bluuebunny/crossref_metadata_2025 huggingface dataset:
Stereology of the Peripheral Nervous System
Authors: Brown Danielle L. , Staup Michael , Swanson Cynthia
Published: June 2019

Qualitative histopathology has been the gold standard for evaluation of morphological tissue changes in all organ systems, including the peripheral nervous system. However, the human eye is not sensitive enough to detect small changes in quantity or size. Peripheral nervous system toxicity can manifest as subtle changes in neuron size, neuron number, axon size, number of myelinated or unmyelinated axons, or number of nerve fibers. Detection of these changes may be beyond the sensitivity of the human eye alone, necessitating quantitative approaches in some cases. Although 2-dimensional (2D) histomorphometry can provide additional information and is more sensitive than qualitative evaluation alone, the results are not always representative of the entire tissue and assumptions about the tissue can lead to bias, or inaccuracies, in the data. Design-based stereology provides 3D estimates of number, volume, surface area, or length, and stereological principles can be applied to peripheral nervous system tissues to obtain accurate and precise estimates, such as neuron number and size, axon number, and total intraepidermal nerve fiber length. This review describes practical stereological approaches to 3 compartments of the peripheral nervous system: ganglia, peripheral nerves, and intraepidermal nerve fibers.
Residents’ assessment of local government road infrastructure delivery in Ile-Ife, Nigeria
Authors: Olojede Olorunfemi A , Agbola Samuel B , Samuel Kayode J
Published: June 2019

Ensuring adequate provision of municipal infrastructure, utilities and services constitutes a major rationale for the local government administration in Nigeria. This paper examined the road infrastructure delivery performance (provision, maintenance and rehabilitation) of the local administration in the two local government areas of Ile-Ife, Nigeria. Data were obtained with the aid of questionnaire and key-informant interview. Using multistage sampling, 600 residents were surveyed. The key-informant interviews were conducted on three local government senior administrative officers. Descriptive statistics and thematic content analysis were employed in the analysis. The study found that the local administrations in the city lacked autonomy, as they practically advance the cause of the state government. Thus, they could neither initiate nor execute any infrastructure project independently. It was also found that residents in the city were often required to contribute financially towards the construction and maintenance of transport infrastructure in their neighbourhoods. The study concluded that the performance of the local administration in the city was poor in terms of its statutory duty of municipal road infrastructure delivery. Consequently, the paper recommends the enhancement of the overall performance of local administration in Osun State through the granting of full political and financial autonomy to the local government.
Unexpected serious aplastic anemia from PD-1 inhibitors: beyond what we know
Authors: Filetti Marco , Giusti Raffaele , Di Napoli Arianna , Iacono Daniela , Marchetti Paolo
Published: June 2019

Introduction:

The recent introduction of checkpoint inhibitor–based immunotherapy has revolutionized the treatment of advanced lung cancers, becoming standard of care in both first- and second-line treatment. New types of toxicity are emerging with the increasingly widespread use of these inhibitors.

Case presentation:

We describe a case of aplastic anemia in a patient with stage IV non-small cell lung cancer after a single administration of nivolumab.

Conclusions:

Several similar case reports reported in literature show an increasing rate of toxicities from immunotherapy in this setting. These real-world data provide an insight into patient outcomes and treatment decisions being made in clinical practice.
Chlamydia pneumoniae Polioencephalomyelitis and Ganglionitis in Captive Houston Toads (Anaxyrus houstonensis)
Authors: Fratzke Alycia , Howard Lauren L. , Tocidlowski Maryanne E. , Armién Anibal , Oliveira Fabiano , Ritchie Branson , Berlin Erin , Snook Eric
Published: June 2019

Chlamydia pneumoniae is a ubiquitous pathogen causing disease in humans, mammals, birds, reptiles, and amphibians. Since 2012, C. pneumoniae infection has caused neurologic disease and mortality in a breeding colony of endangered Houston toads ( Anaxyrus houstonensis) at the Houston Zoo. The purpose of this report is to present the histopathologic and ultrastructural characteristics of C. pneumoniae infection in Houston toads. Fourteen cases were evaluated by histopathology and 1 case was evaluated by electron microscopy. The major histopathologic finding was necrotizing and histiocytic polioencephalomyelitis and ganglionitis. Bacteria formed intracytoplasmic inclusions within neurons but frequently extended into the surrounding tissue from necrotic cells. Ultrastructural evaluation showed the bacteria formed reticulate and elementary bodies characteristic of Chlamydia spp.
Nonocular Melanocytic Neoplasia in Cats: Characterization and Proposal of a Histologic Classification Scheme to More Accurately Predict Clinical Outcome
Authors: Pittaway Rachel , Dobromylskyj Melanie J. , Erles Kerstin , Pittaway Charles E. , Suárez-Bonnet Alejandro , Chang Yu-Mei , Priestnall Simon L.
Published: June 2019

