 75% and 70%.

Conclusions:

It was possible to predict nocturnal hypoglycemic episodes with a ROC-AUC of 0.79. A warning at bedtime about nocturnal hypoglycemia could be of great help for people with diabetes to enable preventive actions. Further development of the proposed algorithm is needed for implementation in everyday practice.
School Leader Perceptions: Coaching Tool and Process
Authors: Damore Sharon J. , Rieckhoff Barbara Stacy
Published: August 2019

This study extends previous work and builds upon the use of a prescribed coaching tool in an effort to build the capacity of school leaders in the role of instructional coaches. By using a reflective interview process and structured protocol, the authors present findings to suggest administrators need more intentional training to strengthen their role as instructional leaders. The results were organized under three themes: (a) instructional leadership growth, (b) teacher growth, and (c) professional conversations. Historically, minimal training that utilizes explicit tools and strategies to strengthen administrator’s roles as instructional leaders has been provided.
Effect of short basalt fibers on durability, mechanical properties, and thermal properties of polylactic acid composites
Authors: Han Lu , Ma Fangwu , Chen Shixian , Pu Yongfeng
Published: August 2019

The effect of basalt fiber (BF) content on the properties of BF-reinforced polylactic acid (PLA) composites was investigated. Composites with 10, 20, 30, 40, 50, and 60 wt% BF were fabricated. The results revealed that (1) the mechanical properties improved with increasing BF content. The maximum tensile strength and modulus of the composites (i.e. 140 and 5050 MPa, respectively) occurred at a BF content of 50%. The maximum flexural strength, that is, 159.5 MPa was two times larger than that of the pure PLA and was obtained at a BF content of 40%. However, the mechanical properties deteriorated at BF contents >50%. (2) BF can stop storage modulus loss and are effective in improving the crystallinity, as revealed by dynamic mechanical analysis and differential scanning calorimetry measurements. The crystallinity improved from 34.6% to 54.6% with BF addition. (3) After the accelerated aging test, pure PLA was too weak for testing. However, high values of the tensile modulus (i.e. 60% that of the nonaged samples) were maintained by the BF-reinforced PLA. This resulted possibly from the high crystallinity of the PLA composites. Therefore, suitable amounts of BF as reinforcements can yield improvements in the performance of PLA composites.
The Translation of Hebrew Flora and Fauna Terminology in North Sámi and West Greenlandic fin de siècle Bibles
Authors: Kahn Lily , Valijärvi Riitta-Liisa
Published: August 2019

This study is a comparative analysis of the strategies employed in the translation of geographically specific flora and fauna terminology in the first complete Hebrew Bible translations into North Sámi (1895) and West Greenlandic (1900). These two contemporaneous translations lend themselves to fruitful comparison because both North Sámi and Greenlandic are spoken in the Arctic by indigenous communities that share a similar history of colonization by Lutheran Scandinavians. Despite this common background, our study reveals a striking difference in translation methods: the North Sámi translation exhibits a systematic foreignizing, formally equivalent approach using loan words from Scandinavian languages (e.g., šakkalak “jackals” from Norwegian sjakaler, granatæbel “pomegranate” from Norwegian granateple), whereas the Greenlandic translation typically creates descriptive neologisms (e.g., milakulâĸ “the spotted one” for “leopard”) or utilizes culturally specific domesticating, dynamically equivalent Arctic terms (e.g., kingmernarssuaĸ “big lingonberry” for “pomegranate”). The article assesses the reasons behind these different translation approaches.
Provocative Vocatives in the Gospels: Part 1, Mark
Authors: Clark David J.
Published: August 2019

This article is the first in a three-part survey of the various vocative forms used in direct discourse in the Gospels, and the similarities and differences among the forms used. Some of the problems associated with finding terms appropriate to each context in English and other languages are raised, and attention is drawn to the complexity of the issues.
The Character of the Peshitta Version of Ruth
Authors: Tully Eric J.
Published: August 2019

The mediating interference left by the translator of the Peshitta is an important source of information for the history of interpretation and for textual criticism. This study, based on terminology and methodology from the discipline of translation studies, is a comprehensive description of the translator’s tendencies in the book of Ruth. The study concludes with a discussion of potential textual variants preserved in the Peshitta and an overall characterization of the translation.
Response to First-Line Antiretroviral Therapy Among PLHIV from a High-Risk, Low-Prevalence Setting
Authors: Rashed Ul Islam Shahria Mohammad , Jahan Munira , Nessa Afzalun , Tabassum Shahina
Published: August 2019

