bluuebunny/crossref_metadata_2025 huggingface dataset:
“In that One the Ālif is Missing”: Eunuchs and the Politics of Masculinity in Early Colonial North India
Authors: Abbott Nicholas
Published: December 2019

Although ostensibly gendered as men and frequently maintaining independent, patriarchal households, enslaved eunuchs (khwājasarās) in pre- and early colonial regimes in South Asia were often mocked for their supposed effeminacy, bodily difference, and pretensions to normative masculinity. In the Mughal successor state of Awadh (1722-1856), such mockery grew more pronounced in the wake of growing financial demands from the British East India Company and attempts by eunuchs to alienate property with wills and testamentary bequests. Through examples of verbal derision directed at eunuchs, this essay shows that not only did ideas of normative masculinity serve as a vehicle for Awadh’s rulers to defend their sovereign authority from colonial encroachment, but that notions of normative manhood continued to inform eunuchs’ own self-perception into the nineteenth century.
Decoding Telegram: Iranian Users and ‘Produsaging’ Discourses in Iran’s 2017 Presidential Election
Authors: Kermani Hossein
Published: December 2019

This paper investigates the most-viewed posts in Persian Telegram channels during the period surrounding Iran’s 2017 presidential election. Telegram has become the most popular social medium in Iran, and its channels have played a significant role in recent social and political events. Based on the produsage theory and user-generated content concept, this research identifies the popular content and produsagers on Persian Telegram channels. Moreover, this paper evaluates the potential of these most-viewed posts to support or challenge the dominant discourses in Iran. Using a combination of content and discourse analyses, results show that user-generated content on Telegram supports and reinforces dominant discourses relatively strongly, rather than challenging them. They also show that politics and entertainment were the most popular content on Telegram and confirm that Telegram is usually considered a good tool for receiving information and news.
Phylogenetic re-examination of the “Gammiella ceylonensis” complex reveals three new genera in the Pylaisiadelphaceae (Bryophyta)

Authors: AKIYAMA HIROYUKI
Published: December 2019

Taxonomic re-examination of the Gammiella ceylonensis complex is done in the light of Sematophyllaceae-Pylaisiadelphaceae circumscription based on morphological and molecular (cpDNAs: rbcL, rps4, and trnL-F) phylogenetic analyses. Three new genera are proposed to accommodate the newly recognized clades. The first is Clastobryellina that is raised from a section level under Clastobryella to include four species—two are existing species with new combinations proposed here (C. ceylonensis, C. merrillii), and two are new species described here (C. lutea, C. orientalis). Clastobryum sect. Clastobryellina is lectotypified by Clastobryum merrillii. The second is Bonnosukea, a new genus described to accommodate only B. serrulata, which is formerly included in Clastobryum, but is shown to be sister to the genus. The last is Microgammiella, a new monotypic genus that is sister to Aptychella, with a newly described species M. flagelliformis. Three species of Clastobryellina, except for a northern Thailand endemic C. lutea, show wide and disjunct distribution in East Asia.
Morphological ontogeny in Tenuipalpus orilloi Rimando (Acari: Tenuipalpidae)
Authors: XU YUN , ZHU YU-ZHEN , WU JIE-QIN , ZHANG FEI-PING
Published: December 2019

The ontogenetic stages of a tenuipalpid mite, Tenuipalpus orilloi Rimando, are described with detailed illustrations of the larva, protonymph, deutonymph and adult male and female specimens recently collected from Evodia lepta (Spreng.) Merr. (Rutaceae) in the Fujian province of China. The ontogenetic changes in idiosomal and leg chaetotaxy are discussed.
Morphological ontogeny, ecology and some biological parameters of Achipteria nitens (Acari: Oribatida: Achipteriidae)
Authors: SENICZAK STANISŁAW , SENICZAK ANNA , KACZMAREK SŁAWOMIR , MARQUARDT TOMASZ
Published: December 2019

The morphological ontogeny of Achipteria nitens (Nicolet, 1855) from Crimea peninsula is redescribed and illustrated, and ecology and some biological parameters of this species are investigated. The larva of this species has short, thick and barbed setae in and of c-series, and anterior part of prodorsum reticulate, whereas the nymphs have most gastronotal setae of medium size and barbed, except for shorter c3, and shorter, thick and smooth p2 and p3. A key to the larva and nymphs of eight species of Achipteria Berlese, 1885 is provided.
Loan Waivers and Bank Credit: Reflections on the Evidence and the Way Forward
Authors: Narayanan Sudha , Mehrotra Nirupam
Published: December 2019

