bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Low Blood Pressure and Clinical Outcomes in Patients With Acute Ischemic Stroke
Authors: Verschoof Merelijne A. , Groot Adrien E. , Vermeij Jan-Dirk , Westendorp Willeke F. , van den Berg Sophie A. , Nederkoorn Paul J. , van de Beek Diederik , Coutinho Jonathan M.
Published: October 2019

Background and Purpose—

Low blood pressure is uncommon in patients with acute ischemic stroke (AIS). We assessed the association between baseline low blood pressure and outcomes in patients with AIS.

Methods—

Post hoc analysis of the PASS (Preventive Antibiotics in Stroke Study). We compared patients with AIS and low (<10th percentile) baseline systolic blood pressure (SBP) to patients with normal SBP (≥10th percentile <185 mm Hg). The first SBP measured at the Emergency Department was used. Outcomes included in-hospital mortality, major complications <7 days of stroke onset, and functional outcome at 90 days (modified Rankin scale score). We used regression analysis to calculate (common) odds ratios and adjusted for predefined prognostic factors.

Results—

Two thousand one hundred twenty-four out of 2538 patients had AIS. The cutoff for low SBP was 130 mm Hg (n=212; range, 70–129 mm Hg). One thousand four hundred forty patients had a normal SBP (range, 130–184 mm Hg). Low SBP was associated with an increased risk of in-hospital mortality (8.0% versus 4.2%; adjusted odds ratio [aOR], 1.58; 95% CI, 1.13–2.21) and complications (16.0% versus 6.5%; aOR, 2.56; 95% CI, 1.60–4.10). Specifically, heart failure (2.4% versus 0.1%; aOR, 17.85; 95% CI, 3.36–94.86), gastrointestinal bleeding (1.9% versus 0.1%; aOR, 26.04; 95% CI, 2.83–239.30), and sepsis (3.3% versus 0.5%; aOR, 5.53; 95% CI, 1.84–16.67) were more common in patients with low SBP. Functional outcome at 90 days did not differ (shift towards worse outcome: adjusted common odds ratio, 1.24; 95% CI, 0.95–1.61).

Conclusions—

Whether it is cause or consequence, low SBP at presentation in patients with AIS was associated with an increased risk of in-hospital mortality and complications, specifically heart failure, gastrointestinal bleeding, and sepsis. Clinicians should be vigilant for potentially treatable complications.

Clinical Trial Registration—

URL:
https://www.controlled-trials.com
. Unique identifier: ISRCTN66140176.
The Treatment of Public Health Measures Affecting Intellectual Property Under Multilateral and Plurilateral Trade and Investment Agreements
Authors: Davison Mark , Emerton Patrick
Published: October 2019

This article considers the interpretation of provisions in international economic agreements that protect intellectual property as they relate to public health measures, and in particular to restrictions on the use of tobacco trademarks. A series of decisions, most recently the World Trade Organization (WTO) panel decision holding that Australia’s plain packaging measures for tobacco products comply with WTO obligations, allow for some generalisations. These include: (1) the nature of intellectual property rights is to confer a privilege of exclusive use on the rights-holder; (2) the interpretation of generally-worded treaty provisions is apt to be informed by recognition of the power of States to regulate for the purposes of public health; and (3) where provisions contain their own specifically-worded balancing tests, any direct or indirect reference to regulation for public health contained in the treaty is likely to be treated as weighing very heavily in favour of the legality of regulatory measures.
An improved nonlinear proportional-integral-differential controller combined with fractional operator and symbolic adaptation algorithm
Authors: Shi Lezhen , Miao Xiaodong , Wang Hua
Published: October 2019

Parameter adjustment is usually applied for designing the proportional-integral-differential (PID) controllers. However, the ability to improve control performance by adjusting parameters is limited. Hence, with the goal to achieve ideal closed-loop response, this paper takes advantage of a structural optimization method for modifying the controller model. A symbolic adaptation algorithm for fractional order PID (FOPID) controller is employed to obtain precise nonlinear controller model. Firstly, a modeling comparison for nonlinear duffing system is carried out to highlight the efficiency of the symbolic adaptation algorithm. The case study indicates the proposed algorithm can establish compact dynamic models by amending the shortcomings of symbolic regression. Secondly, the proposed controller is restructured with the linear FOPID controller and its nonlinearity is increased by adjusting controllers’ components in symbolic form. The proposed controllers are simulated in an unstable second-order system, a time-delay system and a nonlinear VanderPol system. Compared with the IOPID and the FOPID controller, the symbolic adaptation algorithm improves the structural flexibility of these linear controllers. Meanwhile, the system response can better approximate the desired response and the structural integrity of the nonlinear controller model is guaranteed simultaneously. Finally, the nonlinear FOPD controllers for trajectory tracking experiments are carried out on a rotary inverted pendulum control system.
Rational Fouls? Loss aversion on organizational and individual goals influence decision quality
Authors: Greve Henrich R. , Rudi Nils , Walvekar Anup
Published: October 2019

