bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of a novel polydactyl zinc finger with binding specificity for the proximal promoter region of PLN in the proposed treatment of cardiomyopathy.
Authors: Lai Sandy , Elliot Dean
Published: September 2019

Heart disease is the leading cause of death worldwide. Cardiomyopathy, a form of heart disease, is one of the many areas of clinical interest and is characterized as a disease of the heart myocardium. Phospholamban (PLN) is one of the many proteins linked with this disease. Its primary function in the cell is the inhibition of the sarco(endo)plasmic reticulum Ca2+ ATPase (SERCA2) calcium transporter located in muscle tissue. There is a direct causal link between when PLN is over-expressed, super-inhibitory or non-existent and the development of various forms of cardiomyopathy. In an effort to counteract the development of cardiomyopathy, we have designed a novel zinc finger protein named Dandy, which specifically binds form the –77 to -95 region of the proximal promoter of the PLN gene. This protein is expected to transiently block the binding of the NFY promoter and thus, the initiation of transcription. Blocking initiation of transcription should result in an overall decrease in the concentration of PLN. Dandy is a zinc finger protein made up of two three-fingered peptides. It recognizes a 18 bp sequence with a 1 bp gap in the middle. Tertiary structure predictions of Dandy show that the protein has the intended structure of the design. More clinical research into the specific binding interactions will need to be completed before in vivo function and overall efficacy of Dandy is elucidated.
A lux/gfp dual label system for studying attachment and biofilm formation of Enterobacter sakazakii
Authors: Thimodo Melanie
Published: September 2019

A significant feature of Enterobacter sakazakii is the ability to form biofilms enabling its persistence in manufacturing and neonatal environments, and implicating it as the primary cause of outbreaks of neonatal meningitis. Conventional methods of studying E. sakazakii are time consuming, inaccurate and damaging to cells, preventing further analysis. A novel method for detecting biofilm formation has been utilized that takes advantage of a dual lux/gfp reporter system cloned into cells for simultaneous quantification of bacterial metabolic activity and cell numbers respectively. To evaluate the effectiveness and accuracy of the novel method compared to the conventional method, strains of bacteria were allowed to form biofilms and were measured using both methods. Biofilm formation of E. sakazakii strains over 2 days was measured and peak formation and changes in biofilm development was determined for each strain. The lux reporter was utilized to determine metabolic activity of cells in the biofilm, correlating to biofilm formation, over 3 days. Biofilm formation of strains was measured using both methods and compared to detect trends. This study found that the novel method was effective at detecting changes in metabolic activity of cells in biofilm. Cell numbers were to be simultaneously detected via the gfp reporter but filters with correct detection wavelength were unavailable thus cell numbers were not obtained here. These observations determine that this dual reporter system is a promising tool for monitoring bacteria in situ and for further understanding of biofilm formation.
The role of inflammation in metabolic syndrome
Authors: Cuda Cristina
Published: September 2019

The metabolic consequences of obesity have made this highly prevalent condition one of the most common risk factors for type 2 diabetes, hypertension and atherosclerosis. Simultaneous occurrence of these conditions can be explained through the manifestations of metabolic syndrome [MetS]. Clinical indication of MetS is characterized by a clustering of risk factors for complex chronic diseases which all feature metabolic deterioration as a common component. Diagnosis of MetS can be made if a patient exhibits three of the identified risk factors, some of which include: elevated waist circumference, elevated triglycerides, low high density lipoprotein levels, hypertension and elevated blood glucose. The progression from obesity to MetS involves an alteration in body metabolism mediated by cytokines- signalling molecules that coordinate the inflammatory response. Increased visceral adipose tissue contributes to augmented secretion of pro-inflammatory cytokines which can activate several transcription factors, including NF-κB, which promote these inflammatory conditions and lead to increased oxidative stress. Exacerbation of the condition then ensues as oxidative stress results in oxidized low density lipoprotein, dyslipidemia, insulin resistance, hypertension and atherogenesis. This review will not only focus on the role of inflammation in the manifestations of MetS, but also outlines some lifestyle and nutritional treatments that can be used to treat the condition and reduce the risk of chronic disease.
The Wilson family farm
Authors: Murray Derek
Published: September 2019

