bluuebunny/crossref_metadata_2025 huggingface dataset:
Micromechanics-based prediction of the failure locus of angle-ply laminates subjected to biaxial loading
Authors: Romanowicz Marek
Published: April 2019

A mesoscale finite element model is presented for calculating the deformation and initial strength of angle-ply laminates subjected to biaxial tension and biaxial tension–compression. Using the concept that the whole laminate structure can be represented by a rhombohedral unit cell, predictions of the mechanical behavior for various biaxial loading ratios are made. Damage by microcracking at the fiber–matrix interface and shear band formation in the matrix are incorporated into the numerical simulations. The failure locus calculated from the mesoscale model is found to agree with experimental data available in the literature better than do theoretical predictions. Results of this study indicate that computational micromechanics can be used for detecting leakage failure in filament wound tubes.
PhotoLingo—Development and Improvement of Higher-Order Thinking and Language Skills Through Photographs
Authors: Gil-Glazer Ya’ara , Walter Ofra , Eilam Billie
Published: April 2019

This article presents the major findings of a longitudinal study on the use of photograph-based assignments to improve higher-order thinking and language skills among second- and fifth-grade students using an intervention framework and a convergent mixed method (quantitative and qualitative) approach. The method promoted oriented study skills for students with an accent in the combination of higher-order thinking strategies, reading skills, and photo-elicitation. Participants in the second grade attained a level close to participants in the fifth grade. Students with different levels of language skills in the intervention group progressed significantly compared with the control group.
Later Life Care Planning and Concerns of Transgender Older Adults in Canada
Authors: Pang Celeste , Gutman Gloria , de Vries Brian
Published: April 2019

While the particular health-care concerns of transgender people have been documented and transgender aging is an emerging area of scholarship, little is known about planning for later and end-of-life care among transgender older adults. As part of a larger project, focus groups and interviews were conducted with 24 transgender older adults (average age 70 years) living in five cities in Canada exploring their concerns and explicit plans for later life care. Three primary themes emerged: (a) “dealing with the day-to-day” reflecting economic precarity and transitioning in later life, (b) fractures and support within family and community, and (c) “there’s a huge gap between principle and practice” reflecting mixed experiences and perceptions of health-care services. These themes suggest that effective promotion of care planning among older transgender persons requires an appreciation of the daily exigencies of their lives and the extent and nature of social support available to them.
Nasal Mucosal Involvement in Behcet Disease: A Study of its Incidence and Characteristics in 400 Patients
Authors: Shahram Farhad , Zarandy Masoud Motasaddi , Ibrahim Aqeela , Ziaie Naghmeh , Saidi Masumeh , Nabaei Behrooz , Davatchi Fereydoun
Published: April 2019

Behçet disease is a multisystem vasculitis characterized by mucosal aphthosis, primarily in the oral and genital mucosa. Only a few cases of involvement of the nasal mucosa have been reported in the literature, and its true prevalence is not known. We conducted a cross-sectional study of 400 consecutively presenting patients with confirmed Behçet disease (according to classification-tree criteria) to determine the incidence of nasal mucosal involvement, to identify its particular characteristics, and to determine if there are any statistically significant differences in clinical and paraclinical parameters between Behçet disease patients with nasal involvement and those without. To the best of our knowledge, this is the first systematic evaluation of nasal involvement in patients with Behçet disease to be published in the literature. Data analysis was performed with Statistical Package for the Social Sciences software (SPSS), and a confidence interval (CI) at 95% was calculated for each finding. Involvement of the nasal mucosa was seen in 31 of the 400 patients (7.8%; CI: 5.1 to 10.5). Among those 31 patients, the most common nasal symptom was dysosmia, which was seen in 15 patients (3.8% of the total population; CI: 1.9 to 5.7); other nasal symptoms included obstruction in 10 patients (unilateral in 9), ulcers in 2, pain in 2, and a burning sensation and discharge in 1 each. No patient reported a history of epistaxis or nasal itching. Abnormal signs were present in only 16 patients (4.0%; CI: 2.1 to 5.9); they included nasal cartilage deformity in 6, unilateral nasal obstruction in 4, postnasal discharge in 3, nonaphthous ulcer in 3, and crusted ulcer in 2 (2 patients each had 2 abnormal signs). No case of aphthous ulcer, nasal discharge, nasal scar or deformity, septal perforation, or nodular or granulomatous cartilage lesion was found. There were no statistically significant differences in clinical and paraclinical disease manifestations between those patients who had nasal mucosal involvement and those who did not.
Amyloidosis of the External Auditory Canal
Authors: Klemens James J. , Recant Wendy , Baron Joseph M. , Saadia-Redleaf Miriam I.
Published: April 2019

We present a case of bilateral otitis externa that did not respond to local treatment. Cutaneous biopsies revealed bilateral amyloid depositions secondary to multiple myeloma. Persistent, identical bilateral canal lesions may be the only manifestation of treatable systemic disease and should be biopsied, even though their bilaterality argues against malignancy.
Ectopic Thymic Tissue Presenting as a Neck Mass in Children: A Report of 3 Cases
Authors: Meyer Estie , Mulwafu Wakisa , Fagan Johannes J. , Brown Robin A. , Taylor Kathryn
Published: April 2019

