bluuebunny/crossref_metadata_2025 huggingface dataset:
What are the costs associated with child and maternal healthcare within Australia? A study protocol for the use of data linkage to identify health service use, and health system and patient costs
Authors: Callander Emily J , Fox Haylee
Published: February 2018

Introduction

The current literature in Australia demonstrates that there are variations in access and outcomes in perinatal care based on socioeconomic factors. However, little has been done looking at the level of out-of-pocket healthcare costs associated with perinatal care. The primary aim of this project will be to quantify health service use and out-of-pocket healthcare expenditure associated with childbearing and early childhood in Queensland, Australia.

Methods and analysis

This project will build Australia’s first model (called Maternal & Child Cost MOD) of out-of-pocket healthcare expenditure by using administrative data from the Queensland Perinatal Data Collection, of all childbearing women and their resultant children, who gave birth in Queensland between 1 July 2012 and 30 June 2016.

The current costs to the health system and out-of-pocket health care expenditure of patients associated with maternity and early childhood health care will be identified. The differences in costs based on indigenous identification, socioeconomic status and geographic location will be assessed using linear regression modelling and counterfactual modelling techniques.

Ethics and dissemination

Human Research Ethics approval has been obtained from Townsville Hospital and Health Service Human Research Ethics Committee (HREC) (HREC Reference number: HREC/16/QTHS/223). Consent will not be sought from participants whose de-identified data will be used in this study. Permission to waive consent has been gained from Queensland Health under the Public Health Act 2005.

The results of this study will be disseminated through publications in peer-reviewed journals and through presentations at conferences, regionally and nationally. Our target audience is clinicians, health professionals and health policy-makers.
An engaged research study to assess the effect of a ‘real-world’ dietary intervention on urinary bisphenol A (BPA) levels in teenagers
Authors: Galloway Tamara S , Baglin Nigel , Lee Benjamin P , Kocur Anna L , Shepherd Maggie H , Steele Anna M , Harries Lorna W
Published: February 2018

Objective

Bisphenol A (BPA) has been associated with adverse human health outcomes and exposure to this compound is near-ubiquitous in the Western world. We aimed to examine whether self-moderation of BPA exposure is possible by altering diet in a real-world setting.

Design

An Engaged Research dietary intervention study designed, implemented and analysed by healthy teenagers from six schools and undertaken in their own homes.

Participants

A total of 94 students aged between 17 and 19 years from schools in the South West of the UK provided diet diaries and urine samples for analysis.

Intervention

Researcher participants designed a set of literature-informed guidelines for the reduction of dietary BPA to be followed for 7 days.

Main outcome measures

Creatinine-adjusted urinary BPA levels were taken before and after the intervention. Information on packaging and food/drink ingested was used to calculate a BPA risk score for anticipated exposure. A qualitative analysis was carried out to identify themes addressing long-term sustainability of the diet.

Results

BPA was detected in urine of 86% of participants at baseline at a median value of 1.22 ng/mL (IQR 1.99). No effect of the intervention diet on BPA levels was identified overall (P=0.25), but there was a positive association in those participants who showed a drop in urinary BPA concentration postintervention and their initial BPA level (P=0.003). Qualitative analysis identified themes around feelings of lifestyle restriction and the inadequacy of current labelling practices.

Conclusions

We found no evidence in this self-administered intervention study that it was possible to moderate BPA exposure by diet in a real-world setting. Furthermore, our study participants indicated that they would be unlikely to sustain such a diet long term, due to the difficulty in identifying BPA-free foods.
Dynamic changes of circulating tumour DNA in surgical lung cancer patients: protocol for a prospective observational study
Authors: Chen Kezhong , Zhao Heng , Yang Fan , Hui Bengang , Wang Tianyang , Wang Lieu Tu , Shi Yanbin , Wang Jun
Published: February 2018

Introduction

Circulating tumour DNA (ctDNA) has potential applications in cancer management. Most previous studies about ctDNA focused on advanced stage cancer patients. We have completed a clinical prospective study (NCT02645318) and showed the feasibility and clinical application of ctDNA detection in early stage non-small cell lung cancer (NSCLC) patients. The aim of this study is to investigate the elimination rate of ctDNA level after surgery. This is the first prospective study to evaluate the perioperative dynamic changes of ctDNA in surgical lung cancer patients.

Methods and analysis

This is a prospective observational study to determine the elimination rate of circulating tumour DNA after surgery. Consecutive patients with suspected lung cancer who undergo curative-intent lung resection will be enrolled. 10 mL blood samples are taken by intravenous puncture. Plasma samples are obtained before surgery (time A) and at a series of scheduled time-points (2 min to 72 hours, time B to F) after tumour resection. DNA is prepared from 4 mL of purified plasma. A multiplex assay based on circulating single-molecule amplification and resequencing technology (cSMART) is used to simultaneously detect and quantitate hot spot EGFR, KRAS, BRAF, ERBB2, PIK3CA, TP53, ALK, RET and MET plasma DNA variants. Positive plasma mutations are validated in tumour tissue and normal lung tissue by targeted sequencing.

Ethics and dissemination

Ethical approval has been obtained from the Peking University People’s Hospital Medical Ethics Committee (2016PHB156-01). Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals.

