bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview and Assessment of Performance of the Central American Presidential Summit
Authors: Parthenay Kevin
Published: May 2019

This article evaluates the performance of the Central American Presidential Summit, based on a political sociology approach of regionalism, and the concepts of political authority and rules compliance. The trajectory of the Presidential Summits since 1986, is examined through a theoretical approximation inspired by international relations sociologists and by applying an inductive methodology. The results indicate that almost since its creation, the Central American Presidential Summit did not achieve full operability according to its institutional design and diplomatic practices. The evidence suggests that presidential summits do not act as the driver of Central American regionalism. The article affirms that the weak political will from the member states explains the limited institutional performance of the Central American Integration System.
Population cycles in voles and lemmings: state of the science and future directions
Authors: Oli Madan K.
Published: May 2019

Despite nearly a century of research, the causes of population cycles in Arvicoline rodents (voles and lemmings) in northern latitudes are not yet fully understood. Theory tells us that delayed density‐dependent feedback mechanisms are essential for rodent population cycles, suggesting vegetation–rodent, rodent–parasite or rodent–predator interactions as the most likely drivers of population cycles.

However, food provisioning, carried out either indirectly through fertilisation treatments of the habitat or directly through food supplementation, has failed to alter population cycles substantially, suggesting that variation in food supply by itself is not necessary or sufficient to cause cyclic fluctuations in abundance.

Predator exclusion experiments conducted in Fennoscandia have succeeded in slowing population crashes and increasing autumn densities, implicating predation as the most likely cause of rodent cycles in this region. However, experimental removal of specialist predators in northern England had no discernible effect on a cyclic vole population, casting doubt on the notion that predation is a necessary explanation of rodent population cycles.

Population cycle research has contributed substantially to our current understanding of the dynamics, regulation and persistence of biological populations, but we do not yet know with certainty what factors or processes cause multiannual population fluctuations or if population cycles are driven by the same mechanisms everywhere. Recent theoretical and empirical studies suggest that extrinsic factors (primarily food supply and predator abundance) may interact with population intrinsic processes (e.g. dispersal, social behaviour, stress response) to cause multiannual population fluctuations and to explain biological attributes of rodent population cycles.

Solving the enigma of population cycles may necessitate identifying factors and processes that cause phase‐specific demographic changes and performing conclusive experiments to ascertain the mechanisms that generate multiannual density fluctuations.
When I say … merit
Authors: De Freitas Chanté , Grierson Lawrence , Vanstone Meredith
Published: May 2019

Unpacking the term ‘merit’, the authors of this “When I say…” piece critically examine the notion that merit is a commendable quality deserving of reward and questioning the assumption that merit is a matter of social justice.
Personalized scaffolding technologies for alveolar bone regenerative medicine
Authors: Yu Ning , Nguyen Trang , Cho Young D. , Kavanagh Nolan M. , Ghassib Iya , Giannobile William V.
Published: May 2019

Structured Abstract

The reconstruction of alveolar bone defects associated with teeth and dental implants remains a clinical challenge in the treatment of patients affected by disease or injury of the alveolus. The aim of this review was to provide an overview on advances made in the use of personalized scaffolding technologies coupled with biologics, cells and gene therapies that offer future clinical applications for the treatment of patients requiring periodontal and alveolar bone regeneration. Over the past decade, advancements in three‐dimensional (3D) imaging acquisition technologies such as cone‐beam computed tomography (CBCT) and precise scaffold fabrication methods such as 3D bioprinting have resulted in personalized scaffolding constructs based on individual patient‐specific anatomical data. Furthermore, ‘fiber‐guiding’ scaffold designs utilize topographical cues to guide ligamentous fibers to form in orientation towards the root surface to improve tooth support. Therefore, a topic‐focused literature search was conducted looking into fiber‐guiding and image‐based scaffolds and their associated clinical applications.
Oral dysfunction as a cause of malocclusion
Authors: D'Onofrio Linda
Published: May 2019

Structured Abstract

This narrative review surveys current research demonstrating how oral dysfunction can escalate into malocclusion, acquired craniofacial disorder and contribute to generational dysfunction, disorder and disease.

Introduction

Baseline orthodontic consultations are generally recommended beginning age seven. However, the dysmorphic changes that result in malocclusion are often evident years earlier. Similarly, following orthodontic treatment, patients require permanent retention when the bite is not stable, and without such retention, the malocclusion can return.

Setting and Population

Narrative review article including research on infants, children and adults.

Materials and Methods

This review is a brief survey of the symptomology of orofacial myofunctional disorder and outlines 10 areas of oral function that impact occlusal and facial development: breastfeeding, airway obstruction, soft tissue restriction, mouth breathing, oral resting posture, oral habits, swallowing, chewing, the impact of orofacial myofunctional disorder (OMD) over time and maternal oral dysfunction on the developing foetus.

