bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic burden of migraine in Latvia and Lithuania: direct and indirect costs
Authors: Lublóy Ágnes
Published: September 2019

Background

Migraine is a primary headache disorder which affects all aspects of life. The financial burden of migraine imposed on the society might be substantial. This study aims at estimating the economic cost of migraine in Latvia and Lithuania, including both direct and indirect costs. Direct costs encompass the costs of migraine-related health care resource utilization. Indirect costs are related to productivity loss, the potential or expected earnings lost due to migraine.

Methods

Direct cost is assessed by using the prevalence method, a widely used cost-of-illness approach. The prevalence rate of migraine and the migraine-related health care resource utilization are proxied from the literature, whereas unit cost of medical services and procedures are retrieved from national databases and providers. For estimating the indirect cost of migraine, we follow the human capital approach. We quantify three components of indirect costs: reduced labour force participation, absence from work and reduced productivity while at work. The number of unemployed migraineurs, days missed from work and days lost due to impairment while at work are drawn from the literature. Unemployment rate and average income in Latvia and Lithuania are then inserted to assess indirect costs.

Results

We find that the mean per-person total cost of migraine is €801 annually in Latvia, and €721 in Lithuania. In both countries around 30% of total cost is direct cost; cost related to a wide array of migraine-related medical services and interventions. The total cost of migraine is €112.26 million in Latvia, corresponding to 0.42% of Latvia’s GDP. The total cost of migraine is €149.62 million in Lithuania, corresponding to 0.35% of Lithuania’s GDP. In both countries two thirds of total cost is related to lost workdays due to absenteeism and presenteeism.

Conclusions

The financial burden of migraine imposed on the society is substantial in Latvia and Lithuania. Improvements in care for patients with migraine, such as easier access to structured headache assessment services, wider availability of various procedures and preventive medications would significantly increase direct costs. Nevertheless, this cost increase might be far outweighed by lower migraine-related productivity loss, especially as the prevalence of migraine is the highest in the most productive years of life.
Exercise or sports in midlife and healthy life expectancy: an ecological study in all prefectures in Japan
Authors: Monma Takafumi , Takeda Fumi , Noguchi Haruko , Takahashi Hideto , Watanabe Taeko , Tamiya Nanako
Published: September 2019

Background

With the increase of overall life expectancy in Japan, effective and beneficial lifestyle approaches and practices are crucial for individuals to have a long, productive and healthy life. Although previous studies suggest that exercise or sports, especially when performed with others, from midlife level have a positive impact on enhancing healthy life expectancy, there is paucity of information regarding these contexts and possible associations. The present study intends to clarify the relationship between engagement in exercise or sports among middle-aged persons and healthy life expectancy through an ecological study in all prefectures in Japan.

Methods

We tabulated (1) the ratios of middle-aged individuals engaged in exercise or sports and (2) the different methods by which they are engaged in exercise or sports for each prefecture by using data from the 2005–2010 Longitudinal Survey of Middle-aged and Elderly Persons by the Ministry of Health, Labour and Welfare of Japan. Weighted multiple linear regression analyses were performed by sex, using healthy life expectancy in 2010 of each prefecture calculated by Hashimoto (2013) as a criterion variable; indices of (1) and (2) of each year as explanatory variables; and age, living conditions, employment, and chronic diseases as adjusted variables.

Results

For middle-aged males, the ratio of those engaged in exercise or sports in each year from 2005 to 2010 was positively correlated with healthy life expectancy; this relationship was found in the ratio of middle-aged engaging in exercise or sports “with families or friends”. For females, such a relationship could only be found in the ratio of middle-aged females engaged in exercise or sports in 2008, and those engaging in exercise or sports “with families or friends” in 2006, 2008 and 2010.

Conclusion

Prefectures with a higher ratio of middle-aged individuals engaging in exercise or sports, especially when done with families or friends, have longer healthy life expectancies. This was particularly evident for males. Thus, exercise or sports with families or friends in midlife seems to be more effective in promoting healthy life expectancy for males than females in Japan.
Predictive factors for response to salvage stereotactic body radiotherapy in oligorecurrent prostate cancer limited to lymph nodes: a single institution experience
Authors: Oehler Christoph , Zimmermann Michel , Adam Lukas , Curschmann Juergen , Sumila Marcin , Strebel Räto T. , Cathomas Richard , Li Qiyu , Schneider Uwe , Zwahlen Daniel R.
Published: September 2019

Background

In patients presenting with limited nodal recurrence following radical prostatectomy (RP), stereotactic body radiotherapy (SBRT) results might improve with a better case selection.