Trial registration number

NCT02965391; Pre-results.
Inferior heel pain in soccer players: a retrospective study with a proposal for guidelines of treatment
Authors: Saggini Raoul , Migliorini Maurizio , Carmignano Simona Maria , Ancona Emilio , Russo Chiara , Bellomo Rosa Grazia
Published: February 2018

Background

The cause of heel pain among soccer players is multifactorial and is related to repetitive microtrauma due to impact forces involving technical moves, but also the playground, the exercise mode, the recovery time, the climatic conditions and the footwear used.

Aim

To investigate the aetiology of plantar heel pain of soccer players with the objective of proposing an example of guidelines for treatment.

Methods

We investigated the prevalence and characteristics of inferior heel pain of 1473 professional, semiprofessional and amateur players. All evaluated subjects were submitted to a specific rehabilitation protocol that involved advanced physical therapies and viscoelastic insoles depending on the aetiology of pain.

Results

Clinical and instrumental examinations revealed that 960 of 1473 athletes had inferior heel pain. These patients were divided into seven groups based on aetiology: sural nerve compression, abductor digiti minimi compression, atrophy and inflammation of the fat pad, plantar fasciitis, stress injury of the heel spur, stress fracture of the heel bone and heel spur. The proposed rehabilitation treatment aims for a reduction of pain and an early return to sports, with excellent results.

Conclusions

According to what was observed in the present study, related also to the specific treatment of inferior heel pain, and considering the technological progress achieved in recent years, we can now propose an integrated therapeutic approach to treatment of heel pain, properly differentiated according to specific aetiology.
Muscle metastases: rare problem with unusual solution
Authors: Hirst Becky , Powell Jack
Published: February 2018

Skeletal muscle is an unusual site for metastasis from malignancy. We report a patient who presented with calf metastases from a squamous cell carcinoma of lung. Attempts were made to control his pain conservatively for almost 2 years before he was referred for a below-knee amputation. He did well following this and was able to stop the majority of his analgesic drugs.
Randomised, double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke
Authors: Dalmaijer Edwin S , Li Korina M S , Gorgoraptis Nikos , Leff Alexander P , Cohen David L , Parton Andrew D , Husain Masud , Malhotra Paresh A
Published: February 2018

Objective

Unilateral neglect is a poststroke disorder that impacts negatively on functional outcome and lacks established, effective treatment. This multicomponent syndrome is characterised by a directional bias of attention away from contralesional space, together with impairments in several cognitive domains, including sustained attention and spatial working memory. This study aimed to test the effects of guanfacine, a noradrenergic alpha-2A agonist, on ameliorating aspects of neglect.

Methods

Thirteen right hemisphere stroke patients with leftward neglect were included in a randomised, double-blind, placebo-controlled proof-of-concept crossover study that examined the effects of a single dose of guanfacine. Patients were tested on a computerised, time-limited cancellation paradigm, as well as tasks that independently assessed sustained attention and spatial working memory.

Results

On guanfacine, there was a statistically significant improvement in the total number of targets found on the cancellation task when compared with placebo (mean improvement of 5, out of a possible 64). However, there was no evidence of a change in neglect patients’ directional attention bias. Furthermore, Bayesian statistical analysis revealed reliable evidence against any effects of guanfacine on search organisation and performance on our sustained attention and spatial working memory tasks.

Conclusions

Guanfacine improves search in neglect by boosting the number of targets found but had no effects on directional bias or search organisation, nor did it improve sustained attention or working memory on independent tasks. Further work is necessary to determine whether longer term treatment with guanfacine may be effective for some neglect patients and whether it affects functional outcome measures.

Trial registration number

NCT00955253.
‘Cryptogenic Drop Attacks’ revisited: evidence of overlap with functional neurological disorder
Authors: Hoeritzauer Ingrid , Carson Alan J , Stone Jon
Published: February 2018

Objective

In their 1973 BMJ paper ‘Cryptogenic Drop Attacks’, Stevens and Matthews described 40, mostly middle-aged, female patients with drop attacks of unknown cause. Although clinically common, there has been little on this topic since. We aimed to determine clinical features, comorbidity and outcome of patients with drop attacks.

Methods

We carried out a retrospective review of patients with cryptogenic drop attacks seen consecutively by one clinician (JS) between 2006 and 2016. Demographics, phenomenology, duration and frequency of attacks, attack description and comorbid diagnoses were recorded. Patients were followed up with a notes review.

Results

83 patients with cryptogenic drop attacks were predominantly female (89%, n=79), mean age 44  years. The majority (93%, n=77) could not remember the fall itself and almost half (43%, n=36) experienced prodromal dissociative symptoms. Mechanical trips or syncope preceded drop attacks, historically, in 24% (n=20) of cases. Persistent fatigue (73%, n=61), chronic pain (40%, n=33), functional limb weakness (31%,n=26) and dissociative (non-epileptic) attacks 28% (n=23) were common, with the latter usually preceding or emerging from drop attacks. At follow-up (88%, mean 38 months), 28% (n=23) had resolution of their drop attacks. Predisposing (but non-causative) disease comorbidity was found at baseline (n=12) and follow-up (n=5).