Nonocular melanocytic neoplasia is considered uncommon in cats yet is routinely encountered in diagnostic pathology and recognized to exhibit a wide variation in biological behavior. Accurate prediction of clinical outcomes is challenging with no widely recognized prognostic criteria. Signalment and tumor location were retrospectively evaluated in 324 cats diagnosed with nonocular melanocytic neoplasia. Histologic features were described in 141 neoplasms and outcome data were available in 79 cases. Immunohistochemistry using Melan-A, PNL-2, cyclooxygenase 2 (COX-2), and E-cadherin was performed in a subset ( n = 24). Multivariate analysis identified tumor site, mitotic count, and the presence of intratumoral necrosis to be independent predictors of tumor-related death. On the basis of these findings, we propose a novel histologic grading scheme in which nonocular melanocytic neoplasms involving the lips, oral or nasal mucosa, or nasal planum are considered high grade if they fulfill 1 or both of the following criteria: at least 4 mitoses in 10 high-power fields (HPF) or presence of intratumoral necrosis; those arising elsewhere are considered high grade if they fulfill both of the above criteria. Of 79 tumors with outcome data, 43 (54%) were low grade and 36 (46%) were high grade. The grading system had an 80% sensitivity and 92% specificity for predicting tumor-related death in this population of cats. Median survival for cats with low-grade tumors was not reached, and the median survival was 90 days for those with a high-grade tumor. PNL-2 and Melan-A were sensitive markers for feline nonocular melanocytic neoplasia, and although not significantly associated with prognosis, a large proportion expressed COX-2, suggesting a potential therapeutic role for COX-2 inhibitors.
Including Critical Whiteness Studies in the Critical Human Resource Development Family: A Proposed Theoretical Framework
Authors: Bohonos Jeremy W.
Published: June 2019

While the human resource development (HRD) literature has made strides to incorporate critical race theory, critical Whiteness studies has not been substantively addressed. White experiences need to be incorporated into organizational learning literature in racialized ways. Unpacking the racialized experiences of Whites in organizational settings is important because it challenges the often-unstated assumption that White experiences are normal and neutral. The uncritical centering of Whiteness is part of what makes the marginalization of racialized others possible, and critical Whiteness studies research seeks to contribute to the decentering process. This article integrates literature exploring racialized White experiences from disciplines, including history, sociology, theology, and legal studies within an existing framework for HRD. This research will place special emphasis on aspects of critical Whiteness that relate to the workplace. The purpose of this article is to advance a theoretical framework that will enhance HRD’s capacity for research and action pertaining to workplace racism.
Increased blood pressure visit-to-visit variability in patients with systemic lupus erythematosus: association with inflammation and comorbidity burden
Authors: Reese T , Dickson A L , Shuey M M , Gandelman J S , Barnado A , Barker K A , Neal J E , Khan O A , Dupont W D , Stein C M , Chung C P
Published: June 2019

Background

Blood pressure visit-to-visit variability is a novel risk factor for deleterious long-term cardiac and renal outcomes in the general population. We hypothesized that patients with systemic lupus erythematosus (SLE) have greater blood pressure visit-to-visit variability than control subjects and that blood pressure visit-to-visit variability is associated with a higher comorbidity burden.

Methods

We studied 899 patients with SLE and 4172 matched controls using de-identified electronic health records from an academic medical center. We compared blood pressure visit-to-visit variability measures in patients with SLE and control subjects and examined the association between blood pressure visit-to-visit variability and patients’ characteristics.

Results

Patients with SLE had higher systolic blood pressure visit-to-visit variability 9.7% (7.8–11.8%) than the control group 9.2% (7.4–11.2%), P < 0.001 by coefficient of variation. Additional measures of systolic blood pressure visit-to-visit variability (i.e. standard deviation, average real variation, successive variation and maximum measure-to-measure change) were also significantly higher in patients with SLE than in control subjects. In patients with SLE, blood pressure visit-to-visit variability correlated significantly with age, creatinine, CRP, triglyceride concentrations and the Charlson comorbidity score (all P < 0.05). Hydroxychloroquine use was associated with reduced blood pressure visit-to-visit variability ( P < 0.001), whereas the use of antihypertensives, cyclophosphamide, mycophenolate mofetil and corticosteroids was associated with increased blood pressure visit-to-visit variability ( P < 0.05).

Conclusion

Patients with SLE had higher blood pressure visit-to-visit variability than controls, and this increased blood pressure visit-to-visit variability was associated with greater Charlson comorbidity scores, several clinical characteristics and immunosuppressant medications. In particular, hydroxychloroquine prescription was associated with lower blood pressure visit-to-visit variability.
Creating Communities of Support Within Alternative Settings: Perspectives of Practicing Alternative School Administrators
Authors: Duke Richard T. (RT) , Tenuto Penny L.
Published: June 2019