Tradition versus modernity—and the spaces in between—is a major theme not only in the study, but also in the popular image of Canadian rural history. Our rural ancestors are often portrayed as self-sufficient, independent units. Closed off from market economies and providing everything they need on their own, they are models of an ideal, traditional and long-forgotten way of life. On the other hand, it is also possible that these people were market-oriented to the extent of solely producing staple crops for sale on lucrative foreign markets. I have had the opportunity to examine a rich historical source from the mid-nineteenth-century. The account book from the farm of James Wilson of North Dumfries, Ontario from 1866 to 1869 is one of many sources in the University of Guelph’s rural history archive that offers researchers a provocative glimpse of life in Canada in the past. The majority of this paper is devoted to the analysis of James Wilson’s account book itself and the world it reveals. It s in these spaces—in the worlds of which the Wilson farm is one example—that tradition and modernity become secondary to the mediating and motivating force of the needs of the individual, the family or the group. In the mid-nineteenth century the family was the main unit of economic, social and political agency for many people. James Wilson and his family were involved in local affairs at every level: economic, social, cultural, religious, political, etc. The world in which this family lived contained both traditional and modern elements. It was not the case that they blindly followed the traditions of the past, nor was it the case that they put all their faith in free-market economics or the values of modernity. The Wilson family lived between two extremes, with the needs and desires of the family being always paramount.
Was Charles Guiteau Insane?
Authors: McIntyre Mike
Published: September 2019

After fatally shooting United States President James Abram Garfield on July 2, 1881, Charles Julius Guiteau was apprehended and tried for murder the following year in what became one of the most celebrated and controversial cases of the nineteenth century. Guiteau was found guilty of pre-meditated murder in the first degree on January 25, 1882 and was subsequently sentenced to hang that summer as a consequence of his actions. While there can be no doubt that Guiteau was indeed the man who pulled the trigger of the pistol that fired two bullets into President Garfield, his motives and questionable mental competency to stand trial is something that is still argued to this day. As with many disciplines at the time, the field of psychiatry was still evolving and the concept of being mentally unfit to stand trial for ones actions was a relatively new and seldom used defense. Through a close investigation of the beliefs and actions of Charles Guiteau leading up to his crime, it becomes apparent that he was indeed insane.
Susceptibility of a tallgrass prairie to invasion by the herbicidal producing species, Festuca rubra
Authors: Harnden Jesse
Published: September 2019

Disturbance, nutrients, propagule pressure, and the presence of arbuscular mycorrhizal fungi (AMF) have been shown to influence invasion in plant communities, although the relative importance of each remains unclear. A remnant of tallgrass prairie outside Cambridge, ON appears to be resilient to invasion by Festuca rubra, despite its herbicidal properties. A greenhouse experiment was conducted to determine what factors are responsible for the resilience of the native grassland, using synthesized fescue and native sod. The effects of disturbance, nutrient enrichment, propagule pressure, and the presence of AMF and phytotoxin on the establishment ability of F. rubra and the native species Sorghastrum nutans were examined. Propagule pressure was the only factor shown to influence fescue invasion and establishment of S. nutans was unaffected by all factors. These results suggest that the resilience of the native grassland may be due to decreased seed production or viability of F. rubra and not any characteristics of the grassland. Also, the restoration of native grasslands will not be limited by remnants of phytotoxin in the soil, following removal of exotic species.
Recombinant expression and characterization of Solanum tuberosum aspartic protease
Authors: Agro Lauren , Bryska Brian , Yada Rickey
Published: September 2019

Unique to aspartic proteinases from plants are the presence of approximately 100 amino acid regions, which are usually excised during activation of the zymogen. These sequences are termed ‘Plant-Specific Inserts’ and are implicated in membrane interactions of their parent enzymes, including vacuolar targeting and host defense. The need to further characterize the structure-function rol (s) of plant-specific inserts stimulated the current study of the characterization of Solanum tuberosum AP (StAP). Recombinant expression of wild-type StAP resulted in the 54 kDa protein being visualized by SDS-PAGE analysis with a protein yield of 0.03%. A protein purification factor could not be established since activation of the protein at pH 2.2, 3.0, 3.7 and 5.5 was not achieved as evidenced by a lack of change in band patterns on SDS-PAGE as well as acidification and hemoglobin degradation assays. To potentially improve enzyme folding and activation ability, two mutants, (1) lacking the pre-signal sequence and (2) lacking both the signal sequence and the prosegment, were designed, sub-cloned, and expressed. Both products proved to be insoluble and inactive. New constructs were designed for the expression of StAP inclusion bodies for insoluble expression and subsequent re-folding of the protein. Additionally, CysAla mutations for each PSI Cys residue were made to investigate the rol (s) of plant-specific insert disulfide bonds in plant aspartic proteinase enzyme folding and structure. All PSI cysteine mutations (eight mutants) were successfully created using QuickChange MutagenesisTM
Smell and taste recognition in early stages of late-onset Alzheimer’s disease
Authors: Ilhamto Nila , Duizer Lisa M
Published: September 2019