Conclusions

Cryptogenic drop attacks are associated with high frequency of comorbid functional somatic and functional neurological disorders. Patients commonly have prodromal dissociative symptoms and in some there was a clear relationship with prior or subsequent dissociative (non-epileptic) attacks. Some cryptogenic drop attacks may be best understood as phenomena on the spectrum of dissociative attacks.
Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms
Authors: Wang Guang-xian , Liu Jun , Chen You-qiang , Wen Li , Yang Ming-guang , Gong Ming-fu , Zhang Dong
Published: February 2018

Objective

Patient related clinical factors and intracranial aneurysms (IAs) at different locations may lead to statistical bias when investigating the rupture risk of IAs. Thus the purpose of this study was to identify the morphological parameters that are related to the rupture of mirror posterior communicating artery aneurysms (PComAAs).

Methods

Between August 2011 and July 2017, 68 patients with mirror PComAAs and aneurysmal subarachnoid hemorrhage were diagnosed by CT angiography at three medical centers. Morphological characteristics for PComAAs included bifurcation, shape, neck width, width, depth, maximum size, flow angle, parent vessel diameter, aspect ratio (AR), depth/width ratio, bottleneck factor, and size ratio (SR). Multiple logistic regression analysis was performed to determine the independent risk factors for rupture. Receiver operating characteristic curve analysis was performed to obtain the optimal thresholds.

Results

AR (OR 5.623) and SR (OR 5.570) were more commonly observed in the ruptured cohort. The threshold values of AR and SR were 0.98 and 1.21, respectively.

Conclusions

Mirror PComAAs are a useful model to investigate the rupture risk of PComAAs. AR (≥0.98) and SR (≥1.21) are better predictors of ruptured PComAAs.
After the embo: predicting non-hemorrhagic indications for splenectomy after angioembolization in patients with blunt trauma
Authors: Bilello John F , Sharp Victoria L , Dirks Rachel C , Kaups Krista L , Davis James W
Published: February 2018

Background

Successful non-operative management (NOM) of blunt splenic trauma is enhanced with splenic angioembolization (SAE). Patients may still require splenectomy post-SAE for splenic infarction/necrosis. Prior studies have used white blood cell count (WBC), platelet count (PLT), and PLT:WBC ratio after splenectomy to predict complications, but none have evaluated these findings prior to splenectomy in patients who have undergone SAE. Changes in these values may indicate clinically significant splenic infarction, facilitating management of these patients.

Methods

Patients admitted to an American College of Surgeons verified level 1 trauma center from January 2007 to August 2017 who underwent SAE were identified. Patients with successful NOM after SAE (SAE/NOM) were compared with those requiring splenectomy (SAE/SPLEN). Data included demographics, splenic injury grade, Injury Severity Score (ISS), time to SAE and splenectomy, intensive care unit and hospital length of stay (LOS), and complete blood count. Lab values were analyzed immediately post-SAE (time 1) and day 5 post-SAE (or day of discharge) for SAE/NOM patients and day of SPLEN for SAE/SPLEN patients (time 2). Data were analyzed using Mann-Whitney U, χ2tests, and receiver operating characteristic (ROC) curves with significance attributed to P<0.05.

Results

Of 124 patients undergoing SAE, 16 (13%) later required SPLEN for infarction/necrosis at a median of 5 days post-SAE (IQR: 3–10 days). SAE/SPLEN and SAE/NOM patients did not differ by age, gender, ISS, or grade of splenic injury. SAE/SPLEN patients had longer hospital LOS (23 vs. 10 days, P<0.001). WBC, PLT, and PLT:WBC ratio did not differ between the groups at time 1. At time 2, WBC was higher and PLT:WBC ratio was lower in SAE/SPLEN patients. Using ROC curves at time 2, the area under the curve was 0.90 (P<0.001) for WBC and 0.71 (P<0.007) for PLT:WBC ratio.

Discussion

Patients requiring splenectomy for clinically significant infarction/necrosis after SAE develop leukocytosis and decreased PLT:WBC ratio when compared with SAE/NOM patients. Monitoring these parameters allows more prompt diagnosis and operative intervention.

Level of evidence

Therapeutic/care management, level III.
Genomic tools for management and conservation of Atlantic cod in a coastal marine protected area
Authors: Sinclair-Waters Marion , Bentzen Paul , Morris Corey J. , Ruzzante Daniel E. , Kent Matthew P. , Lien Sigbjørn , Bradbury Ian R.
Published: February 2018

Marine protected areas (MPAs) can serve as effective tools for the management and conservation of exploited marine species. The Gilbert Bay MPA in coastal Labrador was created to protect a genetically distinct population of Atlantic cod (Gadus morhua); however, decreases in abundance continue to occur potentially due to exploitation outside the MPA. We developed a single-nucleotide polymorphism (SNP) panel to identify Gilbert Bay cod in areas outside MPA boundaries where mixing with offshore cod occurs. In total, 361 individuals from Gilbert Bay, surrounding areas, and offshore were genotyped for 10 913 SNPs. Using FSTrankings and guided regularized random forest, we selected 23 SNPs that together generate 100% accuracy in individual assignment and accurately estimate the proportion of Gilbert Bay cod in fishery samples from sites outside MPA boundaries: on average, fishery samples included 17.3% Gilbert Bay cod. Estimates of effective population size for the Gilbert Bay population ranged from 655 to 1114. Our findings demonstrate the power of using genomic approaches for management of an exploited marine species and enhancing the design of MPAs.
Hepatoprotective influence of quercetin and ellagic acid on thioacetamide-induced hepatotoxicity in rats
Authors: Afifi Nehal A. , Ibrahim Marwa A. , Galal Mona K.
Published: February 2018

