bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a Bayesian survival model for inclusion body myositis
Authors: Capkun Gorana , Schmidt Jens , Ghosh Shubhro , Sharma Harsh , Obadia Thomas , de Vera Ana , Risson Valery , Amzal Billy
Published: November 2019

Background

Associations between disease characteristics and payer-relevant outcomes can be difficult to establish for rare and progressive chronic diseases with sparse available data. We developed an exploratory bridging model to predict premature mortality from disease characteristics, and using inclusion body myositis (IBM) as a representative case study.

Methods

Candidate variables that may be potentially associated with premature mortality were identified by disease experts and from the IBM literature. Interdependency between candidate variables in IBM patients were assessed using existing patient-level data. A Bayesian survival model for the IBM population was developed with identified variables as predictors for premature mortality in the model. For model selection and external validation, model predictions were compared to published mortality data in IBM patient cohorts. After validation, the final model was used to simulate the increased risk of premature death in IBM patients. Baseline survival was based on age- and gender-specific survival curves for the general population in Western countries as reported by the World Health Organisation.

Results

Presence of dysphagia, aspiration pneumonia, falls, being wheelchair-bound and 6-min walking distance (6MWD in meters) were identified as candidate variables to be used as predictors for premature mortality based on inputs received from disease experts and literature. There was limited correlation between these functional performance measures, which were therefore treated as independent variables in the model. Based on the Bayesian survival model, among all candidate variables, presence of dysphagia and decrease in 6MWD [m] were associated with poorer survival with contributing hazard ratios (HR) 1.61 (95% credible interval [CrI]: 0.84–3.50) and 2.48 (95% CrI: 1.27–5.00) respectively. Excess mortality simulated in an IBM cohort vs. an age- and gender matched general-population cohort was 4.03 (95% prediction interval 1.37–10.61).

Conclusions

For IBM patients, results suggest an increased risk of premature death compared with the general population of the same age and gender. In the absence of hard data, bridging modelling generated survival predictions by combining relevant information. The methodological principle would be applicable to the analysis of associations between disease characteristics and payer-relevant outcomes in progressive chronic and rare diseases. Studies with lifetime follow-up would be needed to confirm the modelling results.
Assessment of childbirth preparation classes: a parallel convergent mixed study
Authors: Hassanzadeh Robab , Abbas-Alizadeh Fatemeh , Meedya Shahla , Mohammad-Alizadeh-Charandabi Sakineh , Mirghafourvand Mojgan
Published: November 2019

Background

Women’s fear from childbirth has been associated with increased medical interventions and traumatized birth experience. Although antenatal education is a crucial factor to empower and prepare women for their birth journey, it is not clear how Iranian childbirth classes can influence women’s fear and prepare them positively towards childbirth. This research is designed to evaluate childbirth preparation classes and their impact on women’s perception on their childbirth experiences.

Methods/design

This mixed method study with the parallel convergent design has two phases. The first phase will be a quantitative cohort study with 204 primiparous pregnant women at the gestational age of 35–37 weeks. The participants will be divided into three groups based on the number of their attendance into the childbirth preparation classes: a) regular participation (4 to 8 sessions), b) irregular participation (1 to 3 sessions), and c) no-participation. Participant will be followed-up to 1 month after birth. Antenatal data will be collected by using a demographic survey questionnaire, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), the Van den Bergh Pregnancy-Related Anxiety Questionnaire, the Satisfaction with Childbirth Preparation Classes Questionnaire, the Edinburgh Postpartum Depression Scale (EPDS) and Knowledge regarding pregnancy and childbirth Questionnaire. Postnatal data will be collected by using an Obstetric and Labor Characteristics Questionnaire, EPDS, and Childbirth experience questionnaire (CEQ). The quantitative data will be analyzed using one-way ANOVA and the multivariate linear regression. The second phase of the study will be a qualitative study that will explore the women’s perceptions on the impact of participation in childbirth preparation classes on their childbirth experience. The sampling in this phase will be purposeful and the participants will be studied individually by using in-depth, semi-structured interviews. The qualitative data will be analyzed through content analysis with conventional approach.

Discussion

Assessing the impact of childbirth preparation classes on women’s childbirth experience in Iran will lead to developing recommendations about the content and quality of the childbirth classes that can improve women’s’ preparation towards positive childbirth.
Offline effects of transcranial direct current stimulation on reaction times of lower extremity movements in people after stroke: a pilot cross-over study
Authors: Coppens Milou J. M. , Staring Wouter H. A. , Nonnekes Jorik , Geurts Alexander C. H. , Weerdesteyn Vivian
Published: November 2019

Background

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has shown promise for rehabilitation after stroke. Ipsilesional anodal tDCS (a-tDCS) over the motor cortex increases corticospinal excitability, while contralesional cathodal tDCS (c-tDCS) restores interhemispheric balance, both resulting in offline improved reaction times of delayed voluntary upper-extremity movements. We aimed to investigate whether tDCS would also have a beneficial effect on delayed leg motor responses after stroke. In addition, we identified whether variability in tDCS effects was associated with the level of leg motor function.