Conclusion

Malocclusions and their acquired craniofacial dysmorphology are the result of chronic oral dysfunction and OMD. In order to achieve long‐term stability of the face, it is critical to understand the underlying pathologies contributing to malocclusion, open bite and hard palate collapse.
Clastic cells in orthodontic treatment: Translational challenges and recent advances
Authors: Rody Wellington J. , Truzman Estela L. , Foster Desmond T. , Smith Leigh N. , Rocha Fernanda G. , Sorenson Heather L. , Wallet Shannon M. , Holliday L. Shannon
Published: May 2019

Structured Abstract

Objectives

Orthodontic treatment consists of numerous appliance activations that rely on stimulation of osteoclasts at alveolar bone sites. However, the action of osteoclast‐like cells on dentin (“odontoclasts”) is a pathological side effect of orthodontic treatment. The aim of this article is twofold: (a) To report preliminary results from ongoing cell culture experiments to identify unique markers of dentin resorption, and (b) To discuss our work using nanoparticle tracking analysis (NTA) and exosomes for developing biological fluid‐based biopsies to monitor clastic cell activity.

Setting and sample population

Twelve healthy volunteers in permanent dentition.

Material and methods

For the in vitro experiments, murine clastic cell precursors were cultured on dentin or bone slices for 7 days and phage‐display biopanning was used to identify molecular surface differences between osteoclasts and odontoclasts. In the human study, gingival crevicular fluid (GCF) samples were collected using different tools and analysed for protein and exosome recovery.

Results

Biopanning generated antibody fragments that were uniquely reactive to odontoclasts. Numerous nanoparticles in the size range of exosomes were detected in all of the human GCF samples.

Conclusions

Our results support that there are molecular differences between osteoclasts and odontoclasts. Emerging technologies may allow the use of exosomes in GCF as a clinical tool to detect markers of root resorption.
3D Airway changes using CBCT in patients following mandibular setback surgery ± maxillary advancement
Authors: Havron Andrew G. , Aronovich Sharon , Shelgikar Anita V. , Kim H. Ludia , Conley R. Scott
Published: May 2019

Structured Abstract

Introduction

The aim of this study was to determine the 3D airway changes that occur following mandibular setback surgery alone vs bimaxillary surgery in patients with similar skeletal start forms.

Setting and Sample Population

The University of Michigan School of Dentistry and Medical Center. A total of 85 patients undergoing mandibular setback with or without simultaneous maxillary advancement.

Materials and Methods

A retrospective evaluation of pre‐ and post‐surgical CBCT scans for patients undergoing mandibular setback surgery alone (14) vs bimaxillary surgery (71) was performed. Cross‐sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed (Dolphin Imaging & Management Solutions).

Results

Patients who underwent mandibular setback surgery alone showed a statistically significant average increase of 47.5 mm2 in minimum axial area. Patients who underwent bimaxillary surgery showed a statistically significant increase in airway volume, minimum axial area, location of minimum axial area, and axial area at the retropalatal and retroglossal regions.

Conclusions

The results demonstrate that the mandible can be setback safely without decreasing airway dimensions. In borderline OSA patients, bimaxillary surgery remains the preferred approach due to the larger airway increases observed. Long‐term follow‐up with polysomnography must be conducted to determine the full functional implications of both procedures.
3D Airway changes using cone beam computed tomography in patients following mandibular advancement surgery with and without constriction
Authors: Furche Silja , Edwards Sean P. , Aronovich Sharon , Hummon Gregory , Shah Kanchi B. , Conley R. Scott
Published: May 2019

Structured Abstract

Objectives

The aim of this study was to compare three‐dimensional airway changes resulting from mandibular advancement surgery and mandibular advancement surgery with constriction.

Setting and Sample Population

The University of Michigan School of Dentistry and Medical Center. A total of 42 patients undergoing mandibular advancement with or without simultaneous constriction.

Materials and Methods

A retrospective airway evaluation of patients undergoing mandibular advancement with or without simultaneous mandibular constriction was performed. Cross‐sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed using Dolphin Imaging TM Version 11.7.

Results

Patients undergoing mandibular advancement with or without constriction experienced significant airway increases (P < 0.05). Patients who underwent mandibular advancement only gained nearly twice as much airway volume as mandibular advancement with simultaneous constriction (8.69 mm3 vs 4.3 mm3). The largest increase for both groups was observed in the minimum axial area in the oropharynx segment (119.5 mm2) and the axial area of the retroglossal region (137.2 mm2).