Methods

Single-institution retrospective analysis of patients presenting with 1–3 lymph node (LN) recurrences (N1 or M1a) on 18F-Choline PET/CT. Prior therapy included radical prostatectomy (RP) ± salvage radiotherapy (RT), in absence of any systemic therapy.

Outcome parameters were biochemical response (BR), time to biochemical recurrence (TBR) and time interval between SBRT and androgen deprivation therapy start (TADT). Time to event endpoints was analysed using Kaplan-Meier method. Potential prognostic factors were examined using univariate proportional hazards regression for TADT and logistic regression for BR. The optimal cut-off point for LN size was calculated using the Contal and O’Quigley method.

Results

25 patients fulfilling study criteria were treated with SBRT from January 2010 to January 2015 and retrospectively analysed. Median follow up was 18 months and median LN diameter 10.5 mm. SBRT was delivered to a median dose of 36 Gy in three fractions (range: 30–45 Gy). BR was reached in 52% of cases. Median TBR was 11.9 months and significantly longer in patients with larger LN (Hazard ratio [HR] = 0.87, P = 0.03). Using 14 mm as cut off for LN, median TBR was 10.8 months for patients with small LN (18 patients), and 21.2 months for patients with large LN (6 patients) (P unadjusted = 0.009; P adjusted = 0.099). ADT was started in 32% of patients after a median follow-up of 18 months.

Conclusions

For PCa patients with 1–3 LN recurrence after RP (± salvage RT), SBRT might result in a better biochemical control when delivered to larger sized (≥ 14 mm) LN metastases. This study is hypothesis generating and results should be tested in a larger prospective trial.
Parental satisfaction and perception of Progress in influencing the Practice of complementary health approaches in children with autism: a cross sectional survey from Negeri Sembilan, Malaysia
Authors: Ong Jun Jean
Published: September 2019

Background

Parents’ use of complementary health approaches (CHA) for children with autism spectrum disorder (ASD) are common despite the uncertain evidence of its benefit. Parents often adopt CHA due to dissatisfaction with conventional treatment. This study aimed to examine parents’ satisfaction with ASD treatment and their perception of progress in their child’s development. Parents’ use of CHA among children with ASD and the factors related were also evaluated.

Methods

Self-administered questionnaires were completed by 48 parents of children with ASD at a single tertiary referral hospital in Malaysia. Correlation analysis was used to explore associations between parental satisfaction scores, perception of progress scores and use of CHA.

Results

Use of CHA was reported by parents for 35.4% of children with ASD in the sample. Parents who were less satisfied with conventional treatment and parents who perceived poorer progress in their child’s development were more likely to use CHA. Strong positive relationship was found between parent satisfaction with ASD treatment scores and parent perception of progress scores, which indicates that parents who were satisfied with treatment were more likely to perceive greater progress in their child’s development. Improvement in child’s progress was most appreciated by parents in their child’s behavior (85.5%), social skills (83.3%) and motor skills (77.1%).

Conclusion

The use of CHA was common among children with ASD. Parents were more likely to practice CHA when they were less satisfied with conventional treatment and perceived poorer progress. A larger multicenter study is required to further explore the practice of CHA among children with ASD throughout Malaysia.
Bottom-up development of national obstetric guidelines in middle-income country Suriname
Authors: Verschueren Kim J. C. , Kodan Lachmi R. , Brinkman Tom K. , Paidin Raez R. , Henar Sheran S. , Kanhai Humphrey H. H. , Browne Joyce L. , Rijken Marcus J. , Bloemenkamp Kitty W. M.
Published: September 2019

Background

Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the ‘bottom-up’ development process of context-tailored national obstetric guidelines in middle-income country Suriname.

Methods

Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH).

Results

The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented.

Conclusion

Development of national context-tailored guidelines is achievable in a middle-income country when using a ‘bottom-up’ approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines.
Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community
Authors: Shanley Dianne C. , Hawkins Erinn , Page Marjad , Shelton Doug , Liu Wei , Webster Heidi , Moritz Karen M. , Barry Linda , Ziviani Jenny , Morrissey Shirley , O’Callaghan Frances , Wood Andrew , Katsikitis Mary , Reid Natasha
Published: September 2019

Background

Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23–94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies.