Methods

In a cross-over design, 13 people with chronic stroke completed three 15-min sessions of anodal, cathodal and sham stimulation over the primary motor cortex on separate days in an order balanced across participants. Directly after stimulation, participants performed a comprehensive set of lower-extremity tasks involving the paretic tibialis anterior (TA): voluntary ankle-dorsiflexion, gait initiation, and backward balance perturbation. For all tasks, TA onset latencies were determined. In addition, leg motor function was determined by the Fugl-Meyer Assessment – leg score (FMA-L). Repeated measures ANOVA was used to reveal tDCS effects on reaction times. Pearson correlation coefficients were used to establish the relation between tDCS effects and leg motor function.

Results

For all tasks, TA reaction times did not differ across tDCS sessions. For gait initiation and backward balance perturbation, differences between sham and active stimulation (a-tDCS or c-tDCS) did not correlate with leg motor function. Yet, for ankle dorsiflexion, individual reaction time differences between c-tDCS and sham were strongly associated with FMA-L, with more severely impaired patients exhibiting slower paretic reaction times following c-tDCS.

Conclusion

We found no evidence for offline tDCS-induced benefits. Interestingly, we found that c-tDCS may have unfavorable effects on voluntary control of the paretic leg in severely impaired patients with chronic stroke. This finding points at potential vicarious control from the unaffected hemisphere to the paretic leg. The absence of tDCS-induced effects on gait and balance, two functionally relevant tasks, shows that such motor behavior is inadequately stimulated by currently used tDCS applications.

Trial registration

The study is registered in the Netherlands Trial Register (NL5684; April 13th, 2016).
Silicon dioxide nanoparticles induce insulin resistance through endoplasmic reticulum stress and generation of reactive oxygen species
Authors: Hu Hailong , Fan Xingpei , Guo Qian , Wei Xiangjuan , Yang Daqian , Zhang Boya , Liu Jing , Wu Qiong , Oh Yuri , Feng Yujie , Chen Kun , Hou Liping , Gu Ning
Published: November 2019

Background

Silicon dioxide nanoparticles (SiO2 NPs) are one of the most widely utilized NPs in various food sectors. However, the potential endocrine toxicity of SiO2 NPs has not been characterized.

Results

In the present study, mice were orally administered a series of doses of SiO2 NPs. All doses of SiO2 NPs were absorbed into the blood, liver, and pancreas of the mice. Administration of 100 mg/kg bw (body weight) of SiO2 NPs significantly increased blood glucose levels in mice. However, the same dose of SiO2 fine-particles (FPs) did not result in altered blood glucose. Whole-genome analysis showed that SiO2 NPs affected the expression of genes associated with reactive oxygen species (ROS) production and endoplasmic reticulum (ER) stress. In addition, we showed that SiO2 NPs activated xenobiotic metabolism, resulting in ER stress. Endoplasmic reticulum stress resulted in increased ROS production, which activated the NF-κB pathway leading to expression of inflammatory cytokines. Increased inflammatory cytokine expression resulted in serine phosphorylation of IRS1, which induced insulin resistance (IR). Furthermore these inflammatory cytokines activated the MAPK pathway, which further promoted the serine phosphorylation of IRS1. Insulin resistance resulted in elevated blood glucose. The ER stress inhibitor 4-phenylbutyric acid (4-PBA) inhibited SiO2 NP-induced ROS production. The ROS scavenger N-acetylcysteine (NAC) did not affect SiO2 NP-induced ER stress, but inhibited SiO2 NP-induced activation of the NF-κB and MAPK pathways, expression of inflammatory cytokines, SiO2 NP-induced serine phosphorylation of IRS1, and SiO2 NP-induced elevations of blood glucose.

Conclusion

Silicon dioxide NPs induced IR through ER stress and generation of ROS, but SiO2 FPs did not. Therefore, lifelong exposure of humans to SiO2 NPs may result in detrimental effects on blood glucose. The results of this study strongly suggested that non-nanoformed SiO2 should be used as food additives.
Vulvar Paget disease secondary to high-grade urothelial carcinoma with underlying massive vascular embolization and cervical involvement: case report of unusual presentation
Authors: Primo Walquiria Quida Salles Pereira , Primo Guttenberg Rodrigues Pereira , Basilio Dunya Bachour , Machado Karime Kalil , Carvalho Jesus Paula , Carvalho Filomena M.
Published: November 2019

Background

Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management.

Case presentation

We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms.