Much can be learned from practicing school leaders, including how they describe their roles navigating between policy and practice with a focus on meeting students’ needs. This article considers how alternative school administrators work with school personnel to create communities for supporting students once considered at risk in traditional public schools. Findings include (1) creating a culture of high standards, (2) adopting a personalized or caring approach to leadership, (3) exploring and implementing innovative practices for teaching and learning, and (4) managing students as a collaborative and individualized process. For further understanding, authors apply emergent themes to a model for advancing democratic professional practice in education.
A Complex Adaptive Systems Approach to Real-Life Team Interaction Patterns, Task Context, Information Sharing, and Effectiveness
Authors: Hoogeboom Marcella A. M. G. , Wilderom Celeste P. M.
Published: June 2019

Interaction dynamics are considered to be key characteristics of complex adaptive systems (CAS). Taking a CAS approach, this study examines how three team interaction patterns affect team effectiveness. Specifically, we analyze recurring, heterogeneous, and participative patterns of team interaction in routine and nonroutine team-task contexts. Fine-grained coding of video-based footage plus nonlinear dynamical systems (NDS) statistics are used to identify the interaction patterns in a sample of 96 real-life teams, comprising 1,395 team members. We establish that recurring patterns of team interaction reduce perceived team information sharing and, in turn, team effectiveness and that these harmful effects are more pronounced in teams doing nonroutine work than in those engaged in routine work. Participative team interaction was found to be positively related to a high level of perceived team information sharing and effectiveness. Heterogeneous team interaction was not associated with perceived team information sharing and effectiveness. Post hoc analyses, in which the behavioral content of the interaction patterns of the 15 most effective and least effective teams is compared, revealed primarily task-directed patterns in the most effective teams. We offer practical recommendations for team development and call for more CAS research on the communicative behaviors within teams of knowledge workers.
Noticing and Noting: Teaching Students With EBD to Effectively Self-Monitor
Authors: Lastrapes Renée E. , Mooney Paul
Published: June 2019

Self-monitoring interventions can be effective components in the specially designed instruction programs of students with emotional and behavioral disorders. This article provides a self-monitoring definition, rationale for use, and summary of research supporting use of the empirically supported intervention. It also includes a description of how to plan, implement, and evaluate implementation of a self-monitoring procedure and performance tips for professionals.
Engaging Children to Support Parental Weight Loss: A Randomized Trial
Authors: Winston Ginger , Sifat Munjireen , Phillips Erica , Dietz William , Wikner Emily , Barrow Maya , Khurana Kunal , Charlson Mary
Published: June 2019

Background. Despite evidence that social network members influence the eating behaviors of adults, no study to date has had the primary aim of examining children as support partners for parents in a weight loss intervention. Aim. To evaluate parent adherence with eating/exercise goals and weight loss in a 6-month study engaging children as support partners. Method. Adults with obesity (body mass index ≥ 30 kg/m2, n = 102) and at least one child ≥12 years were randomized to a child support or control group. In the child support group, children enrolled with their parent and engaged in a supportive behavior 2 days/week. In the control group, there was no enrolled child support. Parents in both groups selected a healthy eating strategy and daily step goal. Results. There was no difference in weight loss between the child support and control groups (−5.97 vs. −5.42 lbs, p = .81). In the child support group, 30% of children did not engage in the study. The majority of parents whose children did not engage withdrew from the study. In secondary analyses, parent adherence with eating/exercise goals increased with the days of child support ( p < .001). For all participants, low chaos in the home environment ( p < .04) and increased parent adherence with follow-ups ( p < .008) predicted weight loss. Conclusions. We found no treatment effect of child support on weight loss. Active child support of eating/exercise goals appeared to facilitate goal adherence, while anticipated but unrealized child support may have had iatrogenic consequences. Further investigation of family-focused weight loss interventions is warranted.
Filovirus Disease Outbreaks: A Chronological Overview
Authors: Languon Sylvester , Quaye Osbourne
Published: June 2019

Filoviruses cause outbreaks which lead to high fatality in humans and non-human primates, thus tagging them as major threats to public health and species conservation. In this review, we give account of index cases responsible for filovirus disease outbreaks that have occurred over the past 52 years in a chronological fashion, by describing the circumstances that led to the outbreaks, and how each of the outbreaks broke out. Since the discovery of Marburg virus and Ebola virus in 1967 and 1976, respectively, more than 40 filovirus disease outbreaks have been reported; majority of which have occurred in Africa. The chronological presentation of this review is to provide a concise overview of filovirus disease outbreaks since the discovery of the viruses, and highlight the patterns in the occurrence of the outbreaks. This review will help researchers to better appreciate the need for surveillance, especially in areas where there have been no filovirus disease outbreaks. We conclude by summarizing some recommendations that have been proposed by health and policy decision makers over the years.
Potential Mechanisms Driving Mitochondrial Motility Impairments in Developing Iron-Deficient Neurons
Authors: Bastian Thomas W
Published: June 2019