Despite all the studies performed to date, therapy choices for liver injuries are very few. Therefore, the search for a new treatment that could safely and effectively block or reverse liver injuries remains a challenge. Quercetin (QR) and ellagic acid (EA) had potent antioxidant and anti-inflammatory activities. The current study aimed at evaluating the potential hepatoprotective influence of QR and EA against thioacetamide (TAA)-induced liver toxicity in rats and the underlying mechanism using silymarin as a reference drug. Fifty mature male rats were orally treated daily with EA and QR in separate groups for 45 consecutive days, and then were injected with TAA twice with 24 h intervals in the last 2 days of the experiment. Administration of TAA resulted in marked elevation of liver indices, alteration in oxidative stress parameters, and significant elevation in expression level of fibrosis-related genes (MMP9 and MMP2). Administration of QR and EA significantly attenuated the hepatic toxicity through reduction of liver biomarkers, improving the redox status of the tissue, as well as hampering the expression level of fibrosis-related genes. In this study, QR and EA were proved to attenuate the hepatotoxicity through their antioxidant, metal-chelating capacity, and anti-inflammatory effects.
Antimicrobial resistance gene surveillance in the receiving waters of an upgraded wastewater treatment plant
Authors: Freeman Claire N. , Scriver Lena , Neudorf Kara D. , Truelstrup Hansen Lisbeth , Jamieson Rob C. , Yost Christopher K.
Published: February 2018

Wastewater treatment plants (WWTPs) have been identified as hotspots for antimicrobial resistance genes (ARGs) and thus represent a critical point where patterns in ARG abundances can be monitored prior to their release into the environment. The aim of the current study was to measure the impact of the release of the final treated effluent (FE) on the abundance of ARGs in the receiving water of a recently upgraded WWTP in the Canadian prairies. Sample nutrient content (phosphorous and nitrogen species) was measured as a proxy for WWTP functional performance, and quantitative PCR (qPCR) was used to measure the abundance of eight ARGs, the intI1 gene associated with class I integrons, and the 16S rRNA gene. The genes ermB, sul1, intI1, blaCTX-M, qnrS, and tetO all had higher abundances downstream of the WWTP, consistent with the genes with highest abundance in the FE. These findings are consistent with the increasing evidence suggesting that human activity affects the abundances of ARGs in the environment. Although the degree of risk associated with releasing ARGs into the environment is still unclear, understanding the environmental dimension of this threat will help develop informed management policies to reduce the spread of antibiotic resistance and protect public health.
Development of an InDel polymorphism database for jute via comparative transcriptome analysis
Authors: Yang Zemao , Dai Zhigang , Xie Dongwei , Chen Jiquan , Tang Qing , Cheng Chaohua , Xu Ying , Wang Tingzhang , Su Jianguang
Published: February 2018

Jute (Corchorus spp.) is one of the most commercially important bast fiber crops in the world. However, molecular markers and high-density genetic maps are still lacking on jute compared with other crops. Insertion/deletion (InDel) markers, one of the most abundant sources of DNA/RNA variations in plant genomes, can easily be distinguished among different accessions using high-throughput sequencing. Using three transcriptome datasets, we identified and developed InDel markers. Altogether, 51 172 InDel sites in 18 800 unigenes were discovered, and the number of InDel loci per unigene varied from 1 to 31. Further, we found 94 InDel types, varying from 1 to 159 bp; the most common were single-nucleotide (23 028), binucleotide (9824), and trinucleotide (9182). In total, 49 563 InDels in 18 445 transcripts were discovered in the comparison between TC and YG, followed by 48 934 InDels in 18 408 transcripts between NY and YG, and 3570 InDels in 2701 unigenes between NY and TC. Additionally, there were 1273 InDel sites in 1129 unigenes with polymorphisms between any two of the three accessions. Twenty-nine (58%) primer pairs represented polymorphisms when compared to the jute accessions, and PIC varied from 0.340 to 0.680, with an average of 0.491.
Accountable CP-ABE with Public Verifiability: How to Effectively Protect the Outsourced Data in Cloud
Authors: Yu Gang , Ma Xiaoxiao , Cao Zhenfu , Zeng Guang , Han Wenbao
Published: February 2018