When organizational tasks require accurate decision-making, it is of interest to examine the quality of decisions in general, and specifically the conditions under which it deteriorates. Many important decisions are made by individuals at work who are hired to pursue organizational goals but also have individual goals, but the potential effects of having two goal sets has not seen enough theoretical and empirical treatment. We are particularly interested in the effects of organizational and individual goals leading to loss framing in decision-making, and in their interaction. We take predictions on loss aversion that have been explored most extensively in experimental studies and investigate them in a high-stakes field context involving organizations: football (soccer) in a European top division. We show that fouls (destructive play) are made rationally overall, and with reductions in rationality that follow the predictions of prospect theory. We show that the main mechanism behind the findings is that decision-making in a loss frame is less sensitive to cost/benefit calculations.
Cycling Without Age Program: The Impact for Residents in Long-Term Care
Authors: McNiel Paula , Westphal Judith
Published: October 2019

Long-term care facilities seek ways to enhance the quality of life for residents. Cycling Without Age (CWA), a new international cycling program, is gaining momentum for older adults. This study explored resident riders’ and trishaw pilots’ lived experience of their participation in the CWA program using a qualitative approach at a long-term care facility in the United States. Researchers conducted 27 face-to-face, semi-structured interviews with riders and pilots. For resident riders, the three themes identified included (a) breath of fresh air; (b) wave, chat, and remember; and (c) sit back and relax. Two themes were identified for the pilots: (a) change in frame of mind, and (b) mental and physical rewards. CWA can be as a new strategy for person-centered care. The CWA program provides nursing an opportunity to advocate, recommend, and obtain an order for residents to participate in the program.
Silencing the social: Debt and depletion in UK social policy
Authors: Dannreuther Charles
Published: October 2019

This article draws on a social reproduction approach to examine how debt informed the development of UK welfare provision. A brief history of the Public Works Loan Board introduces its centrality not only in the delivering of welfare institutions but also in the typographies and social values that informed welfare policies. The depletion of social care services today may be evident in the extensive use of debt to deliver social policy across the United Kingdom. However, in the past access to publicly backed borrowing enabled local authorities to deliver social rights that had been legislated for by central government. We can therefore see that it was not debt but its democratic accountability that played a central role in the changing fortunes of the UK’s welfare state.
Social reproduction strategies: Understanding compound inequality in the intergenerational transfer of capital, assets and resources
Authors: Nunn Alexander , Tepe-Belfrage Daniela
Published: October 2019

This article focuses on the way that households respond to ‘global pressures’ by adapting their social reproduction strategies (SRS). We understand social reproduction strategies to encapsulate the more or less consciously developed day-to-day and inter-generational responses to the social conditions that households confront and their own motivations and aspirations for the future. Yet, due to a range of extant inequalities of accumulated and dynamic resources – some of which are material and some of which are at once ethereal and embodied in the concrete labouring capacities of individuals – we argue that social reproduction strategies, and capacities to pursue them, differ widely. Differences are conditioned by positionality, access to information and the construction of ‘economic imaginaries’ as well as material resources. By looking at these different expressions of social reproduction strategies, we highlight how they reinforce macro-scale socio-economic pressures, creating what we term ‘compound inequality’ into the future. Compound inequalities result from different behavioural responses to socio-economic conditions, inequality and (perceived or real) insecurity, which have the potential to exaggerate inequality and insecurity into the future. Inequalities do not just arise from formal economic markets then but also from the realm of social reproduction.
Bones of Contention: A Comprehensive Literature Review of Non-SSRI Antidepressant Use and Bone Health
Authors: Power Clodagh , Duffy Richard , Mahon James , McCarroll Kevin , Lawlor Brian A.
Published: October 2019