Brain development is highly demanding energetically, requiring neurons to have tightly regulated and highly dynamic metabolic machinery to achieve their ultimately complex cellular architecture. Mitochondria are the main source of neuronal adenosine 5′-triphosphate (ATP) and regulate critical neurodevelopmental processes including calcium signaling, iron homeostasis, oxidative stress, and apoptosis. Metabolic perturbations during critical neurodevelopmental windows impair neurological function not only acutely during the period of rapid growth/development, but also in adulthood long after the early-life insult has been rectified. Our laboratory uses iron deficiency (ID), the most common nutrient deficiency, as a model of early-life metabolic disruptions of neuronal metabolism because iron has a central role in mitochondrial function. Recently, we published that ID reduces hippocampal neuronal dendritic mitochondrial motility and size. In this commentary, we delve deeper into speculation about potential cellular mechanisms that drive the effects of neuronal ID on mitochondrial dynamics and quality control pathways. We propose that understanding the basic cellular biology of how mitochondria respond and adapt to ID and other metabolic perturbations during brain development may be a key factor in designing strategies to reduce the risk of later-life psychiatric, cognitive, and neurodegenerative disorders associated with early-life ID.
Brexit, the NHS and the double-edged sword of populism: Contributor to agonistic democracy or vehicle of ressentiment?
Authors: Hensmans Manuel , van Bommel Koen
Published: June 2019

In this paper we argue that mature political democracies require an agonistic form of populism in order to function. Agonistic populism counters technocratic apathy and instrumental reductionism and provides democracies with discursive legitimacy for the expression of antagonisms. We draw on the exemplary case of Brexit to show how the long-term suppression of English populism by an all-conquering British imperial discourse, and the hegemony of technocratic solutions in Europe, transformed populism’s potentially virtuous agonistic effects into an often anachronistic, toxic and ill-directed ressentiment against the European Union. We call upon management scholars to focus on how popular ressentiment can be used as a force for good in two ways: (1) by contributing agonistically to an alternative, emotionally founded discourse about England, the European Union and a new popular civilizational project that could bind them; and (2) by inducing the creation of collective moral categories embraced across the elite/non-elite divide in the image of the post-World War II National Health Service.
Telecare management of pain and mood symptoms: Adherence, utility, and patient satisfaction
Authors: Bushey Michael A , Kroenke Kurt , Weiner Julia , Porter Brian , Evans Erica , Baye Fitsum , Lourens Spencer , Weitlauf Sharon
Published: June 2019

Introduction

Pain, depression, and anxiety are prominent symptoms that frequently co-occur, causing significant debilitation and frequent primary care visits. This paper examines the acceptability of telecare and self-management modules in managing these conditions in a randomized trial.

Methods

The Comprehensive Management of Mood and Physical Symptoms (CAMMPS) trial compared an automated symptom management (ASM) plus self-management intervention with a comprehensive symptom management (CSM) intervention that added telecare facilitation of enhanced services. Data from the CAMMPS trial were analysed to compare the acceptability of these two interventions as indicated by utilization and patient satisfaction surveys.

Results

The mean number of automated reports completed was similar between the CSM and ASM groups (14.5 vs 14.0). Responses designated with clinically relevant “red alerts” (i.e. patient reports warranting an expedited nurse contact) were more frequent in the CSM group (10.2 vs 8.3). The CSM and ASM groups completed a similar number of the nine self-management modules (6.3 vs 5.8). The mean helpfulness score across all modules was higher in the CSM group than in the ASM group (1.8 vs 1.5; p = .003). The most common feedback suggestion from the ASM group was to have more personal interaction, while participants from both groups commonly suggested technical improvements or requests for more flexible timing of calls.

Discussion

Participants generally found both interventions satisfactory, with a trend in satisfaction data suggesting that patients tended to find the CSM intervention more helpful.
Study on mechanical properties of high damping viscoelastic dampers
Authors: Chen Yun , Chen Chao , Ma Qianqian , Jiang Huanjun , Wan Zhiwei
Published: June 2019

The mechanical properties of the viscoelastic damper made of high damping rubber produced in China are investigated in order to provide the basis for its application. At first, the test on material properties of high damping rubber is conducted. The Mooney–Rivlin model, the Yeoh model and the Prony series are applied for simulating the nonlinear behavior of the high damping rubber with the aid of software ABAQUS. Then, three viscoelastic dampers with different sizes are tested under cyclic loading. The effects of strain amplitude and loading frequency on hysteretic behavior of dampers are analyzed. Viscoelastic dampers possess large deformation capability, stable energy-dissipation capacity and good fatigue-resisting property. The effect of strain amplitude is much more significant than loading frequency. The hysteretic behavior of the dampers is simulated by the Bouc–Wen model and the model of the equivalent stiffness and damping, respectively. The prediction results by using the Bouc–Wen model are in good agreement with the experimental results, which indicates that the Bouc–Wen model is applicable to simulate the mechanical properties of high damping viscoelastic dampers with a wide range of shear strain. As to the model of equivalent stiffness and damping, it has the advantages of clear concept and simple calculation. However, the good accuracy of prediction can be obtained only when the shear strain is not greater than 60%.
Communicating without nonprofit organizations on nonprofits’ social media: Stakeholders’ autonomous networks and three types of organizational ties
Authors: Ihm Jennifer
Published: June 2019