Problems of inadequate nutrition and energy intake are common in the aging population. Smell and taste deficits associated with Late-Onset Alzheimer’s Disease (LOAD) may accentuate the decline in nutritional status of elderly individuals and indirectly enhance progression of cognitive problems in LOAD. The objective of this study was to explore and characterize smell and taste recognition abilities in early stages of LOAD, beyond that of normal healthy aging. A total of 29 healthy-younger subjects aged 18-40 (HY), 13 healthy-elderly (HA) and six elderly adults diagnosed with LOAD (AD) aged 60-85, were recruited from the Guelph community. The Sniffin’ Sticks Screening Test (SSST) and Taste Strips were used to test olfactory and gustatory functions, respectively. Participants also completed the mini-mental state examination (MMSE), clock test and word recall tests to assess cognitive/memory skills. Compared to HA individuals, people with AD had significant odour recognition impairment. Correlation analysis also revealed an age-associated decline in overall taste ability. When specific tastes were examined, impairments in sour and bitter identification were observed with increasing age. However, no significant differences in specific taste abilities were found between HA and AD individuals. In predicting health status (ie. presence or absence of LOAD), an assessment of all variables in this study was conducted using Generalized Linear Model (GLM). Results showed that sweet recognition and clock test scores were the best predictive variables of health status. However, this is a preliminary model that needs refinement through further research using more individuals.
Joint forest management in India: implications and opportunities for women’s participation in community resource management
Authors: Maksimowski Sophie Anne
Published: September 2019

In recent years, state decentralization of control over community resource management has been increasing on a global scale. This process is largely intended to compensate for bureaucratic inefficiencies through the involvement of local users in state conservation efforts. Since India established its National Forest Policy of 1988, such a shift has occurred in natural resource management from the national to the local level. During the 1990’s this process of decentralization was accelerated under India’s Joint Forest Management (JFM) Policy. This paper examines the implications of JFM in involving local stakeholders with forest management practices, and specifically, women’s role within JFM and the degree of their participation within village forest institutions. Women are the primary collectors of forest products in rural India, and it is recognized that as a forest-dependent group, they ought to be involved in decision-making within these institutions for the sustainability of village livelihoods and conservation efforts. The success of JFM programs in this regard requires that a greater role for women be established through a gender policy within JFM. Both within and outside of state policy, measures to enhance women’s participation must take into account social relations and structures that perpetuate women’s exclusion, and identify ways through which these structures can be transformed. Ultimately, promoting women’s empowerment and livelihood rights and opportunities are essential preconditions to their effective participation.
Reflections on metaphor and the nature of mind
Authors: Buchman Ethan
Published: September 2019

Experience is not given to us; it is constructed. As we develop in a particular culture, our minds establish a framework of reality by which we are able to make judgments about the world and discern its nature. Each culture develops a slightly different framework, and tends to see the world in slightly different ways. We often lose sight of this fact, finding ourselves hypnotized by our own mental constructions and technologies. It is through the power of metaphor that we become ensnared in illusory conceptions of reality. But it is also through this same power that we may free ourselves from these bonds.
Research highlights from the Ontario Veterinary College Summer Leadership and Research Program
Authors: Students SLRP
Published: September 2019

The Summer Leadership & Research Program (SLRP) at the Ontario Veterinary College offers BSc, DVM and other summer student researchers at OVC a stimulating slate of events from May to August. The program includes a Round Table series with veterinarians and scientists working in diverse and intriguing areas, field trips to cutting-edge research facilities and the Metro Toronto Zoo, and professional development workshops to prepare for conference-style sessions.
Examining Medical Anthropological Theory as a catalyst for the failure of Clinically Applied Medical Anthropology
Authors: Wallace Lauren J.
Published: September 2019

Medical anthropological theory may be understood in two ways: first as a set of anthropological concepts and second as the application of these concepts. The theoretical concepts themselves are rarely challenged because they have been fairly well developed. However, the approach to theory and its application has traditionally been underdeveloped and thus requires more thought and practice among anthropologists. This paper asserts that a particularly clear example of the problem with the approach to and application of medical anthropological theory can be viewed in the context of clinically applied medical anthropology (CAMA). I examine two medical anthropological concepts that applied medical anthropologists use in their dealings with clinicians – critical medical anthropology and the culture concept. In doing this, I demonstrate that although these concepts are useful and clinicians need to employ them, there are a number of problems with the theoretical approach. I argue that these problems limit the application of these concepts to CAMA and offer preliminary suggestions to resolve them. In particular, clinically applied anthropologists employing critical theory should work to present a more balanced view of the clinic and physician. In addition, anthropologists working in the clinical setting must update the CAMA literature to ensure a thorough assessment of the current use of anthropological knowledge and concepts – such as culture – in medical schools and clinics.
“The quarry proposed by St Marys Cement Inc. for a location near Carlisle, Ontario should not be permitted” : Introduction
Authors: Fox Glenn
Published: September 2019