Osteoporotic fractures are associated with major morbidity and mortality, particularly among older age groups. In recent decades, selective serotonin reuptake inhibitors (SSRI) antidepressants have been linked to reduced bone mineral density and increased risk of fragility fracture. However, up to one-third of antidepressant prescriptions are for classes other than SSRIs. Older patients, who are particularly vulnerable to osteoporosis and its clinical and psychosocial consequences, may be prescribed non-SSRI antidepressants preferentially because of increasing awareness of the risks SSRIs pose to bone health. However, to date, the skeletal effects of non-SSRI antidepressants have not been comprehensively reviewed. In this article, we collate and review the available data and discuss the findings. Based on the current literature, we tentatively suggest that tricyclic antidepressants may increase the risk of fracture via mechanisms other than a direct effect on bone mineral density. The risk is apparently confined to current users only and is greatest in the earliest stage of treatment, diminishing thereafter. There is, as yet, insufficient data to conclusively determine the effects of other antidepressant classes on bone. Judicious prescribing of antidepressants among higher risk groups necessitates a thorough review of the individual’s risk factors for osteoporosis as well as attention to their falls risk. Further longitudinal, rigorously controlled studies are needed to answer some of the remaining questions on the effects of non-SSRI antidepressants on bone and the mechanisms by which they are exerted.
5 Ezra 2:10–14: Its place in the book’s structure and in Christian supersessionism
Authors: Bergren Theodore A
Published: October 2019

5 Ezra (2 Esdras 1–2) is an apocryphal Christian supersessionist tractate dating from the 3rd century. It is structured in three main sections, each of which comprises two contrasting parts. 5 Ezra 2:10–14 is a seemingly anomalous pericope, falling exactly between the two parts of the second main section, but belonging to neither. This article argues that 2:10–14 is actually central to the book’s message. Placed precisely at the middle point of the book’s narrative, it narrates in literary terms the process of transition from Judaism to Christianity that is central to the book’s supersessionist theology. After identifying structural parallels to 2:10–14 in the Gospel of Mark and 4 Ezra, the article continues with a detailed exegesis of 2:10–14. The article concludes by considering the place of 5 Ezra within the larger scheme of Christian supersessionist theology.
Angels among us? The Watchers myth and angelology in Ephrem’s Commentary on Genesis and the Ethiopic tradition
Authors: Skelton David A
Published: October 2019

This study examines the euhemeristic interpretation of Genesis 6:1–4 as it appears in Ephrem of Nisibis’ Commentary on Genesis and its influence on Syriac and Ethiopic commentary traditions. I suggest that Ephrem’s attempt to mitigate the angelic interpretation of Genesis 6 ironically mirrors his own angelology. The distinctive components he adds to the Watchers myth (different geography, diet, and bodies) are central virtues in Ephrem’s attempt to make virginity and monasticism ideals for all Christians. For Ephrem, the angels are paradigms of these ideals, and those who achieve them become equal to the angels. Surprisingly, these distinctive components reappear in the Ethiopian commentary tradition on Genesis ( andemta), but unlike Ephrem, the andemta makes the equation of Sethites with angels and monks quite explicit. Overall, this analysis between Ephrem and the andemta reveals the influence of Syriac interpretation on the Ethiopian commentary tradition as well as the centrality of angelology in the Sethite reading of Genesis 6:1–4.
Is PRP Effective in Reducing the Scar Width of Primary Cleft Lip Repair? A Randomized Controlled Clinical Study
Authors: Refahee Shaimaa Mohsen , Aboulhassan Mamdouh A. , Abdel Aziz Omniya , Emara Dawlat , Seif El Dein Hadeel M. , Moussa Basma Gamal , Abu Sneineh Malek
Published: October 2019

Objective:

To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique.

Hypothesis:

An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function.

Design:

Blind, randomized, controlled clinical trial.

Patients:

From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups.

Intervention:

All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection.

Outcomes Measures:

Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs.

Results:

Scar width showed a significant improvement in the study group.

Conclusions:

Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.
Strategies That Male Allies Use to Advance Women in the Workplace
Authors: Madsen Susan R. , Townsend April , Scribner Robbyn T.
Published: October 2019

The purpose of this research study was to identify and examine, from both men’s and women’s perspectives, the specific behaviors and strategies male allies use to successfully support the advancement of women in workplace settings. From a survey of 243 men and women, the team gathered qualitative survey data that were analyzed to identify the strategies and behaviors used by male allies. Top responses included developmental relationships, human resource (HR) processes, leadership development, recognition (both public and private), treating women as equals, and challenging sexist behavior. Some differences existed between perceptions of men and women in terms of the most critical ally behaviors. These research findings have scholarly and practical implications in future efforts to work toward greater gender parity.
Safety, feasibility, acceptability and effects of a behaviour-change intervention to change physical activity behaviour among people with multiple sclerosis: Results from the iStep-MS randomised controlled trial
Authors: Ryan Jennifer M , Fortune Jennifer , Stennett Andrea , Kilbride Cherry , Lavelle Grace , Hendrie Wendy , DeSouza Lorraine , Abdul Mohammed , Brewin Debbie , David Lee , Anokye Nana , Victor Christina , Norris Meriel
Published: October 2019

Background:

There is limited information regarding the safety, feasibility and acceptability of behaviour-change interventions to increase physical activity (PA) and reduce sedentary behaviour among people with multiple sclerosis (MS). Prior to evaluating efficacy, it is important to identify problems with feasibility and acceptability, which may undermine effectiveness.

