bluuebunny/crossref_metadata_2025 huggingface dataset:
Embodied Reasons in the Public Sphere: The Example of the Hijab
Authors: Wabel Thomas
Published: August 2019

In public debates on moral or political issues between participants from different religious backgrounds, liberal and secular thinkers like John Rawls and Jürgen Habermas recommend to restrict oneself to free-standing reasons that are independent of their religious, social or cultural origin. Following German philosopher Matthias Jung, however, I argue that such reasons fall short of describing the relevance of the issue in question for the adherents of a specific religion or worldview. Referring to the debates in several European countries about the hijab, I am showing how a deeper understanding of reasons as embodied in social practices and as embodied in individual biographies can help to disentangle such debates and to facilitate a dialogue on these issues.
Muted resistance: The deployment of youth voice in news coverage of young women’s sexuality in Aotearoa New Zealand
Authors: Morison Tracy , Herbert Sarah
Published: August 2019

Youth sexuality is typically constructed as a social problem, and associated with a range of negative consequences for larger society and for young people themselves – especially young women. The media play a role in perpetuating this dominant construction, but may also offer a space for resistance. In this article, mainstream news media reportage on youth sexual and reproductive issues in Aotearoa (New Zealand) is discursively analysed to identify instances of resistance to oppressive discourses. Taking a feminist poststructuralist perspective, the aim is to connect news reporting, as a representational practice, with broader relations of power. The focus of the analysis, therefore, is on whether and how young people are allowed a voice in news reportage, and to what effect their voices are deployed. The analysis demonstrates not only that youth voice is relatively muted in comparison to experts, but also that it is frequently used to reinforce the dominant constructions of youth sexuality (as problematic and risky). Yet, instances of resistance are also evident. These are assessed in relation to their impact on gender power relations, and possibilities for amplifying resistance are discussed.
Serum RANKL, osteoprotegerin (OPG) and RANKL/OPG ratio in children with systemic lupus erythematosus
Authors: Ali R , Hammad A , El-Nahrery E , Hamdy N , Elhawary A K , Eid R
Published: August 2019

Background

Systemic lupus erythematosus (SLE) patients have lower bone mineral density (BMD) compared with healthy individuals because of general, genetic, disease and medication-related factors. The disturbance of the receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) ratio has been reported to be associated with low BMD in many disorders in adults and children alike.

Objectives

The objectives of this study were (i) to assess serum OPG, RANKL and RANKL/OPG ratio levels in SLE children and controls, (ii) to determine whether the cumulative glucocorticoid (CGCS) dose had any effect on the concentration of serum RANKL, OPG and RANKL/OPG ratio, and (iii) to determine the relation of these parameters to BMD.

Methods

We evaluated 50 SLE children and 50 age- and sex-matched healthy controls. RANKL and OPG were assessed in serum and compared between patients and controls. For SLE patients, a univariate followed by multivariable analysis were carried out to detect the possible predictors of the changes in RANKL, OPG and RANKL/OPG ratio levels. Lumbar BMD for all patients was assessed by dual-energy X-ray absorptiometry (DXA) scan and then correlated to different probable correlated factors.

Results

RANKL, OPG and RANKL/OPG ratio were significantly higher in SLE patients ( p ≤ 0.001). Univariate analysis showed significant correlations of RANKL with CGCS ( p ≤ 0.001) and with DXA scan z-score ( p = 0.007): OPG was significantly correlated to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ( p = 0.001) and anti-double-stranded DNA ( p = 0.001), whereas RANKL/OPG was significantly correlated to duration of illness and DXA z-score ( p = 0.002). The multivariable analysis showed that DXA z-score was an independent predictor of RANKL and RANKL/OPG ratio ( p = 0.019 and 0.008, respectively), whereas SLEDAI score was an independent predictor of OPG levels. BMD was negatively correlated to disease duration ( p = 0.008) and CGCS dose ( p = 0.015), but no significant correlation has been found between BMD and cumulative SLEDAI score ( p = 0.29).

Conclusions

Serum RANKL/OPG ratio is elevated in Egyptian children with SLE and is considered a risk factor for reduced bone mass in these children. Other risk factors for low BMD include high CGCS dose and disease duration, supporting that osteoporosis in SLE is multifactorial.
City Profile: Patna, India
Authors: Alakshendra Abhinav
Published: August 2019

This profile of Patna focuses on the historical evolution of the city when the city has seen both extreme prosperity as well as destitution. After its glorious past during the Magadh Empire, Patna re-emerged as an important city during the British rule due to its locational advantage but witnessed another decline post-independence period. Being the capital city of the federal state of Bihar, Patna has experienced significant growth in population during the past four decades due to rural–urban migration and physical expansion of the city. However, there has not been a commensurate expansion in the infrastructure and services to accommodate this influx of people to the city. After the inclusion of Patna in the Smart City Mission, it is witnessing initiation of a plethora of infrastructure projects, which is expected to improve the urban service delivery in the near future. This city profile discusses the various dimensions of the city’s development and major policy initiatives undertaken during the recent period.
Interbank Interest-Rate Model for the Banking Business of a Multi-Industry Game
Authors: Thavikulwat Precha , Yu Bosco Wing Tong
Published: August 2019

Background. Even though banking undergirds all businesses of the modern economy, not much has been published about how the banking business should be simulated in a business game. A model of the interbank interest-rate market is useful for multi-industry games that includes the banking business, but such a model has not be described in the extant literature.

