bluuebunny/crossref_metadata_2025 huggingface dataset:
Nd:YAG laser treatment of benign urethral strictures
Authors: Dotti E. , Gaboardi F. , Bozzola A. , Galli L.
Published: November 2018

— 36 patients with benign urethral stenosis were treated with Nd:YAG laser irradiation. In 12 patients the stricture followed urethral infection, in 6 cases endoscopic procedures, in 10 cases it was post-traumatic and 8 cases were of unknown etiology. All the patients had pre-operative urethrocystography, urinalysis, uroflow and ultrasound evaluation. Under general anaesthesia, with an operative cystoscope, a guide wire was inserted to cross the urethral stricture and then a circular laser irradiation was executed. We used an Nd:YAG laser with a power of 25–30 watts/3 sec. After the procedure a catheter was positioned and then removed after 24 hours. Initially the results were excellent but after 18 months of follow-up, 14 patients had recurrences and underwent new treatment.
External urethral sphincterotomy in spinal cord injury: Long-term follow-up concerning 154 patients
Authors: Ronzoni G. , Menchinelli P. , Fanasca A. , Manca A. , De Giovanni L.
Published: November 2018

— The authors report their results on 154 patients with neuropathic bladder due to a previous spinal cord injury, who underwent sphincterotomy. The Authors dwell on indications, surgical endoscopic techniques, complications, short- (2 years) and long- (5 years) term sphincterotomy-related results: reduction of symptomatology of about 70% after 2 years and about 25% after 5 years. The Leak Point Pressure proves to have a predictive valve for long-term results. The authors conclude that sphincterotomy is effective in reducing detrusorial hyperreflessia and dissynergia short-term and, above all, it blocks the mechanisms that lead to upper urinary tract failure. Moreover, the sphincterotomy may be repeated.
Epidermoid cyst of the testis: Report of two cases and literature review
Authors: Baldassarre R. , Ficarra V. , Tontodonati M. , Giusti G. , Beltrami P. , Malossini G.
Published: November 2018

— Epidermoid cysts of the testis are very rare and their treatment is controversial. The lesion is benign but no reliable pre- or intraoperative examination can be achieved. We believe that the most correct treatment is orchiectomy through inguinal access. Conservative surgery can be considered in particular cases. We describe two cases.
Adenomatoid tumour of the epididymis: Case report
Authors: Bonacina R. , Baresi A. , De Cenzo S. , Benelli G. , Mancastroppa A. , Bianchi M.R. , Perego S.
Published: November 2018

Adenomatoid tumours of the epididymis are regarded as uncommon benign intrascrotal tumours. A case of adenomatoid tumour of the head of the epididymis with hypoechoic sonographic appearance is reported.
Idiopathic chronic urinary retention in the female: Case report
Authors: Ballista C. , Baldassarre R. , Rovasio A. , Tallarigo C.
Published: November 2018

Female urinary retention may present various etiological aspects. From reports in literature, the most frequent cause appears to be a neurological lesion (60%), while there is no clearly identifiable cause in the remaining 40%. The Authors report the case of a young woman who, following slight retention immediately after a gynaecological operation, returned after 5 months requiring first of all indwelling vesical catheterisation followed by clean intermittent authocatheterisation. Checks and clinical assessments produced negative results and the real cause of urinary retention was not clear. Clean intermittent autocatheterisation was the only feasible therapy, also allowing functional recovery of the vesico-sphincteric apparatus.
Chronic urine retention secondary to peripheral neuropathy with widespread vegetative involvement. Case description
Authors: Giusti G. , Schiavone D. , Pianon R. , Tallarigo C.
Published: November 2018

In clinical practice it is common to find patients in whom urinary retention is not secondary to cervicourethral obstruction. Therapeutic measures, surgical or otherwise, do not live up to expectations in these patients. The Authors describe the case of a 54-year-old patient who presented with urinary retention. Neuro-urological exams excluded the presence of a cervicourethral obstruction and instead revealed probable parasympathetic denervation, subsequently confirmed by the Cutaneous Sympathetic Response recording and Cardiovascular Tests. In such cases correct diagnosis relies on close co-operation between the urodynamics and the neurophysiology doctors. These are undoubtedly particular cases, but an incorrect diagnostic framework could lead to inappropriate surgical treatment.
Symptom scores and uroflowmetry in the screening of outlet obstruction
Authors: Botturi A. , Simeone C. , Pezzotti G. , Cunico S. Cosciani
Published: November 2018

IPSS has a recognised utility in quantifying the symptoms of outlet obstruction, even if its specificity for benign prostatic hyperplasia has not been proved. Uroflowmetry can also define micturition patterns, but not the degree of obstruction. We correlated the symptom scores and the uroflowmetrograms in the screening of outlet obstruction. A group of 121 patients was evaluated: 111 subjects were observed for voiding symptoms and 10 normal patients were included as a control group. Qmax, IPSS and three new parameters suggested by Nishimoto and coll. (Qmax/T100, TQmax/T100, VV/T100 x Qmax) were considered for all patients. All the values, calculated for each patient, were correlated using Student's T test. A statistically significant correlation between IPSS and Nishimoto's parameters was observed when the latter were indicative of an abnormal flow.
Laparoscopy in the diagnosis and treatment of cryptorchidism
Authors: Milani C. , Aragona F. , Caldironi W. , Tavolini I.M. , Bassi P. , Glazel G. Passerini
Published: November 2018