Conclusions

The findings demonstrate mandibular advancement with constriction results in airway enlargement following surgery.
Wittgenstein on Understanding as a Mental State
Authors: Lin Francis Y.
Published: May 2019

In trying to make clear whether understanding is a mental state Wittgenstein asks a series of questions about the timing and duration of understanding. These questions are awkward, and they have posed a great challenge for commentators. In this paper I review the interpretations by Mole and by Baker and Hacker, and point out their problems. I then offer a new interpretation which shows (1) that a “mental state” in this context means a state of consciousness, (2) that Wittgenstein's questions are intended to elicit the grammars of the words “understand” and a “state of consciousness”, (3) that, in this way, he clearly shows that understanding is not a state of consciousness and (4) that he also provides a therapy to dissolve the problem.
“Winning” and “Losing” the Iran Nuclear Deal: How Advocacy Coalitions and Competition Shape U.S. Foreign Policy
Authors: Lantis Jeffrey S.
Published: May 2019

This study adapts the advocacy coalition framework (ACF) to help explain the puzzle of continuity and changes in U.S. nuclear diplomacy toward Iran. It shows how coalitions of governmental and nongovernmental actors promoted negotiation of the Joint Comprehensive Plan of Action to sharply curtail Iran's nuclear program in exchange for sanctions relief and engagement. This agreement remained in place from 2015 to 2018, even though President Trump and other opponents sought to dismantle the deal. This article demonstrates how competition and power balances shaped the foreign policy decision‐making process over time. Evidence suggests that the ACF offers a compelling lens to explain continuity and change in foreign policy.

Related Articles

Carlsson, Lars. 2017. “Policy Science at an Impasse: A Matter of Conceptual Stretching?”Politics & Policy45 (2): 148‐168.https://doi.org/10.1111/polp.12196

David, Charles‐Philippe. 2015. “Policy Entrepreneurs and the Reorientation of National Security Policy under the G. W. Bush Administration (2001‐04).”Politics & Policy43 (1): 163‐195.https://doi.org/10.1111/polp.12106

Haar, Roberta. 2010. “Explaining George W. Bush's Adoption of the Neoconservative Agenda after 9/11.”Politics & Policy38 (5): 965‐990.https://doi.org/10.1111/j.1747-1346.2010.00265.x

Related Media

Brookings Institution. 2018. “Debating the Iran Deal.”https://www.brookings.edu/series/debating-the-iran-deal/

Harvard Kennedy School Institute of Politics. 2015. “The Iran Nuclear Negotiations: A Discussion with Wendy Sherman.”https://www.youtube.com/watch?v=LF-Oiu99Gn8
Aquaculture and sensometrics: the need to evaluate sensory attributes and the consumers’ preferences
Authors: Calanche Juan B. , Beltrán José A. , Hernández Arias Adrián J.
Published: May 2019

Aquaculture represents a vital food production industry that contributes to the global economy and fish supplies. Several studies had suggested that changes in the production process, especially those related to nutritional and feeding interventions may have an impact on the final quality of farmed animal food products including those from aquaculture. An integrated approach is needed to close the gap between consumers’ response and aquaculture products which sensorial quality aspects could be altered by the inclusion of new alternative protein and lipid sources in aquafeed. Applied research efforts in aquaculture should recognize the significance of consumers’ behaviour and preferences with the aim of making this industry economically sustainable. Until now, sensory research in aquaculture has been developed in different ways depending on the commercial interest of the species implicated. The sensory analyses generally used in aquaculture were identified in four main application research areas: nutrition and feeding, production aspects, quality product and marketing topics. Applied aquaculture research for the continued growth of this industry needs to be complemented with the findings and possibilities offered by sensometrics. This paper aims to provide an overview of sensory analysis used in aquaculture as an activity that supplies products to the market. The main opportunity that sensometrics could offer to the aquaculture industry is to apply an accurate approach that takes into account the consumer.
Flexible (panel) Regression Models for Bivariate Count–Continuous Data with an Insurance Application
Authors: Lu Yang
Published: May 2019

We propose a flexible regression model that is suitable for mixed count–continuous panel data. The model is based on a compound Poisson representation of the continuous variable, with bivariate random effect following a polynomial-expansion-based joint density. Besides the distributional flexibility that it offers, the model allows for closed form forecast updating formulae. This property is especially important for insurance applications, in which the future individual insurance premium should be regularly updated according to one’s own past claim history. An application to vehicle insurance claims is provided.
The importance of peer relatedness at school for affective well‐being in children: Between‐ and within‐person associations
Authors: Schmidt Andrea , Dirk Judith , Schmiedek Florian
Published: May 2019

Two intensive longitudinal studies examining the association between children's feeling of relatedness to peers at school and their affective well‐being were performed. In Study 1, 110 third and fourth graders reported on their positive affect (PA) and negative affect (NA) 4 times daily and on their peer relatedness once a day over 4 weeks. Multilevel analyses revealed that children who reported higher peer relatedness on average also reported higher PA and lower NA (between‐person associations). Moreover, on days when children reported higher peer relatedness than usual, they also reported higher PA, but they did not necessarily report lower NA (within‐person associations). In Study 2, 55 fourth, fifth, and sixth graders indicated their PA, NA, and peer relatedness once a day over 2 weeks. We replicated the findings of Study 1 on both levels. The studies showed that feeling related to peers is associated with high PA at school and at home on a daily basis, illustrating the function of peer relatedness in promoting positive well‐being. The findings further demonstrated the necessity of intensive longitudinal studies focusing on within‐person associations and the importance of measuring both PA and NA in order to capture effects on affective well‐being thoroughly.
FEEDBK: a novel approach for providing feedback
Authors: Hall Catriona , Peleva Emilia , Vithlani Rohan H , Shah Savan , Bashyam Maria , Ramadas Mayurun , Horsburgh Jo , Sam Amir H
Published: May 2019