Executive Summary

In the past decade, farm loan waivers have become a policy instrument to alleviate the financial distress of farmers. Despite agreement on the theoretical rationale for such debt forgiveness and its deep contextual relevance, many fear that in the long run, loan waivers might vitiate the repayment culture in the farm sector and undermine the financial status of banks. At present, critiques of large-scale loan waivers rest on limited evidence. This article reviews and synthesizes existing research and available data on the implications of loan waivers, especially for the flow of credit to farmers from banks. On most of the issues, such as farmer well-being and repayment culture, there seems to be mixed evidence on the consequences of debt waivers. Credible evidence on macroeconomic implications is limited, mainly on account of methodological challenges. This article concludes that even if loan waivers are an inappropriate strategy to support farm incomes in sustainable ways, the wide-ranging negative impacts on the formal banking sector are perhaps overstated. A more fruitful approach would be to focus on whether loan waivers can be designed to reduce the possible negative consequences for the formal banking system as well as for macroeconomic system. The article identifies three possible instruments—loan insurance products that will help banks cope with the consequences of large-scale defaults. Second, to explore the creation of a distress fund that will cushion state finances, should there be a need for debt waivers. Third, it would be useful to consider the operation of debt relief commissions to have an ongoing process for debt waivers.
Assessment of health-related quality of life among adults hospitalized with sickle cell disease vaso-occlusive crisis
Authors: Esham Kimberly S. , Rodday Angie Mae , Smith Hedy P. , Noubary Farzad , Weidner Ruth Ann , Buchsbaum Rachel J. , Parsons Susan K.
Published: December 2019

Sickle cell disease (SCD) is characterized by painful vaso-occlusive crises (VOCs). Self-reported pain intensity is often assessed with the Numeric Rating Scale (NRS), whereas newer patient-reported outcome measures (PROMs) assess multidimensional pain in SCD. We describe pain experiences among hospitalized adults with VOCs, using 2 PROMs: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me). Adults with SCD hospitalized with VOCs at 2 academic centers in Boston, Massachusetts, from April 2016 to October 2017 were eligible. Participants completed the NRS and PROMs at admission and 7 days postdischarge. PROM scores were described and compared with population norms. Length of stay (LOS) and 30-day readmission rates were assessed. Forty-two (96%) of 44 eligible patients consented and completed admission assessments. Mean age was 30.2 years (standard deviation, 9.1), 60% were women, 76% were non-Hispanic black, and 64% had hemoglobin SS. Twenty-seven participants (64%) completed postdischarge assessments. Sixty percent had ≥4 VOCs in the last year. Nearly all PROMIS Global Health and ASCQ-Me scores were worse than population norms. NRS and PROMIS Global Physical Health scores improved after discharge, the latter driven principally by improvements in pain. Overall median LOS was 7 days, and 30-day readmission rate was 40.5%. Administration of PROMs among adults with SCD hospitalized for VOCs is feasible and demonstrates participants experienced recurrent, prolonged, and severe VOCs. PROMIS Global and ASCQ-Me scores indicated substantial suffering, and the striking 30-day readmission rate highlights the vulnerability of these patients.
Platelet α-granules contribute to organ-specific pathologies in a mouse model of severe malaria
Authors: Darling Thayer K. , Schenk Michael P. , Zhou Chengjing C. , Maloba Franklin M. , Mimche Patrice N. , Gibbins Jonathan M. , Jobe Shawn M. , Lamb Tracey J.
Published: December 2019

Key Points

Nbeal2 deficiency leads to significantly reduced lung and brain pathology and enhanced survival in a mouse model of malaria. Both antibody-dependent and antibody-independent platelet depletion in mice recapitulate the findings observed in Nbeal2−/− mice.
Obstacles open the door — Negative shocks can motivate individuals to focus on opportunities
Authors: Feng Jin , Zhou Wenxia , Li Shuoyu , Li Mengyi
Published: December 2019

By responding to the call for research on negative career shocks and future time perspective, this study regarded internal social capital as a tool of resource retention which shifts attention to negative career shocks’ positive effects. We test a moderated mediation model which illustrates the effect of negative career shocks on focus on opportunities—positive dimension of occupational future time perspective. Results revealed that internal social capital acts as the mediator between negative career shocks and focus on opportunities, and organizational embeddedness moderats the mediation effect. The relationship is stronger when individuals are highly embedded in organizations.
A multilevel and dynamic model of intragroup conflict and decision making: application of agent-based modeling
Authors: Wu Jiunyan , Sekiguchi Tomoki
Published: December 2019