Research on nonprofit organizations’ (NPOs) social media strategies has focused on the dialogic features of social media to improve organization–stakeholder relationships and elicit stakeholder responses. However, NPOs may initiate different types of relationships with their stakeholders on social media (i.e. flow, representational, and affinity). Stakeholders may also create autonomous networks among themselves beyond simply responding to the NPOs. Based on observations of 100 NPOs’ and stakeholders’ 1-month-Twitter activities, this study captures varying types of NPOs’ ties embedded in social media and examines how each type correlates with stakeholders’ autonomous networks. The results suggest that each type of tie has a different role in autonomous networks. This study provides a nuanced understanding of diverse networks embedded in social media and sheds light on autonomous networks as distinctive virtual communities for NPOs during this era of transformation in collective action and social change, existing at the intersection of loose organizational coordination and individual autonomy.
Learning from past crises: Evaluating hotels’ online crisis responses to health crises
Authors: Liu-Lastres Bingjie , Kim Hany , Ying Tianyu
Published: June 2019

Organizational learning is an important function of tourism crisis management. By examining and evaluating hotels’ responses to the 2010 bed bug crisis on social media, the purpose of this study was to provide insights into how to establish effective crisis responses. Situational crisis communication theory was used as the theoretical framework and a total of 136 management responses were included in the sample. Content analysis and co-occurrence analysis were conducted. The results revealed a learning curve of crisis management for hotels. Enhancing and Bolstering were the most commonly used strategies within the sample. Further analysis showed the inconsistencies between hotels’ crisis response strategies and the situational crisis communication theory guidelines, where instructing information were seldom included. Based on the findings, this study discussed the importance of creating effective crisis responses and future research directions.
Local governance in the centralized French system of policing: From co-production to conflict of legitimacy
Authors: Mouhanna Christian
Published: June 2019

This article deals with the complex aspect of French public safety policies and offers a big-picture view of the factors that impact both their design and their implementation processes. Indeed, many players are involved in their development: city mayors and local police forces when they exist, but also local agents of the national police forces who have the main responsibilities in this field, and the Public Prosecutor. Whereas cooperation between national police forces and local authorities is statutory and needed in order to address safety issues, conflicts and tensions are not rare. Each stakeholder pursues their own objectives: mayors are seeking public support and try to meet local expectations, while national police chiefs favour priorities set by the Ministry of Home Affairs. Far from following only a rational choice process, the implementation of local safety policy results from power relationships and the position of each player in the game. To gain the upper hand over a partner, a stakeholder can rely on material resources but also on the control of information about security issues, knowledge and expertise in this field, and its legitimacy among the public. In the French case, two forms of legitimacy are in conflict as far as security policy is concerned. If mayors base their arguments on their status conferred by a democratic election, the police chiefs use the fact that they belong to a national service based on a principle of equality – even if it is not applied: every citizen has the same rights and duties, and is subjected to national policies. Because the French Republic does not recognize communities and local peculiarities, institutions tend to favour their own positions rather than dealing concretely with the safety issues.
A Transfer Learning Approach for Malignant Prostate Lesion Detection on Multiparametric MRI
Authors: Chen Quan , Hu Shiliang , Long Peiran , Lu Fang , Shi Yujie , Li Yunpeng
Published: June 2019

Purpose:

In prostate focal therapy, it is important to accurately localize malignant lesions in order to increase biological effect of the tumor region while achieving a reduction in dose to noncancerous tissue. In this work, we proposed a transfer learning–based deep learning approach, for classification of prostate lesions in multiparametric magnetic resonance imaging images.

Methods:

Magnetic resonance imaging images were preprocessed to remove bias artifact and normalize the data. Two state-of-the-art deep convolutional neural network models, InceptionV3 and VGG-16, were pretrained on ImageNet data set and retuned on the multiparametric magnetic resonance imaging data set. As lesion appearances differ by the prostate zone that it resides in, separate models were trained. Ensembling was performed on each prostate zone to improve area under the curve. In addition, the predictions from lesions on each prostate zone were scaled separately to increase the area under the curve for all lesions combined.

Results:

The models were tuned to produce the highest area under the curve on validation data set. When it was applied to the unseen test data set, the transferred InceptionV3 model achieved an area under the curve of 0.81 and the transferred VGG-16 model achieved an area under the curve of 0.83. This was the third best score among the 72 methods from 33 participating groups in ProstateX competition.