The study reports the response of first-line antiretroviral therapy (ART) by assessing CD4 and CD8 T-lymphocyte and viral load (VL) among Bangladeshi people living with HIV (PLHIV). This observational approach was conducted on 100 PLHIVs, grouped into therapy naive (n = 33), therapy initiators with CD4 T-cell count of <350 cells/µL (n = 33), and therapy receivers for >1 year prior to the study period (n = 34). Therapy initiators who continued the study (n = 20) were followed up after 12 and 24 weeks of therapy initiation. The CD4 and CD8 T-lymphocyte count estimation and (VL) were quantified. The mean CD4 T-lymphocyte count was significantly reduced among the therapy initiators in comparison to therapy naive and therapy receivers. Similar findings were observed for CD8 T-lymphocyte count among the study groups. The mean HIV-1 RNA VL among therapy initiators showed a significant decrease after 12 and 24 weeks, and 85% patients in this group obtained undetectable VL status indicating the good therapeutic outcome.
What Decides Women Entrepreneurship in India?
Authors: Khokhar Amit Singh
Published: August 2019

The available research literature considers women entrepreneurship as a source of economic growth and women empowerment. Entrepreneurship is credited for increases in chances of participation of women in economic growth and their overall empowerment. The present study serves two objectives. First, it highlights the recent trend and progress of women entrepreneurship in India. Second, it identifies the determinants of women entrepreneurship in the country. The study reveals the spatial concentration of women enterprises. It discusses the common problems of women entrepreneurship in the country. The results of the regression analysis reveal that female labour force participation rate, affordable credit and women’s participation in decision-making are significant factors that enhance entrepreneurship for women. Female literacy rate, despite being widely accepted as an important determinant of women entrepreneurship, is found to be statistically insignificant for women entrepreneurship. Any considerable relation could not be established between physical infrastructure and women entrepreneurship.
Role of immune cells in the ocular manifestations of pemphigoid diseases
Authors: Bose Tanima
Published: August 2019

Pemphigoid disease is classified according to the phenotypical location of the disease and the presence of different types of antibodies. The ocular distribution of pemphigoid mainly occurs in patients with bullous pemphigoid and mucous membrane pemphigoid. Several immune cells, including the cells of the innate immune system (neutrophils and γδ T cells) and the adaptive immune system (T and B cells), are involved in pemphigoid disease. The treatment of pemphigoid is still wide-ranging, and the most utilized treatment is the use of immunosuppressants and corticosteroids. In this scenario, it is absolutely important to screen the immune cells that are involved in this group of diseases and to determine if a targeted treatment approach is plausible. In conclusion, this review will identify some newer treatment possibilities for the whole spectrum of pemphigoid diseases.
Phf6-null hematopoietic stem cells have enhanced self-renewal capacity and oncogenic potentials
Authors: Hsu Yueh-Chwen , Chen Tsung-Chih , Lin Chien-Chin , Yuan Chang-Tsu , Hsu Chia-Lang , Hou Hsin-An , Kao Chein-Jun , Chuang Po-Han , Chen Yu-Ren , Chou Wen-Chien , Tien Hwei-Fang
Published: August 2019

Plant homeodomain finger gene 6 (PHF6) encodes a 365-amino-acid protein containing 2 plant homology domain fingers. Germline mutations of human PHF6 cause Börjeson-Forssman-Lehmann syndrome, a congenital neurodevelopmental disorder. Loss-of-function mutations of PHF6 are detected in patients with acute leukemia, mainly of T-cell lineage and in a small proportion of myeloid lineage. The functions of PHF6 in physiological hematopoiesis and leukemogenesis remain incompletely defined. To address this question, we generated a conditional Phf6 knockout mouse model and investigated the impact of Phf6 loss on the hematopoietic system. We found that Phf6 knockout mice at 8 weeks of age had reduced numbers of CD4+ and CD8+ T cells in the peripheral blood compared with the wild-type littermates. There were decreased granulocyte-monocytic progenitors but increased Lin–c-Kit+Sca-1+ cells in the marrow of young Phf6 knockout mice. Functional studies, including competitive repopulation unit and serial transplantation assays, revealed an enhanced reconstitution and self-renewal capacity in Phf6 knockout hematopoietic stem cells (HSCs). Aged Phf6 knockout mice had myelodysplasia-like presentations, including decreased platelet counts, megakaryocyte dysplasia, and enlarged spleen related to extramedullary hematopoiesis. Moreover, we found that Phf6 loss lowered the threshold of NOTCH1-induced leukemic transformation at least partially through increased leukemia-initiating cells. Transcriptome analysis on the restrictive rare HSC subpopulations revealed upregulated cell cycling and oncogenic functions, with alteration of key gene expression in those pathways. In summary, our studies show the in vivo crucial roles of Phf6 in physiological and malignant hematopoiesis.
Time-course of upper respiratory tract viral infection and COPD exacerbation
Authors: Stolz Daiana , Papakonstantinou Eleni , Grize Leticia , Schilter Daniel , Strobel Werner , Louis Renaud , Schindler Christian , Hirsch Hans H. , Tamm Michael
Published: August 2019

