bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects on Clinical Outcomes of a 5-Year Surgical Safety Checklist Implementation Experience: A Large-scale Population-Based Difference-in-Differences Study
Authors: Rodella Stefania , Mall Sabine , Marino Massimiliano , Turci Graziella , Gambale Giorgio , Montella Maria Teresa , Bonilauri Stefano , Gelmini Roberta , Zuin Piera
Published: July 2018

The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011 and 2013 through a computerized database. The effects of the intervention were explored through multivariable logistic regression and difference-in-differences (DID) approaches, based on current administrative data sources. In-hospital and 30-days mortality, 30-days readmissions and length-of-stay (LOS) ⩾8 days were the observed outcomes. Adherence to the checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis detected statistically significant differences between surgical interventions performed in hospitals with higher adherence to the checklist (⩾75% of the surgeries) and those performed in other hospitals, as for the 30-days readmissions rate (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS ⩾ 8 days rate (OR: 0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID analysis. No association was observed with mortality outcomes. On the whole, our study attained mixed results. Although a protective effect of the surgical checklist use could not be proved over the first 5 years of this regional implementation experience, our research offers some methodological insights for practical use in the evaluation process of large-scale implementation projects.
Depression severity is associated with increased inflammation in veterans with peripheral artery disease
Authors: Hernandez Natalie VM , Ramirez Joel L , Khetani Sukaynah A , Spaulding Kimberly A , Gasper Warren J , Hiramoto Jade , Lindqvist Daniel , Wolkowitz Owen M , Hills Nancy K , Grenon S Marlene , Zahner Greg J
Published: July 2018

The present study examines the association between depressive symptoms and inflammatory markers in peripheral artery disease (PAD) to better understand the mechanistic relationship between depression and PAD. A cross-sectional sample of 117 patients with PAD (97% male, 76% Caucasian) was recruited from the San Francisco Veterans Affairs Medical Center. Patients were categorized into three subgroups based upon current depressive symptom severity, as defined by Patient Health Questionnaire-8 scores: no symptoms (score of 0–4, n = 62), mild symptoms (score of 5–9, n = 33), and moderate/severe symptoms (score ≥ 10, n = 22). Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-alpha (TNF-α) were assayed and log-transformed for multivariable analysis. To decrease the possibility of Type 1 errors, inflammatory markers were standardized and summed to create a total inflammatory score. In a multivariable analysis controlling for demographics, PAD severity, and atherosclerotic risk factors, mild and moderate/severe depressive symptoms were predictive of a higher total inflammatory score when compared to the group with no symptoms (mild symptoms p = 0.04, moderate/severe symptoms p = 0.007). Exploratory multivariable analyses of individual inflammatory markers found IL-6 levels were significantly higher in the moderate/severe symptoms group ( p = 0.006) than in the no symptoms group. Moreover, hs-CRP and ICAM-1 trended upwards with increasing depression severity. TNF-α was not associated with depression severity. We conclude that depressive symptom severity was independently associated with greater inflammation in PAD. Future research should examine the strength and directionality of this association through larger prospective cohort studies, as well as investigate the pathophysiological mechanisms responsible.
Who decides when people can have sex? Australian mental health clinicians’ perceptions of sexuality and autonomy
Authors: Urry Kristi , Chur-Hansen Anna
Published: July 2018

Sexuality is a central aspect of human experience but there is evidence that this is largely constrained, pathologised or ignored in mental health settings. We conducted in-depth interviews with 22 psychologists, psychiatrists and mental health nurses working across a variety of settings in four Australian cities. Sexuality was most often perceived as relevant in the mental health setting when it was simultaneously constructed as dangerous. Participants located this danger in sexual expression itself or within individuals who, because of mental illness, lacked the autonomy required to successfully engage in ‘safe’ sex. We discuss these findings and their implications for research and professional practice.
The ritual creation of political symbols: International exchanges in public diplomacy
Authors: Pacher Andreas
Published: July 2018

International exchange programmes have been previously conceptualised based on the ‘opinion leader model’. It expects participants to form positive attitudes towards the host country, and to become influential back home. However, the micro-processes through which this goal can be achieved remain undertheorised. Drawing from Interaction Ritual Theory, this article argues that international exchanges consist of a chain of rituals. They strategically immerse targeted individuals into personal experiences with a shared focus on the host country, transforming the latter into a symbol charged with emotional energy and (strategically devisable) cognitive content. The symbol (now affectively and cognitively laden) is then recurrently invoked to re-circulate through the networks of the participants. A case study of a programme in which the symbol ‘Poland’ became systematically charged with the content of ‘multiculturality’ illustrates this proposition. Practical and theoretical implications (e.g. for the literature on socialisation, norm-diffusion, and face-to-face diplomacy) in international relations are discussed.
Leadership climate prevents emotional exhaustion in German police officers
Authors: Engel Sinha , Wörfel Franziska , Maria Andreas Santa , Wolter Christine , Kleiber Dieter , Renneberg Babette
Published: July 2018