The presentation of ectopic cervical thymic tissue as an anterior neck mass is rare. We report 3 similar cases in 3 boys—2 who had a thymic cyst and 1 who had an ectopic cervical thymus. We discuss the radiographic presentation on ultrasound and magnetic resonance imaging in these cases. We also review the typical histologic picture; histology is the only way of diagnosing this condition.
Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study
Authors: Niedzielski Artur , Schwartz Sylwia Greta , Partycka-Pietrzyk Kornela , Mielnik-Niedzielska Grażyna
Published: April 2019

Objectives:

Children experience serious gastrointestinal tract injuries due to consumption of caustic agents more often than adults. The aim of the study was to analyze diagnostic methods and treatment of children with esophageal burns according to the degree of the injury.

Methods:

Our one-center population-based retrospective cohort study included 150 children admitted between 1967 and 2018 to Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology of University Children’s Hospital in Lublin, Poland, due to the chemical burn of the mouth, throat, larynx, and esophagus. Each patient underwent a thorough laryngological examination and endoscopy to assess the place and degree of injury.

Results:

Of 150 patients, 65.3% were male and 34.7% female. The median age was 4 years and 3 months. Salivation, dysphagia, burning sensation, edema, and whitish coating on the oral mucosa, palate, and throat were the most common clinical symptoms. In addition, dyspnea and chest pain were observed in 30% of patients. Esophagus endoscopy results were: Zargar grade I burn (84.7%), grade IIA (8%), grade IIB (2.6%), grade III (0%), and grade 0 (4.7%). Treatment included antibiotics, proton pump inhibitors, analgesics, and intravenous fluid therapy. Late sequelae (scarred esophageal strictures) developed in 20 (13.3%) patients.

Conclusions:

Accidental intake of caustic agents is observed in young children, especially younger than the age of 5. Early esophagus endoscopy should be performed in all patients to assess the grade of injury, plan initial treatment, and predict the risk of developing complications. Early diagnosis and immediate pharmacological treatment reduce the number of late sequelae.
Does Arthroscopic Suture-Spanning Augmentation of Single-Row Repair Reduce the Retear Rate of Massive Rotator Cuff Tear?
Authors: Ma Hsuan-Hsiao , Chen Kun-Hui , Chiang En-Rung , Chou Te-Feng Arthur , Ma Hsiao-Li
Published: April 2019

Background:

Several surgical techniques have been proposed for massive rotator cuff tears (MRCTs), but the failure rates remain high. The suture-spanning augmentation technique of single-row (SSA-SR) repair was shown to reduce failure rates in cadaveric studies, but the outcome in vivo remains unclear.

Purpose:

To determine if adding spanning sutures to SR repair during MRCT repairs can improve functional outcome and reduce failure rates.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

The study included 71 patients with a diagnosed MRCT. The study group (n = 35) received SSA-SR repair. The control (n = 36) received SR repair. The American Shoulder and Elbow Surgeons (ASES) score, Constant score, UCLA (University of California, Los Angeles) score, and visual analog scale for pain were assessed preoperatively and 24 months postoperatively. Magnetic resonance imaging was arranged at 6 months postoperatively to evaluate the rotator cuff.

Results:

At 6 months postoperatively, the overall retear rate was 31.0%. The retear rate was lower in the SSA-SR group (14.3%) than in the SR group (47.2%, P = .002). At 24 months, the SSA-SR group had markedly improved ASES, Constant, and UCLA scores in comparison with the SR group ( P < .05). Within both groups, all scores had significant improvement as compared with the preoperative status ( P < .05).

Conclusion:

The SSA-SR repair technique showed improved functional and radiologic results. Based on the superior postoperative outcome of this technique, the SSA-SR repair technique can be a potential treatment option for MRCT repair.

Registration:

NCT03609164 (ClinicalTrials.gov identifier).
Metal–plastic composites with amplitude-dependent constraint layer damping
Authors: Klaerner Matthias , Wuehrl Mario , Kroll Lothar , Marburg Steffen
Published: April 2019

For metal–plastic composites with thin shear-sensitive cores, high damping can be determined. These materials were developed to reduce the structure-borne noise and are therefore used for thin-walled components with bending loads. In addition to the known sensitivity due to the temperature and frequency, these materials show a significant dependency on vibration amplitudes. Within the framework of this study, the nonlinear damping of metal–plastic composites was determined experimentally using free-vibrating cantilever beams. A detailed analysis of the derived velocity–time curves showed a nonlinear damping within the decay. An exponential approach was successfully used to describe the relation between damping and current deflection. Furthermore, a strain energy-based evaluation is introduced to quantify the share of the core contributions. For this purpose, the strain energy of several acoustically sensitive car components as well as the beams with varying supports and vibration lengths were determined numerically with a finite element analysis. The strain energy ratio of the cores was then derived as a comparative measurement and within a finite element-based design of experiments.