Although intragroup conflict has both multilevel and dynamic natures, less attention has been paid to establishing a holistic model of intragroup conflict that emerges across levels and unfolds over time. To address this research gap, we extend the multilevel view of intragroup conflict (Korsgaard et al. 2008) to develop a multilevel and dynamic model of intragroup conflict that explicitly includes (1) the role of time and (2) the feedback loop to encompass the dynamic aspect of intragroup conflict. We further instantiate the extended model in the context of team decision-making. To achieve this and systematically examine the complex relationships, we use agent-based modeling and simulation (ABMS). We directly investigate how two types of intragroup conflict—task and relationship conflict—interplay with cross-level antecedences, interrelate and develop over time, and affect team outcomes. This study adds to the intragroup conflict research by extending the field with multilevel and dynamic views.
Modelling travelers’ appraisal of ridepooling service characteristics with a discrete choice experiment
Authors: König Alexandra , Grippenkoven Jan
Published: December 2019

Background

Ridepooling services have been predicted a bright future since they promise a flexible and user-centered mobility service. However, there is a research gap in examining the travelers’ perception of ridepooling service characteristics since findings concerning fixed-scheduled public transport are hardly transferable.

Methods

In order to shed some light on the human factors of ridepooling services a Discrete Choice Experiment (N = 410) was performed to identify travelers’ preferences concerning ridepooling’s service features. The study thereby focusses on the effect of trip purpose on the appraisal of the service attributes. Based on a literature review and a focus group six attributes of the operational concept were determined: fare, walking distance to the pick-up point, time of booking in advance, shift of departure time, travel time and information.

Results

The results underline that all of the six attributes significantly affected choice behavior. The appraisal of the service characteristics differed depending on the presented trip purpose. The willingness to pay was calculated for each service characteristics. The results give guidance for the user-centered design and operation of ridepooling systems that meet the requirements of the prospective passengers and thus facilitate behavioral shifts towards more sustainable mobility systems.
Clinical risk prediction with random forests for survival, longitudinal, and multivariate (RF-SLAM) data analysis
Authors: Wongvibulsin Shannon , Wu Katherine C. , Zeger Scott L.
Published: December 2019

Background

Clinical research and medical practice can be advanced through the prediction of an individual’s health state, trajectory, and responses to treatments. However, the majority of current clinical risk prediction models are based on regression approaches or machine learning algorithms that are static, rather than dynamic. To benefit from the increasing emergence of large, heterogeneous data sets, such as electronic health records (EHRs), novel tools to support improved clinical decision making through methods for individual-level risk prediction that can handle multiple variables, their interactions, and time-varying values are necessary.

Methods

We introduce a novel dynamic approach to clinical risk prediction for survival, longitudinal, and multivariate (SLAM) outcomes, called random forest for SLAM data analysis (RF-SLAM). RF-SLAM is a continuous-time, random forest method for survival analysis that combines the strengths of existing statistical and machine learning methods to produce individualized Bayes estimates of piecewise-constant hazard rates. We also present a method-agnostic approach for time-varying evaluation of model performance.

Results

We derive and illustrate the method by predicting sudden cardiac arrest (SCA) in the Left Ventricular Structural (LV) Predictors of Sudden Cardiac Death (SCD) Registry. We demonstrate superior performance relative to standard random forest methods for survival data. We illustrate the importance of the number of preceding heart failure hospitalizations as a time-dependent predictor in SCA risk assessment.

Conclusions

RF-SLAM is a novel statistical and machine learning method that improves risk prediction by incorporating time-varying information and accommodating a large number of predictors, their interactions, and missing values. RF-SLAM is designed to easily extend to simultaneous predictions of multiple, possibly competing, events and/or repeated measurements of discrete or continuous variables over time.Trial registration: LV Structural Predictors of SCD Registry (clinicaltrials.gov, NCT01076660), retrospectively registered 25 February 2010
Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study
Authors: Godfrey Mary , Green John , Smith Jane , Cheater Francine , Inouye Sharon K. , Hurst Keith , Young John
Published: December 2019

Background

Delirium is a frequent complication of hospital admission among older people. Multicomponent interventions which can reduce incident delirium by ≈one-third are recommended by the National Institute of Health and Care Excellence. Currently, a standardised delirium prevention system of care suitable for adoption in the UK National Health Service does not exist. The Prevention of Delirium (POD) system of care is a theory informed, multicomponent intervention and systematic implementation process which includes a role for hospital volunteers. We report POD implementation and delivery processes in NHS hospital wards, as part of a feasibility study.

Methods

A comparative case study design and participatory, multi-method evaluation was performed with sequential six month preparatory and six month delivery stages. Six wards in five hospitals in Northern England were recruited. Methods included: facilitated workshops; observation of POD preparatory activities; qualitative interviews with staff; collection of ward organisational and patient profiles; and structured observation of staff workload.