Police officers are exposed to a high amount of work effort in their everyday employment. This increases their risk of developing emotional exhaustion, the key symptom of the burnout syndrome. Previous research suggests that leadership climate is important for employees’ health and thus might be protective against emotional exhaustion. This study investigated whether a positive leadership climate prevents emotional exhaustion and buffers the negative impact of work effort in police officers. Data from a cross-sectional health survey in a German police department ( N = 570) were used to test the assumptions. Results of the hierarchical linear regression analysis showed that high work effort was correlated with high levels of emotional exhaustion and positive leadership climate was associated with low levels of emotional exhaustion. Furthermore, both predictor variables interacted, indicating a buffer effect of a positive leadership climate under stressful working conditions. This is the first study to show both direct and indirect protective effects of a positive leadership climate in police officers. In police work, stressful working conditions such as high work effort are hard to avoid. Thus, it is crucial to promote preventive factors such as a positive leadership climate to protect police officers’ health. Suggestions of how police supervisors and departments might establish a positive leadership climate are presented.
The Carceral Web we weave: Carceral citizens’ experiences of digital punishment and solidarity
Authors: Gurusami Susila
Published: July 2018

This article asks: How do formerly incarcerated people navigate digital technologies? Using the metaphor of a spider web, I use 18 months of ethnographic observations of formerly incarcerated women of color to argue that formerly incarcerated people must contend with what I call— Carceral Web—the spatial intersection between carceral institutions and digital technologies. I identify two primary features of the Carceral Web: stickiness and entanglements. I characterize stickiness as the Internet’s ability to make carceral histories inescapable across time and physical space, making it impossible for formerly incarcerated people to shed their criminal histories. I characterize entanglements as the intersections of institutional carceral relationships that result from practices and norms of digital connectivity. I argue that the pervasive significance of digital connectivity to everyday life compels formerly incarcerated people to contend with the Carceral Web, but stickiness and entanglements make them susceptible to exploitation and reincarceration. I call the Carceral Web’s production of vulnerable subjects predation, which I characterize as a type of hidden sentence. I contend that despite having limited resources to navigate predation, formerly incarcerated people are tasked with co-opting the Carceral Web to build solidarity and training as a self-defense survival mechanism. Understanding the Spider of the Carceral Web as the convergence of corporations and state interests allows us to see how it feeds on the lives of formerly incarcerated people by consuming their marginalization and exclusion in the interests of racialized and gendered profit.
Dissimilar friction-stir welding of 430 stainless steel and 6061 aluminum alloy: Microstructure and mechanical properties of the joints
Authors: Zandsalimi Sirvan , Heidarzadeh Akbar , Saeid Tohid
Published: July 2018

The effect of friction-stir welding parameters on the microstructure and the mechanical properties of the dissimilar 430 stainless steel and 6061 aluminum alloy joints were investigated. Optical and scanning electron microscopes in conjunction with energy dispersive X-ray analysis were employed to study the microstructure of the joints. Tensile and microhardness tests were used to evaluate the mechanical properties. The results showed that the best appearance quality was achieved at a rotational speed of 900 r/min, a traverse speed of 120 mm/min, and a tool offset of zero. The tool offset was the most effective parameter affecting the weld quality. The stir zone of the joints had a composite structure in which the dispatched steel particles were distributed in aluminum. The best interface quality belonged to the joints welded at an offset of zero, which had a serrated nature with mechanical locking of the dissimilar parts. However, at negative and positive values of offsets, formation of voids and microcracks reduced the tensile properties of the joints. The tensile fracture of the joints occurred in the heat affected zone of the aluminum part, which had the lowest hardness amount between the microstructural zones. The fracture surfaces of the tensile specimens showed bimodal behavior.
Development of a Workplace Intervention for Child Care Staff: Caring and Reaching for Health’s (CARE) Healthy Lifestyles Intervention
Authors: Arandia Gabriela , Vaughn Amber E. , Bateman Lori A. , Ward Dianne S. , Linnan Laura A.
Published: July 2018

Child care staff are among the lowest wage workers, a group at increased risk for a wide array of chronic diseases. To date, the health of child care staff has been largely ignored, and there have been very few interventions designed for child care staff. This article describes the development of the Caring and Reaching for Health (CARE) Healthy Lifestyles intervention, a workplace intervention aimed at improving physical activity and health behaviors among child care staff. Theory and evidence-based behavior change techniques informed the development of intervention components with targets at multiple social ecological levels. Final intervention components included an educational workshop held at a kick-off event, followed by three 8-week campaigns. Intervention components within each campaign included (1) an informational magazine, (2) goal setting and weekly behavior self-monitoring, (3) weekly tailored feedback, (4) e-mail/text prompts, (5) center-level displays that encouraged team-based goals and activities, and (6) coaching for center directors. This multilevel, theory-driven intervention is currently being evaluated as part of a larger randomized controlled trial. Process evaluation efforts will assess the extent to which child care staff participated in, engaged with, and were satisfied with the intervention. Lessons learned will guide future intervention research engaging child care workers.
Punishing the Poor and the Limits of Legality
Authors: Lorca Rocio
Published: July 2018