The following three papers were developed by one of the three lab sections of ENVS 4300, Environmental Law, in the fall semester of 2010. During the course, students participate in a series of three role playing exercises involving three environmental topics. Over the course of the semester, each student is part of three teams: one that makes a case in support of an assigned environmental proposition, one that makes a case against an assigned environmental proposition and one that conducts an impartial adjudication of a dispute. The two contending teams also cross examine their opponents as part of the process. The following three papers are based on the submissions of the two opposing sides in one of the disputes in the fall semester, 2010, as well as on the adjudicators report. These reports were produced to address the third dispute topic of the semester, “The quarry proposed by the St. Mary’s Cement Company for a location near Carlisle, Ontario, should not be permitted.”
University students’ propensity towards white-collar versus street crime
Authors: Watt Rochelle
Published: September 2019

While several traditional criminological theories have been used to explain the causes of white-collar crime, few research studies have examined the role that personality plays in explaining the causes of these types of crimes. University students were measured on two personality scales, self-control and desire for control, to determine the extent to which these factors affect the propensity to commit either street crime or white-collar crime. The findings indicate that self-control has the most significant effect on offending, but only when students indicated that they were willing to commit both street crime and white-collar crime. On the other hand, desire for control did not predict a propensity towards committing either type of crime.
Mobile customer relationship management: Factors affecting consumer mobile technology adoption within the hotel industry
Authors: Chan Tina Y. T.
Published: September 2019

Mobile and smartphone technologies have been on the rise for a decade now, and their rapid adoption has compelled researchers to study the impact of this technological trend. While many of the studies focus on the general effects of mobile technology within the world of commerce, this paper aims to identify the factors that influence mobile customer relationship management by hotel brands. A multi-disciplinary review of research and literature identified several barriers and drivers of mobile technology adoption. The key drivers, immediacy, ubiquity and message personalization, were found to have a positive impact on mobile connections as they build trust and enhance satisfaction, thereby facilitating customer relationship management.
Effects of volunteerism and relationship status on empathy
Authors: Milanovic Melissa
Published: September 2019

Volunteerism and relationship status differences were examined for their relatedness to empathy level, in the context of a psychological instrument for measuring empathy, the Baron-Cohen and Wheelwright Empathy Quotient (EQ). This Likerttype scale consisting of 60 items was completed by each of 100 participants, who were categorized based on self-declared volunteerism (a volunteer or not) and relationship status (in a relationship or not). Volunteerism was found to be a statistically significant factor in empathy level: those who volunteered exhibited higher empathy levels than those who did not. Relationship status was additionally statistically significant, such that those in a relationship had higher empathy levels than those who were not. When analyzed together, the factors of volunteerism and relationship status showed significant interaction in their influence on the dependent variable, empathy.

Keywords: volunteerism; relationship status; empathy
Tourism in Kenya's national parks: A cost-benefit analysis
Authors: Cheung Hubert
Published: September 2019

East Africa is home to some of the most stunning wildlife in the world. With tourism in the region’s wildlife parks growing in popularity, it is imperative to evaluate the socioeconomic and environmental costs and benefits of this expanding industry. This study conducted a cost-benefit analysis of the various impacts that tourism has brought to Kenya’s national parks by monetarily valuating each impact. While the results of this cost-benefit analysis suggest that the benefits far outweigh the costs, even when non-measurable costs are considered, a number of fundamental issues must be addressed in order to improve the cost-benefit balance. The results are likely to be representative of the overall state of tourism in Kenya’s national parks and expose key areas where improvements can be made. Improvements to tourism in Kenya’s national parks can have positive implications for local people, the environment, wildlife species, tourists, and biodiversity conservation.

Keywords: tourism; national parks; Kenya; cost-benefit analysis
The liberalism of fear
Authors: Wilson Nicholas J.
Published: September 2019

The research compiled is formulated into a critique of a dated yet highly sophisticated political ideology that is perpetuating inequality in the lives of ordinary people, prevailing over the fates of Western citizens, and of those abroad in developing countries. The arguments contained herein target liberal principles via the involuntary acceptance of unrestrained capitalist structures that frame the current Western socioeconomic paradigm. Overall, the current framework of domestic laws in the West is found to be unable to justify liberal democratic interventions in developing nations.

