bluuebunny/crossref_metadata_2025 huggingface dataset:
Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation
Authors: Whiteford Gail , Jones Katherine , Weekes Gemma , Ndlovu Nomagugu , Long Cassandra , Perkes Danielle , Brindle Sophie
Published: September 2019

Introduction

Occupational deprivation is a risk for residents of institutions. This is problematic at several levels: it can cause diminution of individual capacities; such environments pose philosophical and practical challenges for occupational therapists and the erosion of human rights can be an issue. Occupational therapists in an Australian forensic mental health setting ‘reclaimed’ occupation-centred practice, committed to occupational justice and tackled the experience of occupational deprivation of patients through utilising a practice-based enquiry approach.

Method

A community of practice scholars used a practice-based enquiry approach – a type of action methods research – involving iterative cycles of data collection, analysis, critique and implementation of practice innovations.

Findings

Through the practice-based enquiry process, participants’ practice became more occupation-centred, based and focused, resulting in: the creation of more opportunities for patients, which combatted occupational deprivation and increased potential for community reintegration; enhanced professional satisfaction and identity; and increased institutional ‘valuing’ of the occupational therapy service.

Conclusion

Ameliorating occupational deprivation can be achieved through becoming occupation-centred and embracing a stated commitment to occupational justice in the challenging practice setting of a forensic hospital. The use of the deeply reflective process of practice-based enquiry was pivotal to this shift in focus for the group of occupational therapists who participated in this study and also contributed to enhanced practitioner satisfaction, identity, autonomy and confidence.
Flow structures and thermal field with modulated jet near the semi-circular leading edge
Authors: Sarkar S
Published: September 2019

Influence of external modulation on unsteady flow and heat transfer near the leading edge of a constant thickness aerofoil has been described through large eddy simulation. This is a simplified approach to study film cooling activities near the leading edge of a turbine blade. Discrete jets, which are forced at a Strouhal number (St) of 0.37 with an averaged blowing ratio of unity, are ejected normally from a series of film cooling holes to a separated boundary layer. The results are compared against the corresponding steady injection. Larger coherent structures appear for a forced jet with an augmented vortex dynamics resulting in high jet lift-off, earlier break down, enhanced mixing with the cross flow and dilution of coolant layer. Resolved hairpins, which are the signature of coherent structures, illustrate that the vorticity and thermal field are highly correlated. Furthermore, evolution of hairpins and their advection control scalar transport and mixing. In brief, the modulation of coolant jet near the leading edge appears not beneficial for the combination of blowing ratio and frequency considered here.
Metformin's effectiveness in preventing prednisone-induced hyperglycemia in hematological cancers
Authors: Ochola Lucy A , Nyamu David G , Guantai Eric M , Weru Irene W
Published: September 2019

Background

Research has established the development of steroid-induced hyperglycemia as a glucometabolic side effect of high-dose prednisone therapy. Few studies, however, have demonstrated preventative measures that could effectively curtail this side effect in susceptible patients undergoing high-dose prednisone treatment.

Objective

To assess metformin's prophylactic effectiveness of prednisone-induced hyperglycemia among hematological cancer patients.

Setting

Prospective randomized controlled trial conducted at the Kenyatta National Hospital Oncology Clinic and Wards, Nairobi, Kenya.

Method

Non-hyperglycemic hematological cancer patients on current or newly initiated high-dose prednisone-based chemotherapy were randomized to receive metformin 850 mg once then 850 mg twice daily for two successive weeks each or to the control group receiving the standard care. Patients were subjected to once weekly fasting and 2-h postprandial glucose measurements for four weeks.

Main outcome measure

The primary outcome of measure was the development of hyperglycemia defined by fasting capillary blood glucose values >5.6 mmol/L or 2-h postprandial capillary blood glucose values >7.8 mmol/L.

Results

Eighteen of 24 randomized patients completed the study (11 control and 7 treatment). The proportion of the control subjects that developed prediabetes was 72.7% (95% confidence interval 45.5–90.9%) using fasting glucose and 54.5% (95% confidence interval 27.3–81.8%) using 2-h postprandial glucose. One treatment group participant developed prediabetes using fasting glucose, representing 14.3% (95% confidence interval 0–42.9%). No prediabetes was detected using the 2-h postprandial glucose. Analysis of mean fasting glucose between the two arms found no significant difference. However, significant differences in mean 2-h postprandial glucose were noted in week 2 ( p = 0.0144), week 3 ( p = 0.0095), and week 4 ( p = 0.0074) of the study. Double dose (1700 mg) metformin was more effective in lowering blood glucose than single dose (850 mg) ( p = 1.0000 (fasting), p = 0.4531(2-h postprandial).