Aim. Our aim is to present a spliced model of the interbank interest-rate market that is derived from the nature of the modern banking system, and to show how the model is used in a game that gives participants practice in executing strategic business decisions and setting national monetary policies.

Method. Mathematics based on equilibrium arguments is used to formulate the model.

Argument. The interbank interest rate can be derived for three conditions depending on the relationship between aggregated loan requirements and aggregated loanable funds. The derived curves meet smoothly at a single splice point.

Conclusion. The spliced model should be useful in any multi-industry game that includes the banking business.
Patient Satisfaction With Venous Thromboembolism Treatment
Authors: Webb David , Kim Kibum , Tak Casey R. , Witt Daniel M. , Feehan Michael , Munger Mark A.
Published: August 2019

Venous thromboembolism (VTE) represents a major health-care problem. Understanding patient satisfaction with VTE care is an important health-care goal. A national online survey was administered to adults who had experienced a recent VTE event. The survey assessed patient satisfaction by: (1) satisfaction with VTE care provider; (2) likelihood to recommend VTE provider; and (3) satisfaction with communication between VTE care providers. Each question was correlated with patient demographics, patient care harms (ie, misdiagnosis, wrong treatment), patient beliefs concerning outcomes, and type of anticoagulant therapy. Respondents (907) were 52.4 ± 14.4 years, predominantly Caucasian, mostly women, and generally had health insurance. Most respondents were satisfied with VTE care providers, likely to recommend their VTE provider, and satisfied with communication between providers. Dissatisfaction was strongly associated with treatment mistakes, a wrong diagnosis or treatment, or delayed treatment. A national sample of VTE patients were generally satisfied with VTE care experiences. The VTE care dissatisfaction was strongly associated with perceived mistakes in VTE care. Interventions aimed at reducing, acknowledging, and communicating errors could be studied to improve VTE care satisfaction.
Loss of BRG1 (SMARCA4) Immunoexpression in a Pediatric Non-Central Nervous System Tumor Cohort
Authors: Saunders Jessica , Ingley Katrina , Wang Xiu Qing , Harvey Melissa , Armstrong Linlea , Ng Tony , Dunham Christopher , Bush Jonathan
Published: August 2019

Malignant rhabdoid tumors and atypical teratoid/rhabdoid tumors of the central nervous system are primitive malignancies associated with a poor prognosis. These tumors have previously been characterized by inactivation of the switch/sucrose nonfermenting (SWI/SNF) chromatin remodeling complex protein integrase interactor 1 (INI1), encoded by the SMARCB1 gene. In the last decade, sporadic publications have shown that a different SWI/SNF protein, brahma-related gene 1 (BRG1), encoded by the SMARCA4 gene, is associated with a similar rhabdoid phenotype and possible germline mutation termed rhabdoid tumor predisposition syndrome type 2. We sought to determine the presence of BRG1 expression in pediatric embryonal tumors. Using a local tissue microarray consisting of 28 tumors diagnosed as having an undifferentiated, polyphenotypic, or rhabdoid morphology, expression of BRG1 by immunohistochemistry was performed. Four cases showed loss of INI1, while 3 of the remaining 24 cases demonstrated loss of BRG1. Two cases were diagnosed as soft tissue sarcomas, and 1 case was diagnosed as a small cell carcinoma of the ovary, hypercalcemic type. Survival ranged from less than 6 months after diagnosis to more than 5 years at the time of last follow-up. In conclusion, we demonstrate that BRG1 immunohistochemistry is a useful second-line immunostain for the workup of undifferentiated, polyphenotypic or rhabdoid pediatric tumors that demonstrate retained expression of INI1.
A Comparison of Reproducibility of Inductively Coupled Spectrometric Techniques in Soil Metal Analyses
Authors: Nyika Joan , Onyari Ednah , Dinka Megersa Olumana , Mishra Shivani Bhardwaj
Published: August 2019

Precise estimation of metals in samples remains a challenge as a result of analytical biases and errors, which occur at sample collection, preparation, and measurement stages. A poor understanding of the nature and occurrence of these errors further aggravates this challenge. This study aimed at comparing the effectiveness of inductively coupled plasma (ICP) mass spectrometry (MS) and optical emission spectrometry (OES) techniques in quantifying metals from contaminated soils of Roundhill landfill vicinity. Using statistical tools, the study evaluated biases of the 2 methods. High coefficients of variation were realized for V, Cr, and Pb concentrations varied at various sampling sites. Concentrations of elements obtained using the 2 methods had no significant differences using t-test analysis. Definitive agreement for the 2 methods was observed for V, Cr, Co, Ni, Cu, Zn, Sr, and Pb concentrations, whereas the concentrations of Mg, Ca, Ti, Mn, and Fe showed some deviations in their regression lines. Spectral, systematic, memory, and carry over errors could be attributable to these deviations. The errors promote chelation and adsorption of ions in samples to form insoluble compounds that cannot be quantified. Overall, ICP-MS had greater sensitivity than ICP-OES in trace elements analysis compared with major elements.
The Role of IL-17 in Papulopustular Rosacea and Future Directions
Authors: Amir Ali Asma , Vender Reid , Vender Ronald
Published: August 2019