Conclusions

Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.
Signet ring cell variant of follicular thyroid carcinoma: Report of two cases with focus on morphological, expressional and genetic characteristics
Authors: Hysek Martin , Jatta Kenbugul , Stenman Adam , Darai-Ramqvist Eva , Zedenius Jan , Höög Anders , Juhlin C. Christofer
Published: November 2019

Background

Follicular thyroid carcinoma (FTC) is a neoplasm that presents with a micro-follicular growth pattern and a neutrally stained cytoplasm. Seldom, FTCs display unusual morphological characteristics – but given the rarity of these histological subtypes, little is known regarding the underlying genetics and the coupling to patient outcome.

Case presentation

We present two extremely rare cases of minimally invasive FTC with signet ring cell morphology (SRC-FTC) and describe the cytological, microscopic, immunohistochemical and molecular features for both tumors. Both were male patients, age 71 and 51 respectively. The preoperative cytology for both cases could not pinpoint a clear-cut signet ring cell morphology, but a tendency towards nuclear marginalization was seen. The tumors were 38 mm and 22 mm respectively and displayed evident signet ring cell features in subsets of tumor cells as well as degenerative stromal changes. The tumor cells were positive for TTF1, PAX8 and thyroglobulin, and the proliferation indexes were 4% and 1,9% respectively. Both tumors displayed capsular invasion, but not lymphovascular invasion. The tumors were sequenced for mutations in the TERT promoter and 22 additional cancer-related genes, interestingly; one patient was shown to carry a deleterious intronic variant in PTEN, a tumor suppressor gene coupled to thyroid tumorigenesis and Cowden syndrome. Both patients are alive and well awaiting postoperative radioiodine treatment.

Conclusions

The SRC-FTCs described herein were small, TERT promoter wildtype tumors exhibiting low proliferation, thereby suggesting that these exceedingly rare lesions probably carry a favorable prognosis – although the scarce availability regarding descriptions of this tumor entity nevertheless might justify careful clinical monitoring and mandate investigations in larger case series.
Instantaneous and non-destructive relative water content estimation from deep learning applied to resonant ultrasonic spectra of plant leaves
Authors: Fariñas María Dolores , Jimenez-Carretero Daniel , Sancho-Knapik Domingo , Peguero-Pina José Javier , Gil-Pelegrín Eustaquio , Gómez Álvarez-Arenas Tomás
Published: November 2019

Background

Non-contact resonant ultrasound spectroscopy (NC-RUS) has been proven as a reliable technique for the dynamic determination of leaf water status. It has been already tested in more than 50 plant species. In parallel, relative water content (RWC) is highly used in the ecophysiological field to describe the degree of water saturation in plant leaves. Obtaining RWC implies a cumbersome and destructive process that can introduce artefacts and cannot be determined instantaneously.

Results

Here, we present a method for the estimation of RWC in plant leaves from non-contact resonant ultrasound spectroscopy (NC-RUS) data. This technique enables to collect transmission coefficient in a [0.15–1.6] MHz frequency range from plant leaves in a non-invasive, non-destructive and rapid way. Two different approaches for the proposed method are evaluated: convolutional neural networks (CNN) and random forest (RF). While CNN takes the entire ultrasonic spectra acquired from the leaves, RF only uses four relevant parameters resulted from the transmission coefficient data. Both methods were tested successfully in Viburnum tinus leaf samples with Pearson’s correlations between 0.92 and 0.84.

Conclusions

This study showed that the combination of NC-RUS technique with deep learning algorithms is a robust tool for the instantaneous, accurate and non-destructive determination of RWC in plant leaves.
Combined use of intravenous and topical tranexamic acid in patients aged over 70 years old undergoing total hip arthroplasty
Authors: Jia Junqing
Published: November 2019

Purpose

The present study was designed to evaluate the efficacy and safety of combined use of intravenous (IV) TXA administration and topical intraarticular tranexamic acid (TXA) strategy in patients aged over 70 undergoing total hip arthroplasty (THA).

Methods

One hundred eighty patients were randomized into three groups, including an IV group, a local group, and a combined group. Patients were administrated with 15 mg/kg of IV-TXA in the IV group, 2 g TXA in the topical group, or 15 mg/kg IV-TXA combined with 2 g TXA in the combined group. Total blood loss (TBL), maximum hemoglobin drop, the transfusion rate and the number of allogeneic blood units, and the incidence of deep venous thrombosis (DVT), and pulmonary embolism (PE) were recorded and analyzed.

Results

TBL was 757.75 ± 188.95 mL in the combined group, which was significantly lower than in the IV group (892.75 ± 218.47) or the topical group (1015.75 ± 288.71) (p = 0.015, p = 0.001 respectively). The mean values of maximum hemoglobin drop in the combined, IV, and topical groups were 2.67 ± 0.42, 3.28 ± 0.52, and 3.75 ± 0.62 g/dL, respectively, with a significant intergroup difference (p < 0.001 for all). PE was not detected within 1 month after the surgery. Asymptomatic DVT was reported in 1 patient of the IV group, and in 2 patients from the combined group, while the difference was not statistically significant.

