bluuebunny/crossref_metadata_2025 huggingface dataset:
A multi-start iterated tabu search algorithm for the multi-resource agent bottleneck generalized assignment problem
Authors: Bektur Gülçin
Published: October 2019

In this study, a multi-resource agent bottleneck generalized assignment problem (MRBGAP) is addressed. In the bottleneck generalized assignment problem (BGAP), more than one job can be assigned to an agent, and the objective function is to minimize the maximum load over all agents. In this problem, multiple resources are considered and the capacity of the agents is dependent on these resources and it has minimum two indices. In addition, agent qualifications are taken into account. In other words, not every job can be assignable to every agent. The problem is defined by considering the problem of assigning jobs to employees in a firm. BGAP has been shown to be NP- hard. Consequently, a multi-start iterated tabu search (MITS) algorithm has been proposed for the solution of large-scale problems. The results of the proposed algorithm are compared by the results of the tabu search (TS) algorithm and mixed integer linear programming (MILP) model.
Abscess formation following hydrogel spacer for prostate cancer radiotherapy: a rare complication
Authors: Hoe Venetia , Yao Henry Han-I , Huang James G , Guerrieri Mario
Published: October 2019

Periprostatic abscess is a rare complication of hydrogel spacers in radiotherapy for prostate cancer. We present the case of a 61-year-old man who developed this condition. Abdominopelvis CT scan revealed a 54×35×75 mm collection in the location of the SpaceOAR, for which ultrasound-guided transperineal percutaneous drainage of the periprostatic abscess was performed. The patient remains well with serial CT scans showing near resolution of the collection.
Positive molecular breast imaging: challenges and problem solving with contrast-enhanced spectral mammography
Authors: Ong Jeremy SL , Whitewood Felicity , Taylor Donna B , Dissanayake Deepthi
Published: October 2019

Molecular breast imaging (MBI) is a relatively new technique with high sensitivity for breast cancer detection. However, because it only provides limited anatomical information, cross-correlation of MBI findings with conventional breast imaging modalities such as full field digital mammography can be challenging. We report a case of a positive MBI study in a supplemental screening setting, where cross-correlation of MBI, ultrasound, mammogram and biopsy findings was difficult. Contrast-enhanced spectral mammography (CESM) demonstrated a hypervascular lesion at the biopsy clip, helping to prove imaging/histopathological concordance. This case highlights the challenges of incorporating MBI into conventional imaging workup, as well as the use of CESM in problem solving.
Small bowel diaphragm disease from long-term non-steroidal anti-inflammatory use
Authors: Pereira Ryan , Slater Kellee
Published: October 2019

Small bowel diaphragm disease (SBDD) is characterised by circumferential lesions of short length (<5 mm), causing intrinsic stenosis of the small bowel lumen. A 63-year-old women with a history of long-term non-steroidal anti-inflammatory use, presented with a 12-month history of intermittent episodes of colicky abdominal pain, nausea and vomiting. Her only past surgery was a laparoscopic hysterectomy. Abdominal CT demonstrated an area of thickening in the mid small bowel, however a diagnostic laparoscopy failed to demonstrate adhesions or any external abnormality. A capsule endoscope did not progress beyond the mid small bowel at the site of a suspected diaphragm. The patient underwent a laparotomy and using the retained capsule as a marker, the area of bowel affected by SBDD was identified. With an ageing population and the widespread use of non-steroidalanti-inflammatory drugs, general surgeons may see an increase in the incidence of SBDD.
Iatrogenic pneumothorax following vigorous suctioning of mucus plug during flexible bronchoscopy
Authors: Muthu Valliappan , Sehgal Inderpaul Singh , Prasad Kuruswamy Thurai , Agarwal Ritesh
Published: October 2019

Flexible bronchoscopy is a commonly performed procedure in pulmonary medicine. The common complications following bronchoscopy include minor bleeding, transient hypoxaemia, pneumothorax and others. Pneumothorax during diagnostic flexible bronchoscopy is mainly encountered after performing transbronchial lung biopsy. Iatrogenic pneumothorax is uncommon when lung biopsy is not performed. Herein, we report the unusual occurrence of pneumothorax following bronchoscopic suctioning while removing a mucus plug.
Novel missense mutation in the ATP1A2 gene associated with atypical sporadic hemiplegic migraine
Authors: Rispoli Marianna Gabriella , Di Stefano Vincenzo , Mantuano Elide , De Angelis Maria Vittoria
Published: October 2019