Rosacea is a chronic, progressive, inflammatory condition phenotypically subtyped into diagnostic features, major features, and minor/secondary features. There is currently no cure for rosacea, and it carries a significant negative psychosocial burden for afflicted patients. While there are a number of treatment modalities at the disposal of the clinician, clinical experience has suggested a need for updated treatments. The pathogenesis of rosacea is multifactorial; however, this paper will focus on the pivotal role of interleukin 17 (IL-17) in the development and progression of the disease. Furthermore, this paper will explore the mechanism of action of standard rosacea treatments and their effect on different stages of the IL-17 pathway. The standard treatments for rosacea are usually effective in controlling the symptoms of the disease in its mild-to-moderate form; however, their efficacy is diminished in the setting of severe and treatment-resistant rosacea. We hypothesize that IL-17 inhibitors, currently used successfully in psoriasis and psoriatic arthritis, could perhaps be used to treat severe and treatment-resistant papulopustular rosacea in the future; however, clinical trials and case reports will be needed to dictate expanded indications of IL-17 inhibitors. Furthermore, the high cost of IL-17 inhibitors presently prevents their use in disease states other than psoriasis or psoriatic arthritis.
Who cares for academics? We need to talk about emotional well-being including what we avoid and intellectualise through macro-discourses
Authors: Smith Charlie , Ulus Eda
Published: August 2019

This article explores academics’ well-being through analysing published sensitive disclosures, bringing to journal space the pain, rawness and emotional suffering of individuals’ experiences. We confront the taboos of speaking openly about mental health and emotional well-being in academic institutions, with masculine structures and encroaching neoliberal discourses that create hostile atmospheres unsupportive of vulnerability and uncertainty. We also challenge existing discourses about academics’ well-being, implicitly burdening individuals as responsible for their pain and creating walls of shame, rather than building new healthy structures. By spotlighting the voices of academics’ emotional disclosures, intensified by embodied social inequalities, we plead for openness in formal academic outlets for sharing pre-existing emotional struggles and new wounds created by cruelly competitive, winner-takes-all structures, fortified by neoliberal ideals. Led by individuals’ voices and experiences, we make recommendations for supporting academics as an attempt to extract academia from its current perverse state and commit to repair and transformation.
‘When you think of exercising, you don’t really want to think of puking, tears, and pain’: Young adolescents’ understanding of fitness and #fitspiration
Authors: Bell Beth T , Deighton-Smith Nova , Hurst Megan
Published: August 2019

Adolescents access information about fitness, including content labelled as #fitspiration, through social media. A total of 77 adolescents (mean age = 12.49; standard deviation = 0.55; girls = 27) participated in semi-structured focus groups to explore their perspectives on #fitspiration and fitness more broadly. Through inductive thematic analysis, four themes were developed: (1) fitness enhances physical function and appearance, but these are not always linked; (2) fitness is transformative but requires hard work; (3) fitness should be an intrinsically motivated personal choice; and (4) pain in the pursuit of fitness. Findings highlight young adolescents’ complex understandings of fitness negotiated through their critical interpretation of #fitspiration.
Uneasy Neoliberal Governance in a Low-Trust Society: Barriers to Responsibilisation in the Czech Republic
Authors: Hájek Martin , Šrám Kristián , Kolomoiets Maksym , Cuker Ivan
Published: August 2019

In our research, we examined how, if at all, a neoliberal responsibilisation of individuals is under way in the Czech Republic – a society characterised by low trust in its institutional system. Drawing on Giesler and Veresiu’s model of three-step consumer responsibilisation, we carried out a qualitative analysis of data generated primarily through an originally designed card-matching game and individual interviews, further complemented with field observation. The findings revealed that distrust in market institutions is generally a barrier to responsibilisation of citizens, leading to several kinds of semi-responsibilised subjectivities instead: restrained subjectivity, partially neoliberally responsibilised subjectivity, and economically responsibilised subjectivity. Lack of confidence in established institutions may effectively weaken or change the process of neoliberal responsibilisation of individuals, in particular in non-economic areas such as the environment, health, and social solidarity.
Flags on fire: Consequences of a national symbol’s desecration for intergroup relations
Authors: Marinthe Gaëlle , Falomir-Pichastor Juan Manuel , Testé Benoit , Kamiejski Rodolphe
Published: August 2019

Desecrating a national symbol is a powerful means of protest or of showing antipathy for a national group, but how do such actions impact ingroup favoritism? We investigated this issue via two field studies conducted prior to the France versus Ireland (Study 1, N = 72) and France versus Germany (Study 2, N = 165) matches at the Euro 2016 soccer tournament. We asked French participants to imagine the ingroup/competition outgroup flag being burnt by ingroup/competition outgroup perpetrators. Imagining the ingroup flag being burnt increased proingroup bias through increase in either ingroup favoritism (Study 1) or outgroup derogation (for all outgroups, including those unconnected with the threat; Study 2). Perpetrators’ group membership did not have the expected moderating effect. We discuss the implications of these results for social identity defense strategies and for the consequences of intragroup versus intergroup threats.
MiR-1254 Functions as a Tumor Suppressor in Oral Squamous Cell Carcinoma by Targeting CD36
Authors: Chen Ruixue , Zhang Yang , Zhang Xudong
Published: August 2019