A cantilever beam setup with a component-specific beam length representing similar core strain energy ratios was retested and showed a similar exponential amplitude dependence but higher damping parameters.
Optimal robotic assembly sequence planning using stability graph through stable assembly subset identification
Authors: Murali G Bala , Deepak BBVL , Raju MVA , Biswal BB
Published: April 2019

Assembly sequence planning is one of the multi-model optimization problems, in which more than one objective function has to be optimized at a time to obtain the quality assembly sequence. Moreover obtaining the feasible sequences from the possible finite set of sequences is a difficult task as the assembly sequence planning problem is N-P hard combinatorial problem. To solve the assembly sequence planning problem, researchers have developed various techniques to obtain the optimum solution. The developed methodologies have many drawbacks like struck at local optima, poor performance, huge search space and many more. To overcome these difficulties, the current research work aims to use stability graph to generate stable assembly subsets for obtaining the optimum assembly sequences. In the proposed methodology, to reduce the search space and to obtain the quality assembly sequences, stability graph is considered. Moreover, the fitness of assembly subsets is evaluated according to the user weights at each level before proceeding to the higher levels. Due to this, the higher fitness value subsets are eliminated at each stage by which time of execution will reduce enormously. The proposed methodology has implemented on various industrial products and compared the results with the various well-known algorithms.
Effect of EH domain containing protein 2 on the biological behavior of clear cell renal cell carcinoma
Authors: Liu C , Liu S , Wang L , Wang Y , Li Y , Cui Y
Published: April 2019

To investigate the effects of EH domain containing protein 2 (EHD2) on clear cell renal cell carcinoma (ccRCC) and provide new insights for the clinical treatment of rental cancer. Forty patients (26 males and 14 females, 62.4 ± 5.7 years old) with ccRCC were selected from January 2015 to December 2016 to serve as research subjects in this study. The EHD2 protein expression in the tumor tissues and adjacent healthy tissues of ccRCC patients were detected by Western Blot assay. The cells of ccRCC cell lines RLC-310 and 786-O were divided into normal control group (control), no-load control group (pLV), EHD2 overexpression group (pLV-EHD2), and EHD2 interference group (pLV-siEHD2). The expression levels of EHD2 protein in each group of cells were detected by western blot. The cell proliferation was detected by Cell Counting Kit-8 (CCK-8) assay. Wound healing assay was performed to check the cell migration ability. Transwell invasion assay was used to detect the cell invasion ability. Cell apoptosis was detected by flow cytometry. The expression level of EHD2 was significantly increased in pLV-EHD2 group and decreased in pLV-siEHD2 group compared with control group and pLV-siEHD2 group, indicating the successfully established EHD2 overexpression cell line and EHD2 RNA interference cell line. EHD2 overexpression enhanced the proliferation, invasion, and migration but inhibited the apoptosis of ccRCC cells, while EHD2 interference showed opposite functions. EHD2 interference can inhibit the development of ccRCC by inhibiting the proliferation, invasion, and migration, and EHD2 can potentially serve as a molecular target for the clinical treatment of ccRCC.
The ECB’s quantitative easing programme as a constitutional game changer
Authors: Tuori Klaus
Published: April 2019

The European Central Bank started its quantitative easing programme in 2015 in order to support euro area financial conditions and ultimately increase inflation. The controversial Public Sector Purchase programme has resulted in central bank purchases of government bonds in the magnitude of €2.1 trillion and the Eurosystem (the European Central Bank and the national central banks) become the largest creditor to the euro area Member States. The constitutional framework of the European Central Bank did foresee such a programme, which also makes it potentially problematic for the European Central Bank’s accountability. The underlying source for constitutional concerns is the European Central Bank’s exceptional independence, which could be justified with a narrow central banking model, but becomes problematic when the European Central Bank’s influence on the society becomes more multifaceted, which blurs the borderlines between monetary policy and other economic policies. The specific constitutional concerns related to the Public Sector Purchase programme and accountability are highlighted by three claims: (a) With the Public Sector Purchase programme, the European Central Bank takes deeper inroads to the society than with traditional monetary policy; (b) Through the Public Sector Purchase programme, the European Central Bank became the largest creditor to Member States it was not allowed to finance; and (c) The Public Sector Purchase programme can lead to conflicts between the price stability objective and financial stability.
Vision loss with pembrolizumab treatment: A report of two cases
Authors: Telfah Mohammad , Whittaker Thomas J. , C. Doolittle Gary
Published: April 2019

Background

Vision loss and other ocular toxicities are rare, but detrimental, side effects of immune checkpoint inhibitors. Herein, we report two patients who developed vision loss while on pembrolizumab treatment.