Ciphertext-policy attribute-based encryption, denoted by CP-ABE, extends identity based encryption by taking a set of attributes as users’ public key which enables scalable access control over outsourced data in cloud storage services. However, a decryption key corresponding to an attribute set may be owned by multiple users. Then, malicious users are subjectively willing to share their decryption keys for profits. In addition, the authority who issues decryption keys in CP-ABE system is able to generate arbitrary decryption key for any (including unauthorized) user. Key abuses of both malicious users and the authority have been regarded as one of the major obstacles to deploy CP-ABE system in real-world commercial applications. In this paper, we try to solve these two kinds of key abuses in CP-ABE system, and propose two accountable CP-ABE schemes supporting any LSSS realizable access structures. Two proposed accountable CP-ABE schemes allow any third party (with the help of authorities if necessary) to publicly verify the identity of an exposed decryption key, allow an auditor to publicly audit whether a malicious user or authorities should be responsible for an exposed decryption key, and the key abuser can’t deny it. At last, we prove the two schemes can achieve publicly verifiable traceability and accountability.
Confidentiality-Preserving Publicly Verifiable Computation
Authors: Sun Jiameng , Zhu Binrui , Qin Jing , Hu Jiankun , Wu Qianhong
Published: February 2018

Cloud computing enables users to outsource complicated computational tasks to a commercial computing server and relieves the users from establishing and maintaining expensive local computation systems. In this scenario, the minimum security requirement is that the result returned by the server must be correct. Publicly verifiable computation (PVC) has been proposed to address this issue by allowing the computational result to be publicly verifiable. Observing that computational tasks are usually private business in practice, we propose a confidentiality-preserving security tool referred to as confidentiality-preserving publicly verifiable computation (CP-PVC), to efficiently address the scenario where a client would like to outsource a computational task to a cloud server but does not possess the input value locally. The CP-PVC allows the client to delegate the outsourcing computational task to anyone authorized and keeps the computational result confidential to anyone except the client, while not sacrificing the property of public verifiability. We propose a CP-PVC construction based on any one-key secure attribute-based encryption (ABE). Our construction is general as known ABE schemes are all one-key secure. Analysis shows that our CP-PVC scheme achieves computational result privacy without any significant extra cost and is almost as efficient as the up-to-date PVC schemes. These features render our CP-PVC as a practical and widely applicable tool to secure cloud computing.
Recommendations for Designing Reinforced Concrete Beams Against Low Velocity Impact Loads
Authors: Wongmatar Piyapong , Hansapinyo Chayanon , Vimonsatit Vanissorn , Chen Wensu
Published: February 2018

This study investigates the behaviors of simply supported reinforced concrete (RC) beams subjected to impact loads. A numerical model of RC beams has been calibrated and a total of 18 RC beams with varying longitudinal reinforcement, transverse shear reinforcement, span and effective depth are investigated, subjected to different input impact energy. It is found that inertia force plays an important role in resisting an impact load at the starting time. The slenderness of the beam can cause increased downward reaction force and also amplifies the upward reaction force. Based on the numerical results, recommendations are made for designing RC beams under low velocity impact load. A formula is derived to predict the maximum mid-span deflection under low velocity impact load with respect to the kinetic energy and static bending capacity. The maximum spacing and the diameter of stirrups are also recommended so as to avoid the brittle failure under impact load.
INNOVATION MANAGEMENT TECHNIQUES AND TOOLS: ITS IMPACT ON FIRM INNOVATION PERFORMANCE
Authors: ALBORS-GARRIGOS JOSE , IGARTUA JUAN IGNACIO , PEIRO ANGEL
Published: February 2018

Innovation management is a subject that raises the interest of academics and practitioners in the field of management. However, the academic literature is scarce regarding the details of implementing it in a systemic and routinised way. Additionally, although there are multiple tools and models to apply it at a firm level, there is little information concerning its effectiveness. The purpose of this paper is to fill this research gap by analysing how the utilisation of Innovation Management Techniques (IMTS) influences the innovation performance of firms. The research was based on a large and representative sample of industries in the Basque Region in Northeast Spain. The primary conclusions drawn from the research are that IMTS have a definite positive impact on the firm’s innovation results, and some of them have a stronger influence, with a significant impact on incremental innovation; the latter results will affect the radical innovation performance of the companies. Additionally, it has been concluded that the industry environment has a strong moderating influence on this relationship.
ARE PUBLIC FINANCING SCHEMES BENEFICIAL FOR UNIVERSITY SPIN-OFFS AND THE TECHNOLOGY TRANSFER OF INNOVATIONS?
Authors: BOCK CAROLIN , LANDAU CHRISTIAN , ORENDT MORITZ , SCHMIDT MAXIMILIAN
Published: February 2018

We investigate the effectiveness of public financing programmes for university spin-offs (USOs) in their seed stage. These ventures often identify groundbreaking innovations which are not commercialised due to financing problems. USOs show characteristics which expose them even more to the typical financing gap ventures face and for which public programmes aim to provide relief. We test on a sample of 127 German USOs whether these ventures’ characteristics increase the selection for public programmes and whether these positively affect the ventures’ development. The results indicate that only certain characteristics of USOs are decisive for receiving public support. However, the supported spin-offs have an increased likelihood of facing financial difficulties after the phase of support and do not have a higher investment readiness for finding an external investor.
China’s Energy Strategy in the MENA Region
Authors: Besada Hany , Salam Justine
Published: February 2018