Keywords: liberalism; individual rights; imperialism; security; capitalism; personhood; Maritime Law; collectivism
Three short studies from field studies in marine biology and oceanography
Authors: Barry Melanie , Ferraro Shannon , Wagner Kaitlyn
Published: September 2019

ZOO*4300 (Marine Biology and Oceanography) is a senior-level field course offered by the Department of Integrative Biology at the University of Guelph. This two-week course is held at the Huntsman Marine Science Centre in St. Andrew’s New Brunswick, Canada. Students enrolled in the course study various aspects of the ecology, behaviour, physiology, biochemistry and genetics of marine organisms using a variety of oceanographic techniques. The course also includes group exercises to study various intertidal and sub-tidal environments as well as boat cruises to collect plankton, benthic invertebrates, marine fish, and to observe marine mammals. The course provides excellent opportunities for students to familiarize themselves with state-of-the-art techniques involved in various branches of marine biology and oceanography and conduct an individual research project. This feature highlights three individual research projects by University of Guelph students. More information about the field course in marine biology and oceanography is accessible at the following link: http://www.uoguelph.ca/ib/undergrad/fieldcourses_marine.shtml.
A study of platinum accumulation in radish (Raphanus sativus) and durum wheat (Triticum durum) plants
Authors: Oke Sofia , Kikkert Julie , Vasiluk Luba , Hale Beverley
Published: September 2019

The aim of this study was to investigate the accumulation of platinum (Pt) in C3 plants. In this experiment, radish (Raphanus sativus) and durum wheat (Triticum durum) were chosen as test species and three uncontaminated soils from Simcoe, Elora, and Kettleby, Ontario were chosen to represent a range of soil characteristics. Soils were amended with 0 to 20 mg Pt kg-1, applied as a Pt solution, before plants were exposed to the contaminated soils for 14 days. Statistical analyses using a Linear Model Procedure and a Student-Newman Keuls Test at α=0.05 found a significant different between Pt accumulation and plant type, tissue type, and soil type. Overall, root tissue in all soil and plant types accumulated approximately eight times more Pt than the corresponding shoot tissue (p
A defense of the modern, high-tech redneck on reality TV: Why the world loves Duck Dynasty and its resulting redemptive representation of Rednecks
Authors: McGuire Sarah
Published: September 2019

This article uses key terms and concepts from Television Studies to “close read” the reality TV show Duck Dynasty in its visual form. This article questions not only how Duck Dynasty represents rednecks, but also how the representation of the “redneck” is understood by the TV audience. It explores the success of Duck Dynasty as a reality TV show and argues that it redeems “rednecks” from Hollywood’s previous portrayals of the overly caricatured redneck stereotype. The Robertsons have the ability to convey truth – even if it is through a partially fake/mediated realm – and what they actually represent is a more subdued, modern form of redneck identity in comparison to classic Hollywood depictions. However, viewers cannot trust reality TV to wholly or singularly inform how they understand other social groups despite how “real” reality may appear on reality TV shows. Instead of viewing the redneck jokes and portrayal on reality TV as offensive, Duck Dynasty’s jokes and portrayals can be powerful tools for exposing the absurdity of the stereotypes previously perpetuated by Hollywood and can help subvert them.

Keywords: Duck Dynasty; Duck Commander; Buck Commander; Robertson; redneck (representations of); reality TV; television studies; hillbilly; Southern culture; stereotypes; sitcom; American dream; American television
Effect of self-referant primes about language and memory on measures of working memory in individuals with and without second languages
Authors: Marshall Paul Robert
Published: September 2019

In our multicultural North American society people whose primary language is not English may either benefit if they can fluently speak both English and another language, or they may suffer if they cannot fluently speak English. This may be partly because of stereotypes about people who can (2LS) or can’t speak a second language (W2L) which may lead to stereotype threat and arousal. Specifically, it was hypothesized that whether a prime was self-relevant would interact with the type of prime given to an individual to induce stereotype threat or arousal. To test this we subjected 2LS and W2L speakers to negative, neutral and positive primes about having a second language and then measured working memory (WM). We predicted that positive self-referent primes would enhance, whereas negative primes would disrupt WM independent of language status, and that neutral primes would not differ among language groups. Confirming this hypothesis a significant crossover interaction between prime manipulations and condition was demonstrated with no main effect of language group. These results suggest that while WM capacity does not differ between language groups when these same groups are given self-referent positive and negative primes these can induce stereotype threat and arousal which may have effects on WM through modifying physiological and psychological processes.
Avaliação de custo-efetividade do cateterismo em veia jugular interna guiado por ultrassom no Sistema Único de Saúde brasileiro
Authors: Boller Carlos Eduardo , Senna Kátia , Teixeira Roberta , Goulart Marcelo , Tura Bernardo , Santos Marisa
Published: September 2019