Background

High‐quality feedback is fundamental to students’ learning. We describe and evaluate FEEDBK, a novel feedback tool that encompasses the focus of learning, student self‐evaluation (reflection), the encounter with the patient (professionalism), one task that the student should continue to do (reinforcement), one task that they could do better (improvement) and a key take‐home message for self‐directed learning.

Methods

Medical students received regular bedside teaching and feedback during a 9‐week clinical placement at a teaching hospital. Teaching fellows gave feedback in their usual style during weeks 1–3 and then used the FEEDBK tool during weeks 4–9. Questionnaires and focus groups were used to evaluate the students’ experience of feedback before and after the introduction of FEEDBK.

Results

FEEDBK significantly enhanced the feedback experience across six domains: identifying learning objectives, chance to reflect, feedback on communication skills/professionalism, specific suggestions for improvement, clear take‐home message and personalised feedback. The analysis of the feedback from focus groups yielded four categories: (i) FEEDBK influenced the feedback process (delivering timely feedback); (ii) the nature of the feedback (enhancing both the quantity and the quality of the feedback received); (iii) the structure of the feedback; and (iv) the evolution of teaching and learning.

Discussion

FEEDBK may enhance both the quantity and the quality of feedback and has the potential to improve the quality of teaching. It provides teachers with a quick and easy‐to‐follow framework to signpost curriculum‐aligned feedback.
Learning knee arthrocentesis using YouTube videos
Authors: Karim Jumanah , Marwan Yousef , Dawas Ahmed , Esmaeel Ali , Snell Linda
Published: May 2019

Background

This study aims to compare medical students’ educational outcomes in performing knee arthrocentesis through searching and using YouTube videos versus traditional supervisor‐led sessions.

Method

Seventy‐one medical students were randomly assigned to three groups. Group A had a traditional supervisor‐led clinical session, where the supervisor demonstrated the procedure. Students in group B were provided with links to YouTube videos of knee arthrocentesis that were deemed to be of high educational quality, whereas group C searched and learned from any YouTube video that they found themselves based on the learning objectives provided. Student performance was first examined following the learning sessions, and then again after receiving feedback on the performance.

Results

Prior to feedback, statistically significant higher mean scores were noted for group A in the identification of an appropriate puncture site (p = 0.015), puncture site sterilization (p = 0.046), wearing sterile gloves (p < 0.001) and direction of needle insertion (p < 0.001). The overall mean scores (maximum possible score is 21) before feedback for groups A, B and C were 17.9 ± 1.9, 14.9 ± 2.0 and 15.4 ± 1.8, respectively (p < 0.001). The overall mean scores after feedback for groups A, B and C were 21.0 ± 0.0, 20.9 ± 0.3 and 21.0 ± 0.0, respectively (p = 0.037).

Conclusion

Students performed equally whether they were provided with videos or found their own; however, without appropriate learner feedback from an instructor, YouTube videos cannot replace traditional supervisor‐led sessions for learning knee arthrocentesis.
Practicing Healthcare Professionals’ Evidence‐Based Practice Competencies: An Overview of Systematic Reviews
Authors: Saunders Hannele , Gallagher‐Ford Lynn , Kvist Tarja , Vehviläinen‐Julkunen Katri
Published: May 2019

Background

Evidence‐based practice (EBP) competencies are essential for all practicing healthcare professionals to provide evidence‐based, quality care, and improved patient outcomes. The multistep EBP implementation process requires multifaceted competencies to successfully integrate best evidence into daily healthcare delivery.

Aims

To summarize and synthesize the current research literature on practicing health professionals’ EBP competencies (i.e., their knowledge, skills, attitudes, beliefs, and implementation) related to employing EBP in clinical decision‐making.

Design

An overview of systematic reviews.

Methods

PubMed/MEDLINE, CINAHL, Scopus, and Cochrane Library were systematically searched on practicing healthcare professionals’ EBP competencies published in January 2012–July 2017. A total of 3,947 publications were retrieved, of which 11 systematic reviews were eligible for a critical appraisal of methodological quality. Three independent reviewers conducted the critical appraisal using the Rapid Critical Appraisal tools developed by the Helene Fuld National Institute for Evidence‐Based Practice in Nursing & Healthcare.

Results

Practicing healthcare professionals’ self‐reported EBP knowledge, skills, attitudes, and beliefs were at a moderate to high level, but they did not translate into EBP implementation. Considerable overlap existed in the source studies across the included reviews. Few reviews reported any impact of EBP competencies on changes in care processes or patient outcomes. Most reviews were methodologically of moderate quality. Significant variation in study designs, settings, interventions, and outcome measures in the source studies precluded any comparisons of EBP competencies across healthcare disciplines.