Hemiplegic migraine (HM) is a rare subtype of migraine with aura in which attacks include transient motor weakness or hemiparesis that can last several days. HM is linked to mutations in three different genes, CACNA1A, ATP1A2 and SCN1A, which encode for ion transporters. The clinical spectrum includes atypical symptoms such as impaired consciousness, epileptic seizures, permanent cerebellar ataxia or mental retardation. We describe a novel mutation found in the ATP1A2 gene in a patient with late-onset HM. His attacks were characterised by motor weakness associated with altered mental status, diplopia and ataxia. He also showed up MRI abnormalities and incomplete response to prophylactic therapy with verapamil. Late-onset HM should be considered among the possible causes of focal neurological deficits even in older patients with cerebrovascular risk factors when a stroke appears to be more likely.
Coexistence of myasthenia gravis with hypokalemic periodic paralysis: a rare presentation
Authors: Khan Farah Gul , Namran Sidra
Published: October 2019

Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.
Atypical radiological presentation of multiple cystic brain metastases from lung cancer simulating neurocysticercosis
Authors: Barbone Filomena , Peri Marta , Vitale Michela , Di Stefano Vincenzo
Published: October 2019

Brain metastases (BMs) are usually characterised by vasogenic oedema and mass effect, but cystic appearance can rarely occur, mimicking parasitosis, such as neurocysticercosis (NCC). A woman in her mid-50s was admitted for dizziness and upper left extremity paresis. Neuroimaging showed multiple cystic lesions consistent with multiple stages of NCC evolution, and empiric albendazole was started, without any clinical improvement. A whole-body CT revealed a pulmonary lesion in the right superior lobe. Pathological analysis from brain specimen demonstrated a clear cell lung carcinoma. The patient gradually worsened and died 4 months after the diagnosis. In conclusion, multiple cystic BMs are an atypical presentation on neuroimaging; in these cases, a meticulous diagnostic workup should be performed, looking for the possible site of malignancy. Even when it is not possible to perform a biopsy from the primitive lesion, as reported in this case, a brain biopsy should be considered.
Melanotic neuroectodermal tumour of infancy presenting as a lytic lesion in femur: a rare tumour at a rare site with an unusual behaviour
Authors: Bhardwaj Nishu , Yadav Rajni , Sampath Kumar Venkatesan , Khan Shah Alam
Published: October 2019

Melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon tumour, predominantly occurring in head and neck, mostly maxilla, but also in skull and mandible. Although a benign lesion, it is known to recur in 15%–27% of cases, and rarely, may undergo malignant transformation. We present a case of a 5-month-old female patient, who presented with a gradually progressive swelling in the right thigh. On imaging, an osteolytic lesion was seen, involving the metadiaphysis of shaft of right femur. A biopsy was performed, on which diagnosis of MNTI was made. MNTI is rarely seen in extremities. To the best of our knowledge, only six cases have been reported in femur, the present case being the seventh. The tumour showed spontaneous regression on follow-up in our patient, which has rarely been described. A knowledge of characteristic morphology and immunohistochemistry is the key to differentiate it from other tumours.
Glaucoma following cataract surgery in the first 2 years of life: frequency, risk factors and outcomes from IoLunder2
Authors: Solebo Ameenat Lola , Rahi Jugnoo S
Published: October 2019

Background

We investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohort

Methods

Population based observational cohort study of children undergoing cataract surgery aged 2 years or under between January 2009 and December 2010. Glaucoma was defined using internationally accepted taxonomies based on the consequences of elevated intraocular pressure (IOP). Glaucoma related adverse events were any involving elevated IOP. Multivariable analysis was undertaken to investigate potential predictors of secondary glaucoma with adjustment for within-child correlation in bilateral cataract. Unilateral and bilateral cataract were analysed separately.

Results

Complete follow-up data were available for 235 of 254, 93% of the inception cohort. By 5 years after primary cataract surgery, 20% of children with bilateral cataract and 12% with unilateral had developed secondary glaucoma. Glaucoma related complications had been diagnosed in 24% and 36% of children, respectively. Independent predictors of glaucoma were younger age at surgery (adjusted OR for reduction of week in age: 1.1, 95%C I 1.1 to 1.2, p<0.001); the presence of significant ocular comorbidity (adj OR 3.2, 95% CI 1.1 to 9.6, p=0.01); and shorter axial length (adj OR for each mm 1.7, 95% CI 10.0 to 1, p=0.05) for bilateral cataract. Shorter axial length was the single independent factor in unilateral disease (adj OR 9.6, 95% CI 1.7 to 52, p=0.009)

Conclusions

Both younger age at surgery (the strongest marker of ocular ‘immaturity’) and smaller ocular size (a marker of both immaturity and developmental vulnerability) can be used to identify those at greatest risk of glaucoma due to early life cataract surgery.
The state of strategic plans for the health workforce in Africa
Authors: Afriyie Doris Osei , Nyoni Jennifer , Ahmat Adam
Published: October 2019

