bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between Defence Healthcare Engagement and humanitarian assistance
Authors: Falconer Hall Thomas , Horne S , Ross D
Published: March 2020

Humanitarian assistance and Defence Healthcare Engagement have traditionally both been taught on the Medical Humanitarian Stabilisation Operations Course. However, the two activities are distinct. This paper outlines the critical differences between them, focusing on their specific purposes, scope, timescales and ethics. Humanitarian assistance will remain a distinct activity with a focus on the relief of suffering, guided by international norms, while Defence Healthcare Engagement will encompass a broader range of activities, less constrained by internationally agreed principles. This presents an opportunity for the Defence Medical Services to directly contribute to projecting UK influence, preventing conflict and building stability. However, it requires the Defence Medical Services to take responsibility for the ethical issues that Defence Healthcare Engagement raises. This paper recommends the development of an ethical framework that reconciles the strategic aims of Defence Healthcare Engagement with maximising patient welfare at the tactical level. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
Accuracy and consequences of usingtrial-of-antibioticsfor TB diagnosis (ACT-TB study): protocol for a randomised controlled clinical trial
Authors: Divala Titus Henry , Fielding Katherine L , Sloan Derek J , French Neil , Nliwasa Marriott , MacPherson Peter , Kandulu Chikondi Charity , Chiume Lingstone , Chilanga Sanderson , Ndaferankhande Masiye John , Corbett Elizabeth L
Published: March 2020

Introduction

Over 40% of global tuberculosis case notifications are diagnosed clinically without mycobacteriological confirmation. Standard diagnostic algorithms include ‘trial-of-antibiotics’—empirical antibiotic treatment given to mycobacteriology-negative individuals to treat infectious causes of symptoms other than tuberculosis, as a ‘rule-out’ diagnostic test for tuberculosis. Potentially 26.5 million such antibiotic courses/year are prescribed globally for the 5.3 million/year mycobacteriology-negative patients, making trial-of-antibiotics the most common tuberculosis diagnostic, and a global-scale risk for antimicrobial resistance (AMR). Our systematic review found no randomised controlled trial (RCT) to support use of trial-of-antibiotic. The RCT aims to determine the diagnostic and clinical value and AMR consequences of trial-of-antibiotics.

Methods and analysis

A three-arm, open-label, RCT randomising (1:1:1) Malawian adults (≥18 years) seeking primary care for cough into: (a) azithromycin 500 mg one time per day for 3 days or (b) amoxicillin 1 g three times per day for 5 days or (c) standard-of-care (no immediate antibiotic). We will perform mycobacteriology tests (microscopy, Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) andMycobacterium tuberculosisculture) at baseline. We will use audiocomputer-assisted self-interview to assess clinical improvement at day 8. First primary outcome will be proportion of patients reporting day 8 improvement out of those with negative mycobacteriology (specificity). Second primary outcome will be day 29 incidence of a composite endpoint of either death or hospitalisation or missed tuberculosis diagnosis. To determine AMR impact we compare proportion of resistant nasopharyngealStreptococcus pneumoniaeisolates on day 29. 400 mycobacteriology-negative participants/arm will be required to detect a ≥10% absolute difference in diagnostic specificity with 80% power. We will estimate measures of effect by comparing outcomes in antibiotic arms (combined and individually) to standard-of-care.

Ethics and dissemination

The study has been reviewed and approved by Malawi College of Medicine Research and Ethics Committee, London School of Hygiene & Tropical Medicine (LSHTM) Research Ethics Committee and Regional Committee for Health and Research Ethics – Norway, and Malawi Pharmacy, Medicines and Poisons Board. We will present abstracts at relevant conferences, and prepare a manuscript for publication in a peer-reviewed journal.

Trial registration number

The clinical trial is registered with ClinicalTrials.gov,NCT03545373
Unwanted effects of treatments for depression in children and adolescents: a mapping of systematic reviews
Authors: Eidet Lise Mette , Dahlgren Astrid , Elvsåshagen Mari
Published: March 2020

Objectives

To describe the results of a mapping review exploring the coverage of unwanted treatment effects in systematic reviews of the effects of various treatments for moderate to severe depression in children and adolescents.

Setting

Any context or service providing treatment for depression, including interventions delivered in local communities and school settings, as well as services provided in primary or specialist care.

Participants

Children and young people with moderate to severe depression (<18 years).

Interventions

Systematic reviews published in 2011 or later comparing the effects of any treatment for children and adolescents with moderate to severe depression meeting the Database of Abstracts of Reviews of Effects criteria. The systematic search was performed in April 2018 and updated in December 2018.

Primary outcomes

Any unwanted effects of treatments as defined in the systematic review.

