bluuebunny/crossref_metadata_2025 huggingface dataset:
Tailoring integrated student supports to rural contexts
Authors: Weiss Elaine
Published: September 2019

Rural poverty rises to higher levels than poverty in urban and suburban areas, and rural communities and their schools face greater isolation, which means that families must travel farther than their urban and suburban counterparts to access available services and learning opportunities. Elaine Weiss describes two rural communities, one in Arkansas and another in Kentucky, that provide models for how rural communities might create ways for students and families to access resources that otherwise would be out of reach. Grant funding allowed one district to open up additional spots in a local preschool, while a partner organization in another community converted school buses into preschool classrooms, so they could take learning directly to distant families. These districts also used technology to improve their STEM offerings, provide access to e-books that students could download on school-provided tablets at school and read at home without internet access, and put students in touch with medical care, mentors, and learning opportunities beyond their local community.
First Person: Everywhere, like Jerusalem, the ground is burning: On teaching in a time of conflict
Authors: Moses Danial Noah
Published: September 2019

For nearly 20 years, Daniel Noah Moses has worked with educators to promote dialogue and understanding in some of the world’s most violent conflict zones, such as Israel/Palestine, Armenia, and Pakistan. Now, after moving back to the United States, he finds that tensions are soaring in the U.S. as well. For the first time, he writes, it strikes him that American educators can relate to the challenges facing teachers in global hotspots.
Introduction to the Special Issue
Authors: Block Fred
Published: September 2019

This article introduces the articles and commentaries in the special issue titled “Democratizing Finance.” Here, the term “democratizing finance” focuses on reducing inequalities of income, wealth, and power.
Unresolvable Tensions and Ethical Dilemmas: Reflections on the Experience of Doing “Prison Research” in China—A Research Note
Authors: Zhang Shaoying
Published: September 2019

In this article, I reflect on the ethical implications of my research visit to China’s prisons. I argue that satisfying instituted ethical protocols in this type of research is the beginning of the ethical process, not the end. “Ethical research” involves constant reflection on how the researcher’s self is constituted in relation to others, not only the primary research group but also fellow researchers, gatekeepers, facilitators, prison officials, and the representatives of the many organizations involved in such a program. Interpretive or critical inquiries are not solely about deciding “whose side we are on,” but more about what kind of relations between the self and various stakeholders existed before, during, and after fieldwork.
I, Daniel Blake (2016): Vulnerability, Care and Citizenship in Austerity Politics
Authors: Gibbs Jacqueline , Lehtonen Aura
Published: September 2019

This article offers a reading of Ken Loach’s 2016 film I, Daniel Blake, a fictionalised account of experiences of the UK welfare system in conditions of austerity. We consider, firstly, the significant challenge the film poses to dominant figurations of welfare recipients under austerity, through a focus on vulnerability to state processes. We follow with a reading of some of the film’s interventions in relation to reciprocity, drawing on the important trajectories of care, community and resistance that the film renders visible through the collective stories of the major characters. Finally, we conclude with reflections on citizenship, subject narratives and alternative imaginaries of ‘deservingness’. Our article offers an ‘against the grain’ reading (hooks, 1996; Wearing, 2013) of the film, highlighting some of the radical possibilities of the more minor moments, character arcs and subject positionalities within the film’s central narrative of Daniel’s experiences in the shadow of the steadily crumbling welfare state.
Comparison of Temporalis Fascia and Transcanal Composite Chondroperichondrial Tympanoplasty Techniques
Authors: Gozeler Mustafa Sitki , Sahin Abdulkadir
Published: September 2019