Oral squamous cell carcinoma is one of the most common cancers around the world. The patients with oral squamous cell carcinoma are often diagnosed at late stages, leading to unfavorable prognosis. MicroRNAs might function as oncogenes or tumor suppressor genes in the tumorigenesis of cancer. This study aimed to explore the role of miR-1254 in oral squamous cell carcinoma. We examined the expression levels of miR-1254 in oral squamous cell carcinoma tissue samples and cell line.Proliferation and invasion assays were performed in oral squamous cell carcinoma cells with miR-1254 overexpression or underexpression. The potential regulatory mechanisms were also explored. We found that miR-1254 was significantly reduced in oral squamous cell carcinoma tissues and cell lines. In addition, downregulation of miR-1254 in oral squamous cell carcinoma tumor tissues was closely associated with cancer staging and lymph node metastasis. Enforced expression of miR-1254 significantly inhibited proliferation and invasion in oral cancer cells, and downregulation of miR-1254 promoted the oncogenic activities of oral cancer cells. CD36 was identified as a direct downstream target of miR-1254 by the luciferase reporter assay. Overexpression of CD36 partially restored the proliferation and invasion capacity inhibited by miR-1254. CD36 expression was inversely correlated with miR-1254 expression in the oral squamous cell carcinoma tissues. Taken together, our study provided the compelling evidence that miR-1254 might inhibit the progression of OSCC by partially downregulating CD36, and restoration of miR-1254 may represent an effective strategy for treating oral squamous cell carcinoma.
Iliac-Ileal Conduit Fistula
Authors: Coello Torà Iris , Martínez Moreno Ana Isabel , Guimerà García Jorge , de la Cruz Ruíz Marta , Pieras Ayala Enrique Carmelo
Published: August 2019

One of the possible complications of chronic ureteral stenting is an artery–urinary tract fistula, although it is very rare. If it occurs, it is an emergency that needs surgery because of hemorrhage. We describe a case of an iliac-ileal conduit fistula, which is extremely rare, that was successfully treated by endovascular stent grafting.
Investigating alternatives for system architectures to enhance discrete manufacturing
Authors: Afshar Sara , Koroorian Fereidon , Ashjaei Mohammad , Granlund Anna
Published: August 2019

This article investigates the possibility of advancing discrete manufacturing using system architectures that are developed for Collaborative Process Automation Systems. Collaborative Process Automation System is a technology that has the potential to achieve production excellence for process industry. However, not much attention has been paid on using the architectures based on Collaborative Process Automation Systems for discrete manufacturing domains. In this article, we propose a base architecture consisting of three layers, and we discuss various alternatives to make the communications among the layers. We consider legacy components in the proposal, in contrast to most of the related works. In order to show the practicality of the proposed alternatives, we present an example that has been implemented in an ongoing project at ABB Robotics in Sweden.
Atorvastatin Induced Erythrocytes Membrane Blebbing
Authors: Rana Rumaisa Bashir , Jilani Kashif , Shahid Muhammad , Riaz Muhammad , Ranjha Mazhar Hussain , Bibi Ismat , Asghar Asma , Irfan Muhammad
Published: August 2019

Atorvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl-coenzymeA reductase, is usually used for the treatment of hypercholesterolemia. Besides its pharmacological and side actions, its toxic effects on human nucleus devoid of erythrocytes are still unknown. Eryptosis is an alternative term used for suicidal erythrocyte death. Membrane blebbing is among the common markers of eryptosis. In this study, eryptotic effect of atorvastatin was investigated by exposing the erythrocytes for 48 hours to different concentrations (1-10 µM) of atorvastatin. The experimental work related to investigation of eryptosis was done by cell size measurement and calcium channel inhibition. As a possible mechanism of eryptosis, atorvastatin-induced oxidative stress was evaluated by determining catalase, glutathione peroxidase, and superoxide dismutase activities. Similarly, necrotic effect of atorvastatin was also determined by hemolytic assay. Results of our study illustrated that the tested doses of atorvastatin may induce oxidative stress as observed by significant reduction in superoxide dismutase, glutathione peroxidase, and catalase activities as well as induce eryptosis, featured by erythrocytes membrane blebbing. The study concluded that induction of oxidative stress by atorvastatin may lead to eryptosis.
Wavelet Packets Transform processing and Genetic Neuro-Fuzzy classification to detect faulty bearings
Authors: Hernández Angela , Castejón Cristina , García-Prada Juan Carlos , Padrón Isidro , Marichal Graciliano Nicolas
Published: August 2019

A great investment is made in maintenance of machinery in any industry. A big percentage of this is spent both in workers and in materials in order to prevent potential issues with said devices. In order to avoid unnecessary expenses, this article presents an intelligent method to detect incipient faults. Particularly, this study focuses on bearings due to the fact that they are the mechanical elements that are most likely to break down. In this article, the proposed method is tested with data collected from a quasi-real industrial machine, which allows for the measurement of the behaviour of faulty bearings with incipient defects. In a second phase, the vibrations obtained from healthy and defective pieces are processed with a multiresolution analysis with the purpose of extracting the most interesting characteristics. Particularly, a Wavelet Packets Transform processing is carried out. Finally, these parameters are used as Genetic Neuro-Fuzzy inputs; this way, once it has been trained, it will indicate whether the analyzed mechanical element is faulty or not.
Development and validation of wear models by using innovative three-dimensional laser scanners
Authors: Butini E , Marini L , Meli E , Rindi A , Valigi MC , Logozzo S
Published: August 2019