Methods

The Yapatjarrathati project (named by the local First Nations community and meaning ‘to get well’) is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process.

Discussion

Co-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.
The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project
Authors: Jones Katherine J. , Crowe John , Allen Joseph A. , Skinner Anne M. , High Robin , Kennel Victoria , Reiter-Palmon Roni
Published: September 2019

Background

Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture.

Methods

During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exactPvalues to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT.

Result

Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction.

Conclusions

Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.
Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
Authors: Zhao Miaomiao , Liu Baohua , Shan Linghan , Li Cui , Wu Qunhong , Hao Yanhua , Chen Zhuo , Lan Lan , Kang Zheng , Liang Libo , Ning Ning , Jiao Mingli
Published: September 2019

Background

Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness.

Methods

A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices.

Results

Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality.

Conclusions

The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.
Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care
Authors: Kaltenbrunner Monica , Bengtsson Lars , Mathiassen Svend Erik , Högberg Hans , Engström Maria
Published: September 2019

Background

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.
Natural outer membrane permeabilizers boost antibiotic action against irradiated resistant bacteria
Authors: Farrag Hala A. , Abdallah Nagwa , Shehata Mona M. K. , Awad Ebthag M.
Published: September 2019

Background

This study sought to develop new strategies for reverting the resistance of pathogenic Gram-negative bacilli by a combination of conventional antibiotics, potent permeabilizers and natural beta lactamase inhibitors enhancing the activity of various antibiotics.

Methods

The antibiotic susceptibility in the presence of natural non-antibacterial tested concentrations of phytochemicals (permeabilizers and natural beta lactamase inhibitors) was performed by disk diffusion and susceptibility assays. Thymol and gallic acid were the most potent permeabilizers and facilitated the passage of the antibiotics through the outer membrane, as evidenced by their ability to cause LPS release, sensitize bacteria to SDS and Triton X-100.

Results

The combination of permeabilizers and natural beta lactamase inhibitors (quercetin and epigallocatechin gallate) with antibiotics induced greater susceptibility of resistant isolates compared to antibiotic treatment with beta lactamase inhibitors alone. Pronounced effects were detected with 24.4 Gy in vitro gamma irradiation on permeability barrier, beta lactamase activity, and outer membrane protein profiles of the tested isolates.

Conclusions

The synergistic effects of the studied natural phytochemicals and antibiotics leads to new clinical choices via outer membrane destabilization (permeabilizers) and/or inactivation of the beta lactamase enzyme, which enables the use of older, more cost-effective antibiotics against resistant strains.
Development of transplantable B-cell lymphomas in the MHC-defined miniature swine model
Authors: Andrews Alec R. , Wang Zhaohui , Wilkinson Robert A. , Fishman Jay A. , Sachs David H. , Navarro-Alvarez Nalu , Huang Christene A.
Published: September 2019

Background

Establishment of transplantable tumors in clinically relevant large animals allows translational studies of novel cancer therapeutics.

Methods

Here we describe the establishment, characterization, and serial transplantation of a naturally occurring B-cell lymphoma derived from a unique, highly inbred sub-line of Massachusetts General Hospital (MGH) major histocompatibility complex (MHC)-defined miniature swine.

Results

The lymphoblastic cell line (LCL) originated from peripheral blood of a 2.5 year old female swine leukocyte antigen (SLA)dd-inbred miniature swine breeder demonstrating clinical signs of malignancy. Flow cytometric phenotypic analysis of subclones derived from the original cell line revealed surface markers commonly expressed in a B-cell lineage neoplasm. A subclone of the original LCL was transplanted into mildly-conditioned histocompatible miniature swine and immunocompromised NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) mice. Tissue and blood samples harvested 2 weeks following subcutaneous and intravenous injection in a highly inbred SLAdd pig were cultured for tumor growth and phenotypic analysis before serial transfer into NSG mice. Evidence of tumor growth in vivo was found in all tumor cell recipients. In vitro growth characteristics and surface phenotype were comparable between the original and serially transplanted tumor cell lines.