The purpose of this study was to compare the success rates and hearing outcomes of transcanal composite chondroperichondrial cartilage graft with that of underlay temporal muscle fascia (TMF) graft for myringoplasty. In this retrospective study, the medical records of patients who underwent type 1 myringoplasty between September 2015 and February 2018 at Otorhinolaryngology Department of Erzurum Ataturk University were reviewed. Demographic properties, preoperative otological findings, preoperative pure ton audiogram findings, postoperative pure ton audiogram findings, and duration of surgeries were reviewed from medical records. The patients with lack of one or more of these information at medical records or lost to at least 3 months of follow-up were excluded from the study. According to the graft material used in the operation, the patients were divided into 2 groups. The patients operated with cartilage graft by transcanal composite chondropericondrial cartilage graft myringoplasty (TCM) technique was regarded as first group, while patients operated with temporal fascia was regarded as the second group (TMF). Both groups were compared according to preoperative and postoperative air–bone gap (ABG), graft acceptance rate, and duration of operation using SPSS version 20.0 software. A total of 113 patients whose medical records met the inclusion criteria were included in the study. Of these, 59 underwent TCM and 54 underwent TMF myringoplasty. Tympanic membrane perforation closure success rate was higher in the cartilage group (94.9%) than in the fascia group (83.3%; P = .046). In the former, preoperative and postoperative ABG was 19.5 ± 5 and 10.8 ± 4.8 dB, respectively. In the latter, the corresponding values were 20.7 ± 5.4 and 11.5 ± 5.4 dB, respectively ( P < .05). Duration of surgery was 29.5 ± 3.4 minutes in the TCM group and 61.5 ± 6.0 minutes in the TMF group ( P < .05). Transcanal cartilage myringoplasty could be considered as an appropriate surgical option because of its simplicity, shorter operation time, and rapid patient recovery, with no significant difference in terms of hearing outcomes compared to temporal fascia.
A Fresh Start or the Devil You Know? Examining Relationships Between Release Location Choices, Community Experiences, and Recidivism for High-Risk Parolees
Authors: Robson Sarah , Yesberg Julia A. , Wilson Marc S. , Polaschek Devon L. L.
Published: September 2019

This study investigated the effects of residential relocation in a sample of 282 high-risk male offenders paroled from New Zealand prisons. Initially we compared those returning to their old neighborhoods ( devil you know) and those released to a new location ( fresh start). This second category was then further divided: those released to a new location voluntarily ( fresh start-voluntary) versus those forced to start anew at the behest of the parole board that was releasing them ( fresh start-duress). All three categories were then compared on the quality of their community experiences and recidivism. Results indicated that parolees returning by choice to either their old neighborhood or a new location each were reconvicted in the first year after release at approximately the same rate; however, parolees relocating to a new area at the direction of the parole board (under duress) were reconvicted at a higher rate than those in either of the voluntary location categories. Significant group differences in ratings of community life quality were few, but there were some indications that compared with those choosing to return to a familiar location, making a voluntary residential relocation may lead to better parole experiences, particularly in terms of avoiding criminal peers, and that making a residential relocation under duress may lead to poorer parole experiences than for those returning to a familiar location.
Grand challenges in management research: Attributes, achievements, and advancement
Authors: Brammer Stephen , Branicki Layla , Linnenluecke Martina , Smith Tom
Published: September 2019

Management scholarship is increasingly paying attention to “grand challenges” such as climate and demographic changes, sociopolitical uncertainty, poverty alleviation, and global health improvement. Drawing upon a review of grand challenges research, we highlight the lack of a coherent conceptualization of a “grand challenge” and examine the diversity of the conceptual, policy, and empirical research. We problematize the failure in current research to distinguish between qualitatively different types of grand challenges—in our view, the resolution of different challenges calls for distinct research, policy, and practice approaches. We propose a novel framework that encompasses four distinct forms of grand challenge, situate the existing empirical literature within our framework, describe how the contributions to our special issue advance grand challenges research, and explore implications for future management research that responds to the imperatives of grand challenges.

JEL Classification: D81, G01, M14, I18, Q54, Q55, Q56, Q57
Pathway to professionalizing health leadership in Canada: The two faces of Janus
Authors: Dickson Graham , Van Aerde John , Tholl Bill
Published: September 2019

This article looks at the current state of health leadership in terms of expectations for professionalism: controlled entry, exit, and licensure/certification; a social contract to provide public services for the good of Canadians; and a unique body of knowledge and practice generally accepted. Looking to the future, and using the same three criteria, a compelling case for pursuing the professionalization of health leadership is made using LEADS as a roadmap. The article also outlines how to realize the professionalization of health leadership in Canada and why it is important to do so.
Labour Market Participation for Young People with Disabilities: The Impact of Gender and Higher Education
Authors: Ballo Jannike Gottschalk
Published: September 2019

To what extent does higher education promote labour market participation for disabled people in school-to-work transitions and early career trajectories? This article argues that the effect of higher education on labour market outcomes for disabled people must be studied in correlation to gender. Intersectional theory warns against the generalisability of the female and male experiences, and predicts that disability may influence sexism, and that gender may influence disableism. Norwegian full-population register data on recipients of disability benefits are used to explore the effect of higher education on three labour market outcomes for men and women with disabilities. Contrary to common intersectionality expectations, the results show that men experience more extreme employment disadvantages related to their disabilities than women. Higher education has a stronger effect on participation for disabled women than for disabled men. However, gender differences in participation are smaller for people with disabilities than for the general population.
Pretend Play as an Intervention for Children With Cancer: A Feasibility Study
Authors: Frygner-Holm Sara , Russ Sandra , Quitmann Julia , Ring Lena , Zyga Olena , Hansson Mats , Ljungman Gustaf , Höglund Anna T.
Published: September 2019

