bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid Treatment of Extracranial Carotid Artery Disease
Authors: Bozzay Joseph , Broce Mike , Mousa Albeir Y.
Published: June 2017

Objective:

High-degree stenosis of both innominate (IA) or left common carotid artery (CCA) and carotid bifurcation is uncommon but still represents a significant challenge to interventionists in many aspects including techniques, timing, and priority. There are several strategies for intervention that have been reported in the literature. A well-described, less-invasive strategy for extracranial tandem carotid lesions is concomitant carotid endarterectomy (CEA) with retrograde carotid angioplasty and stenting (CAS). In this study, we examine intermediate-term outcomes of this hybrid procedure and review other described treatments.

Methods:

Electronic medical records of all patients who underwent hybrid (ostial CAS and CEA) procedures in a tertiary center over the last 10 years were reviewed. High-degree stenosis of the IA or CCA was defined according to North American Symptomatic Carotid Endarterectomy Trial criteria.

Results:

A total of 6 patients were identified. The population included 4 males and 2 females with a median age of 65 years. Five patients were symptomatic and all had stenosis >75% by angiography. Five of the patients underwent left CEA with proximal stenting and one patient underwent right-sided CEA with proximal stenting. Combined 30-day mortality and stroke rate was 0%. No restenosis, stroke, heart attack, or death occurred during a follow-up range of 1 to 36 months (mean 12.8 months, median 7.8 months).

Conclusion:

The combined CEA with retrograde stenting for tandem extracranial lesion procedure is safe and feasible, with adequate intermediate-term outcomes consistent with the recent literature.
Peripheral Artery Stent Dehiscence: Percutaneous Management
Authors: Karur Satish , Shankarappa Ravindranath K. , Nanjappa Manjunath C.
Published: June 2017

An elderly male presented with left abdominal swelling of 1-week duration and inability to move the left lower limb. He had undergone bilateral common iliac and left external iliac artery stenting with self-expandable stents for aortoiliac occlusive disease 1 month back. Clinical examination revealed tender abdominal nonpulsatile mass with systolic bruit. Ultrasonography suggested retroperitoneal hematoma. His hemoglobin was 7 g%. Echocardiogram showed ejection fraction of 40%. Computed tomography angiogram revealed large 10 × 10 retroperitoneal hematoma with possibility of continued bleeding from the left external iliac artery. He was taken up for urgent catheterization after consultation with the vascular surgeons who deemed him high risk for surgery in view of left ventricular dysfunction. Abdominal aortogram showed diffuse extravasation of contrast from the junction of left common iliac artery and external iliac artery into the retroperitoneal space. Sustained balloon occlusion of the vessel across the extravasated portion was done, still the leak persisted. Two covered stents were deployed in the external iliac artery overlapping each other, percutaneously resulting in complete closure of leak with good distal runoff. His symptoms improved considerably the next day with a decrease in abdominal swelling and he was able to move his left lower limb. Ultrasound of the abdomen showed regression of the retroperitoneal hematoma and no suspicion of leak. Computed tomography angiogram done 10 days and 2 months later showed regression of retroperitoneal hematoma and no extravasation with good peripheral runoff.
Fractured Superior Mesenteric Artery Stent With Stent Displacement Leading to Recurrent Symptoms of Superior Mesenteric Ischemia
Authors: Juszkat Robert , Klimont Michał , Śliwa Magdalena , Krasiński Zbigniew
Published: June 2017

We report a case of a patient with recurrent symptoms of superior mesenteric ischemia 7 months after successful percutaneous angioplasty and implantation of a stent in the superior mesenteric artery (SMA). Stent fracture and stent displacement were observed. To the best of our knowledge, this is the first report of SMA stent fracture with stent displacement.
Social Influences on Fertility: A Comparative Mixed Methods Study in Eastern and Western Germany
Authors: Bernardi Laura , Keim Sylvia , Von Der Lippe Holger
Published: June 2017

This article uses a mixed methods design to investigate the effects of social influence on family formation in a sample of eastern and western German young adults at an early stage of their family formation. Theoretical propositions on the importance of informal interaction for fertility and family behavior are still rarely supported by systematic empirical evidence. Major problems are the correct identification of salient relationships and the comparability of social networks across population subgroups. This article addresses the two issues through a combination of qualitative and quantitative data collection and analysis. In-depth interviewing, network charts, and network grids are used to map individual personal relationships and their influence on family formation decisions. In addition, an analysis of friendship dyads is provided.
Negotiating the Complexities and Risks of Interdisciplinary Qualitative Research
Authors: Trussell Dawn E. , Paterson Stephanie , Hebblethwaite Shannon , Xing Trisha M. K. , Evans Meredith
Published: June 2017