China is in dire need of energy resources to sustain its economic growth. In recent years, China has been turning more to Saudi Arabia and Iran in the Middle East, as well as Sudan in North Africa, as trading partners to secure its energy supply. This article explores China’s energy strategy in the Middle East and North African (MENA) region through case studies of China’s energy diplomacy with Saudi Arabia and Iran. It argues that China’s energy strategy is very much driven by the “Beijing Consensus” that features respect for others’ sovereignty, emphasis on sustainability, equality, and quality-of-life, as well as incremental change to past institutions and practices. China has applied an equity ownership strategy to gain more control over oil flows as a shield against price fluctuations and to reduce the possibility of supply interruption; however, civil unrest and conflicts in the MENA region threaten to disrupt China’s energy supply channels, which implies that China should work harder for regional peace in order to achieve sustainable energy supply.
Democratic Local Institutions for Sustainable Management and Use of Minor Irrigation Systems: Experience of Pani Panchayats in Odisha, India
Authors: Behera Bhagirath , Mishra Pulak
Published: February 2018

Generally, public investments in irrigation projects fail to deliver the desired outcomes largely due to inefficient management and use of the assets by the local level institutions. Against this backdrop, the present paper attempts to understand how the Pani Panchayats have performed in sustainable management and use of minor irrigation structures in the Indian state of Odisha. Using primary data and information collected from selected state-funded minor irrigation projects implemented in Cuttack district of the state, the paper finds that the Pani Panchayats, being backed by The Orissa Pani Panchayat Act (2002) and following a democratic decision making process, have been successful in managing the irrigation projects efficiently, especially in respect of pricing and distribution of irrigation water, maintenance of the systems, and their expansion, leading to socially inclusive and sustainable agricultural intensification in the area.
The Hand Surgeon Consultation Improves Patient Knowledge in a Hand Surgery Mission to Honduras
Authors: Walker Marc E. , Chuang Carolyn , Moores Craig R. , Webb Matthew L. , Buonocore Samuel D. , Grant Thomson J.
Published: February 2018

Background: The purpose of this study was to assess impact of the surgeon consultation and informed consent process on patient education in an international hand surgery mission compared with a US academic hand surgery practice. These two groups were selected to evaluate communication difficulties in a surgical mission setting compared with standard of care in a high-income country.

Methods: A multi-part survey was administered to patients presenting to a hand surgery mission during March 2012 and new patients of a university hand center in a 3-month period during 2011. Surveys were administered prior to and following surgeon consultation with one fellowship-trained hand surgeon. The survey assessed knowledge of basic hand anatomy, physiology, disease, individual diagnosis, and surgical risks.

Results: 71 patients participated in the study (university n=36, mission n=35). Pre-consultation quiz score averaged 58% in the university group versus 27% in the mission group. Post-consultation quiz scores averaged 62% in the university group versus 40% in the mission group. Only the mission group’s quiz score increase was statistically significant. 93% of the university group reported learning about their condition and diagnosis, but only 40% demonstrated correct insight into their diagnosis. In the mission group, 73% reported learning about their condition and diagnosis while 53% demonstrated correct insight into their diagnosis. Although all consultations involved discussion of surgical risks, only 62% of the university group and 52% of the mission group recalled discussing surgical risks.

Conclusions: The hand surgeon consultation was more effective in improving hand knowledge in the surgery mission group compared to in a university hand practice. This suggests that the surgeon consultation should be pursued despite communication barriers in surgical missions. However, the discrepancy between patient perception of knowledge gains and correct insight into diagnosis, and the deficit of patient retention of surgical risks need to be improved.
A Prospective Study of Acute Undisplaced and Minimally Displaced Scaphoid Fractures Managed by Aggressive Conservative Approach
Authors: Bhat Anil K. , Acharya Ashwath M. , Manoh S , Kamble Vinay
Published: February 2018

Background: To identify acute un-displaced and minimally displaced scaphoid fractures which are unlikely to unite with non-operative treatment at six weeks with CT scan and stabilize them with percutaneous screw fixation with the aim of preventing non-union.

Methods: A scaphoid series radiographs of wrist were obtained for patients with undisplaced or minimally displaced fractures and were immobilized in a thumb spica cast for six weeks. At six weeks, CT scan was done for patients showing doubtful signs of clinical and radiographic union. Patients with a gap less than 2 mm were continued on cast for an additional two to four weeks. Those with gap more than 2 mm underwent percutaneous screw fixation. In both cases the immobilisation was discontinued when the fracture was considered to be united and mobilization was initiated.

Results: 21 out of 39 patients managed initially with cast for six weeks showed clinical and radiological evidence of union. 18 patients showed persistent tenderness of which eight showed a clear gap in radiographs and 10 patients had doubtful union. Eight of these 10 patients on CT scan showed fracture gap of more than 2 mm while two patients showed fracture gap of less than 2 mm. Hence, 16 patients underwent percutaneous fixation. Repeat radiographs showed progression to union at an average of 3.8 weeks from surgery. Remaining two eventually united on continuing the cast. All patients showed confirmed union at one year on follow up.

