bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Solved and Unsolved No-Body Homicides in Australia: An Exploratory Analysis
Authors: Ferguson Claire , Pooley Kamarah
Published: May 2019

Factors that are both within and outside of police discretion can pose challenges to solving homicides generally. There has been little study of no-body homicides, nor why some remain unresolved. This analysis compares solved and unsolved no-body homicides in Australia using Pearson’s chi-square tests of independence. Coroners’ findings, case law, and media reports from 1983 to 2017 were examined. Cases ( N = 55; 42.4% solved) differed based on the victim’s age, who reported them missing, reward money, Coronial inquests, who determined homicide, availability of evidence and confessions, suspects lying, establishing crime scenes, and motivations.
Fast search of third-order epistatic interactions on CPU and GPU clusters
Authors: Ponte-Fernández Christian , González-Domínguez Jorge , Martín María J
Published: May 2019

Genome-Wide Association Studies (GWASs), analyses that try to find a link between a given phenotype (such as a disease) and genetic markers, have been growing in popularity in the recent years. Relations between phenotypes and genotypes are not easy to identify, as most of the phenotypes are a product of the interaction between multiple genes, a phenomenon known as epistasis. Many authors have resorted to different approaches and hardware architectures in order to mitigate the exponential time complexity of the problem. However, these studies make some compromises in order to keep a reasonable execution time, such as limiting the number of genetic markers involved in the interaction, or discarding some of these markers in an initial filtering stage. This work presents MPI3SNP, a tool that implements a three-way exhaustive search for cluster architectures with the aim of mitigating the exponential growth of the run-time. Modern cluster solutions usually incorporate GPUs. Thus, MPI3SNP includes implementations for both multi-CPU and multi-GPU clusters. To contextualize the performance achieved, MPI3SNP is able to analyze an input of 6300 genetic markers and 3200 samples in less than 6 min using 768 CPU cores or 4 min using 8 NVIDIA K80 GPUs. The source code is available at https://github.com/chponte/mpi3snp .
Developing and Validating a Scale for Multidimensional Attributes of Honeymoon Tourism
Authors: Fakfare Pipatpong , Lee Jin-Soo
Published: May 2019

This study aims to identify and validate a scale for multidimensional attributes of honeymoon tourism. Although having a romantic experience is an important reason why newlywed couples go on a honeymoon, multidimensional attributes that affect honeymoon tourist experience have yet to be fully explored in the honeymoon tourism literature. This study offers an extended view of honeymoon tourism from the perspective of multidimensional attributes. Data were collected through a survey among international honeymoon tourists. A total of 565 usable samples were collected in Phuket, Thailand, via convenience sampling. Thereafter, refinement and validation of the measurement scale were conducted. Findings indicate that the multidimensional attributes are represented by a nine-factor structure. The findings are expected to extend and enrich the honeymoon tourism literature. Theoretical and managerial implications were also discussed.
Expression of Bone Morphogenetic Protein-7 Significantly Correlates With Non-small Cell Lung Cancer Progression and Prognosis: A Retrospective Cohort Study
Authors: Aoki Masaya , Umehara Tadashi , Kamimura Go , Imamura Nobuhiro , Morizono Shoichiro , Nonaka Yuto , Tokunaga Takuya , Takeda Aya Harada , Maeda Koki , Watanabe Yui , Nagata Toshiyuki , Otsuka Tsunayuki , Yokomakura Naoya , Kariatsumari Kota , Yanagi Masakazu , Sato Masami
Published: May 2019

Background:

Bone morphogenetic protein-7 (BMP-7) is a signaling molecule belonging to the transforming growth factor-β superfamily. Recent studies have demonstrated that BMP-7 is expressed in various human cancers and plays an important role in the progression of their cancers. The purpose of this study was to investigate the clinicopathologic and prognostic impact of BMP-7 expression in clinical samples of non-small cell lung cancer.

Methods:

This study enrolled 160 patients with non-small cell lung cancer who underwent complete resection. Expression of BMP-7 in cancer tissue was evaluated by immunohistochemistry. Correlations between expression of BMP-7 and clinicopathologic factors and prognosis were analyzed.

Results:

In non-small cell lung cancer, BMP-7 expression was identified not only in cell membranes but also in the cytoplasm of cancer cells. Expression of BMP-7 correlated with p-T ( P = .047), N factor ( P = .013), and p-stage ( P = .046). Overall survival rate was significantly lower in the BMP-7-positive group than in the BMP-7-negative group ( P = .004). Multivariate analysis indicated that BMP-7 expression was one of the independent prognosis factors of overall survival ( P = .021). Furthermore, among patients with postoperative recurrence (n = 58), the BMP-7-positive group (n = 29) had a significantly poorer prognosis than the BMP-7-negative group (n = 29) ( P = .012).