Conclusion

Metformin's prophylactic effectiveness was demonstrated in this randomized study on new and previously exposed non-diabetic cancer patients on high-dose prednisone-based chemotherapy.
Excellence in elective hip and knee surgery: what does it look like? A positive deviance approach
Authors: Hughes Lesley , Sheard Laura , Pinkney Lisa , Lawton Rebecca L
Published: September 2019

Objectives

Positive deviance is a way of examining variation across health care settings to understand how and why high-performing clinical teams or organizations achieve their results despite facing the same constraints as others. This study explores how exceptional performance is delivered within enhanced hip and knee elective surgery in England. We were particularly interested in non-clinical factors that may influence patient outcomes.

Methods

We used 28-day emergency readmissions and patient-reported outcomes to identify two hospitals providing enhanced elective hip and knee replacement surgery and who presented different levels of performance. We used ethnographic observations, in-depth interviews, focus groups and documentary analysis, conducted over eight months. The study involved 54 health care professionals from multiple professional backgrounds.

Results

Five key themes were identified, which may underpin the high performance in the site identified as a positive deviant: (i) leadership and engagement that adopts a distributed approach to sustain progress and engage team members; (ii) autonomy, in particular the ability for all clinical staff to make decisions about patient care; (iii) relationships and communication, which promote clear lines of communication and a climate of shared decision making within and across teams; (iv) patient empowerment, which supports patients in managing their behaviour before and after surgery; and (v) resilience, which enables the workforce to respond to threats to maintain high performance such as those that could reduce capacity and flow, or interfere with provision and coordination.

Conclusions

Our study demonstrates that it is possible to build an excellent service that meets the needs of the local population and the wider organization agenda despite constraints and rising demands. The findings can inform orthopaedic and other surgical departments on ways in which they can achieve high performance within existing resources.
Online patient feedback: a scoping review and stakeholder consultation to guide health policy
Authors: Boylan Anne-Marie , Williams Veronika , Powell John
Published: September 2019

Objective

To provide a synthesis of the current evidence base of online patient feedback using a scoping review and a consultation of stakeholders in England, UK.

Methods

We searched MEDLINE, EMBASE, PsycINFO, CINAHL and the Social Science Citation Index and conducted hand searches up to January 2018. We included primary studies of internet-based reviews and other online feedback (e.g. social media and blogs) from patients, carers or the public about health care providers (individuals, services or organizations). Key findings were extracted and tabulated for further synthesis guided by the themes arising from a stakeholder consultation.

Results

The review found that awareness and usage of online feedback is increasing. Most feedback is about physicians, and is typically positive. Online reviews and ratings are used by some service users to inform choice of provider or treatment while providers tend to be concerned about the validity and representativeness of feedback. Reviewed studies found that those who post feedback are generally not representative of the general population, tending to be younger and more educated, but online feedback does broadly correlate with some other measures of health care quality.

Conclusions

In an increasingly digital society, where citizens provide and use feedback for a range of goods and services, online patient feedback can offer a convenient, low cost and widely accessible mechanism to capture experiences of health care, while being mindful to avoid issues of digital exclusion. This review provides important insights to inform policy development seeking to harness the opportunities offered by online feedback.
All in this together? Austerity and the gender-age gap in the 2015 and 2017 British general elections
Authors: Sanders Anna , Shorrocks Rosalind
Published: September 2019

The 2010–2015 Conservative-led Coalition’s austerity policies hit women financially harder than men. However, contrary to expectations at the time, the Conservatives still gained more support from women than men on average in the 2015 general election. We examine the impact of austerity on vote choice in the 2015 and 2017 general elections through analysis of Labour and Conservative economic policy in conjunction with data from the British Election Study’s face-to-face post-election surveys. The expectation that women should be particularly anti-austerity and thus less supportive of the Conservative Party does hold for younger women, who were especially pessimistic relative to their male peers and older age groups about their living costs, household finances, the economy, and the National Health Service in both elections. However, this does not hold for older women, who were protected by the Coalition’s policies on pensions and were more similar to men in their assessment of their economic situation.
Combined Puncture and Cutting of Soft-Coated Fabrics by a Pointed Blade: Energy, Force and Stress Failure Criteria
Authors: Triki Ennouri , Gauvin Chantal
Published: September 2019