One of the main problems in railway and tramway systems, both dynamically (safety, comfort etc.) and economically (planning of maintenance interventions, reduction of wheel and rail lifetime etc.), is represented by the wear of wheel and rail profiles, due to the wheel–rail interaction. The profile’s shape variation caused by wear influences the dynamic behaviour of the vehicle and, in particular, the wheel–rail contact conditions. Hence, nowadays, one of the most important topics in the railway field is the development of reliable wear models to predict profiles evolution, together with the use of more efficient and accurate measuring instruments for the model validation and the rolling components inspection. In this context, the aim of this research work is the development and the validation of wear models, using experimental data acquired through an innovative measuring instrument based on noncontact three-dimensional laser scanning technology. The tramway line of the city of Florence, characterized by very narrow curves and critical in terms of wear, has been chosen as a reference test case. Moreover, the inspection procedures currently adopted on this line for the maintenance plan are based only on classical two-dimensional contact measurement systems, not so accurate for a complete wear assessment. Therefore, the introduction of a new three-dimensional laser scanning technology may have a great impact on the maintenance management of the line.
Multi-mobile robots and multi-trips feeding scheduling problem in smart manufacturing system: An improved hybrid genetic algorithm
Authors: Yao Feng , Song Yan-Jie , Zhang Zhong-Shan , Xing Li-Ning , Ma Xin , Li Xun-Jia
Published: August 2019

Modern manufacturing systems require timely and efficient production tasks. Any mistakes can have serious consequences which effect the production process obviously. The supply of goods is the beginning of the production process, ensuring that production can proceed normally. Using mobile robots for transportation and supply of production lines can achieve automatic manufacturing. We studied the use of multiple mobile robots to supply multiple production lines. Robots need to return to warehouse when no goods exist. This problem is called a multi-mobile robots and multi-trips feeding scheduling problem. We constructed a mathematical model describing multi-mobile robots and multi-trips feeding scheduling problem, and the objective function is to minimize the transportation cost and waiting cost. To solve this problem, we proposed an improved hybrid genetic algorithm, where a strategy of mixing improved genetic algorithm and tabu search algorithm is adopted to find robots with reasonable routes. Combining genetic algorithm with tabu search algorithm can improve the route planning effect and find a lower cost solution. In the experimental part, it is verified that the proposed algorithm could effectively find reasonable ways for robots to provide services. We also put forward suggestions for the scenarios of using robots in actual production.
The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release
Authors: Maempel Julian F. , Jenkins Paul J. , McEachan Jane E.
Published: August 2019

We studied whether mental health status is significantly correlated to patient reported functional outcomes and satisfaction after carpal tunnel release. Over a 7-year period, 809 patients completed Short Form-12 (SF-12) questionnaires which allowed calculation of the SF-12 mental component summary 1 year postoperatively, 780 (96%) completed a satisfaction questionnaire and 777 (96%) completed a QuickDisabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Median QuickDASH score was 55 preoperatively (interquartile range [IQR] 28) and 14 postoperatively (IQR 32). A total of 674 patients were satisfied. Patients with mental disability had worse QuickDASH scores (median 34, IQR 41) and a higher incidence of dissatisfaction (52/245, 21%) than those without mental disability (n = 9, IQR 20, 10%, both p < 0.001). Regression analyses indicated scores in the SF-12 mental component summary were significantly related to postoperative QuickDASH score ( p < 0.001) and satisfaction ( p = 0.02). We concluded that patients with mental disability report poorer outcomes and lower satisfaction rates; however, the majority still exhibit significant improvements and are satisfied.

Level of evidence: II
Vascularized flap transfer to fingers with volar digital veins as recipient vessels
Authors: Chen Chao , Wang Zeng Tao , Hao Li Wen , Liu Yang , Liu Huan Long
Published: August 2019

Traditionally free vascularized flap transfers to the fingers connect to the proper digital artery and dorsal veins. We report our experience using the volar digital veins as recipient veins for free vascularized flap transfers in 14 fingers of 12 patients. One or two veins (three flaps with two veins, 11 flaps with one vein) of the flap were anastomosed to volar digital veins in the recipient site. The arteries of these flaps were connected to the proper digital arteries. All the transferred flaps survived. No vessel crisis occurred. Our patients demonstrated that volar veins can be the recipient veins for free flap transfers in the fingers without increased risk of venous crisis and flap loss.

Level of evidence: IV
Emergency hormonal contraceptive service provision via community pharmacies in the UK: a systematic review of pharmacists’ and young women’s views, perspectives and experiences
Authors: Chirewa B , Wakhisi A
Published: August 2019

Aims:

Unintended pregnancy among young people remains a major public health problem in the UK, despite recent evidence suggesting that the number of teenage pregnancies in England is falling. Community pharmacies have the potential to reduce health inequalities among young women through improved and appropriate access to sexual health services. This study seeks to examine the views, perceptions and experiences of young women and community pharmacists concerning emergency hormonal contraceptive (EHC) provision from community pharmacies in the UK.