Children with cancer suffer from symptoms and burdensome treatments that often cause distress to children and their families. Mortality is one aspect of cancer diagnosis, while another is the quality of life and well-being during and after the treatment. By supporting children’s communication, self-efficacy and coping ability in the care situation, children are given the possibilities for increased independence and participation and are allowed to develop an influence over their care. The aim of this study was to develop and evaluate the feasibility and acceptability of an adult-facilitated pretend play intervention for children with cancer. Five children with ongoing treatment for cancer were invited to a play intervention that consisted of six to eight sessions of structured pretend play aimed at increasing participation, independence, and well-being. A mixed method design was used to evaluate the feasibility and acceptability of the play intervention. Measures were collected before and after interventions, and in conjunction with every play session. Results suggest that the children enjoyed the play intervention. Findings indicate small improvements regarding self-efficacy in care situations and equal or increased quality of life for participants. A main finding was that no adverse events or increased worrying was reported in conjunction with play sessions. Therefore, the intervention is regarded as safe, feasible, and acceptable as reported by participants and their primary caregivers and a possible means of increasing participation and independence in children with a cancer diagnosis.
Sedation Requirements in Patients on Venovenous or Venoarterial Extracorporeal Membrane Oxygenation
Authors: Patel Mitulkumar , Altshuler Diana , Lewis Tyler C. , Merchan Cristian , Smith Deane E. , Toy Bridget , Zakhary Bishoy , Papadopoulos John
Published: September 2019

Background:There is a paucity of data evaluating optimal dosing strategies of commonly utilized opioids and sedatives for patients on extracorporeal membrane oxygenation (ECMO) support where pharmacokinetic and pharmacodynamic variables of these administered agents are altered. Objective: To assess the daily dosing requirement of sedatives and analgesics for patients on venovenous (VV) and venoarterial (VA) ECMO after the initial ECMO cannulation period. Methods: We performed a retrospective, observational study of adult patients receiving sedation and analgesia while receiving ECMO support for at least 24 hours. Patients cannulated at an outside hospital more than 24 hours before transfer, those with a history of intravenous drug use or acute alcohol withdrawal, or those who died within 48 hours of ECMO initiation were excluded. Results: We evaluated 26 patients on ECMO, including 13 on VV and 13 on VA ECMO. The median dose of fentanyl was 140 µg/h, with the VV group requiring a higher dose compared with the VA group (167 vs 106 µg/h, P < 0.001). The median doses of dexmedetomidine and propofol were 0.7 µg/kg/h and 26 µg/kg/min, respectively, with no significant differences between groups ( P = 0.38 and P = 0.24, respectively). The median daily doses of fentanyl, dexmedetomidine, and propofol did not significantly increase throughout the time on ECMO support. Conclusions and Relevance: We found that the overall opioid daily dosing requirements were lower than previously reported in the literature. Additionally, light sedation strategies with a target RASS of −1 to 0 are feasible in this patient population.
Analysis of Tourism Seasonality as a Factor Limiting the Sustainable Development of Rural Areas
Authors: Martín Martín José María , Salinas Fernández Jose Antonio , Rodríguez Martín José Antonio , Ostos Rey María del Sol
Published: September 2019

Several sustainable development strategies in rural areas have relied on tourism as a tool for economic growth and job creation. The alternating peak and valley periods that seasonality entails—and their corresponding negative economic, environmental, or social impacts—may somewhat condition the success of these policies. The aim of this article is to analyze whether rural destinations suffer from higher levels of seasonality as compared with those of beach and urban tourism. The analysis is applied to Andalusia, a region in southern Spain, one of the major tourist destinations in Europe and a provider of diverse tourist products. The methodological innovation and contribution of this study is to measure seasonality intensity by means of a DP2 synthetic indicator that gathers information derived from various facets of seasonality, ultimately allowing us to overcome the disadvantages of single-variable assessment. We conclude that seasonality in rural tourism should not be evaluated generally, since each destination has specific conditions that determine stability or seasonality in the area. We obtain evidence that some rural areas show a lower level of seasonality than cultural-urban destinations (the most stable in terms of annual activity). Thus, rural destinations will not suffer from the problems associated with high seasonality. Due to the great differences among rural destinations, this methodology should be applied to regions with different characteristics to complement the conclusions drawn from this study and determine which destinations call for public policies and specific strategies to reduce seasonality.
Effects of journalism awards as quality signals on demand
Authors: Wellbrock Christian-Mathias , Wolfram Marvin
Published: September 2019