Soft elastomer-coated fabrics are widely used in engineering and protective applications. Puncture cutting by sharp-tipped objects is one of the most common failure modes of protective gloves made of coated fabrics. In order to investigate the puncture-cutting process of soft elastomer-coated fabrics, we studied the mechanisms and mechanics of pointed-blade insertion into specimens cut out from four protective gloves. Experimental and analytical analyses showed that total energy and critical puncture-cutting force calculated analytically are both able to predict the puncture-cutting resistance of soft elastomer-coated fabrics measured experimentally. Total energy is obtained from the relationship between the puncture-cutting work and the created fracture area, while critical force is calculated by two analytical models developed for soft elastomeric membranes. The components of the critical puncture-cutting force are predicted analytically and then used to calculate the compressive and shear loading stress components based on the contact surface between the pointed blade tip and material. Since there is a linear relationship between the compressive stress component and shear stress component, a modified linear strength criterion is proposed for puncture cutting of soft elastomer-coated fabrics by a pointed blade. Our stress-based criterion connects the 45° tensile strength (in the 45° direction) and biaxial strengths (in the course direction, 0°, and wale direction, 90°) to both compressive and shear loading stresses. The analytical and experimental results are consistent. This investigation can be used as a guideline to evaluate the puncture cutting of soft elastomer-coated fabrics using an energy-based criterion, critical force-based criterion, or stress-based criterion.
Mechanical Performance of glass/epoxy composites enhanced by micro- and nanosized aluminum particles
Authors: Megahed M , Fathy A , Morsy D , Shehata F
Published: September 2019

In this article, the effects of using nanometer and micrometer-sized aluminum particles in glass fiber reinforcement epoxy composites have been studied. The study evaluates the mechanical properties improvement with the addition of nanometer and micrometer-sized aluminum particles to glass fiber reinforcement epoxy composites. The combination of aluminum and woven glass fibers provide high potential for the modification of the epoxy matrix. The composites were produced by hand lay-up technique. The glass fiber volume fraction was kept constant at 35%, while the contents of aluminum particles were increased from 0.2 to 4 wt%. The developed composites showed enhanced tensile, flexural, hardness, wear, and impact behavior as compared to glass fiber reinforcement epoxy. An enhancement of 27% was attained in tensile strength with glass fiber reinforcement epoxy filled with 2 wt% aluminum nanoparticles; however, adding 4 wt% nanometer-sized aluminum particles showed an improvement of 114%, 116%, 21%, 52.2%, 21.4%, 76.6% in tensile elongation, toughness, tensile modulus, flexural strength, flexural strain, flexural modulus, respectively as compared to neat glass fiber reinforcement epoxy. Increasing the nanometer-sized aluminum particles in glass fiber reinforcement epoxy composites to 4 wt% reversed the improvement trend in tensile strengths, wear, and hardness. However, increasing the micrometer-sized aluminum particles to 4 wt% has shown fair improvement in all used aluminum loadings. Microscopy results showed that the aluminum particles were well dispersed in the epoxy matrix. However, a higher weight fraction of nano-aluminum in the epoxy had promoted little agglomerations.
Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview
Authors: Milionis Haralampos , Ntaios George , Korompoki Eleni , Vemmos Konstantinos , Michel Patrik
Published: September 2019

Background and aims

To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents.

Methods

English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots.

Results

Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60–0.82; p < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70–0.90; p < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of “the lower the better” hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals.

Conclusions

Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.
Video-based e-learning for an undergraduate engineering course
Authors: Zaneldin Essam , Ahmed Waleed , El-Ariss Bilal
Published: September 2019

E-learning offers tremendous benefits to teachers and students as it enhances the teaching and learning experience. Despite the adoption of e-learning in many educational institutions worldwide, delivery of construction management courses has been limited to traditional lecturing approach and the use of limited technology such as PowerPoint presentations and smartboards. This study investigates the effectiveness, benefits, and students’ satisfaction of using video-based e-learning approach in delivering the topics of a construction management undergraduate course by introducing instructional videos related to the topics of the course. A total of 67 undergraduate students were surveyed using a closed- and open-ended questionnaire in one of the leading universities in the United Arab Emirates. The survey was designed and posted using the Blackboard learning platform and students were asked to access these videos and respond to the survey via Blackboard. Surveyed students took the construction management undergraduate course in the “Fall 2018” semester using instructional videos supplied to them in the form of quick response codes in order to be more attractive learning experience to the students rather than using a direct web link that would be more accessible and even could be enriched with logo or numbers that reflects the quick response code contents rather than to distract them. This course has seven learning outcomes and the performance of students in the seven course learning outcomes was compared with that of students who took the same course in the “Spring 2018” semester using the conventional face-to-face lecturing. The responses received from students indicated that they are satisfied with the contents of the instruction videos and benefited from these videos. The received data were statistically analyzed and, despite the fact that this course required more hands-on applications, the results showed that e-learning resulted in better learning outcomes as compared to face-to-face lecturing and boosted student’s learning experience. Students also considered the e-learning approach useful as it allows them to access course material anytime and anywhere. Moreover, it has been revealed that absolutely more than 60% of the students preferred to study by blended learning, a combination of e-learning and traditional face-to-face lecturing since it is useful and helpful to their academic progress. It has been shown that despite the limited online e-learning resources of the course, educators can find solutions to enhance the traditional contents of the course material with the available online recorded resources or even to encourage students to develop a related interactive material to the course content that would be used for the subsequent semesters.
Successful use of eculizumab to treat atypical hemolytic uremic syndrome in patients with inflammatory bowel disease
Authors: Hanna Ramy M. , Merin Noah , Burwick Richard M. , Abdelnour Lama , Selamet Umut , Yanny Beshoy , Bui Patrick , Fouad Mary , Kurtz Ira
Published: September 2019