Methods:

Six electronic databases were searched for articles published in English between 2000 and 2017. Titles and abstracts were screened by two researchers according to the inclusion criteria.

Results:

A total of eight papers reporting studies carried out within the UK were included. Five key themes were identified from the perspectives of young women: convenience and ease of access, embarrassment and non-judgemental services, free services, confidentiality and pharmacist being helpful. Six key themes were identified from the perspectives of the pharmacists: concerns about supply of EHC, improved access, no need for appointment, confidentiality, free EHC and training.

Conclusions:

The review suggests that services should be designed based on the views, perceptions and experiences of the service users and providers in order to reduce inequities to access of EHC. Pharmacists who provide EHC should continuously upgrade their knowledge base through training if the sexual health needs of the young women who access pharmacies are to be adequately met.
Missed opportunities for organ donation in patients with intracranial haemorrhage at the emergency department: A single-centre study
Authors: Pek Jen Heng , Ho Vui Kian , Ng Wei Sheng , Kabir Tousif , Tiah Ling , Koh Yexin
Published: August 2019

Background:

The demand for transplantable organs has increased in Singapore. However, organ donation has been consistently lower than international standards. Donation after brain death (DBD) most commonly follows intracranial haemorrhage (ICH).

Objective:

Our aim was to identify missed opportunities for organ donation among those who presented to the Emergency Department (ED) and died following ICH.

Methods:

A retrospective study was carried out for all cases of ICH presenting to the ED from 1 January 2013 to 31 December 2017. The patients’ medical records were reviewed for identification of potential donors and actualisation of organ donation.

Results:

There were 615 cases of ICH, with a mortality rate of 6.0%. Among those who died, 28 (75.7%) died in the Intensive Care Unit (ICU) and nine (24.3%) patients had withdrawal of care in the ED. Thirty patients (81.1%) were potential donors but organ donation was actualised in only three (8.1%) patients. Thirteen organs, as well as heart valves and iliac vessels were retrieved from the organ donors for transplantation.

Conclusion:

There were missed opportunities for organ donation. EDs have an important role to play in the national organ donation programme by identifying potential donors for organ donation and considering admitting these patients to ICU to facilitate organ donation.
How the Japanese Term Kawaii Is Perceived Outside of Japan: A Study in Israel
Authors: Lieber-Milo Shiri , Nittono Hiroshi
Published: August 2019

In Japan, many products contain the characteristics of small, round, bright colors, and are adorable and sweet, in short kawaii (“cute” in direct translation into English). Over the years, the mass production of kawaii goods has made its way to the West, initially through visual media and later on through consumption goods. This exposure has brought increased interest in Japan and its culture among young Westerners as well as a rise in familiarity with everyday Japanese words like kawaii. This study illuminates how non-Japanese people, in this case Israelis, define and treat the term kawaii. The results of the survey showed that a high number of respondents were familiar with the term kawaii, were able to define it in their own words, and had a positive approach toward it. This article provides some empirical evidence of a successful penetration of the Japanese consumer-related culture and popular words in Israel.
Together, We Inspire Smart Eating (WISE): An Examination of Implementation of a WISE Curriculum for Obesity Prevention in Children 3 to 7 Years
Authors: Whiteside-Mansell Leanne , Swindle Taren , Selig James P.
Published: August 2019

This study examined the implementation of a school-based, obesity prevention curriculum, Together, We Inspire Smart Eating (WISE), targeting 3- to 7-year-old low-income children. Survey data from a convenience sample were collected from educators and parents (N = 73, N = 188, respectively) at the beginning and end of a school year in which WISE was implemented. Educators also reported on lessons weekly. Measures to evaluate the success of the implementation were conceptually distinct implementation outcomes (Educators: Perceived Barriers, Appropriateness, Acceptability, Feasibility, Fidelity; Parents: Adoption, Appropriateness). WISE was successfully implemented in 33 target classrooms representing 7 preschool centers and 2 elementary schools. Based on educator report, perceived barriers were reduced. Educators rated Appropriateness, Acceptability, and Feasibility high. Evidence of Fidelity was mixed. Parents reported indicators of Adoption and Appropriateness high. The study provided support for WISE in preschools and elementary schools serving young children from low-resource homes.
A Practical Approach to Clinical Ethics Education for Undergraduate Medical Students: A Case Study From Guatemala
Authors: Aguilera María Lorena , Martínez Siekavizza Sergio , Barchi Francis
Published: August 2019

Objective:

This case study describes a faculty initiative to create a curriculum in applied medical ethics for undergraduate medical students at the Universidad Francisco Marroquin (UFM) in Guatemala City, Guatemala.

Methods:

The new ethics curriculum (PRACTICE) incorporates ethics short-courses into the university’s system of nontraditional, credit-bearing electives offered to students as part of their 6-year undergraduate medical education and complements existing didactic courses in normative ethics. Structured case-based activities allow for flexibility in design and scheduling, do not compete with core requirements of the existing curriculum, and enable students to develop critical reasoning approaches to ethical situations they will encounter in medical practice. Two preliminary workshops provided teaching opportunities for the faculty, stimulated student interest in future ethics courses, and provided an evidence base to guide the development of a formal curriculum.