Results

POD implementation and delivery was fully accomplished in four wards. On these wards, implementation strategies informed by Normalization Process Theory operated synergistically and cumulatively. An interactive staff training programme on delirium and practices that might prevent it among those at risk, facilitated purposeful POD engagement. Observation of practice juxtaposed to action on delirium preventive interventions created tension for change, legitimating new ways of organising work around it. Establishing systems, processes and documentation to make POD workable in the ward setting, enhanced staff ownership. ‘Negotiated experimentation’ to involve staff in creating, appraising and modifying systems and practices, helped integrate the POD care system in ward routines. Activating these change mechanisms required a particular form of leadership: pro-active ‘steer’, and senior ward ‘facilitator’ to extend ‘reach’ to the staff group. Organisational discontinuity (i.e. ward re-location and re-modelling) disrupted and extended POD implementation; staff shortages adversely affected staff capacity to invest in POD. Findings resulted in the development of ‘site readiness’ criteria without which implementation of this complex intervention was unlikely to occur.

Conclusions

POD implementation and delivery is feasible in NHS wards, but a necessary context for success is ‘site readiness.’
Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial
Authors: Meng Weikun , Huang Zhong , Wang Haoyang , Wang Duan , Luo Zeyu , Bai Yang , Gao Liang , Wang Guanglin , Zhou Zongke
Published: December 2019

Background

The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH).

Methods

Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively.

Results

Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches.

Conclusion

The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches.

Trial registration information

The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.
Dental anomalies and orthodontic characteristics in patients with pseudohypoparathyroidism
Authors: Hejlesen Jane , Underbjerg Line , Gjørup Hans , Sikjaer Tanja , Rejnmark Lars , Haubek Dorte
Published: December 2019

Background

Pseudohypoparathyroidism (PHP) is a rare and inherited disease caused by mutations in theGNAS-gene or upstream of the GNAS complex locus. It is characterized by end-organ resistance to PTH, resulting in hypocalcemia and hyperphosphatemia. We aimed to investigate the dental anomalies according to tooth types and the orthodontic characteristics of patients with PHP.

Methods

Using a cross-sectional design, 29 patients (23 females) with PHP, living in Denmark, were included, and their clinical intraoral photos and radiographs were examined.

Results

Pulp calcification was found in 76% of the patients. Blunting of root apex was present in 55% and shortening of root in 48% of the examined patients. Blunting and shortening of roots were seen more often in premolars than in other tooth types (pboth < 0.01). Crowding of lower anterior teeth was frequently observed (36%) as well as diastema in the upper arch (25%), midline diastema (18%), and Class III malocclusion (11%).

Conclusion

In the present study population, the teeth were frequently affected by pulp calcification and/or deviation of the root morphology. Blunting and shortening of root(s) were more often seen in premolars than in other tooth types. Class III malocclusion was relatively prevalent. It is important to pay attention to dental anomalies and occlusion in order to provide adequate care for patients with PHP.
Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3–5-year-old children in Ile-Ife, Nigeria
Authors: Folayan Morenike Oluwatoyin , Alade Michael , Adeniyi Abiola , El Tantawi Maha , Finlayson Tracy L.
Published: December 2019

Background

To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3–5-year-old children resident in Ile-Ife, Nigeria.

Methods

This was a cross-sectional study. We analyzed data for 3–5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0–5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status.

Results

Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91–4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92–4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance.

Conclusions

Enamel hypoplasia and hypomineralized second primary molars are developmental dental anomalies associated with ECC. developmental dental anomalies also increases the probability of having poor oral hygiene in the population studied.
The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators
Authors: Marek Ewa , Łagocka Ryta , Kot Katarzyna , Woźniak Krzysztof , Lipski Mariusz
Published: December 2019

Background

Accurate determination of working length (WL) is crucial for the success of endodontic therapy. The aim of this study was to determine the influence of 2% chlorhexidine digluconate solution, 2% chlorhexidine digluconate gel and 2% hypochlorite solution on the accuracy of two devices: the Raypex 5 and the ApexDal.

Methods

Twenty-nine single-rooted human teeth were used in this study. The crowns were cut horizontally and embedded in an alginate mass. In each tooth, six endodontic measurements were made using two electronic apex locators (EALs): a Raypex 5 and an ApexDal. For each EAL, measurements were taken with the following products: 2% chlorhexidine solution (CHX-S group), 2% chlorhexidine gel (CHX-G group) and 2% NaOCl (NaOCl group). After performing an endodontic measurement, the endodontic instruments were stabilized with flow resin composite. Afterwards, the roots were removed from the alginate mass, and the apical one-third of each root was cut lengthways to recover the canal system. Last, the distance between the file tip and the apical foramen was measured under a microscope at 60 x magnification.