Background

Atypical hemolytic uremic syndrome is a rare group of disorders that have in common underlying complement amplifying conditions. These conditions can accelerate complement activation that results in a positive feedback cycle. The known triggers for complement activation can be diverse and include, infection, autoimmune disease, and malignancy. Recent reports suggest that certain autoimmune and rheumatological triggers of complement activation may result in atypical hemolytic uremic syndrome that does not resolve despite treating the underlying disorder. Specifically, patients with systemic lupus erythematosus and microangiopathic hemolysis may not respond to treatment of their underlying rheumatological trigger but responded to complement blockade.

Case presentations

We report two patients with inflammatory bowel disease complicated by development of atypical hemolytic uremic syndrome. In both cases, patients were on treatment for inflammatory bowel disease, that was not well controlled/flaring at the time. The first patient is a male who developed Crohn’s disease and microangiopathic hemolysis at age 5 and was treated with eculizumab successfully. Discontinuation of the medication led to multiple relapses, and the patient currently is being treated with eculizumab and has normal hematological and stable renal parameters. The second patient is a 49-year-old female with Ulcerative Colitis treated with 6-Mercaptopurine. She developed acute kidney injury and microangiopathic hemolysis. Prompt diagnosis and treatment with eculizumab resulted in the recovery of kidney injury along with a complete hematological response.

Conclusions

These two cases are the fifth and sixth patients to be published in the literature with atypical hemolytic uremic syndrome and inflammatory bowel disease treated with complement blockade. This confirms that C5 complement blockade is effective in treating complement mediated thrombotic microangiopathy/atypical hemolytic uremic syndrome when it is triggered in patients with inflammatory bowel disease.
Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature
Authors: Bonilla Alex , Blair Alexander J. , Alamro Suliman M. , Ward Rebecca A. , Feldman Michael B. , Dutko Richard A. , Karagounis Theodora K. , Johnson Adam L. , Folch Erik E. , Vyas Jatin M.
Published: September 2019

Background

Primary spontaneous pneumothorax is a common disorder occurring in young adults without underlying lung disease. Although tobacco smoking is a well-documented risk factor for spontaneous pneumothorax, an association between electronic cigarette use (that is, vaping) and spontaneous pneumothorax has not been noted. We report a case of spontaneous pneumothoraces correlated with vaping.

Case presentation

An 18-year-old Caucasian man presented twice with recurrent right-sided spontaneous pneumothoraces within 2 weeks. He reported a history of vaping just prior to both episodes. Diagnostic testing was notable for a right-sided spontaneous pneumothorax on chest X-ray and computed tomography scan. His symptoms improved following insertion of a chest tube and drainage of air on each occasion. In the 2-week follow-up visit for the recurrent episode, he was asymptomatic and reported that he was no longer using electronic cigarettes.

Conclusions

Providers and patients should be aware of the potential risk of spontaneous pneumothorax associated with electronic cigarettes.
Shear Resistance Prediction of Post-fire Reinforced Concrete Beams Using Artificial Neural Network
Authors: Cai Bin , Xu Long-Fei , Fu Feng
Published: September 2019

In this paper, a prediction method based on artificial neural network was developed to rapidly determine the residual shear resistance of reinforced concrete (RC) beams after fire. Firstly, the temperature distribution along the beam section was determined through finite element analysis using software ABAQUS. A residual shear strength calculation model was developed and validated using the test data. Using this model, 384 data entries were derived for training and testing. The input layer of neural network involved parameters of beam height, beam width, fire exposure time, cross-sectional area of stirrup, stirrup spacing, concrete strength, and concrete cover thickness. The output was the shear resistance of RC beams. It was found that use of BP neural network could precisely predict the post-fire shear resistance of RC beams. The predicted data were highly consistent with the target data. Thus, this is a novel method for computing post-fire shear resistance of RC beams. Using this new method, further investigation was also made on the effects of different parameters on the shear resistance of the beams.
Imaging secondary reaction products at the surface of Vermeer’s Girl with the Pearl Earring by means of macroscopic X-ray powder diffraction scanning
Authors: De Meyer Steven , Vanmeert Frederik , Vertongen Rani , van Loon Annelies , Gonzalez Victor , van der Snickt Geert , Vandivere Abbie , Janssens Koen
Published: September 2019