Results:

The elective currently includes six 2-hour modules, each of which is a stand-alone unit with learning goals and objectives, brief didactic lecture, assigned readings, discussion case, and assessment. To date, more than 110 students have participated in the workshops and courses. Student feedback and evaluations are being used to refine pedagogical approaches and drive future course content.

Conclusions:

The PRACTICE course format offers a transformative model for ethics education in Guatemala that can be used in medical education throughout the country and region.
Ixekizumab—An Effective and Safe Treatment for Moderate-to-Severe Plaque Psoriasis in Patients Previously Treated With Other IL-17 Inhibitors: Results From IXORA-P
Authors: Papp Kim , Blauvelt Andrew , Sullivan John , Tada Yayoi , Polzer Paula , Mallbris Lotus , Zhang Lu , Hong Chi-ho
Published: August 2019

Background:

The impact of treatment with interleukin 17 (IL-17) inhibitors on the efficacy of subsequent IL-17 inhibitor therapy is unknown.

Objective:

To evaluate the impact of previous treatment with IL-17 inhibitors on the 52-week efficacy of ixekizumab in patients with moderate-to-severe psoriasis.

Methods:

In a phase 3, randomized, double-blinded trial (IXORA-P; NCT02513550), patients with moderate-to-severe plaque psoriasis were randomized (2:1:1) to ixekizumab 80 mg every 2 weeks (IXE Q2W, n = 611), every 4 weeks (IXE Q4W, n = 310), or IXE Q4W/IXE Q2W dose adjustment (per predefined criteria; n = 306). Psoriasis Area and Severity Index 75%, 90%, and 100% response rates (PASI 75, PASI 90, and PASI 100) were assessed.

Results:

Overall, 288 (23.5%) of 1227 patients were IL-17 inhibitor experienced (brodalumab, 22.6%; secukinumab, 1.1%). The PASI 75, 90, and 100 at week 52 were similar between IL-17 inhibitor-naive and IL-17 inhibitor-experienced patients. The PASI 75 at week 52 for IL-17 inhibitor-naive and -experienced patients was 85% and 89% (IXE Q2W), 79% and 81% (IXE Q4W), and 83% and 85% (IXE Q4W/IXE Q2W), respectively. The PASI 90 at week 52 for IL-17 inhibitor-naive and -experienced patients was 79% and 82% (IXE Q2W), 65% and 67% (IXE Q4W), and 73% and 75% (IXE Q4W/IXE Q2W), respectively. The PASI 100 at week 52 for IL-17 inhibitor-naive and -experienced patients was 60% and 59% (IXE Q2W), 44% and 42% (IXE Q4W), and 49% and 52% (IXE Q4W/IXE Q2W), respectively. Safety findings were generally similar between IL-17 inhibitor-naive and -experienced patients.

Conclusion:

Ixekizumab was demonstrated to be an effective and safe therapeutic option for patients previously treated with other IL-17 inhibitors.
Opioid Prescribing in the Elderly: A Systematic Review
Authors: Jassal Melissa , Egan Greg , Dahri Karen
Published: August 2019

Objective: To characterize the literature describing the therapeutic use of opioids in the elderly. Data Sources: Two electronic databases, EMBASE and MEDLINE, were searched from years 1990 to September 5, 2018. Relevant reference lists were reviewed. Searches were restricted to English language. Study Selection and Data Extraction: Two reviewers independently screened 827 citations to identify observational studies, population-based cohort studies, retrospective analyses, and control trials looking at the management of persistent pain in patients aged ≥65 years and/or frail patients. Data Synthesis: Thirty-nine articles were included in the systematic review. More specifically, 17 observational studies, 7 population-based cohort studies, 10 retrospective analyses, and 4 controlled trials. The most common etiology of persistent pain was musculoskeletal (50%), and the most often adverse effects reported were central nervous system related (41%) and falls/fractures (39%). Relevance to Patient Care and Clinical Practice: As there is a lack of strong evidence-based recommendations for opioid use in the elderly, this review aims to evaluate opioid use in the elderly and compare their efficacy and safety among this population. Conclusions: Overall, central nervous system adverse effects were most commonly seen in the elderly. However, higher quality evidence is required to further appreciate the dose-related effects on efficacy and safety of opioids in the elderly.
The efficiency of murine MLL-ENL–driven leukemia initiation changes with age and peaks during neonatal development
Authors: Okeyo-Owuor Theresa , Li Yanan , Patel Riddhi M. , Yang Wei , Casey Emily B. , Cluster Andrew S. , Porter Shaina N. , Bryder David , Magee Jeffrey A.
Published: August 2019