This article interrogates the experiences of an interdisciplinary research team that engaged in a qualitative research program for over 5 years, beginning with the grant writing process through to knowledge dissemination. We highlight the challenges of constructing shared understanding and developing research synergies, embracing vulnerability and discomfort to advance knowledge, and negotiating risks of legitimacy and transcending disciplinary boundaries. Based on critical reflections from the research team, the findings call attention to the politics of knowledge production, the internal and external obstacles, and the open mindedness and emotional sensitivity necessary for interdisciplinary qualitative research. Emphasis is placed on relational and structural processes and mechanisms to negotiate these challenges and the potential for interdisciplinary research to enhance the significance of scholarly work.
Peripheral inflammatory injury alters the relative abundance of Gα subunits in the dorsal horn of the spinal cord and in the rostral ventromedial medulla of male rats
Authors: Wattiez Anne-Sophie , Walder Roxanne Y , Sande Christopher M , White Stephanie R , Hammond Donna L
Published: June 2017

A diverse array of G protein-coupled receptors (GPCRs) is implicated in the modulation of nociception. The efficacy and potency of several GPCR agonists change as a consequence of peripheral inflammatory injury. Whether these changes reflect alterations in expression of the G proteins themselves is not known. This study examined the expression of transcripts and proteins for the α subunits of three classes of heteromeric G proteins in the dorsal horn of the spinal cord and the rostral ventromedial medulla (RVM) of male rats four days and two weeks after intraplantar injection of complete Freund’s adjuvant (CFA) or saline. Levels of Gα transcript in the dorsal horn or RVM were unchanged by CFA treatment. However, in the dorsal horn, Gαi protein decreased in cytosolic and membrane fractions four days after CFA treatment. Levels of Gαz protein decreased in the membrane fraction. Levels of the other Gα subunits did not differ. Levels of the Gα subunits were unchanged two weeks after CFA treatment. In the RVM, Gαz protein levels decreased in the cytosolic fraction four days after CFA treatment. No other differences were observed. Two weeks after CFA, the levels for all Gα subunits trended higher in the RVM. These data indicate that peripheral inflammatory injury induces subtle changes in the abundance of Gα subunits that is specific with respect to class, subcellular compartment, tissue, and time after injury. These changes have the potential to alter the balance of the different subcellular signaling pathways through which GPCR agonists act to modulate nociception.
Outcomes of repair of the lacerated A2 pulley with extensor retinaculum during primary flexor tendon repair
Authors: El-Shebly A. , El Fahar M. , Mohammed H. , Bahaa Eldin A.
Published: June 2017

We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits. Using the Strickland and Glogovac criteria, there were four excellent, five good and one fair result. One finger was graded excellent, eight good, and one fair according to Tang’s criteria. No clinical bowstringing was observed. We conclude that extensive pulley lacerations reconstructed with extensor retinaculum primarily ensure functional recovery after tendon repair.

Level of evidence: IV
Modification of the use of the extensor retinaculum for reducible distal radioulnar joint instability: technique and results
Authors: Filius A. , Zuidam J. M. , Jaquet J. B. , Slijper H. P. , Coert J. H.
Published: June 2017

Different surgical techniques have been described for chronic distal radioulnar joint instability: they are often complicated, quite invasive and may not be recommended for bidirectional instability. We describe a procedure using a radial-based extensor retinaculum strip and a capsular plication. This is a simple technique and less invasive than ‘anatomic’ radioulnar ligament reconstructions. We report the results of 38 patients (38 wrists) who we treated. After a minimum of 8 months we quantified the outcomes of the patients objectively by assessing ranges of motion, grip strength and clinical assessment of stability, and subjectively using questionnaires. Overall, 36 out of 38 patients were stable after surgery. The operated forearm and wrist had approximately 3° less range of motion in all planes and 3 kgf less grip strength compared with the unoperated side. The median Mayo modified wrist score was 90; the median visual analogue scale score was 2. This surgical technique appears to successfully treat patients with chronic reducible distal radioulnar joint instability. Anatomic reconstruction of both radioulnar ligaments is not always necessary.

Level of evidence: IV
Using social network analysis to identify stakeholders’ influence on energy efficiency of housing
Authors: Zedan Sherif , Miller Wendy
Published: June 2017

Energy-efficient housing is a product that integrates various stakeholders’ tasks throughout the different stages of its life cycle. The relationships between these stakeholders impact on the degree of knowledge sharing and informed decision-making and can potentially enhance or lower the energy efficiency of the product – the house. This article uses a social network analysis (SNA) approach to visualize the social networks of the stakeholders of a number of owner-occupied housing case studies in Australia. The aim is to analyse, contrast and quantify the degrees of connectivity and centrality of the housing stakeholders to identify which groups have more connectivity in the stakeholders’ network of energy-efficiency housing and consequently more potential to influence the energy efficiency outcomes and which practices are more likely to enhance transparency and information sharing that is essential for producing energy-efficient housing.
Cartilage Regeneration in Full-Thickness Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis
Authors: Grawe Brian , Burge Alissa , Nguyen Joseph , Strickland Sabrina , Warren Russell , Rodeo Scott , Shubin Stein Beth
Published: June 2017

Background

Full-thickness cartilage lesions of the patella represent a common source of pain and dysfunction. Previously reported surgical treatment options include marrow stimulation, cell-based treatments, and osteochondral transfer. Minced juvenile allograft cartilage is a novel treatment option that allows for a single stage approach for these lesions.