The use of non-invasive macroscopic imaging techniques is becoming more prevalent in the field of cultural heritage, especially to avoid invasive procedures that damage valuable artworks. For this purpose, an X-ray powder diffraction scanner (MA-XRPD) capable of visualising crystalline compounds in a highly specific manner was recently developed. Many inorganic pigments present in paintings fall into this category of materials. In this study, the 17th century oil painting Girl with a Pearl Earring (c. 1665) by Johannes Vermeer was analysed with a combination of transmission and reflection mode MA-XRPD. By employing this scanner in reflection mode, the relative sensitivity for compounds that are present at the paint surface could be increased, establishing it as a highly relevant technique for investigating the degradation processes that are ongoing at paint surfaces. Many of the original pigments employed by Vermeer could be identified, along with four secondary alteration products: gypsum (CaSO4·2H2O), anglesite (PbSO4), palmierite (K2Pb(SO4)2) and weddellite (CaC2O4·2H2O). The formation of gypsum was linked to the presence of chalk in the upper glaze layer while the formation of palmierite and weddellite is driven by the presence of lake pigments (and their substrates). In this manner, MA-XRPD can also be used to pinpoint locations relevant for sampling and synchrotron µ-XRPD analysis, which provides information on the microscopic make-up of the paint. A paint cross-section taken from an area rich in palmierite was analysed with synchrotron µ-XRPD, which confirmed the presence of this secondary compound at the interface of the upper paint layer with the ground layer as well as the presence of anglesite in the ground layer. The capacity of MA-XRPD to identify and chart secondary alteration products in a non-invasive manner has only very recently been demonstrated and makes it a highly relevant technique for the assessment of the chemical condition of works of art.
Large area flexible pressure/strain sensors and arrays using nanomaterials and printing techniques
Authors: Parameswaran Chithra , Gupta Dipti
Published: September 2019

Sensors are becoming more demanding in all spheres of human activities for their advancement in terms of fabrication and cost. Several methods of fabrication and configurations exist which provide them myriad of applications. However, the advantage of fabrication for sensors lies with bulk fabrication and processing techniques. Exhaustive study for process advancement towards miniaturization from the advent of MEMS technology has been going on and progressing at high pace and has reached a highly advanced level wherein batch production and low cost alternatives provide a competitive performance. A look back to this advancement and thus understanding the route further is essential which is the core of this review in light of nanomaterials and printed technology based sensors. A subjective appraisal of these developments in sensor architecture from the advent of MEMS technology converging present date novel materials and process technologies through this article help us understand the path further.
Baseline diet quality of predominantly minority children and adolescents from households characterized by low socioeconomic status in the Childhood Obesity Prevention and Treatment Research (COPTR) Consortium
Authors: Truesdale Kimberly P. , Matheson Donna M. , JaKa Meghan M. , McAleer Sarah , Sommer Evan C. , Pratt Charlotte A.
Published: September 2019

Background

The Healthy Eating Index (HEI-2010) is a measure of diet quality that examines conformance with the Dietary Guidelines for Americans. The objectives of this study were to estimate baseline diet quality of predominantly low-income minority children using the HEI-2010 and to identify the most important HEI components to target for dietary intervention.

Methods

Two or three baseline 24 h dietary recalls were collected in-person or over telephone between May 2012 and June 2014 from 1,745 children and adolescents from four randomized clinical trials in the Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. Nine adequacy and three moderation food components were calculated and averaged to determine overall HEI scores. The overall HEI-2010 scores were categorized as ≥81, 51–80, or ≤ 50 based on the HEI-2005 classification. For each study, mean overall and component HEI scores were estimated using linear regression models.

Results

Mean (95% CI) overall HEI scores ranged from 47.9 (46.8, 49.0) to 64.5 (63.6, 65.4). Only 0.3 to 8.1% of children and adolescents had HEI-2010 score ≥ 81. The average component score for green and beans was less than 30% of maximum score for all trials. In contrast, the average component score for protein, dairy (except for IMPACT), and empty calories (except forIMPACT) was more than 80% of maximum score.

Conclusions

Based on HEI-2010 scores, few children and adolescents consumed high quality diets. Dietary interventions for children and adolescents should focus on improving intakes of green vegetables and beans.

Clinical trial registry numbers

GROW study (clinical trial # NCT01316653); NET-Works study (clinical trial #NCT01606891); Stanford Goals (clinical trial #NCT01642836); IMPACT (clinical trial # NCT01514279).
Total phenolic and flavonoid contents and antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic activities of Cordia myxa L. leaves
Authors: Abdel-Aleem Enas R. , Attia Eman Z. , Farag Fatma F. , Samy Mamdouh N. , Desoukey Samar Y.
Published: September 2019

Background

Many plants of genus Cordia are traditionally used as astringent, anti-inflammatory, anthelminthic, antimalarial, diuretic, febrifuge, appetite suppressant and cough suppressant and to treat urinary infections, lung diseases and leprosy. The aim of the study is to determine the total phenolic and flavonoid contents of total ethanol extract and different fractions of C. myxa L. leaves, in addition to evaluation of some pharmacological activities including antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic effects.