Linking Evidence to Action

As EBP is a shared competency, the development, adoption, and use of an EBP competency set for all healthcare professionals are a priority along with using actual (i.e., performance‐based), validated outcome measures. The widespread misconceptions and misunderstandings that still exist among large proportions of practicing healthcare professionals about the basic concepts of EBP should urgently be addressed to increase engagement in EBP implementation and attain improved care quality and patient outcomes.
Role of human and porcine MHC DRB1 alleles in determining the intensity of individual human anti‐pig T‐cell responses
Authors: Hundrieser Joachim , Hein Rabea , Pokoyski Claudia , Brinkmann Antje , Düvel Heike , Dinkel Astrid , Trautewig Britta , Siegert Janina‐Franziska , Römermann Dorothee , Petersen Björn , Schwinzer Reinhard
Published: May 2019

Background

Differences in quality and strength of immune responses between individuals are mainly due to polymorphisms in major histocompatibility complex (MHC) molecules. Focusing on MHC class‐II, we asked whether the intensity of human anti‐pig T‐cell responses is influenced by genetic variability in the human HLA‐DRB1 and/or the porcine SLA‐DRB1 locus.

Methods

ELISpot assays were performed using peripheral blood mononuclear cells (PBMCs) from 62 HLA‐DRB1‐typed blood donors as responder and the porcine B cell line L23 as stimulator cells. Based on the frequency of IFN‐γ‐secreting cells, groups of weak, medium, and strong responder individuals were defined. Mixed lymphocyte reaction (MLR) assays were performed to study the stimulatory capacity of porcine PBMCs expressing different SLA‐DRB1 alleles.

Results

Concerning the MHC class‐II configuration of human cells, we found a significant overrepresentation of HLA‐DRB1*01 alleles in the medium/strong responder group as compared to individuals showing weak responses to stimulation with L23 cells. Evaluation of the role of MHC class‐II variability in porcine stimulators revealed that cells expressing SLA‐DRB1*06 alleles triggered strong proliferation in approximately 70% of humans. Comparison of amino acid sequences indicated that strong human anti‐pig reactivity may be associated with a high rate of similarity between human and pig HLA/SLA‐DRB1 alleles.

Conclusion

Variability in human and porcine MHC determines the intensity of individual human anti‐pig T‐cell responses. MHC typing and cross‐matching of prospective recipients of xenografts and donor pigs could be relevant to select for donor‐recipient combinations with minimal anti‐porcine immunity.
Effect of Dielectric Imperfections on the Electroactive Deformations of Polar Dielectric Elastomers
Authors: Jiang Yanhui , Liu Yang
Published: May 2019

We find that the ratio of dielectric permittivity to shear modulus is linearly related to the number of polar groups per polymer chain in polar dielectric elastomers (PDEs). Our discovery is verified via computational modeling and validated by experimental evidences. Based on the finding, we introduce the new concept of dielectric imperfection (DI) and provide some physical insights into understanding it through demonstrating the large nonlinear deformation of PDEs with DIs under electric fields. The results show remarkable DI-induced inhomogeneous deformation and indicate that the size and dielectric permittivity of DIs have a significant impact on the deformation stability of PDEs under electric fields. With this concept, we propose some potential applications of PDEs with DIs.
Analysis and Numerical Solutions for Fractional Stochastic Evolution Equations With Almost Sectorial Operators
Authors: Ding Xiao-Li , Nieto Juan J.
Published: May 2019

Fractional stochastic evolution equations often arise in theory and applications. Finding exact solutions of such equations is impossible in most cases. In this paper, our main goal is to establish the existence and uniqueness of mild solutions of the equations, and give a numerical method for approximating such mild solutions. The numerical method is based on a combination of subspaces decomposition technique and waveform relaxation method, which is called a frequency decomposition waveform relaxation method. Moreover, the convergence of the frequency decomposition waveform relaxation method is discussed in detail. Finally, several illustrative examples are presented to confirm the validity and applicability of the proposed numerical method.
Custom Patient-Specific Three-Dimensional Printed Mitral Valve Models for Pre-Operative Patient Education Enhance Patient Satisfaction and Understanding
Authors: Hung Kay S. , Paulsen Michael J. , Wang Hanjay , Hironaka Camille , Woo Y. Joseph
Published: May 2019