Objective:

To examine the safety, feasibility and acceptability of a behaviour-change intervention to increase PA and reduce sedentary behaviour among people with MS.

Methods:

Sixty people received a 3-month intervention or usual care. Fatigue, pain and adverse events (AEs) were assessed. Feasibility and acceptability were explored through focus groups with physiotherapists and interviews with participants. Fidelity to intervention content, delivery skills, programme receipt and programme task were assessed.

Results:

There was no difference in AE rate between groups ( p = 0.965). Fatigue and pain were not higher in the intervention group at 3 or 9 months. Therapists reported the intervention was feasible to deliver and fidelity was acceptable. Twenty-nine participants (97%) attended at least 75% of sessions. Participants found the intervention acceptable but suggested some amendments were required to intervention components.

Conclusions:

The intervention was safe, feasible and acceptable. Although modifications are required to intervention components, the intervention warrants further evaluation in a future trial.
Psychological distress in Ghana: Are unemployed people more afflicted?
Authors: Sulemana Iddisah , Doabil Louis , Anarfo Ebenezer Bugri
Published: October 2019

The detrimental consequences of unemployment to the psychological well-being of people have been well documented. However, much of this research has been conducted for developed countries. This study contributes to the literature by providing empirical evidence on this topic from a Ghanaian perspective. Our results revealed no significant association between unemployment and psychological distress. Rather, we found that part-time and full-time employees who were looking for a job were significantly more likely to suffer psychological distress. When we analysed the association between unemployment and psychological distress for males and females separately, we did not find a statistically significant relationship for either gender group.
miR-491 inhibits BGC-823 cell migration via targeting HMGA2
Authors: Liu Zhigang , Lü Yun , Jiang Qiuyu , Yang Yang , Dang Chengxue , Sun Ruifang
Published: October 2019

Purpose:

miR-491 functions as a tumor suppressor in several types of cancer. However, its function and mechanism in gastric cancer proliferation and metastasis have not been well defined. The aim of this study was to explore the role and regulatory mechanism of miR-491 in cell proliferation and migration in gastric cancer.

Methods:

Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) was used to detect the expression pattern of miR-491 in gastric cancer tissues. miR-491 overexpression vector, miR-491 inhibitor, and siHMGA2 were used; and MTT, wound healing, and transwell assays were employed to examine proliferation and migration for BGC-823 cells. A dual-luciferase reporter gene was used to measure the target relationship between miR-491 and HMGA2.

Results:

Most gastric cancer patients exhibit decreased miR-491 expression. miR-491 overexpression inhibited cell proliferation and migration, whereas miR-491 inhibitor treatment produced the opposite effect. Mechanistically, HMGA2 was identified as a direct target of miR-491. Moreover, HMGA2 knockdown inhibited cell proliferation and migration, which was similar to the effect of miR-491 overexpression. HMGA2 was decreased after transfection of the miR-491 vector and increased after transfection of the miR-491 inhibitor.

Conclusion:

Our results suggest that miR-491 suppressed cell proliferation and cell motility in gastric cancer by targeting HMGA2. Silencing HMGA2 produced a similar effect to miR-491 overexpression on cell proliferation and migration. miR-491/HMGA2 signaling may be a potential therapeutic target for gastric cancer patients with decreased miR-491 expression.
A third trial oversight committee: Functions, benefits and issues
Authors: Lane J Athene , Gamble Carrol , Cragg William J , Tembo Doreen , Sydes Matthew R
Published: October 2019

Background/aims:

Clinical trial oversight is central to the safety of participants and production of robust data. The United Kingdom Medical Research Council originally set out an oversight structure comprising three committees in 1998. The first committee, led by the trial team, is hands-on with trial conduct/operations (‘Trial Management Group’) and essential. The second committee (Data Monitoring Committee), usually completely independent of the trial, reviews accumulating trial evidence and is used by most later phase trials. The Independent Data Monitoring Committee makes recommendations to the third oversight committee. The third committee, (‘Trial Steering Committee’), facilitates in-depth interactions of independent and non-independent trial members and gives broader oversight (blinded to comparative analysis). We investigated the roles and functioning of the third oversight committee with multiple research methods. We reflect upon these findings to standardise the committee’s remit and operation and to potentially increase its usage.

Methods:

We utilised findings from our recent published suite of research on the third oversight committee to inform guideline revision. In brief, we conducted a survey of 38 United Kingdom–registered Clinical Trials Units, reviewed a cohort of 264 published trials, observed 8 third oversight committee meetings and interviewed 52 trialists. We convened an expert panel to discuss third oversight committees. Subsequently, we interviewed nine patient/lay third committee members and eight committee Chairs.