Conclusions:

Expression of BMP-7 in non-small cell lung cancer was correlated with clinicopathologic factors and poorer prognosis. BMP-7 expression may be a useful predictor of aggressive activity of tumor behavior and postoperative outcome of patients with non-small cell lung cancer.
Eight theories of societalization: Toward a theoretically sustainable concept of society
Authors: Schmidt Volker H
Published: May 2019

This article critically engages a recent essay Jeffrey Alexander has published on ‘societalization’, whose conceptualization it finds problematic; first, because in contrast to the impression conveyed by the essay, the term itself is anything but new (as shown in a summary of six theories of societalization which precede Alexander’s by decades, in two cases, by more than a century), and, second, because the way Alexander employs the term is highly aporetic, while also being emblematic of much deeper problems that afflict the whole discipline. Following a reconstruction of the term’s morphology and the transmutations it underwent during its gradual incorporation into the English language, the article identifies an undertheorized concept of society as the root cause behind the difficulties into which Alexander maneuvers himself. It concludes with a brief sketch of an alternative that can contribute to overcoming these difficulties.
The simpler, the better: Analytical methods for nonlinear oscillators and fractional oscillators
Authors: He Ji-Huan
Published: May 2019

In engineering, a fast estimation of the periodic property of a nonlinear oscillator is much needed. This paper reviews some simplest methods for nonlinear oscillators, including He’s frequency formulation, the max-min approach and the homotopy perturbation method. A mathematical insight into He’s frequency formulation is given, and the weighted average is introduced to further improve the estimated accuracy of the frequency. Fractional oscillators are also discussed.
Reflections of stress in US abortion narratives
Authors: Sperlich Mickey , Ely Gretchen E , Rouland Rebecca S , Walters Connor A , Carwile Max
Published: May 2019

A trauma-informed, thematic analysis that identified stress-related themes evident in 39 personal abortion narratives from the Tennessee Stories Project in the United States is presented in this paper. Using the Braun and Clarke model of thematic analysis, guided by the trauma-informed social work framework, researchers examined these narratives to identify stress related themes.

Findings

An overall theme of stress and traumatic stress was found to be present throughout the abortion narratives. These themes were categorized into subthemes, including: (a) existing life stressors preceding the abortion experience, (b) stressors while trying to access abortion services, (c) stressors while obtaining abortion services, and (d) stressors arising after the procedure.

Applications

These results suggest that stress and traumatic stress were reflected in these abortion narratives throughout the abortion seeking experience. This finding supports the need for social work practice responses that are designed to address and eliminate stress during the process of seeking and obtaining an abortion in the United States. A trauma-informed framework is recommended for guiding social work education about abortion, social worker interactions with clients who are seeking abortions, and the development of abortion policy in the United States in order to better align the abortion seeking experience with the principles of trauma-informed care.
The necessity of a relational ethics alongside Noddings’ ethics of care in narrative inquiry
Authors: Caine Vera , Chung Simmee , Steeves Pamela , Clandinin D. Jean
Published: May 2019

Amidst a winter snow storm we drove slowly and carefully to our research site. Leaving much earlier than usual we wanted to be there to greet the indigenous youth who we had come to know in the process of inquiring into their ongoing identity making. We came to know them over several months in a junior high school arts club and had developed relationships with them that were marked by care. In attending to care, Noddings (1984) offered us a way to think about ethics. Yet Noddings did not explicitly turn her attention to an ethics for research, rather her focus was on an ethics of care in moral education. Drawing on our work alongside indigenous youth we show how these four components of an ethics of care shaped our narrative inquiry and show how a relational ethics builds on, and extends, an ethics of care in narrative inquiry.
Evaluation of Neurofeedback for Posttraumatic Stress Disorder Related to Refugee Experiences Using Self-Report and Cognitive ERP Measures
Authors: Askovic Mirjana , Watters Anna J. , Coello Mariano , Aroche Jorge , Harris Anthony W. F. , Kropotov Jury
Published: May 2019

Background. Neurofeedback holds promise as an intervention for the psychophysiological dysfunction found in posttraumatic stress disorder (PTSD). Few empirical studies have assessed the efficacy of neurofeedback for PTSD, and none in individuals with refugee trauma. A proposed mechanism for neurofeedback efficacy in PTSD is through remediating deficits in cognitive control. We assessed pre- and postchanges in symptoms and neurocognitive functioning of refugee clients participating in a neurofeedback intervention for PTSD. Methods. Clinical data for 13 adult refugees with chronic PTSD who participated in neurofeedback combined with trauma counseling (NFT) was compared with 13 adult refugees placed on a waitlist to receive neurofeedback. Waitlist clients continued to receive trauma counseling alone (TC). NFT was additionally assessed pre- and posttherapy for changes in event-related potentials (ERPs) and behavioral indices of cognitive control using a visual continuous performance task (VCPT). Comparison VCPT data from healthy controls (HC) was available from the Human Brain Index database. Results. Posttherapy, NFT had significantly lower symptoms of trauma, anxiety, and depression compared with TC. NFT demonstrated an increased P3 amplitude and improved behavioral performance suggesting a normalization of cognitive control. Conclusions. These preliminary observations are consistent with a possible benefit of neurofeedback for remediating PTSD. This may be achieved at least partially by an improvement in cognitive control. Further confirmation of the effectiveness of the treatment now requires a randomized controlled trial that considers issues such as placebo response, nonspecific therapist effects, and duration of treatment.
Laminar-turbulent transition in a constricted tube: Comparison of Reynolds-averaged Navier–Stokes turbulence models and large eddy simulation with experiments
Authors: Elcner Jakub , Lizal Frantisek , Jedelsky Jan , Tuhovcak Jan , Jicha Miroslav
Published: May 2019