In recent years, advances in medical imaging and three-dimensional (3D) additive manufacturing techniques have increased the use of 3D-printed anatomical models for surgical planning, device design and testing, customization of prostheses, and medical education. Using 3D-printing technology, we generated patient-specific models of mitral valves from their pre-operative cardiac imaging data and utilized these custom models to educate patients about their anatomy, disease, and treatment. Clinical 3D transthoracic and transesophageal echocardiography images were acquired from patients referred for mitral valve repair surgery and segmented using 3D modeling software. Patient-specific mitral valves were 3D-printed using a flexible polymer material to mimic the precise geometry and tissue texture of the relevant anatomy. 3D models were presented to patients at their pre-operative clinic visit and patient education was performed using either the 3D model or the standard anatomic illustrations. Afterward, patients completed questionnaires assessing knowledge and satisfaction. Responses were calculated based on a 1–5 Likert scale and analyzed using a nonparametric Mann–Whitney test. Twelve patients were presented with a patient-specific 3D-printed mitral valve model in addition to standard education materials and twelve patients were presented with only standard educational materials. The mean survey scores were 64.2 (±1.7) and 60.1 (±5.9), respectively (p = 0.008). The use of patient-specific anatomical models positively impacts patient education and satisfaction, and is a feasible method to open new opportunities in precision medicine.
T-Cell Immunophenotyping and Cytokine Production Analysis in Patients with Chagas Disease 4 Years after Benznidazole Treatment
Authors: Llaguno Mauricio , da Silva Marcos Vinicius , Batista Lara Rocha , da Silva Djalma Alexandre Alves , de Sousa Rodrigo Cunha , de Resende Luiz Antonio Pertili Rodrigues , da Silva Valdo Jose Dias , Lages-Silva Eliane , Oliveira Carlo José Freire , Machado Juliana Reis , Rodrigues Denise Bertulucci Rocha , Correia Dalmo , Rodrigues Virmondes
Published: May 2019

The major problem with Chagas disease is evolution of the chronic indeterminate form to a progressive cardiac disease. Treatment diminishes parasitemia but not clinical progression, and the immunological features involved are unclear. Here, we studied the clinical course and the immune response in patients with chronic-phase Chagas disease at 48 months after benznidazole treatment.
Chlamydia muridarum Induces Pathology in the Female Upper Genital Tract via Distinct Mechanisms
Authors: Yu Heze , Lin Hui , Xie Lingxiang , Tang Lingli , Chen Jianlin , Zhou Zhiguang , Ni Jiangdong , Zhong Guangming
Published: May 2019

Sexually transmitted infection with
Chlamydia trachomatis
may lead to fibrotic blockage in women’s upper genital tracts, resulting in tubal infertility. Intravaginal inoculation with
C. muridarum
readily induces fibrotic blockage or hydrosalpinx in mice and is used for investigating
C. trachomatis
pathogenicity.
Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences
Authors: Chinoy Amish , Mughal Mohamed Zulf , Padidela Raja
Published: May 2019

Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP – primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.
Treatment of symptomatic coral reef aorta by a nitinol self-expanding stent
Authors: Vijayvergiya Rajesh , Mohammed Shadaab , Kanabar Kewal , Behera Arunangshu
Published: May 2019

Coral reef aorta (CRA) is a rare condition, characterised by rock-hard calcification of the juxta-renal and supra-renal aorta with luminal encroachment causing significant stenosis of the aorta and its branches. It usually presents as resistant hypertension, renal dysfunction, mesenteric ischaemia, limb claudication or embolic manifestations. Although surgical thrombo-endarterectomy along with bypass graft to the affected visceral arteries remains the cornerstone of treatment, it is associated with considerable mortality and morbidity, especially in patients with pre-existing comorbidities. Here we report an elderly female of resistant hypertension, who had successful endovascular aortic stenting using a non-graft self-expanding stent. Her blood pressure dramatically improved following endovascular management. In comparison to the conventional surgical approach, endovascular stenting can be an alternative, less invasive approach in selected CRA patients.
Safety and efficacy of herbal medicine for acute intracerebral hemorrhage (CRRICH): a multicentre randomised controlled trial
Authors: Zeng Liling , Tang Guanghai , Wang Jing , Zhong Jianbin , Xia Zhangyong , Li Jiexia , Chen Guangsheng , Zhang Yongbo , Luo Saihua , Huang Gan , Zhao Qianshan , Wan Yue , Chen Chaojun , Zhu Kaiyun , Qiao Hanzi , Wang Jian , Huang Tao , Liu Xian , Zhang Qixin , Lin Rongming , Li Haijun , Gong Baoying , Chen Xiuyan , Zhou Yuexiang , Wen Zehuai , Guo Jianwen
Published: May 2019

Objective

To evaluate the safety and efficacy of removing blood stasis (RBS) herbal medicine for the treatment of acute intracerebral haemorrhage (AICH) within a 6-hour time window.

Study design

A randomised, multicentre, double-blind, placebo-controlled study performed in 14 hospitals in China.

Participants and interventions

Patients with AICH were randomly assigned to receive a placebo, the ICH-1 (Intracerebral Haemorrhage) formula (eight herbs, including the RBS herbshirudoandtabanus) or the ICH-2 formula (six herbs without the RBS herbshirudoandtabanus) within 6 hours of ICH onset.