Results:

In the survey, most Clinical Trials Units required a third committee for all their trials (27/38, 71%) with independent members (ranging from 1 to 6). In the survey and interviews, the independence of the third committee was valued to make unbiased consideration of Independent Data Monitoring Committee recommendations and to advise on trial progress, protocol changes and recruitment issues in conjunction with the trial leadership. The third committee also advised funders and sponsors about trial continuation and represented patients and the public by including lay members. Of the cohort of 264 published trials, 144 reported a ‘steering’ committee (55%), but the independence of these members was not described so these may have been internal Trial Management Groups. Around two thirds of papers (60%) reported having an Independent Data Monitoring Committee and 26.9% neither a steering nor an Independent Data Monitoring Committee. However, before revising the third committee charter (Terms of Reference), greater standardisation is needed around defining member independence, composition, primacy of decision-making, interactions with other committees and the lifespan.

Conclusion:

A third oversight committee has benefits for trial oversight and conduct, and a revised charter will facilitate greater standardisation and wider adoption.
Beyond climate policy: The perspective of sustainability
Authors: Wölkner Sabina
Published: October 2019

Since the 2019 European elections, the spotlight has been on climate protection. However, this strict focus obscures a broader view. Sustainability has three dimensions, all of which are of equal value. Thus, realising sustainability requires holistic action and a forward-looking approach. Sustainability also has the potential to be the driver behind economic modernisation and innovation. To tap into its real potential, what is needed is, instead of the apocalyptic global warming rhetoric of a self-fulfilling prophecy, a sound vision that unites ecological sustainability, economic performance and social justice. Given the European People’s Party’s comprehensive views on politics and society, the party is predestined to take the lead in the debate about a sustainable EU. Among Germany’s Christian Democrats, a renewed positioning around this topic has recently begun.
Chemical Composition and Enzyme Inhibitory Activities of Turkish Pancratium maritimum Bulbs
Authors: Bozkurt Buket , Kaya Gulen I. , Somer Nehir U.
Published: October 2019

The chemical composition of the bulbs of Pancratium maritimum L. (Amaryllidaceae) from Turkey (Pamucak, Aydın) has been determined by gas chromatography-mass spectrometry. A total of 29 compounds belonging to different skeletal types of Amaryllidaceae alkaloids were identified. Lycorine, galanthamine, crinine, and pancracine were found as major constituents. Interestingly, indole alkaloids (1-acetyl-β -carboline and galanthindole) were also detected. Acetylcholinesterase, butyrylcholinesterase, and prolyl oligopeptidase inhibitory activity potentials of the alkaloidal extract were also determined. The results of the present study show that Turkish P. maritimum comprises a rich repository for bioactive alkaloids with intriguing structural diversities.
The emerging field of pancreatic tissue engineering: A systematic review and evidence map of scaffold materials and scaffolding techniques for insulin-secreting cells
Authors: Salg Gabriel Alexander , Giese Nathalia A , Schenk Miriam , Hüttner Felix J , Felix Klaus , Probst Pascal , Diener Markus K , Hackert Thilo , Kenngott Hannes Götz
Published: October 2019

A bioartificial endocrine pancreas is proposed as a future alternative to current treatment options. Patients with insulin-secretion deficiency might benefit. This is the first systematic review that provides an overview of scaffold materials and techniques for insulin-secreting cells or cells to be differentiated into insulin-secreting cells. An electronic literature survey was conducted in PubMed/MEDLINE and Web of Science, limited to the past 10 years. A total of 197 articles investigating 60 different materials met the inclusion criteria. The extracted data on materials, cell types, study design, and transplantation sites were plotted into two evidence gap maps. Integral parts of the tissue engineering network such as fabrication technique, extracellular matrix, vascularization, immunoprotection, suitable transplantation sites, and the use of stem cells are highlighted. This systematic review provides an evidence-based structure for future studies. Accumulating evidence shows that scaffold-based tissue engineering can enhance the viability and function or differentiation of insulin-secreting cells both in vitro and in vivo.
Long-term Prognosis and Impact of Osgood-Schlatter Disease 4 Years After Diagnosis: A Retrospective Study
Authors: Guldhammer Clara , Rathleff Michael Skovdal , Jensen Hans Peter , Holden Sinead
Published: October 2019

Background:

Knee pain is common during adolescence, with Osgood-Schlatter disease (OSD) being the most frequent condition. Despite this, research regarding the long-term prognosis of OSD is limited.