Methods

Air dried powder of C. myxa leaves were extracted using 95% ethanol and fractionated successively with petroleum ether, dichloromethane, ethyl acetate and finally with n-butanol. The fractions were concentrated and then investigated for their antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic activities using phosphomolybidinum and DPPH assays, carrageenan-induced paw edema, hot plate, yeast -induced pyrexia and streptozotocin-induced hyperglycemia methods, respectively.

Results

The ethyl acetate fraction showed the highest antioxidant activity with high phenolic and flavonoid contents (31.03 ± 0.15 mg gallic acid equivalent/g dried weight and 811.91 ± 0.07 mg rutin equivalent/g dried weight, respectively). Dichloromethane and ethyl acetate fractions exhibited higher anti-inflammatory activity with percentages of inhibition 45.16% and 40.26%, respectively, which were quite comparable to that of indomethacin (51.61%). The petroleum ether and dichloromethane fractions showed the highest analgesic activity with reaction time 289.00 ± 3.00 and 288.33 ± 20.82, respectively. Evaluation of antipyretic activity revealed that the total ethanol extract and different fractions showed high antipyretic activities after 2 h, which were very close to that of the standard acetyl salicylic acid with a rapid onset (30 min). The total ethanol extract and the petroleum ether fraction exhibited the most potent hypoglycemic effect with a significant reduction in blood glucose level especially after 3 h to 95.67 ± 5.77 mg/dl and 87.67 ± 10.26 mg/dl, respectively and percentages decrease in blood glucose level were 68.22% and 70.78%, respectively.

Conclusion

Cordia myxa L. extract and fractions exhibited antioxidant, anti-inflammatory analgesic, antipyretic and antidiabetic activities which may be attributed by the presence of active phytoconstituents.
Genial tubercle position and genioglossus advancement in obstructive sleep apnea (OSA) treatment: a systematic review
Authors: Chang Edward T. , Kwon Yong-Dae , Jung Junho , Capasso Robson , Riley Robert , Liu Stanley C. , Camacho Macario
Published: September 2019

Background

To systematically review the literature for methods to localize the genial tubercle as a means for performing an advancement of the genioglossus muscle.

Methods

PubMed, Google Scholar, CRISP, EMBASE, CINAHL, and Scopus were searched from inception through June 16, 2015.

Results

One hundred fifty-two articles were screened, and the full text versions of 12 articles were reviewed in their entirety and 7 publications reporting their methodology for localizing the genial tubercle. Based upon these measurements and the results published from radiographic imaging and cadaveric dissections of all the papers included in this study, we identified the genial tubercle as being positioned within the mandible at a point 10 mm from the incisor apex and 10 mm from the lower mandibular border.

Conclusion

Based upon the results of this review, the genial tubercles were positioned within the mandible at a point 10 mm from the incisor apex and 10 mm from the lower mandible border. It may serve as an additional reference for localizing the genial tubercle and the attachment of the genioglossus muscle to the mandible, although the preoperative radiological evaluation and the palpation of the GT are recommended to accurately isolate.
Isolated cervical extraosseous intradural chordoma attached to the C5 nerve root: a case report
Authors: Rotter Juliana , Mueller Kyle , MacConnell Ashley , McGowan Jason , Spitz Steven
Published: September 2019

Background

As chordomas are slow growing and locally invasive with high recurrence rates, initial recommendations include complete surgical resection with or without radiation therapy. A large proportion of recurrences occur years after initial resection necessitating lengthy follow-up. The novel biomarker brachyury and the repurposing of pharmaceutical products have the potential to substantially impact long-term recurrence rates.

Case presentation

A 43-year-old woman presented with an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root underwent a C3-5 laminectomy, C3-5 lateral mass screw instrumentation, and mass resection. All symptoms resolved by the 12-month postoperative follow-up visit.

Conclusions

This is the first report of an isolated, cervical extraosseous intradural extramedullary chordoma attached to a nerve root, and this case adds to the previous six Type IV chordomas in the literature. Unfortunately, the very rare form of extraosseous intradural chordoma is poorly understood: the lack of detailed knowledge in how they are differentiated from other forms of chordoma confounds the development of optimal treatment strategies and follow-up guidelines.
Prevalence and associated factors of subclinical atherosclerosis in rheumatoid arthritis at the university hospital of Kinshasa
Authors: Mulumba Christophe , Lebughe Pierrot , Mbuyi-Muamba Jean-Marie , Makulo Jean-Robert , Lepira François , Mukaya Jean , Westhovens Rene , Verschueren Patrick , Malemba Jean-Jacques
Published: September 2019

Background

Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expectancy due to premature atherosclerosis. This reduction is the consequence of traditional cardiovascular risk factors (TCRF) as well as systemic inflammation. The aim of the present study was to describe the prevalence and factors associated with subclinical atherosclerosis in RA at the University Hospital of Kinshasa (UHK).