Outcomes

The primary safety outcome was the incidence of haematoma enlargement at 24 hours and at 10 days after treatment. The secondary outcome was the incidence of poor prognosis (mortality or modified Rankin Scale score ≥5) assessed at 90 days after symptom onset.

Results

A total of 324 subjects were randomised between October 2013 and May 2016: 105 patients received placebo; 108 patients received the ICH-1 formula; and 111 patients received the ICH-2 formula. The incidence of haematoma enlargement at 24 hours was 7.8% in the placebo group, 12.3% in the ICH-1 group and 7.5% in the ICH-2 group; the incidence of haematoma enlargement on day 10 was 1.1% in the placebo group, 1.1% in the ICH-1 group, and 3.1% in the ICH-2 group, with no significant differences among the groups (P>0.05). The mortality rates were 3.8% in the placebo group, 2.8% in the ICH-1 group, and 0.9% in the ICH-2 group; the incidences of poor prognosis were 7.1% in the placebo group, 6.0% in the ICH-1 group and 4.8% in the ICH-2 group at 3 months, with no significant differences among the groups (p>0.05). However, the overall frequency of treatment-emergent adverse events in the ICH-1 group (12.1%) was higher among the three groups (5.8% and 2.8%, respectively, p<0.05). All three cases of serious adverse events were in the ICH-1 group.

Conclusions

Ultra-early administration of ICH-1 formula for AICH patients did not exert significant beneficial effects on clinical outcomes but increased the risk of bleeding, which probably resulted from the inclusion of RBS herbal medicines in ICH-1.

Trialregistration number

NCT01918722.
Patient and public involvement in health research in low and middle-income countries: a systematic review
Authors: Cook Natalie , Siddiqi Najma , Twiddy Maureen , Kenyon Richard
Published: May 2019

Objectives

Patient and public involvement (PPI) is argued to lead to higher quality health research, which is more relatable to and helps empower the public. We synthesised the evidence to look for examples of PPI in health research in low/middle-income countries (LMICs), looking at levels of involvement and impact. Additionally, we considered the impact of who was undertaking the research on the level of involvement and reported impact.

Design

Systematic review.

Data sources

EMBASE, Medline and PsychINFO, along with hand-searching references, grey literature, Google search and expert advice.

Eligibility criteria

Any health research with evidence of patient or public involvement, with no language restrictions dated from 1978 to 1 Dec 2017.

Data extraction and synthesis

Data relating to stage and level of involvement, as well as impact, were extracted by one researcher (NC), and a coding framework was developed using an inductive approach to examine the impact of PPI on research. Extracted data were then independently coded by a second lay researcher (RK) to validate the data being collected. Discrepancies were referred to a third independent reviewer (MT) for review and consensus reached.

Results

Sixty-two studies met the inclusion criteria. The review revealed the most common stage for PPI was in research planning, and the most common level of involvement was collaboration. Most studies did not provide evidence of effectiveness or elaborate on the impact of PPI, and they tended to report impact from the researcher’s perspective. Where impact was mentioned, this generally related to increased relevance to the community, empowerment of participants and alterations in study design.

Conclusions

The literature describing approaches to and impact of PPI on LMIC health research is sparse. As PPI is essential to conducting high-quality research, it should be fully reported and evaluated at the end of the research project.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme
Authors: Brede Jostein Rødseth , Lafrenz Thomas , Krüger Andreas J , Søvik Edmund , Steffensen Torjus , Kriesi Carlo , Steinert Martin , Klepstad Pål
Published: May 2019

Background

Out-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study.

Methods

We developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study.

Results

Seven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3–12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8–15) min. The total objective assessment scores of the candidates’ competency was 41.8 (39–43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure.

Conclusion

This four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.

Trial registration number

NCT03534011.
More than pills: alternative adjunct therapies to improve comfort in hospitalised patients
Authors: Moore Megan , Schuler Maria , Wilson Samantha , Whisenhunt Morgan , Adams Ashleigh , Leiker Britany , Butler Tori , Shankweiler Caylin , Jones Matthew , Gibson Cheryl
Published: May 2019

Discomfort in the hospitalised patient continues to be one of the healthcare system’s greatest challenges to positive patient outcomes. The patients’ ability to focus on healing is impaired by discomforts such as pain, nausea and anxiety. Alternative, non-pharmacological therapies have shown to be effective in reducing discomfort and managing pain, complementing analgesic agents and optimising pain therapy modalities. This multi-cycle project is aimed to assess the effect of alternative therapies on inpatient, progressive care patients who reported discomfort or little to no relief in discomfort from prescribed analgesics and adjuvant agents. In the first Plan Do Study Act (PDSA) cycle, patients who reported discomfort were offered aromatherapy or visual relaxation DVDs. In the second PDSA cycle, patients were offered a comfort menu that consisted of multiple alternative interventions such as aromatherapy, ice or heat and ambulation. During each cycle, participants completed a survey measuring comfort levels before and after patient-selected alternative intervention(s) were administered. In the first PDSA cycle, 88% of patients reported an increase in comfort level after the intervention, and 97% reported an interest in using alternative therapy again. In the second PDSA cycle, 47% reported increased comfort, and 89% indicated a willingness to try alternative therapies again for improvement of comfort level. Overall, the quality improvement project increased the level of comfort reported by hospitalised patients, creating a gateway to comfort with less emphasis on prescribed analgesic medications.
Low rates of radiographic progression of structural joint damage over 2 years of baricitinib treatment in patients with rheumatoid arthritis
Authors: van der Heijde Desirée , Schiff Michael , Tanaka Yoshiya , Xie Li , Meszaros Gabriella , Ishii Taeko , Casillas Marta , Ortmann Robert A , Emery Paul
Published: May 2019