Purpose:

To evaluate the prognosis 2 to 6 years after the diagnosis of OSD.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This retrospective cohort study included patients diagnosed with OSD at a single orthopaedic department between 2010 and 2016. Patients were contacted in 2018 and asked to complete a self-reported questionnaire regarding knee pain, knee function (Knee injury and Osteoarthritis Outcome Score [KOOS] Sports/Recreation subscale), Health-related quality of life (HRQoL) (youth version of EuroQol 5 dimensions 3 levels [EQ-5D-3L-Y]), and physical activity.

Results:

Out of 84 patients, 43 responded. Of these, 60.5% (n = 26) reported OSD-related knee pain at follow-up (median follow-up, 3.75 years). The median symptom duration was 90 months (interquartile range, 24-150 months) for those still experiencing knee pain, and 42.9% of these reported daily knee pain. Fifty-four percent with knee pain had reduced their sports participation compared with 35.3% of those without knee pain. KOOS Sports/Recreation subscale scores were significantly lower in those with knee pain compared with those without knee pain (53 [95% CI, 42-63] vs 85 [95% CI, 76-94], respectively). Participants with knee pain reported lower HRQoL (0.71 [95% CI, 0.57-0.84]) compared with those without knee pain (0.99 [95% CI, 0.97-1.00]).

Conclusion:

This study indicates that OSD may not always be self-limiting. The lower self-reported function and HRQoL in those with continued pain may be a consequence of impaired physical activity due to knee pain.
Integrating Research Experiences Into Public Health Curricula: Effects on Undergraduate Students’ Knowledge of Neighborhood Inequalities, Perception of Research, and Motivation to Talk About Health Issues
Authors: Zografos Kara , Alcala Emanuel , Capitman John , Khang Leepao
Published: October 2019

Undergraduate research is defined as an inquiry or investigation conducted by an undergraduate student in collaboration with a faculty member that makes an intellectual or creative contribution to the discipline. This study assessed the impact of integrating undergraduate research experiences into public health curricula on students’ knowledge of neighborhood inequalities, perception of research, and motivation to talk about health issues. The sample consisted of 132 undergraduate students from two groups (intervention and comparison). The intervention group ( n = 71) conducted a structured social observation in various zip codes to characterize assets and liabilities of the local built environment. Self-reported questionnaires assessing the key study variables were administered to the students at baseline and at postintervention. Compared with those in the comparison group, improvements were noted in knowledge among those in the intervention group from pretest to posttest. Participants in the intervention group were also more motivated to talk about health issues compared with those in the comparison group. Perception of research among those in the intervention group also improved over time when participants were divided into two research confidence level groups (confident and nonconfident). The evaluation of this intervention demonstrates the positive impact integrating undergraduate research experiences can have on a sample of students.
Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases
Authors: Kutzner Karl Philipp , Donner Stefanie , Loweg Lennard , Rehbein Philipp , Dargel Jens , Drees Philipp , Pfeil Joachim
Published: October 2019

Background

In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available.

Materials and methods

Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones.

Results

At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed.

Conclusions

The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage.

Level of evidence

IV, Prospective observational study

Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered)
The use of 5-azacytidine in pregnant patient with Acute Myeloid Leukemia (AML): a case report
Authors: Alrajhi Abdullah M. , Alhazzani Sarah A. , Alajaji Nouf M. , Alnajjar Fouad H. , Alshehry Nawal F. , Tailor Imran K.
Published: October 2019

Background

The management of Acute Myeloid Leukemia (AML) during pregnancy remains challenging as both the maternal and fetal outcomes should be considered. Several reports suggested that chemotherapy can be administered safely during the second and third trimester of pregnancy. However, the use of 5-azacytidine presents limitation due to lack of data.

Case presentation

A 28-years-old woman in the 26th week of gestation diagnosed with FLT3/ITD-mutated AML, complete remission was induced by Daunorubicin and Cytarabine, and subsequently with 5-azacytidine (75 mg/m2 daily for 7 days) with no fetal hematological or toxicity issues. Fetal ultrasound showed no aberrant morphology. Fetal size below the 5th percentile with normal umbilical artery dopplers, normal middle cerebral artery dopplers and ductus venosus doppler.

Three weeks post 5-azacytidine, the team determined the most appropriate time for delivery after balancing the risks of prematurity and prevention of disease relapse since patient in hematological remission. The patient underwent elective lower segment caesarian section and had a baby girl delivered at 35 weeks of gestation weighing 1670 g without apparent anomalies.

Conclusion

Treatment using 5-azacytadine during last trimester of pregnancy resulted in no major fetal and maternal complications. These findings concluded that 5-azacytadine during the third trimester of pregnancy seems to be safe however, potential risks of this agent should be considered.
Demographic and clinical predictors of progression and mortality in connective tissue disease-associated interstitial lung disease: a retrospective cohort study
Authors: Chan Chrystal , Ryerson Christopher J. , Dunne James V. , Wilcox Pearce G.
Published: October 2019

Background

Connective tissue disease-associated interstitial lung disease (CTD-ILD) is associated with reduced quality of life and poor prognosis. Prior studies have not identified a consistent combination of variables that accurately predict prognosis in CTD-ILD. The objective of this study was to identify baseline demographic and clinical characteristics that are associated with progression and mortality in CTD-ILD.