Conclusions

Compared to intravenous or topical use of TXA, the combined therapy effectively decreased total blood loss and reduced the transfusion rate, simultaneously possessed the same degree of safety in primary THA patients aged over 70.
Successful management of cutaneous lymphangitis carcinomatosa arising from cervical cancer with paclitaxel-cisplatin and bevacizumab combination therapy: a case report and review of the literature
Authors: Nakamura Fumihiro , Seino Manabu , Suzuki Yuriko , Sakaki Hirotsugu , Sudo Takeshi , Ohta Tsuyoshi , Tsutsumi Seiji , Nagase Satoru
Published: November 2019

Background

Globally, cervical cancer is the fourth most common cancer in women. Here, we report a case of cutaneous lymphangitis carcinomatosa arising from cervical cancer, an extremely rare and treatment-resistant condition.

Case presentation

A 64-year-old Japanese woman presented with genital bleeding. She was diagnosed as having stage IB1 squamous cell cervical cancer and subsequently treated with radiotherapy. Approximately 2 years after the curative radiotherapy, she developed itching, skin rash, and small nodules on her left femoral and pubic area. Slight 18F-fluorodeoxyglucose uptake was detected at her left femoral skin on positron emission tomography with computed tomography. A histopathological examination was performed on a biopsy sample from an erythematous macule on her left femoral skin and vulva. Consequently, she was diagnosed as having cutaneous lymphangitis carcinomatosa arising from cervical cancer. Paclitaxel (135 mg/m2), cisplatin (50 mg/m2), and bevacizumab (15 mg/kg) combination therapy was administered every 21 days. Both itching and rash improved after three treatment cycles. After the completion of six cycles, skin erythema in the femoral and vulval area disappeared completely. Our patient experienced a 25-month symptom-free interval after the last chemotherapy session.

Conclusion

Our findings suggest that combination chemotherapy plus bevacizumab is an effective therapeutic option in patients with cutaneous lymphangitis carcinomatosa arising from cervical cancer.
Adult validation of a self-administered tablet audiometer
Authors: Bastianelli Mark , Mark Amy E. , McAfee Arran , Schramm David , Lefrançois Renée , Bromwich Matthew
Published: November 2019

Background

There is evidence to suggest that rates of hearing loss are increasing more rapidly than the capacity of traditional audiometry resources for screening. A novel innovation in tablet, self-administered portable audiometry has been proposed as a solution to this discordance. The primary objective of this study was to validate a tablet audiometer with adult patients in a clinical setting. Secondarily, word recognition with a tablet audiometer was compared against conventional audiometry.

Methods

Three distinct prospective adult cohorts underwent testing. In group 1 and group 2 testing with the automated tablet audiometer was compared to standard sound booth audiometry. In Group 1, participants’ pure tone thresholds were measured with an automated tablet audiometer in a quiet clinic exam room. In Group 2, participants completed monosyllabic word recognition testing using the NU-6 word lists. In Group 3, internal reliability was tested by having participants perform two automated tablet audiometric evaluation in sequence.

Results

Group 1 included 40 patients mean age was 54.7 ± 18.4 years old and 60% female; Group 2 included 44 participants mean age was 55.2 ± 14.8 years old and 68.2% female; Group 3 included 40 participants with mean age of 39.4 + 15.9 years old and 60.5% female. In Group 1, compared to standard audiometry, 95.7% (95% CI: 92.6–98.9%) of thresholds were within 10 dB. In Group 2, comparing word recognition results, 96.2% (95% CI: 89.5–98.7%) were clinically equivalent and within a critical difference range. In Group 3, One-way Intraclass Correlation for agreement for the both left- and right-ear pure tone average was 0.98. The mean difference between repeat assessments was 0 (SD = 2.1) in the left ear, and 0.1 (SD = 1.1) in the right ear.

Conclusion

Puretone audiometry and word recognition testing appears valid when performed by non-healthcare experts using a tablet audiometer outside a sound booth in a quiet environment.