Many of us feel that there is something distinctly wrong about punishing people who are extremely poor. Criminal law theorists have offered different explanations for this disquietude, among these is the idea that punishing the poor may be unwarranted because extreme poverty undermines the authority of the state to punish. This article argues that the issue of authority is indeed the heart of the matter, but unlike most views it argues that extreme poverty completely subverts the meaning of punishment and renders it into an instance of pure force. By looking into foundational ideas of punishment and legality in literary resources like The Oresteia as well as in early modern philosophical discourse, the article argues that punishment requires a context of authority to be a part of legal and political justice, and even in a minimal account of political legitimacy such as that formulated by Hobbes, extreme poverty undermines such context.
Tenecteplase for the treatment of acute ischemic stroke: A review of completed and ongoing randomized controlled trials
Authors: Coutts Shelagh B , Berge Eivind , Campbell Bruce CV , Muir Keith W , Parsons Mark W
Published: July 2018

Alteplase has been the mainstay of thrombolytic treatment since the National Institutes of Neurological Disorders and Stroke trial was published in 1995. Over recent years, several trials have investigated alternative thrombolytic agents. Tenecteplase, a genetically engineered mutant tissue plasminogen activator, has a longer half-life, allowing single intravenous bolus administration without infusion, is more fibrin specific, produces less systemic depletion of circulating fibrinogen, and is more resistant to plasminogen activator inhibitor compared to alteplase. Tenecteplase is established as the first-line intravenous thrombolytic drug for myocardial infarction, where it has been shown to achieve comparable reperfusion with reduced risk of systemic bleeding in comparison to alteplase. We review the literature on tenecteplase for the treatment of acute ischemic stroke, with a focus on the major completed and ongoing trials. Overall, tenecteplase shows promise for treatment of acute ischemic stroke, both in populations currently eligible for alteplase and also in groups not currently treated with thrombolysis.
Unexpected complications during insertion of a central venous catheter
Authors: Tirumala Sridhar , Hyatali Farees , Eskander John , Leandre Mario , Patil Shilpadevi , Cornette Elyse
Published: July 2018

Introduction

Central venous catheters are essential and widely used in medical practice. Their use may be accompanied with complications during insertion and removal. Complications related to the guidewire are rare, and information about appropriate management is scarce. We report a case of a 34-year-old patient admitted for a left femur fracture. Venous access was deemed difficult, so a decision was made to place a central venous catheter before surgery. During insertion of the central venous catheter, there was difficulty in advancing the guidewire. Attempts were made to remove the guidewire through the introducer, but the guidewire would not thread out of the introducer. The introducer and guidewire were then removed as a unit with ease. The guidewire had lost its shape and uncoiled itself, becoming much more flimsy and fragile.

Conclusion

While this case had no adverse outcome secondary to the removal of the guidewire and introducer as a unit, careful attention should be noted when attempting to remove the guidewire during central venous catheter placement. If faced with a similar scenario where the guidewire is stuck and does not thread out easily, removing the guidewire and introducer as a unit is a safe method of action.
Perioperative accountable care teams: Improving surgical team efficiency and work satisfaction through interprofessional collaboration
Authors: Marrone Stephen R.
Published: July 2018

The purpose of this performance improvement project was to design, implement and evaluate an interprofessional education initiative intended to improve surgical team efficiency, communication and work satisfaction. The development of interprofessional perioperative accountable care teams in three surgical specialties, cardiothoracic, neurosurgery and orthopedics, demonstrated a reduction in turnover time, increased staff, patient and surgeon satisfaction, and increased operating room (OR) revenue generated by the surgical specialties within one year of implementation.
Reimbursement Pathways for New Diabetes Technologies in Europe: Top-Down Versus Bottom-Up
Authors: Seidel David , Boggio Mesnil Francesca , Caruso Antonio
Published: July 2018

Reimbursement by payers (policy makers and budget holders) is critical for the uptake and use of new diabetes technologies. The purpose of this article is to describe the different reimbursement pathways that exist for new diabetes technologies in five selected European countries using examples of recent reimbursement decisions. Countries can be grouped into one of three categories: “top-down” (where reimbursement decisions are usually made by policy makers, eg, France), “bottom-up” (where reimbursement decisions are usually made by budget holders, eg, Italy and Spain) and “mixed” (where reimbursement decisions can be made by both policy makers and budget holders, eg, Germany and England). Whatever category a specific country falls into will have different implications from a market access perspective.
Medicinal Use and Legalized Trade of Rhinoceros Horn From the Perspective of Traditional Chinese Medicine Practitioners in Hong Kong
Authors: Cheung Hubert , Mazerolle Lorraine , Possingham Hugh P. , Biggs Duan
Published: July 2018