This article examines the question whether journalism awards can serve as quality signals and increase the demand for quality journalism. Information asymmetries between suppliers (journalists) and consumers (reader, viewers, users) can lead to inefficiently low demand for high-quality journalistic products, since consumers are unable to verify the product’s quality before consumption (ex ante). This problem can be addressed by providing customers with quality signals. We test the hypothesis that journalism awards can serve as quality signals by analyzing the signaling power of the German Grimme Prize in the category ‘Information and Culture’. A quantitative difference-in-differences approach is used to discover differences in the audience development of 109 nominees and winners. Results show that winning the Grimme Prize has a small positive effect on audience reach with respect to the total audience. Nevertheless, no effect on broadcasts’ market shares is discernable. Considering different audience groups, winning the award particularly seems to attract those consumers who are expected to have lesser experience with journalistic broadcasts.
Provocative Walking Test of Strength for Diagnosis, Management, and Outcome Assessment of Symptomatic Lumbar Spinal Stenosis
Authors: Dobkin Bruce H.
Published: September 2019

Background. Clinical care and randomized trials of rehabilitation or surgery for symptomatic lumbar spinal stenosis with neurogenic claudication (LSS) are complicated by the lack of standard criteria for diagnosis and outcome measurement. Objective. To evaluate whether manual muscle testing (MMT) can detect transient lower-extremity weakness provoked by walking in patients with likely LSS. Methods. A total of 19 patients with symptoms and MRI findings suggestive of LSS were tested for a decline in lower-extremity strength, using the British Medical Council scale of MMT, by comparing strength at rest to a change in strength within 60 s of completing a 400-foot walk. They were retested after reclining supine for another 2 minutes. This examination was repeated following decompressive lumbar surgery. Results. All patients developed bilateral weakness in the distribution of their LSS, but always including the hip extensors and knee flexors, when tested immediately after the provocative walking test. Most patients were not aware of weakness or change in gait during the walking task. They recovered to baseline strength after resting supine. The patients did not improve with physical therapy. When examined within 8 weeks after decompressive laminectomy, no one developed weakness during the 400-foot walk, and daily lower-extremity pain had resolved. Conclusions. A careful repetitive motor examination can detect transient paraparesis in patients with definite LSS. This finding supports the diagnosis and the functional severity of LSS while providing an objective outcome measurement for physical therapy and surgical interventions that goes beyond symptoms of pain.
Leaders’ Timely Succession: Neither Term Limits nor “Golden Parachutes,” Rather Periodic Tests of Trust Ascendance
Authors: Shapira Reuven
Published: September 2019

Successful leaders tend to reach a dysfunction phase and to become conservative self-serving oligarchic. Polities and large organizations try to prevent this by term limits despite many drawbacks, while corporations use “Golden Parachutes,” a costly measure with major drawbacks as well. Despite much research, the timely succession of leaders in large organizations remains a recalcitrant problem demanding a solution. A review of current solutions points to the plausible use of intangible rewards rather than tangible ones by offering leaders possibility of multiple terms with each reelection requiring a higher majority in a proper constituency. This will reward leaders by plausible tenure prolongation, prestigious higher majority reelection, and plausible creative innovation due to long time horizon, while barring dysfunctional oligarchic continuity. Suggestions for practicing this solution and for further study of the problems it entails are offered.
Rebel tactics and external public opinion
Authors: Arves Stephen , Cunningham Kathleen Gallagher , McCulloch Caitlin
Published: September 2019

Rebel groups employ a number of strategies beyond violence, and these alternative tactics are often thought to improve the reputation and legitimacy of rebel actors. How powerful states (and their publics) view rebels can affect their chances of international recognition, inclusion in peace talks, and whether they are eventually successful at achieving their objectives. This study employs two experiments to test the link between rebel tactics and opinions of these rebels held by external audiences. We examine the impact of six rebel behaviors on American public opinion: (a) nonviolent demonstrations, (b) nonviolent interventions (such as blockades and sit ins), (c) social noncooperation (such as hunger strikes), (d) terrorism, (e) stone throwing, and (f) the use of local democratic practice (elections) in rebel groups. We find that the use of elections within rebel actors, demonstrations, and hunger strikes improve positive perceptions of rebels, whereas rebel use of terrorism decreases support.
Physicians’ Perceptions of Stakeholder Influence on Discharge Timing in a Children’s Hospital
Authors: Bornstein Lea M. , Landers Sara E. , Rosenthal Susan L. , McCann Teresa A.
Published: September 2019