Methods

Patients were retrospectively identified from an adult CTD-ILD clinic. The predictive significance of baseline variables on serial forced vital capacity (FVC), diffusion capacity (DLCO), and six-minute walk distance (6MWD) was assessed using linear mixed effects models, and Cox regression analysis was performed to assess impact on mortality.

Results

359 patients were included in the study. Median follow-up time was 4.0 (IQR 1.5–7.6) years. On both unadjusted and multivariable analysis, male sex and South Asian ethnicity were associated with decline in FVC. Male sex, positive smoking history, and diagnosis of systemic sclerosis (SSc) vs. other CTD were associated with decline in DLCO. Male sex and usual interstitial pneumonia (UIP) pattern predicted decline in 6MWD. There were 85 (23.7%) deaths. Male sex, older age, First Nations ethnicity, and a diagnosis of systemic sclerosis vs. rheumatoid arthritis were predictors of mortality on unadjusted and multivariable analysis.

Conclusion

Male sex, older age, smoking, South Asian or First Nations ethnicity, and UIP pattern predicted decline in lung function and/or mortality in CTD-ILD. Further longitudinal studies may add to current clinical prediction models for prognostication in CTD-ILD.
Assessment of proliferating cell nuclear antigen (PCNA) expression at the invading front of oral squamous cell carcinoma
Authors: Lu Emily Ming-Chieh , Ratnayake Jithendra , Rich Alison Mary
Published: October 2019

Background

Accurate prediction of the behaviour of oral squamous cell carcinoma (OSCC) is necessary to determine prognosis and provide appropriate treatment. Therefore, it is important to investigate potential prognostic markers to determine their predictive ability. Histological assessment of specific features at the invading front of oral squamous cell carcinomas has shown to provide accurate and reproducible prognostic information. Proliferating cell nuclear antigen (PCNA) is a nuclear marker known to reflect cell turnover and may be used as a marker for tumour aggressiveness.

Methods

Twenty cases of OSCC were histologically assessed to evaluate the correlation between proliferating cell nuclear antigen expression and invasive front grading. Each case was first assessed on a haematoxylin and eosin stained slide and an invading front grading (IFG) score was determined. In order to obtain a PCNA score, immunohistological staining was carried out using the peroxidase-labelled streptavidin-biotin technique with the monoclonal antibody PC10.

Results

In all cases, tumour islands had a periphery of intensely stained proliferating cell nuclear antigen-positive epithelial cells. The average IFG score was 8 ± 1.8, and the average PCNA score was 75% ± 11.2. Regression analysis was done using data from the IFG score and PCNA score and taking the latter as the predictor variable. The Pearson correlation coefficient was 0.134, with a p-value of 0.572.

Conclusion

Since the correlation between PCNA score and IFG score was not significant (p > 0.05), we conclude that there is no association between cell proliferation at the invading tumour front and the histological grading of OSCC.
More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire – Expanded
Authors: Cohen S. Robin , Russell Lara B. , Leis Anne , Shahidi Javad , Porterfield Pat , Kuhl David R. , Gadermann Anne M. , Sawatzky Richard
Published: October 2019

Background

Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. TheMcGill Quality of Life Questionnaire (MQOL) – Revisedmeasures the four common domains. The aim of this study was to create a psychometrically sound instrument,MQOL – Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance.

Methods

Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics.

Results

Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033).

Conclusions

MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction
Authors: Nabeshima Yosuke , Namisaki Hidehiro , Teshima Toshihiro , Kurashige Yasuhiko , Kakio Akiko , Fukumitsu Azusa , Otsuji Yutaka , Takeuchi Masaaki
Published: October 2019

Background

Left ventricular (LV) ejection fraction (LVEF) assessed by two-dimensional echocardiography (2DE) is the most widely used parameter for clinical decision-making, but reproducibility and accuracy problems remain. We evaluated the usefulness of a novel training program based on cardiac magnetic resonance (CMR) imaging to obtain more reliable values of 2DE-derived LVEF and LV volumes.

Methods

Fifty-four sonographers from five hospitals independently measured LV volumes and LVEF using the same 2DE images from 15 patients who underwent CMR and 2DE. After receiving a lecture from an expert on how to properly trace the LV endocardium, each sonographer voluntary performed the measurements using the same datasets, and was invited to perform the same analysis for additional patients. The effect of the training intervention was evaluated using the coefficient of variation (CV) and coverage probability (CP).