Cases presentation

Case 1 – A 58-year-old man was started on pembrolizumab for advanced melanoma. He was tolerating the treatment well. After receiving 14 cycles of pembrolizumab, he developed acute bilateral vision loss and occipital headaches. An emergent ophthalmologic evaluation revealed bilateral shallow choroidal effusion with bilateral focal exudative retinal detachment. After excluding other possible etiologies, inflammatory process secondary to pembrolizumab was suspected. Pembrolizumab was stopped, and the patient was started on a course of systemic and topical steroids. His vision improved within days and he recovered completely within two months. Calculated Naranjo Nomogram score was 7 indicating a “probable” correlation; Case 2 – A 57-year-old man with stage IIIC melanoma was started on adjuvant pembrolizumab. After a few weeks of treatments, he reported minor bilateral vision changes that progressively worsened over a period of six months. An ophthalmologic evaluation revealed bilateral posterior uveitis with right optic disc edema. Pembrolizumab-related inflammatory changes were suspected, and he was started on systemic and topical steroids. His symptoms improved within a few weeks and steroids were tapered. He was re-challenged with pembrolizumab and his symptoms quickly re-occurred. Pembrolizumab was stopped indefinitely and the patient again treated with systemic and topical steroids. His symptoms resolved and his vision returned to baseline within two months. The Naranjo Nomogram score was 9 indicating a “definite” correlation.

Conclusions

Vision loss is a serious complication that may occur at any point during treatment with PD-1 inhibitors. Vision loss is very distressing to the patients and their families. It is prudent for practitioners to recognize early vision abnormalities in patients receiving PD-1 antagonists to prevent permanent vision loss.
Chemotherapy-Induced Hair Loss: The Use of Biomarkers for Predicting Alopecic Severity and Treatment Efficacy
Authors: Haslam Iain S , Smart Eleanor
Published: April 2019

Damage to hair follicles following exposure to toxic chemotherapeutics can cause substantial hair loss, commonly known as chemotherapy-induced alopecia (CIA). Preventive therapies remain limited; however, recent advances in the use of scalp cooling technologies have proved successful in preventing or reducing hair loss in some patients. Further improvements in scalp cooling efficacy and/or development of novel treatments to prevent chemotherapy-induced hair loss are required. To achieve this, post-chemotherapy assessment of hair follicle damage markers, with and without scalp cooling, would provide invaluable mechanistic and prognostic information. At present, the availability of such data is extremely limited. This article describes the potential utility of a combination of biomarkers in assessing drug-induced alopecia and the protective potential of existing or new treatments. A greater understanding of the precise mechanisms of anti-CIA therapies through biomarker analysis would enhance the rationale, use, and development of such treatments.
Making implausible futures possible: The challenges of cultural psychology
Authors: Pérez Huenteo Camila Alejandra
Published: April 2019

This article is a review of the book “The challenges of cultural psychology. Historical legacies and future responsibilities”, edited by Gordana Jovanović, Lars Allolio-Näcke and Carl Ratner (2019) and published by Routledge. In this book, several authors cover both origins and current developments of cultural psychology, contributing to a biographical perspective of this science. Regarding the theoretical proposals of cultural psychology, besides reviewing them thoroughly, this work encourages a reflection on how these proposals could improve people’s lives. This work evinces the colonization of the natural science model over cultural psychology. In other words, it describes how mainstream psychology has been forced to adopt natural science’s methods as their own, even though their objects of study are deeply different. Likewise, this book declares how the natural science model has shaped servility, favoring a political and economic system that in turn, favors only elites. In this sense, cultural psychology has one major challenge ahead: to form an alliance with those excluded groups, with whom it shares the experience of resistance. Probably, it is difficult to visualize a future where this exclusion does not exist. However, to imagine those futures that seem implausible, it is the first step to make them possible.
The reality of conscientious objection: Response to Shahvisi
Authors: Saad Toni C , Rassam David M
Published: April 2019

Arianne Shahvisi has argued that a doctor’s conscientious objection to abortion is a misuse of their authority which unduly burdens patients and, moreover, does not succeed in its aim of exculpating objectors from participating in perceived evil. We examine these claims in this response. First, we ask what the ‘conscience clause’ really requires of doctors and whether Shahvisi has interpreted it correctly. Second, we explore the notions of vulnerability and power in the doctor–patient relationship and cast doubt on Shahvisi’s claims about these. Third, we tackle Shahvisi’s claim that conscientious objection is self-defeating because it entails remaing causally implicated in a chain of events leading to abortion. We show that this claim entails absurdity, then revisit the classical framework for the ethics ethics of co-operation to show that conscientious objection can suceed in exculpating objectors from perceived wrongdoing. We briefly critically evaluate the General Medical Council’s guidance on conscientious objection before drawing attention to some of the complexities surrounding abortion and clinical medicine which Shahvisi has overlooked.
Intracranial mechanical thrombectomy using a proximal balloon guide catheter via a transradial access
Authors: Maus Volker , Styczen Hanna , Psychogios Marios-Nikos
Published: April 2019

We present a description of a successful recanalization of an intracranial vessel occlusion by stent retriever-based mechanical thrombectomy with a proximal balloon guide catheter introduced via a transradial access. Therefore, we used the radial artery itself as a natural sheath, as the introduction of a balloon guide catheter would not have been possible through a common radial sheath.
Transitions outside the mainstream: Stories of children and their families
Authors: Warren Jane , Harden-Thew Kathryn
Published: April 2019