Results

We included 10 systematic reviews covering 19 treatment comparisons. Unwanted effects were assessed for seven of 19. Three comparisons were evaluations of pharmaceutical interventions or combination therapy, reporting effects on ‘suicidal ideation’ and ‘suicide risk’. Two included therapy, reporting ‘self-harm’, and ‘suicidal ideation’, and two comparisons included transcranial magnetic stimulation and electroconvulsive treatment. Unwanted effects evaluated for these treatments were mostly symptoms of physical discomfort such as headache or cramps. For the remaining treatment comparisons evaluating psychological and psychosocial therapies, unwanted effects were not evaluated or found. A limitation of overviews of systematic reviews such as this mapping study is that data extraction is done based on the reporting of results by the review authors and not on the primary studies.

Conclusion

The unwanted effects of widely used treatments for children and young people with depression is unknown. This is a major barrier for evidence informed decision making about treatment choices for children and young people. We suggest that unwanted effects should be a reporting standard in all protocols describing evaluations of treatments, including primary studies as well as systematic reviews.
Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial
Authors: Williams Brian , Hibberd Carina , Baldie Deborah , Duncan Edward A S , Elders Andrew , Maxwell Margaret , Rattray Janice E , Cowie Julie , Strachan Heather , Jones Martyn C
Published: March 2020

Background

Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design.

Method

The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge.

Results

We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge.

Conclusions

We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved.

Trial registration number

UKCRN 14195.
Utility and validity of dynamic chest radiography in cystic fibrosis (dynamic CF): an observational, non-controlled, non-randomised, single-centre, prospective study
Authors: FitzMaurice Thomas Simon , McNamara Paul Stephen , Nazareth Dilip , McCann Caroline , Bedi Ram , Shaw Matthew , Walshaw Martin
Published: March 2020

Introduction

Dynamic chest radiography (DCR) uses novel, low-dose radiographic technology to capture images of the thoracic cavity while in motion. Pulmonary function testing is important in cystic fibrosis (CF). The tolerability, rapid acquisition and lower radiation and cost compared with CT imaging may make DCR a useful adjunct to current standards of care.

Methods and analysis

This is an observational, non-controlled, non-randomised, single-centre, prospective study. This study is conducted at the Liverpool Heart and Chest Hospital (LHCH) adult CF unit. Participants are adults with CF. This study reviews DCR taken during routine CF Annual Review (n=150), validates DCR-derived lung volumes against whole body plethysmography (n=20) and examines DCR at the start and end of pulmonary exacerbations of CF (n=20). The primary objectives of this study are to examine if DCR provides lung function information that correlates with PFT, and lung volumes that correlate whole body plethysmography.

Ethics and dissemination

This study has received the following approvals: HRA REC (11 December 2019) and LHCH R&I (11 October 2019). Results are made available to people with CF, the funders and other researchers. Processed, anonymised data are available from the research team on request.

Trial registration number

ISRCTN 64994816.
Confidence and skills for cystic fibrosis end-of-life care
Authors: Harris-Skillman Eva , Chapman Stephen , Lowney Aoife , Miller Mary , Flight William
Published: March 2020

Objectives

Optimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.

Methods

An electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.

Results

35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.

Conclusions

Few members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.
Effect of soluble-viscous dietary fibre on coronary heart disease risk score across 3 population health categories: data from randomized, double-blind, placebo-controlled trials
Authors: Vuksan Vladimir , Sievenpiper John L. , Jovanovski Elena , Jenkins Alexandra L. , Komishon Allison , Au-Yeung Fei , Zurbau Andreea , Ho Hoang V.T. , Li Dandan , Smircic-Duvnjak Lea
Published: March 2020

We applied the Framingham risk equation in healthy, metabolic syndrome, and diabetes populations, following treatment with viscous fibre from konjac-based blend (KBB). KBB yielded reduction in estimated risk score by 16% (1.04 ± 0.03 vs. 0.87 ± 0.04, p < 0.01) in type 2 diabetes, 24% (1.08 ± 0.01 vs. 0.82 ± 0.02, p < 0.01) in metabolic syndrome, and 25% (1.09 ± 0.05 vs. 0.82 ± 0.06, p < 0.01) in healthy individuals. Drivers for decreased risk were improvements in blood cholesterol and systolic blood pressure. The composite coronary heart disease risk across populations was reduced 22% (p < 0.01).

Novelty Viscous fibre from konjac-xanthan reduced 10-year relative coronary heart disease using Framingham Risk Score across the glycemic status spectrum.
Application of the hydrotime model to assess seed priming effects on the germination of rapeseed (Brassica napus L.) in response to water stress
Authors: Tatari Samaneh , Ghaderi-Far Farshid , Yamchi Ahad , Siahmarguee Asieh , Shayanfar Ali , Baskin Carol C.
Published: March 2020