Many African countries have a shortage of health workers. As a response, in 2012, the Ministers of Health in the WHO African Region endorsed a Regional Road Map for Scaling Up the Health Workforce from 2012 to 2025. One of the key milestones of the roadmap was the development of national strategic plans by 2014. It is important to assess the extent to which the strategic plans that countries developed conformed with the WHO Roadmap. We examine the strategic plans for human resource for health (HRH) of sub-Saharan African countries in 2015 and assess the extent to which they take into consideration the WHO African Region’s Roadmap for HRH. A questionnaire seeking data on human resources for health policies and plans was sent to 47 Member States and the responses from 43 countries that returned the questionnaires were analysed. Only 72% had a national plan of action for attaining the HRH target. This did not meet the 2015 target for the WHO, Regional Office for Africa’s Roadmap. The plans that were available addressed the six areas of the roadmap. Despite all their efforts, countries will need further support to comprehensively implement the six strategic areas to maintain the health workers required for universal health coverage
Poor availability of essential medicines for women and children threatens progress towards Sustainable Development Goal 3 in Africa
Authors: Droti Benson , O’Neill Kathryn Patricia , Mathai Matthews , Yao Tsidi Dovlo Delanyo , Robertson Jane
Published: October 2019

Background

Most maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide life-saving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality.

Methods

Available data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported.

Results

The mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%–80% (median 61%) versus 20%–39% (median 23%) and for children’s medicines 31%–71% (median 58%) versus 27%–57% (median 48%). Availability was higher in public than private facilities: for women’s medicines, range 21%–41% (median 34%) versus 4%–36% (median 27%) and for children’s medicines 28%–58% (median 51%) versus 5%–58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children’s medicines.

Conclusions

The survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.
Contribution of primary care organisation and specialist care provider to variation in GP referrals for suspected cancer: ecological analysis of national data
Authors: Burton Christopher , O'Neill Luke , Oliver Phillip , Murchie Peter
Published: October 2019

Objectives

To examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations.

Design

Ecological analysis of national data on fast-track referrals for suspected cancer from general practices. Data were analysed at the levels of general practice, primary care organisation (Clinical Commissioning Group) and secondary care provider (Acute Hospital Trust) level. Analysis of variation in detection rate was by multilevel linear and Poisson regression.

Setting

6379 group practices with data relating to more than 50 cancer cases diagnosed over the 5 years from 2013 to 2017.

Outcomes

Proportion of observed variation attributable to primary and secondary care organisations in standardised fast-track referral rate and in cancer detection rate before and after adjustment for practice characteristics.

Results

Primary care organisation accounted for 21% of the variation between general practices in the standardised fast-track referral rate and 42% of the unadjusted variation in cancer detection rate. After adjusting for standardised fast-track referral rate, primary care organisation accounted for 31% of the variation in cancer detection rate (compared with 18% accounted for by practice characteristics). In areas where a hospital trust was the main provider for multiple primary care organisations, hospital trusts accounted for the majority of the variation attributable to local health services (between 63% and 69%).

Conclusion

This is the first large-scale finding that a substantial proportion of the variation between general practitioner practices in referrals is attributable to their local healthcare systems. Efforts to reduce variation need to focus not just on individual practices but on local diagnostic service provision and culture at the interface of primary and secondary care.
Gut microbiota shape ‘inflamm-ageing’ cytokines and account for age-dependent decline in DNA damage repair
Authors: Guedj Avital , Volman Yael , Geiger-Maor Anat , Bolik Julia , Schumacher Neele , Künzel Sven , Baines John F , Nevo Yuval , Elgavish Sharona , Galun Eithan , Amsalem Hagai , Schmidt-Arras Dirk , Rachmilewitz Jacob
Published: October 2019

Objective

Failing to properly repair damaged DNA drives the ageing process. Furthermore, age-related inflammation contributes to the manifestation of ageing. Recently, we demonstrated that the efficiency of repair of diethylnitrosamine (DEN)-induced double-strand breaks (DSBs) rapidly declines with age. We therefore hypothesised that with age, the decline in DNA damage repair stems from age-related inflammation.

Design

We used DEN-induced DNA damage in mouse livers and compared the efficiency of their resolution in different ages and following various permutations aimed at manipulating the liver age-related inflammation.

Results

We found that age-related deregulation of innate immunity was linked to altered gut microbiota. Consequently, antibiotic treatment, MyD88 ablation or germ-free mice had reduced cytokine expression and improved DSBs rejoining in 6-month-old mice. In contrast, feeding young mice with a high-fat diet enhanced inflammation and facilitated the decline in DSBs repair. This latter effect was reversed by antibiotic treatment. Kupffer cell replenishment or their inactivation with gadolinium chloride reduced proinflammatory cytokine expression and reversed the decline in DSBs repair. The addition of proinflammatory cytokines ablated DSBs rejoining mediated by macrophage-derived heparin-binding epidermal growth factor-like growth factor.