Smooth transitions through the early years of education are recognised as pivotal to later personal and academic success. However, for children considered outside the mainstream, these transitions can provide extra challenge for them, their families and educators. This paper reveals the findings of two qualitative studies investigating early years’ transitions. The first study focused on the transition of children with disabilities into early childhood education and care (ECEC) centres; the second explored transition to school for emergent bilingual children. These studies highlight ‘strengths-based’ perspectives (Perry, Dockett, & Petriwskyj, 2013), wherein participants are understood as experts in their own lives bringing strengths as well as challenges to the new context. Despite the differences in participants, timing and methods, key themes were evident across the studies: parent perceptions of transition; educator attitudes; and home/centre or home/school relationships. These themes are significant to all educational transitions for children considered outside the mainstream.
Effect of Acacia Honey on Transforming Growth Factor-Beta-1-Induced Myofibroblast Differentiation and Matrix Metalloproteinase-9 Production in Nasal Polyp Fibroblasts
Authors: Shin Seung-Heon , Ye Mi-Kyung , Lee Dong-Won , Che Mi-Hyun
Published: April 2019

Background

Acacia honey is known to have antioxidant, immune-modulatory, and antiproliferative properties. Nasal fibroblasts participate in local immune responses that control the recruitment of inflammatory cells and the production of extracellular matrix.

Objectives

The aim of this study was to determine the effect of acacia honey on myofibroblast differentiation and matrix metalloproteinase-9 (MMP-9) production in nasal polyp fibroblasts.

Methods

Primary nasal fibroblasts were isolated from nasal polyps and treated with transforming growth factor-beta 1 (TGF-β1). Reverse transcription-polymerase chain reaction and Western blot analysis were then performed to determine α-smooth muscle actin (α-SMA), tissue inhibitors of matrix metalloproteinase-1, and MMP-9 mRNA expression and protein production in nasal polyp fibroblasts. Phosphorylated Smad ( pSmad) 2/3 and phosphorylated adenosine monophosphate-activated protein kinase ( pAMPK) were then determined by Western blotting.

Results

TGF-β1 stimulation increased α-SMA and MMP-9 mRNA expression and protein production in nasal polyp fibroblasts. Acacia honey effectively suppressed α-SMA and MMP-9 mRNA expression and protein production. It also prevented phosphorylation of Smad 2/3 and AMPK.

Conclusion

Acacia honey can inhibit TGF-β1-induced myofibroblast differentiation and MMP-9 production in nasal fibroblasts. These results suggest that acacia honey might be useful for inhibiting nasal polyp formation.
Comparative Assessment of the Magnitude of Hyperlipidemia in HIV-Infected Patients Receiving Lopinavir/r- and Atazanavir/r-Based Antiretroviral Drugs
Authors: Muya Esther , Kamuhabwa Appolinary
Published: April 2019

Objective:

To assess prevalence of hyperlipidemia in patients receiving lopinavir boosted with ritonavir (LPV/r) and atazanavir boosted with ritonavir (ATV/r) antiretroviral drugs.

Methods:

HIV-infected patients (300) were recruited in the study between December 2015 and April 2016. Lipid profile including triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) were assessed.

Results:

Prevalence of derangement in TG was 71.0% in patients using LPV/r compared to 44% in those using ATV/r ( P = .01). Use of LPV/r was independently associated with increased total cholesterol (TC; P = .001) and TG ( P = .0003). Females had raised levels of TC compared to males ( P = .00008). Body mass index of ≥ 25 kg/m2 was also associated with raised TC ( P = .002) and LDL-C ( P = .006).

Conclusion:

LPV/r was significantly associated with lipid derangements, indicating the need to regularly monitor lipid profile in patients using LPV/r.
NAV-KIDS2 trial: protocol for a multi-centre, staggered randomised controlled trial of a patient navigator intervention in children with chronic kidney disease
Authors: van Zwieten Anita , Caldwell Patrina , Howard Kirsten , Tong Allison , Craig Jonathan C. , Alexander Stephen , Howell Martin , Armando Teixeira-Pinto , Hawley Carmel , Jesudason Shilpa , Walker Amanda , Mackie Fiona , Kennedy Sean , McTaggart Steve , McCarthy Hugh , Carter Simon , Kim Siah , Crafter Sam , Woodleigh Reginald , Guha Chandana , Wong Germaine
Published: April 2019

Background

Chronic kidney disease (CKD) is a devastating illness associated with increased mortality, reduced quality of life, impaired growth, neurocognitive impairment and psychosocial maladjustment in children. There is growing evidence of socioeconomic disparities in health outcomes among children with CKD. Patient navigators are trained non-medical personnel who assist patients with chronic conditions journey through the continuum of care and transit across different care settings. They help vulnerable and underserved populations to better understand their diagnosis, treatment options, and available resources, guide them through complex medical systems, and help them to overcome barriers to health care access. Given the complexity and chronicity of the disease process and concerns that current models of care may not adequately support the provision of high-level care in children with CKD from socioeconomically disadvantaged backgrounds, a patient navigator program may improve the provision of care and overall health of children with CKD.