Laparoscopy plays an outstanding role in the diagnosis of non palpable testis. Laparoscopy is as accurate as surgical exploration but, compared with the latter, is less invasive and faster; moreover in cases of testicular absence it makes surgery unnecessary. Concerning laparoscopic surgery in the case of abdominal testis, orchiectomy is an easy procedure which prolongs diagnostic laparoscopy for only a short time. It is indicated in pediatric patients with hypoplasic testis. In adult patients, except for cases of monorchidism and bilateral abdominal testis, orchiectomy is always recommended. At present laparoscopic orchiopexy does not seem to offer sure advantages compared to traditional surgery.
La chirurgia conservativa renale nell'anziano: Kidney preserving surgery in the elderly
Authors: Tallarigo C. , Novella G. , Mastroeni F. , Luciani L.G. , Ortalda V.
Published: November 2018

Conservative renal surgery has recently been extended to elderly patients who have decreased renal function and reduced survival rates in the case of dialytic treatment. Furthermore, age is no longer a limiting factor despite the increased anethesiological risk. Fifteen cases of renal neoplasm in patients over 70, who had undergone conservative surgery, were reviewed: 14 are alive and disease-free after 14-135 months and 1 died from unrelated causes. It is concluded that conservative renal surgery has a role even in the elderly.
L'imaging della fibrosi retroperitoneale primitiva: Primitive retroperitoneal fibrosis imaging
Authors: D'Attoma N. , Residori E. , Mariotto R. , Cerini R. , Gregianin M. , Lotto A.
Published: November 2018

Idiopathic retroperitoneal fibrosis (RPF) is characterised by the development of a fibrotic mass in the prelumbar or presacral area which becomes clinically significant when it causes ureteral obstruction. New imaging techniques have improved accuracy of the morphological approach to the disease, but urography and sequential renal scintigraphy are still important for assessing ureteral involvement. The role of imaging techniques is discussed and current diagnostic and therapeutic tools are evaluated.
La fibrosi retroperitoneale idiopatica. Presidi mini-invasivi: Idiopathic retroperitoneal fibrosis. Minimally invasive devices
Authors: Monaco C. , Poletti G. , Olivo G. , Lotto A.
Published: November 2018

Some endoscopic percutaneous techniques are described that are useful both in the diagnosis and therapy of retroperitoneal fibrosis. These techniques allow urinary drainage, easily resolving an acute episode, and may be a temporary solution in patients who should respond to medical therapy. They may be considered a final therapy in patients who cannot be operated.
Incontinenza urinaria nella donna: Inquadramento clinico e nostra esperienza nella terapia chirurgica: Urinary incontinence in women: Clinical classification and personal experience in surgical treatment
Authors: Mancini E. , Caserta D. , Stillitani E. , Brunori S. , Signore S. , Fico A. , Bellanova G. , Rizzo G.L. , Rizzo F.M. , Acconcia A. , Traina U.
Published: November 2018

After having outlined the clinical classification and physiopathology of urinary incontinence (IU), the authors present their cases which include 225 operations using Burch's colposuspension technique. Patients with 1st grade or no cystocele, slight relaxation of the pelvic floor and no sign of bladder instability were selected for this procedure. The technique is described. Lastly the authors confirm the effectiveness of the method, given the good results and total absence of risks and complications.
The contribution of realist evaluation to critical analysis of the effectiveness of entrepreneurship education competitions
Authors: Brentnall Catherine , Rodríguez Iván Diego , Culkin Nigel
Published: November 2018

The purpose of this article is to explore the effectiveness of entrepreneurship education (EE) programmes through the lens of realist evaluation (RE). The interest of the authoring team – a practitioner–academic mix with professional experience including developing EE in primary and secondary schools – lies with EE competitions, a type of intervention recommended for and delivered to students and pupils of all ages. RE is a theory-driven philosophy, methodology and adaptable logic of enquiry with which to conceptualize and analyse such programmes. In this study, we undertake an act of ‘organized scepticism’, as described by evidenced-based policy academic Ray Pawson, to identify and question the declared outcomes of EE competitions in European policy over a 10-year period. However, our contribution goes beyond the application of an evaluation approach, novel to EE. We argue that, while education generally, and EE specifically, appears committed to emulating ‘gold standard’ scientific evaluation approaches (e.g. randomized controlled trials, systematic review and meta-analysis), the field of evidenced-based policymaking has moved on. Now, alternative methodological strategies are being embraced and RE in particular has evolved as an approach which better aligns knowledge production with the reality of complex, socially contingent programmes. By using this approach, we not only establish that education and psychology theories challenge the outcomes of EE competitions declared in policy, but also demonstrate the wider relevance of RE to the appraisal and refinement of the theorizing and practice of entrepreneurship programmes and interventions.
A fuzzy logic based method for fault tolerant hierarchical load management of more electric aircraft
Authors: Ge Yuxue , Song Bifeng , Pei Yang , Mollet Yves , Gyselinck Johan
Published: November 2018

