bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Pitch Variation and Diameter Variation on Screw Pullout in 3D Printed Screws
Authors: Veenstra Joshua , Gustafson Peter , Bearden Cody , Jastifer James
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

There are many screw and thread designs available to the foot and ankle surgeon for bone fixation. Comparing screws between companies is difficult because properties including core diameter, thread diameter, and pitch confound direct comparisons. There is a paucity of literature on comparative mechanical properties of various screw designs including variable pitch screws and tapered screws. The purpose of this study was to determine the effect of varying thread pitch and/or tapering a screws core diameter. Our hypothesis was that variable pitch screws and tapered screws would have decreased strength compared to screws with constant diameter and constant pitch.

Methods:

3D metal printing technology was used to manufacture screws that varied in only the test variables. Four different screws designs were created including variable and constant pitch screws in both straight and tapered diameter versions. These screws were pulled out of synthetic bone at a constant rate while force was measured. Pull out strength and stiffness was calculated for each screw. A generalized linear model and ANOVA were completed to assess the effect on pull out strength and stiffness of the pitch and taper variables.

Results:

The pull out strength of the constant pitch screws (304.9N+-25.3 N, p<0.001) was significantly greater than the variable pitch screws (259.7N+-23.4 N). The pull out strength was also significantly greater for screws with a tapered diameter (305.4N+- 24.1 N) than a constant diameter (259.1N+-23.5 N, p<0.001). Tapered diameter variable pitch screws had the largest stiffness overall (mean stiffness 556.6 N/mm), which was greater than all other screw designs (p=0.001). The difference in stiffness between all screws with either constant pitch or constant diameter was not statistically significant (p=0.060).

Conclusion:

The pull out strength is significantly greater for screws with a constant pitch than for a variable pitch and greater for a tapered diameter than a constant diameter. The clinical significance of this study is that it provides data on the effects that thread design and tapering have on the pullout strength of screws providing some evidence that variable pitch screws may have lower pull out strength than constant pitch screws. Utilizing 3D printed screws allowed for the control of all other variables, which may otherwise confound the comparison of different commercially available screws.
Preliminary results of the “four-dimensional six degrees-of-freedom” gait simulation system improvement
Authors: Wang Xu , Ma Xin
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Using computer-controlled electro-hydraulic servo technology, we studied the improved “four-dimensional six degrees-of-freedom” gait simulation system based on motor and hydraulic hybrid drive control and achieved the human body’s normal gait cycle with fresh cadavers

Methods:

Through the superimposed combination of a composite servo motor drive mechanism, a highly precise “four-dimensional six degrees-of-freedom” at the tibia could be achieved using fresh cadavers below the knee. At the same time, ten sets of independently controlled electro-hydraulic servo hydraulic cylinders were used to achieve the mechanical loading of the tendon and tibia to reproduce the dynamic and kinematic parameters of the normal gait cycle with the cadaver model

Results:

The time for the system to complete a gait cycle was controlled at approximately three seconds. The coordinate motion curve of the tibia in the six degrees-of-freedom space was consistent with the M curve of the normal gait cycle, and the measurement results of plantar stress were similar to the measurement curves of the normal gait cycle.

Conclusion:

The improved “four-dimensional six degrees-of-freedom” gait simulation system successfully reproduced a gait cycle that was the closest to the normal gait cycle among all existing research.
Fusion Versus Flexible Reconstruction for Patients with Flexible Flatfoot
Authors: Whitelaw Kathryn , Shah Shivesh , Hagemeijer Noortje , Guss Daniel , Johnson Anne , DiGiovanni Christopher
Published: September 2018

Category:

Other

Introduction/Purpose:

When passively correctible, adult acquired flatfoot deformities (AAFD) are often treated with joint-sparing procedures. Questions remain, however, as to the efficacy of such flexible procedures when clinical deformities become more severe. In patients with increasingly severe deformities, a primary fusion may lead to more predictable outcomes, but also risks nonunion. The primary aim of this study was to compare the reoperation rates and complication rates following flexible reconstructions versus fusion procedures in the treatment of flexible AAFD.

Methods:

All patients, who were diagnosed and treated surgically for a flexible AAFD between January 1, 2001 and January 1, 2016, were identified. Exclusion criteria included incomplete medical records, rigid flatfoot deformities, and prior flatfoot surgery. Procedures defined as flexible reconstructions included medial calcaneal osteotomy (MCO), lateral calcaneal lengthening (LCL), double osteotomy, posterior tibial tendon (PTT) debridement, or PTT augmentation; procedures defined as fusions included subtalar (ST) arthrodesis, talonavicular (TN) arthrodesis, calcaneocuboid (CCJ) arthrodesis (alone or in combination with a LCL), double arthrodesis, or triple arthrodesis. Patient demographics, type of surgical procedure, postoperative complications, and reoperation rates were collected. Bivariate analysis was performed to compare patients who had a flexible reconstruction procedure versus a fusion procedure.

Results:

Two-hundred-thirty-nine patients (255 feet, mean follow up 62±50 months, range 15-104) were included. Two-hundred-eight (87%) patients underwent a flexible reconstruction, average age 55 (±12.0), while 31 (13%) patients underwent a fusion, average age 58 (±14.4) (p = 0.161). Age, BMI, diabetes and neuropathy rates were similar for both groups. Fifty-four patients (24%) underwent a flexible reconstruction and returned to the OR versus 11 (34%) in the fusion group (p = 0.217). Nonunion occurred more in the fusion group, with 5 (16%) versus 10 (4%) nonunions in the flexible reconstruction (p = 0.027). Symptomatic nonunion rates were similar. Rates of surgical revision for nonunion among patients returning to the OR were similar between flexible (7/54, 3%) and fusion (3/11, 9%) groups (p = 0.117).