Hypothesis

Particulated juvenile allograft cartilage (PJAC) for the treatment of chondral defects of the patella would offer acceptable lesion fill rates, mature over time, and not be associated with any negative biologic effects on the surrounding tissue.

Methods

A retrospective chart review of prospectively collected data was conducted to identify consecutive patients who were treated with PJAC for a full thickness symptomatic cartilage lesion. Qualitative (fast spin echo) and quantitative (T2 mapping) magnetic resonance imaging (MRI) was undertaken at the 6-, 12-, and 24-month postoperative mark. Numerous patient, lesion, and graft specific factors were assessed against MRI scores and percent defect fill of the graft. Graft maturation over time was also assessed.

Results

Forty-five patients total were included in the study. Average age at the time of surgery was 26.5 years (range 13-45 years), average lesion size was 208 mm2 (range 4-500 mm2), and average donor age was 49.5 months (range 3-120 months). Sixty percent of the patients were female, while 93% of all patients underwent a concomitant procedure at the time of the index operation. Six-month MRI findings revealed that no patient-, graft-, or donor-specific factors correlated with MR scores, and 82% of the knees demonstrated good to excellent fill. Twelve-month MRI findings revealed that T2 relaxation times of deep graft demonstrated negative correlation with patient age ( P = 0.049) and donor age ( P = 0.006), the integration zone showed a negative correlation with donor age ( P = 0.026). In all, 85% of patients at 12 months displayed good to moderate fill of the graft. At 24 months, patient age demonstrated negative correlation with average T2 relaxation times of the deep and superficial graft ( P = 0.005; P = 0.0029) and positive correlation with the superficial zone of the adjacent cartilage ( P = 0.001). Donor age showed negative correlation with grayscale score ( P = 0.004) and T2 relaxation times at deep integration zone ( P = 0.018). T2 relaxation times of deep and superficial graft and integration zone improved over time ( P < 0.001) and between each time point.

Conclusions

Particulated juvenile allograft tissue appears to be an acceptable reconstructive option for full-thickness cartilage lesions of the patella, offering satisfactory tissue defect fill at 6, 12, and 24 months after surgery. Imaging of the repaired cartilage demonstrates progressive graft maturation over time.
A detailed comparison of two material models for concrete in the dynamic loading regime, RHT and HPG
Authors: Esteban Beatriz , Gebbeken Norbert
Published: June 2017

Throughout the last decades, great attention has been given to model the dynamic behaviour of concrete. As such, numerous material models have been conceived in hydrocodes to describe the complex behaviour of this composite material subjected to large deformations leading to damage and failure. Concrete shows, for instance, strain rate dependency as well as hydrostatic pressure dependency. This article focuses on the comparison of two material models conceived for such purpose. These are the RHT model (RHT - Riedel, Hiermaier, Thoma) developed at the Fraunhofer Ernst-Mach-Institut and the HPG (HPG - Hartmann, Pietzsch, Gebbeken) model developed at the University of the Bundeswehr Munich, both of which have been proven to be successful in a variety of scenarios. They are macro-level models, i.e., they regard concrete as a homogeneous material. Both models incorporate the traditional splitting in hydrocodes of the hydrostatic and the deviatoric response. On the one hand, both material models have three pressure-dependent limit surfaces in the stress space to characterise concrete strength. These are the elastic limit surface, the failure surface and the residual strength surface, the latter being related to a damage model. Strain rate effects are inherent in the models. On the other hand, both material models use the p–α formulation in the Mie–Grüneisen equation of state. The parameters of this equation are, however, differently calculated. A final comparison of these two models is done by conducting numerical simulations where the RHT and the HPG models are used as material models. The scenario is a contact detonation as an example of a high strain rate problem. Such an in-depth and detailed comparison has not been done to date. It aims to help the user decide which material model to choose as well as to provide ideas for future development in the field of material modelling.
The anticoagulant effects of warfarin and the bleeding risk associated with its use in patients with chronic thromboembolic pulmonary hypertension at a specialist center in Japan: a retrospective cohort study
Authors: Jujo‐Sanada Takayuki , Tanabe Nobuhiro , Sakao Seiichiro , Sugiura Toshihiko , Sekine Ayumi , Nishimura Rintaro , Suda Rika , Naito Akira , Miwa Hideki , Yamamoto Keiko , Sasaki Akane , Matsumura Akane , Ema Ryogo , Kasai Hajime , Kato Fumiaki , Tatsumi Koichiro
Published: June 2017

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong anticoagulation therapy. However, the bleeding risk and recurrence of venous thromboembolism (VTE) in CTEPH patients who are administered warfarin have not been adequately evaluated. The purpose of this study was to evaluate the risk of clinically relevant bleeding, recurrent VTE, and clinical worsening in patients with CTEPH who were administered warfarin.