Rhino poaching in Africa has risen alarmingly over the last decade, driven by illegal trade and demand for horns in Asia, where it is used medicinally. Traditional Chinese medicine (TCM) has deep cultural roots, and understanding demand drivers will inform conservation decision-making. We interviewed 15 TCM practitioners in Hong Kong, investigating their familiarity with rhino horn, prescription experiences, and perspectives toward its use and trade. All interviewees believe that rhino horn possesses medicinal properties, despite general unfamiliarity with its chemical composition or any active ingredient. We compiled a list of 16 substitutes, finding that dosage adjustments produce equivalent treatment outcomes that compensate for potency differences. While most interviewees expressed support for trade legalization, most would prefer to continue prescribing substitutes. Further research into TCM stakeholder perspectives and preferences for rhino horn can inform conservation policy.
Riociguat use in sickle cell related chronic thromboembolic pulmonary hypertension: A case series
Authors: Weir Nargues A. , Conrey Anna , Lewis Denise , Mehari Alem
Published: July 2018

Adults with sickle cell disease can develop pulmonary hypertension from a multitude of etiologies. Classified as WHO Group 5, there are no therapies approved for the treatment of sickle cell disease‐pulmonary hypertension. Thromboembolic disease is prevalent in sickle cell disease and can lead to pulmonary hypertension. The only approved medical therapy for chronic thromboembolic pulmonary hypertension is riociguat. We report the experience, safety and tolerability of riociguat use in a series of sickle cell disease patients with chronic thromboembolic pulmonary hypertension.
Idiopathic hypereosinophilic syndrome with pulmonary hypertension
Authors: Zhang Liping , Peng Xia , Adhikari Binay Kumar , Li Bo , Liu Quan , Mikeladze Jondo , Zhang Weihua
Published: July 2018

Hypereosinophilic syndrome is a myeloproliferative disorder characterized by persistent eosinophilia with involvement of multiple organs. The occurrence of severe pulmonary hypertension (PH) in the setting of hypereosinophilic syndrome is very uncommon. A 43‐year‐old man with documented idiopathic hypereosinophlic syndrome presented to the hospital with symptoms of paroxysmal chest discomfort and progressive exertional dyspnea. Physical examination showed distended jugular veins, cyanosed lips, increased P2 sound, and moderate pitting edema of the lower extremities. Echocardiography revealed enlarged right atrium, enlarged right ventricle, increased pulmonary artery systolic pressure, and decreased right ventricular systolic function. Venous ultrasound of the lower extremities, computed tomography pulmonary angiography, and right heart catheterization (RHC) were negative for thrombus. The pulmonary artery systolic pressure was found severely increased during the RHC. Treatment included prednisolone, ambrisentan, diuretics, and digoxin. The involvement of the pulmonary artery in patients with idiopathic hypereosinophilic syndrome is an uncommon finding. The patient presents with clinical manifestations of right ventricular systolic dysfunction resulted from severely increased PH.
Heart rate recovery is associated with ventilatory constraints and excess ventilation during exercise in patients with chronic obstructive pulmonary disease
Authors: Crisafulli Ernesto , Vigna Matteo , Ielpo Antonella , Tzani Panagiota , Mangia Angelo , Teopompi Elisabetta , Aiello Marina , Alfieri Veronica , Bertorelli Giuseppina , Palange Paolo , Chetta Alfredo
Published: July 2018

Background

Heart rate recovery delay is a marker of cardiac autonomic dysfunction. In chronic obstructive pulmonary disease patients, the ventilatory response to exercise during incremental cardiopulmonary exercise test may add information about dynamic hyperinflation by low values of inspiratory capacity/total lung capacity ratio (at peak) and excess ventilation by the slope of minute ventilation to carbon dioxide output ratio (VE/VCO2 slope). We aimed to assess if the ventilatory response to exercise might be a determinant for heart rate recovery delay.

Design

An observational, prospective study.

Methods

Anthropometric characteristics, lung function and cardiopulmonary exercise test data were recorded in chronic obstructive pulmonary disease outpatients. A cut-off of heart rate recovery of 12 or more beats was used to define heart rate recovery delay.

Results

Of 254 patients enrolled, 156 (61%) showed heart rate recovery delay. As compared to patients with normal heart rate recovery, patients with delay were older, with a worse lung function and with lower values of peak oxygen uptake, maximal workload, oxygen pulse at rest and at peak, and inspiratory capacity/total lung capacity at peak. Conversely, VE/VCO2 slope and dyspnoea and leg fatigue perception at peak were higher in patients with heart rate recovery delay. In the multivariate regression model adjusted for age, sex, fat-free mass, heart rate at rest and use of β-blockers, we found that inspiratory capacity/total lung capacity at peak (<0.25) (odds ratio 2.61; P = 0.007) and VE/VCO2 slope (>32) (odds ratio 2.26; P = 0.018) predict the risk of heart rate recovery delay.