Conclusion:

No significant difference in reoperation rates was found between flexible AAFD patients who were treated with flexible reconstructions versus fusions. As expected, the nonunion rate was significantly higher in the fusion group. Notably, rates of revision surgery for nonunion were similar between groups. Our findings suggest that nonunion should be less of a concern when considering a flexible versus fusion procedure for patients with a severe AAFD, and that other factors such as the degree of deformity should guide decision making.
Association between avulsion fracture of the distal fibula and recurrent sprain in children with ankle sprain
Authors: Yamaguchi Satoshi , Nakagawa Ryosuke
Published: September 2018

Category:

Sports

Introduction/Purpose:

The incidence of ankle sprain is higher in children than in adolescents and adults. Avulsion fractures of the distal fibula, where the anterior tibiofibular ligament attaches, commonly occur with lateral ankle sprain in children. If the avulsion fracture remains ununited, it will become a subfibular ossicle (Figure), and can cause pain, instability, and recurrent sprain. However, the incidence and radiographic result of avulsion fracture, as well as the impact of the fracture on clinical outcomes, are not well-studied. The purposes of this study were 1) to clarify the incidence and union rate of distal fibular avulsion fracture with lateral ankle sprain in children, and 2) to assess the association between avulsion fracture and recurrent sprain.

Methods:

Patients who presented to four orthopaedic clinics were prospectively examined. Patients with a first-time inversion ankle sprain, aged from 6 to 12 years, and visiting the clinics within 48 hours after injury, were included. Patients underwent anteroposterior and lateral radiographs, and the ATFL view (Figure) at the first visit, and the incidence of avulsion fracture was assessed. The patients with avulsion fractures underwent follow-up radiographs after 8 weeks, and fracture union was assessed. Treatment was not standardized, and ranged from an elastic bandage to a non-weightbearing cast for 6 weeks. Recurrent sprain of the ipsilateral ankle was surveyed by a review of the medical record and the questionnaire that was sent to the patients regularly. Furthermore, patients were divided into 3 groups: patients with no avulsion fracture, fracture union, and fracture nonunion. The rates of recurrent sprain were compared among the groups using the chi-square test and multiple comparisons.

Results:

From April 2014 to August 2015, 144 ankles of 144 patients (53 female and 91 male) with a mean age of 8.8 years underwent the radiographs at the first visit. Recurrent sprain was assessed in 105 (73%) patients with a mean follow-up of 23months. The incidence of distal fibular avulsion fracture was 62% (89/144 patients). The union rate of avulsion fracture was only 17%. The overall rate of recurrent sprain was 32% (34/105 patients). The rates were 45% (5/11) in patients with fracture union and 39% (20/51) in patients with nonunion. These rates were significantly higher than that in patients with no avulsion fracture (21%, 9/43) (P=0.02). However, the rates were similar between patients with fracture union and nonunion.

Conclusion:

Avulsion fractures of the distal fibula were surprisingly common with ankle sprain in children, and the most of the fractures remained ununited. The rate of recurrent sprain was relatively high at a 23 month follow-up. The presence of avulsion fracture was associated with a higher risk of recurrent sprain, however achieving fracture union did not reduce the risk.
First metatarsophalangeal arthrodesis for treatment of hallux valgus with metatarsus adductus
Authors: Zhu Yuan
Published: September 2018

Category:

Bunion

Introduction/Purpose:

The surgical treatment of hallux valgus with severe metatarsus adductus deformity can be challenging. This study aims to investigate the clinical and radiologic outcomes of first metatarsophalangeal arthrodesis in treating this complex deformity.

Methods:

Between Jun 2009 and Jun 2015, 15 consecutive cases of hallux valgus with severe metatarsus adductus [metatarsus adductus angle, MAA>25°(modified Sgarlato method)] received first metatarsophalangeal arthrodesis for correction with a dorsal plate and a lag screw. The clinical outcome of these patients (average age of 63.1 years) was evaluated by means of the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux MTP-IP Scale and ankle pain on the visual analogue scale (VAS). Radiological imaging included hallux valgus angle (HVA) and 1st intermetatarsal angle (IMA).

Results:

All these 15 patients were available for follow-up at a mean of 12.7 months. The average postoperative AOFAS Hallux MTP-IP Scale 12 months after surgery was 88.6 (compare with 60.8 preoperatively). The mean visual analog scale score decreased from 5.51 ± 1.53 preoperatively to 0.98 ± 0.98 at the latest follow-up. All the metatarsophalangeal joints got complete fused without delayed fusion. The HVA improved from 45.2°preoperatively in average to 17.3°postoperatively. No deformity recurrence was observed by the time of the latest follow-up.