Our aim was to determine whether the parameters of the hydrotime model can be used to compare the effects of seed priming treatments on germination. Seeds of three rapeseed cultivars (‘H61’, ‘H4815’, and ‘DK003’) were exposed to priming treatments and then their germination was tested at different water potentials. Seed priming improved the germination percentage, which was higher in ‘H4815’ than in the other two cultivars, and it increased germination rate (decreased θH) and uniformity (decreased σψb). The increase in germination rate was higher in PEG-osmoprimed than in NaCl-osmoprimed and hydroprimed seeds. The base water potential allowing 50% germination ([Formula: see text]) also was affected by seed priming, but the response of cultivars to different priming treatments varied. Compared with the control seeds, hydropriming of ‘H61’ seeds shifted ψb(50) toward negative values, whereas NaCl-osmopriming of ‘H4815’ seeds shifted ψb(50) toward negative values. On the other hand, priming of ‘DK003’ seeds shifted ψb(50) to more positive values and increased susceptibility to water stress. After dormancy-breaking and dormancy-induction treatments, ψb(50) shifted to more negative or positive values, indicating the release of primary dormancy and induction of dormancy, respectively. Therefore, priming treatments should be selected, depending on the environmental conditions anticipated to prevail during the germination of rapeseed seeds.
Fragmentation alters ecological gradients and headwater fish assemblage composition relative to land use in a dendritic river system
Authors: Hubbell Joshua P. , Schaefer Jake F. , Flood Peter , Warren Melvin L. , Sterling Ken A.
Published: March 2020

The spatial and hydrological properties of headwaters allow dendritic systems to contribute to patterns of regional diversity. However, such ecological gradients may be disrupted as a result of habitat fragmentation. We tested the hypothesis that coarse-scale anthropogenic disturbances such as upstream land use and proximity to reservoirs can alter ecological gradients, thus influencing instream habitat, headwater fish assemblage composition, and species turnover in the Little Tallahatchie River system in north-central Mississippi. To test this hypothesis, we calculated species turnover coefficients, ordinated samples, and examined the correlations between assemblage composition and environmental and anthropogenic variables. Assemblage composition was strongly correlated with instream habitat and river system connectivity, and instream habitat was strongly associated with land use. Gradients in assemblage composition associated with ecological factors were altered due to land use. Our research highlights the importance of headwaters as distinctive habitat patches driving species turnover and the influence of land use in disrupting the ecological gradients that allow for the formation of these distinctive habitat types.
Satellite cell division and fiber hypertrophy alternate with new fiber formation during indeterminate muscle growth in juvenile lake sturgeon (Acipenser fulvescens)
Authors: Hiebert A. , Anderson J.E.
Published: March 2020

Age-dependent changes in muscle fiber size, myonuclear domain volume, fiber-end-terminal configuration, fiber and fish growth, and stem cell or satellite cell (SC) number and proliferation were investigated in developing lake sturgeon (Acipenser fulvescens Rafinesque, 1817) to characterize indeterminate muscle growth during early life. We hypothesized that up to 29 months post hatch (MPH), SC numbers and mitotic activity, the mitotic cycle duration of SCs, fiber morphology, and the volume of cytoplasmic domains around fiber nuclei would change during periods of fiber hypertrophy and hyperplasia. Single-fiber cultures were used in pulse-chase studies of SC division and the Pax7+ SC population. The number of SCs per fiber increased until 17 MPH, peaking as a proportion of fiber nuclei at 3 and 17 MPH. SC cycle time decreased in duration with age after peaks at 3 and 5 MPH. Domain volume was high at 1 and 29 MPH and low from 2 to 6 MPH. Fibers with uniformly tapered ends were most frequent at 4 MPH. Results suggest 3 and 6–17 MPH as intervals for both SC proliferation and fiber hypertrophy, and that fiber growth alternated with new fiber formation (termed fiber hyperplasia) from 4 to 5 MPH and from 17 to 29 MPH. These patterns of cellular dynamics in lake sturgeon muscle growth advance our understanding of indeterminate growth.
Generation of geolocated and radiometrically corrected true reflectance surfaces in the visible portion of the electromagnetic spectrum over large bodies of water using images from a sUAS
Authors: Arango Juan G. , Holzbauer-Schweitzer Brandon K. , Nairn Robert W. , Knox Robert C.
Published: March 2020

The focus of this study was to develop true reflectance surfaces in the visible portion of the electromagnetic spectrum from small unmanned aerial system (sUAS) images obtained over large bodies of water when no ground control points were available. The goal of the research was to produce true reflectance surfaces from which reflectance values could be extracted and used to estimate optical water quality parameters utilizing limited in-situ water quality analyses. Multispectral imagery was collected using a sUAS equipped with a multispectral sensor, capable of obtaining information in the blue (0.475 μm), green (0.560 μm), red (0.668 μm), red edge (0.717 μm), and near infrared (0.840 μm) portions of the electromagnetic spectrum. To develop a reliable and repeatable protocol, a five-step methodology was implemented: (i) image and water quality data collection, (ii) image processing, (iii) reflectance extraction, (iv) statistical interpolation, and (v) data validation. Results indicate that the created protocol generates geolocated and radiometrically corrected true reflectance surfaces from sUAS missions flown over large bodies of water. Subsequently, relationships between true reflectance values and in-situ water quality parameters were developed.
Imprints of an extended Chevallier–Polarski–Linder parametrization on the large scale of our universe
Authors: Pan Supriya , Yang Weiqiang , Paliathanasis Andronikos
Published: March 2020