Conclusions: An objective measurement of fracture gap by CT scan at six weeks is useful in predicting cases with tendency for delayed union. Early percutaneous fixation of fractures would not further jeopardize the blood supply of fracture site. This aggressive conservative management also avoids unnecessary surgery in all acute scaphoid fractures.
The Predictive Value of Ultrasound Scanning in Certain Hand and Wrist Conditions
Authors: Al-Hourani Khalid , Gamble David , Armstrong Paul , O’Neill Greg , Kirkpatrick James
Published: February 2018

Background: Fast and accurate diagnosis of conditions of the hand and wrist is essential in guiding management. We aimed to analyse the predictive value of ultrasound in identifying different pathologies in the hand and wrist by correlating pre-operative ultrasound findings with per-operative surgical findings.

Methods: We retrospectively reviewed the case notes of all patients under the care of the senior author on whom a hand/wrist ultrasound had been performed between January 2007–May 2013. Of these only patients who proceeded to surgery were included as this was the correlating endpoint. Positive and negative predictive values (PPV/NPV) and sensitivity and specificity were calculated for ultrasound in identifying (i) post-repair complete tendon ruptures (versus intact repairs with scar adherence), (ii) ganglionic cysts, (iii) soft tissue masses and (iv) nerve injuries.

Results: Of 70 patients who underwent ultrasound, 36 proceeded to surgery. Fifteen patients were post traumatic and the remaining 21 were elective presentations. The median age was 38 (range 14–87) with a 1.25:1 male to female ratio. All results had a 95% confidence interval. Ultrasound had a 100% PPV for identifying post-repair complete tendon ruptures and for ganglionic cysts (sensitivities 75% and 87% respectively). Of our 6 soft tissue masses ultrasound also showed a 100% PPV. For the two nerve injury patients, PPV was 100%.

Conclusions: Our study shows that ultrasound is diagnostic for post-repair tendon ruptures and ganglionic cysts, and shows promising results for benign soft tissue masses and nerve injuries. We propose the use of ultrasound as an extension to physical examination in a dynamic clinic setting.
Cylinder-Shaped Bone Graft for Scaphoid Nonunion
Authors: Hatanaka Hitoshi , Takasaki Minoru , Furusho Hiroko , Omori Yasuhiro
Published: February 2018

Background: Wedge-shaped bone grafts that are internally fixed by a Herbert-type screw are a well-established surgical treatment for scaphoid nonunion. A procedure using cylinder-shaped bone grafts was also reported, but preoperative wrist functions were not assessed. In addition, it was not reported whether the humpback deformity of the scaphoid nonunion was corrected. The purpose of the current study was to compare preoperative wrist functions in cases of scaphoid nonunion with those observed at final follow-up, using cylinder-shaped bone grafts The humpback deformity of the scaphoid nonunion was also evaluated.

Methods: We conducted a retrospective study to examine operative outcomes from 2008 to 2015. Twelve wrists in 12 patients (average age, 41 years; range, 17–67), with a mean follow-up of 19 months, were included in the current study. Cylinder-shaped bone grafts were obtained from the iliac crest with a newly designed trephine and fixed with a Herbert-type screw. We reviewed both the preoperative wrist functions and those obtained at final follow-up.

Results: Union was achieved in 11 of 12 nonunion cases. Preoperative wrist functions, except for the range of wrist motion, significantly improved by final follow-up.

Conclusions: We conclude that the use of cylinder-shaped bone grafts improves preoperative wrist functions in cases of scaphoid nonunion.
Irreducible Volar Rotatory Subluxation of the Proximal Interphalangeal Joint of the Finger
Authors: Tohyama Masahiko , Konishi Sadahiko
Published: February 2018

We describe 4 cases of irreducible volar rotatory subluxation of the proximal interphalangeal (PIP) joint of the finger that required open reduction. All of the patients had radiographically proven (in lateral-view radiographs) volar rotatory subluxation of the PIP joint, without fracture. The causes of irreducibility were interposition of the lateral band about the condyle of the middle phalanx in 2 cases, interposition of the collateral ligament in 1 case, and scarring of the injured central slip in 1 case. Rupture of the collateral ligament of one side was found in all cases. Acceptable results were provided with all cases after restoration of the collateral ligaments and the damaged parts. Accurate early diagnosis by careful physical examination and obtaining true lateral radiographs of the PIP joint is important.
Pyrolytic Carbon Hemiarthroplasty for Avascular Necrosis of the Metacarpal Head: A Case Report
Authors: Kim Kahyun , Gong Hyun Sik , Baek Goo Hyun
Published: February 2018

Avascular necrosis of the metacarpal head is a rare entity. Surgical interventions, such as curettage, bone-grafting, and osteotomy, have been reported in symptomatic patients. We present a patient who underwent pyrolytic carbon hemiarthroplasty of the metacarpal head and had satisfactory outcomes at 1-year follow-up.
Treatment of precocious puberty in a McCune–Albright syndrome patient using Chinese medicinal herbs combined with megestrol acetate: A case report
Authors: Sun Wen , Wang Yonghong , Yu Jian , Ji Min
Published: February 2018

Introduction: McCune–Albright Syndrome (MAS) is a rare congenital sporadic disorder characterized by fibrous bone dysplasia, café-au-lait pigmented spots on the skin, and non-gonadotropin dependent precocious puberty (PP), which is caused by a postzygotic somatic activating mutation in the GNAS gene encoding the alpha subunit of Gs protein. In our case study, we recorded a girl with the onset of MAS and treated her with Chinese medicinal herbs combined with megestrol acetate. We aim to provide a method for the treatment of children with this rare form of precocious puberty.