Conclusion:

First metatarsophalangeal arthrodesis is a simple, reasonable and reliable option for the treatment of hallux valgus with severe metatarsus adductus deformity, especially for elderly patients with degenerated symptomatic metatarsophalangeal joint.
Pore-size-dependent fluid substitution method for magnetic resonance measurements
Authors: Medellin David , Ravi Vivek Ramachandran , Torres-Verdín Carlos
Published: September 2018

Pore-size distribution and permeability can be accurately estimated from nuclear magnetic resonance (NMR) measurements acquired in single-fluid-saturated rocks. However, most rocks penetrated by wells contain multiple fluids and are commonly affected by mud-filtrate invasion, which makes the analysis and interpretation of longitudinal ([Formula: see text]) and transverse ([Formula: see text]) relaxation measurements challenging. It is necessary to replace the hydrocarbon NMR response of the original measurements with an equivalent water response to estimate petrophysical quantities of interest. We have developed an improved NMR fluid substitution method that takes into account partial water and hydrocarbon pore saturation and does not require knowledge of permeability and surface relaxivity. The method consists of two steps: first, the hydrocarbon NMR response is removed from the initially water-hydrocarbon-saturated NMR data. Then, the NMR distribution of the resulting hydrocarbon-depleted system is transformed to that of a completely water-saturated system. Four pore-size-dependent saturation distributions are considered in the study. Tests of verification are performed on Berea sandstone and Indiana limestone samples. Our results show that the method can be reliably applied to Berea sandstone but has limited applicability to the Indiana limestone samples.
Spending on Antineoplastic Agents in the United States, 2011 to 2016
Authors: Hong Samuel J. , Li Edward C. , Matusiak Linda M. , Schumock Glen T.
Published: September 2018

Purpose:

Recent cancer drug approvals are lauded as being more effective with relatively fewer adverse effects, but these treatments come with a great cost to the US health care system. There is little information on recent trends in actual antineoplastic expenditures representative of the whole US health care system or by sector. Therefore, the objective of this study was to describe antineoplastic expenditures in the United States by year and sector.

Methods:

This was a retrospective, cross-sectional study of IQVIA (formerly QuintilesIMS) National Sales Perspective data for the period of January 1, 2011, to December 31, 2016. Actual expenditures were totaled by health care sector and calendar year, then adjusted for medical-cost inflation to 2016 dollars. Growth was calculated as the percentage increase from the previous year.

Results:

Total expenditures of antineoplastic agents across all channels grew from $26.8 billion in 2011 to $42.1 billion in 2016. Antineoplastic spending increased 12.2% in 2016 (compared with the previous year), followed by 15.6% in 2015, 13.4% in 2014, 6.3% in 2013, and 0.4% in 2012. Throughout the study period, 96.5% of total antineoplastic expenditures occurred within clinics, mail-order pharmacies, nonfederal hospitals, and retail pharmacies.

Conclusion:

Antineoplastic expenditures are expected to increase because of continuing development and approval of costly targeted cancer therapies. Cost containment and utilization management strategies must be balanced so as not to restrict access or disrupt innovation. Future policies should focus on ensuring safe and appropriate use of antineoplastics while balancing long-term drug costs.
Reducing Glucokinase Activity Restores Endogenous Pulsatility and Enhances Insulin Secretion in Islets From db/db Mice
Authors: Jahan Ishrat , Corbin Kathryn L , Bogart Avery M , Whitticar Nicholas B , Waters Christopher D , Schildmeyer Cara , Vann Nicholas W , West Hannah L , Law Nathan C , Wiseman Jeffrey S , Nunemaker Craig S
Published: September 2018

An early sign of islet failure in type 2 diabetes (T2D) is the loss of normal patterns of pulsatile insulin release. Disruptions in pulsatility are associated with a left shift in glucose sensing that can cause excessive insulin release in low glucose (relative hyperinsulinemia, a hallmark of early T2D) and β-cell exhaustion, leading to inadequate insulin release during hyperglycemia. Our hypothesis was that reducing excessive glucokinase activity in diabetic islets would improve their function. Isolated mouse islets were exposed to glucose and varying concentrations of the glucokinase inhibitor d-mannoheptulose (MH) to examine changes in intracellular calcium ([Ca2+]i) and insulin secretion. Acutely exposing islets from control CD-1 mice to MH in high glucose (20 mM) dose dependently reduced the size of [Ca2+]i oscillations detected by fura-2 acetoxymethyl. Glucokinase activation in low glucose (3 mM) had the opposite effect. We then treated islets from male and female db/db mice (age, 4 to 8 weeks) and heterozygous controls overnight with 0 to 10 mM MH to determine that 1 mM MH produced optimal oscillations. We then used 1 mM MH overnight to measure [Ca2+]i and insulin simultaneously in db/db islets. MH restored oscillations and increased insulin secretion. Insulin secretion rates correlated with MH-induced increases in amplitude of [Ca2+]i oscillations (R2 = 0.57, P < 0.01, n = 10) but not with mean [Ca2+]i levels in islets (R2 = 0.05, not significant). Our findings show that correcting glucose sensing can restore proper pulsatility to diabetic islets and improved pulsatility correlates with enhanced insulin secretion.
Midface and upper airway dysgenesis in FGFR2-craniosynostosis involves multiple tissue-specific and cell cycle effects
Authors: Holmes Greg , O'Rourke Courtney , Perrine Susan M. Motch , Lu Na , van Bakel Harm , Richtsmeier Joan T. , Jabs Ethylin Wang
Published: September 2018