With the increasing number of electrical loads, load management of the more electric aircraft becomes crucial for reliability and efficiency. One of the major challenge is to develop an optimal and reliable adaptive power control. This paper presents a three-level load management method with dedicated time steps for fault tolerance and increasing calculation efficiency. Both the operative mode and the health level of the loads are taken into account in the control using fuzzy logic. The electrical system of a V-tail more electric aircraft that consists of a generator, an auxiliary power unit, and several AC/DC buses and loads is examined by the proposed method in normal and faulty cases. Compared with some conventional methods, the proposed load management method has the advantage of efficiently shedding loads according to the power imbalance and the fault situation.
Overactive bladder symptom bother and health-related quality of life in patients with systemic lupus erythematosus and primary Sjögren syndrome
Authors: Pereira e Silva R , Romão V C , Neves M , Garcia R , Oliveira S , Brites J , Ramos F Oliveira , Canhão H , Palma dos Reis J , Pereira da Silva J A , Lopes T
Published: November 2018

Objective

The objective of this paper is to assess overactive bladder (OAB) symptom bother (SB) and health-related quality of life (HRQL) among patients with systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS).

Methods

We recruited adult SLE and pSS patients and two groups of age- and sex-matched controls. We applied the OAB questionnaire-short form (OABq-SF) to all participants to assess SB and HRQL and collected clinical information relevant for OAB. We compared the OABq-SF scores for SB and HRQL between patients and controls using univariate and multivariate linear regression analysis.

Results

We recruited 95 rheumatic patients (68 SLE, 27 pSS) and 231 controls. Compared to controls SLE patients showed higher OABq-SF SB scores (22.6 ± 20.4 vs 14.7 ± 17.0, p = 0.004) and lower HRQL scores (89.8 ± 15.8 vs 93.8 ± 11.4, p = 0.044). On multivariate analysis SLE was significantly associated with a higher SB score (ß-coefficient 7.13, p = 0.008) and tended to be associated with worse HRQL values (ß-coefficient –3.53, p = 0.055). Patients with pSS had numerically higher mean SB scores (22.8 ± 22.5 vs 16.2 ± 18.0, respectively, p = 0.107) and lower HRQL scores (91.0 ± 10.7 vs 93.2 ± 11.6, respectively, p = 0.369), although these differences were not statistically significant. Diagnosis of pSS was not significantly associated with SB or HRQL scores on univariate or multivariate analysis.

Conclusions

Patients with SLE have significantly worse OAB-SB and poorer HRQL compared to controls. A similar trend was seen for pSS patients, especially for SB. These findings suggest that clinically subtle OAB symptoms may be present in rheumatic patients for whom, later on, bladder pain syndrome may occur.
Applications of Neuroscience for Managing Affective State at Workplace
Authors: Ray Sonia Baloni
Published: November 2018

This article is an effort to bridge the gap between two research fields, namely organisational behaviour and neuroscience. Organisational behaviour corresponds to the study of human behaviour at workplace, which is significantly modulated/controlled by the affective state of individuals. Neuroscience, on the other hand, is a multidisciplinary field of biology involved in the study of the nervous system. Research in the field of neuroscience has provided valuable insights into the mechanisms of emotion processing and psychopathologies of various affective disorders. These findings, although nascent, can be directly or indirectly extended in an organisational setting. This article begins with a review of different forms of emotions at workplace, followed by its implications in the productivity of an organisation. Further, this article explores the ways in which research in the field of neuroscience can be extended in an organisational setting to improve the overall affective state of individuals at workplace, thereby the efficacy of an organisation.
Training thought and action for virtuoso performance
Authors: Lisboa Tânia , Demos Alexander P. , Chaffin Roger
Published: November 2018

The skills needed to play fast, challenging music with passion and conviction are much the same as the skills needed to play reliably from memory. We illustrate the relationship between virtuosic performance and memorization by describing how an experienced cellist (the first author) prepared the Prelude from J. S. Bach’s Suite No. 6 (BWV 1012) for solo cello for public performance in more than 30 hours of practice, and then taught a student pianist to memorize by showing her how to practice in a similar fashion. The cellist’s practice was guided by her artistic image of how the piece should sound, which directed her attention during practice to important musical transitions. These transitions were the location of performance cues (PCs), thoughts about musical intentions and technical choices that the cellist reported attending to during performance. These PCs served as retrieval cues, providing places where the cellist could recover from a memory failure, making it possible for her to perform from memory. They also affected expressive timing, reminding the cellist to “breathe” between phrases, with the result that tempo arches were taller and more tilted in phrases that started with a PC than in phrases that did not. Thus, attending to musical goals during practice made it possible to play from memory and with passion and conviction.
Mother–infant attachment, musical idol worship, and the origins of human behaviour
Authors: Parncutt Richard
Published: November 2018