Conclusions

These results indicate the feasibility of developing a large-animal transplantable tumor model using cells derived from spontaneously occurring hematologic malignancies within the highly inbred miniature swine herd.
Complement lectin pathway protein levels reflect disease activity in juvenile idiopathic arthritis: a longitudinal study of the Nordic JIA cohort
Authors:   for the Nordic Study Group of Pediatric Rheumatology (NoSPeR), Glerup Mia , Thiel Steffen , Rypdal Veronika , Arnstad Ellen Dalen , Ekelund Maria , Peltoniemi Suvi , Aalto Kristiina , Rygg Marite , Nielsen Susan , Fasth Anders , Berntson Lillemor , Nordal Ellen , Herlin Troels
Published: September 2019

Background

To determine the serum levels of the lectin pathway proteins early in the disease course and 17 years after disease onset and to correlate the protein levels to markers of disease activity in participants from a population-based Nordic juvenile idiopathic arthritis (JIA) cohort. Additionally, to assess the predictive value of lectin pathway proteins with respect to remission status.

Methods

A population-based cohort study of consecutive cases of JIA with a disease onset from 1997 to 2000 from defined geographical areas of Finland, Sweden, Norway and Denmark with 17 years of follow-up was performed. Clinical characteristics were registered and H-ficolin, M-ficolin, MASP-1, MASP-3, MBL and CL-K1 levels in serum were analyzed.

Results

In total, 293 patients with JIA were included (mean age 23.7 ± 4.4 years; mean follow-up 17.2 ± 1.7 years). Concentrations of the lectin protein levels in serum were higher at baseline compared to the levels 17 years after disease onset (p ≤ 0.006, n = 164). At baseline, the highest level of M-ficolin was observed in systemic JIA. Further, high M-ficolin levels at baseline and at 17-year follow-up were correlated to high levels of ESR. In contrast, high MASP-1 and MASP-3 tended to correlate to low ESR. CL-K1 showed a negative correlation to JADAS71 at baseline.

None of the protein levels had prognostic abilities for remission status 17 years after disease onset.

Conclusion

We hypothesize that increased serum M-ficolin levels are associated with higher disease activity in JIA and further, the results indicate that MASP-1, MASP-3 and CL-K1 are markers of inflammation.
The effect of group A streptococcal carrier on the epidemic model of acute rheumatic fever
Authors: Yokchoo Natsuda , Patanarapeelert Nichaphat , Patanarapeelert Klot
Published: September 2019

Background

Group A streptococcus (GAS) is the most frequent cause of bacterial pharyngitis in school-aged children. The postinfection sequel as acute rheumatic fever (ARF) and rheumatic heart disease that cause morbidity and mortality among young people is public health concerns in several developing countries. Asymptomatic carriage state of GAS is not fully understood in terms of host and bacterial factors. Although the ability of transmitting GAS of the asymptomatic carriers is relatively low, they may present the reservoir of the epidemic. A fraction of GAS carriers is difficult to estimate in practice and may greatly vary between populations. Understanding the role of carriage on the transmission dynamic of GAS is important for assessing the public health impact of the ARF.

Method

This study investigates the effect of GAS carriers on both the transmission and dynamic of ARF cases by using a mathematical model.

Result

We derive the sufficient conditions for which the GAS can spread or extinct from the naive population under the variation of the fraction of symptomatic cases over the incidence of GAS. The threshold is possible to occur in general, but the last condition which is rather restrictive and involves parameter uncertainty. The increasing of carriers in the endemic state leads to the reduction in magnitude of the reproduction number and the number of ARF patients. We demonstrate that the adjustment of parameters can be carried out by the use of endemic state and some specific data.

Conclusion

We show theoretically that the presence of asymptomatic carriers may induce the epidemic threshold and reduce the virulence of GAS and the prevalence of ARF.
From bench to bed: the tumor immune microenvironment and current immunotherapeutic strategies for hepatocellular carcinoma
Authors: Fu Yaojie , Liu Shanshan , Zeng Shan , Shen Hong
Published: September 2019

Hepatocellular carcinoma (HCC) ranks the most common primary liver malignancy and the third leading cause of tumor-related mortality worldwide. Unfortunately, despite advances in HCC treatment, less than 40% of HCC patients are eligible for potentially curative therapies. Recently, cancer immunotherapy has emerged as one of the most promising approaches for cancer treatment. It has been proven therapeutically effective in many types of solid tumors, such as non-small cell lung cancer and melanoma. As an inflammation-associated tumor, it’s well-evidenced that the immunosuppressive microenvironment of HCC can promote immune tolerance and evasion by various mechanisms. Triggering more vigorous HCC-specific immune response represents a novel strategy for its management. Pre-clinical and clinical investigations have revealed that various immunotherapies might extend current options for needed HCC treatment. In this review, we provide the recent progress on HCC immunology from both basic and clinical perspectives, and discuss potential advances and challenges of immunotherapy in HCC.
Knowledge, attitude, and practice of healthcare professionals regarding infection prevention at Gondar University referral hospital, northwest Ethiopia: a cross-sectional study
Authors: Yazie Teshiwal Deress , Sharew Gezahegn Bewket , Abebe Wondwossen
Published: September 2019