Conclusions

In chronic obstructive pulmonary disease outpatients, heart rate recovery is associated with dynamic hyperinflation and excess ventilation during exercise.
Editor’s Choice-The treatment of electrical storm: an educational review
Authors: Hendriks Astrid A , Szili-Torok Tamas
Published: July 2018

Electrical storm is characterised by a state of severe electrical instability that occurs in a rare combination of circumstances, and may lead to multiple implantable cardioverter defibrillator shocks and haemodynamic instability, and possible death. The main goal of treating electrical storm is to eliminate the trigger and modify the substrate of the arrhythmia. The aim of this educational review is to provide information for a better understanding of the underlying mechanisms and therefore help to improve the treatment of electrical storm patients.
Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases
Authors: Lavan L , Kyriazis G , Mbiabjeu D , Gormley R , Hall S , Robinson R , Hodgson D
Published: July 2018

Objective:

We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period.

Patients and methods:

All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded.

Results:

Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016.

Conclusions:

Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications.

Level of evidence:

4 (Oxford Centre for Evidence-Based Medicine (CEBM)).
Macular Changes on Optical Coherence Tomography Before, During, and After Silicone Oil Tamponade for Macula-On Retinal Detachment: A Case Series
Authors: Kheir Wajiha J. , Mehanna Carl-Joe , Koaik Mona , Bashshur Ziad
Published: July 2018

Purpose:

Assess changes on spectral domain optical coherence tomography (OCT) before, during, and after removal of silicone oil (SO).

Methods:

Retrospective series of patients who underwent SO tamponade for macula-on rhegmatogenous retinal detachment. OCT scans of the affected eye were taken before, during, and 3 months after SO tamponade. Qualitative assessment of foveal contour and quantitative comparison of OCT parameters (central macular, cube, ganglion cell layer [GCL], and outer retinal thicknesses) were done between 3 time points.

Results:

Ten eyes of 9 patients were included. Flattening of the foveal contour during SO tamponade was completely reversed after SO removal. Average cube and GCL thicknesses decreased with SO tamponade and increased after SO removal ( P = .01 and P = .02, respectively). Outer retinal thicknesses did not vary among 3 time points ( P = .09).

Conclusions:

SO tamponade causes foveal flattening and thinning of the inner retinal layers, which is reversible on removal.
Insight into origins, mechanisms, and utility of DNA methylation in B-cell malignancies
Authors: Oakes Christopher C. , Martin-Subero Jose I.
Published: July 2018

Understanding how tumor cells fundamentally alter their identity is critical to identify specific vulnerabilities for use in precision medicine. In B-cell malignancy, knowledge of genetic changes has resulted in great gains in our understanding of the biology of tumor cells, impacting diagnosis, prognosis, and treatment. Despite this knowledge, much remains to be explained as genetic events do not completely explain clinical behavior and outcomes. Many patients lack recurrent driver mutations, and said drivers can persist in nonmalignant cells of healthy individuals remaining cancer-free for decades. Epigenetics has emerged as a valuable avenue to further explain tumor phenotypes. The epigenetic landscape is the software that powers and stabilizes cellular identity by abridging a broad genome into the essential information required per cell. A genome-level view of B-cell malignancies reveals complex but recurrent epigenetic patterns that define tumor types and subtypes, permitting high-resolution classification and novel insight into tumor-specific mechanisms. Epigenetic alterations are guided by distinct cellular processes, such as polycomb-based silencing, transcription, signaling pathways, and transcription factor activity, and involve B-cell-specific aspects, such as activation-induced cytidine deaminase activity and germinal center–specific events. Armed with a detailed knowledge of the epigenetic events that occur across the spectrum of B-cell differentiation, B-cell tumor–specific aberrations can be detected with improved accuracy and serve as a model for identification of tumor-specific events in cancer. Insight gained through recent efforts may prove valuable in guiding the use of both epigenetic- and nonepigenetic-based therapies.
The frequency of post‐traumatic stress disorder symptoms in athletes with and without sports related concussion
Authors: Brassil Heather E. , Salvatore Anthony P.
Published: July 2018

Background

Purpose of this study is to investigate the presence and frequency of post‐traumatic stress disorder (PTSD) symptoms in post‐concussed (PC) athletes compared to a group of healthy control (HC) athletes.

Research design and method

A pre and post‐test group design was used to compare a post‐concussed group to a matched healthy control group of athletes. An archival database which included PC (n = 62) and HC (n = 62) participants matched on age, years of education and gender who completed a test battery at baseline and post injury, The test battery was comprised of a neurocognitive assessment, self‐reported symptom inventory and PTSD symptom questionnaire. Post‐concussion assessment was obtained within 0–13 days post‐injury.