Actors, sportspeople, and politicians may be idolised for their appearance, personality, skills, or ideals. The idolisation of musicians additionally involves transcendental musical emotions. Fans devote extraordinary amounts of time, energy and money to following, empathising with, identifying with and imitating their idols. During great performances, fans experience altered states of consciousness. Existing evolutionary approaches can explain social dominance hierarchies but not specific fan behaviours. Another approach involves the mother schema: the perceptions, cognitions, and emotions that the late foetus and early infant (3rd and 4th trimesters) associate with the mother and her changing behaviours and physical/emotional states. The mother schema was an evolutionary response to the fragility (altriciality) of human infants, born earlier due to a larger brain and upright gait. Active reciprocal interactions between infants and carers (e.g. motherese) involve both the carer’s infant schema and the infant’s mother schema. In later life, the typical emotions of the mother schema are evoked by stimulus patterns reminiscent of the mother as perceived by the infant. In ritual situations, where the focus is on shared subjectivity, similar patterns and emotions are created. Evolutionary by-products of the mother schema include musical behaviours, religious behaviours and musical idol worship. The theory can explain why musical idols are perceived as all-loving, all-knowing and/or all-powerful, and is consistent with psychosocial functions of music and religion such as social cohesion and identity, collective motivation, empathy and mood regulation, catharsis and coping, distraction and entertainment, conflict resolution, and skill transfer.
Mental virtuosity: A new theory of performers’ attentional processes and strategies
Authors: Stachó László
Published: November 2018

In contrast to the widespread approach of the notion of “virtuosity” highlighting mechanical dexterity, I advance the view that a crucial feature of both technical virtuosity and musical expressivity is a specific ability to readily and quickly adapt the attention to various constantly changing aspects of the musical process while performing. In this sense, virtuosity can be likened to general mental capabilities such as intelligence. Based on concepts taken from performance analysis, pedagogical practice and sports science (especially from recent research of attentional control in sports), I attempt to define and discuss key features of performance virtuosity as “mental dexterity”. This includes the ability to quickly position oneself into different temporal perspectives in real time during performance; the ability to quickly shift the attentional focus, as well as to quickly modulate the depth of attention; furthermore, to promptly position oneself into different empathic perspectives, similarly to projecting oneself into another person’s position.
Paved with good intentions: Misdirected idealism in the lead-up to 2008’s GFC
Authors: Gould Anthony M , Lokrou Milène R
Published: November 2018

Irresponsible lending practices on the part of financial institutions and proliferation of tradable derivatives were key causal agents of the 2008 financial crisis. However, it is less clear why, historically, loose credit arrangements were so widespread. Somewhat misleadingly, much conjecture has laid blame at the feet of financial institutions themselves. While it is true that duplicitous and even corrupt lending practices were consequential antecedents of the crisis, a legacy commitment to certain – laudable – elements of New-Dealism created context for these elements to become established. To understand really what went wrong, it is necessary to look back before the 2000s and appreciate the interaction that was occurring between a long-term policy commitment to neoliberalism and piecemeal/fragmented application of approaches that aimed to assist financially disadvantaged people. Using the analogy of heart-attack pathology to guide some of its analysis, this essay argues for better policy-integration.
De-Escalation of Antiplatelet Therapy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Clinical Trials
Authors: Kheiri Babikir , Osman Mohammed , Abdalla Ahmed , Chahine Adam , Ahmed Sahar , Osman Khansa , Bachuwa Ghassan , Hassan Mustafa , Bhatt Deepak L.
Published: November 2018

Aims:

Patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) are recommended to be placed on potent P2Y12 blockade. However, the long-term bleeding risk is high. Therefore, despite no definitive evidence, switching to clopidogrel beyond the acute phase is common. We aimed to evaluate the clinical outcomes of antiplatelet de-escalation compared with continuation in patients treated with PCI.

Methods:

We searched databases for randomized clinical trials (RCTs) that evaluated the safety and efficacy of antiplatelet de-escalation compared with continuation in patients treated with PCI. Pooled summary estimates were calculated.

Results:

We included 3 RCTs with 3391 patients (median follow-up: 12 months). Compared with the continued group, the net clinical outcome (composite of bleeding or thrombotic events) was significantly reduced in the group switched to clopidogrel (8.7% vs 12.1%; risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.43-0.97; P = .03). However, there were similar clinical outcomes between groups for major adverse cardiovascular events (MACE; RR: 0.78; 95% CI: 0.55-1.11; P = .17), all Bleeding Academic Research Consortium (BARC) types bleeding (RR: 0.61; 95% CI: 0.33-1.11; P = .10), or BARC types ≥2 bleeding (RR: 0.49; 95% CI: 0.19-1.26; P = .14).