Objectives

Workplace health and safety is vital in every organization particularly in the healthcare settings. The aim was to assess the levels of knowledge, attitude, and practices of the healthcare professionals towards safety at Gondar University referral hospital. An institution based cross-sectional study was conducted from February to June 2018. Proportional random sampling technique was used to include 282 study participants and data were collected using a structured self-administered questionnaire and analyzed using SPSS version 20.

Results

Among 282 study participants, 230 (81.6%), 181 (64.2%), and 162 (57.4%) had adequate knowledge, favorable attitude, and adequate practice scores, respectively. More than half (55.3%) of the study participants were untrained. There was a high (26.6%) prevalence of needlestick injury; however, the use of post-exposure prophylaxis after potential exposures was very limited. Generally, the levels of knowledge, attitude, and practice scores among the study participants were low. Therefore, there should be adequate and consistent supply of personal protective devices and other materials used for infection prevention and control. In addition, there should be awareness raising mechanism, including the provision of job aids and periodic training. Further, comprehensive studies should be conducted by including different types and levels of health facilities.
In vivo imaging of early stages of rheumatoid arthritis by α5β1-integrin-targeted positron emission tomography
Authors: Notni Johannes , Gassert Florian T. , Steiger Katja , Sommer Peter , Weichert Wilko , Rummeny Ernst J. , Schwaiger Markus , Kessler Horst , Meier Reinhard , Kimm Melanie A.
Published: September 2019

Background

Rheumatoid arthritis (RA) is one of the most common rheumatic diseases. Joint inflammation and pathological growth of joint cartilage cause swollen and painful joints, which severely diminishes the patients’ life quality. There is no causal treatment. Symptomatic therapies should start as early as possible to take maximal effect. Hence, diagnostic procedures capable of detecting affected joints before the onset of clinical symptoms are highly desirable. We explored the value of PET imaging of integrin subtypes αvβ3 and α5β1 for early detection of RA foci in collagen-induced arthritis (CIA) mouse models.

Results

Development of RA in CIA mice was monitored by paw scoring, and αvβ3- and α5β1-integrin expression was quantified by μPET using 68Ga-Avebetrin and 68Ga-Aquibeprin. For consecutive sections of selected decalcified joints (knee, ankle), arthritic degeneration and integrin expression were assessed by MOVAT staining and β3/α5 immunohistochemistry (IHC), respectively. β3- and α5-IHC revealed elevated levels of both αvβ3- and α5β1-integrin in arthritic joints. Unlike αvβ3, α5β1 is strongly expressed in the proliferating synovial lining layer, which suggests that its presence is directly related to RA development. For mice with advanced RA (6 weeks after CIA), PET signals for α5β1-integrin were substantially stronger (> 300% of baseline) than that of αvβ3-integrin (< 200%). A longitudinal PET follow-up revealed that the manifestation of clinical symptoms of RA is preceded by upregulation of α5β1- but not of αvβ3-integrin.

Conclusion

α5β1-integrin PET could add a new functional imaging aspect to the portfolio of RA diagnostics because it appears to be a sensitive biomarker for early RA development. We suggest α5β1-integrin PET as a valuable tool to achieve a higher precision for early diagnosis of RA, including initial staging, monitoring of the disease course, and drug treatment, and for planning of radiosynoviorthesis (RSO).
Robust visual tracking via samples ranking
Authors: Zhu Heyan , Wang Hui
Published: September 2019

In recent years, deep convolutional neural networks (CNNs) have achieved great success in visual tracking. To learn discriminative representations, most of existing methods utilize information of image region category, namely target or background, and/or of target motion among consecutive frames. Although these methods demonstrated to be effective, they ignore the importance of the ranking relationship among samples, which is able to distinguish one positive sample better than another positive one or not. This is especially crucial for visual tracking because there is only one best target candidate among all positive candidates, which tightly bounds the target. In this paper, we propose to take advantage of the ranking relationship among positive samples to learn more discriminative features so as to distinguish closely similar target candidates. In addition, we also propose to make use of the normalized spatial location information to distinguish spatially neighboring candidates. Extensive experiments on challenging image sequences demonstrate the effectiveness of the proposed algorithm against several state-of-the-art methods.
Approximation by a generalized class of Dunkl type Szász operators based on post quantum calculus
Authors: Alotaibi Abdullah
Published: September 2019