In the present work we perform a systematic analysis of a new dark energy parametrization and its various corrections at first and higher orders around the presence epoch $$z=0$$z=0, where the first order correction of this dark energy parametrization recovers the known Chevallier–Polarski–Linder model. We have considered up to the third order corrections of this parametrization and investigate the models at the level of background and perturbations. The models have been constrained using the latest astronomical datasets from a series of potential astronomical data, such as the cosmic microwave background observations, baryon acoustic oscillations measurements, recent Pantheon sample of the supernova type Ia and the Hubble parameter measurements. From the analyses we found that all parametrization favor the quintessential character of the dark energy equation of state where the phantom crossing is marginally allowed (within 68% CL). Finally, we perform the Bayesian analysis using to quantify the statistical deviations of the parametrizations compared to the standard $$\Lambda $$ΛCDM cosmology. The Bayesian analysis reports that $$\Lambda $$ΛCDM is favored over all the DE parametrizations.
Free and forced axial vibration of single walled carbon nanotube under linear and harmonic concentrated forces based on nonlocal theory
Authors: Khosravi Farshad , Hosseini Seyyed Amirhosein , Hayati Hasti
Published: March 2020

The aim of this paper is to investigate the free and forced axial vibrations under the two various linear and harmonic axial concentrated forces in zigzag single-walled carbon nanotube (SWCNT). Two different boundary conditions, namely clamped–clamped and clamped-free, are established. Eringen’s nonlocal elasticity is employed to justify the nonlocal behavior of constitutive relations. The governing equation and the associated boundary condition are derived based on Hamilton’s principle. In order to solve the derived equation numerically, the assumed modes method is utilized. In the free axial vibration section, the first three natural frequencies are obtained for the various values of the nonlocal parameter. The results are in good agreement in comparison with another study. The fundamental natural frequencies with respect to the nonlocal parameter of the case study as a semiconducting nanotube with boron nitride nanotube (BNNT) as a semiconducting nanotube and SWCNT (5,5) as a metallic nanotube are compared. The effects of the nonlocal parameter, thickness and ratio of the excitation-to-natural frequencies overtime on dimensional and nondimensional axial displacements are studied.
Everything You Should Know About Intel SGX Performance on Virtualized Systems
Authors: Dinh Ngoc Tu , Bui Bao , Bitchebe Stella , Tchana Alain , Schiavoni Valerio , Felber Pascal , Hagimont Daniel
Published: March 2020

Intel SGX has attracted much attention from academia and is already powering commercial applications. Cloud providers have also started implementing SGX in their cloud offerings. Research efforts on Intel SGX so far have mainly concentrated on its security and programmability. However, no work has studied in detail the performance degradation caused by SGX in virtualized systems. Such settings are particularly important, considering that virtualization is the de facto building block of cloud infrastructure, yet often comes with a performance impact. This paper presents for the first time a detailed performance analysis of Intel SGX in a virtualized system in comparison with a bare-metal system. Based on our findings, we identify several optimization strategies that would improve the performance of Intel SGX on such systems.
Collaboratively Learning the Best Option on Graphs, Using Bounded Local Memory
Authors: Su Lili , Zubeldia Martin , Lynch Nancy
Published: March 2020

We consider multi-armed bandit problems in social groups wherein each individual has bounded memory and shares the common goal of learning the best arm/option. We say an individual learns the best option if eventually (as $t\diverge$) it pulls only the arm with the highest expected reward. While this goal is provably impossible for an isolated individual due to bounded memory, we show that, in social groups, this goal can be achieved easily with the aid of social persuasion (i.e., communication) as long as the communication networks/graphs satisfy some mild conditions. In this work, we model and analyze a type of learning dynamics which are well-observed in social groups. Specifically, under the learning dynamics of interest, an individual sequentially decides on which arm to pull next based on not only its private reward feedback but also the suggestion provided by a randomly chosen neighbor. To deal with the interplay between the randomness in the rewards and in the social interaction, we employ the \em mean-field approximation method. Considering the possibility that the individuals in the networks may not be exchangeable when the communication networks are not cliques, we go beyond the classic mean-field techniques and apply a refined version of mean-field approximation:

Using coupling we show that, if the communication graph is connected and is either regular or has doubly-stochastic degree-weighted adjacency matrix, with probability → 1 as the social group size N → ∞, every individual in the social group learns the best option.

If the minimum degree of the graph diverges as N → ∞, over an arbitrary but given finite time horizon, the sample paths describing the opinion evolutions of the individuals are asymptotically independent. In addition, the proportions of the population with different opinions converge to the unique solution of a system of ODEs. Interestingly, the obtained system of ODEs are invariant to the structures of the communication graphs. In the solution of the obtained ODEs, the proportion of the population holding the correct opinion converges to 1 exponentially fast in time.