Constricted tubes appear in many engineering as well as biological systems such as blood vessels or pulmonary airways. The aim of this article is to test the ability of different turbulence models to predict the flow field and deposition of particles in a constricted tube. The constricted geometry of Ahmed and Giddens was employed to compare various numerical approaches. Two large eddy simulations and several Reynolds-averaged Navier–Stokes models were used for calculations using the Star-CCM+ commercial solver. The performance of these models was compared with the experiments and other published studies. For selected turbulence models, deposition of particles with different Stokes numbers using Lagrangian multiphase model was enabled. The results show that large eddy simulation best predicts the transition from laminar to turbulent flow in terms of mean axial velocity, and similarly does also standard low-Reynolds k–ε model. The comparison of deposition fractions shows substantial differences among the models, especially for the smallest particles. It was demonstrated that even a simple stenosed smooth tube is a very intricate problem for the present computational fluid dynamics models; therefore, to get reliable results, numerical models need to be validated for the same geometry and similar conditions.
Branch atheromatous disease diagnosed as embolic stroke of undetermined source: A sub-analysis of NAVIGATE ESUS
Authors: Uchiyama Shinichiro , Toyoda Kazunori , Kitagawa Kazuo , Okada Yasushi , Ameriso Sebastian , Mundl Hardi , Berkowitz Scott , Yamada Takashi , Liu Yan Yun , Hart Robert G ,   on behalf of the NAVIGATE ESUS Investigators
Published: May 2019

Background

Branch atheromatous disease (BAD) is distinctive from large and small arterial diseases, which is single subcortical infarction larger than lacunar stroke in the territories of deep perforators without relevant arterial stenosis. BAD meets the current criteria of embolic stroke of undetermined source. We performed an exploratory analysis of BAD in patients recruited to NAVIGATE embolic stroke of undetermined source, a randomized controlled trial to compare rivaroxaban and aspirin in embolic stroke of undetermined source patients.

Methods and results

Among 3972 stroke patients in cerebral hemispheres with intracranial arterial imaging, 502 (12.6%) patients met the criteria for BAD. BAD was associated with younger age (years; OR: 0.97, 95% CI: 0.96–0.98), race (Asian; OR: 1.78, 95% CI: 1.44–2.21), region (Eastern Europe; OR: 2.49, 95% CI: 1.87–3.32), and higher National Institute of Health Stroke Scale (OR: 1.17, 95% CI: 1.12–1.22) at randomization. During follow-up, stroke or systemic embolism (2.5%/year vs. 6.2%/year, p = 0.0022), stroke (2.1%/year vs. 6.2%/year, p = 0.0008), and ischemic stroke (2.1%/year vs. 5.9%/year, p = 0.0013) occurred less frequently in BAD than non-BAD patients. There were no differences in annual rates of stroke or systemic embolism (2.5%/year vs. 2.5%/year, HR: 1.01, 95% CI: 0.33–3.14) or major bleeding (1.3%/year vs. 0.8%/year, HR: 1.51, 95% CI: 0.25–9.05) between rivaroxaban and aspirin groups among BAD patients.

Conclusions

BAD was relatively common, especially in Asian and from Eastern Europe among embolic stroke of undetermined source patients. Stroke severity was higher at randomization but recurrence of stroke was fewer in BAD than non-BAD patients. The efficacy and safety of rivaroxaban and aspirin did not differ among BAD patients.
Does the type of disability influence salivary cortisol concentrations of athletes in official wheelchair basketball games?
Authors: Seron Bruna Barboza , Carvalho Emanuel Messias Oliveira de , Modesto Everaldo Lambert , Almeida Eloise Werle de , Moraes Solange Marta Franzói de , Greguol Márcia
Published: May 2019

The objective of this work is to describe and compare the behavior of cortisol in official wheelchair basketball matches according to the type of disability. This is a cross-sectional study in which 34 elite wheelchair basketball athletes were divided into three groups, based on disability (spinal cord injury, poliomyelitis, and amputation). Cortisol concentration (baseline, pre-, and post-game) and heart rate were analyzed in five official games. Heart rate data were stratified according to the Edwards method. Significant differences were observed in pre- and post-cortisol concentrations only for the amputated group. No significant correlations were found between cortisol variation and intensity ranges. Athletes with neurological damage were not responsive to wheelchair basketball in relation to salivary cortisol concentrations. The game intensity cannot be verified by the biomarker cortisol for all types of disabilities. It is necessary to pay attention to the energy availability for athletes with neurological injuries during the game and post-game recovery.
The progesterone-only pill
Authors: Yusuf Zarah , Evans Chloe , Forsythe Annabel
Published: May 2019

The progesterone-only pill is a popular and effective contraceptive method. It is particularly useful when either an oral method of contraception is preferred or there are contraindications to the combined pill. It is taken daily without a pill-free interval, and works mainly by increasing the cervical mucus. Desogestrel also inhibits ovulation. The progesterone-only pill is useful for those needing a reliable form of contraception within a short period, as it is effective after 48 hours when ‘quick started’. This article reviews current guidelines and answers some common clinical queries.
A qualitative study to identify indicators of the quality of wound closure
Authors: Blencowe NS , Rooshenas L , Tolkien Z , Bera KD , Gould Brown H , Elliott D , Reeves BC , Blazeby JM
Published: May 2019

Background:

Wound healing after surgery may be complicated by surgical site infection (SSI). SSI development may be influenced by surgical techniques surrounding primary wound closure; for example, the standard to which surgical wounds are closed at the end of an operation.