Conclusion:

The transfer learning approach is a promising method for prostate cancer detection on multiparametric magnetic resonance imaging images. Features learned from ImageNet data set can be useful for medical images.
Characteristics of Breakthrough Pain and Its Impact on Quality of Life in Terminally Ill Cancer Patients
Authors: Gonella Silvia , Sperlinga Riccardo , Sciannameo Veronica , Dimonte Valerio , Campagna Sara
Published: June 2019

Purpose. This study aimed to characterize breakthrough pain (BTP) and investigate its impact on quality-of-life (QoL) in terminally-ill cancer patients. Similarities and differences between high and low predictable BTP were also tested. Methods. Secondary analysis of a multicenter longitudinal observational study included 92 patients at their end-of-life. BTP was assessed with a short form of the Italian version of the Alberta Breakthrough Pain Assessment Tool. QoL was assessed with the Palliative Outcome Scale (0-40). Patients were stratified by self-reported BTP predictability into unpredictable BTP (never or rarely able to predict BTP) and predictable BTP (sometimes to always able to predict BTP). Results. In all, 665 BTP episodes were recorded (median 0.86 episodes/day). A median duration of 30 minutes and a median peak intensity score of 7 out of 10 were reported. Time to peak was <10 minutes, 10 to 30 minutes, and ≥30 minutes in 267 (41.1%), 259 (39.9%), and 30 (4.6%) of the episodes, respectively. Onset of relief occurred after a median of 30 minutes. Time to peak ( P < .001) and duration ( P = .046) of BTP was shorter in patients with predictable pain ( n = 31), who usually were younger than those with unpredictable pain ( P = .03). The mean (SD) QoL score was 14.6 (4.6). No difference in QoL between patients with predictable and unpredictable BTP was found ( P = .49). Conclusions. In terminally-ill cancer patients, BTP is a severe problem with a negative impact on QoL and has different characteristics according to its predictability.
Validating Autoclave Cycles for Carcass Disposal in Animal Biosafety Level 2/3 Containment Laboratories
Authors: McGirr Rebecca , Sample Christopher , Arwood Leslee , Burch James , Alderman Scott
Published: June 2019

Introduction:

Animal carcasses differ in composition from other types of solid waste, and through prior testing it was determined that cycle parameters applied to general, solid biohazardous waste did not ensure proper sterilization of ferret carcasses.

Objectives:

The goals of this study were to develop and validate an autoclave cycle that would ensure the decontamination of infectious animal carcasses before removal from an animal biosafety level 2/3 containment suite for downstream disposal and to test different ways to prepare and package animal carcasses for autoclaving.

Methods:

Intact ferret carcasses were implanted with biological indicators, and the carcasses were placed in biohazard bags, then into metal pans. To test the efficacy of the autoclave cycle on larger biomasses, 1, 2, or 4 ferret carcasses were placed in a biohazard bag. A total of 4 carcasses were placed in each pan. An autoclave cycle was created to begin the study. After initial tests, minor modifications to the initial test cycle parameters were made, and a new cycle was validated for ferret carcasses up to 2 kg each. Parameters for the validated cycle were as follows: sterilization time 240 minutes, temperature 125°C, 5 prevacuum pulses, and chamber pressure 15 psi.

Results:

The results of this study indicate that an extended sterilization time is required to successfully decontaminate animal carcasses compared with regular, solid, and biohazardous waste.

Conclusions:

This study demonstrates that it is possible to sterilize multiple intact ferret carcasses per load under validated autoclave cycle conditions.
Privacy-aware relationship semantics–based XACML access control model for electronic health records in hybrid cloud
Authors: Kanwal Tehsin , Jabbar Ather Abdul , Anjum Adeel , Malik Saif UR , Khan Abid , Ahmad Naveed , Manzoor Umar , Shahzad Muhammad Naeem , Balubaid Muhammad A
Published: June 2019

State-of-the-art progress in cloud computing encouraged the healthcare organizations to outsource the management of electronic health records to cloud service providers using hybrid cloud. A hybrid cloud is an infrastructure consisting of a private cloud (managed by the organization) and a public cloud (managed by the cloud service provider). The use of hybrid cloud enables electronic health records to be exchanged between medical institutions and supports multipurpose usage of electronic health records. Along with the benefits, cloud-based electronic health records also raise the problems of security and privacy specifically in terms of electronic health records access. A comprehensive and exploratory analysis of privacy-preserving solutions revealed that most current systems do not support fine-grained access control or consider additional factors such as privacy preservation and relationship semantics. In this article, we investigated the need of a privacy-aware fine-grained access control model for the hybrid cloud. We propose a privacy-aware relationship semantics–based XACML access control model that performs hybrid relationship and attribute-based access control using extensible access control markup language. The proposed approach supports fine-grained relation-based access control with state-of-the-art privacy mechanism named Anatomy for enhanced multipurpose electronic health records usage. The proposed (privacy-aware relationship semantics–based XACML access control model) model provides and maintains an efficient privacy versus utility trade-off. We formally verify the proposed model (privacy-aware relationship semantics–based XACML access control model) and implemented to check its effectiveness in terms of privacy-aware electronic health records access and multipurpose utilization. Experimental results show that in the proposed (privacy-aware relationship semantics–based XACML access control model) model, access policies based on relationships and electronic health records anonymization can perform well in terms of access policy response time and space storage.
Coil embolisation of multiple cerebral aneurysms with lateral type I persistent primitive trigeminal artery: A case report and literature review
Authors: Wan Zheng , Meng Hao , Xu Ning , Liu Tianyi , Chen Zhongping , Zhang Zheming , Xu Jianjun , Wang Honglei
Published: June 2019