Notably, our results hold even if the communication graphs are highly sparse.
Retroactive Packet Sampling for Traffic Receipts
Authors: Nikolopoulos Pavlos , Pappas Christos , Argyraki Katerina , Perrig Adrian
Published: March 2020

Is it possible to design a packet-sampling algorithm that prevents the network node that performs the sampling from treating the sampled packets preferentially? We study this problem in the context of designing a "network transparency'' system. In this system, networks emit receipts for a small sample of the packets they observe, and a monitor collects these receipts to estimate each network's loss and delay performance. Sampling is a good building block for this system, because it enables a solution that is flexible and combines low resource cost with quantifiable accuracy. The challenge is cheating resistance: when a network's performance is assessed based on the conditions experienced by a small traffic sample, the network has a strong incentive to treat the sampled packets better than the rest. We contribute a sampling algorithm that is provably robust to such prioritization attacks, enables network performance estimation with quantifiable accuracy, and requires minimal resources. We confirm our analysis using real traffic traces.
A chronic high-fat diet exacerbates contractile dysfunction with impaired intracellular Ca2+ release capacity in the skeletal muscle of aged mice
Authors: Eshima Hiroaki , Tamura Yoshifumi , Kakehi Saori , Kakigi Ryo , Hashimoto Ryota , Funai Katsuhiko , Kawamori Ryuzo , Watada Hirotaka
Published: March 2020

The aim of this study was to examine the effect of high-fat diet (HFD)-induced obesity on contractile function and Ca2+ release capacity in aged skeletal muscle. Not only were the force production and peak Ca2+ levels decreased by aging and HFD feeding, respectively, but also, these interventions had an additive effect in aged HFD-fed mice. These data suggest that the impairment in the contractile force in aged muscle is aggravated by a HFD, which may be due to synergistic dysfunction in intracellular Ca2+ release.
Limitations to exercise tolerance in type 1 diabetes: the role of pulmonary oxygen uptake kinetics and priming exercise
Authors: Goulding Richie P. , Roche Denise M. , Scott Sam N. , Koga Shunsaku , Weston Philip J. , Marwood Simon
Published: March 2020

Patients with type 1 diabetes demonstrated slower oxygen uptake (V̇o2) kinetics compared with healthy control subjects. Furthermore, a prior bout of high-intensity exercise speeded V̇o2 kinetics and increased critical power in people with type 1 diabetes. Prior exercise speeded muscle deoxygenation kinetics, indicating that V̇o2 kinetics in type 1 diabetes are limited primarily by oxygen extraction and/or intracellular factors. These findings highlight the potential for interventions that decrease metabolic inertia for enhancing exercise tolerance in this condition.
Pyoderma Gangrenosum as a Presenting Feature of Undifferentiated Spondyloarthropathy with Erosive Inflammatory Arthritis
Authors: Kaler Jaspreet , Sheffield Sandra , Thway Myint , Ramsubeik Karishma , Kaeley Gurjit
Published: March 2020

Pyoderma gangrenosum is a rare inflammatory condition with varying clinical presentations and severity. It is commonly seen in association with an underlying condition, most common of which is inflammatory bowel disease. We report a case of a 26-year-old male who came to the emergency department with increasing lower extremity ulcers, intermittent hematochezia, and pain in the small joints of his hands. After excluding a broad list of differentials for lower extremity ulcers, the diagnosis of pyoderma gangrenosum was made. He was also found to have erosive changes at multiple proximal interphalangeal joints and jug-like syndesmophytes at T12 and L1 on CT scan. Although there was evidence of a spondyloarthropathy, there was no evidence of inflammatory bowel disease on colonoscopy, psoriasis, or sexually transmitted infections. After multiple failed trials of medications including azathioprine and sulfasalazine, 4 weeks of Adalimumab resulted in rapid healing of pyoderma gangrenosum lesions and improvement in his synovitis. Coupled together, this suggests a diagnosis of pyoderma gangrenosum associated with undifferentiated spondyloarthropathy and erosive inflammatory arthritis. This case is suggestive of spondyloarthropathy going underdiagnosed and untreated in other patients with pyoderma gangrenosum as lower extremity ulcerations can be the primary complaint for seeking treatment. Although rare, axial spondyloarthropathy associated with pyoderma gangrenosum should be kept as an associated differential diagnosis when faced with pyoderma gangrenosum.
Bayesian Estimation of Gumbel Type-II Distribution under Type-II Censoring with Medical Applications
Authors: Abbas Kamran , Hussain Zamir , Rashid Noreen , Ali Amjad , Taj Muhammad , Khan Sajjad Ahmad , Manzoor Sadaf , Khalil Umair , Khan Dost Muhammad
Published: March 2020