Attending physicians (N = 53) at a nonprofit, university-affiliated academic children’s hospital completed a survey about how key stakeholders affect timing of patient discharge beyond attending assessment of medical stability. Physicians perceived families and hospital administration as more often having an impact on discharge timing than they should and perceived members of the care team and peer physicians/consultants as less frequently having an impact than they should. All but one physician reported discharging a patient either earlier or later than they felt was appropriate due to pressure from at least one stakeholder group; almost all physicians had done so in response to pressure from families. When physicians changed discharge timing based on stakeholder pressure, they tended to extend hospital stay except in the case of administrative pressure. These findings highlight the need for improvements in communication regarding discharge goals and for future research on how navigating competing interests affect physician stress.
Is OpenStreetMap a good source of information for cultural statistics? The case of Italian museums
Authors: Balducci Francesco
Published: September 2019

Data coming from Volunteered Geographic Information (VGI) are a precious source of knowledge, especially when official statistics are difficult to produce at a detailed level. However, in order to be used effectively as a supporting source, Volunteered Geographic Information must meet thorough standards of quality. In this work, the quality of OpenStreetMap (OSM) – in terms of completeness, positional and semantic accuracies – is evaluated in the cultural sector with reference to the official survey of Italian museums. This study offers novel insights into the quality assessment of OpenStreetMap points of interest, and it is a useful benchmark for the use of unconventional information for cultural analysis and policy. The results show that the number of museums mapped in OpenStreetMap accounts for 86% of the official total while – in terms of completeness – OpenStreetMap coverage is 39% overall. The distance is less than 150 metres for 77.7% of the matching museums and the similarity index among denominations is higher than 0.9 for more than half of the museums. OpenStreetMap cultural information appears to be quantitatively rich as well as positionally and semantically accurate. However, some concerns do arise about the reliability and consistency of tags and metadata.
Natural mordenite-rich tuff as an alternative for removing textile dyes (Asucryl red): adsorption properties, kinetic and equilibrium studies
Authors: Ayaden Brahim , Benabdeslam Nouara , Bouzidi Nedjima , Mahtout Laila , Bounouala Mohamed , Merabet Djoudi
Published: September 2019

This work examines a tuff from the Tinebdar deposit located in Sidi Aich (east Algeria) for possible use as an alternative material for the adsorption of Asucryl red (a textile dye). Natural tuff represents an economic and environmentally friendly alternative compared to synthetic zeolites. The starting materials were characterized by means of powder X-ray diffraction, Brunauer–Emmett–Teller-specific surface area and pore diameter analysis. Batch experiments were performed and various parameters that have an effect on the adsorption process (i.e. pH, clay amount, contact time and initial concentration) were investigated. The <125 μm grain-size fraction of the tuff contains 45 wt.% mordenite. The adsorption equilibrium was established in 10 min and the adsorption kinetics were better described by the second-order kinetic model. The adsorption isotherm of the results obtained fits better to the Langmuir and Timkin models. The adsorption capacity qt varies from 60 to 70 mg g–1 with temperature increasing from 293 to 333 K. The thermodynamic nature of the adsorption process was determined by calculating ΔH°, ΔS° and ΔG° values. The positive value for ΔH° confirms that the adsorption is endothermic.
Is food supply for shellfish-eating birds in the western Wadden Sea affected by the between-species synchrony in year-to-year fluctuations of bivalve population parameters?
Authors: Beukema J. J. , Dekker R.
Published: September 2019

For a better understanding of functioning and stability of ecosystems, it is important to know to what extent constituent species show similarity in their long-term fluctuation patterns, i.e. whether their numbers and biomass frequently show simultaneous peaks and lows. Synchronic peaks and lows of important species would enhance variability in the functioning of the entire system and might affect its stability. When fluctuation patterns of individual species are largely independent, their peaks and lows would tend to extinguish each other’s effect on overall parameters (such as total zoobenthic biomass), thus promoting system stability. A long-term (46 years) monitoring study of the macrozoobenthos in a large (50 km2) tidal-flat area revealed that the 4 most important bivalve species (3 suspension feeders: Cerastoderma edule, Mytilus edulis, Mya arenaria and 1 deposit/suspension feeder: Limecola (Macoma) balthica) frequently showed peak numbers of their recruits in the same years. The annual growth rates of the three suspension feeding species showed some synchrony as well. Annual survival rates, on the other hand, did not show any synchronization, wiping out the initial synchrony of numbers within less than 2 years. As a result, annual biomass values did not show any positive between-species correlations. Annual amounts of bivalves that are accessible as bird food rarely declined to levels below 5 g AFDW m−2 and showed limited (5 to 10 fold difference between maximal and minimal values) variation. Oystercatchers left the area quicker in late winter and showed increased death rates at very low levels of food supply. Total bivalve bird food did not show any significant long-term trend. However, biomass of Mya arenaria showed an increasing trend and that of Limecola balthica a declining trend.
Genetic parameters for body weight and different definitions of residual feed intake in broiler chickens
Authors: Mebratie Wossenie , Madsen Per , Hawken Rachel , Romé Hélène , Marois Danye , Henshall John , Bovenhuis Henk , Jensen Just
Published: September 2019