Objetivo: Determinar a factibilidade econômica da técnica de cateterismo central em veia jugular interna guiada pelo ultrassom comparado à técnica-padrão, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Métodos: Análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária. Os custos diretos dos materiais e procedimentos foram estimados utilizando bancos de registros de compras nacionais. Os desfechos foram a ocorrência ou não da punção arterial acidental grave (principal complicação associada ao sítio de punção). Também foram conduzidas análises de sensibilidade determinística e probabilística, bem como curva de aceitabilidade. Resultados: A intervenção onerou o modelo em R$ 53,81. A razão de custo-efetividade incremental calculada foi de R$ 17.936,66 por complicação grave evitada e a curva de aceitabilidade evidenciou que a técnica é custo-efetiva sob uma intenção de pagar de R$ 18.125,00. Na análise de sensibilidade probabilística, 63,6% das simulações mostraram-se custo-efetivas. Conclusão: A intervenção é custo-efetiva, contribuindo para a redução das complicações graves, e o resultado pode proporcionar segurança para tomadas de decisões quanto à padronização do uso da ultrassonografia como orientador do procedimento.
Impacto orçamentário de natalizumabe para o tratamento em primeira linha da esclerose múltipla remitente-recorrente altamente ativa sob a perspectiva do sistema de saúde privado brasileiro
Authors: Rigolon Jéssica , Silva Antônio Artur , Rosim Ricardo
Published: September 2019

Objetivos: Os objetivos deste estudo são calcular o custo de um surto de esclerose múltipla sob a perspectiva de uma operadora de saúde privada e o impacto orçamentário da adoção de natalizumabe em primeira linha para esclerose múltipla remitente-recorrente altamente ativa (EMRRAA). Métodos: Para o cálculo do custo do surto, duas abordagens foram adotadas: para surtos que não levam a hospitalizações, foi aplicada uma pesquisa a 33 médicos neurologistas para identificação do consumo de recursos. Microcusteio foi realizado com base em bases de dados públicas. Para o cálculo do custo de surtos que levam a hospitalizações, foi utilizada uma base de contas médicas. Para o cálculo do impacto orçamentário, foi construído um modelo baseado em prevalência. Foram assumidos os seguintes custos: custo de aquisição de natalizumabe, custo de infusão de natalizumabe e custo de surtos. Taxa de ocorrência de surtos para natalizumabe e para seus comparadores, disponível apenas no sistema público, foi obtida em estudos clínicos e metanálises. O caso-base foi realizado considerando-se uma operadora que atende 100 mil vidas na região Sudeste. Análise de sensibilidade foi realizada. Resultados: O custo calculado de um surto foi de R$ 14.157,21. O impacto orçamentário calculado para adoção de natalizumabe para EMRRAA foi de R$ 0,64 por beneficiário por ano, ou 0,02% das despesas assistenciais de uma operadora de saúde suplementar, ou 0,02% de suas receitas de contraprestações. A análise de sensibilidade confirma que o impacto não chega a 1 real por beneficiário por ano e atinge, no máximo, 0,03% das despesas assistenciais. Conclusão: Dados os altos benefícios clínicos de natalizumabe, o impacto orçamentário de sua adoção para primeira linha de EMRRAA é considerado baixo. O impacto pode estar superestimado, visto que não foram considerados custos de progressão da doença.
Vinculação aos planos de saúde de menor abrangência e seu impacto na utilização da rede de serviços do SUS: uma análise a partir da Pesquisa Nacional de Saúde de 2013
Authors: Silva Carlos , Luiz Ronir , Bahia Ligia
Published: September 2019

Objetivo: Identificar se a vinculação aos referidos planos pode ser considerada como uma causa ou um fator incrementador da utilização do SUS por esses clientes. Métodos: Trabalhou-se com os dados fornecidos pela Pesquisa Nacional de Saúde realizada em 2013. A técnica utilizada foi a do escore de propensão. Resultados: Houve significância estatística quando se avaliou a utilização do Sistema Único de Saúde (SUS) pelos clientes dos planos de menor abrangência tanto em consultas e outros procedimentos quanto para internações, sendo essas utilizações, respectivamente, de 37,9% e 46,4%. Conclusão: Pode-se observar que a vinculação aos planos de menor abrangência se constitui em um fator incrementador à utilização da rede de serviços do SUS, reforçando a argumentação de que a oferta desses sistemas protetivos no mercado não contribui para desafogar a rede pública de saúde.
Os efeitos do memorando de entendimento nas Unidades Locais de Saúde: o caso da Unidade Local de Saúde de Castelo Branco
Authors: Farias Sérgio , Nunes Alexandre
Published: September 2019