The time to event or survival time usually follows certain skewed probability distributions. These distributions encounter vital role using the Bayesian framework to analyze and project the maximum life expectancy in order to inform decision-making. The Bayesian method provides a flexible framework for monitoring the randomized clinical trials to update what is already known using prior information about specific phenomena under uncertainty. Additionally, medical practitioners can use the Bayesian estimators to measure the probability of time until tumor recurrence, time until cardiovascular death, and time until AIDS for HIV patients by considering the prior information. However, in clinical trials and medical studies, censoring is present when an exact event occurrence time is not known. The present study aims to estimate the parameters of Gumbel type-II distribution based on the type-II censored data using the Bayesian framework. The Bayesian estimators cannot be obtained in explicit forms, and therefore we use Lindley’s approximation based on noninformative prior and various loss functions such as squared error loss function, general entropy loss function, and LINEX (linear exponential) loss function. The maximum likelihood and Bayesian estimators are compared in terms of mean squared error by using the simulation study. Furthermore, two data sets about remission times (in months) of bladder cancer patients and survival times in weeks of 61 patients with inoperable adenocarcinoma of the lung are analyzed for illustration purposes.
Teenage Pregnancy: Obstetric and Perinatal Outcome in a Tertiary Centre in Indonesia
Authors: Indarti Junita , Al Fattah Adly Nanda , Dewi Zulfitri , Hasani Rachmat Dediat Kapnosa , Mahdi Fitri Adinda Novianti , Surya Raymond
Published: March 2020

Background. The incidence of teenage pregnancy is increasing in the world. It is a high-risk condition leading to adverse perinatal and obstetric outcomes. This study aims to evaluate the obstetric and perinatal outcomes of teenage pregnancy in Indonesian population. Method. A retrospective study was conducted to evaluate obstetric and perinatal outcomes among teenagers and average maternal age (AMA) women. We assessed all singleton live pregnancies during the year period of 2013 in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. Results. We studied 1,676 eligible subjects during the one-year period in our centre. The prevalence of teenage pregnancy (12 to 19 years old) was 11.40% (191/1676). We found higher prevalence of eclampsia (AOR: 4.03; 95% CI: 1.73–9.39), preterm delivery (AOR: 1.5; 95% CI: 0.88–2.53), anaemia at labour (AOR: 2.42; 95% CI: 1.60–3.67), postpartum haemorrhage (AOR: 2.59; 95% CI: 0.86–7.37), and low birth weight (AOR: 2.28; 95% CI: 1.60–3.25) among teenagers. However, caesarean section was found to be significantly lower among teenage pregnancies. Conclusion. Teenage pregnancy carries significant obstetric complications that should draw physicians’ serious attention. A holistic, comprehensive antenatal, and preventive program should be conducted to prevent teenage pregnancy-related adverse outcomes.
Financing Target and Product Line Design on the Flexible and Fixed Reward Crowdfunding
Authors: Liu Xiaofeng , Zhang Hong , Xi Nannan , Juho Hamari
Published: March 2020

This study examined the product line design under two different types of reward crowdfunding, namely, the fixed and the flexible reward crowdfunding. To investigate different effects of the two different reward crowdfunding mechanisms, we addressed the problem of product and pricing decisions in reward crowdfunding by incorporating individual rationality and incentive compatibility into different funding modes. Specifically, when the creator designed the menu price, we compared the menu design, which includes price and quality between the product line under two different crowdfunding mechanisms. We found that when the quality was exogenous, the project could have higher success rate and get more expected profit under the fixed reward crowdfunding than that under the flexible reward crowdfunding; however, the creator could set a higher target and a larger price discrepancy under the flexible reward crowdfunding in some specific market condition. Then, we extended to the situation where the quality was endogenous and found the similar results as the quality was exogenous. Interestingly, the quality differentiation of the product line under the flexible reward crowdfunding is much more than that under the fixed reward crowdfunding. These results can provide the guideline and suggestion to help the creators design their product line, set the target, and select the suitable modes between the fixed and the flexible reward crowdfunding.
Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn’s Disease: Case Vignette and Systematic Literature Review
Authors: Epistola Raisa , Do Tiffanie , Vankina Ritika , Wu Daniel , Yeh James , Fleischman Michael W. , Lee Jennifer M.
Published: March 2020

While the association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) has been described in a few case reports, management of ITP as an extraintestinal manifestation of Crohn’s disease (CD) is less studied. There are approximately a dozen cases describing the management of patients dually diagnosed with CD/ITP. Previous reports postulated that the mechanism of ITP in CD was through the presence of circulating immune complexes in the serum and antigenic mimicry due to increased mucosal permeability in active colitis, versus increased mucosal production of TH1-type proinflammatory cytokines during CD flares, which may account for remission of ITP with surgery for CD. We present a case of a 27-year-old man who presented with medically refractory CD and ITP who responded to surgical management with colectomy and splenectomy, along with a systematic review of the literature. These cases suggest that colectomy should be considered in the treatment of medically refractory ITP among patients with concomitant CD.
Axillary Lymph Node Dissection in Angiosarcomas of the Breast: An Asian Institutional Perspective
Authors: Ragavan Sharanniyan , Lim Hui Jun , Tan Joey Wee-Shan , Hendrikson Josephine , Chan Jason Yongsheng , Farid Mohamad , Chia Claramae Shulyn , Tan Grace Hwei Ching , Soo Khee Chee , Teo Melissa Ching Ching , Ong Chin-Ann Johnny
Published: March 2020