Trial registration

ClinicalTrials.gov Identifier: NCT02761798. Registered April, 2016 < https://clinicaltrials.gov/ct2/show/NCT02761798>
Imaging of polar cap patches with a low-cost airglow camera: pilot observations in Svalbard, Norway
Authors: Hosokawa Keisuke , Ogawa Yasunobu , Taguchi Satoshi
Published: November 2019

We evaluate the capability of a low-cost all-sky imager (ASI), which has been operative in Longyearbyen (78.1° N, 15.5° E), Norway, to detect 630.0 nm airglow signatures of polar cap patches. The ASI is composed of a small camera, with a charge-coupled device (CCD), manufactured by Watec Co. Ltd., a fish-eye lens, and an optical filter whose central wavelength is 632.0 nm and full-width half maximum (FWHM) is 10 nm. In Longyearbyen, another ASI equipped with a cooled electron-multiplying charge-coupled device (EMCCD) camera has been operative for observations of polar cap patches. We compare the images from the two systems and investigate the performance of the low-cost ASI. On the night of December 4, 2013, a series of polar cap patches were observed by the EMCCD ASI. The low-cost ASI also detected regions of enhanced 630.0 nm airglow passing through the fields-of-view. The quality of the raw images from the low-cost ASI obtained every 4 s were visibly much worse than that of the EMCCD ASI. However, an integration of 7–15 consecutive images made it possible to capture the temporal evolution and spatial structure of the patches, for example, their anti-sunward propagation and finger-like structures along the trailing edge. The estimated values of the absolute optical intensity from the low-cost ASI were found to be consistent with those from the EMCCD ASI, whereby the offset was < 100 R. This offset can be explained by the contribution of the background continuum emission to the low-cost ASI images, because the band width of the optical filter used for the low-cost ASI is ~ 3 times wider than that used for the EMCCD ASI. The results indicate that the airglow measurement with the low-cost ASI is feasible even for quantitative studies of F-region phenomena such as the dynamics of polar cap patches.
Teachers’ beliefs about developmentally appropriate practices in Saudi Arabia
Authors: Alghamdi Ahlam A. , Ernest James M.
Published: November 2019

Since the first release of NAEYC’s guidelines, DAP has received a lot of attention from childhood professionals in the United States. Internationally, many countries have also shown a growing interest regarding DAP, yet interest in DAP is new to the Saudi educators. Thus, the purpose of this study was to explore preschool teachers’ subjective beliefs toward NAEYC’s guidelines of DAP in Saudi Arabia, one of the most conservative Middle Eastern countries. Q Methodology, as a mixed methods approach, was used to study 37 preschool teachers randomly selected from five preschools in Mecca city. The participants sorted 50 cards with examples of DAP and developmentally inappropriate practice (DIP) or “In Contrast” statements which represented perceived importance of the practice to the sorter. To analyze the data, a Principal Component Analysis (PCA) with Varimax rotation indicated four main components regarding the beliefs of Saudi preschool teachers as they relate to DAP’s guidelines. Each component represents a unique perspective (viewpoint) on how Saudi preschool teachers view DAP and contrasting items based on their subjective points of view. The four main perspectives that emerged from the analysis show a dominance consensus among perspectives that fit equitably within the DAP framework regarding the best practice of early childhood education. Findings from this study provide evidence that many aspects of developmentally appropriate practice can be appropriate in different cultures and countries.
The feasibility and impact of embedding pedagogical strategies targeting physical activity within undergraduate teacher education: Transform-Ed!
Authors: Lander Natalie , Koorts Harriet , Mazzoli Emiliano , Moncrieff Kate , Salmon Jo
Published: November 2019

Purpose

Low levels of physical activity and high levels of sedentary behaviour are pervasive, especially in schools. Pre-service teacher education is pivotal to school and educational reform but is an under-studied setting for physical activity and sedentary behaviour intervention research. The objective of this pilot study was to test the feasibility and potential impact of embedding evidence-based active pedagogy based on an adapted version ofTransform-Us!,Transform-Ed!in one core unit of an undergraduate teacher education degree.

Methods

Baseline and follow-up measures (i.e. surveys) were conducted with Bachelor of Education (Primary) pre-service teachers who received theTransform-Ed!intervention and academic educators who delivered the intervention. Focus groups of senior academics and telephone interviews with primary school principals examined perceptions of intervention feasibility and explored potential real-world relevance and impact of pre-service teachers training in active pedagogy.

Results

After 12 weeks, pre-service teachers (n = 218) were significantly more willing (pre–post changeΔ = 0.54, 95% CI [0.16, 0.91]), confident (Δ = 1.40, 95% CI [0.89, 1.91]) and competent (Δ = 2.39, 95% CI [1.85, 2.92]) to deliverTransform-Ed!, had more positive feelings about the impact of physical activity on student outcomes (Δ = 2.05, 95% CI [1.58, 2.52]), and perceived fewer barriers to integratingTransform-Ed!into current and future teaching (Δ = − 7.26, 95% CI [− 8.88, − 5.64]). Four major themes emerged from the focus groups (n = 9) and interviews (n = 5) around participant perceptions ofTransform-Ed!: (i) acceptability and appropriateness, (ii) need (tertiary level), (iii) need (primary level) and (iv) overcoming challenges.