Conclusions:

Our results suggest a net clinical benefit of de-escalation therapy shortly after PCI, without increased risk of MACE. Larger randomized trials will be necessary to confirm these findings.
Necrotizing Fasciitis: An Overview and 2 Illustrative Cases
Authors: Kapp Daniel L. , Rogers Montanah , Hermans Michel H. E.
Published: November 2018

Necrotizing fasciitis is the generic term for a series of progressive gangrenous infections of the skin and subcutaneous tissues. Typically, necrotizing fasciitis start with an, often small, infected lesion with atypical symptoms, which then quickly develops into a rapidly spreading, massive infection. The primary therapy is excision of all necrotic tissue in combination with treatment of systemic symptoms such as shock. The defects resulting from rigorous excision are often very large. Once they are clean, they require closure with an autograft. This article reviews the symptoms and treatment of necrotizing fasciitis. In addition, it illustrates, with 2 cases, how a hyaluronic-based extracellular matrix can be used to “fill in” with neodermis for the lost dermis and can create a wound bed most suitable for grafting.
A multi-responsibility–oriented coalition formation framework for dynamic task allocation in mobile–distributed multi-agent systems
Authors: Xie Bing , Gu Xueqiang , Chen Jing , Shen LinCheng
Published: November 2018

In this article, we study a problem of dynamic task allocation with multiple agent responsibilities in distributed multi-agent systems. Agents in the research have two responsibilities, communication and task execution. Movements in agent task execution bring changes to the system network structure, which will affect the communication. Thus, agents need to be autonomous on communication network reconstruction for good performance on task execution. First, we analyze the relationships between the two responsibilities of agents. Then, we design a multi-responsibility–oriented coalition formation framework for dynamic task allocation with two parts, namely, task execution and self-adaptation communication. For the former part, we integrate our formerly proposed algorithm in the framework for task execution coalition formation. For the latter part, we develop a constrained Bayesian overlapping coalition game model to formulate the communication network. A task-allocation efficiency–oriented communication coalition utility function is defined to optimize a coalition structure for the constrained Bayesian overlapping coalition game model. Considering the geographical location dependence between the two responsibilities, we define constrained agent strategies to map agent strategies to potential location choices. Based on the abovementioned design, we propose a distributed location pruning self-adaptive algorithm for the constrained Bayesian overlapping coalition formation. Finally, we test the performance of our framework, multi-responsibility–oriented coalition formation framework, with simulation experiments. Experimental results demonstrate that the multi-responsibility oriented coalition formation framework performs better than the other two distributed algorithms on task completion rate (by over 9.4% and over 65% on average, respectively).
Breaking the language barrier? Comparing TV news frames across texts in different languages
Authors: Al Nahed Sumaya
Published: November 2018

This article examines two factors which have become increasingly important in today’s multi-channel international media environment, but which add significant extra levels of complexity to framing analysis: language differences and tone of voice. Through case studies examining English and Arabic language television news reports, the article considers some of the difficulties facing researchers who aim to compare spoken texts in different languages about the same events. In particular, the author focuses on the different cultural understandings of the appropriateness of emotive language in Arabic and English language journalism, and argues that in order to analyse the framing of stories in television news it is necessary to take account of the role of reporter tone in building frames. By comparing Al Jazeera’s and the BBC’s coverage of the 2011 Arab uprisings, the article aims to bridge some methodological gaps in this area, and to advance the reliability and validity of studies that attempt to compare news frames of the same events in different languages. It also considers the additional challenge of comparing tones of voice, particularly if they fluctuate throughout the story. Ultimately, the article proposes ways of going beyond literal understandings of both language and tone in order to establish the impact of both on the construction of news frames.
Clinical significance of proximal interphalangeal joint pain in patients with trigger fingers
Authors: Young Kim Jin , Jin Choi Gook , Mo Kang Dong
Published: November 2018

We investigated incidence, clinical features and surgical outcomes of trigger finger accompanied by proximal interphalangeal joint pain. One-hundred and seventy-nine consecutive patients with trigger finger who had A1 pulley release were recruited. Forty-two patients (24%) complained of proximal interphalangeal joint pain at the time of surgery. Symptom duration was investigated, and tenderness at the proximal interphalangeal joint was palpated. Range of motion and pain score of the affected finger were measured pre- and post-operatively. Bone scan was performed to identify joint lesions. A comparison of the results between the proximal interphalangeal joint pain group and the non-proximal interphalangeal joint pain group shows that the proximal interphalangeal joint pain seemed to result from long symptom duration and consequent joint pathology. The proximal interphalangeal joint pain was incompletely resolved after A1 pulley release. Thus, the surgical outcomes might be worse than expected in spite of resolution of painful clicking, especially when there was additional joint tenderness on palpation.

Level of evidence: IV
Tenogenically differentiated adipose-derived stem cells are effective in Achilles tendon repair in vivo
Authors: Norelli Jolanta B , Plaza Dawid P , Stal Drew N , Varghese Anish M , Liang Haixiang , Grande Daniel A
Published: November 2018