Objetivo: Verificar se o Memorando de Entendimento sobre Condicionalismos Específicos de Política Económica (MECPE), imposto em Portugal em período de crise pelo Fundo Monetário Internacional, Banco Central Europeu e Comissão Europeia, gerou melhoria nos resultados de eficiência no sector da Saúde. Métodos: Foi realizado um estudo de caso para avaliação dos resultados de eficiência nos departamentos clínicos da Unidade Local de Saúde de Castelo Branco (ULSCB), localizada em uma das áreas economicamente mais desfavorecidas Recorreu-se à técnica da Análise Envoltória de Dados, levando em consideração como insumos os custos e como resultados a produção registada de cada departamento clínico em três períodos de tempo antes (2002-2010), durante (2011-2014) e após a austeridade (2015-2017). Os dados referentes ao custo e produção foram fornecidos pelo Gabinete de Apoio à Gestão e pelo Gabinete de Contabilidade do hospital. Em complemento da análise quantitativa, utilizou-se o método qualitativo de análise do conteúdo das entrevistas semiestruturadas, aos diretores e administradores do hospital, que permitiu avaliar a informação que detém e que é resultado do seu treinamento e sua experiência. Resultados: Durante o período de austeridade e execução do MECPE, a unidade hospitalar estudada obteve eficiência técnica média de 0,84, que significou um aumento de 16% em relação ao período anterior. Em particular, apenas um departamento clínico (neurologia) não registou essa melhoria em sua eficiência técnica. Na análise qualitativa do estudo, a maioria dos entrevistados sentiu que a austeridade teve impacto negativo na eficiência de seus departamentos e de seu hospital, o que não se confirma pelos resultados obtidos. Conclusões: O MECPE não apenas aumentou a eficiência técnica, mas também incentivou medidas inovadoras para aumentar os ganhos nos anos subsequentes.
Technology Focus: Tight Reservoirs
Authors: Kalfayan Leonard
Published: September 2019

Technology Focus

The industry has an increasingly difficult battle on its hands when it comes to unconventional-resource development in the lower-for-longer oil price environment in which we continue to dwell. Taking measures to reduce well costs and reduce rig use while trying to meet or exceed field production targets and increase resource recovery is a daily challenge—in other words, trying to get more with, and out of, less.

Since this time last year, operator and service provider efforts to optimize well and fracture cluster spacing in new completions has increased. Room and desire, of course, remain for collaborative improvement. Restimulation of existing wells also has been on the rise, but implementation is still quite limited relative to new-well drilling and completion. The optimal restimulation procedure in a particular unconventional play is still largely in question; results from one approach or another in one formation can vary greatly from those same approaches in another formation. Also, additional attention continues to be placed on improved-oil-recovery and enhanced-oil-recovery (IOR/EOR) methods applicable in tight reservoirs and shales, but approaches are still in the experimental stage, realistically and•understandably.

To continue to advance optimization in new-well completions, to cost-effectively restimulate existing wells, and to enhance recovery will require capacity for laboratory studies and field trial programs and implementation of a range of analytical methodologies to accelerate application of lessons•learned.

Along those lines, three papers are featured this month. The first provides a detailed review of IOR/EOR methods applied in unconventional oil reservoirs, including numerical modeling studies, laboratory investigations, and field trial studies. The second addresses well spacing and completion optimization by use of a fast-paced optimization work flow. The third discusses methods to optimize fracturing and fluid design using public data across multiple basins and various analytical and statistical methods to identify trends and the key parameters that can lead more rapidly to stimulation optimization.

Recommended additional reading at OnePetro: www.onepetro.org.

SPE 192808 Increasing Stimulated Reservoir Volume in Unconventional Reservoirs: A Microstructural and Rock Mechanical Study by Ayyaz Mustafa, King Fahd University of Petroleum and Minerals, et al.
Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial
Authors: Song Jie , Liu Xiaofen , Jiang Weiwei , Wang Jiayou , Li Yun , Chen Hong , Zhang Ye
Published: September 2019