The main purpose of this paper is to introduce a generalized class of Dunkl type Szász operators via post quantum calculus on the interval$[ \frac{1}{2},\infty )$[12,∞). This type of modification allows a better estimation of the error on$[ \frac{1}{2},\infty ) $[12,∞)rather than$[ 0,\infty )$[0,∞). We establish Korovkin type result in weighted spaces and also study approximation properties with the help of modulus of continuity of order one, Lipschitz type maximal functions, and Peetre’sK-functional. Furthermore, we estimate the degrees of approximations of the operators by modulus of continuity of order two.
An optimal equilibrium for a reformulated Samuelson economic discrete time system
Authors: Barros Maria Filomena , Ortega Fernando
Published: September 2019

This paper studies the equilibrium of an extended case of the classical Samuelson’s multiplier–accelerator model for national economy. This case has incorporated some kind of memory into the system. We assume that total consumption and private investment depend upon the national income values. Then, delayed difference equations of third order are employed to describe the model, while the respective solutions of third-order polynomial correspond to the typical observed business cycles of real economy. We focus on the case that the equilibrium is not unique and provide a method to obtain the optimal equilibrium.
Autoimmune rhabdomyolysis and a multiorgan display of PD-1 inhibitor induced immune related adverse events during treatment of metastatic melanoma
Authors: Pourhassan Hoda Z. , Tryon David , Schaeffer Brett , Mirshahidi Hamid , Wong John
Published: September 2019

Background

Programmed death-1 (PD-1) inhibitors are among the immunotherapies that have revolutionized our approach to treating several cancers. These novel agents act by blocking PD-1 receptor/PD-1 ligand interactions that would otherwise allow tumor cells to evade host immune destruction by inhibiting response of cytotoxic T-lymphocytes. They are overall well tolerated, though they have been associated with a constellation of immune mediated adverse events (irAEs).

Case presentation

We present a case of rare nivolumab mediated adverse events in a patient with nodular recurrence of melanoma. The patient presented with rhabdomyolysis and shortly thereafter developed a constellation of immune-mediated organ derangements. This case further demonstrates the utility and effectiveness of steroid therapy in the setting of irAEs despite our patient’s eventual poor clinical outcome. While PD-1 inhibitors have revolutionized the treatment of several cancers, they require vigilance by the clinician for early detection and treatment of uncommon but potentially fatal irAEs.

Conclusions

PD-1 inhibitors are now widely used in a multitude of cancer types including melanoma, advanced non-small cell lung cancer, metastatic renal cell carcinoma, and Hodgkin lymphoma amongst others. While these agents are often well tolerated, they are associated with a unique profile of immune-related toxicities that can cause significant morbidity and mortality. Education of both patients and healthcare providers is essential for diagnosis and treatment of these adverse events early in their course. This case highlights the uncommon but potentially serious PD-1-associated toxicity of myopathy and rhabdomyolysis along with other organ involvement and is directly applicable to use of these agents in patients with advanced cancers.
Morphometric evaluation of bone regeneration in segmental mandibular bone defects filled with bovine bone xenografts in a split-mouth rabbit model
Authors: Soares Mariana Quirino Silveira , Van Dessel Jeroen , Jacobs Reinhilde , Yaedú Renato Yassutaka Faria , Sant’Ana Eduardo , da Silva Corrêa Danilo , Madeira Maria Fernanda Conceição , Duarte Marco Antônio Húngaro , Rubira-Bullen Izabel Regina Fischer
Published: September 2019

Background

Bovine bone grafts have been widely used in dentistry for guided tissue regeneration and can support new bone formation in direct contact with the graft. The aim of this study was to compare the morphometric and bone density changes after using two different bovine bone graft blocks in segmental osseous defects in the mandible of rabbits following different postoperative periods.

Material and methods

Critical size segmental defects were surgically created bilaterally in the jaw of 18 rabbits. The defects were filled with either deproteinized bovine bone mineral with 10% collagen (DBBM-C; BioOss Collagen®), lyophilized bovine medullary bone (LBMB; Orthogen®), or left untreated according to a split-mouth design. Animals were sacrificed after 3 or 6 months of healing. The hemimandibles were scanned ex vivo using a high-resolution (19 μm) microcomputed tomography. Morphometric and bone density parameters were calculated in the region of the defect using CT-Analyser (Bruker). Initial graft blocks were used as baseline.