Methods

Patients with a diagnosis of RA based on the 2010 ACR/EULAR criteria were included in this cross-sectional study from 1 June 2014 to 31 May 2015 at the UHK. RA disease activity was measured using the DAS28-ESR. Active RA was defined by a DAS 28 > 2.6. Severe RA was defined by the presence of extra-articular manifestation, joint erosions on X-rays or HAQ ≥0.5. An assessment of subclinical atherosclerosis was performed by the measurement of the carotid intima-media thickness (cIMT) using two-dimensional ultrasonography. Subclinical atherosclerosis was defined by a cIMT ≥0.9 mm. A diagnosis of atheroma plaque was retained when the cIMT was ≥1.5 mm. The association between subclinical atherosclerosis and potential risk factors was modeled using logistic regression analysis.

Results

We recruited 75 patients. The average age was 51.8 ± 14.6 years, with a sex ratio F/M of 4. The prevalence of subclinical atherosclerosis was 32%. In logistic regression being a woman of ≥55 years old (aOR 10.6, 95% CI [2.087–53.82], p = 0.028), DAS28-ESR > 2.6 (aOR 3.5,95% CI [1.55–10.38], p = 0.044), severe RA (aOR 32.6,95% CI [1.761–60.37],p = 0.035), high blood pressure (aOR 22.4,95% CI [5.04–99.41], p = 0.005) and obesity (aOR 32.3, 95% CI [2.606–40.73], p = 0.026) emerged as factors associated with subclinical atherosclerosis.

Conclusion

Subclinical atherosclerosis is common in RA patients attending the UHK. It appears to be associated with RA disease activity and severity apart from traditional cardiovascular risk factors. These results suggest that early management of subclinical atherosclerosis targeting remaining RA disease activity and cardiovascular risk factors could slow down progression to clinical cardiovascular disease.
STR technique for the detection of contamination by exogenous DNA in paraffin blocks and histological slides
Authors: Barcelos Denise , Funabashi Karina , Mazloum Susana , Fernandes Mariana , Cardili Leonardo
Published: September 2019

Gastrointestinal Stromal Tumors (GIST) present different types of mutations that may or may not be sensitive to specific target therapy. The laboratory procedure required to prepare histological sections traditionally demands multiple steps, making the process prone to contamination by exogenous genetic material (DNA). An eventual contamination of the biological sample with exogenous DNA may jeopardize subsequent analysis of mutations. The Short Tandem Repeat (STR) technique is frequently used in forensic science fields and presents a potential application in surgical pathology, especially in situations of suspected sample exchange. In the present study, the objective is to verify the possible contamination by exogenous DNA in gastric GIST samples and to evaluate if the presence of contamination can interfere in the detection of the mutations of interest. We assessed eight gastric GISTs by the Sanger sequencing and STR sequence analyses. Seven samples presented more than one profile, a result interpreted as contamination. Our results indicate that exogenous DNA contamination occurred in most of the samples studied and that this was more frequent in samples obtained from the slides than those obtained from the block. The presence of contamination did not inhibit the detection of the mutations of interest for a specific target therapy. Furthermore, the histologic block revealed to be more advantageously when compared to the slide for molecular pathology diagnosis.
A rare presentation of Austrian syndrome with septic arthritis in an immunocompetent female
Authors: Battisha Ayman , Madoukh Bader , Altibi Ahmed , Sheikh Omar
Published: September 2019

Background

Austrian syndrome, which is also known as Osler’s triad, is a rare aggressive pathology consisting of pneumonia, endocarditis, and meningitis caused by Streptococcus pneumoniae and carries drastic complications.

Case presentation

A case of a 68-year-old female with a past medical history of hypertension and had a recent viral influenza is presented. She developed bacterial pneumonia, endocarditis with mitral and aortic vegetations and perforation, meningitis, and right sternoclavicular septic arthritis. Two prior case reports have described sternoclavicular septic arthritis as part of Austrian syndrome. Our case is the third case; however, it is the first case to have this tetrad in an immunocompetent patient with no risk factors, i.e., males, chronic alcoholism, immunosuppression, and splenectomy.

Conclusions

Clinicians should maintain a high index of suspicion for the possibility of sternoclavicular joint septic arthritis as a complication of Austrian syndrome in immunocompetent patients.
Improving Documentation of Pain and Constipation Management Within the Cancer Center of a Large Urban Academic Hospital
Authors: Chineke Iloabueke , Adams Curry Marjorie , Bell Winifred , Flood Darica , Mishra Pooja , Power Steve , Bernal-Mizrachi Leon
Published: September 2019

PURPOSE:

Pain and constipation are common among patients with cancer and remain inadequately controlled in many. The Quality Oncology Practice Initiative assessment of pain and constipation at the Georgia Cancer Center for Excellence at Grady Health System identified documentation to be below benchmark levels. A quality improvement initiative to improve pain and constipation management was conducted.