Results

Statistically significant differences were found between CHX-S and NaOCl and CHX-G and NaOCl, but no significant differences were detected between CHX-S and CHX-G during the testing of both devices. No statistically significant differences were observed between the Raypex 5 and ApexDal for all intracanal media tested.

Conclusion

The EALs Raypex 5 and ApexDal had higher accuracy in the anatomical foramen of the root containing chlorhexidine in the gel or in the solution form than in the canal containing sodium hypochlorite.
Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability
Authors:   for the SwiSCI Study Group, Tough Hannah , Brinkhof Martin W. G. , Siegrist Johannes , Fekete Christine
Published: December 2019

Background

Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers’ SEP with caregiver burden (‘actor effect’); 2) the association of the care-receivers’ SEP with caregiver burden (‘partner effect’), and 3) potential mediators of the association between SEP and caregiver burden.

Methods

Cross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership.

Results

We observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden.

Conclusions

Our study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.
The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation
Authors: Kwarteng Anthony , Akazili James , Welaga Paul , Dalinjong Philip Ayizem , Asante Kwaku Poku , Sarpong Doris , Arthur Samuelina , Bangha Martin , Goudge Jane , Sankoh Osman
Published: December 2019

Background

In 2004, Ghana implemented a national health insurance scheme (NHIS) as a step towards achieving universal health coverage. In this paper, we assessed the level of enrollment and factors associated with NHIS membership in two predominantly rural districts of northern Ghana after eight years of implementation, with focus on the poor and vulnerable populations.

Methods

A cross-sectional survey was conducted from July 2012 to December 2012 among 11,175 randomly sampled households with their heads as respondents. Information on NHIS status, category of membership and socio-demographic characteristics of household members was obtained using a structured questionnaire. Principal component analysis was used to compute wealth index from household assets as estimates of socio-economic status (SES). The factors associated with NHIS enrollment were assessed using logistic regression models. The reasons behind enrollment decisions of each household member were further investigated against their SES.

Results

Approximately half of the sampled population of 39,262 were registered with a valid NHIS card; 53.2% of these were through voluntary subscriptions by payment of premium whilst the remaining (46.8%) comprising of children below the ages of 18 years, elderly 70 years and above, pregnant women and formal sector workers were exempt from premium payment. Despite an exemption policy to ameliorate the poor and vulnerable households against catastrophic health care expenditures, only 0.5% of NHIS membership representing 1.2% of total exemptions granted on accounts of poverty and other social vulnerabilities was applied for the poor. Yet, cost of premium was the main barrier to NHIS registration (92.6%) and non-renewal (78.8%), with members of the lowest SES being worst affected. Children below the ages of 18 years, females, urban residents and those with higher education and SES were significantly more likely to be enrolled with the scheme.

Conclusions

Despite the introduction of policy exemptions as an equity measure, the poorest of the poor were rarely identified for exemption. The government must urgently resource the Department of Social Welfare to identify the poor for NHIS enrollment.
Survival benefits of neoadjuvant chemo(radio)therapy versus surgery first in patients with resectable or borderline resectable pancreatic cancer: a systematic review and meta-analysis
Authors: Pan Long , Fang Jing , Tong Chenhao , Chen Mingyu , Zhang Bin , Juengpanich Sarun , Wang Yifan , Cai Xiujun
Published: December 2019

Background

Pancreatic adenocarcinoma is a highly lethal malignancy. Neoadjuvant chemo(radio)therapy [NAC(R)T] is recommended to use for borderline resectable pancreatic cancer (BRPC) and high-risk resectable pancreatic cancer (RPC), but no high-level evidence exists.

Methods

We searched PubMed, EMBASE, Web of Science, and Cochrane library to identify trials comparing survival data of NAC(R)T with SF for RPC or BRPC. Overall survival (OS) was synthesized in analysis of all the patients (intention-to-treat [ITT] analysis) and resected patients respectively.