Conclusions

Taken together, our results reveal a previously unrecognised link between commensal bacteria-induced inflammation that results in age-dependent decline in DNA damage repair. Importantly, the present study support the notion of a cell non-autonomous mechanism for age-related decline in DNA damage repair that is based on the presence of ‘inflamm-ageing’ cytokines in the tissue microenvironment, rather than an intrinsic cellular deficiency in the DNA repair machinery.
Overexpression of EI2BL promoted human non-small cell lung cancer progression by inducing cell EMT phenotype
Authors: Li Hao-Ran , Qiu Bai-Quan , Gao Jian , Jin Chun , Jiang Jia-Hao , Ding Jian-Yong
Published: October 2019

Aims

To unveil the role of EI2BL in non-small cell lung cancer (NSCLC) and the relationship between expression of EI2BL and the prognosis of patients with NSCLC.

Methods

Immunohistochemistry (IHC), western blot analysis, immunofluorescence and real-time quantitative PCR (RT-qPCR) were used to evaluate EI2BL protein and mRNA levels in NSCLC and corresponding peritumour tissues. Cell Counting Kit-8, transwell assay and wound healing assay were used to analyse the abilities of cell proliferation, invasion and migration. In addition, the analysis of epithelial-mesenchymal transition (EMT) markers was also assessed by western blot analysis, RT-qPCR and immunofluorescence. Tissue micro-array analysis of 200 NSCLC cases was used to assess the relationship between EI2BL expression and clinicopathological characteristics. Moreover, the prognostic role of EI2BL in 200 patients with NSCLC was evaluated by Cox regression models and Kaplan-Meier methods.

Results

Elevated EI2BL expression was more common in NSCLC tissues than paired peritumour tissues in both mRNA and protein level. EI2BL promoted the proliferation, invasion and migration of NSCLC cells. In addition, aberrant EI2BL expression might modulate the expression of key molecules of EMT by ERK1/2 signal pathway. The expression of EI2BL was significantly associated with tumour stage, lymph node metastasis and tumour size. Moreover, higher expression of EI2BL in patients with NSCLC had a poor overall survival rate.

Conclusions

Our study illustrated that elevated expression of EI2BL promoted NSCLC cell proliferation, migration and invasion and EI2BL overexpression may be a reliable biomarker of poor prognosis.
What can public health do for the welfare state? Occupational health could be an answer
Authors: Benavides Fernando G , Serra Consol , Delclos George L
Published: October 2019

Background

The welfare state has a long history of uncertain future. Nonetheless, health indicators of people living in countries with a more universal and generous welfare state remain better than those living under less generous and more individualist welfare regimes. In this essay, we reflect on how occupational health, as part of public health, can contribute to the sustainability of the welfare state.

Methods

Over the course of the political and social transformations of the State, from single guarantor of security to assuming civil and social rights, the practice of public health has added, to its original objectives related to the control of epidemics of contagious diseases, the promotion of health and the reduction of inequalities in health. In the context of the 2030 Agenda of Sustainable Development Goals, there is a great opportunity to expand the welfare state through public health policies.

Results

On the other hand, the welfare state is only possible when persons are employed in the formal sector. Through their taxes, workers and employers support the welfare state. Occupational health, by preventing injury and illness, and promoting the health of working people, can contribute significantly to the existence of decent work and a quality labour market.

Conclusion

The mission of occupational health is to help people enjoy a healthy and prolonged working life, as a critical component of human well-being.
Increasing knowledge in IGF1R defects: lessons from 35 new patients
Authors: Giabicani Eloïse , Willems Marjolaine , Steunou Virginie , Chantot-Bastaraud Sandra , Thibaud Nathalie , Abi Habib Walid , Azzi Salah , Lam Bich , Bérard Laurence , Bony-Trifunovic Hélène , Brachet Cécile , Brischoux-Boucher Elise , Caldagues Emmanuelle , Coutant Regis , Cuvelier Marie-Laure , Gelwane Georges , Guemas Isabelle , Houang Muriel , Isidor Bertrand , Jeandel Claire , Lespinasse James , Naud-Saudreau Catherine , Jesuran-Perelroizen Monique , Perrin Laurence , Piard Juliette , Sechter Claire , Souchon Pierre-François , Storey Caroline , Thomas Domitille , Le Bouc Yves , Rossignol Sylvie , Netchine Irène , Brioude Frédéric
Published: October 2019

Background

The type 1 insulin-like growth factor receptor (IGF1R) is a keystone of fetal growth regulation by mediating the effects of IGF-I and IGF-II. Recently, a cohort of patients carrying an IGF1R defect was described, from which a clinical score was established for diagnosis. We assessed this score in a large cohort of patients with identified IGF1R defects, as no external validation was available. Furthermore, we aimed to develop a functional test to allow the classification of variants of unknown significance (VUS) in vitro.

Methods

DNA was tested for either deletions or single nucleotide variant (SNV) and the phosphorylation of downstream pathways studied after stimulation with IGF-I by western blot analysis of fibroblast of nine patients.