Methods

The NAV-KIDS2 trial is a multi-centre, staggered entry, waitlisted randomised controlled trial assessing the health benefits and costs of a patient navigator program in children with CKD (stages 3–5, on dialysis, and with kidney transplants), who are of low socioeconomic backgrounds. Across 5 sites, 210 patients aged from 3 to 17 years will be randomised to immediate receipt of a patient navigator intervention for 24 weeks or waitlisting with standard care until receipt of a patient navigator at 24 weeks. The primary outcome is child self-rated health (SRH) 6-months after completion of the intervention. Other outcomes include utility-based quality of life, caregiver SRH, satisfaction with healthcare, progression of kidney dysfunction, other biomarkers, missed school days, hospitalisations and mortality. The trial also includes an economic evaluation and process evaluation, which will assess the cost-effectiveness, fidelity and barriers and enablers of implementing a patient navigator program in this setting.

Discussion

This study will provide clear evidence on the effectiveness and cost-effectiveness of a new intervention aiming to improve overall health and well-being for children with CKD from socioeconomically disadvantaged backgrounds, through a high quality, well-powered clinical trial.

Trial registration

Prospectively registered (12/07/2018) on the Australian New Zealand Clinical Trials Registry (ACTRN12618001152213).
Long-lasting insecticidal nets and indoor residual spraying may not be sufficient to eliminate malaria in a low malaria incidence area: results from a cluster randomized controlled trial in Ethiopia
Authors: Loha Eskindir , Deressa Wakgari , Gari Taye , Balkew Meshesha , Kenea Oljira , Solomon Tarekegn , Hailu Alemayehu , Robberstad Bjarne , Assegid Meselech , Overgaard Hans J. , Lindtjørn Bernt
Published: April 2019

Background

Conflicting results exist on the added benefit of combining long-lasting insecticidal nets (LLINs) with indoor residual spraying (IRS) to control malaria infection. The main study objective was to evaluate whether the combined use of LLINs and IRS with propoxur provides additional protection against Plasmodium falciparum and/or Plasmodium vivax among all age groups compared to LLINs or IRS alone.

Methods

This cluster-randomized, controlled trial was conducted in the Rift Valley area of Ethiopia from September 2014 to January 2017 (121 weeks); 44 villages were allocated to each of four study arms: LLIN + IRS, IRS, LLIN, and control. Each week, 6071 households with 34,548 persons were surveyed by active and passive case detection for clinical malaria. Primary endpoints were the incidence of clinical malaria and anaemia prevalence.

Results

During the study, 1183 malaria episodes were identified, of which 55.1% were P. falciparum and 25.3% were P. vivax, and 19.6% were mixed infections of P. falciparum and P. vivax. The overall malaria incidence was 16.5 per 1000 person-years of observation time (PYO), and similar in the four arms with 17.2 per 1000 PYO in the LLIN + IRS arm, 16.1 in LLIN, 17.0 in IRS, and 15.6 in the control arm. There was no significant difference in risk of anaemia among the trial arms.

Conclusions

The clinical malaria incidence and anaemia prevalence were similar in the four study groups. In areas with low malaria incidence, using LLINs and IRS in combination or alone may not eliminate malaria. Complementary interventions that reduce residual malaria transmission should be explored in addition to LLINs and IRS to further reduce malaria transmission in such settings.

Trial registration PACTR201411000882128 (08 September 2014)
High Detection Rate of MYD88 Mutations in Cerebrospinal Fluid From Patients With CNS Lymphomas
Authors: Watanabe Jun , Natsumeda Manabu , Okada Masayasu , Kobayashi Daiki , Kanemaru Yu , Tsukamoto Yoshihiro , Oishi Makoto , Kakita Akiyoshi , Fujii Yukihiko
Published: April 2019

PURPOSE

Biopsy is the gold standard for the diagnosis of primary CNS lymphoma (PCNSL). However, surgical biopsy has problems of morbidity related to hemorrhagic complications and false-negative findings, so safer and more reliable diagnostic methods are required. The aim of this study is to detect the MYD88 mutation, an important driver mutation, in the cerebrospinal fluid (CSF) of patients with CNS lymphoma.

PATIENTS AND METHODS

Twenty-six patients with CNS lymphoma (20 primary CNS lymphoma and six CNS relapse from systemic lymphoma) were studied. We extracted cell-free DNA (cfDNA) from CSF by lumbar puncture. cfDNA was extracted from 1 mL of CSF, and Sanger sequencing and droplet digital polymerase chain reaction (ddPCR) were performed. Furthermore, we performed DNA sequencing of MYD88 in 21 cases with available surgically obtained formalin-fixed paraffin-embedded (FFPE) tissue and compared the results.

RESULTS

The median cfDNA amount extracted from 1 mL CSF was 219 ng/mL (25th to 75th percentile, 129 to 333 ng/mL). MYD88 mutations were detected from CSF in 76.9% (20 of 26 cases), and L265P in exon 5 was the most frequent mutation in 19 out of 20 (95.0%) cases. S219C in exon 3 was detected in one case. In four patients, MYD88 mutation was confirmed by ddPCR but not by Sanger sequencing. In all 21 cases with sufficient FFPE tissue for DNA analysis, the detection of MYD88 mutation from cfDNA was consistent with those of tumor-derived DNA from FFPE tissue.