Results

The meta-analysis included 17 trials with 2286 participants. For BRPC, NAC(R)T improved OS both in ITT analysis (HR, 0.49; 95% CI, 0.37–0.65; P < 0.001) and in analysis of resected patients (HR, 0.66; 95% CI, 0.51–0.85; P = 0.001) in comparison to SF, accompanied with comparable overall resection rate [odds ratio (OR), 0.69; 95% Cl, 0.41–1.16; P = 0.159]. Disease-free survival, R0 rate, and recurrence were also in favor of NAC(R)T. For RPC, OS in analysis of resected patients was higher with NAC(R)T (HR, 0.75; 95% CI, 0.63–0.89; P = 0.001), but OS in ITT analysis was similar (HR, 1.02; 95% CI, 0.85–1.22; P = 0.818). The overall resection rate (OR, 0.50; 95% Cl, 0.25–0.99; P = 0.048) was lower, but R0 rate was higher with NAC(R)T. No differences in disease-free survival and recurrence between NAC(R)T and SF. Survival benefits of NAC(R)T basically persisted across sensitivity and subgroup analyses.

Conclusions

This meta-analysis demonstrates that NAC(R)T can provide survival benefits in BRPC patients and a subgroup of RPC patients compared with SF. Future research should focus on investigating the potential biomarkers to screen the subgroup of RPC patients who can benefit from neoadjuvant therapy.

Trial registration

CRD42018103086.
Is in vivo and ex vivo irradiation equally reliable for individual Radiosensitivity testing by three colour fluorescence in situ hybridization?
Authors: Mayo Theresa , Haderlein Marlen , Schuster Barbara , Wiesmüller Anna , Hummel Christian , Bachl Maximilian , Schmidt Manfred , Fietkau Rainer , Distel Luitpold
Published: December 2019

Background

Individual radiosensitivity is influencing the outcome of radiation therapy. A general ex vivo testing is very work-intensive. It is of interest to see if a significant prediction concerning the sensitivity can be made by in vivo irradiation during radiation treatment.

Methods

Blood samples of 274 patients with rectal cancer and 43 lung cancer patients receiving radiotherapy were examined after 2 Gy ex vivo and in vivo ionizing radiation. Chromosomes # 1, 2 and 4 were stained by the 3-color-fluorescence in situ hybridization. Chromosomal aberrations were analyzed as breaks per metaphase (B/M). The deposited energy per session was calculated for each patient.

Results

Weak correlation could be found between the chromosomal aberrations ex and in vivo. Though receiving significantly smaller deposited energy during radiation therapy (RT) the lung cancer cohort displayed B/M values similar to the rectal cancer cohort. Considering the individual deposit energy differences improved slightly the correlation.

Conclusions

As various factors influence the induction of chromosomal aberrations it seems not feasible to estimate individual radiosensitivity via in vivo irradiation. An ex vivo estimation of individual radiosensitivity should be preferred.
Decision-makers impact on the internationalization of high-technology firms in emerging markets
Authors: Neubert Michael , Van Der Krogt Augustinus Stijn
Published: December 2019

This study examines the impact of decision-makers from Paraguayan software firms on internationalization. It aims to have a better understanding about the (non-) rational decision logic of the CEOs and founders shaping the internationalization processes of 45 Paraguayan software firms. This study uses an observational, comparative descriptive, and a descriptive, correlational-research design based on a survey with the CEOs and founders of 45 Paraguayan software firms. The results suggest a significant correlational impact of decision-makers’ characteristics on the software firm’s internationalization and calls for further collaboration with high-tech firms from different industries in emerging as well as developed markets.
Toxicological implications of the fruit of Harungana madagascariensis on wistar rats
Authors: Shorinwa Olusayo Aderonke , Monsi Barizonmdu
Published: December 2019

Background

The unopened buds of the fruit of Harungana madagascariensis is used in the treatment of anaemia and skin diseases in traditional medicine. Hence, this study aims to scientifically evaluate the effects of oral administration of the fruit extract of Harungana madagascariensis on haematological, biochemical and histological parameters in Wistar rats.

Methods

Phytochemical screening of the ethanol fruit extract of H. madagascariensis was carried out. Acute toxicity test was done using Lorke’s method. Sub-acute toxicity studies were done using 24 rats of both sexes which were randomized into four groups of six rats each. Animals in groups A, B, C were administered with the extract at doses of 250, 500 and 1000 mg/kg, respectively while group D animals were given distilled water (5 mg/kg) and served as the control group. All administrations were done through the oral route for 30 consecutive days. Body weights of the animals were taken weekly during the study. The animals were sacrificed under diethyl ether anaesthesia and blood samples collected for evaluation of haematological (red blood cell, haemoglobin, packed cell volume and white blood cell) and biochemical (alanine transferase, alanine aminotransferase, alkaline phosphatase, urea, creatinine, total cholesterol and total protein) parameters. Histological examination was conducted on the liver and kidney of the animals.