Results

DBBM-C presented a denser microarchitecture, in comparison to LBMB at baseline. DBBM-C and LBMB grafted regions showed a similar progressive remodeling, with a significant decrease in structure complexity and maintenance of bone volume fraction during the postoperative follow-up periods. Both graft materials showed an enhanced bone replacement and more complex structure compared to untreated defects. The apparent fusion between the graft and host bone was observed only in the defects filled with LBMB.

Conclusion

LBMB grafts showed a similar behavior as DBBM-C regarding structural remodeling. In LBMB samples, apparent integration between the host bone and the graft was present.
Low Abundance of Circulating Tumor DNA in Localized Prostate Cancer
Authors: Hennigan S. Thomas , Trostel Shana Y. , Terrigino Nicholas T. , Voznesensky Olga S. , Schaefer Rachel J. , Whitlock Nichelle C. , Wilkinson Scott , Carrabba Nicole V. , Atway Rayann , Shema Steven , Lake Ross , Sweet Amalia R. , Einstein David J. , Karzai Fatima , Gulley James L. , Chang Peter , Bubley Glenn J. , Balk Steven P. , Ye Huihui , Sowalsky Adam G.
Published: September 2019

PURPOSE

Despite decreased screening-based detection of clinically insignificant tumors, most diagnosed prostate cancers are still indolent, indicating a need for better strategies for detection of clinically significant disease before treatment. We hypothesized that patients with detectable circulating tumor DNA (ctDNA) were more likely to harbor aggressive disease.

METHODS

We applied ultra-low-pass whole-genome sequencing to profile cell-free DNA from 112 patients diagnosed with localized prostate cancer and performed targeted resequencing of plasma DNA for somatic mutations previously identified in matched solid tumor in nine cases. We also performed similar analyses of data from patients with metastatic prostate cancer.

RESULTS

In all cases of localized prostate cancer, even in clinically high-risk patients who subsequently had recurrent disease, ultra-low-pass whole-genome sequencing and targeted resequencing did not detect ctDNA in plasma acquired before surgery or before recurrence. In contrast, using both approaches, ctDNA was detected in patients with metastatic prostate cancer.

CONCLUSION

Our findings demonstrate clear differences between localized and advanced prostate cancer with respect to the dissemination and detectability of ctDNA. Because allele-specific alterations in ctDNA are below the threshold for detection in localized prostate cancer, other approaches to identify cell-free nucleic acids of tumor origin may demonstrate better specificity for aggressive disease.
OBSERVAÇÕES SOBRE O SIGNIFICADO JURÍDICO DA RESPONSABILIDADE POLÍTICA
Authors: Millard Eric
Published: September 2019

Este artigo trata das dificuldades que envolvem o significado da expressão responsabilidade política.
Εκπαιδευτικές δραστηριότητες σε επιφανειακά ύδατα με την αξιοποίηση του Διαδικτύου των Αντικειμένων
Authors: ΤΖΙΩΡΤΖΙΩΤΗ ΧΡΥΣΑΝΘΗ , ΜΑΥΡΟΜΜΑΤΗ ΕΙΡΗΝΗ , ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ ΙΩΑΝΝΗΣ , ΑΜΑΧΙΛΑΤΗΣ ΔΗΜΗΤΡΗΣ
Published: September 2019