Results

We detected 21 IGF1R defects in 35 patients, including 8 deletions and 10 heterozygous, 1 homozygous and 1 compound-heterozygous SNVs. The main clinical characteristics of these patients were being born small for gestational age (90.9%), short stature (88.2%) and microcephaly (74.1%). Feeding difficulties and varying degrees of developmental delay were highly prevalent (54.5%). There were no differences in phenotypes between patients with deletions and SNVs of IGF1R. Functional studies showed that the SNVs tested were associated with decreased AKT phosphorylation.

Conclusion

We report eight new pathogenic variants of IGF1R and an original case with a homozygous SNV. We found the recently proposed clinical score to be accurate for the diagnosis of IGF1R defects with a sensitivity of 95.2%. We developed an efficient functional test to assess the pathogenicity of SNVs, which is useful, especially for VUS.
Complete loss of KCNA1 activity causes neonatal epileptic encephalopathy and dyskinesia
Authors: Verdura Edgard , Fons Carme , Schlüter Agatha , Ruiz Montserrat , Fourcade Stéphane , Casasnovas Carlos , Castellano Antonio , Pujol Aurora
Published: October 2019

Background

Since 1994, over 50 families affected by the episodic ataxia type 1 disease spectrum have been described with mutations in KCNA1, encoding the voltage-gated K+ channel subunit Kv1.1. All of these mutations are either transmitted in an autosomal-dominant mode or found as de novo events.

Methods

A patient presenting with a severe combination of dyskinesia and neonatal epileptic encephalopathy was sequenced by whole-exome sequencing (WES). A candidate variant was tested using cellular assays and patch-clamp recordings.

Results

WES revealed a homozygous variant (p.Val368Leu) in KCNA1, involving a conserved residue in the pore domain, close to the selectivity signature sequence for K+ ions (TVGYG). Functional analysis showed that mutant protein alone failed to produce functional channels in homozygous state, while coexpression with wild-type produced no effects on K+ currents, similar to wild-type protein alone. Treatment with oxcarbazepine, a sodium channel blocker, proved effective in controlling seizures.

Conclusion

This newly identified variant is the first to be reported to act in a recessive mode of inheritance in KCNA1. These findings serve as a cautionary tale for the diagnosis of channelopathies, in which an unreported phenotypic presentation or mode of inheritance for the variant of interest can hinder the identification of causative variants and adequate treatment choice.
Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study
Authors: Verboon Christine , van den Berg Bianca , Cornblath David R , Venema Esmee , Gorson Kenneth C , Lunn Michael P , Lingsma Hester , Van den Bergh Peter , Harbo Thomas , Bateman Kathleen , Pereon Yann , Sindrup Søren H , Kusunoki Susumu , Miller James , Islam Zhahirul , Hartung Hans-Peter , Chavada Govindsinh , Jacobs Bart C , Hughes Richard A C , van Doorn Pieter A
Published: October 2019

Objective

To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.

Methods

From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.

Results

Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an ‘early’ second IVIg course (1–2 weeks after start of the first IVIg course) and 18 patients a ‘late’ second IVIg course (2–4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.

Conclusions

This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.
Sarah Orne Jewett’s depictions of women in a changing medical profession: Nan Prince and Almira Todd
Authors: Hand Catherine
Published: October 2019

Sarah Orne Jewett, who lived from 1849 to 1909, witnessed a revolution in medicine that led to the formation of the medical profession as it is recognised today. By comparing two of the author’s works, one written at the outset of her career and the other written much later, this paper discusses how Jewett’s views about women’s role in medicine changed and developed. In the first novel,A Country Doctor, a young Jewett celebrates the new-found power of scientific medicine in the period directly after germ theory was widely adopted. The author depicts a female physician as a pioneer bravely breaking into a male-dominated field. Later, inThe Country of the Pointed Firs, Jewett’s depiction of a female medical practitioner is much more nuanced— the matured writer’s views are accompanied by discrete but deep-seated criticisms of medical ideology as she saw it developing. The comparison of these novels gives us insight into Jewett’s world, and leaves questions for readers today. Most importantly, how should women today approach traditional medicine given the discipline’s deeply misogynist roots? Jewett’s unique perspectives serve as a catalyst for this discussion.
Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact
Authors: Espinel‐Rupérez Jorge , Martín‐Ríos Maria Dolores , Salazar Veronica , Baquero‐Artigao Maria Rosario , Ortiz‐Díez Gustavo
Published: October 2019

Objectives

To determine (1) the incidence of surgical site infection (SSI) in patients undergoing soft tissue surgery at a veterinary teaching hospital and to study (2) and describe the main risk factors associated with SSI and (3) assess the economic impact of SSI.

Design

Prospective cohort study.

Setting

Veterinary teaching hospital.

Participants

184 dogs undergoing soft tissue surgery during a 12‐month period (October 2013 to September 2014).

Primary outcome measure

Surgical site infection.