Results

Preliminary phytochemical screening of the extract revealed the presence of alkaloids, anthraquinones, steroidal nucleus, saponins, carbohydrates, flavonoids, and tannins. Acute toxicity test showed that the LD50 was greater than 5000 mg/kg. There was no statistically significant (P < 0.05) difference in the RBC, HB, PCV and WBC of the extract treated groups when compared to the control group. There was however, a statistically significant (P < 0.05) difference in the creatinine level of the 500 mg/kg extract –treated group and the control. There was no statistically significant (P < 0.05) difference in other biochemical parameters of the extract treated groups and the control group except for a marginal increase in the total protein in the group treated with 1000 mg/kg of the extract (60 g/L) compared with control (54.80 g/L). Histopathological examination showed alterations in the morphology of the liver and kidney in extract treated groups as compared to the control groups.

Conclusion

The findings have revealed that the ethanol fruit extract of H. madagascariensis should be used with caution especially during prolonged usage as the histology showed it has nephrotoxic and hepatotoxic potentials. Further studies will be done to establish the effects of the extract on white blood cells.
The work of the Konrad-Adenauer-Stiftung (KAS) in Northeast Asia
Authors: Samse Stefan , Brauer Rabea , Badenheim Alexander , Hefele Peter , Merkle David
Published: December 2019

Northeast Asia contains several geopolitical hot spots, which alone or in combination, have a high risk potential for regional and global security. The rising assertiveness of the PR China, shifting economic weights, the need for a comprehensive economic transformation in an age of digitalisation and demographic shifts - these challenges shape the future of all Northeast Asian nations.

The Konrad-Adenauer-Stiftung (KAS), one of the largest political foundations of Germany, takes up these challenges not only with and within the respective societies, but also by developing platforms in the region and with Europe.

The article describes key issues, the target groups, and the methodological approaches taken by KAS in each of the Northeast Asian countries. It shows the diversity of the approaches, and highlights the opportunities and limits for a German political foundation in the region.
Black rain in Hiroshima: a critique to the Life Span Study of A-bomb survivors, basis of the linear no-threshold model
Authors: Sutou Shizuyo
Published: December 2019

Ionizing radiation is regulated by the linear no-threshold model (LNT), which asserts that the lowest doses of ionizing radiation are hazardous in proportion to the dose and dose rate. LNT is based on the data of the Life Span Study (LSS) of A-bomb survivors in Hiroshima and Nagasaki. Radiation doses of the survivors were estimated by using initial radiation (5% of blast energy) and residual radiation (10%) was neglected. The major component of residual radiation was fallout, most of which must be brought down to the ground by black rain. The rain was highly radioactive. There are three major black rain maps reporting that black rain covered wide areas of Hiroshima-City. The three lead to an important conclusion that not only A-bomb survivors but also not-in-the-city control subjects (NIC) were irradiated with residual radiation to a greater or lesser degree. This means that exposure doses in LSS were largely underestimated and that use of NIC as the negative control is faulty. Thus, LNT based on LSS is invalid. In addition, LSS ignores radiation hormesis ─ ionizing radiation is not always hazardous, but beneficial depending on doses and dose rates. Indeed, when LSS data of longevity were examined, a clear J-shaped dose-response, a hallmark of radiation hormesis, is apparent. Also, cancer mortality ratios are in the increasing order: NIC (exposed to residual radiation), A-bomb survivors (exposed to both initial and residual radiations), and the Japanese in general (no exposure). Thus, low dose radiation (LDR) is hormetic. Obstinate application of invalid LNT to regulation-unnecessary LDR has been causing tremendous human, social, and economic losses in Fukushima. Also, LNT prevents clinical application of radiation hormesis to age-associated diseases such as Alzheimer’s disease and cancers.
Rapid, efficient, and economical synthesis of PET tracers in a droplet microreactor: application to O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET)
Authors: Lisova Ksenia , Chen Bao Ying , Wang Jia , Fong Kelly Mun-Ming , Clark Peter M. , van Dam R. Michael
Published: December 2019

Background

Conventional scale production of small batches of PET tracers (e.g. for preclinical imaging) is an inefficient use of resources. Using O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET), we demonstrate that simple microvolume radiosynthesis techniques can improve the efficiency of production by consuming tiny amounts of precursor, and maintaining high molar activity of the tracers even with low starting activity.

Procedures

The synthesis was carried out in microvolume droplets manipulated on a disposable patterned silicon “chip” affixed to a heater. A droplet of [18F]fluoride containing TBAHCO3 was first deposited onto a chip and dried at 100 °C. Subsequently, a droplet containing 60 nmol of precursor was added to the chip and the fluorination reaction was performed at 90 °C for 5 min. Removal of protecting groups was accomplished with a droplet of HCl heated at 90 °C for 3 min. Finally, the crude product was collected in a methanol-water mixture, purified via analytical-scale radio-HPLC and formulated in saline. As a demonstration, using [18F]FET produced on the chip, we prepared aliquots with different molar activities to explore the impact on preclinical PET imaging of tumor-bearing mice.