The clinical records of 72 patients with CTEPH who regularly visited our institution and were administered warfarin were retrospectively reviewed between 1 January 2011 and 31 December 2015. We investigated the incidence of clinically relevant bleeding events, recurrent VTE, and hospitalization for the deterioration of pulmonary hypertension or right heart failure (RHF) during the observation period.

The mean observation period for the 72 patients was 3.60 ± 1.60 person‐years. Clinically relevant bleeding, RHF, and recurrent VTE occurred in 21 (29.2%), eight (11.1%), and three (4.2%) of 72 patients, respectively, and the incidence rates for these events were 8.1%/person‐year, 3.1%/person‐year, and 1.2%/person‐year, respectively. The incidence rates for the major and non‐major bleeding events were 5.0%/person‐year and 3.9%/person‐year, respectively. The incidence of clinically relevant bleeding events was 20.8%/person‐year during medical treatment with a soluble guanylate cyclase stimulator. One of 35 patients (2.9%) during the post‐pulmonary endarterectomy period experienced hemoptysis during observation period (> 6 months after pulmonary endarterectomy). No bleeding events occurred during the post‐balloon pulmonary angioplasty period.

In conclusion, warfarin effectively prevents VTE recurrence in CTEPH patients, but its effects may be associated with a considerable bleeding risk.
Tools Beyond Control: Social Media and the Work of Advocacy Organizations
Authors: Hestres Luis E.
Published: June 2017

Advocacy organizations rely on social media services, such as Facebook and Twitter, to engage their supporters. These services increasingly influence how citizens and advocacy organizations engage politically online through the technical features and policies they choose to implement—a phenomenon that can sometimes disrupt the work of advocates. Interviews with digital strategists at several US advocacy organizations revealed low levels of awareness of this phenomenon, despite its potential impact on their work; substantial dependence on these services for advocacy work; and a shared sense of necessity to embrace these tools, despite their potential downsides. Implications for the scholarship and practice of Internet governance and digitally mediated advocacy are discussed.
Shahi al-Ḥuriya: Militant optimism and freedom tea
Authors: Tayeb Leila
Published: June 2017

This essay traces utopian impulses, following Ernst Bloch and José Esteban Muñoz, in three musical performances of 2011 Libya. It contends that these performances illustrate the militant optimism that characterized this historical moment in Libya, and that reading them closely enables a nuanced engagement with Blochian theorizations of utopia as they are relevant to the quotidian both in seemingly unremarkable and in extraordinary times.
Effect of Energy Equalization on the Intelligibility of Speech in Fluctuating Background Interference for Listeners With Hearing Impairment
Authors: D’Aquila Laura A. , Desloge Joseph G. , Reed Charlotte M. , Braida Louis D.
Published: June 2017

The masking release (MR; i.e., better speech recognition in fluctuating compared with continuous noise backgrounds) that is evident for listeners with normal hearing (NH) is generally reduced or absent for listeners with sensorineural hearing impairment (HI). In this study, a real-time signal-processing technique was developed to improve MR in listeners with HI and offer insight into the mechanisms influencing the size of MR. This technique compares short-term and long-term estimates of energy, increases the level of short-term segments whose energy is below the average energy, and normalizes the overall energy of the processed signal to be equivalent to that of the original long-term estimate. This signal-processing algorithm was used to create two types of energy-equalized (EEQ) signals: EEQ1, which operated on the wideband speech plus noise signal, and EEQ4, which operated independently on each of four bands with equal logarithmic width. Consonant identification was tested in backgrounds of continuous and various types of fluctuating speech-shaped Gaussian noise including those with both regularly and irregularly spaced temporal fluctuations. Listeners with HI achieved similar scores for EEQ and the original (unprocessed) stimuli in continuous-noise backgrounds, while superior performance was obtained for the EEQ signals in fluctuating background noises that had regular temporal gaps but not for those with irregularly spaced fluctuations. Thus, in noise backgrounds with regularly spaced temporal fluctuations, the energy-normalized signals led to larger values of MR and higher intelligibility than obtained with unprocessed signals.
Optimal reblocking as a practical tool for neighborhood development
Authors: Brelsford Christa , Martin Taylor , Bettencourt Luís MA
Published: June 2017