Aim:

This study aimed to identify indicators of the quality of wound closure, and factors affecting this, to enable the future development of a tool to measure the quality of wound closure in the context of abdominal surgery.

Methods:

This study was undertaken within the context of an ongoing feasibility study comparing dressing strategies for patients undergoing abdominal surgery. Content analysis of published literature, non-participant observations of wound closure in the operating theatre, and semi-structured interviews with clinicians were used to identify indicators of the quality of wound closure.

Results:

A long list ( n = 38 domains) was categorized into visible markers indicating the quality of wound closure (e.g. suture visibility, apposition of wound edges, evidence of gaps in the wound or tethering of the skin edges), factors that might influence this (e.g. surgeon’s expertise, time taken to closure the wounds) and patient factors (e.g. obesity, skin conditions).

Conclusions:

This is the first study to investigate what is meant by ‘good wound closure’ and factors that might influence it. Findings will result in the development of a tool to assess quality of primary wound closure.
Nuclear Magnetic Resonance Characterization of Water Soluble Organic Carbon of Atmospheric Aerosol Types
Authors: Chalbot Marie-Cecile G. , Kavouras Ilias G.
Published: May 2019

The water soluble organic carbon of the prevalent atmospheric aerosol sources (traffic exhausts, paved road dust, agricultural soil, native soil, wood combustion, epicuticular waxes from pine and broad-leaved trees, and pollen) has been characterized using 1H (1-dimensional), 1H-1H-correlation spectroscopy and 1H-13C-heteronuclear single quantum correlation 2-dimensional (2D) nuclear magnetic resonance (NMR) spectroscopy. Traffic exhaust particles were mainly constituted of primary alcohols, carbohydrates, functionalized olefins, C3 and C4 oxy- and hydroxyl-carboxylic acids, and short-chain alkanes. Road dust was a mixture of soil particles and traffic components. Agricultural, natural, road dust, and traffic particles contained broad signals that were attributed to poly-carboxylic compounds typically found in humic compounds and humic-like substances. Traces of traffic particles (ie, peaks in the 7.3-7.5 ppm [phthalic acid derivatives] and signals found in the 0.5-3 ppm originating from functionalized carboxylic acids) were also found in natural soil dust. Long-chain (>C3) fatty acids and amino acids were found in road dust, natural soil, pine trees waxes, pollen, and woodburning. The aromatic region mainly constituted of lignin derivatives and cellulose/hemicellulose pyrolysis products (signals in 2D-NMR) in woodburning. Primary biogenic and woodburning particles were uniquely clustered as compared to traffic exhausts, road, agricultural, and natural dust based on the relative ratio of hydro-oxygenated functional groups (H-C-O and H-C-C=O) to the sum of aliphatics. Overall, source-specific NMR spectrometric fingerprints, functional composition profiles, and several organic compounds were identified allowing for the reconciliation of ambient organic aerosol sources including the degree of atmospheric aging.
Ant Occupation of Twigs in the Leaf Litter of the Atlantic Forest: Influence of the Environment and External Twig Structure
Authors: Fernandes Tae Tanaami , Dáttilo Wesley , Silva Rogério R. , Luna Pedro , Oliveira Carla M. , Morini Maria Santina de Castro
Published: May 2019

Twig cavities are microhabitats that may be used by different ant species for nesting and colony expansion. However, ants do not colonize all twigs available in the leaf litter, pointing to the existence of environmental or twig-related filters. In this study, we analyzed which environmental and twig attributes affected twig occupation by ants. We surveyed seven plots in six Atlantic forest sites in southeastern Brazil. To characterize the environmental filters, we quantified canopy cover and leaf litter moisture and depth. At the twig level, we measured twig length and diameter and the area and circumference of all holes in each twig. Ant colonies occupied 13.42% of the 4,805 twigs surveyed, and we recorded a total of 52 twig-nesting ant species. Brachymyrmex admotus was the most frequent species. Ant species richness increased with canopy cover and leaf litter moisture and with the relative number of occupied twigs. In addition, we found that ant species richness increased with length and diameter of the twigs, and that twigs with smaller holes were more frequently occupied by ants, regardless of the availability of larger diameter holes. Our work demonstrates that both environmental characteristics and twig morphology can structure occupation of twigs by ants. In addition, we demonstrated that certain species show a preference for certain twig types. We highlight the importance of twigs for maintaining ant diversity and for colony expansion of arboreal species and species inhabiting the leaf litter.
Enabling identity as an ethical tension in a community of philosophical inquiry with children and young adults
Authors: Kizel Arie
Published: May 2019

This article focuses on an ethical tension in a community of philosophical inquiry with children and young adults; the resolution that the author suggests is called “enabling identity.” The “enabling identity” model seeks to endow a voice to children and adolescents from marginalized groups by challenging the mainstream hegemonic discourse that governs the discourse where communities of philosophical inquiry operate. One of the challenges that philosophy for children faces today is enabling the voices of marginalized groups represented within communities of philosophical inquiry comprising children or adults to be heard. The participants in communities of philosophical inquiry who come from non-privileged backgrounds and low socio-economic sectors or national minorities, whose narrative does not accord with that of the dominant national narrative, feel uncomfortable expressing their feelings and experiences, preferring not to raise the questions that interest them. Even if they are amicable, such communities of inquiry are governed—even if implicitly—by the hegemonic metanarrative. This article analyzes this ethical tension and suggests a three-phase theoretical and practical model which depicts this enabling while relying on narrative theory as well as the philosophical and dialogical work of Emmanuel Levinas and Martin Buber. The last part also offers insights from research in German and Israeli communities of inquiry with children and young adults that have used this model.
Teaching Indigenous children in Taiwan: Tensions, complexities and opportunities
Authors: Nesterova Yulia
Published: May 2019