Results

The microdroplet synthesis exhibited an overall decay-corrected radiochemical yield of 55 ± 7% (n = 4) after purification and formulation. When automated, the synthesis could be completed in 35 min. Starting with < 370 MBq of activity, ~ 150 MBq of [18F]FET could be produced, sufficient for multiple in vivo experiments, with high molar activities (48–119 GBq/μmol). The demonstration imaging study revealed the uptake of [18F]FET in subcutaneous tumors, but no significant differences in tumor uptake as a result of molar activity differences (ranging 0.37–48 GBq/μmol) were observed.

Conclusions

A microdroplet synthesis of [18F]FET was developed demonstrating low reagent consumption, high yield, and high molar activity. The approach can be expanded to tracers other than [18F]FET, and adapted to produce higher quantities of the tracer sufficient for clinical PET imaging.
Utilization of nitrate stable isotopes of Chydorus sphaericus (OF Müller) to elucidate the hydrological characteristics of riverine wetlands in the Nakdong River, South Korea
Authors: CHOI Jong-Yun , KIM Seong-Ki , KIM Jeong-Cheol , LA Geung-Hwan
Published: December 2019

Background

This study aimed to identify NO3−-N sources using the stable isotope δ15N in Chydorus sphaericus (OF Müller), to investigate hydrological characteristics and nutrient states in artificial wetlands near the Nakdong River. Chydorus sphaericus is dominant in wetlands where aquatic plants are abundant, occurring in high density, and is sensitive to wetland water pollution, making it suitable for identification of NO3−-N sources.

Results

NO3−-N sources for each wetland were strongly dependent on hydrological characteristics. Wetlands with sewage or rainfall/groundwater as their main sources had high levels of NO3−-N, whereas wetlands with surface water as their main input had comparatively lower levels. Since wetlands with sewage and rainfall/groundwater as their main water sources were mostly detention ponds, their inputs from tributaries or the main river stream were limited and nutrients such as NO3−-N easily become concentrated. Changes in NO3−-N levels at each wetland were closely associated with δ15N of C. sphaericus. Interestingly, regression analysis also showed positive correlation between δ15N of C. sphaericus and NO3−-N level.

Conclusions

We conclude that the nitrate stable isotope (δ15N) of C. sphaericus can be used to elucidate the hydrological characteristics of riverine wetlands. This information is important for maintenance and conservation of artificial wetlands at the Nakdong River.
Development and psychometric properties of the Thai Graves’ ophthalmopathy quality of life (GO-QOL) questionnaire
Authors: Lumyongsatien Mingkwan , Keeratidamkerngsakul Benjama , Pornpanich Kanokrat , Vangveeravong Sumalee , Saonanon Preamjit , Wiwatwongwana Damrong , Mahaisavariya Pornchai , Aryasit Orapan , Pongpirul Krit
Published: December 2019

Purpose

To develop and assess the psychometric properties of the Thai version of the Graves’ Ophthalmopathy Quality of Life (GO-QOL) questionnaire.

Background

Graves’ ophthalmopathy (GO) is a chronic condition that causes negative self-image and impaired visual function. These conditions impact quality of life (QOL) but are rarely documented. Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL) has good validity, reliability and responsiveness. In this study we developed a Thai GO-QOL questionnaire by translating the questionnaire from English to the Thai language and evaluated its reliability and validity.

Patients and methods

Forward and backward translations were performed independently by four translators with extensive experience in both English and Thai. Seventy patients at the thyroid clinic responded to the Thai translated version upon their first visit and again 2–3 weeks afterwards. Validity was assessed by the content validity index (CVI) and correlation with relevant clinical parameters. Reliability was evaluated by Cronbach’s alpha, the intraclass correlation coefficient, and the Bland-Altman plot.

Results

The Thai GO-QOL version showed high CVI (0.97) and a moderate negative correlation of the functional QOL score with disease severity (r = − 0.49), the clinical activity score (r = − 0.31), and exposure parameter (r = − 0.32). It showed good reliability with a high intraclass correlation coefficient (0.92) and high Cronbach’ s coefficient (0.86).

Conclusion

The Thai GO-QOL has good validity and reliability. It can be used to evaluate the quality of life of Graves’ ophthalmopathy patients as a consequence of their disease in thyroid treatment programs.