MLL rearrangements are translocation mutations that cause both acute lymphoblastic leukemia and acute myeloid leukemia (AML). These translocations can occur as sole clonal driver mutations in infant leukemias, suggesting that fetal or neonatal hematopoietic progenitors may be exquisitely sensitive to transformation by MLL fusion proteins. To test this possibility, we used transgenic mice to induce one translocation product, MLL-ENL, during fetal, neonatal, juvenile and adult stages of life. When MLL-ENL was induced in fetal or neonatal mice, almost all died of AML. In contrast, when MLL-ENL was induced in adult mice, most survived for >1 year despite sustained transgene expression. AML initiation was most efficient when MLL-ENL was induced in neonates, and even transient suppression of MLL-ENL in neonates could prevent AML in most mice. MLL-ENL target genes were induced more efficiently in neonatal progenitors than in adult progenitors, consistent with the distinct AML initiation efficiencies. Interestingly, transplantation stress mitigated the developmental barrier to leukemogenesis. Since fetal/neonatal progenitors were highly competent to initiate MLL-ENL–driven AML, we tested whether Lin28b, a fetal master regulator, could accelerate leukemogenesis. Surprisingly, Lin28b suppressed AML initiation rather than accelerating it. This may explain why MLL rearrangements often occur before birth in human infant leukemia patients, but transformation usually does not occur until after birth, when Lin28b levels decline. Our findings show that the efficiency of MLL-ENL–driven AML initiation changes through the course of pre- and postnatal development, and developmental programs can be manipulated to impede transformation.
Axitinib in Combination With Toripalimab, a Humanized Immunoglobulin G4 Monoclonal Antibody Against Programmed Cell Death-1, in Patients With Metastatic Mucosal Melanoma: An Open-Label Phase IB Trial
Authors: Sheng Xinan , Yan Xieqiao , Chi Zhihong , Si Lu , Cui Chuanliang , Tang Bixia , Li Siming , Mao Lili , Lian Bin , Wang Xuan , Bai Xue , Zhou Li , Kong Yan , Dai Jie , Wang Kai , Tang Xiongwen , Zhou Huaning , Wu Hai , Feng Hui , Yao Sheng , Flaherty Keith T. , Guo Jun
Published: August 2019

PURPOSE

Metastatic mucosal melanoma responds poorly to anti–programmed cell death-1 (PD-1) monotherapy. Vascular endothelial growth factor (VEGF) has been shown to play an important immunosuppressive role in the tumor microenvironment. The combination of VEGF inhibition and PD-1 blockade provides therapeutic opportunities for patients refractory to either therapy alone.

PATIENTS AND METHODS

We conducted a single-center, phase IB trial evaluating the safety and preliminary efficacy of toripalimab, a humanized immunoglobulin G4 monoclonal antibody against PD-1 in combination with the VEGF receptor inhibitor axitinib in patients with advanced melanoma, including patients with chemotherapy-naïve mucosal melanomas (88%). Patients received toripalimab at 1 or 3 mg/kg via intravenous infusion every 2 weeks, in combination with axitinib 5 mg orally twice a day, in a dose-escalation and cohort-expansion study until confirmed disease progression, unacceptable toxicity, or voluntary withdrawal. The primary objective was safety. Secondary objectives included efficacy, pharmacokinetics, pharmacodynamics, immunogenicity, and tumor tissue biomarkers.

RESULTS

Thirty-three patients were enrolled. No dose-limiting toxicities were observed. Ninety-seven percent of patients experienced treatment-related adverse events (TRAEs). The most common TRAEs were mild (grade 1 or 2) and included diarrhea, proteinuria, hand and foot syndrome, fatigue, AST or ALT elevation, hypertension, hypo- or hyperthyroidism, and rash. Grade 3 or greater TRAEs occurred in 39.4% of patients. By the cutoff date, among 29 patients with chemotherapy-naïve mucosal melanoma, 14 patients (48.3%; 95% CI, 29.4% to 67.5%) achieved objective response, and the median progression-free survival time was 7.5 months (95% CI, 3.7 months to not reached) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.

CONCLUSION

The combination of toripalimab plus axitinib was tolerable and showed promising antitumor activity in patients with treatment-naïve metastatic mucosal melanoma. Patients enrolled in this study were all Asian, and this combination therapy must be validated in a randomized phase III trial that includes a non-Asian population before it can become a standard of care.
Myosin 1a Regulates Osteoblast Differentiation Independent of Intestinal Calcium Transport
Authors: Munson Scott , Wang Yongmei , Chang Wenhan , Bikle Daniel D
Published: August 2019

Myosin 1A (Myo1a) is a mechanoenzyme previously thought to be located exclusively in the intestinal epithelium. It is the principle calmodulin-binding protein of the brush border. Based on earlier studies in chickens, we hypothesized that Myo1a facilitates calcium transport across the brush border membrane of the intestinal epithelium, perhaps in association with the calcium channel Trpv6. Working with C2Bbe1 cells, a human intestinal epithelial cell line, we observed that overexpression of Myo1a increased, whereas the antisense construct blocked calcium transport. To further test this hypothesis, we examined mice in which either or both Myo1a and Trpv6 had been deleted. Although the Trpv6-null mice had decreased intestinal calcium transport, the Myo1a-null mouse did not, disproving our original hypothesis, at least in mice. Expecting that a reduction in intestinal calcium transport would result in decreased bone, we examined the skeletons of these mice. To our surprise, we found no decrease in bone in the Trpv6-null mouse, but a substantial decrease in the Myo1a-null mouse. Double deletions were comparable to the Myo1a null. Moreover, Myo1a but not Trpv6 was expressed in osteoblasts. In vitro, the bone marrow stromal cells from the Myo1a-null mice showed normal numbers of colony-forming units but marked decrements in the formation of alkaline phosphatase–positive colonies and mineralized nodules. We conclude that Myo1a regulates osteoblast differentiation independent of its role, if any, in intestinal calcium transport, whereas Trpv6 functions primarily to promote intestinal calcium transport with little influence in osteoblast function.