Conclusion

TheTransform-Ed!pilot study demonstrated promising results across multiple participant levels, as it was perceived to be feasible, acceptable and appropriate by pre-service teachers, academics and school principals. The findings have direct implications for the progression ofTransform-Ed!from pilot to a future definitive trial.
Vehicle ergonomics contributing to a diabetic foot ulcer
Authors: Jarocki Christine , Schmidt Brian M. , Holmes Crystal Murray
Published: November 2019

Background

Diabetes mellitus continues to be a rising concern in the United States. It affects an estimated 9.4% of the population and approximately 1.5 million Americans are diagnosed annually. Approximately 85% of diabetic foot ulcers are associated with diabetic peripheral neuropathy and an infected diabetic foot ulcer is often the first sign of diabetes. There are countless studies within the literature that investigate how insensate feet and the manifestation of a foot ulcer further decrease quality of life and increase risk for mortality. Literature focuses on gait and kinematics that contribute to the formation of a diabetic foot ulcer. While pressure and shear forces are etiologic factors that may lead to the formation of diabetic foot ulcers, the position of the foot while driving an automobile has been ignored as a possible risk factor.

Case presentation

The clinical case will describe the events of healing a neuropathic diabetic foot ulcer beyond the standard of care treatment plan. It is one of the first case reports to describe vehicle ergonomics as an etiologic factor contributing to a diabetic foot ulcer. Once the patient becomes aware of the unnecessary source of pressure, education and care is provided to manage this likely source of daily pressure to the neuropathic foot.

Conclusion

The article emphasizes the importance of a complete assessment, including nontraditional factors, which may lead to diabetic complications.
Viscoacoustic reverse time migration of joint primaries and different-order multiples
Authors: Qu Yingming , Li Jinli , Guan Zhe , Li Zhenchun
Published: November 2019

Compared to primary arrivals, multiples have longer propagation paths and smaller reflection angles, leading to a wider illumination area in the horizontal direction and higher resolution in the vertical direction. Hence, it is better to make full use of the multiples rather than suppressing them. However, seismic attenuation exists widely in the subsurface medium, especially directly below the deep sea bottom. Therefore, to compensate for the attenuation effect during multiple imaging, we have developed a viscoacoustic reverse time migration (RTM) method of different-order multiples. Following the multiple propagation paths, we compensate for the attenuation during source wavefield forward propagation and receiver backward propagation, and we introduce a regularization operator to automatically eliminate the exponential high-frequency noise during the attenuation compensation process. Taking advantage of the full wavefield information, we jointly use the different-order multiples and primaries when implementing viscoacoustic RTM. In numerical examples, we validate the viscoacoustic RTM of different-order multiples in a three-layer attenuation model and an attenuating Sigsbee2B model. Our results suggest that our method can image the models using different-order multiples separately, which suppresses crosstalk artifacts, balances energy, raises resolution, and improves subsalt images dramatically.
Testicular Ultrasound to Stratify Hormone References in a Cross-Sectional Norwegian Study of Male Puberty
Authors: Madsen André , Oehme Ninnie B , Roelants Mathieu , Bruserud Ingvild S , Eide Geir Egil , Viste Kristin , Bjerknes Robert , Almås Bjørg , Rosendahl Karen , Sagen Jørn V , Mellgren Gunnar , Juliusson Petur B
Published: November 2019

Context

Testicular growth represents the best clinical variable to evaluate male puberty, but current pediatric hormone references are based on chronological age and subjective assessments of discrete puberty development stages. Determination of testicular volume (TV) by ultrasound provides a novel approach to assess puberty progression and stratify hormone reference intervals.

Objective

The objective of this article is to establish references for serum testosterone and key hormones of the male pituitary-gonadal signaling pathway in relation to TV determined by ultrasound.

Design, Setting, and Participants

Blood samples from 414 healthy Norwegian boys between ages 6 and 16 years were included from the cross-sectional “Bergen Growth Study 2.” Participants underwent testicular ultrasound and clinical assessments, and serum samples were analyzed by liquid chromatography tandem–mass spectrometry and immunoassays.

Main Outcome Measures

We present references for circulating levels of total testosterone, luteinizing hormone, follicle-stimulating hormone, and sex hormone–binding globulin in relation to TV, chronological age, and Tanner pubic hair stages.

Results

In pubertal boys, TV accounted for more variance in serum testosterone levels than chronological age (Spearman r = 0.753, P < .001 vs r = 0.692, P < .001, respectively). Continuous centile references demonstrate the association between TV and hormone levels during puberty. Hormone reference intervals were stratified by TV during the pubertal transition.