Midface dysgenesis is a feature of over 200 genetic conditions, in which upper airway anomalies frequently cause respiratory distress, but its etiology is poorly understood. Mouse models of Apert and Crouzon craniosynostosis syndromes exhibit midface dysgenesis similar to the human conditions. They carry activating mutations of Fgfr2, which is expressed in multiple craniofacial tissues during development. Magnetic resonance microscopy of three mouse models of Apert and Crouzon syndromes revealed decreased nasal passage volume in all models at birth. Histological analysis suggested overgrowth of the nasal cartilage in the two Apert syndrome mouse models. We used tissue-specific gene expression and transcriptome analysis to further dissect the structural, cellular, and molecular alterations underlying midface and upper airway dysgenesis in Apert Fgfr2+/S252W mutants. Cartilage thickened progressively during embryogenesis due to increased chondrocyte proliferation in the presence of Fgf2. Oral-epithelium expression of mutant Fgfr2, which resulted in a distinctive nasal septal fusion defect, and premature facial suture fusion contributed to the overall dysmorphology. Midface dysgenesis in Fgfr2-craniosynostosis is a complex phenotype arising from the combined effects of aberrant signaling in multiple craniofacial tissues.
The Secretory Pathway Calcium ATPase 1 (SPCA1) controls neural tube closure by regulating cytoskeletal dynamics
Authors: Brown Joel M. , García-García María J.
Published: September 2018

Neural tube closure relies on the apical constriction of neuroepithelial cells. Research in frog and fly embryos has found links between the levels of intracellular calcium, actomyosin dynamics and apical constriction. However, genetic evidence for a role of calcium in apical constriction during mammalian neurulation is still lacking. The Secretory Pathway Calcium ATPase (SPCA1) regulates calcium homeostasis by pumping cytosolic calcium into the Golgi. Loss of function in Spca1 causes cranial exencephaly and spinal cord defects in mice, phenotypes previously ascribed to apoptosis. However, our characterization of a novel allele of Spca1 revealed that neurulation defects in Spca1 mutants are not due to cell death, but rather to a failure of neuroepithelial cells to apically constrict. We show that SPCA1 influences cell contractility by regulating myosin II localization. Furthermore, we found that loss of Spca1 disrupts actin dynamics and the localization of the actin remodeling protein cofilin1. Taken together, our results provide evidence that SPCA1 promotes neurulation by regulating the cytoskeletal dynamics that promote apical constriction and identify cofilin 1 as a downstream effector of SPCA1 function.
Limits to sustained energy intake XXIX: the case of the golden hamster (Mesocricetus auratus)
Authors: Ohrnberger S. A. , Hambly C. , Speakman J. R. , Valencak T. G.
Published: September 2018

Golden hamster females have the shortest known gestation period among placental mammals and at the same time raise very large litters of up to 16 offspring, which are born in a naked and blind state and are able to pick up food from days 12-14 only. We quantified energy metabolism and milk production in female golden hamsters raising offspring under cold (8°C), normal (22°C) and hot (30°C) ambient temperature conditions. We monitored energy intake, subcutaneous body temperature, daily energy expenditure, litter size and pup masses over the course of lactation. Our results show that, in line with the concept of heat dissipation limitation, female golden hamsters had the largest energy intake under the coldest conditions and a significantly lower intake at 30° (partial for influence of ambient temperature: F2,403=5.6; p= 0.004). Metabolisable energy intake as well as milk energy output showed the same pattern and were significantly different between the temperatures (partial for milk energy production: F1,40= 86.4; p<0.0001). With consistently higher subcutaneous temperatures in the reproductive females (F1,813= 36.77; p<0.0001) compared to baseline females. These data suggest that raising offspring in golden hamsters comes at the cost of producing large amounts of body heat up to a level constraining energy intake, similar to that observed in some laboratory mice. Notably, we observed that females seemed to adjust litter size according to their milk production with the smallest litters (3.4±0.7 pups) being raised by hot exposed mothers. Future research is needed to unravel the mechanism by which females assess their own milk production capabilities and how this may be linked to litter size at different ambient temperatures. Golden hamsters reach 8-10 times resting metabolic rate (RMR) when raising offspring under cold conditions, which is compatible with the findings from laboratory mice and other rodents.
Optical Switching between Liquid-Crystalline Assemblies with Different Structural Symmetries and Molecular Orders
Authors: Nagai Aya , Kondo Hideaki , Miwa Yohei , Kondo Tomonori , Kutsumizu Shoichi , Yamamura Yasuhisa , Saito Kazuya
Published: September 2018

Optical switching between one-dimensionally ordered layered smectic C (SmC) and three-dimensionally periodic bicontinuous cubic (Cubbi) liquid-crystalline (LC) phases is a fascinating challenge because of the dramatic changes of structural symmetries and orders as well as physical properties. In this work, we have developed a new light-driven Cubbi phase system consisting of 4′-n-hexadecyloxy-3′-cyanobiphenyl-4-carboxylic acid (ACBC-16) and a structurally analogous azo compound (Azo-2). The employment of the CN side-group in the host compound brought about outstanding responsiveness under ultraviolet (UV) light in the mixtures containing 11 and 19 mol % Azo-2, leading to a UV response time of ∼5 s and excellent repeatability of on-off switching for the conversion between the two LC phases. The modification also enabled us to quantitatively analyze the mechanism of the light-induced transformation between the two LC phases. The evaluation revealed that the presence of ∼4% of bent molecules in the system under UV light destabilizes the SmC layered structure originally constructed by rod-shaped molecules, causing formation of the Cubbi phase at temperatures 10–35 K below the temperature range of the thermally-stable Cubbi phase.
A Strategy for in Silico Prediction of the Membrane Permeability of Drugs
Authors: Fujii Yu , Yoshida Erina , Osakai Toshiyuki
Published: September 2018