Viral respiratory tract infections have been implicated as the predominant risk factor for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We aimed to evaluate, longitudinally, the association between upper respiratory tract infections (URTI) caused by viruses and AECOPD.

Detection of 18 viruses was performed in naso- and orοpharyngeal swabs from 450 COPD patients (Global Initiative for Chronic Obstructive Lung Disease stages 2–4) who were followed for a mean of 27 months. Swabs were taken during stable periods (n=1909), at URTI onset (n=391), 10 days after the URTI (n=356) and during an AECOPD (n=177) and tested using a multiplex nucleic acid amplification test.

Evidence of at least one respiratory virus was significantly higher at URTI onset (52.7%), 10 days after the URTI (15.2%) and during an AECOPD (38.4%), compared with the stable period (5.3%, p<0.001). During stable visits, rhinovirus accounted for 54.2% of all viral infections, followed by coronavirus (20.5%). None of the viruses were identified in two consecutive stable visits. Patients with a viral infection at URTI onset did not have a higher incidence of exacerbation than patients without viral infection (p=0.993). Τhe incidence of any viral infection during an AECOPD was similar between URTI-related AECOPD and non-URTI-related AECOPD (p=0.359). Only 24% of the patients that had a URTI-related AECOPD had the same virus at URTI onset and during an AECOPD. Detection of parainfluenza 3 at URTI onset was associated with a higher risk of an AECOPD (p=0.003). Rhinovirus and coronavirus were the most frequently detected viruses during AECOPD visits, accounting for 35.7% and 25.9% of all viral infections, respectively.

The prevalence of viral infection during the stable period of COPD was low. The risk of exacerbation following the onset of URTI symptoms depends on the particular virus associated with the event and was significant only for parainfluenza 3.
Epidemiology and health outcomes of sarcoidosis in a universal healthcare population: a cohort study
Authors: Fidler Lee M. , Balter Meyer , Fisher Jolene H. , To Teresa , Stanbrook Matthew B. , Gershon Andrea
Published: August 2019

Sarcoidosis-related mortality appears to be rising in North America, with increasing rates in females and the elderly. We aimed to estimate trends in sarcoidosis incidence, prevalence and mortality in Ontario, Canada.

We performed a cohort study using health administrative data from Ontario between 1996 and 2015. International Classification of Diseases and Ontario Health Insurance Plan codes were used for case detection. Three disease definitions were created: 1) sarcoidosis, two or more physician claims within 2 years; 2) chronic sarcoidosis, five or more physician claims within 3 years; and 3) sarcoidosis with histology, two or more physician claims with a tissue biopsy performed between claims.

Overall, 18 550, 9199 and 3819 individuals with sarcoidosis, chronic sarcoidosis and sarcoidosis with histology, respectively, were identified. The prevalence of sarcoidosis was 143 per 100 000 in 2015, increasing by 116% (p<0.0001) from 1996. The increase in age-adjusted prevalence was higher in males than females (136%versus99%; p<0.0001). The incidence of sarcoidosis declined from 7.9 to 6.8 per 100 000 between 1996 and 2014 (15% decrease; p=0.0009). A 30.3% decrease in incidence was seen among females (p<0.0001) compared with a 5.5% increase in males (p=0.47). Age- and sex-adjusted mortality rates of patients with sarcoidosis rose from 1.15% to 1.47% between 1996 and 2015 (28% increase; p=0.02), with the overall trend being nonsignificant (p=0.39). Mortality rates in patients with chronic sarcoidosis increased significantly over the study period (p=0.0008).