Taiwan’s Indigenous children are culturally and linguistically different and socially and economically marginalized compared to their Han Chinese peers. For decades, education assimilated Indigenous people into the mainstream society by undermining their languages, cultures and traditional spaces. Since the 1990s, multicultural policies have been cast as the remedy for the inequalities and injustices they experienced and, since 2016, Taiwan has started the process of reconciliation and transitional justice. The purpose of this article is twofold. It first discusses whether these new policies and initiatives have been more accommodating and friendlier to Indigenous students, or whether they still clash with Indigenous visions of and needs for a sustainable and just society. Following this, the article focuses on non-Indigenous teachers who work with Indigenous students, and what knowledge, skills and attitudes they have and/or lack. An ethnographic study conducted with 23 Indigenous representatives shows that Indigenous people are dissatisfied with state education due to its culturally insensitive and contextually irrelevant and irresponsive curriculum, pedagogy and school environment, which are shaped around Chinese values and a Chinese view of history, language, knowledge and way of engaging with the ‘Other’. The participants discuss their own vision of education that can help address the problematic experiences and outcomes of Indigenous students, and ‘rewrite’ education to eliminate tensions between Chinese and Indigenous values, histories, knowledge(s) and other aspects. The implications of the tensions between Indigenous and non-indigenous visions of education are then presented for a rewriting of the curriculum and retraining of non-indigenous teachers to engage with Indigenous children and communities in a culturally respectful and ethical manner.
A network meta‐analysis of randomized controlled trials exploring the role of fecal microbiota transplantation in recurrent Clostridium difficile infection
Authors: Rokkas Theodore , Gisbert Javier P , Gasbarrini Antonio , Hold Georgina L , Tilg Herbert , Malfertheiner Peter , Megraud Francis , O'Morain Colm
Published: May 2019

Background

Recurrence remains a challenge in Clostridium difficile infection (CDI), and in this field fecal microbiota transplantation (FMT) has attracted significant interest. Network meta‐analysis (NWM) has been established as an evidence‐synthesis tool that incorporates direct and indirect evidence in a collection of randomized controlled trials. So far no NWM exists concerning therapeutic interventions for recurrent CDI (rCDI).

Objective

In this NWM we assessed the comparative effectiveness of various therapies for rCDI to examine the efficacy rank order and determine the optimum therapeutic approach.

Methods

A Bayesian network meta‐analysis was performed to investigate the efficacy rank order of rCDI interventions.

Results

Six eligible RCTs were entered into an NWM. They included 348 rCDI patients, in whom seven therapeutic interventions were used, i.e. donor fecal microbiota transplantation (DFMT), vancomycin, fidaxomicin, vancomycin + DFMT, vancomycin + bowel lavage, autologous FMT and placebo. DFMT showed the highest efficacy in comparison with vancomycin [odds ratio (95% credible interval), 20.02 (7.05–70.03)] and fidaxomicin (22.01 (4.38–109.63)).

Conclusion

This NWM showed that DFMT is the optimum therapeutic approach for rCDI, as it was the most efficacious among various therapeutic interventions, particularly in comparison with commonly used antibiotics such as vancomycin or fidaxomicin.
Relationship Between Lower Limb Tightness and Practice Time Among Adolescent Baseball Players With Symptomatic Osgood-Schlatter Disease
Authors: Omodaka Takuya , Ohsawa Takashi , Tajika Tsuyoshi , Shiozawa Hiroyuki , Hashimoto Syogo , Ohmae Hiroaki , Shitara Hitoshi , Ichinose Tsuyoshi , Sasaki Tsuyoshi , Hamano Noritaka , Takagishi Kenji , Chikuda Hirotaka
Published: May 2019

Background:

Osgood-Schlatter disease (OSD) is characterized by traction apophysitis of the tibial tuberosity. Few studies on symptomatic and asymptomatic OSD have correlated findings with clinical examination.

Purpose:

To investigate the relationship between lower limb tightness and practice time among adolescent baseball players with symptomatic OSD.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The study participants were 402 male baseball players (N = 804 knees) with a mean ± SD age of 10.9 ± 1.5 years (range, 7-14 years). Participant age, height, body weight, body mass index, practice time per week, range of motion of the hip and ankle joints, heel-buttock distance (HBD), and straight-legged raise angle were evaluated. Tibial tuberosity development, as assessed with ultrasonography, was classified into 4 stages: cartilaginous, apophyseal, epiphyseal, and bony. Knees that were classified as apophyseal or epiphyseal were investigated. Participants were divided into 3 groups: non-OSD, asymptomatic OSD, and symptomatic OSD.