Conclusions

Objective ultrasound assessments of TV and stratification of hormone references increase the diagnostic value of traditional references based on chronological age or subjective staging of male puberty.
Is an analytical dose engine sufficient for intensity modulated proton therapy in lung cancer?
Authors: Teoh Suliana , Fiorini Francesca , George Ben , Vallis Katherine A , Van den Heuvel Frank
Published: November 2019

Objective:

To identify a subgroup of lung cancer plans where the analytical dose calculation (ADC) algorithm may be clinically acceptable compared to Monte Carlo (MC) dose calculation in intensity modulated proton therapy (IMPT).

Methods:

Robust-optimised IMPT plans were generated for 20 patients to a dose of 70 Gy (relative biological effectiveness) in 35 fractions in Raystation. For each case, four plans were generated: three with ADC optimisation using the pencil beam (PB) algorithm followed by a final dose calculation with the following algorithms: PB (PB-PB), MC (PB-MC) and MC normalised to prescription dose (PB-MC scaled). A fourth plan was generated where MC optimisation and final dose calculation was performed (MC-MC). Dose comparison and γ analysis (PB-PB vs PB-MC) at two dose thresholds were performed: 20% (D20) and 99% (D99) with PB-PB plans as reference.

Results:

Overestimation of the dose to 99% and mean dose of the clinical target volume was observed in all PB-MC compared to PB-PB plans (median: 3.7 Gy(RBE) (5%) (range: 2.3 to 6.9 Gy(RBE)) and 1.8 Gy(RBE) (3%) (0.5 to 4.6 Gy(RBE))). PB-MC scaled plans resulted in significantly higher CTVD2 compared to PB-PB (median difference: −4 Gy(RBE) (−6%) (-5.3 to −2.4 Gy(RBE)), p ≤ .001). The overall median γ pass rates (3%–3 mm) at D20 and D99 were 93.2% (range:62.2–97.5%) and 71.3 (15.4–92.0%). On multivariate analysis, presence of mediastinal disease and absence of range shifters were significantly associated with high γ pass rates. Median D20 and D99 pass rates with these predictors were 96.0% (95.3–97.5%) and 85.4% (75.1–92.0%). MC-MC achieved similar target coverage and doses to OAR compared to PB-PB plans.

Conclusion:

In the presence of mediastinal involvement and absence of range shifters Raystation ADC may be clinically acceptable in lung IMPT. Otherwise, MC algorithm would be recommended to ensure accuracy of treatment plans.

Advances in knowledge:

Although MC algorithm is more accurate compared to ADC in lung IMPT, ADC may be clinically acceptable where there is mediastinal involvement and absence of range shifters.
Image-stitching artefacts and distortion in CCD-based cephalograms and their association with sensor type and head movement: ex vivo study
Authors: Svystun Olesya , Wenzel Ann , Schropp Lars , Spin-Neto Rubens
Published: November 2019

Objectives:

To assess presence and severity of image-stitching artefacts and distortion in lateral cephalograms acquired by CCD-based sensors and their association with movement.

Methods:

A human skull was mounted on a robot simulating five head movement types (anteroposterior translation/lifting/nodding/lateral rotation/tremor), at three distances (0.75/1.5/3 mm), based on two patterns (skull returning/not returning to the initial position, except for tremor). Three cephalometric units, two ProMax-2D (Planmeca Oy, Finland), one with Dimax-3 (D-3) and one with Dimax-4 (D-4) sensor, and one Orthophos-SL (ORT, Dentsply-Sirona, Germany), acquired cephalograms during the predetermined movements, in duplicate (54 with movement and 28 controls with no movement per unit). One observer assessed the presence of an image-stitching line (none/thin/thin with vertical stripes or thick), misalignment between the anatomical structure display (none/<1/1–3/>3 mm), and distortion in each image quadrant (present/absent), in duplicate. Severe image-stitching artefacts were defined for images scored with a thin line with vertical stripes or thick line and/or misalignment between anatomical structure display ≥1 mm. Severe distortion was defined for images scored with distortion in both anterior quadrants of the skull. κ-statistics provided intraobserver agreement.

Results:

Intraobserver reproducibility was >0.8 (all assessed parameters). Severe image-stitching artefacts were scored in 70.4 and 18.5% of D-3 and D-4 movement images, respectively. Severe distortion was scored in 64.8% of D-3, 5.6% of D-4 and 37% of ORT movement images. Neither severe image-stitching artefacts nor severe distortion were observed in control images.