Results

Out of the 184 patients analysed, SSI was diagnosed in 16 (8.7 per cent) patients, 13 (81.3 per cent) were classified as superficial incisional infection, 2 (12.5 per cent) as deep incisional infection and 1 (6.3 per cent) as organ/space infection. The administration of steroidal anti‐inflammatory drugs (P=0.028), preoperative hyperglycaemia (P=0.015), surgical times longer than 60 minutes (P=0.013), urinary catheterisation (P=0.037) and wrong use of the Elizabethan collar (P=0.025) were identified as risk factors. Total costs increased 74.4 per cent, with an increase in postsurgical costs of 142.2 per cent.

Conclusions

The incidence of SSI was higher than the incidence reported in other published studies, although they were within expected ranges when a surveillance system was implemented. This incidence correlated with an increase in costs. Additionally new important risk factors for its development were detected.
Longitudinal study describing time to Salmonella seroconversion in piglets on three farrow‐to‐finish farms
Authors: Cevallos‐Almeida Maria , Fablet Christelle , Houdayer Catherine , Dorenlor Virginie , Eono Florent , Denis Martine , Kerouanton Annaëlle
Published: October 2019

Background

Pigs are frequently colonised with Salmonella enterica, and this constitutes a major risk for human salmonellosis. The infection can be assessed by the serological response of pigs to S enterica. A longitudinal study was undertaken on‐farm to correctly describe this serological response and investigate factors associated with age at Salmonella seroconversion.

Methods

Three pig farms and in each farm three successive batches were considered. Per batch, 40 piglets were selected at random from 10 sows (four piglets per sow). Blood was sampled from sows one week after farrowing and from piglets at weeks 1, 6, 10, 14, 18 and 22 and at the slaughterhouse. Salmonella antibodies were detected in serum using a commercial ELISA test. Factors related to farm characteristics, batch management system, porcine reproductive and respiratory syndrome infection, and sows’ Salmonella serological status were recorded to assess their effect on age at seroconversion.

Results

At week 1 after farrowing, 96.5 per cent of the sows had antibodies against Salmonella. The serological results of piglets at weeks 1 and 6 only were positively correlated with those of the sows. The average age at Salmonella seroconversion was 137±2.2 days (confidence interval at 95 per cent). The first seroconversions occurred from weeks 10 to 14, but most of the pigs (54.6 per cent) were seropositive at the end of the fattening period, with variations between farms and batches (28.9–75.7 per cent). Herd/farm was significantly associated with age at seroconversion.

Conclusion

This longitudinal study allowed the authors to follow precisely the evolution of Salmonella seroconversion from maternity to slaughterhouse and confirm the relationship between the seroconversion of sows and serology of their piglets. Moreover, factors related to farm practices and management as a whole are more influential than individual factors (at the pig level) on age at Salmonella seroconversion.
Axions are blind to anomalies
Authors: Quevillon Jérémie , Smith Christopher
Published: October 2019

The axion couplings to SM gauge bosons are derived in various models, and shown to always arise entirely from non-anomalous fermion loops. They are thus independent of the anomaly structure of the model. This fact is without consequence for vector gauge interactions like QCD and QED, but has a major impact for chiral gauge theories. For example, in the DFSZ axion model, the couplings of axions to electroweak gauge bosons do not follow the pattern expected from chiral anomalies, as we prove by an explicit calculation. The reason for this mismatch is traced back to triangle Feynman diagrams sensitive to the anomalous breaking of the vector Ward identity, and is ultimately related to the conservation of baryon and lepton numbers. Though our analyses are entirely done for true axion models, this observation could have important consequences for axion-like particle searches.
Self-Control and Crime: Beyond Gottfredson & Hirschi's Theory
Authors: Burt Callie H.
Published: October 2019

Over the past several decades, Gottfredson & Hirschi's self-control theory (SCT) has dominated research on self-control and crime. In this review, I assess the current state of self-control knowledge and encourage the field to move beyond SCT, as its peculiar conceptualization of self-control and the causal model present challenges for integrative scholarship. Drawing heavily on scholarship outside criminology, I clarify the definition of self-control; describe the malleable nature of trait self-control; highlight its situational variability as state self-control; and consider the multiplicity of contextual, situational, and individual factors that affect its operation in relation to crime. This specification of contingencies and the interplay between impulse strength and control efforts in the process of self-control is intended as a springboard for research moving beyond SCT and its key premise that self-control (ability) is sufficient to explain individual variation in crime (i.e., is tantamount to criminality). Finally, I address what I see as important areas for further study in light of current knowledge.
Mitochondrial Dynamics and Its Involvement in Disease
Authors: Chan David C.
Published: October 2019