Parallel artificial membrane permeation assay (PAMPA) was performed for nine amine drugs and their permeability coefficient (log Ppampa) was determined at different pHs. The previously developed digital simulation method was successfully used to reproduce the sigmoid-like pH dependence of log Ppampa, and the distribution coefficient (log KD,M) to the lipid-containing dodecane membrane could be determined for all the amine drugs studied. The thus determined log KD,M values showed a linear free-energy relationship with the standard ion-transfer potential ($\Delta _{\text{O}}^{\text{W}}\phi ^{ \circ }$; R2 = 0.754) and the distribution coefficient (log KD; R2 = 0.891), which were previously determined by ion-transfer voltammetry with the 1,2-dichloroethane|water interface. On the other side, we can predict $\Delta _{\text{O}}^{\text{W}}\phi ^{ \circ }$ very accurately by a previously proposed solvation model called the “non-Bornian” model. These findings suggest a possible strategy for perfect in silico prediction of the membrane permeability of drugs.
Cell–cell adhesion: linking Wnt/β-catenin signaling with partial EMT and stemness traits in tumorigenesis
Authors: Basu Sayon , Cheriyamundath Sanith , Ben-Ze’ev Avri
Published: September 2018

Changes in cell adhesion and motility are considered key elements in determining the development of invasive and metastatic tumors. Co-opting the epithelial-to-mesenchymal transition (EMT) process, which is known to occur during embryonic development, and the associated changes in cell adhesion properties in cancer cells are considered major routes for tumor progression. More recent in vivo studies in tumor tissues and circulating tumor cell clusters suggest a stepwise EMT process rather than an “all-or-none” transition during tumor progression. In this commentary, we addressed the molecular mechanisms underlying the changes in cell adhesion and motility and adhesion-mediated signaling and their relationships to the partial EMT states and the acquisition of stemness traits by cancer cells.
Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016
Authors: Cazabon Danielle , Pande Tripti , Kik Sandra , Van Gemert Wayne , Sohn Hojoon , Denkinger Claudia , Qin Zhi Zhen , Waning Brenda , Pai Madhukar
Published: September 2018

Background: Xpert® MTB/RIF, a rapid tuberculosis (TB) molecular test, was endorsed by the World Health Organization in 2010. Since then, 34.4 million cartridges have been procured under concessional pricing. Although the roll out of this diagnostic is promising, previous studies showed low market penetration.

Methods: To assess 3-year trends of market penetration of Xpert MTB/RIF in the public sector, smear and Xpert MTB/RIF volumes for the year 2016 were evaluated and policies from 2014-2016 within 22 high-burden countries (HBCs) were studied. A structured questionnaire was sent to representatives of 22 HBCs. The questionnaires assessed the total smear and Xpert MTB/RIF volumes, number of modules and days of operation of GeneXpert machines in National TB Programs (NTPs). Data regarding the use of NTP GeneXpert machines for other diseases and GeneXpert procurement by other disease control programs were collected. Market penetration was estimated by the ratio of total sputum smear volume for initial diagnosis divided by the number of Xpert MTB/RIF tests procured in the public sector.

Results: The survey response rate was 21/22 (95%). Smear/Xpert ratios decreased in 17/21 countries and increased in four countries, since 2014. The median ratio decreased from 32.6 (IQR: 44.6) in 2014 to 6.0 (IQR: 15.4) in 2016. In 2016, the median GeneXpert utilization was 20%, however seven countries (7/19; 37%) were running tests for other diseases on their NTP-procured GeneXpert systems in 2017, such as HIV, hepatitis-C virus (HCV), Chlamydia trachomatis, and Neisseria gonorrhoeae. Five (5/15; 33%) countries reported GeneXpert procurement by HIV or HCV programs in 2016 and/or 2017.

Conclusions: Our results show a positive trend for Xpert MTB/RIF market penetration in 21 HBC public sectors. However, GeneXpert machines were under-utilized for TB, and inadequately exploited as a multi disease technology.
Strengthening ethical community engagement in contemporary Malawi
Authors: Nyirenda Deborah , Gooding Kate , Sambakunsi Rodrick , Seyama Linley , Mfutso-Bengo Joseph , Manda Taylor Lucinda , Gordon Stephen B. , Parker Michael
Published: September 2018

Although community engagement is increasingly promoted in global health research to improve ethical research practice, there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practice, less attention is paid to engaging communities for the ‘intrinsic’ value of showing respect and ensuring inclusive participation of community partners in research design. Rather, more attention is paid to the use of community engagement for ‘instrumental’ purposes to improve community understanding of research and ensure successful study implementation. Against this backdrop, we reviewed the literature and engaged various research stakeholders at a workshop to discuss ways of strengthening ethical engagement of communities and to develop context-relevant guidelines for community engagement in health research in Malawi.
Mathematics: When D for Data…
Authors: Hammond Paula , Lillie Stephen
Published: September 2018

This month, we continue our series based on the maths area of learning in the foundation stage, providing an A-Z of activities that will help children progress while having fun.
Curl up in a cosy place to sleep
Authors: Chalmers Debbie
Published: September 2018

Sleeping deeply through the night contributes to good health and wellbeing. Young children need to be able to take naps in safe and comfortable spaces during the day.
Patterns of prescribing in the management of gastro-oesophageal reflux in infants in Scotland
Authors: Cowie Jean , Holland Paula , Pirie Iain , Milligan Christine
Published: September 2018