Background

The objectives of this study were to (1) simultaneously estimate genetic parameters for BW, feed intake (FI), and body weight gain (Gain) during a FI test in broiler chickens using multi-trait Bayesian analysis; (2) derive phenotypic and genetic residual feed intake (RFI) and estimate genetic parameters of the resulting traits; and (3) compute a Bayesian measure of direct and correlated superiority of a group selected on phenotypic or genetic residual feed intake. A total of 56,649 male and female broiler chickens were measured at one of two ages ($${\text{t}}$$
t
or $${\text{t}} - 6$$

t
-
6

days). BW, FI, and Gain of males and females at the two ages were considered as separate traits, resulting in a 12-trait model. Phenotypic RFI ($${\text{RFI}}_{\text{P}}$$

RFI
P

) and genetic RFI ($${\text{RFI}}_{\text{G}}$$

RFI
G

) were estimated from a conditional distribution of FI given BW and Gain using partial phenotypic and partial genetic regression coefficients, respectively.

Results

Posterior means of heritability for BW, FI and Gain were moderately high and estimates were significantly different between males and females at the same age for all traits. In addition, the genetic correlations between male and female traits at the same age were significantly different from 1, which suggests a sex-by-genotype interaction. Genetic correlations between $${\text{RFI}}_{\text{P}}$$

RFI
P

and $${\text{RFI}}_{\text{G }}$$

RFI

G

were significantly different from 1 at an older age but not at a younger age.

Conclusions

The results of the multivariate Bayesian analyses in this study showed that genetic evaluation for production and feed efficiency traits should take sex and age differences into account to increase accuracy of selection and genetic gain. Moreover, for communicating with stakeholders, it is easier to explain results from selection on $${\text{RFI}}_{\text{G}}$$

RFI
G

than selection on $${\text{RFI}}_{\text{P}}$$

RFI
P

, since $${\text{RFI}}_{\text{G}}$$

RFI
G

is genetically independent of production traits and it explains the efficiency of birds in nutrient utilization independently of energy requirements for production and maintenance.
Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona
Authors: Claramonte Nieto Marta , Meler Barrabes Eva , Garcia Martínez Sandra , Gutiérrez Prat Mireia , Serra Zantop Bernat
Published: September 2019

Background

Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona.

Methods

Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed.

Results

A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found.

Conclusions

Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.
Targeted Next Generation Sequencing for malaria research in Africa: current status and outlook
Authors:   Plasmodium Diversity Network Africa, Ghansah Anita , Kamau Edwin , Amambua-Ngwa Alfred , Ishengoma Deus S. , Maiga-Ascofare Oumou , Amenga-Etego Lucas , Deme Awa , Yavo William , Randrianarivelojosia Milijaona , Ochola-Oyier Lynette Isabella , Helegbe Gideon Kofi , Bailey Jeffery , Alifrangis Michael , Djimde Abdoulaye
Published: September 2019

Targeted Next Generation Sequencing (TNGS) is an efficient and economical Next Generation Sequencing (NGS) platform and the preferred choice when specific genomic regions are of interest. So far, only institutions located in middle and high-income countries have developed and implemented the technology, however, the efficiency and cost savings, as opposed to more traditional sequencing methodologies (e.g. Sanger sequencing) make the approach potentially well suited for resource-constrained regions as well. In April 2018, scientists from the Plasmodium Diversity Network Africa (PDNA) and collaborators met during the 7th Pan African Multilateral Initiative of Malaria (MIM) conference held in Dakar, Senegal to explore the feasibility of applying TNGS to genetic studies and malaria surveillance in Africa. The group of scientists reviewed the current experience with TNGS platforms in sub-Saharan Africa (SSA) and identified potential roles the technology might play to accelerate malaria research, scientific discoveries and improved public health in SSA. Research funding, infrastructure and human resources were highlighted as challenges that will have to be mitigated to enable African scientists to drive the implementation of TNGS in SSA. Current roles of important stakeholders and strategies to strengthen existing networks to effectively harness this powerful technology for malaria research of public health importance were discussed.
Medulloblastoma rendered susceptible to NK-cell attack by TGFβ neutralization
Authors: Powell Allison B. , Yadavilli Sridevi , Saunders Devin , Van Pelt Stacey , Chorvinsky Elizabeth , Burga Rachel A. , Albihani Shuroug , Hanley Patrick J. , Xu Zhenhua , Pei Yanxin , Yvon Eric S. , Hwang Eugene I. , Bollard Catherine M. , Nazarian Javad , Cruz Conrad Russell Y.
Published: September 2019