Results:

Of 400 knees in the apophyseal and epiphyseal stages, 23 knees had asymptomatic OSD, and 11 had symptomatic OSD. Players with symptomatic OSD practiced for significantly longer than the non-OSD group ( P = .001) and asymptomatic OSD group ( P = .001). Players with symptomatic OSD also had a larger HBD ( P = .006) and smaller range of motion regarding internal rotation of hip ( P = .023) and dorsiflexion of the ankle ( P = .013) than the non-OSD group.

Conclusion:

Players with symptomatic OSD had longer practice times than the non-OSD and asymptomatic OSD players. Symptomatic OSD was also associated with tightness of the lower limbs as assessed by the HBD and range of motion in the hip and ankle joints.
Examining the Impact of the Vaginal Birth After Cesarean Risk Calculator Estimation on Trial of Labor After Cesarean Counseling
Authors: Jeffries Erin , Falcone-Wharton Amy , Daggy Joanne , Tucker Edmonds Brownsyne
Published: May 2019

Background. Because failed trial of labor after cesarean (TOLAC) is associated with greater morbidity than planned cesarean, it is important to distinguish women with a high likelihood of successful vaginal birth after cesarean (VBAC) from those likely to fail. The VBAC Calculator may help make this distinction but little is known about how often providers use it; nor whether use improves risk estimation and/or influences TOLAC counseling. Methods. In a cross-sectional survey, a convenience sample of obstetrical providers reported their likelihood (4-point Likert-type scale) to “Recommend,”“Offer,” or “Agree to” TOLAC for patients presented first through five clinical vignettes; then, in different order, by corresponding VBAC calculator estimates. Results. Of the 85 (of 101, 84% response rate) participants, 88% routinely performed TOLAC, but only 21% used the Calculator. The majority (67.1% to 89.3%) overestimated the likelihood of success for all but one vignette (which had the highest estimate of success). Most providers (42% to 89%) recommended TOLAC for all five vignettes. Given calculated estimates, the majority of providers (67% to 95%) recommended TOLAC for success estimates exceeding 40%. For estimates between 20% and 40%, most providers offered (58%) or agreed (68%) to TOLAC; and even below 20%, over half still agreed to TOLAC. The vignette with the lowest estimate of success (18.7%) had the weakest intraprovider agreement (kappa = 0.116; confidence interval [CI] = 0.045–0.187), whereas the strongest agreement was found in the two vignettes with highest success estimates: 77.9% (kappa = 0.549; CI = 0.382–0.716) and 96.6% (kappa = 0.527; CI = 0.284–0.770). Limitations. Survey responses may not reflect actual practice patterns. Conclusion. Providers are overly optimistic in their clinical estimation of VBAC success. Wider use of decision support could aid in risk stratification and TOLAC counseling to reduce patient morbidity.
Antibiotic treatment for pneumonia complicating stroke: Recommendations from the pneumonia in stroke consensus (PISCES) group
Authors: Kishore Amit K , Jeans Adam R , Garau Javier , Bustamante Alejandro , Kalra Lalit , Langhorne Peter , Chamorro Angel , Urra Xabier , Katan Mira , Napoli Mario Di , Westendorp Willeke , Nederkoorn Paul J , van de Beek Diederik , Roffe Christine , Woodhead Mark , Montaner Joan , Meisel Andreas , Smith Craig J
Published: May 2019

Purpose

The microbiological aetiology of pneumonia complicating stroke is poorly characterised. In this second Pneumonia in Stroke ConsEnsuS statement, we propose a standardised approach to empirical antibiotic therapy in pneumonia complicating stroke, based on likely microbiological aetiology, to improve antibiotic stewardship.

Methods

Systematic literature searches of multiple databases were undertaken. An evidence review and a round of consensus consultation were completed prior to a final multi-disciplinary consensus meeting in September 2017, held in Barcelona, Spain. Consensus was approached using a modified Delphi technique and defined a priori as 75% agreement between the consensus group members. Findings: No randomised trials to guide antibiotic treatment of pneumonia complicating stroke were identified. Consensus was reached for the following: (1) Stroke-associated pneumonia may be caused by organisms associated with either community-acquired or hospital-acquired pneumonia; (2) Treatment for early stroke-associated pneumonia (<72 h of stroke onset) should cover community-acquired pneumonia organisms; (3) Treatment for late stroke-associated pneumonia (≥72 h and within seven days of stroke onset) should cover community-acquired pneumonia organisms plus coliforms +/− Pseudomonas spp. if risk factors; (4) No additional antimicrobial cover is required for patients with dysphagia or aspiration; (5) Pneumonia occurring after seven days from stroke onset should be treated as for hospital-acquired pneumonia; (6) Treatment should continue for at least seven days for each of these scenarios.

Discussion

Consensus recommendations for antibiotic treatment of the spectrum of pneumonia complicating stroke are proposed. However, there was limited evidence available to formulate consensus on choice of specific antibiotic class for pneumonia complicating stroke.

Conclusion

Further studies are required to inform evidence-based treatment of stroke-associated pneumonia including randomised trials of antibiotics and validation of candidate biomarkers.
Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea
Authors: Cohn Jason E. , Relyea George E. , Daggumati Srihari , McKinnon Brian J.
Published: May 2019

Objective

To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population.

Study Design

A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017.

Setting

A tertiary care, university children’s hospital.

Subjects and Methods

Unpaired Student t test was used to compare average pre‐ and postsurgical apnea‐hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre‐ and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery.