Fast urbanization is a common feature of many developing human societies. In many cases, past and present, explosive population growth in cities outstrips the rate of provision of housing and urban services and leads to the formation of informal settlements or slums. Slums are extremely varied in terms of their histories, infrastructure, and rates of change, but they share certain common features: informal land use, lack of physical accesses, and nonexistent or poor quality urban services. Currently, about 1 billion people worldwide live in slums, a number that could triple by 2050 if no practical solutions are enacted to reverse this trend. Underlying most problems of slums is the issue of lack of physical accesses to places of work and residence. This prevents residents and businesses from having an address, obtaining basic services such as water and sanitation, and being helped in times of emergency. Here, we show how the physical layout of any neighborhood can be classified quantitatively in terms of its access topology in a way that is independent of its geometry. Topological indices capturing levels of access to structures within a city block can then be used to define a constrained optimization problem, whose solution generates an access network that makes each structure in the settlement accessible to services with minimal disruption and cost. We discuss the general applicability of these techniques to several informal settlements in developing cities and demonstrate various technical aspects of our solutions. Finally, we discuss how these techniques could be used on a large scale to speed up human development processes in cities throughout the world while respecting their local identity and history.
Loss of thymic innate lymphoid cells leads to impaired thymopoiesis in experimental graft-versus-host disease
Authors: Dudakov Jarrod A. , Mertelsmann Anna M. , O’Connor Margaret H. , Jenq Robert R. , Velardi Enrico , Young Lauren F. , Smith Odette M. , Boyd Richard L. , van den Brink Marcel R. M. , Hanash Alan M.
Published: June 2017

Key Points

Thymic ILCs and their production of IL-22 are reduced in mice with GVHD; IL-22 deficiency worsens thymic epithelial damage in GVHD. Administration of IL-22 posttransplant can enhance thymopoiesis after experimental allogeneic bone marrow transplant.
Early Response–Based Therapy Stratification Improves Survival in Adult Early Thymic Precursor Acute Lymphoblastic Leukemia: A Group for Research on Adult Acute Lymphoblastic Leukemia Study
Authors: Bond Jonathan , Graux Carlos , Lhermitte Ludovic , Lara Diane , Cluzeau Thomas , Leguay Thibaut , Cieslak Agata , Trinquand Amélie , Pastoret Cedric , Belhocine Mohamed , Spicuglia Salvatore , Lheritier Véronique , Leprêtre Stéphane , Thomas Xavier , Huguet Françoise , Ifrah Norbert , Dombret Hervé , Macintyre Elizabeth , Boissel Nicolas , Asnafi Vahid
Published: June 2017

Purpose

Early thymic precursor (ETP) acute lymphoblastic leukemia (ALL) is an immunophenotypically defined subgroup of T-cell ALL (T-ALL) associated with high rates of intrinsic treatment resistance. Studies in children have shown that the negative prognostic impact of chemotherapy resistance is abrogated by the implementation of early response–based intensification strategies. Comparable data in adults are lacking.

Patients and Methods

We performed comprehensive clinicobiologic, genetic, and survival analyses of a large cohort of 213 adult patients with T-ALL, including 47 patients with ETP-ALL, treated in the GRAALL (Group for Research on Adult Acute Lymphoblastic Leukemia) -2003 and -2005 studies.

Results

Targeted next-generation sequencing revealed that the genotype of immunophenotypically defined adult T-ALL is similar to the pediatric equivalent, with high rates of mutations in factors involved in cytokine receptor and RAS signaling (62.2%), hematopoietic development (29.7%), and chemical modification of histones (48.6%). In contrast to pediatric cases, mutations in DNA methylation factor genes were also common (32.4%). We found that despite expected high levels of early bone marrow chemotherapy resistance (87%), the overall prognosis for adults with ETP-ALL treated using the GRAALL protocols was not inferior to that of the non–ETP-ALL group (5-year overall survival: ETP, 59.6%; 95% CI, 44.2% to 72.0% v non-ETP, 66.5%; 95% CI, 58.7% to 73.2%; P = 0.33) and that allogeneic stem-cell transplantation had a beneficial effect in a large proportion of patients with ETP-ALL.

Conclusion

Our results suggest that the use of response-based risk stratification and therapy intensification abrogates the poor prognosis of adult ETP-ALL.
Building a Network of Health Professionals for Breast and Cervical Cancer Control in the Andean Region
Authors: Mendoza-Cervantes Diana , Otero Isabel , Zujewski Jo Anne , Ferrandiz Salazar Jorge , López Córdova Gabriela , Muha Cathy , Stevens Lisa
Published: June 2017

Purpose

Cancer mortality is approximately twice as high in Latin American countries than in more developed countries. In particular, the countries of the high Andean region of Latin America carry a double burden of breast and cervical cancers. In these countries, there are disproportionately higher mortality to incidence ratios compared with other regions in Latin America. The US National Cancer Institute’s Center for Global Health, the Pan American Health Organization, and the Ministry of Health in Peru collaborated to design and execute an education and advocacy workshop in Lima, Peru. The workshop was convened to discuss regional challenges and practices, as well as to support the implementation of Plan Esperanza, Peru’s national cancer control plan.