The primitive trigeminal artery is an anastomotic vessel of the carotid–basilar artery system that occurs only transiently during the embryonic period. Persistent primitive trigeminal artery occurs in approximately 0.1–0.6% of the population. Here, we report the case of a 60-year-old woman with Fisher II grade subarachnoid haemorrhage. Computed tomography angiography demonstrated a lateral, Saltzman type I persistent primitive trigeminal artery with three cerebral aneurysms, including one anterior communicating artery aneurysm, one suspicious right anterior choroidal artery aneurysm and one distal basilar artery aneurysm supplied by the persistent primitive trigeminal artery. All three aneurysms were treated with coil embolisation. At the 8-month follow-up, the anterior communicating artery aneurysm had a neck remnant, the other two aneurysms exhibited complete occlusion. Persistent primitive trigeminal artery with multiple cerebral aneurysms is extremely rare, and only seven cases of persistent primitive trigeminal artery with multiple cerebral aneurysms have previously been reported in publications that included information on treatment. Most aneurysms were treated by open surgery. This is the first report of coil embolisation treatment of multiple aneurysms in persistent primitive trigeminal artery patients with follow-up results, and provides relevant and valuable information about the persistent primitive trigeminal artery and the endovascular treatment of multiple aneurysms in persistent primitive trigeminal artery patients.
Analytically founded yaw control algorithm for walking on uneven terrain applied to a hexapod robot
Authors: Fućek Luka , Kovačić Zdenko , Bogdan Stjepan
Published: June 2019

This article presents a new control algorithm for the omnidirectional motion of a legged robot on uneven terrain based on an analytical kinematic solution without the use of Jacobians. In order to control the robot easily and efficiently in all situations, a simplified circle-based workspace approximation has been introduced. Foot trajectories for legged robot movement were generated on concentric circular paths around an analytically computed common centre of motion. This systematic motion model, together with new gait control variables that can be changed during legged robot motion, enabled the implementation of a new adaptive gait phase control algorithm, as well as the addition of algorithms for ground-level adaptation, 3-dimensional map-based step adjustment and fusion of all corrections to establish and/or maintain foot contact with the ground. The method being applicable to different legged robot designs was performed and tested on the laboratory prototype of a hexagonal hexapod robot, and the results of the experiments showed the practical value of the proposed adaptive yaw control method (available also as a video supplement).
Police perceptions of residents in a high-crime area in Trinidad and Tobago: Community framing and crime wars
Authors: Watson Danielle , Johnson Lee Michael , Pino Nathan , Morgan Paula
Published: June 2019

This article examines police perceptions of residents of a marginalized community in Trinidad and Tobago. The discourses of 40 members of the Trinidad and Tobago Police Service are examined to determine how they define residents of the community and situate them within specific interactive contexts. Results show that the officers typically have extremely negative views of the community and its residents, which amplify their perceptions of policing as difficult and dangerous. The potential impact of these perceptions upon police practices, officer well-being and police–community relations are discussed. The study contributes to the emerging scholarly dialogue on policing in the global South and highlights the benefits of discourse analysis within country case studies to elucidate country-specific nuances in police–community relations.
Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety study
Authors: van der Louw Elles J. T. M. , Olieman Joanne F. , van den Bemt Patricia M. L. A. , Bromberg Jacoline E. C. , Oomen-de Hoop Esther , Neuteboom Rinze F. , Catsman-Berrevoets Coriene E. , Vincent Arnaud J. P. E.
Published: June 2019

Background:

High-grade glioma cells consume mainly glucose and cannot compensate for glucose restriction. Apoptosis may potentially occur under carbohydrate restriction by a ketogenic diet (KD). We explored the feasibility and safety of KD during standard treatment of chemoradiation in patients with glioblastoma multiforme.

Methods:

A full liquid KD induced ketosis within 2 weeks before start of chemoradiation. After 6 weeks, the KD was modified with solid foods and medium-chain-triglyceride emulsions and used for an additional 6 weeks while maintaining ketosis. During the total study period (14 weeks), feasibility, safety, coping (both patient and partner), quality of life (QoL), neurological functioning and impairment were measured. Overall survival was analyzed with actuarial estimates.

Results:

Eleven patients started the study protocol, nine reached ketosis and six (67%) completed the study. Severe adverse effects did not occur. The majority of coping scores ranged from 3 to 6 on a 10-point scale at all timepoints; QoL, neurological functioning, and impairment did not essentially change over time; overall survival ranged between 9.8 and 19.0 months.

Conclusion:

KD was feasible and safe as an adjuvant to standard chemoradiation treatment of glioblastoma multiforme. A supportive partner and intensive counseling were essential for coping. Future research should identify possible beneficial effects on overall survival.