METHODS:

Given the low baseline documentation rates for pain (60%) and constipation (20%), we aimed for an increase of 20 percentage points within 1 year. On the basis of cause-and-effect analysis and provider questionnaires to understand fully the causal factors, our multidisciplinary team developed a new provider note template to integrate nurse’s assessment of pain and constipation into the provider’s documentation. A new order panel was developed in the electronic medical record to link appropriate orders with the pain and constipation plan.

RESULTS:

The integration of the initial nursing assessment into the provider note template increased pain score documentation from 66.7% to 100% ( P < .01), and the pain management plan improved from 65.3% to 86.4% ( P = .06). Similarly, constipation assessment documentation improved from 20.4% to 100% ( P < .01), and a documented constipation plan improved accordingly from 11.2% to 29.1% ( P < .01). As a result of this intervention, pain control at the third clinic visit improved from 61.5% to 86.8% ( P < .01). Emergency department visits related to pain and constipation decreased (16.2% to 14.9%; P = .19), and hospitalizations marginally increased (1.6% to 3.6%) during the study period ( P =.28).

CONCLUSION:

A standardized visit template and hardwired assessment of pain and constipation exceeded the goal for improvement in documentation and positively affected outcomes.
Employment Outcomes, Financial Burden, Anxiety, and Depression Among Caregivers of African American Cancer Survivors
Authors: Hastert Theresa A. , Ruterbusch Julie J. , Nair Mrudula , Noor Mirza Ishrat , Beebe-Dimmer Jennifer L. , Schwartz Kendra , Baird Tara E. , Harper Felicity W.K. , Thompson Hayley , Schwartz Ann G.
Published: September 2019

PURPOSE:

Caregivers of cancer survivors may need to take time off work or make other employment changes to handle caregiving demands. Work impacts of caregiving, financial burden, and psychosocial outcomes of caregivers are not well understood.

METHODS:

Results include information from surveys completed by 202 employed caregivers of participants in the Detroit Research on Cancer Survivors cohort, a population-based cohort of African American survivors of breast, colorectal, lung, or prostate cancer. Relationships between work outcomes, financial burden, and anxiety and depression were assessed using logistic regression models controlling for demographic and cancer-related factors.

RESULTS:

Most (73.8%) caregivers made some employment change. Sixty percent changed their schedule, hours, duties, or employment status; 15.3% took at least 1 month off to provide care, and 38% reported difficulty balancing work and caregiving. Employment changes were strongly associated with difficulty balancing work and caregiving (odds ratio [OR], 5.83; 95% CI, 2.38 to 14.0) and financial burden (OR, 2.12; 95% CI, 1.05 to 4.27). Difficulty balancing work and caregiving was associated with symptoms of anxiety (OR, 1.86; 95% CI, 1.01 to 3.43) and depression (OR, 2.40; 95% CI, 1.16 to 4.96). High ( v low) financial burden was associated with symptoms of anxiety (OR, 2.85; 95% CI, 1.01 to 8.06).

CONCLUSION:

Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial well-being.
Psychosis with lacosamide: a case report
Authors: Nemlekar Saumitra , Srivastava Ashish , Mathur Surabhi
Published: September 2019

An association between epilepsy and psychosis has been demonstrated in various reviews, and it has been estimated that psychosis in the form of schizophrenia affects between 3% and 7% of all epileptic patients. Lacosamide an anti-epileptic was synthesised and used for treatment of epilepsy as well as neuropathic pain. Psychosis is not included as a common adverse effect of the drug. The mechanism by which psychosis is associated with lacosamide is not yet known and is not known to modulate serotonin or dopamine systems. Literature review shows only a few cases reported with similar presentations. We present here a case of a 38 year old male; with Lacosamide induced psychosis.
Contemporary views on shyness – a literature review
Authors: Chęć Magdalena
Published: September 2019

Aim: The aim of this paper is to present the phenomenon of shyness, its etiology and the underlying mechanisms in the development of anxiety disorders.
Background: Shyness is a social problem affecting many people worldwide. Increasing use of social media, replacing real, direct social interactions does not foster proper development of social skills. Difficulties in establishing or maintaining relationships with other people lead to or exacerbate social anxiety, associated with both shyness and social phobia.
Results: Many years of global research reveal that shyness is affected by both biological (including temperamental), as well as environmental factors. Currently, shyness is considered a relatively stable personality trait, and should therefore be distinguished from social anxiety (ie. a state) or social phobia (ie. a disorder).
Discussion: There are qualitative and quantitative differences between shyness and anxiety disorders.
Conclusion: Psychotherapy is a good treatment option for shyness. The most popular and effective methods of therapy include: behavioral therapy, cognitive - behavioral therapy, role play therapy and social skills training.