The aim of this study was to determine trends over time and geographical differences in prescribing for gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) in infants aged 0–1 year in Scotland. National prescribing data obtained from the Information Services Division of NHS Scotland (ISD Scotland) was quantitatively analysed using the software tool Minitab16. Prescribing of the three key medicines, alginate, omeprazole and ranitidine, used in the management of GOR and GORD in infants aged 0–1 year increased in Scotland over the 7 years between 2010 and 2016. The rise in the prescribing rates of alginate, omeprazole and ranitidine is a cause for concern given the uncertainty regarding the efficacy of these medicines in this age group, and that omeprazole and ranitidine are not licensed for use in infants under 1 year of age in the UK. While the data suggest that the prescribing rate of alginate may have stabilised, the increasing trends for omeprazole and ranitidine show no sign of abating and this may have financial implications for the NHS, as well as potential ethical and health implications for young infants.
Mental health of the whole family
Authors: Hanley Jane
Published: September 2018

It is gradually being recognised that fathers have been disenfranchised by health visiting and midwifery services, says Jane Hanley. Is there more we can do to ensure efforts to include fathers continue?
Advanced care planning in end-of-life care: the key role of ambulance services
Authors: Kirk Andrew
Published: September 2018

Overview

Effective communication and coordination between individual care providers is vitally important to ensure that patients' wishes are respected throughout their care and when they die, as well as that families and loved ones are supported following the patient's death. Ambulance services play an increasingly key role in end-of-life care and this is especially true in terms of transfer of the dying patient ( NEoLCP, 2012 ). This month's continuing professional development (CPD) article will explore advanced care planning and, in particular, it will focus on do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, advanced decisions to refuse treatment (ADRTs) and rapid discharge transfers.
The nurse's role in efficiently using telecare
Authors: Cund Audrey
Published: September 2018

The use of technology in healthcare can still be a touchy subject: it is sometimes perceived as cold and impersonal. However, there are many benefits and nurses are perfectly placed to adopt new technologies. Audrey Cund explains how.
A team approach: Working at scale
Authors: Lone Kaiser
Published: September 2018

Primary care provider Midlands Medical Partnership received a Care Quality Commission rating of ‘outstanding’ in 2017. Kaiser Lone explains the challenges the organisation faced on its journey to working at scale
Meningococcal disease update
Authors: Emptage Shirley
Published: September 2018

Cases of meningococcal disease are reported worldwide and should always be viewed as a medical emergency with prompt diagnosis. Shirley Emptage presents a guide for practice managers on prevention and immunisation in travellers
Hope springs eternal
Authors: Ainsworth Steve
Published: September 2018

GPs and their practice staff, in the decades since 1974, have witnessed multiple changes to the way they are supported by the NHS – most recently by the privatisation of those support services to Capita, says Steve Ainsworth
‘Without fear or favour’ – MPs urge Ofsted chief to speak out
Authors: Henshaw Pete
Published: September 2018

Select committee report says Amanda Spielman is ‘reluctant’ to comment on wider issues and calls for her to speak ‘more freely’
More than just a queue of questions
Authors: Mackay Laura
Published: September 2018

Investing more time in coaching approaches to professional development could pay dividends for your school, says assistant principal Laura Mackay. She offers some tenets of good practice
Faulty thinking patterns
Authors: Knightsmith Pooky
Published: September 2018

Faulty thinking patterns can present a real threat to pupils' mental health and wellbeing. Dr Pooky Knightsmith looks at recognising and responding to these ‘cognitive distortions’
Jérôme Glicenstein – L’invention du curateur. Mutations dans l’art contemporain
Authors: Ungan Umut
Published: September 2018

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Laurent Dornel – Les étrangers dans la Grande Guerre
Authors: Buzzi Pierre-Louis
Published: September 2018

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Joan Stavo-Debauge, Philippe Gonzalez, Roberto Frega (dir.) – Quel âge post-séculier ? Religions, démocraties, sciences
Authors: Rouméas Élise
Published: September 2018

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Rémi Dormois – Les politiques urbaines. Histoire et enjeux contemporains
Authors: Lévêque Antoine
Published: September 2018

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Jean-Louis Fabiani – Pierre Bourdieu. Un structuralisme héroïque
Authors: Fond Bastien
Published: September 2018

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Étienne Balibar – Europe. Crise et fin ?
Authors: Duhé Arthur
Published: September 2018

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Sherry Turkle - Seuls ensemble. De plus en plus de technologies de moins en moins de relations humaines
Authors: Belaid Nouha
Published: September 2018

L’ouvrage Seuls ensemble se présente comme le bilan d’un long travail de recherche portant sur les cultures informatiques et notamment sur la question des « relations humaines médiatisées par des machines »...
PENGENDALIAN PEMBANGUNAN PERUMAHAN SKALA KECIL TAK BERIZIN DI KAWASAN LINDUNG PAMURBAYA
Authors: A'isyah Siti , Manaf Asnawi
Published: September 2018