Case Presention: A 4-year-old girl presented with vaginal bleeding and enlarged breasts. The activating mutation of GNAS was not detected in the patient’s peripheral blood samples, as some had reported. Because of peripheral PP and fibrous dysplasia of the diagnosed bone, the patient was considered as MAS. We chose the Chinese medicinal herbs combined with megestrol acetate for treatment, and the patient was effectively treated.

Conclusion: The combination therapy of Chinese medicinal herbs plus megestrol acetate in managing PP in an MAS is one of the useful treatments.
Implications of preliminary subsidence analyses for the Parnaíba cratonic basin
Authors: Rodríguez Tribaldos Verónica , White Nicky
Published: February 2018

Cratonic sedimentary basins are underlain by thick lithosphere and subside over hundreds of millions of years. The driving mechanism for these basins remains enigmatic due to the paucity of crustal-scale constraints. To address this shortcoming, an integrative study of the Parnaíba cratonic basin of NE Brazil is underway. We summarize field observations, well-log information, seismic reflection profiles and subsidence analyses with the objective of shedding light on possible basin-forming mechanisms. Lithological descriptions and borehole logs reveal a stratigraphic succession that consists of interbedded shallow marine and continental deposits. On seismic reflection profiles, this succession is divided into packages of relatively undisturbed reflections bounded by basin-wide disconformities. These disconformities are manifest as bright, rugose reflections that probably represent buried palaeo-landscapes. Backstripped and water-loaded subsidence curves calculated from boreholes distributed throughout the basin show that tectonic subsidence decreases exponentially over
c.
350 Ma. A simple model suggests that this subsidence pattern agrees with a thermal time constant of 70–100 Ma, placing a significant constraint on the likely basin-forming mechanism. This background trend is punctuated by minor increases in subsidence that follow basin-wide erosional disconformities. These departures could be indicative of transient epeirogenic uplift events caused by changing patterns of dynamic topography.
CD8 T Cell Exhaustion in Chronic Infection and Cancer: Opportunities for Interventions
Authors: Hashimoto Masao , Kamphorst Alice O. , Im Se Jin , Kissick Haydn T. , Pillai Rathi N. , Ramalingam Suresh S. , Araki Koichi , Ahmed Rafi
Published: February 2018

Antigen-specific CD8 T cells are central to the control of chronic infections and cancer, but persistent antigen stimulation results in T cell exhaustion. Exhausted CD8 T cells have decreased effector function and proliferative capacity, partly caused by overexpression of inhibitory receptors such as programmed cell death (PD)-1. Blockade of the PD-1 pathway has opened a new therapeutic avenue for reinvigorating T cell responses, with positive outcomes especially for patients with cancer. Other strategies to restore function in exhausted CD8 T cells are currently under evaluation—many in combination with PD-1-targeted therapy. Exhausted CD8 T cells comprise heterogeneous cell populations with unique differentiation and functional states. A subset of stem cell–like PD-1+ CD8 T cells responsible for the proliferative burst after PD-1 therapy has been recently described. A greater understanding of T cell exhaustion is imperative to establish rational immunotherapeutic interventions.
Heart Failure with Preserved Ejection Fraction
Authors: Gladden James D. , Chaanine Antoine H. , Redfield Margaret M.
Published: February 2018

Heart failure (HF) is a clinical syndrome of diverse etiologies and can be associated with preserved, reduced, or mid-range ejection fraction (EF). In the community, heart failure with preserved ejection fraction (HFpEF) is emerging as the most common form of HF. There remains considerable uncertainty regarding its pathogenesis, diagnosis, and optimal therapeutic approach. Hypotheses have been advanced to explain the underlying pathophysiology responsible for HFpEF, but to date, no specific therapy based on these hypotheses has been proven to improve outcomes in HFpEF. We provide a clinically focused review of the epidemiology, clinical presentation, diagnostic approach, pathophysiology, and treatment of HFpEF.
Antibody–Drug Conjugates for Cancer Treatment
Authors: Lambert John M. , Berkenblit Anna
Published: February 2018

The concept of exploiting the specific binding properties of monoclonal antibodies as a mechanism for selective delivery of cytotoxic agents to tumor cells is an attractive solution to the challenge of increasing the therapeutic index of cell-killing agents for treating cancer. All three parts of an antibody–drug conjugate (ADC)—the antibody, the cytotoxic payload, and the linker chemistry that joins them together—as well as the biologic properties of the cell-surface target antigen are important in designing an effective anticancer agent. The approval of brentuximab vedotin in 2011 for treating relapsed Hodgkin's lymphoma and systemic anaplastic large cell lymphoma, and the approval of ado-trastuzumab emtansine in 2013 for treating HER2-positive metastatic breast cancer, have sparked vigorous research in the field, with >65 ADCs currently in clinical evaluation. This review highlights the ADCs that are approved for marketing, in pivotal clinical trials, or in at least phase II clinical development for treating both hematologic malignancies and solid tumors.