CONCLUSION

This pilot study provided evidence that the somatic driver mutation MYD88 can be reliably detected by combination of Sanger sequencing and ddPCR in the cfDNA taken from 1 mL of CSF in patients with CNS lymphomas.
Genomic Characterization of Prostatic Ductal Adenocarcinoma Identifies a High Prevalence of DNA Repair Gene Mutations
Authors: Schweizer Michael T. , Antonarakis Emmanuel S. , Bismar Tarek A. , Guedes Liana B. , Cheng Heather H. , Tretiakova Maria S. , Vakar-Lopez Funda , Klemfuss Nola , Konnick Eric Q. , Mostaghel Elahe A. , Hsieh Andrew C. , Nelson Peter S. , Yu Evan Y. , Montgomery R. Bruce , True Lawrence D. , Epstein Jonathan I. , Lotan Tamara L. , Pritchard Colin C.
Published: April 2019

PURPOSE

Ductal prostate cancer (dPC) is a rare variant of prostatic adenocarcinoma associated with poor outcomes. Although its histopathologic features are well characterized, the underlying molecular hallmarks of this aggressive subtype are not well described. We sought to provide a comprehensive overview of the spectrum of mutations associated with dPC.

METHODS

Three case series across multiple institutions were assembled. All patients had a diagnosis of dPC, and histopathologic classification was confirmed by an expert genitourinary pathologist. Case series 1 included men who were prospectively enrolled in a tumor sequencing study at the University of Washington (n = 22). Case series 2 and 3 included archival samples from men treated at Johns Hopkins Hospital (n = 21) and University of Calgary (n = 8), respectively. Tumor tissue was sequenced on a targeted next-generation sequencing assay, UW-OncoPlex, according to previously published methods. The frequency of pathogenic/likely pathogenic mutations are reported.

RESULTS

Overall, 25 patients (49%) had at least one DNA damage repair gene alteration, including seven (14%) with a mismatch repair gene mutation and 16 (31%) with a homologous repair mutation. Germline autosomal dominant mutations were confirmed or suspected in 10 patients (20%). Activating mutations in the PI3K pathway (n = 19; 37%), WNT pathway (n = 16; 31%), and MAPK pathway (n = 8; 16%) were common.

CONCLUSION

This study strongly suggests that dPCs are enriched for actionable mutations, with approximately 50% of patients demonstrating DNA damage repair pathway alteration(s). Patients with dPC should be offered next-generation sequencing to guide standard-of-care treatment (eg, immune checkpoint inhibitors) or triaged toward an appropriate clinical trial (eg, poly [ADP-ribose] polymerase inhibitors).
Snakes and Gutters
Authors: DeCaroli Robert
Published: April 2019

Visitors to early (second century bce–fifth century ce) Buddhist monastic sites across South Asia encountered prominent figural images of nāgas, serpent-like beings who were believed to be closely connected to water and rainfall. Such images are commonly identified as guardians and occasionally have been linked to nearby water systems, such as ponds, tanks, and rivers. Yet, these images have not been studied as an aspect of water regulation within the monasteries themselves. This paper will first consider the water-related challenges that confronted the monks and architects at rock-cut monasteries. Then methods of hydraulic engineering designed to regulate the flow of water at the sites will be considered in relation to the role of nāga imagery. Their proximity to gutters and tanks reveals the Buddhist reliance on supernatural forces as an aspect of water control. The highly visible nature of this arrangement helps to explain the emergence of ritual texts, primarily after the fourth century ce, in which Buddhist ritualists adopt the role of rainmakers. These elaborate ceremonies promise to bring rain or end flooding for the benefit of the saṃgha and the wider community. The ritualists invariably invoke a special relationship with the nāgas, whom they enjoin to rectify undesirable conditions. This connection between image and text reveals a centuries-long process by which the monastic community developed an association with weather regulation that was contingent on a cultivated and highly public relationship with Buddhist-friendly nāgas.
Constructing the Afterlife, Reenvisioning Salvation
Authors: Chusid Miriam
Published: April 2019

By the thirteenth century in Japan, King Enma (Sanskrit: Yama-rāja) had become a familiar deity in the Buddhist pantheon. Largely understood as the judge of one's past deeds, Enma's position as one king in a series of ten was common knowledge, and offerings made to him, as well as to the other nine, served to ensure the petitioner a favorable rebirth in his or her next life. This article brings to light Enma's roles independent of this schema. It argues that far from serving solely as the judge of one's actions, Enma could be a figure to whom one petitioned for worldly benefits and even directed prayers for salvation. In addition, this essay shows that the architectural and spatial settings in which Enma was placed influenced the understanding of his varied functions, and ultimately enabled his refiguration as a salvific deity who had the power to grant birth in a Buddha land.
Modelling Human Decision Behaviour with Preference Learning
Authors: Aggarwal Manish , Fallah Tehrani Ali
Published: April 2019