Clinical trial registration:

Netherlands Trial Registry: NTR5167 (registration date 29-01-2015), http://www.trialregister.nl/trialreg/index.asp
Prescription Of analgesia in Emergency Medicine (POEM): a multicentre observational survey of pain relief in patients presenting with an isolated limb fracture and/or dislocation
Authors: Sheehan James Robert , Wilson Sarah , Quinlan Jane , Beer Sally , Darwent Melanie , Dainty Jack R , Ezra Martyn , Keating Liza
Published: June 2019

Background:

Acute pain is one of the most commonly cited reasons for attendance to the emergency department (ED), and the Royal College of Emergency Medicine (RCEM) Best Practice Guideline (2014) acknowledged that the current management of acute pain in UK EDs is inadequate and has a poor evidence base.

Methods:

The Prescription Of analgesia in Emergency Medicine (POEM) survey is a cross-sectional observational survey of consecutive patients presenting to 12 National Health Service (NHS) EDs with limb fracture and/or dislocation in England and Scotland and was carried out between 2015 and 2017. The primary outcome was to assess the adequacy of pain management in the ED against the recommendations in the RCEM Best Practice Guidelines.

Results:

In all, 8346 patients were identified as attending the ED with a limb fracture and/or dislocation but adherence to RCEM guidelines could only be evaluated for the 4160 (49.8%) patients with a recorded pain score. Of these, 2409/4160 (57.9%) patients received appropriate pain relief, but only 1347 patients were also assessed within 20 minutes of their arrival in the ED. Therefore, according to the RCEM guidelines, only 16.1% (1347/8346) of all patients were assessed and had satisfactory pain management in the ED.

Conclusions:

The POEM survey has identified that pain relief for patients with an isolated limb fracture remains inadequate when strictly compared to the RCEM Best Practice Guidelines. However, we have found that some patients receive analgesia despite having no pain score recorded, while other analgesic modalities are provided that are not currently encompassed by the Best Practice Guidelines. Future iterations of these guidelines may wish to encompass the breadth of available modalities of pain relief and the whole patient journey. In addition, more work is needed to improve timely and repeated assessment of pain and its recording, which has been better achieved in some EDs than others.
Preoperative lymphocyte count in relation to sarcoma prognosis
Authors: Teck Seo Soon , Singh Vivek Ajit , Yasin Nor Faissal
Published: June 2019

Purpose:

Inflammation plays a major role in tumour development, progression and metastasis. Multiple inflammatory markers such as absolute lymphocyte count, neutrophil–lymphocyte ratio (NLR), lymphocyte–monocyte ratio (LMR) and platelet–lymphocyte ratio have been discovered as prognostic markers for various malignancies. We investigate preoperative lymphocyte count and other cell count ratios and their relation to survival and prognosis of sarcoma patients after surgery.

Methods:

A total of 142 patients from the Orthopaedics Oncology Database were included into this retrospective study. Kaplan–Meier curve and multivariate Cox proportional models were used to calculate the overall survival of patients with sarcoma who underwent radical excision surgery.

Results:

High preoperative LMR is significantly associated with better overall survival and prognosis in sarcoma patients, whereas high preoperative NLR is significantly associated with shorter overall survival and poorer prognosis. Multivariate analysis shows that LMR and NLR are good predictors for overall survival at 3 and 5 years after surgery, respectively. Patients with high preoperative lymphocytes count are associated with longer overall survival, but this association is not statistically significant. Our findings suggest that preoperative NLR and LMR are good predictive markers for survival of sarcoma patients.

Conclusion:

LMR and NLR can be used to identify patients at risk for poor clinical outcome, so that a more aggressive course of treatment can be applied to improve outcome. These are cost-effective prognostic tools as they are calculated from routine preoperative peripheral blood counts. In conclusion, preoperative NLR and LMR are good prognostic markers for predicting the clinical outcome of patients with sarcoma.
Barbed sutures versus staples for closure in total hip arthroplasty using wound ooze as a primary outcome measure: A prospective study
Authors: Knapper Thomas D , Dahill Mark , Eastaugh-Waring Stephen , Baker Richard P , Webb Jason CJ , Blom Ashley W , Whitehouse Michael R
Published: June 2019

Background:

Prosthetic joint infection is a rare, but devastating complication of primary total hip arthroplasty (THA). Postoperative wound discharge and deep infection are related. We examined whether barbed sutures were associated with a decrease in the incidence of postoperative wound discharge when compared with skin closure using metal staples.

Methods:

Prospective nonrandomized comparison between two groups (35 barbed suture closures vs. 49 staple closures). Wounds were assessed daily for postoperative wound discharge until dry. Hemoglobin and hematocrit were recorded at the preoperative assessment and on day 3 postoperative.

Results:

There were no significant differences between the groups with regard to age, body mass index, gender, preoperative hemoglobin, preoperative hematocrit, or estimated blood volume. The number of days elapsed until the wound was dry was significantly lower in the barbed suture group than the staples group ( p < 0.0001). In the staples cohort, ongoing wound ooze resulted in delayed hospital discharge in three (6%) patients, six bed days total.

Conclusion:

Barbed sutures reliably reduce the period of postoperative wound ooze following primary THA compared to staple closure. The use of barbed sutures may prevent delayed patient discharge from hospital, decreasing the bed burden.