Kawasan lindung Pamurbaya merupakan kawasan yang rentan terjadinya perubahan lahan akibat dari ekspansi pertumbuhan perkotaan sampai ke pinggiran kota. Sementara di pinggiran Kota Surabaya bagian timur terdapat kawasan lindung Pamurbaya yang terancam akibat pembangunan perumahan skala kecil yang tidak berizin tepatnya di Kelurahan Medokan Ayu Kecamatan. Tujuan penelitian ini untuk melakukan kajian pengendalian pemanfaatan ruang pembangunan perumahan skala kecil tak berizin pada kawasan lindung Pamurbaya. Penelitian ini menggunakan pendekatan kualitatif dengan strategi studi kasus. Hasil penelitian menunjukkan upaya pengendalian pembangunan perumahan skala kecil tak berizin ini efektif telah dilakukan baik dengan cara pengaturan zonasi, perizinan, insentif dan disinsentif, penghentian sementara pemberian hak atas tanah oleh BPN, kelembagaan dan koordinasi maupun keterbukaan informasi rencana tata ruang. Tetapi pemerintah menghadapi kesulitan dalam hal pengenaan sanksi administratif guna penertiban kawasan. Salah satu rekomendasi guna lebih mengefektifkan pengendalian yaitu Pemerintah Kota Surabaya segera melegalkan dan merealisasikan rencana kegiatan atau rencana strategis serta pembiayaan pada kawasan tersebut.
STRATEGI INTEGRASI SISTEM TRANSPORTASI UMUM DALAM MENUNJANG PARIWISATA KOTA YOGYAKARTA
Authors: Ramadhan Gilang Rizki , Buchori Imam
Published: September 2018

The development of Yogyakarta City arises the issue of congestion that might interfere various activities, one of them is tourism activity. This aims at strategizing integration of public transport system for reducing congestion. It seeks an integration strategy of public transport system that can improve accessibility and support tourism in Yogyakarta City based on domestic tourist preference. Using descriptive statistics, service quality (servqual), and importance-performance analysis (IPA), it was revealed that respondents feel less satisfied with the quality of service of integration of public transport system, for which an improvement is needed. This can be done by strategizing integration of public transport system, from the strategy will be known the order of handling priority each variable, i.e. (1) schedule integration, (2) network integration, (3) land use integration, (4) physical integration, and (5) information integration which is done by improving its performance. Furthermore, (6) social integration, (7) environmental integration, and (8) fare and ticket integration which is done by maintaining its performance.
W POSZUKIWANIU CIERPIENIA ZWIERZĄT. O POLSKIEJ I ROSYJSKIEJ NAJNOWSZEJ POEZJI KOBIET
Authors: Kwiatkowska Agnieszka
Published: September 2018

Kryzys hermeneutyki i zwrot w badaniach antropologicznych sprzyjają budowaniu nieantropocentrycznej, posthumanistycznej perspektywy, rekonstruowaniu w literaturze zwierzęcej percepcji i zwierzęcych doświadczeń, między innymi cierpienia. Polska najnowsza poezja kobiet (między innymi Justyny Bargielskiej i Wisławy Szymborskiej) ukazuje zwierzęta jako ofiary ludzkiej opresji oraz istoty do człowieka podobne. Empatii często towarzyszy antropomorfizacja. W poezji kobiet pisanej w języku rosyjskim motyw cierpienia zwierząt występuje stosunkowo rzadko. Dominuje w niej perspektywa globalna (nie jednostkowa), a kategoria cierpienia zarezerwowana jest dla zbiorowości (społeczeństwa, narodu). Cierpienie jest przymiotem ludzi, a nie zwierząt między innymi w poezji Olgi Siedakowej, Reginy Dieriewej, Lubow Salomon czy Olgi Lewickiej.
STEREOTYPY IDEOWE W OBRAZOWANIU SŁOWACJI W CZESKIEJ POEZJI LAT 1860–1939
Authors: Tureček Dalibor
Published: September 2018

Studium poświęcone jest obrazowi Słowacji w czeskiej poezji lat 1860–1939, tj. stereotypom ideowym, które ukształtowały się jeszcze przed powstaniem w 1918 roku wspólnego państwa czesko-słowackiego. Słowacja odbierana byla wtedy w duchu romantycznym jako piękna kraina z dziewiczą przyrodą i ludem niedotkniętym zepsuciem cywilizacyjnym. Negatywnie oceniano dążenie Słowaków do językowego i narodowego samostanowienia – nie uwzględniając aspektu historycznego, etnicznego i politycznego mniemano, iż Słowacja stanowi naturalną część czeskiego projektu narodowego. Odnoszenie się Czechów do Słowaków z poczuciem wyższości, ich postawa „starszego brata“ może zostać określona, nieco hiperbolicznie, jako kolonialna.
GOTHIC FIELDING? PHILIP JAMES DE LOUTHERBOURG’S TOM JONES
Authors: Lipski Jakub
Published: September 2018

This article confronts P.J. de Loutherbourg’s drawings of the selected scenes from Tom Jones with the possible “Gothic” content in Henry Fielding’s novel. Commenting on Fielding’s pictorialism, I argue that the most suitable scene from Tom Jones would have been the actual Gothic mansion of Mr. Allworthy, but the scene does not attract the illustrator’s attention. Then, I discuss de Loutherbourg’s patterns of Gothicizing the selected scenes in the manner of Salvator Rosa, which in the original depend on the mock-heroic or the grotesque. The article concludes with raising more general questions about the paradigms of de-contextualization and re-contextualization in late 18th century print market and book illustration.
WOKÓŁ SERBSKIEJ FANTASTYKI
Authors: Pieniążek-Marković Krystyna
Published: September 2018