Preferences provide a means for specifying the desires of a decision maker (DM) in a declarative way. In this paper, based on a DM’s pairwise preferences, we infer the DM’s unique decision model. We capture (a) the attitudinal character, (b) relative criteria importance, and (c) the criteria interaction, all of which are specific to the DM. We make use of the preference-learning (PL) technique to induce predictive preference models from empirical data. Because PL is emerging as a new subfield of machine learning, we could use standard machine-learning methods to accomplish our learning objective. We consider the DM’s exemplary preference information in the form of pairwise comparisons between alternatives as the training information. The DM’s decision model is captured in terms of (a), (b), and (c), through the parameters of an attitudinal Choquet integral operator. The proposed learning approach is validated through an experimental study on 16 standard data sets. The superiority of the proposed method in terms of predictive accuracy and easier interpretability is shown both theoretically as well as empirically.
Research roundup: April 2019
Authors: Seal Joanne , Odd Dawn
Published: April 2019

In this section, a range of brief synopses of recently published articles that may be of interest to health visitors is presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
La estética del secreto en una novela de espionaje : La deuxième mort de Ramón Mercader de Jorge Semprún
Authors: Kroll Simon
Published: April 2019

This paper examines a specific characteristic of spy novels, the aesthetics of secrecy, on the example of Jorge Semprún's La deuxième mort de Ramón Mercader. An important aspect in the creation of an aesthetic of secrecy in the novel in question is the variation of the famous figure of the double. Ramón Mercader, the protagonist of the novel presents an interesting case of this, which will be analysed in the first part of this paper. The second part of the article points out the overruling organisation principle of the novel: the secret. The complex narratological and temporal structure of the novel obeys to the secret, which makes it the major formal principle of this text. The story does not only narrate secrets but the secret as a formal principle creates a text with plenty of voices and a complex temporal structure, contributing to the creation of an aesthetic of secrecy.
La metáfora del viaje en Un viaje de novios de Emilia Pardo Bazán
Authors: Kidakou Antoine Bouba
Published: April 2019

Within the vast corpus of the nineteenth century Spanish narrative, Emilia Pardo Bazán’s Un viaje de novio, deserve a different consideration due to a particular style adopted by the author and the consideration of travel as an allegory of life. The author departs, hence fore, from the way how travel was understood in the nineteenth century when writers based their travel writings or novels on the scientific and educational aspects. Pardo Bazan explores the transcendental aspect of travel fact and this paper studies the different techniques used by the writer to develop the metaphor of travel considering the geographical movement as an internal trip. The subjective and progressive transformation of the main protagonist, according to the itinerary of the trip, is studied as that internal journey.
El impacto del boom latinoamericano en los escritores serbios
Authors: Kovačević Petrović Bojana
Published: April 2019

In this work we want to show the strong links between Spanish-American and Serbian writers, through the books translated from Spanish and works written in Serbian. Assuming that each writer is above all a good reader, and considering the importance of translation for literature in general, we have investigated the influence of Borges, Cortázar, Fuentes, García Márquez and Vargas Llosa on Serbian writers since the 1950s until today. Through authentic testimonies - interviews made for this research - and the reviews and analysis of books and particular texts influenced by the authors of the boom, we will present a creative variety and authentic literary creation of a small country with many translations and dedicated writers, and show that the great impact of Spanish-American literature in Serbia began half a century ago and never ceased.
La presencia de los nahuatlismos en el español de México desde un enfoque diacrónico
Authors: Petkova Ingrid
Published: April 2019

The aim of this article is, on one hand, to talk about the language contacts between Mexican Spanish and the indigenous languages of Mexico, more specifically Nahuatl; on the other hand, to introduce the linguistic phenomenon of Nahuatl loanwords and their presence in the Mexican literature from diachronic point of view.
Un encuentro morfofonológico insólito
Authors: Gaál Zoltán Kristóf
Published: April 2019

In this article we will examine a somewhat strange and still unexplored area of Spanish morphophonology. It is a well-known fact that the use of evaluative (and particularly the diminutive) suffixes enjoys a great vitality in today’s Spanish. Their vitality is reflected by the regular and productive character of the application of the process. It has also been demonstrated that the choice between the allomorphs of the diminutive suffixes is governed by welldefined phonological principles. But what happens when native speakers must leave behind their linguistic routine and have to add a diminutive suffix to words that they rarely would summit to this mechanism (namely, international brand names)? The article displays a pioneer approach to the question with particular focus on analogy and concludes that while the suffixation of the brand names that end in a phonotactically natural segment is somewhat less consistent than the suffixation of Spanish words with the same ending, those of exotic ending do show certain degree of coherence with the rest of the system.
Undo, redo, delete: visiones del hogar y sus implicaciones en la literatura hispanoamericana contemporánea
Authors: Bakucz Dóra
Published: April 2019

En el artículo se analizan tres cuentos de tres autoras hispanoamericanas (dos argentinas, Ana María Shua y Samantha Schweblin, así como una chilena, Andrea Jeftanovic), que de alguna manera u otra dan una visión de las condiciones del cambio del hogar y sus implicaciones, como la familia y las relaciones familiares, en las sociedades contemporáneas. En el plano teórico partimos de las ideas de Zygmunt Bauman sobre la “modernidad líquida” y “el amor líquido” que caracteriza las sociedades de hoy, y utilizamos la metáfora de los comandos de los procesadores de texto: undo, redo, delete.