Methods

Workshop participants included local and international experts to present the state of the science, health practitioners, and advocacy groups to discuss unique barriers that women in the region experience.

Results

Inequalities in access to and distribution of medical expertise, lack of continuity of cancer control plans, and the need for sustained public buy-in emerged as obstacles.

Conclusion

The workshop provided a forum to discuss key issues regarding breast and cervical cancer control among health professionals and advocates in Peru and the region. This article outlines the resulting recommendations.
Medical Management of Hepatocellular Carcinoma
Authors: Rich Nicole E. , Yopp Adam C. , Singal Amit G.
Published: June 2017

Hepatocellular carcinoma (HCC) typically occurs in patients with advanced liver disease, so therapeutic decisions must account for the degree of underlying liver dysfunction and patient performance status in addition to tumor burden. Curative treatment options, including liver transplantation, surgical resection, and local ablative therapies, offer 5-year survival rates exceeding 60% but are restricted to patients with early-stage HCC. Surgical resection and local ablative therapies are also limited by high recurrence rates, highlighting a need for adjuvant and/or neoadjuvant therapies. A majority of patients with HCC are diagnosed beyond an early stage, when the tumor is no longer amenable to curative options. For patients with liver-localized HCC in whom curative options are not possible, transarterial therapies, either chemoembolization or radioembolization, can prolong survival but are rarely curative. Sorafenib and regorafenib are the only approved first-line and second-line systemic therapies, respectively, with a survival benefit for patients with advanced HCC; however, the benefit is primarily observed in patients with intact liver function and good performance status. There are several ongoing phase II and III trials evaluating novel systemic therapies, including immunotherapies. Patients with poor performance status or severe hepatic dysfunction do not derive any survival benefit from HCC-directed therapy and have a median survival of approximately 6 months. These patients should be treated with best supportive care, with a focus on maximizing quality of life. Multidisciplinary care has been shown to improve appropriateness of treatment decisions and overall survival and should be considered standard of care for patients with HCC.
Platelet distribution width, mean platelet volume and haematological parameters in patients with uncomplicated plasmodium falciparum and P. vivax malaria
Authors: A. Ali Elrazi , M. Abdalla Tajeldin , Adam Ishag
Published: June 2017

Background: The association between the haematological profile (including abnormal platelets) and malaria is not completely understood. There are few published data on haematological profiles of malaria patients in areas with unstable malaria transmission. The current study was conducted to investigate if the haematological parameters, including platelet indices, were reliable predictors for microscopically-diagnosed malaria infection.

Methods: A case-control study with a total of 324 participants (162 in each arm) was conducted at the out-patient clinic of New Halfa hospital during the rainy and post rainy season (August 2014 through to January 2015). The cases were patients with uncomplicated Plasmodium falciparum (107; 66.9%) and P. vivax malaria (55, 34.0%) infections. The controls were aparasitemic individuals. The haematological parameters were investigated using an automated hemo-analyser.

Results: There was no significant difference in the mean (±SD) age between the study groups; however, compared to the controls, patients with uncomplicated malaria had significantly lower haemoglobin, leucocyte and platelet counts, and significantly higher red cell distribution width (RDW), platelet distribution width (PDW) and mean platelet volume (MPV).

Conclusions: The study revealed that among the haematological indices, PDW and MPV were the main predictors for uncomplicated P. falciparum and P. vivax malaria infection.

Abbreviations: OR: odds ratio.
Overinterpretation of Research Findings: Evidence of “Spin” in Systematic Reviews of Diagnostic Accuracy Studies
Authors: McGrath Trevor A , McInnes Matthew D F , van Es Nick , Leeflang Mariska M G , Korevaar Daniël A , Bossuyt Patrick M M
Published: June 2017

BACKGROUND

We wished to assess the frequency of overinterpretation in systematic reviews of diagnostic accuracy studies.

METHODS

MEDLINE was searched through PubMed from December 2015 to January 2016. Systematic reviews of diagnostic accuracy studies in English were included if they reported one or more metaanalyses of accuracy estimates. We built and piloted a list of 10 items that represent actual overinterpretation in the abstract and/or full-text conclusion, and a list of 9 items that represent potential overinterpretation. Two investigators independently used the items to score each included systematic review, with disagreements resolved by consensus.