Objectives

To evaluate radiographic progression of structural joint damage over 2 years in patients with rheumatoid arthritis from baricitinib clinical trials who were disease-modifying antirheumatic drug (DMARD)–naïve or had an inadequate response to conventional synthetic DMARDs (csDMARD-IR).

Methods

Patients had completed one of three phase III studies and entered a long-term extension (LTE) study, continuing on the same baricitinib dose as at originating study completion. At 52 weeks, DMARD-naïve patients receiving methotrexate (MTX) or combination therapy (baricitinib 4 mg+MTX) were switched to baricitinib 4 mg monotherapy (±MTX per investigator opinion); MTX-IR patients receiving adalimumab were switched to baricitinib 4 mg on background MTX. At 24 weeks, csDMARD-IR patients receiving placebo were switched to baricitinib 4 mg on background csDMARD. Radiographs at baseline, year 1 and year 2 were scored using the van der Heijde modified Total Sharp Score. Linear extrapolation was used for missing data.

Results

Of 2573 randomised patients, 2125 (82.6%) entered the LTE, of whom 1893 (89.1%) entered this analysis. At year 2, progression was significantly lower with initial baricitinib (monotherapy or combination therapy) versus initial MTX in DMARD-naïve patients (proportion with non-progression defined by ≤smallest detectable change (SDC): 87.3% baricitinib 4 mg+MTX; 70.6% MTX; p≤ 0.001). In MTX-IR patients, progression with initial baricitinib was significantly lower than with initial placebo and similar to initial adalimumab (≤SDC: 82.7% baricitinib 4 mg; 83.5% adalimumab; 70.6% placebo; p≤0.001). In csDMARD-IR patients, significant benefit was seen with baricitinib 4 mg (≤SDC: 87.2% vs 73.2% placebo; p≤0.01).

Conclusions

Treatment with once-daily baricitinib resulted in low rates of radiographic progression for up to 2 years.
Controls on creek margin stability by the root systems of saltmarsh vegetation, Beaulieu Estuary, Southern England
Authors: Chen Yining , Thompson Charlotte , Collins Michael
Published: May 2019

The retreat of cliffs (lateral expansion) within tidal creeks results in a net loss of saltmarshes, but this retreat process can be retarded by root systems. To understand the interaction between root presence and bank sediment, quantitative measurements of two saltmarsh species root systems (Atriplex portulacoides and Juncus maritima) were carried out in a saltmarsh in Southern England, and their relationships with bank stability were examined. Computed Tomography (CT) Scanning techniques were used to investigate three-dimensional root architecture. The data obtained (e.g., root volume, diameter, and distribution patterns of roots) were examined alongside more traditional root density measurements. The volumetric percentage, ratio between horizontal (lateral) and vertical roots (H/V ratio), and root diameter distribution are discussed in relation to their influence on bank sediment erosion threshold and shear strength. The results suggest that Atriplex portulacoides is more effective than Juncus maritimus in stabilising banks. This is because root systems that provide a high resistance to flow-induced erosion are better than those that provide a high resistance to gravity-induced erosion in stabilising cliff banks. This conclusion is relevant to future saltmarsh protection and re-establishment.
Microscopic behavioural analysis of cyclist and pedestrian interactions in shared spaces
Authors: Alsaleh Rushdi , Hussein Mohamed , Sayed Tarek
Published: May 2019

This study investigates the microscopic interaction behaviour between cyclists and pedestrians in shared space environments. Video data was collected at the Robson Square shared space in downtown Vancouver, British Columbia. Trajectories of cyclists and pedestrians involved in 208 interactions (416 trajectories) were extracted using computer vision algorithms. The extracted trajectories were used to define different indicators for the analysis. The indicators included the speed and acceleration profiles and the longitudinal and lateral distances between road users during different phases of the interactions. The study also investigated the collision avoidance mechanisms employed by road users to avoid collisions with other shared space users. The collision avoidance mechanisms included changing the walking–cycling speed and changing the movement direction. The results showed that the collision avoidance mechanisms depend on the shared space density and the space available for road users. The study identified a set of parameters that can be used to calibrate microscopic cyclist–pedestrian modeling platforms to represent the behaviour of pedestrians and cyclists in shared space environments.