Results

In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively (P =. 005). However, it did not significantly decrease OSN.

Conclusion

This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology.
Primed PMNs in healthy mouse and human circulation are first responders during acute inflammation
Authors: Fine Noah , Barzilay Oriyah , Sun Chunxiang , Wellappuli Nimali , Tanwir Farzeen , Chadwick Jeffrey W. , Oveisi Morvarid , Tasevski Nikola , Prescott David , Gargan Martin , Philpott Dana J. , Dror Yigal , Glogauer Michael
Published: May 2019

Polymorphonuclear neutrophils (PMNs) are the most abundant circulating leukocytes, and the first cells recruited to sites of tissue inflammation. Using a fixation method to preserve native CD marker expression prior to immunophenotyping, we identified a distinct population of “primed for recruitment” PMNs in healthy mouse and human blood that has high expression of adhesion and activation markers compared with the bulk resting-state PMNs. In response to acute tissue inflammation, primed PMNs (pPMNs) were rapidly depleted from the circulation and recruited to the tissue. One hour after acute peritoneal insult, pPMNs became the dominant PMN population in bone marrow (BM) and blood, returning to baseline levels with resolution of inflammation. PMN priming was induced by the granulopoietic factors granulocyte-macrophage–colony-stimulating factor (GM-CSF) and granulocyte–colony-stimulating factor (G-CSF). High levels of pPMNs were observed in neutropenic mice and in pediatric neutropenic patients who were resistant to infection, highlighting an important role of this population in innate immune function.
A systematic review and meta-analysis of supplemental education in patients treated with oral anticoagulation
Authors: Paquette Miney , Witt Daniel M. , Holbrook Anne , Skov Jane , Ansell Jack , Schünemann Holger J. , Wiercioch Wojtek , Nieuwlaat Robby
Published: May 2019

Oral anticoagulants (OACs) are indicated for treatment and prevention of thromboembolic diseases. Supplemental patient education (education) has been proposed to improve outcomes, and this systematic review assesses the effect of education on mortality, thromboembolic events (TEEs) including venous thromboembolism (VTE), and bleeding in patients taking OACs. Randomized controlled trials were included, and 2 authors independently screened articles and assessed risk of bias. In 9 trials (controls, n = 720; intervention group patients, n = 646), 4 assessed critical outcomes of mortality, TEEs (VTE, stroke, and systemic embolism), and bleeding to estimate absolute risk ratios. When comparing education with usual care, in 1000 patients, there may be 12 fewer deaths (95% confidence interval [CI], 19 fewer to 154 more) and 16 fewer bleeding events (95% CI, 34 fewer to 135 more), but this evidence is uncertain; the evidence also suggests 6 fewer VTEs (95% CI, 10 fewer to 16 more) and 8 fewer TEEs (95% CI, 16 fewer to 18 more). The mean difference in time in therapeutic range may be 2.4% higher in the education group compared with usual care (95% CI, 2.79% lower to 7.58% higher). We also found very low certainty of evidence for a large increase in knowledge scores (standardized mean difference, 0.84 standard deviation units higher; 95% CI, 0.51-1.16). Overall, the certainty of evidence was low to very low because of serious risk of bias and serious imprecision. Additional sufficiently powered trials or different approaches to education are required to better assess supplemental education effects on outcomes in patients taking OACs.
Cost-effectiveness of tyrosine kinase inhibition in first-line treatment of patients with EGFR-mutated advanced non-small cell lung cancer.
Authors: Han Jiaqi , Hu Huabin , Liao Mengting , She Longjiang , Yao Linli , Ding Dong , Zeng Shan , Liang-Fang Shen , Huang Jin
Published: May 2019

e20504

Background: Patients with advanced non-small cell lung cancer (NSCLC) harbouring an epidermal growth factor receptor (EGFR) mutation have improved survival with tyrosine kinase inhibitor (TKI) treatments, but the economic efficiency of this application is unclear, especially in limited health resource settings. To inform policy makers about the value of these medications, we developed a Markov model to compare the cost-effectiveness of these strategies. Methods: A Markov model was developed to compare the cost-effectiveness of chemotherapy, gefitinib, erlotinib, afatinib and osimertinib treatments from a public payers’ perspective in the U.S and China. Health states consisted of progression-free survival, progressive disease, and death. Model transition, adverse event probabilities, disease progression, and death were obtained from randomized clinical trials and network meta-analysis. Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) over a 10-year lifetime horizon were calculated. One-way and probabilistic sensitivity analyses were performed by multiple potentially modifiable parameters. Results: The tyrosine kinase inhibitors were more cost-effective than chemotherapy treatment in both the U.S and China. In the U.S, compared with erlotinib, afatinib had an ICER of $241,420/QALY while osimertinib had an ICER of $351,315/QALY. In China, the incremental utility for osimertinib versus gefitinib was 0.68QALYs, and the ICER was $25,622/QALY. The probability sensitivity analyses also illustrated that the erlotinib was the optimal treatment at a willingness-to-pay (WTP) threshold of $150,000/QALY in the U.S and osimertinib was the most cost-effective treatment at a WTP of $26,508/QALY in China. Conclusions: Based on our current analysis, erlotinib appears to be the preferred first-line treatment for advanced EGFR mutation-positive NSCLC patients in the US at a WTP of $150,000/QALY. However, because of the price reduction and more health benefits, osimertinib was considered to be most cost-effective at a WTP of $26,508/QALY in China.
Immunotherapeutic efficacy in NSCLC and patients’ smoking status: A meta-analysis.
Authors: Wang Shanshan , Wang Guoqiang , Xu Yu , Cai Shangli , Xiong Jianping
Published: May 2019