The dynamic properties of mitochondria—including their fusion, fission, and degradation—are critical for their optimal function in energy generation. The interplay of fusion and fission confers widespread benefits on mitochondria, including efficient transport, increased homogenization of the mitochondrial population, and efficient oxidative phosphorylation. These benefits arise through control of morphology, content exchange, equitable inheritance of mitochondria, maintenance of high-quality mitochondrial DNA, and segregation of damaged mitochondria for degradation. The key components of the machinery mediating mitochondrial fusion and fission belong to the dynamin family of GTPases that utilize GTP hydrolysis to drive mechanical work on biological membranes. Defects in this machinery cause a range of diseases that especially affect the nervous system. In addition, several common diseases, including neurodegenerative diseases and cancer, strongly affect mitochondrial dynamics.
Cardiomyocyte Polyploidy and Implications for Heart Regeneration
Authors: Gan Peiheng , Patterson Michaela , Sucov Henry M.
Published: October 2019

In mammals, most cardiomyocytes (CMs) become polyploid (they have more than two complete sets of chromosomes). The purpose of this review is to evaluate assumptions about CM ploidy that are commonly discussed, even if not experimentally demonstrated, and to highlight key issues that are still to be resolved. Topics discussed here include ( a) technical and conceptual difficulties in defining a polyploid CM, ( b) the candidate role of reactive oxygen as a proximal trigger for the onset of polyploidy, ( c) the relationship between polyploidization and other aspects of CM maturation, ( d) recent insights related to the regenerative role of the subpopulation of CMs that are not polyploid, and ( e) speculations as to why CMs become polyploid at all. New approaches to experimentally manipulate CM ploidy may resolve some of these long-standing and fundamental questions.
Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction
Authors: Vergaro Giuseppe , Ghionzoli Nicolò , Innocenti Lisa , Taddei Claudia , Giannoni Alberto , Valleggi Alessandro , Borrelli Chiara , Senni Michele , Passino Claudio , Emdin Michele
Published: October 2019

Background

A thorough analysis of noncardiac determinants of mortality in heart failure (
HF
) is missing. Furthermore, evidence conflicts on the outcome of patients with
HF
and no or mild systolic dysfunction. We aimed to investigate the prevalence of noncardiac and cardiac causes of death in a cohort of chronic
HF
patients, covering the whole spectrum of systolic function.

Methods and Results

We enrolled 2791 stable
HF
patients, classified into HF with reduced ejection fraction (
HF
r
EF
; left ventricular ejection fraction [EF] <40%), HR with midrange EF (
HF
mr
EF
; left ventricular
EF
41–49%), or HF with preserved
EF
(
HF
p
EF
; left ventricular
EF
≥50%), and followed up for all‐cause, cardiac, and noncardiac mortality (adjudicated as due to cancer, sepsis, respiratory disease, renal disease, or other causes). Over follow‐up of 39 months, adjusted mortality was lower in
HF
p
EF
and
HF
mr
EF
versus
HF
r
EF
(hazard ratio: 0.75 [95%
CI,
0.67–0.84],
P
<0.001 for
HF
p
EF
; hazard ratio: 0.78 [95%
CI
, 0.63–0.96],
P
=0.017 for
HF
mr
EF
).
HF
r
EF
had the highest rates of cardiac death, whereas noncardiac mortality was similar across left ventricular
EF
categories. Noncardiac causes accounted for 62% of deaths in
HF
p
EF
, 54% in
HF
mr
EF
and 35% in
HF
r
EF
; cancer was twice as frequent as a cause of death in
HF
p
EF
and
HF
mr
EF
versus
HF
r
EF
. Yearly rates of noncardiac death exceeded those of cardiac death since the beginning of follow‐up in
HF
p
EF
and
HF
mr
EF
.

Conclusions

Noncardiac death is a major determinant of outcome in stable
HF
, exceeding cardiac‐related mortality in
HF
p
EF
and
HF
mr
HF
. Comorbidities should be regarded as main therapeutic targets and objects of dedicated quality improvement initiatives, especially in patients with no or mild systolic dysfunction.
Unlocking the Arctic’s Resources Equitably: Using a Law-and-Science Approach to Fix the Beaufort Sea Boundary
Authors: Bekker Pieter , van de Poll Robert
Published: October 2019

This article analyses the unresolved maritime boundary situated in Arctic waters in the Beaufort Sea, between Canada and the United States through an integrated law-and-science approach incorporating new imagery technology. Resolving the Canada-United States disagreement over the Beaufort Sea boundary based on modern geo-scientific technology and the three-step delimitation methodology developed in the jurisprudence of international courts and tribunals could serve as a catalyst for the peaceful and equitable resolution of all other unresolved boundaries in the Arctic Ocean. This includes the boundaries involving Russia, which can claim more than 40 per cent of the Arctic shoreline. Given that the United States is not a party to the United Nations Convention on the Law of the Sea, this article focuses on mechanisms available to Canada and the United States under general international law and by applying ‘best law’ and ‘best science’.
Range sizes of groundwater amphipods (Crustacea) are not smaller than range sizes of surface amphipods: a case study from Iran
Authors: Esmaeili-Rineh Somayeh , Mamaghani-Shishvan Mahmoud , Fišer Cene , Akmali Vahid , Najafi Nargess
Published: October 2019