Background

Medulloblastoma (MB), the most common pediatric brain cancer, presents with a poor prognosis in a subset of patients with high risk disease, or at recurrence, where current therapies are ineffective. Cord blood (CB) natural killer (NK) cells may be promising off-the-shelf effector cells for immunotherapy due to their recognition of malignant cells without the need for a known target, ready availability from multiple banks, and their potential to expand exponentially. However, they are currently limited by immune suppressive cytokines secreted in the MB tumor microenvironment including Transforming Growth Factor β (TGF-β). Here, we address this challenge in in vitro models of MB.

Methods

CB-derived NK cells were modified to express a dominant negative TGF-β receptor II (DNRII) using retroviral transduction. The ability of transduced CB cells to maintain function in the presence of medulloblastoma-conditioned media was then assessed.

Results

We observed that the cytotoxic ability of nontransduced CB-NK cells was reduced in the presence of TGF-β-rich, medulloblastoma-conditioned media (21.21 ± 1.19% killing at E:T 5:1 in the absence vs. 14.98 ± 2.11% in the presence of medulloblastoma-conditioned media, n = 8, p = 0.02), but was unaffected in CB-derived DNRII-transduced NK cells (21.11 ± 1.84% killing at E:T 5:1 in the absence vs. 21.81 ± 3.37 in the presence of medulloblastoma-conditioned media, n = 8, p = 0.85. We also observed decreased expression of CCR2 in untransduced NK cells (mean CCR2 MFI 826 ± 117 in untransduced NK + MB supernatant from mean CCR2 MFI 1639.29 ± 215 in no MB supernatant, n = 7, p = 0.0156), but not in the transduced cells. Finally, we observed that CB-derived DNRII-transduced NK cells may protect surrounding immune cells by providing a cytokine sink for TGF-β (decreased TGF-β levels of 610 ± 265 pg/mL in CB-derived DNRII-transduced NK cells vs. 1817 ± 342 pg/mL in untransduced cells; p = 0.008).

Conclusions

CB NK cells expressing a TGF-β DNRII may have a functional advantage over unmodified NK cells in the presence of TGF-β-rich MB, warranting further investigation on its potential applications for patients with medulloblastoma.
Personalized prediction of live birth prior to the first in vitro fertilization treatment: a machine learning method
Authors: Qiu Jiahui , Li Pingping , Dong Meng , Xin Xing , Tan Jichun
Published: September 2019

Background

Infertility has become a global health issue with the number of couples seeking in vitro fertilization (IVF) worldwide continuing to rise. Some couples remain childless after several IVF cycles. Women undergoing IVF face greater risks and financial burden. A prediction model to predict the live birth chance prior to the first IVF treatment is needed in clinical practice for patients counselling and shaping expectations.

Methods

Clinical data of 7188 women who underwent their first IVF treatment at the Reproductive Medical Center of Shengjing Hospital of China Medical University during 2014–2018 were retrospectively collected. Machine-learning based models were developed on 70% of the dataset using pre-treatment variables, and prediction performances were evaluated on the remaining 30% using receiver operating characteristic (ROC) analysis and calibration plot. Nested cross-validation was used to make an unbiased estimate of the generalization performance of the machine learning algorithms.

Results

The XGBoost model achieved an area under the ROC curve of 0.73 on the validation dataset and showed the best calibration compared with other machine learning algorithms. Nested cross-validation resulted in an average accuracy score of 0.70 ± 0.003 for the XGBoost model.