Results

PTSD symptom scores were greater in PC post injury group (Mdn = 0) than for the HC group (Mdn = 0.0), U = 1282.0, p = 0.000, r = 0.34. A Wilcoxon Signed‐ranks test indicated that PTSD symptom scores post‐injury (Mdn = 0) were significantly higher than pre‐injury (Mdn = 0), Z = − 2.75, p = 0.000, r = 0.35. Within the PC post injury group athletes having “difficulty sleeping” was the highest reported symptom an average of 25.8% followed by “avoiding similar situations” at an average of 19.4%. “Having trouble keeping thoughts of incident out of your head” was reported at an average of 17.7% and “flashbacks” were reported at an average of 12.9%. “Nightmares” and “feeling numb and detached” were reported at an average of 8.1 and 6.5% respectively.

Conclusion

Athletes who reported no PTSD symptoms prior to sports related concussion do exhibit symptoms of PTSD. Providing a PTSD symptom questionnaire may provide a more comprehensive treatment plan for PC post injury athletes who may be at risk of chronic PTSD symptoms.
Actionable Gene Alterations in an Asian Population With Triple-Negative Breast Cancer
Authors: Nagahashi Masayuki , Ling YiWei , Hayashida Tetsu , Kitagawa Yuko , Futamura Manabu , Yoshida Kazuhiro , Kuwayama Takashi , Nakamura Seigo , Toshikawa Chie , Yamauchi Hideko , Yamauchi Teruo , Kaneko Koji , Kanbayashi Chizuko , Sato Nobuaki , Miyoshi Yasuo , Tsuchida Junko , Nakajima Masato , Shimada Yoshifumi , Ichikawa Hiroshi , Lyle Stephen , Takabe Kazuaki , Okuda Shujiro , Wakai Toshifumi
Published: July 2018

Purpose

It has been suggested that the biologic characteristics of breast cancer may differ among different geographic or ethnic populations. Indeed, triple-negative breast cancer (TNBC), the most lethal breast cancer subgroup, has been reported to occur at a higher incidence in Japan than in the United States. However, most genomic studies of these tumors are from Western countries, and the genomic landscape of TNBC in an Asian population has not been thoroughly investigated. Here, we sought to elucidate the geographic and ethnic diversity of breast cancer by examining actionable driver alterations in TNBC tumors from Japanese patients and comparing them with The Cancer Genome Atlas (TCGA) database, which gathers data primarily from non-Asian patients.

Materials and Methods

We performed comprehensive genomic profiling, including an analysis of 435 known cancer genes, among Japanese patients with TNBC (n = 53) and compared the results with independent data obtained from TCGA (n = 123).

Results

Driver alterations were identified in 51 (96%) of 53 Japanese patients. Although the overall alteration spectrum among Japanese patients was similar to that of TCGA, we found significant differences in the frequencies of alterations in MYC and PTK2. We identified three patients (5.7%) with a high tumor mutational burden, although no microsatellite instability was observed in any of the Japanese patients. Importantly, pathway analysis revealed that 66.0% (35 of 53) of Japanese patients, as well as 66.7% (82 of 123) of TCGA cohort, had alterations in at least one actionable gene targetable by US Food and Drug Administration–approved drug.

Conclusion

Our study identified actionable driver alterations in Japanese patients with TNBC, revealing new opportunities for targeted therapies in Asian patients.
Translating Gene Signatures Into a Pathologic Feature: Tumor Necrosis Predicts Disease Relapse in Operable and Stage I Lung Adenocarcinoma
Authors: Lin Emily Pei-Ying , Hsiao Tzu-Hung , Lu Jo-yang , Wong Siao-Han , Lu Tzu-Pin , Peck Konan , Takahashi Takashi , Yang Pan-Chyr
Published: July 2018

Purpose

The high 5-year disease relapse rate in patients with stage I lung adenocarcinoma indicates the need for additional risk stratification parameters. This study assessed whether gene signatures translate into a pathologic feature for better disease stratification.

Materials and Methods

The mutual interdependence and risk stratification power of three gene signatures, cell cycle, hypoxia, and mammalian target of rapamycin (mTOR), were investigated in nine cohorts of patients with lung adenocarcinoma and five cohorts of patients with lung squamous cell carcinoma. The translation from gene signatures to a pathologic feature, tumor necrosis, was validated in The Cancer Genome Atlas lung adenocarcinoma cohort. The translation of signature score to pathway activity was further investigated by integrative analyses using The Cancer Genome Atlas and The Cancer Protein Atlas lung adenocarcinoma data sets.

Results

The results showed that the three gene signatures were mutually interdependent in lung adenocarcinoma but not in lung squamous cell carcinoma. The signature activities were higher in necrosis-positive tumors than in necrosis-negative tumors. The signature score correlated with the expression level of the representative protein that implicated the activity of each pathway. These signatures stratified patients with operable and stage I lung adenocarcinomas into different risk groups independent of age and stage. Furthermore, the signatures translated to a pathologic feature, tumor necrosis, which predicted shorter overall and relapse-free survival in patients with operable and stage I lung adenocarcinomas.