The connectivity of groundwater aquifers is lower compared to surface waters. Consequently, groundwater species are expected to have smaller distributional ranges than their surface relatives. Molecular taxonomy, however, unveiled that many species comprise complexes of morphologically cryptic species, with geographically restricted distributional ranges in subterranean as well as in surface waters. Hence, the range sizes of surface and groundwater species might be more similar in size than hitherto thought. We tested this hypothesis by comparing the range size of surface amphipods of the genus Gammarus and subterranean amphipods of the genus Niphargus in Iran. We re-analyzed the taxonomic structure of both genera using two unilocus species delimitation methods applied to a fragment of the COI mitochondrial marker, to identify molecular operational taxonomic units (MOTUs), and assessed the maximum linear extent (MLE) of the ranges of MOTUs from both genera. Genus Gammarus comprised 44–58 MOTUs while genus Niphargus comprised 20–22 MOTUs. The MLEs of the two genera were not significantly different, regardless the delimitation method applied. The results remained unchanged also after exclusion of single site MOTUs. We tentatively conclude that in this case there is no evidence to consider that groundwater species are geographically more restricted than surface species.
A Propensity Score Method for Investigating Differential Item Functioning in Performance Assessment
Authors: Chen Michelle Y. , Liu Yan , Zumbo Bruno D.
Published: October 2019

This study introduces a novel differential item functioning (DIF) method based on propensity score matching that tackles two challenges in analyzing performance assessment data, that is, continuous task scores and lack of a reliable internal variable as a proxy for ability or aptitude. The proposed DIF method consists of two main stages. First, propensity score matching is used to eliminate preexisting group differences before the test, ideally creating equivalent groups as in a randomized experimental study. Then, linear mixed effects models are adopted to perform DIF analysis based on the matched data set. We demonstrate this propensity DIF method using a high-stakes functional English language proficiency test. DIF due to education was investigated in the writing component, which consists of two continuously scored performance-based tasks. Although the proposed method is demonstrated in the context of language testing, it can be applied to other types of performance assessments.
Cross-cultural nuances of the sources and consequences of subjective feelings of unsafety: A qualitative analysis in four cities
Authors: Valente Riccardo , Crescenzi Lanna Lucrezia
Published: October 2019

The research aims at analyzing the fear of crime and its consequences on social cohesion and informal social control. The study is based on data collected through a triangulation of qualitative techniques (in-depth interviews, participant observation, and semi-structured focus groups) throughout eight neighborhoods of four European cities. Challenging the initial expectations, the results obtained show that, under certain circumstances, the fear of crime might foster genuine forms of social involvement and problem-solving participation. Nevertheless, the general trend indicates that crime-related anxieties are fueling the emergence of nostalgic, passive-aggressive, and violent forms of identity, which might promote potentially dangerous types of collective action.
Hidden Success: Learning From the Counternarratives of High School Graduates Impacted by Student Homelessness
Authors: Edwards Earl J.
Published: October 2019

The number of youth experiencing homelessness in the United States has nearly doubled over the past decade from 688,000 in 2006 to over 1.3 million as of 2017. While graduating high school is a significant barrier for many students experiencing homelessness, many youth are able to successfully graduate despite their unstable living conditions. This qualitative study used the antideficit achievement framework to analyze the counternarratives of eight youth who successfully graduated high school while experiencing homelessness. Findings showed that strong peer relationships, the support from caring teachers, and attending church served as impactful influences that helped youth experiencing homelessness graduate high school.
Caregiver Experiences of Care Coordination for Recently Discharged Patients: A Qualitative Metasynthesis
Authors: Callister Catherine , Jones Jacqueline , Schroeder Shara , Breathett Khadijah , Dollar Blythe , Sanghvi Urvi Jhaveri , Harnke Ben , Lum Hillary D. , Jones Christine D.
Published: October 2019

Caregivers of patients often provide key support for patients after hospitalization. This qualitative metasynthesis describes caregiver perspectives about care coordination for patients discharged from the hospital. A literature search of Ovid Medline and CINAHL completed on May 23, 2018, identified 1,546 studies. Twelve articles were included in the final metasynthesis. Caregiver perspectives about care coordination were compiled into overall themes. A subanalysis of studies in which patients were discharged with home health services was completed. Five main themes emerged related to caregiver perspectives on care coordination after hospitalization: (a) Suboptimal access to clinicians after discharge, (b) Feeling disregarded by clinicians, (c) Need for information and training at discharge, (d) Overwhelming responsibilities to manage appointments and medications, and (e) Need for emotional support.

Findings from this metasynthesis suggest the need for clinicians to engage with caregivers to provide support, training, and communication after hospital discharge.