The purpose of this study was to characterize rat adipose-derived stem cells, induce adipose-derived stem cell tenogenesis, and analyze adipose-derived stem cell effects on tendon repair in vivo. Adipose-derived stem cells demonstrated an immunomodulatory, pro-angiogenic, and pro-proliferatory profile in vitro. Tenogenesis was induced for 1, 7, 14, and 21 days with 24 combinations of growth differentiation factor-5, 6, and 7 and platelet-derived growth factor–BB. Adipose-derived stem cells expression of scleraxis and collagen type I increased the most after 14 days of induction with growth differentiation factor-6 and platelet-derived growth factor–BB. Achilles excision defects injected with hydrogel alone (Gp2), with undifferentiated (Gp3) adipose-derived stem cells, or tenogenically differentiated (Gp4) adipose-derived stem cells exhibited improved tissue repair compared with untreated tendons (Gp1). Addition of adipose-derived stem cells improved tissue cytoarchitecture and increased expression of collagen type I and III, scleraxis, and tenomodulin. Adipose-derived stem cells significantly improved biomechanical properties (ultimate load and elastic toughness) over time more than hydrogel alone, while tenogenically differentiated adipose-derived stem cells improved the mean histological score and collagen fiber dispersion range closest to normal tendon. In addition, tendon sections treated with GFP-adipose-derived stem cells exhibited green fluorescence and positive GFP immunostaining on microscopy confirming the in vivo survival of adipose-derived stem cells that were injected into tendon defects to support the effects of adipose-derived stem cells on tissue up to 4.5 weeks post injury.
Treatment patterns, healthcare resource utilization, and healthcare costs among patients with pulmonary arterial hypertension in a real‐world US database
Authors: Studer Sean , Hull Michael , Pruett Janis , Koep Eleena , Tsang Yuen , Drake William
Published: November 2018

Several new medications for pulmonary arterial hypertension (PAH) have recently been introduced; however, current real‐world data regarding US patients with PAH are limited. We conducted a retrospective administrative claims study to examine PAH treatment patterns and summarize healthcare utilization and costs among patients with newly diagnosed PAH treated in US clinical practice. Patients newly treated for PAH from 1 January 2010 to 31 March 2015 were followed for ≥12 months. Patient characteristics, treatment patterns, healthcare resource utilization, and costs were described. Adherence (proportion of days covered), persistence (months until therapy discontinuation/modification), and the probability of continuing the index regimen were analyzed by index regimen cohort (monotherapy versus combination therapy). Of 1637 eligible patients, 93.8% initiated treatment with monotherapy and 6.2% with combination therapy. The most common index regimen was phosphodiesterase type 5 inhibitor (PDE‐5I) monotherapy (70.0% of patients). A total of 581 patients (35.5%) modified their index regimen during the study. Most patients (55.4%) who began combination therapy did so on or within six months of the index date. Endothelin receptor agonists (ERAs) and combination therapies were associated with higher adherence than PDE‐5Is and monotherapies, respectively. Healthcare utilization was substantial across the study population, with costs in the combination therapy cohort more than doubling from baseline to follow‐up. The majority of patients were treated with monotherapies (most often, PDE‐5Is), despite combination therapies and ERAs being associated with higher medication adherence. Index regimen adjustments occurred early and in a substantial proportion of patients, suggesting that inadequate clinical response to monotherapies may not be uncommon.
Activity of eltrombopag in severe aplastic anemia
Authors: Scheinberg Phillip
Published: November 2018

Since the approval of horse antithymocyte globulin (ATG) decades ago, there was a long hiatus in therapies with activity in severe aplastic anemia (SAA). This scenario changed in 2014 when eltrombopag, a thrombopoietin receptor agonist, was approved for SAA after an insufficient response to initial immunosuppressive therapy (IST). The basis for this approval was the observation of single-agent activity of eltrombopag in this patient population, where 40% to 50% recovered blood counts at times involving >1 lineage. The achievement of transfusion independence confirmed the clinical benefit of this approach. Increase in marrow cellularity and CD34+ cells suggested a recovery to a more functioning bone marrow. Further in its development, eltrombopag was associated with standard horse ATG plus cyclosporine in first line, producing increases in overall (at about 90%) and complete response rates (at about 40%) and leading to transfusion independence and excellent survival. Interestingly, best results were observed when all drugs were started simultaneously. The cumulative incidence of clonal cytogenetic abnormalities to date has compared favorably with the vast experience with IST alone in SAA. Longer follow-up will help in define these long-term risks. In this review, the development of eltrombopag in SAA will be discussed.
Failing to notice? Uneven teachers’ attention to boys and girls in the classroom
Authors: Bassi Marina , Mateo Díaz Mercedes , Blumberg Rae Lesser , Reynoso Ana
Published: November 2018

This paper analyzes whether teachers’ attention to boys and girls differs in low-performing schools in Chile, where large gender gaps in test scores are also observed. We coded 237 videotaped classes of fourth graders, identifying specific behaviors of teachers toward boys and girls. The results show a general imbalance in teachers’ attention and interactions favoring boys. Gender attention gap is correlated with lower scores in math for girls on Chile’s national standardized test (SIMCE). The gender attention gap was also greater in general in classrooms in which teachers had overall worse interactions with students, as measured by the Classroom Assessment Scoring System (CLASS). The evidence in this paper contributes to the discussion about whether traditional measures of teacher–student interactions really capture all that matters for learning.