Results

Before the intervention, the LV volumes were significantly underestimated and the LVEF was significantly overestimated compared to the CMR results; however, these differences were reduced after the intervention. In particular, the CP (0.52 vs. 0.76, p < 0.001) for the LVEF showed significant improvement. However, the degree of improvement differed among institutions, and the CV actually became worse in two hospitals after the intervention. Level of experience and self-practice was associated with the reproducibility after the intervention.

Conclusions

A training program using CMR as a reference improved the accuracy of 2DE-determined LV measurements. Since the degree of improvements differed among hospitals, individualization of training programs and periodical objective evaluation may be required to reduce inter-institutional variability.
Correction to: Elevated TRIP13 drives the AKT/mTOR pathway to induce the progression of hepatocellular carcinoma via interacting with ACTN4
Authors: Zhu Meng-Xuan , Wei Chuan-Yuan , Zhang Peng-Fei , Gao Dong-Mei , Chen Jie , Zhao Yan , Dong Shuang-Shuang , Liu Bin-Bin
Published: October 2019

In the original publication of this article [1], the author would like to revise Figure 4.
Optimizing sequencing protocols for leaderboard metagenomics by combining long and short reads
Authors: Sanders Jon G. , Nurk Sergey , Salido Rodolfo A. , Minich Jeremiah , Xu Zhenjiang Z. , Zhu Qiyun , Martino Cameron , Fedarko Marcus , Arthur Timothy D. , Chen Feng , Boland Brigid S. , Humphrey Greg C. , Brennan Caitriona , Sanders Karenina , Gaffney James , Jepsen Kristen , Khosroheidari Mahdieh , Green Cliff , Liyanage Marlon , Dang Jason W. , Phelan Vanessa V. , Quinn Robert A. , Bankevich Anton , Chang John T. , Rana Tariq M. , Conrad Douglas J. , Sandborn William J. , Smarr Larry , Dorrestein Pieter C. , Pevzner Pavel A. , Knight Rob
Published: October 2019

As metagenomic studies move to increasing numbers of samples, communities like the human gut may benefit more from the assembly of abundant microbes in many samples, rather than the exhaustive assembly of fewer samples. We term this approach leaderboard metagenome sequencing. To explore protocol optimization for leaderboard metagenomics in real samples, we introduce a benchmark of library prep and sequencing using internal references generated by synthetic long-read technology, allowing us to evaluate high-throughput library preparation methods against gold-standard reference genomes derived from the samples themselves. We introduce a low-cost protocol for high-throughput library preparation and sequencing.
gem-Difluorobisarylic derivatives: design, synthesis and anti-inflammatory effect
Authors: Ayoub Abeer J. , Hariss Layal , El-Hachem Nehme , El-Achkar Ghewa A. , Ghayad Sandra E. , Dagher Oula K. , Borghol Nada , Grée René , Badran Bassam , Hachem Ali , Hamade Eva , Habib Aida
Published: October 2019

Introduction

New fluorinated diaryl ethers and bisarylic ketones were designed and evaluated for their anti-inflammatory effects in primary macrophages.

Methods

The synthesis of the designed molecules started from easily accessible and versatilegem-difluoro propargylic derivatives. The desired aromatic systems were obtained using Diels–Alder/aromatization sequences and this was followed by Pd-catalyzed coupling reactions and, when required, final functionalization steps. Both direct inhibitory effects on cyclooxygenase-1 or -2 activities, protein expression of cyclooxygenase-2 and nitric oxide synthase-II and the production of prostaglandin E2, the pro-inflammatory nitric oxide and interleukin-6 were evaluated in primary murine bone marrow-derived macrophages in response to lipopolysaccharide. Docking of the designed molecules in cyclooxygenase-1 or -2 was performed.

Results

Only fluorinated compounds exerted anti-inflammatory activities by lowering the secretion of interleukin-6, nitric oxide, and prostaglandin E2, and decreasing the protein expression of inducible nitric oxide synthase and cyclooxygenase-2 in mouse primary macrophages exposed to lipopolysaccharide, as well as cyclooxygenase activity for some inhibitors with different efficiencies depending on the R-groups. Docking observation suggested an inhibitory role of cyclooxygenase-1 or -2 for compoundsA3,A4andA5in addition to their capacity to inhibit nitrite, interleukin-6, and nitric oxide synthase-II and cyclooxygenase-2 expression.

Conclusion

The new fluorinated diaryl ethers and bisarylic ketones have anti-inflammatory effects in macrophages. These fluorinated compounds have improved potential anti-inflammatory properties due to the fluorine residues in the bioactive molecules.