Το υδατικό περιβάλλον διαδραματίζει έναν εξόχως σημαντικό ρόλο για την ύπαρξη της ζωής στη Γη. Ωστόσο, τα υδατικά οικοσυστήματα κινδυνεύουν άμεσα από την ολοένα αυξανόμενη ρύπανση, την κλιματική αλλαγή και την απώλεια της βιοποικιλότητας, με αποτέλεσμα να καθίσταται κάτι περισσότερο από απαραίτητη η διαρκής, όσο και λεπτομερής παρακολούθησή τους. Σε αυτή την εργασία, παρουσιάζεται η εφαρμογή μιας εκπαιδευτικής πρακτικής STEM που αξιοποιεί συστήματα Διαδικτύου των Αντικειμένων με αισθητήρες (Internet of Things, IoT), σε συνδυασμό με κατάλληλα σχεδιασμένες εκπαιδευτικές δραστηριότητες που βασίζονται στη Μάθηση μέσω Σχεδιασμού (Design Based Learning), για την κατανόηση του υδάτινου περιβάλλοντος.  Συγκεκριμένα, περιγράφεται ο σχεδιασμός και η λειτουργία ενός αυτοματοποιημένου συστήματος, το οποίο αξιοποιεί δεδομένα αισθητήρων εγκατεστημένων σε λίμνες και ποτάμια, για την παρακολούθηση και καταγραφή των περιβαλλοντικών παραμέτρων. Μέσα από την προσπάθεια ευαισθητοποίησης της σχολικής κοινότητας σε θέματα προστασίας της ποιότητας των υδάτων ως αποτέλεσμα εκπαιδευτικών δραστηριοτήτων STEM, στις οποίες εφαρμόζονται οι γνώσεις των φυσικών επιστημών, της τεχνολογίας, της μηχανικής και των μαθηματικών, οι μαθητές στοχεύουν: α) στη γνώση και κατανόηση των βασικών φυσικών και χημικών παραμέτρων του νερού υδατικών οικοσυστημάτων, και β) στην ικανότητα συσχετισμού, ερμηνείας και εκτίμησης των μεταβολών των φυσικών και χημικών παραμέτρων του νερού.
Editorial
Authors: Λιοναράκης Αντώνης
Published: September 2019

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Examining Salesperson Effort Allocation in Teams: A Randomized Field Experiment
Authors: Li Jia , Lim Noah , Chen Hua
Published: September 2019

Using a field experiment, this paper examines how salespeople adjust their effort when coworker's ability changes, under different compensation contracts in a retailing context.
Urinary catheterization 2: technique and managing failure
Authors: Tan Elizabeth , Ahluwalia Aashish , Kankam Hadyn , Menezes Pravin
Published: September 2019

Urinary catheterization is an important procedure that is regularly performed in hospital. All clinicians should have a good working knowledge of urinary catheters and the competence to manage them effectively. This topic is discussed over two articles: the first article focused on indications, and this second discusses techniques and managing failure. Good technique is essential to prevent complications and if problems do occur, these must be managed efficiently to prevent long-term consequences. In some situations, this may require referral to the urology team for more specialized intervention. This article discusses this in more detail to help guide clinicians involved in urethral catheterization.
Determination of flow front velocity and optimal injection pressures for better impregnation of E-glass with polyester in resin transfer mold
Authors: KOPPARTHI Phaneendra Kumar , KUNDAVARAPU Vengal Rao , DASARI Venkata Ravishankar , PATHAKOKILA Bhaskara Rao
Published: September 2019

Flow front velocity of resin plays a key role in yielding better impregnation of fiber reinforcement in resin transfer molding to fabricate quality composites. A video camera was used to capture the patterns of resin flowing below the grid lines drawn on the acrylic sheet of resin transfer mold and also to accurately measure the flow front velocity using an image conversion tool. The effect of flow front velocity, permeability, Reynolds number and void content at five different injection pressures on chopped strand E-glass/polyester composites consisting of 4, 5 and 6 layers has been studied. On the basis of Reynolds number of resin flow and void content present in the composite, optimal injection pressures are suggested for better impregnation of preform. Composites processed at these injection pressures gave superior properties in tension and flexure. Fractured parts of the specimens were examined on Scanning Electron Microscope to explain the causes of superior mechanical properties.
Comparing The Loyalty Of Two Mini Markets’ Customers: The Role Of Store Image And Satisfaction
Authors: Suhud Usep , Divyna Mahasta Patricia
Published: September 2019

Indomaret and Alfamart are two franchise-local-mini markets in Indonesia. Side by side, they invade dwelling areas within cities: where there is an Indomaret store, there will be Alfamart, but with a lack of differentiation among them. This study aims to assess and compare the impact of store image on customer satisfaction and loyalty between two franchise-retail stores in Jakarta, Indonesia: Indomaret and Alfamart. There were 200 participants involved those who were regularly visiting one or both mini markets. Different cases showed different results. In the case of Indomaret, store image had a significant impact on customer satisfaction and loyalty, and satisfaction had a significant effect on customer loyalty. In the case of Alfamart, store image had a significant impact on satisfaction. In addition, satisfaction had a significant impact on loyalty, whereas store image had an insignificant effect on loyalty. Recommendations for management and future study are discussed.