JEL Classification

O12, J16, I2
An adaptive model for the autonomous monitoring and management of water end use
Authors: Nguyen Khoi A. , Stewart Rodney A. , Zhang Hong , Sahin Oz
Published: November 2018

Most pattern classification systems are usually developed based on the training of historical data, and as a result, the performance of these models relies heavily on the amount of collected information. However, in many cases, such data collection process is relatively costly, which eventually limits the efficiency as well as the widespread implementation of the final developed model. In this context, the paper focuses on presenting an advanced universal water management system, which could interface with both water consumers and utilities via smart phone and web application. Originally, Autoflow©, a prototype tool that is used to disaggregate total water consumption into each end-use category was developed, which achieved an accuracy ranging from 74 to 94%. However, a drawback of this model was that it was trained with data collected from only Australia; therefore, accuracy reductions would likely be observed when this system is implemented in different countries having very different water using appliances and behaviour patterns. To avoid the costly data collection process for model calibration when operating in new regions, this research study introduces an enhanced model, namely AutoflowU (i.e. U stands for Universal). This new tool can be applied in residential properties globally to autonomously disaggregate water consumption into the seven main water end-use categories, namely: shower, toilet, tap, clothes washer, dishwasher, evaporative air cooler and irrigation, without the need for collecting new regional end-use data for model calibration. In order to develop this new tool, Decision Trees, Dynamic Time Warping (DTW), Self Organising Map (SOM) and Hidden Markov Model (HMM) techniques were utilised. The test results obtained from 230 properties in both Australia and the US showed that the AutoflowU achieved 72–93% accuracy.
Optimizing Cardiovascular Care in Children With Acute Myeloid Leukemia to Improve Cancer-Related Outcomes
Authors: Armenian Saro H. , Ehrhardt Matthew J.
Published: November 2018

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

A 14-year-old African American female presented with fatigue, easy bruising, and fever. On examination, she had scattered bruising, lymphadenopathy, and hepatosplenomegaly. Laboratory evaluation revealed pancytopenia with peripheral blasts, and acute myeloid leukemia (AML; French-American-British M2, t[8;21][q22;q22.1]) was diagnosed on bone marrow biopsy. A baseline echocardiogram revealed normal left ventricular (LV) systolic function (ejection fraction [EF], 60%; shortening fraction [SF], 32%), and conventional chemotherapy was initiated that consisted of two cycles of remission induction (cytarabine, etoposide, and daunorubicin [50 mg/m2 × 3 days per cycle]) followed by intensification 1 (high-dose cytarabine and etoposide), intensification 2 (high-dose cytarabine and mitoxantrone [12 mg/m2/dose daily; four total doses]), and intensification 3 (high-dose cytarabine and l-asparaginase). Of note, an echocardiogram was not repeated before the start of intensification 1. During intensification 1, the patient developed Streptococcus viridans sepsis, which required 4 days in the intensive care unit with antimicrobial and inotropic support. Repeat echocardiogram after recovery from the sepsis episode demonstrated low-normal LV systolic function (EF, 53%; SF, 27%), and she subsequently began intensification 2. On day 3 of intensification 2, the patient developed afebrile tachypnea, tachycardia, and an increasing oxygen requirement. Chest x-ray revealed cardiomegaly and pulmonary vascular congestion. Cardiac troponins were normal, whereas N-terminal pro B-type natriuretic peptide was 10 times the upper limit of normal. Repeat echocardiogram showed an enlarged LV with moderate to severely depressed LV function (EF, 28%; SF, 14%). Day 4 mitoxantrone was omitted and a cardiology consult obtained.
POSGRADO EN DIDÁCTICA DE LA MATEMÁTICA DE LA PONTIFICIA UNIVERSIDAD CATÓLICA DE VALPARAÍSO: UN MULTIPROCESO EN BÚSQUEDA DE LA CONSTRUCCIÓN CIUDADANA
Authors: Parraguez González Marcela
Published: November 2018

Sin duda un programa académico o profesional de posgrado en didáctica de la matemática centrado en la innovación o en la investigación científica es por sí sola un proyecto de suma relevancia para la institución que lo alberga (Bachelard, 1938). El Posgrado en Didáctica de la Matemática (dm) de la Pontificia Universidad Católica de Valparaíso (pucv), conformado por los Programas de Magíster y Doctorado nace en el seno del Instituto de Matemáticas (ima) de dicha universidad y se inserta en la Facultad de Ciencias, lo que lo convierte en un programa único en su tipo.
Exact Solution of the Evasive Flow Capturing Problem
Authors: Arslan Okan , Jabali Ola , Laporte Gilbert
Published: November 2018

In a transportation network, the regulatory authority locates law enforcement facilities to intercept unlawful vehicles, whereas these vehicles may deviate from their route up to a certain tolerance factor to avoid being intercepted. Taking this noncooperative behavior into account, the objective of the “evasive flow capturing problem” is to determine the location of the law enforcement facilities. The problem has applications in transportation, revenue management, and security management. In “Exact Solution of the Evasive Flow Capturing Problem,” O. Arslan, O. Jabali, and G. Laporte develop a bilevel model and reformulate it using polyhedral theory to accelerate the solution process and to expand the size of the solvable instances of this highly complex problem.
VERIFYING NUCLEAR WASTE TILE-HOLES USING GAMMA RADIATION SCANNING
Authors: Johnston James , Yue Shuwei , Stewart Jeremy
Published: November 2018

Nuclear waste management facilities at Chalk River Laboratories (CRL) use below-ground “tile-holes” to store solid waste from various activities such as medical isotope production. After long periods of isotopic decay, some of the waste has decayed down to low activities and can be transferred to low-level waste storage facilities. This paper presents a method to verify the radiation level of the waste inside tile-holes by performing gamma radiation scans along the depth of waste storage tile-holes. Such measurements allow for noninvasive verification of tile-hole contents and provide input to the assessment of radiological risk associated with removal of the waste. Using the radiation profile system, the radiation level of the radioactive waste may be identified based on the radiation profile. This information will support planning for possible transfer of this waste to a licensed waste storage facility designed for low-level waste, thus freeing storage space for possible tile-hole re-use for more highly radioactive waste.