RESULTS

We included 112 systematic reviews. The majority had a positive conclusion regarding the accuracy or clinical usefulness of the investigated test in the abstract (n = 83; 74%) and full-text (n = 83; 74%). Of the 112 reviews, 81 (72%) contained at least 1 actual form of overinterpretation in the abstract, and 77 (69%) in the full-text. This was most often a “positive conclusion, not reflecting the reported summary accuracy estimates,” in 55 (49%) abstracts and 56 (50%) full-texts and a “positive conclusion, not taking high risk of bias and/or applicability concerns into account,” in 47 abstracts (42%) and 26 full-texts (23%). Of these 112 reviews, 107 (96%) contained a form of potential overinterpretation, most frequently “nonrecommended statistical methods for metaanalysis performed” (n = 57; 51%).

CONCLUSIONS

Most recent systematic reviews of diagnostic accuracy studies present positive conclusions and a majority contain a form of overinterpretation. This may lead to unjustified optimism about test performance and erroneous clinical decisions and recommendations.
EVALUACIÓN DEL IMPACTO SOBRE EL MARGEN BRUTO DE UN CONJUNTO DE ESTRATEGIAS DE MANEJO EN LA ACTIVIDAD LECHERA
Authors: ROSSLER N. , GIUSIANO J. , BLANGETTI D.
Published: June 2017

Utilizando la metodología de estudio de caso se comparó el margen bruto de un tambo ubicado al oeste de la provincia de Córdoba, con su manejo habitual versus una situación hipotética mejorada del mismo. El objetivo fue evaluar el impacto económico de algunas estrategias de manejo que mejoran los indicadores productivos y reproductivos del sistema.Los problemas identifi cados están vinculados a cuestiones de manejo del rodeo en particular y del sistema en general: elevado porcentaje de rechazo y muerte de animales, bajas carga animal, relación VO/VT y producción individual de leche, venta de animales en categorías regulares, elevado nivel de Gastos sanitarios. La solución de estos problemas mediante la implementación de estrategias de manejo debajo o nulo costo repercutió de manera positiva en el margen bruto, principalmente por un incrementoen los ingresos. El margen bruto de la situación mejorada duplicó al margen bruto de la situación actual.
MITIGACIÓN DEL ESTRÉS CALÓRICO DURANTE EL PREPARTO EN VACAS LECHERAS
Authors: TOFFOLI G. D. , LEVA P. E. , SOSA J. L. , GHIANO J. E. J. , FERNANDEZ G. B. , GARCIA M. S. , TAVERNA M. , WALTER E.
Published: June 2017

Se utilizaron 30 vacas en preparto que se alojaron en un corral seco con acceso a sombra artificial durante el verano. Las vacas fueron distribuidas en dos grupos: sin refrescado (TS) y con refrescado (TR) en el sector comedero. El peso corporal y la condición corporal fueron evaluadas al inicio y a los 25 días. La frecuencia respiratoria se realizó dos veces por semana en cuatro momentos del día. El registro de comportamiento dos veces a la semana. Los datos de analizaron con t Student y χ2. El peso y condición corporal no presentaron diferencia signifi cativa. Se observó un efecto del tratamiento en el día y horario para la frecuencia respiratoria (p<0,0001). La conducta de parado a la sombra fue al que dedicaron mayor tiempo en ambos tratamientos 27 % en TS y 29 % en TR. No hubo diferencias en la producción lechera entre TS y TR: 31,4 l/v/d y 30,6 l/v/d respectivamente.
The effect of internal control and anti-fraud awareness on fraud prevention (A survey on inter-governmental organizations)
Authors: YR Rozmita Dewi , Ariandi Irfan
Published: June 2017

The objectives of this research are to analyze the effect of internal control and anti-fraud awareness on the fraud prevention in inter-governmental organization. Fraud prevention is devoted in the procurement process. This study used internal control and anti-fraud awareness as independent variable, while fraud prevention as the dependent variable. In addition, it also used a convenience sampling for collecting the data. The sample of the data was taken using questionnaires which were distributed to Indonesian Staff who had been involved or they had participated in the procurement process. The total number of the sample was 58 respondents. Furthermore, the data were analyzed by means of multiple regressions. The results showed that internal control and anti-fraud awareness have significant effects on fraud prevention. It indicates that the action of doing fraud can be prevented by establishing a good internal control and increasing anti-fraud awareness to all parties in the organization.
The Islamic Capital Market Response to the Real Earnings Management
Authors: Yuliana Rita , Alim M Nizarul
Published: June 2017

This study aims to prove the effect of the company's status, i.e membership on the Islamic capital market and the status as suspect firm, as a determinant of real earnings management (REM). REM is conducted by abnormally increasing sales, increasing production and reducing discretionary costs in order to achieve a certain earnings target. This study uses Earnings Distribution Analysis (EDA) technique, which refers to the Prospect Theory (Kahneman & Tversky, 1979) to identify the suspect firms. Suspect firms are companies that have small positive earnings. The samples of this research are companies listed on the Indonesia Stock Exchange in 2011 and 2012. Based on the result of regression analysis, hypothesis testing results show that the suspect firms conduct real earnings management in all three types of activities more aggressively than the non-suspect firms. Furthermore, this study also showed empirical evidence that there are differences in real earnings management actions between companies listed in the Islamic capital market compared to conventional capital markets. Then, this study also showed that the Islamic capital market is more appropriate in response to the REM than the conventional capital market.
Clinician Perspectives of Antisocial and Borderline Personality Disorders Using DSM-5 Section III Dimensional Personality Traits
Authors: Anderson Jaime L. , Sellbom Martin , Shealy R. Clayton
Published: June 2017