The prevalence of sarcoidosis is rising in Ontario, with an apparent shifting trend in disease burden from females to males. Mortality is increasing in patients with chronic sarcoidosis.
A systematic review of comorbidities and outcomes of adult patients with pleural infection
Authors: Cargill Tamsin N. , Hassan Maged , Corcoran John P. , Harriss Elinor , Asciak Rachelle , Mercer Rachel M. , McCracken David J. , Bedawi Eihab O. , Rahman Najib M.
Published: August 2019

Background

Pleural infection remains an important cause of mortality. This study aimed to investigate worldwide patterns of pre-existing comorbidities and clinical outcomes of patients with pleural infection.

Methods

Studies reporting on adults with pleural infection between 2000 and 2017 were identified from a search of Embase and MEDLINE. Articles reporting exclusively on tuberculous, fungal or post-pneumonectomy infection were excluded. Two reviewers assessed 20 980 records for eligibility.

Results

211 studies met the inclusion criteria. 134 articles (227 898 patients, mean age 52.8 years) reported comorbidity and/or outcome data. The majority of studies were retrospective observational cohorts (n=104, 78%) and the most common region of reporting was East Asia (n=33, 24%) followed by North America (n=27, 20%). 85 articles (50 756 patients) reported comorbidity. The median (interquartile range (IQR)) percentage prevalence of any comorbidity was 72% (58–83%), with respiratory illness (20%, 16–32%) and cardiac illness (19%, 15–27%) most commonly reported. 125 papers (192 298 patients) reported outcome data. The median (IQR) length of stay was 19 days (13–27 days) and median in-hospital or 30-day mortality was 4% (IQR 1–11%). In regions with high-income economies (n=100, 74%) patients were older (mean 56.5versus42.5 years, p<0.0001), but there were no significant differences in prevalence of pre-existing comorbidity nor in length of hospital stay or mortality.

Conclusion

Patients with pleural infection have high levels of comorbidity and long hospital stays. Most reported data are from high-income economy settings. Data from lower-income regions is needed to better understand regional trends and enable optimal resource provision going forward.
Patterns of systemic and local inflammation in patients with asthma hospitalised with influenza
Authors: Jha Akhilesh , Dunning Jake , Tunstall Tanushree , Thwaites Ryan S. , Hoang Long T. ,   The MOSAIC Investigators, Kon Onn Min , Zambon Maria C. , Hansel Trevor T. , Openshaw Peter J.
Published: August 2019

Background

Patients with asthma are at risk of hospitalisation with influenza, but the reasons for this predisposition are unknown.

Study setting

A prospective observational study of adults with PCR-confirmed influenza in 11 UK hospitals, measuring nasal, nasopharyngeal and systemic immune mediators and whole-blood gene expression.

Results

Of 133 admissions, 40 (30%) had previous asthma; these were more often female (70%versus38.7%, OR 3.69, 95% CI 1.67–8.18; p=0.0012), required less mechanical ventilation (15%versus37.6%, Chi-squared 6.78; p=0.0338) and had shorter hospital stays (mean 8.3versus15.3 days, p=0.0333) than those without. In patients without asthma, severe outcomes were more frequent in those given corticosteroids (OR 2.63, 95% CI 1.02–6.96; p=0.0466) or presenting >4 days after disease onset (OR 5.49, 95% CI 2.28–14.03; p=0.0002). Influenza vaccination in at-risk groups (including asthma) were lower than intended by national policy and the early use of antiviral medications were less than optimal. Mucosal immune responses were equivalent between groups. Those with asthma had higher serum interferon (IFN)-α, but lower serum tumour necrosis factor, interleukin (IL)-5, IL-6, CXCL8, CXCL9, IL-10, IL-17 and CCL2 levels (all p<0.05); both groups had similar serum IL-13, total IgE, periostin and blood eosinophil gene expression levels. Asthma diagnosis was unrelated to viral load, IFN-α, IFN-γ, IL-5 or IL-13 levels.

Conclusions

Asthma is common in those hospitalised with influenza, but may not represent classical type 2-driven disease. Those admitted with influenza tend to be female with mild serum inflammatory responses, increased serum IFN-α levels and good clinical outcomes.
Complex post-traumatic stress disorder: a new diagnosis in ICD-11
Authors: Brewin Chris R.
Published: August 2019

The World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.