Conclusions

A prediction model based on XGBoost was developed using age, AMH, BMI, duration of infertility, previous live birth, previous miscarriage, previous abortion and type of infertility as predictors. This study might be a promising step to provide personalized estimates of the cumulative live birth chance of the first complete IVF cycle before treatment.
Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine
Authors:   For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF), Reignier Jean , Feral-Pierssens Anne-Laure , Boulain Thierry , Carpentier Françoise , Le Borgne Pierrick , Del Nista Denis , Potel Gilles , Dray Sandrine , Hugenschmitt Delphine , Laurent Alexandra , Ricard-Hibon Agnès , Vanderlinden Thierry , Chouihed Tahar
Published: September 2019

For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.
Best-worst scaling improves measurement of first impressions
Authors: Burton Nichola , Burton Michael , Rigby Dan , Sutherland Clare A. M. , Rhodes Gillian
Published: September 2019

A common goal in psychological research is the measurement of subjective impressions, such as first impressions of faces. These impressions are commonly measured using Likert ratings. Although these ratings are simple to administer, they are associated with response issues that can limit reliability. Here we examine best-worst scaling (BWS), a forced-choice method, as a potential alternative to Likert ratings for measuring participants’ facial first impressions. We find that at the group level, BWS scores correlated almost perfectly with Likert scores, indicating that the two methods measure the same impressions. However, at the individual participant level BWS outperforms Likert ratings, both in terms of ability to predict preferences in a third task, and in terms of test-retest reliability. These benefits highlight the power of BWS, particularly for use in individual differences research.
Reduction of radiation exposure to operating physician and assistant using a real-time auditory feedback dosimeter during femoral artery puncturing: a study on swine model
Authors: Khan Muhammad Umair Ahmad , Yi Byung-Ju
Published: September 2019

Background

Real-time dosimeters may create a relatively safer environment not only for the patient but also for the physician and the assistant as well. We propose the use of a real-time radiation measurement dosimeter having auditory feedback to reduce radiation exposure.

Methods

Radiation dose rates were measured for 30 fluoroscopy-guided puncturing procedures of femoral arteries in swine. Fifteen puncturing procedures were performed with real-time radiation measurement dosimeter having auditory feedback and other 15 were performed without auditory feedback dosimeter by an interventional cardiologist with 10 years of experience.

Results

The left body side of the operating physician (38%, p < 0.001) and assistant (25%, p < 0.001) was more exposed as compared to the right body side. Radiation dose rate to the left hand, left arm and left leg were reduced from 0.96 ± 0.10 to 0.79 ± 0.12 mSv/h (17% reduction, p < 0.001), from 0.11 ± 0.02 to 0.07 ± 0.01 mSv/h (36% reduction, p < 0.001) and from 0.22 ± 0.06 to 0.15 ± 0.02 mSv/h (31% reduction, p < 0.001) with the use of auditory feedback dosimeter, respectively. The mean fluoroscopic time was reduced from 4.8 ± 0.43 min to 4.2 ± 0.53 min (p < 0.001). The success rate of performing arterial puncturing was 100%.

Conclusions

The use of auditory feedback dosimeter resulted in reduction in effective dose. The sound beep alerted the physician from the danger of exposure, and this approach induced awareness and protective mindset to the operating physician and assistant.
The Prevalence of Osteoporosis Tested by Quantitative Computed Tomography in Patients With Different Glucose Tolerances
Authors: Li Yufeng , Zhao Zihou , Wang Liangying , Fu Zuodi , Ji Linong , Wu Xiaohong
Published: September 2019

Aim

The objectives of the present study were to compare bone characteristics with quantitative computed tomography (QCT) and other metabolic factors relevant to bone health in subjects with normal glucose tolerance, impaired glucose tolerance (IGT), and diabetes mellitus (DM) and to evaluate the association of various laboratory factors with bone characteristics qualified by QCT.

Methods

This cross-sectional population-based survey of diabetes and metabolic syndrome was conducted in Pinggu, China. The oral glucose tolerance test was conducted and QCT was tested. The volumetric bone mineral density (vBMD) of lumbar vertebrae 2 through 4 was measured.

Results

Among the 4001 eligible participants, the average age was 47.41 ± 11.86 years. The prevalence of osteoporosis evaluated by QCT was 10.6% in the normal glucose tolerance group, 14.8% in the IGT group, and 16.9% in the DM group. Multivariate linear regression analysis showed that age was negatively associated with vBMD, whereas body mass index and waist-hip ratio were positively associated with vBMD across all participants. However, the levels of hemoglobin A1c, fasting plasma glucose, and postprandial glucose were not associated with vBMD after adjusting for sex, age, systolic and diastolic blood pressure, body mass index, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, FT4, FT3, thyroid-stimulating hormone, urine albumin-to-creatinine ratio, creatinine, and serum uric acid.

Conclusions

We found that the prevalence of osteoporosis evaluated by QCT was 10.6% in the normal glucose tolerance group, 14.8% in the IGT group, and 16.9% in the DM group. The levels of hemoglobin A1c, fasting plasma glucose, and postprandial glucose were not associated with vBMD after adjusting for metabolic factors in a Chinese sample.