Angiosarcomas of the breast (ASB) are rare, making up to less than 8% of all angiosarcomas. The surgical management for this disease continues to vary throughout centres worldwide due to the current limited evidence. We aim to examine the necessity of axillary lymph node dissection in this pathology through a retrospective study of axillary metastasis and recurrence patterns in patients treated at our institution. A retrospective review of a prospectively-maintained database was performed. All adult patients with a histologically confirmed diagnosis of ASB seen at the National Cancer Centre Singapore between 2006 and 2019 were identified. Axillary lymph node status, treatment, survival, and recurrence data were collated. Thirteen patients were identified with a confirmed diagnosis of ASB, of which there were 11 primary and 2 secondary angiosarcoma cases. Eight patients had some form of axillary lymph node dissection and 5 did not. No positive nodes were found in any examined axillary nodes despite high median number of nodes harvested (13, range 8–24). 5/13 patients had disease progression, of whom none had locoregional recurrence to the axilla. ASB continues to be rare and recurrent and presents as a challenge to treat. Axillary lymph node involvement is most likely not present in a majority of patients. Prophylactic removal is unwarranted in patients presenting without lymph node involvement due to the lack of axillary metastasis.
Complement Activation in Association with Markers of Neutrophil Extracellular Traps and Acute Myocardial Infarction in Stable Coronary Artery Disease
Authors: Kluge Karsten E. , Langseth Miriam S. , Opstad Trine B. , Pettersen Alf Å. , Arnesen Harald , Tønnessen Theis , Seljeflot Ingebjørg , Helseth Ragnhild
Published: March 2020

Complement activation and neutrophil extracellular traps (NETs) have both been suggested to drive atherosclerotic plaque progression. Although experimental studies suggest interplay between these two innate immunity components, the relevance in patients with coronary artery disease (CAD) is unclear. The aim of this study was to assess associations between complement activation and NETs in patients with stable CAD and examine the role of complement activation on clinical outcome. Blood samples from a cohort of patients with angiographically verified stable CAD (n=1001) were analyzed by ELISA for the terminal complement complex (TCC) and by relative quantification for gene expression of the C5a receptor 1 (C5aR1) as markers of complement activation. As markers of NETs, dsDNA was analyzed by fluorescent nucleic acid stain and myeloperoxidase-DNA (MPO-DNA) by ELISA. Clinical outcome was defined as unstable angina, nonhemorrhagic stroke, acute myocardial infarction (MI), or death (n=106, whereof 36 MI). Levels of TCC and C5aR1 were not significantly correlated to dsDNA (TCC:r=−0.045,p=0.153; C5aR1:r=−0.060,p=0.434) or MPO-DNA (TCC:r=0.026,p=0.414; C5aR1:r=0.123,p=0.107). When dividing TCC and C5aR1 levels into quartiles (Q), levels of MPO-DNA differed significantly across quartiles (TCC:p=0.008, C5aR1: 0.049), while dsDNA did not (TCC:p=0.181, C5aR1:p=0.771). Patients with TCC levels in Q4 had significantly higher levels of MPO-DNA than Q1-3 (p=0.019), and C5aR1 levels in Q3-4 had significantly higher levels of MPO-DNA than Q1-2 (p=0.046). TCC levels did not differ between patients experiencing a clinical endpoint or not, but high levels were associated with increased risk of acute MI (OR. 1.97, 95% CI: 0.99-3.90,p=0.053) during two-year follow up, also when adjusted for relevant covariates. In conclusion, TCC and C5aR1 were moderately associated with the NET marker MPO-DNA, and TCC levels were related to the risk of future MI in this cohort of patients with stable CAD.
Anesthesia Experience for Open Gastrostomy with Ultrasound-Guided Erector Spinae Plane Block: A Case Report
Authors: Bagaphou Claude Thierry , Piraccini Emanuele , Norgiolini Lucia , Ciabucchi Chiara , Carsena Valentina , Evoli Luca P. , Santonastaso Domenico Pietro , Gori Fabio
Published: March 2020

From the first description in 2016 till today, hundreds of studies have extensively presented Erector Spinae Plane block as an excellent perioperative analgesic technique especially in a multimodal pain management scenario. Only in few cases, this technique was used alone to provide surgical anesthesia.
Plumbagin Enhances the Anticancer Efficacy of Cisplatin by Increasing Intracellular ROS in Human Tongue Squamous Cell Carcinoma
Authors: Xue Danfeng , Pan Shu-Ting , Zhou Xiongming , Ye Fangfei , Zhou Qun , Shi Fanzhe , He Fei , Yu Hui , Qiu Jiaxuan
Published: March 2020