e20510

Background: In non-small cell lung cancer (NSCLC), tumour mutational burden (TMB) has been validated in predicting the clinical benefit of immunotherapy. Smoke, delivering the carcinogens that form covalently bound DNA adducts into respiratory system, is the critical cause of miscoding events and mutational burden in NSCLC. However, the predictive potential of tobacco consumption in immunotherapy remains controversial. Here, we did a meta-analysis to assess the heterogeneity of immune checkpoint inhibitor (ICI) efficacy in NSCLC patients with or without smoking habit. Methods: We systematically searched PubMed, the Cochrane Central library and Embase, for the randomized controlled trials (RCTs) of ICIs (inhibitors of PD-1, PD-L1, CTLA-4, or combination) in NSCLC. The studies were excluded due to the unpublished hazard ratio (HR) for both progression-free survival (PFS) and overall survival (OS) according to smoking status. Pooled estimates of survival HR and 95% confidence interval (CI) in smokers and non-smokers were performed using a random-effects model, and the heterogeneity between the two estimates was assessed using an interaction test by Review Manager. Results: In total, 13 eligible RCTs of FDA-approved ICIs (concerning ipilimumab, nivolumab, pembrolizumab, atezolizumab, and avelumab) containing 8154 patients with NSCLC (6800 [83.4%] smokers and 1354 [16.6%] non-smokers) were included for analysis. Compared to standard treatment, a prolonged PFS was observed in smokers treated with ICIs (pooled HR, 0.72, 95% CI 0.63-0.81, P < 0·001) instead of non-smokers (pooled HR, 0.98, 95% CI 0.73-1.31, P = 0·90). The pooled HR of OS between immunotherapy and standard treatment was 0.77 (95% CI 0.69-0.86, P < 0·001) in smokers and 0.78 (95%CI 0.59-1.02, P = 0·07) in non-smokers. Similar results were observed among sub-groups according to the different histology (squamous and non-squamous), class of ICIs (anti-PD-1 or PD-L1) and lines of treatment (first-line or subsequent). The difference in efficacy between smokers and non-smokers treated with ICIs was also significant (HR 0.75, 95% CI 0.62-0.92, P = 0·005). Conclusions: ICIs can improve PFS and OS for patients with advanced NSCLC, but the magnitude of benefit depends on smoking history, especially for PFS. Future clinical trials are supposed to include more non-smokers and concentrate on enhancing the efficacy of ICIs in the NSCLC patients without cigarette consumption, possibly discovering distinctive immunotherapeutic approaches in smokers and non-smokers.
The mutation profile of EGFR in resectable Chinese lung cancer patients.
Authors: Mao Wenjun , Chen Ruo , Chen Jingyu , Liu Feng , He Yijun , Ye Shugao , Lu Rongguo , Qi Martin , Zheng Mingfeng
Published: May 2019

e20519

Background: The frequency of EGFR mutation in Asian advanced lung cancer patients is about 40% and the application of EGFR tyrosine kinase inhibitors (TKIs) has become a standard treatment therapy. Several studies showed that usage of EGFR TKIs in adjuvant or neo-adjuvant therapy was promising, while the mutation profile of EGFR mutations in resectable Chinese lung cancer patients was still scanty. Our study investigated EGFR mutation profile and its correlation with clinicopathological factors. Methods: 343 resectable patients with lung cancer were selected for eligibility criteria, and tumor tissues were collected for gene detection. EGFR genetic testing was performed by amplification refractory mutation system PCR (ARMS-PCR) with specific sensitive mutation sites. The clinicopathological factors of study population were recorded based on pre-design protocol. Chi-square or fish exact test were used to statistic analysis Results: A total of 343 patients were enrolled in study. 42.6% (146/343) patients were male, 20.4% (68/333) patients were smokers, the adenocarcinoma accounted for 93.8 % (319/340), and stage 0, I, II, III was 7.3% (25/343), 68.8% (236/343), 8.5% (29/343), 15.5% (53/343), respectively. The frequency of EGFR mutation was 54.2% (186/343) in whole population, and the proportion of EGFR L858R, 19Del, 719X, 768I, 861Q mutation was 31.2% (107/343), 21.3% (73/343), 1.2% (4/343), 1.0% (3/343), 1.0% (3/343), respectively. 1.2% (4/343) patients presented EGFR co-mutation (EGFR G719X/S768I; L858R/S768I; G719X/S768I; L858R/L861Q) .The mutation frequency of EGFR mutation was associated with sex, smoking, differentiation, pathology (P = 0.0076, < 0.0001, < 0.0001, < 0.0001, respectively). In subgroup analysis, the incidence of two main mutation types, EGFR L858R and 19del, were associated with disease stage (P = 0.044) and age (P = 0.035). Conclusions: EGFR mutation in resectable lung cancer was a common phenomenon as advanced stage and our study might provide useful informations for using EGFR-TKIs in further adjuvant or neo-adjuvant therapy.