Background: There are no well-recognized guidelines for intraoperative fluid management in patients with end-stage renal failure (ESRF) . Goal-directed fluid therapy (GDFT) is a concept of perioperative fluid management that improves patients’ prognosis. Dynamic indicators better predict fluid response than static indicators.
Aim: In this study, we assessed a GDFT protocol with monitoring of pulse pressure variation (PPV) in patients with ESRF undergoing parathyroidectomy.
Methods: The study included 102 patients who underwent elective parathyroidectomy. They were randomized to a control group (restrictive group, n = 51) that was managed with a restricted fluid regimen or a PPV group (GDFT group, n = 51) that was given a normal saline infusion and was monitored for change in PPV during the intraoperative period. If PPV reached >13%, 250 mL normal saline was administered over 15 min. Ephedrine was given at increments of 6 mg to keep mean arterial pressure >65 mmHg . Hemodynamic variables in the perioperative period were recorded. The primary endpoint was the occurrence of postoperative hypotension.
Results: The occurrence of postoperative hypotension in the GDFT group was lower than in the restrictive group (0 vs. 11.67%, P = 0.027). The patients with complications in the GDFT group was lower than in the restrictive group (35.3% vs. 54.9%, P = 0.047). The volume of saline infused during the intraoperative period was 364 (219-408) mL in the GDFT group and 50 (50-50) mL in the restrictive group ( P = 0.001). Ephedrine was given to 16/51 (29.4%) of the GDFT group and 27/51 (52.9%) of the restrictive group ( P = 0.027).
Conclusion: The use of goal-directed fluid therapy with the dynamic PPV indicator in patients with ESRF undergoing parathyroidectomy guides the administration of infused fluids, with reduced incidence of postoperative hypotension.
Effect Of Long Term Inhaled Corticosteroid Therapy On Adrenal Suppression, Growth And Bone Health In Children With Asthma
Authors: Anuradha K W D A , Prematilake G L D C , Batuwita B A U I , Kannangoda KASR , Hewagamage U S , Wijeratne S , Lankatilake Kantha , de Silva KSH
Published: September 2019

Abstract
Background
Inhaled corticosteroids(ICS) are the most effective treatment for children with persistent asthma .However adverse effects of ICS on Hypothalamo Pituitary Adrenal (HPA) axis, growth and bone metabolism are a concern. Hence the primary objective of this study was to describe the effects of long term inhaled corticosteroid therapy (ICS) on adrenal function, growth and bone health in children with asthma in comparison to an age and sex matched group of children with asthma who were not on long term ICS. .Describing the association between the dose of ICS and duration of therapy on the above parameters were secondary objectives.
Method
Seventy children with asthma on ICS and 70 controls were studied. Diagnosis of asthma in selected patients was reviewed according to the criteria laid down by GINA 2018 guidelines .The estimated adult heights were interpreted relative to their Mid Parental Height (MPH) range. Serum calcium, alkaline phosphatase and vitamin D levels were analyzed in both groups and cortisol value at 30 minutes following a low dose short synacthen test was obtained from the study group. The average daily dose of ICS (Beclamethasone) was categorized as low, medium and high (100-200, 200-400, >400 ug /day) respectively according to published literature.
Results
Heights of all children were within the MPH range. There was no statistically significant difference in the bone profiles and vitamin D levels between the two groups (Ca: p=0.554, vitamin D: p=0.187) but vitamin D levels were insufficient (<50 nmol/l) in 34% of cases and 41% of controls. Suppressed cortisol levels were seen in 24%. Doses of ICS were low, medium and high in 56%, 32% and 12% of children respectively. The association between adrenal suppression with longer duration of therapy (p<0.01) and with increasing dose of ICS (p<0.001) were statistically significant.
Conclusion
ICS had no impact on the growth and bone profiles but its dose and duration were significantly associated with adrenal suppression.
Key Words- Asthma, Inhaled corticosteroids, Growth, Adrenal suppression, Bone Metabolism, Vitamin D
Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database
Authors: Wang Xuefei , Zhao Junjie , Fairweather Mark , Yang Tingsong , Sun Yihong , Wang Jiping
Published: September 2019

Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group.
Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013.
Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities.
Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.
Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study
Authors: Zeng Yanping , Cheng Peng , Tan Jiulin , Li Zhilin , Chen Yuan , Li Li Tao , Zheng Yonghong , Wang Gaoju , Xu Jianzhong , Zhang Zehua
Published: September 2019

Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three surgical approaches through a multicentre retrospective study.
Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion in a single- or two-stage procedure (Group B) and 80 underwent posterior debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Operations at each centre were performed by the same senior medical team in each centre.
Results: All three surgical approaches achieved bone fusion and pain relief. All patients with neurological deficits had different degrees of recovery after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively.
The mean loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05).
Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is superior to the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as the anterior-only or combined procedure but with shorter operation times, less trauma and less blood loss.

Keywords: Spinal tuberculosis; Thoracolumbar junction lesion; Surgical treatment; Outcome.