Conclusion

This study showed that gene signatures could translate into a pathologic feature, tumor necrosis, with risk stratification ability in patients with operable and stage I lung adenocarcinomas.
Combining Videolaryngoscopy With Fiber-Optic Orotracheal Intubation for Inclusion in the Nonemergency Pathway of the Difficult Airway Algorithm
Authors: Riegel Ann-Kathrin , Winterhalter Michael
Published: July 2018

As technology progresses, our clinical treatment options rise steadily. We are comfortable now with the handling of ready-to-use high-quality videolaryngoscopes and fiber optics, and there is increasing knowledge and practice that the combination of these 2 techniques has a high “rescue rate” in situations when fiber-optic intubation or videolaryngoscopic intubation fails. Therefore, we would recommend to specifically include this technique in the “difficult airway algorithm—nonemergency pathway,” so it comes routinely into mind when faced with a “can ventilate, but cannot intubate” situation that warrants intubation for the surgical operation.
Identification of additional regulatory RNPs that impact rRNA and U6 snRNA methylation
Authors: Burke Marilyn F. , Logan Madelyn K. , Hebert Michael D.
Published: July 2018

Ribosomes can be heterogeneous, and the major contributor to ribosome heterogeneity is variation in rRNA modification. There are two major types of rRNA modification, pseudouridylation and ribose methylation. In humans, the majority of these rRNA modifications are conducted by two classes of small nucleolar ribonucleoproteins (snoRNPs), which contain a guide RNA (small nucleolar RNA, snoRNA) complexed with proteins. Box H/ACA snoRNPs conduct pseudouridylation modifications and box C/D snoRNPs generate ribose methylation modifications. It is unclear how ribosome heterogeneity is accomplished in regards to the understanding of the signals and factors that regulate rRNA modifications. We have recently reported that a new class of RNP that we term regulatory RNP (regRNP) may contribute to rRNA modification, as well as the modification of nucleolar trafficked U6 snRNA, via interactions with snoRNPs. Here we report the identification of additional regRNP activities that influence the methylation of two sites within 18S rRNA, two sites within 28S rRNA and one site within U6 snRNA. These findings provide additional proof that regulation of snoRNP activity contributes to ribosome heterogeneity.
STUDY OF TECHNOLOGY OF GLAZED POTTERY FROM AN EXCAVATION IN THESSALONIKI, GREECE
Authors: Σοφιανοπούλου Α. , Λαμπρόπουλος Β. , Καντηράνης Ν.
Published: July 2018

Samples of seven shells from vessels of glazed pottery of Palaeologan and post Byzantine period that were found during saving excavation of the 9th Ephoreia of Byzantine Antiquities in the centre of Thessaloniki, were studied with the methods of PXRD and SEM-EDS in order to investigate their firing conditions. Each shell is separated in three layers: the biscuit, the slip and the glaze. Biscuit constituted mainly of quartz, feldspars and muscovite, while the slip from quartz, feldspars, Pb-rich phase and muscovite. The glaze is constituted mainly by the Pb-rich phase that was recognized in the slip, quartz and feldspars. Amorphous phase was determined in all samples with increased percentages from biscuit to glaze. The EDS study confirms most of the results of PXRD study and shows, particularly in the glaze, the presence of very high percentages of PbO. The presence of Pb-rich phase in glaze constitutes an evidence for the temperature of second firing of glazed pottery and we believe that this temperature varied between 650 and 750 °C. Relatively to the maintenance of the studied glazed ceramics is recommended the reject of chemicals that solvating and dissolving the lead (e.g. EDTA, ethyl alcohol). The use of these chemicals can be cause weakening and destruction of enamelling and accordingly alteration of exterior layer of vessel.
LEAD ISOTOPE CHARACTERIZATION OF COPPER INGOTS FROM SARDINIA (ITALY): INFERENCES ON THEIR ORIGINS
Authors: Pinarelli L.
Published: July 2018

The provenance of the materials making up the metal artifacts represents a fundamental question for archaeological research. The complex processes necessary to extract the metals from the minerals cause considerable changes in their chemical composition. By contrast, the ratio of the different lead isotopes in artifacts is not influenced by metallurgie processes. Therefore, the raw mineral material and the extracted metal exhibit the same isotope "footprint". Over the course of history, Sardinia has played a major role in maritime routes. Its considerably rich mineral resources, with copper, lead and iron mineralizations, moreover complemented its strategic importance. During the 10th and 9th centuries BC Sardinia, because of its strategic location, was to become directly involved in the "precolonial" Phoenician expansion. Two repositories of copper ingots recovered at different levels within a nuragic village in northwest Sardinia, can be placed within this historical context of intense traffic and exchange of goods between native Sardinian and Phoenician communities. The ingots were made in different shapes: plane-convex, biconvex, truncated cone and irregular. The analyzed ingots exhibit a considerable lead isotopie variability, although no systematic differences in isotope composition were revealed between the ingots from the two different repositories. Moreover, no systematic isotopie variations were observed between the different shapes in which the material was found. Overall, the ingots exhibit a linear distribution in the lead/lead diagrams. The group of ingots with the lowest isotope ratios project onto the area defined by the northwestern Sardinian mineralizations. The ingot located on the other extreme end of the straight line in the Pb diagrams overlaps the area defined by the southern Sardinian deposits. The isotope footprints of the intermediate samples seem to indicate that they stem from the mixing of two components from two different mining areas of Sardinia, one in the north, the other in the south. Therefore, widespread exchange of metal must have taken place throughout the island, and such an exchange does not seem to have been hindered by the advent of the Phoenicians in Sardinia. The results of the present investigation indicate that the majority of the examined ingots was produced with metal from the northwest of the island, and that these mines were therefore known and exploited in nuragic times. Such findings shed new light on the complex issues involved in proto-historic Sardinian metallurgy
THE APPLICATION OF THE TRANSIENT EM METHOD INTO THE GEOTHERMAL FIELD EXPLORATION
Authors: Κάρμης Π. , Βαργεμέζης Γ. , Παπαδόπουλος Η. , Τσούρλος Π.
Published: July 2018