The DSM-5 includes an alternative model for the diagnosis of personality disorders (PDs). Although there has been growing support for this model there has been little investigation into how it will be utilized by clinicians. The current study evaluated clinician perspectives of a “prototypical” individual with antisocial and borderline PD using Section III traits in a sample of 105 mental health professionals. Results showed that clinicians' perspectives of these disorders were generally consistent with the Section III trait operationalizations. Indeed, clinicians rated each trait facet as more prototypical than nonproposed facets. Similarly, they rated nonproposed facets as less prototypical than included facets for both disorders, with some exceptions for borderline PD. Furthermore, the authors found that these ratings were generally in statistical agreement with empirical associations between Section III traits and Section II PDs found in previous studies. Overall, results suggest support for the trait operationalizations of these disorders by clinicians.
Turning Passion into Profession: A History of Craft Beer in Italy
Authors: Fastigi Matteo , Cavanaugh Jillian R.
Published: June 2017

This article investigates the Italian craft brewing revolution, a florescence of small-scale, artisanal beer production that began in the late 1990s. This revolution presents a number of provocative paradoxes, such as the growing importance of beer consumption and production in a country long known for its wine, its economic success at a time of ongoing and severe economic crisis in Italy, and the ways in which a love of drinking beer is driving many to choose to make it. Drawing on extensive survey data among craft brewers, ethnographic research, and interviews with craft brewers and their supporters, we show that Italian craft beer is a valuable case study of productive leisure leading to passionate production, and sketch the regional contours of Italian craft brewing against the contemporary global rise in artisanal beer production and consumption.
PB&J: The Rise and Fall of an Iconic American Dish
Authors: Estes Steve
Published: June 2017

The rise of the peanut butter and jelly sandwich and its potential decline illustrate major themes in recent U.S. history. The growing popularity of the PB&J in the twentieth century reflected changing family structures and child-rearing practices as well as the evolution of food production and consumption. From the 1950s to the 1990s, the PB&J symbolized how much parents (particularly mothers) cared about their children. However, health concerns eventually tarnished the sandwich's iconic image. This article argues that the PB&J became an iconic dish by bridging social divisions based on age, gender, and income levels in the United States.
The Wonder of Bread: Teaching University Students the Cost of Eating with Their Hands
Authors: Pallant Eric
Published: June 2017

Because many students of college age arrive at school with limited understanding of where food comes from or even how to prepare food from authentic ingredients, I planted a field of wheat so I could teach, and learn about, what went into baking the staff of life—bread. Raising enough wheat to make a single loaf of bread, and then expending the energy to thresh, winnow, grind, knead, and bake was more costly and difficult than imagined at the outset. In the process of making bread with their own hands students learned agronomy, engineering, history, anthropology, environmental science, and economics. And then they consumed what they had learned.
Women as Public Scientists in the Atomic Age
Authors: Richmond Marsha L.
Published: June 2017

With the onset of the atomic age in 1945, geneticists increasingly spoke out about how nuclear fallout and radiation impacted heredity and reproduction. The scholarship discussing post–World War II activism focuses almost exclusively on males, with little attention given to women who served as public scientists or the role gender played in gaining public trust and influencing policy makers. This paper examines two women, both trained in genetics, who became activists in the 1950s and 1960s to educate the public about the dangers radiation and wartime chemicals posed to the human germ plasm. In Genetics in the Atomic Age (1956), Charlotte Auerbach (1899–1994) described basic genetic principles to explain why radiation-induced mutations could be harmful. In Silent Spring (1962), Rachel Carson (1907–1964) drew on genetics to warn about the possible mutagenic properties of DDT along with other concerns. Both women fostered scientific literacy to empower an informed citizenry that could influence public policy. They appealed both to men and to the growing cadre of middle-class educated women, encouraging an expanded role for maternal responsibility: not only protecting families but also the well-being of all humankind.

This essay is part of a special issue entitled THE BONDS OF HISTORY edited by Anita Guerrini.
Exploring Interprofessional, Interagency Multimorbidity Care: Case Study Based Observational Research
Authors: McKinlay Eileen M. , Morgan Sonya J. , Gray Ben V. , Macdonald Lindsay M. , Pullon Susan R.H.
Published: June 2017

Background

The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care.

Objective

To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care.

Design

Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration.

Results

The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals.

Conclusion

Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.