Cisplatin is widely used in the treatment of tongue squamous cell carcinoma (TSCC), but its clinical efficacy is limited by drug resistance and toxic side effects. Hence, a novel compound capable of enhancing the anticancer effect of cisplatin while reducing the side effects is urgently needed. We have previously shown that plumbagin (PLB), an anticancer phytochemical, is able to inhibit the growth of TSCC in vitro and in vivo. The objective of this study was to investigate the effect of PLB in reversing the resistance of TSCC to cisplatin as well as its molecular mechanisms. Here, we found that PLB enhances cisplatin-induced cytotoxicity, apoptosis, and autophagy in CAL27 and cisplatin-resistant CAL27/CDDP cells. PLB could inhibit the viability and growth of TSCC cells by increasing the production of intracellular reactive oxygen species (ROS). In addition, the combination treatment of PLB and cisplatin resulted in a synergistic inhibition of TSCC viability, apoptosis, and autophagy by increasing intracellular ROS, which may be achieved by activating JNK and inhibiting AKT/mTOR signaling pathways. Finally, the synergistic treatment was also demonstrated in vivo. Therefore, PLB combined with cisplatin is a potential therapeutic strategy against therapy TSCC cisplatin resistance.
Ligneous Periodontitis in a Patient with Type 1 Plasminogen Deficiency: A Case Report and Review of the Literature
Authors: Sadasivan Arun , Ramesh Roshni , Mathew Deepu George
Published: March 2020

Background. Ligneous periodontitis or destructive membranous periodontal disease is a rare condition involving gingival tissues, which is due to plasminogen deficiency and fibrin deposition. Plasminogen deficiency is an ultrarare autosomal recessive disease. The disease is characterized by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. A defect in fibrinolysis and abnormal wound healing are the main pathogenesis of this condition. It is caused by mutations inPLG, the gene coding for plasminogen, which results in decreased levels and functional activity.Case Presentation. In this case report, clinical and histopathological findings of a 26-year-old male patient who presented with generalized membranous gingival enlargement are presented. He was the third child of consanguineous parents and had multicystic congenital hydrocephalus at birth. Besides the gingival enlargement, he also presented ligneous conjunctivitis since childhood. The intraoral examination revealed generalized periodontal breakdown. Radiographs showed alveolar bone loss present in every quadrant. All blood investigations were normal except for plasminogen deficiency. A biopsy sample was excised from affected gingiva and a series of histopathological evaluation was performed. Based on clinical and histopathological evidence, a diagnosis of destructive membranous periodontal disease or ligneous periodontitis was made. A clinical exome assay for the PLG gene was also done. It was confirmed as Type 1 plasminogen deficiency.Conclusion. Ligneous periodontitis has been rarely reported in India. The reasons could be because of the rarity of the disease or missed diagnosis. The need to take a proper history and perform a proper clinical examination and histopathologic evaluation has to be stressed when diagnosing and treating gingival enlargements. If a genetic condition is suspected, genetic screening is also needed. All these will help the clinician in correctly diagnosing the disease and formulating a proper treatment plan for managing the condition.
Foam Concrete: A State‐of‐the‐Art and State‐of‐the‐Practice Review
Authors: Fu Yanbin , Wang Xiuling , Wang Lixin , Li Yunpeng
Published: March 2020

Foam concrete (FC) has the potential of being an alternative to ordinary concrete, as it reduces dead loads on the structure and foundation, contributes to energy conservation, and lowers the cost of production and labor cost during the construction and transportation. The paper reports a state‐of‐the‐art review of foam concrete in terms of its components, manufacturing and material properties like drying shrinkage, compressive strength, stability and pore structure, etc. In view of the significance of the FC in engineering construction, it also includes a state‐of‐the‐practice review of foam concrete in tunnel and underground engineering. Some shortcomings and technical limitations as well as emerging direction for performance enhancement of FC are also discussed. Current review concludes that the long‐term performance and enhancement‐associated properties need to be deeply investigated. This study can help alleviate consumer concerns and further encourage the wider application of FC in civil engineering.
A Lévy Risk Model with Ratcheting Dividend Strategy and Historic High-Related Stopping
Authors: Zhang Aili , Liu Zhang
Published: March 2020

This paper focuses on the De Finetti’s dividend problem for the spectrally negative Lévy risk process, where the dividend is deducted from the surplus process according to the racheting dividend strategy which was firstly introduced in Albrecher et al. (2018). A major feature of the racheting strategy lies in which the dividend rate never decreases. Unlike the conventional studies, the closed form expression for the expected, accumulated, and discounted dividend payments until the draw-down time (rather than the ruin time) is obtained in terms of the scale functions corresponding to the underlying Lévy process. The optimal barrier for the ratcheting strategy is also studied, where the dividend rate can be increased. Finally, two special cases, where the scale functions are explicitly known, i.e., the Brownian motion with drift and the compound Poisson model, are considered to illustrate the main result.