WOKÓŁ SERBSKIEJ FANTASTYKI
A versatile perfusion bioreactor and endothelializable photo cross-linked tubes of gelatin methacryloyl as promising tools in tissue engineering
Authors: Huber Birgit , Hoch Eva , Calderon Iván , Borchers Kirsten , Kluger Petra J.
Published: September 2018

Size and function of bioartificial tissue models are still limited due to the lack of blood vessels and dynamic perfusion for nutrient supply. In this study, we evaluated the use of cytocompatible methacryl-modified gelatin for the fabrication of a hydrogel-based tube by dip-coating and subsequent photo-initiated cross-linking. The wall thickness of the tubes and the diameter were tuned by the degree of gelatin methacryl-modification and the number of dipping cycles. The dipping temperature of the gelatin solution was adjusted to achieve low viscous fluids of approximately 0.1 Pa s and was different for gelatin derivatives with different modification degrees. A versatile perfusion bioreactor for the supply of surrounding tissue models was developed, which can be adapted to several geometries and sizes of blood-vessel mimicking tubes. The manufactured bendable gelatin tubes were permeable for water and dissolved substances, like Nile Blue and serum albumin. As a proof of concept, human fibroblasts in a three-dimensional collagen tissue model were successfully supplied with nutrients via the central gelatin tube under dynamic conditions for 2 days. Moreover, the tubes could be used as scaffolds to build-up a functional and viable endothelial layer. Hence, the presented tools can contribute to solving current challenges in tissue engineering.
Evaluation of serum alkaline phosphatase measurement through the 4-year trueness verification program in China
Authors: Wang Jing , Wang Yufei , Zhang Tianjiao , Zeng Jie , Zhao Haijian , Guo Qi , Yan Ying , Zhang Jiangtao , Zhou Weiyan , Chen Wenxiang , Zhang Chuanbao
Published: September 2018

Background

Alkaline phosphatase (ALP) is critical for various diseases. The International Federation of Clinical Chemistry and Laboratory Medicine had recommended the new reference procedure in 2011, but many manufacturers did not trace results to the higher procedure. Since 2012, the National Center for Clinical Laboratories (NCCL) in China has organized the trueness verification program (TV) with commutable materials. The present study summarizes the 4-year TV program to give an overview of the measurement standardization for ALP results.

Methods

Commutable serum-based materials with different concentrations were prepared and sent to participating laboratories. The target values were assigned by the reference lab network.

Results

The analytical performance was evaluated according to three indexes: trueness (bias), imprecision (CV) and accuracy (total error [TE]). The number of participating laboratories increased from 115 in 2012 to 287 in 2016. The pass rates of precision for homogeneous and heterogeneous systems were all above 85% over the 4 years; however, the pass rates of bias were much lower (<50%). Among the homogeneous systems, Roche Cobas/Modular had an obvious negative bias, whereas the mean positive bias for Beckman AU was prominent. As to the heterogeneous systems, the pass rates of bias for Sichuan Maccura (57.1%–78.6%) were higher than Roche Cobas/Modular (4.4%–33.9%) and Beckman AU (35.7%–64.8%).

Conclusions

The PT/EQA program with commutable materials can be used to assess the trueness against target values assigned by reference procedures. For ALP, homogeneous systems did not perform better than heterogeneous systems. The bias for ALP performance was notable and was the main obstacle to its standardization in China.
A comparison of complete blood count reference intervals in healthy elderly vs. younger Korean adults: a large population study
Authors: Lee Eun Jin , Kim Miyoung , Lee Eunyup , Jeon Kibum , Lee Jiwon , Lee Jee-Soo , Kim Han-Sung , Kang Hee Jung , Lee Young Kyung
Published: September 2018

Background

The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20–59 years.

Methods

Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical checkups, 8151 healthy subjects (12.6%, 5270 men and 2881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument.

Results

Overall, healthy individuals aged ≥60 years did not require separate reference intervals from those aged <60 years except for red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) in women. However, subjects aged ≥60 years still required sex-specific reference intervals for red blood cell count, hemoglobin, hematocrit, MCH, monocytes and eosinophils. Separate reference intervals were required for MCH, eosinophils and basophils for certain age subgroups of men aged ≥60 years, and for MCH and RDW in certain age subgroups of women aged ≥60 years, compared to counterparts <60 years of age.

Conclusions

Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated.
Propensity Score Estimation Using Classification and Regression Trees in the Presence of Missing Covariate Data
Authors: Penning de Vries Bas B.L. , van Smeden Maarten , Groenwold Rolf H.H.
Published: September 2018

Data mining and machine learning techniques such as classification and regression trees (CART) represent a promising alternative to conventional logistic regression for propensity score estimation. Whereas incomplete data preclude the fitting of a logistic regression on all subjects, CART is appealing in part because some implementations allow for incomplete records to be incorporated in the tree fitting and provide propensity score estimates for all subjects. Based on theoretical considerations, we argue that the automatic handling of missing data by CART may however not be appropriate. Using a series of simulation experiments, we examined the performance of different approaches to handling missing covariate data; (i) applying the CART algorithm directly to the (partially) incomplete data, (ii) complete case analysis, and (iii) multiple imputation. Performance was assessed in terms of bias in estimating exposure-outcome effects among the exposed, standard error, mean squared error and coverage. Applying the CART algorithm directly to incomplete data resulted in bias, even in scenarios where data were missing completely at random. Overall, multiple imputation followed by CART resulted in the best performance. Our study showed that automatic handling of missing data in CART can cause serious bias and does not outperform multiple imputation as a means to account for missing data.