In this work we examine the potential of the time-domain electromagnetic method (Transient EM) in the exploration of geothermal field and the study of the geological environment. The method was applied in the geothermal field of Aristino (Alexandroupolis), westwards of the Traianoupolis, where the known hot springs exist. The EM method and more specifically magnetotellurics (MT), it has been applied in the past in Greece by various researchers, but it is the first time the TEM method is applied for geothermal exploration purposes. As it has been shown by previous works, in the wider region of Aristino an important geothermal field is developed, with geothermal fluid temperature of 30°-90° and high content of dissolved salts of 10gr/lt. These factors result to the appearance of highly conductive geoelectrical anomalies which are directly related to the geothermal field. The existence of two drillholes in the region allowed the calibration and the control of the effectiveness of the TEM method. The geophysical survey has delimited the area of local geothermal interest that is formed by hot aquifer at a relatively shallow depth, extended North of Aristino and between the main faults of the region. The two main faults are responsible for the creation of a tectonic graben in the intermediary region and the development of a highly conductive formation which correlates well with the hot aquifer tank. The geothermal fluid circulates through the faulting system having high temperature caused by the contact with magmatic masses. The application of TEM proved the operational advantages of the method in the geothermal field exploration. The relatively limited number of TEM soundings presented here does not allow the export of safe conclusions regarding the geothermal field of the wider region, although the evaluation of results based on the geological and geoelectrical data of the region is extremely encouraging and justifies the use of the TEM method in the systematic study and mapping of geothermal fields.
THE USE OF THREE-DIMENSIONAL SCANNING AS METHODOLOGY OF 3 D LASER SCANNING AT CAVES' SURVEYING. PRESENTATION AT AGIOS GEORGIOS CAVE OF KILKIS
Authors: Παγούνης Β. , Καλυκάκης Σ. , Μπιζά Π. , Παπαδόπουλος Χ.
Published: July 2018

The systematic study of the caves demands the existence of a reliable and detailed background at a suitable form and scale so as to satisfy any cognitional subject of the geosciences (geology, speleology, paleontology, statics, e.t.c). The composite geometry as well as the complexity of the schematisms is the main characteristics that make recording, surveying and validation of a cave an especially difficult procedure. The faddish conditions that are carried out at caves make the classical - traditional surveying methods (topography - photogrammetry) time consuming and unprofitable procedures. The use of three-dimensional scanning is not only an alternative methodology but also a significant tool at caves' surveying. With this up-to-date method there can be produced very fast 3D digital models of high accuracy, easy modeled, cost effective comparatively to the classic surveying methods. With the 3D laser scanner the three dimensions of the surfaces are determined and represented as a point-cloud. During the scanning thousands of separate 3D points are measured and the 3D model of the scan is represented in real-time. Additionally, by the recording of the intensity of the reflected radiation, useful information can be obtained for the texture of the surface. This paper deals with the study of the capabilities and the preconditions for the usage of the methodology of 3D laser scanning at caves' surveying. A case study of this methodology is represented that took place at a part of Agios Georgios cave , Kilkis region.
A WAVELET REPRESENTATION OF HVSR TECHNIQUE
Authors: Hloupis G. , Vallianatos F. , Stonham J.
Published: July 2018

In order to evaluate eathquake site amplification characteristics, horizontal to vertical Fourier spectrum of microtremor has been widely used. As long as the Fourier transform (FT) cannot distinguish between stationary and non-stationary coefficients we cannot eliminate the contamination of microtremors signals from short period transients. The wavelet transform (WT), using the property of localization of wavelet bases has been widely used in signal processing. Unlike the Short Time Fourier Transform (STFT) in which the width of window is fixed, the WT localizes signal in a variable window using the dilation parameter. This property, which derived directly from multiresolution analysis provide us the ability to decompose a signal in a well localized set of coefficients and identify the non-stationary portions of it. In the present study we use the WT in order to eliminate the non-stationahties in microtremor signals before we calculate the spectrum of each one using conventional FFT algorithms