CRL-developed small diode-based gamma radiation sensors have been used in these radiation scans. The diode sensors were deployed into verification tubes adjacent to the tile-holes to measure the radiation profile. Over 10 tile-holes have been scanned using this technique since 2009.
Understanding the spectrum of paediatric mechanical finger and hand trauma seeking acute care
Authors: Gibly R. F. , Shomaker T. , Bompadre V. , Steinman S. E.
Published: November 2018

Purpose

Paediatric hand injuries are a frequent reason for acute medical evaluation. Previous studies have reported only fracture rates, surgical injuries or are limited to database diagnosis coding. The average fracture rates and injury distributions across the hand for all mechanical injuries have not been well-described.

Methods

We performed a retrospective review of all emergent/urgent care visits over 18 months at a US paediatric tertiary hospital with hand injuries recorded anywhere in the encounter. Patient, injury and encounter details were recorded with additional imaging review, categorized and described.

Results

A total of 523 patient visits (0.64% of all encounters) were for mechanical hand trauma. The injury mechanism was 42% crush, 19% jammed, 12% impact, 12% fall on outstretched hand, 7% hyperextension and 8% other/unclear. Crush was responsible for 80% of injuries in patients aged 0 to six years old but only 17% in patients aged 13 to 18 years. Crush resulted in fractures only 26% of the time, while other mechanisms were more likely to fracture (33% to 87%). Border digits were injured more often than others (21% to 23% versus 13% to 17%), and were most commonly fractured in the proximal phalanx (57% to 67% versus 22% to 34% for non-border digits). Providers correctly coded for basic fracture presence in 89.1% of injuries, but 53% of codes were not finger or laterality-specific, and only 15% specified a bony segment demonstrating that International Classification of Diseases-9 coding was nonspecific for injury patterns.

Conclusion

Patients with paediatric hand injuries frequently utilize emergency care and understanding the basic patterns of injury can guide resource utilization and future studies on optimal treatment algorithms in this setting.

Level of Evidence

IV, Prognostic, Case Series
Implementation of a supervised exercise therapy programme
Authors: Murgitroyd E , Fraser SCA , Hebson A , Lewis DR
Published: November 2018

Introduction

Guidelines for peripheral vascular disease state that supervised exercise therapy (SET) programmes improve walking distance and quality of life in patients with intermittent claudication. This paper outlines the steps needed to implement a successful SET programme and discusses some of the challenges.

Methods

Edinburgh Leisure was approached to coordinate an exercise programme aimed at rehabilitation, run by level 4 members of the Register of Exercise Professionals. It is estimated to be cost effective at 500 referrals compared with physiotherapy referral. Success is measured by walking distance, reduction of symptoms and weight loss. Edinburgh Leisure also measures success with feedback and membership numbers at its health centres.

Results

Between 4 March 2014 and 25 January 2016, 155 patients were referred to the SET programme with a median age of 68 years (range: 39–95 years) and a male-to-female ratio of 1.2:1. Of these, 117 patients attended and 29 have completed the programme. The mean walking distance increased from 298.5m (range: 150–385m) to 360m (range: 195–482m), an improvement of 20%. Increasing class numbers and venues, and introducing evening classes to make the programme accessible to more patients has addressed initial patient engagement issues.

Conclusions

Collaboration with motivated local authorities can help implement a successful healthcare intervention. Early analysis is necessary to improve the system and engage as many patients as possible. The SET programme discussed has shown similar results to those of previous studies but is available at no personal cost to regional patients with intermittent claudication.
Using a Functional Analysis Followed by Differential Reinforcement and Extinction to Reduce Challenging Behaviors in Children With Smith-Magenis Syndrome
Authors: Hodnett Jennifer , Scheithauer Mindy , Call Nathan A. , Mevers Joanna Lomas , Miller Sarah J.
Published: November 2018

Smith-Magenis syndrome (SMS) is a genetic disorder, commonly caused by a 17p11.2 deletion, affecting the Retinoic Acid Induced 1 gene. It affects approximately 1 in 25,000 individuals, with over 90% engaging in challenging behaviors. Function-based treatments, using the principles of applied behavior analysis, have consistently been shown to decrease challenging behaviors exhibited by individuals with developmental delays. However, additional research is needed to determine the effects of these interventions with specific diagnostic subsets, including SMS. The current study identified the function of challenging behavior for 2 children with SMS and found a function-based treatment, consisting of differential reinforcement and extinction, reduced challenging behavior for both.