Conclusion:

Sensor type, movement type, distance and pattern affected presence and severity of image-stitching artefacts and distortion in CCD-based cephalograms.
The Analytic Model of Consent and The Square of Opposition
Authors: Papageorgiou Konstantinos
Published: November 2019

Modelling consent is a process prior to any discussion about it, be it theoretical or practical. Here, after examining consent, I shall attempt to present a “logical generator” that produces all different cases of consent (and/or of non-consent), so that afterwards we may articulate a two-dimensional model which will enable us to coherently demonstrate all possible types of consent. The resulting model will be combined with Aristotle’s square of opposition, offering us even greater insight.  I shall claim that full(y) informed consent is an archetype, not realized in most cases; it is just one case out of hundreds more. I shall conclude with an educational model for consent, the principle of specificity, arguing that if we wish to both understanding consent and become more adept in exercising it, we need a targeted educational system – not just “better education” in general.
The Concept of Political Difference in Oliver Marchart and its Relationship with the Heideggerian Concept of Ontological Difference
Authors: Efthimiou Christoforos
Published: November 2019

The concept of political difference concerns the distinction between politics and the political. The political refers to the ontological making possible of the different domains of society, including the domain of politics in the narrow sense. Political difference was introduced as a reaction to the theoretical controversy between foundationalism and anti-foundationalism. This reaction took the form of post-foundationalism. According to Marchart, post-foundationalism does not entirely deny the possibility of grounding. It denies only the possibility of an ultimate transcendent foundation insofar as this ontological impossibility makes possible the historical and contingent grounds in plural.The Heideggerian concept of ontological difference also undermines the possibility of an ultimate ontical ground which establishes the presence of all the other beings. If one wants to think beyond the concept of ground, one should obtain a clear understanding of Being as Being, namely one should grasp the Being in its difference from beings. All the same, Heidegger tends to replace the ontical grounds of metaphysics with Being itself as a new kind of ultimate ontological foundation.On the other hand, one can detect in many points of Heideggerian argumentation traces of a second alternative understanding of ontological difference which does not belong in Heidegger’s intentions and which undermines the primordiality of Being. This alternative understanding establishes a reciprocity between Being and beings. In our view, political difference not only is based in this second way of understanding but, at the same time, develops more decisively the mutual interdependence between Being and beings.In political difference the grounding part, namely the political, possesses both a grounding character and a derivative one. Politics and political both grounds and dislocate each other in an incessant and oscillating, historical procedure which undermines any form of completion of the social.
The Impacts of Using Pictures for Teaching Vocabulary to the Seventh Grade Students of SMP N 2 Imogiri in Academic Year 2018/2019
Authors: Khafidhoh Khafidhoh
Published: November 2019

The research objective is to investigate the impact of using pictures for teaching vocabulary. The research belongs to experimental study. The study population was seventh-grade students of SMP N 2 Imogiri. While two groups or classes of the population as the sample, they are experimental and control group. The data collection technique used was pre-test and post-test. The research findings were the impacts of using pictures, and the pre-test and post-test mean score. First, the impacts of using pictures can improve the students' score, besides it also can draw the students' attention, and students enjoyed and want to participate in the instructional process. Second, the pre-test mean score of the experimental group was 63.04 and the control group was 70. While the post-test mean score of both groups had increased, the mean score of the experimental group was 90.54, and the control group was 84.29. The result of t-test indicated that there is a significant difference in students' vocabulary achievement between both groups. Then, the Sig. (2-tailed) was 0.009 which is lower than 0.05 (0.009<0.05). Thus, the Ha of the hypothesis was accepted. It can be concluded that there is a significant difference in students’ vocabulary achievement of students between both groups.
An Exploration of English Students’ Attitude toward Learning English
Authors: Zulfikar Teuku , Dahliana Syarifah , Sari Riska Amelia
Published: November 2019

Attitude is one of the success factors in language learning. It includes students’ feelings, beliefs, and behavior tendencies. This study is conducted using the mixed-method research  exploring English Department students’ attitude on learning English. The main focus of the study is to discover students’ belief on English, to understand students’ attitude, feeling and behavior on learning English. The data were collected through questionnaire and semi-structured interview. The participants of the reseach were fifty five students selected randomly to fill in the questionnaire. However, only six students were selected purposively to gain data more in-depth through interview. The results indicate that English department students show positive attitude in three points of cognitive aspect; the students’ reason for learning English, the students’ level of English competeent, and the students’ thinking toward learning English which they consider that English is important.  Moreover, the students have positive in four points of emotional attitude; the students’ interesting in learning English, the students’ feeling in learning English, the students’ preference in learning English, and the students’ enjoyment in learning English which the students show good feeling in learning English. Furthermore, the students have positive in three points of behavioral attitude; the students’ attention during learning English, students’ participation in the English which the students act posively during learning English. In other words, English Department students were found to have positive attitudes toward learning English.
The diagnostic accuracy of the faecal immunochemical test for colorectal cancer in risk-stratified symptomatic patients
Authors: D’Souza N , Hicks G , Benton SC , Abulafi M
Published: November 2019

Introduction

The faecal immunochemical test detects blood in the faeces, reporting faecal haemoglobin quantitatively in micrograms of haemoglobin per gram of faeces. The aim of this pilot study was to determine the feasibility of using the faecal immunochemical test as a rule-out test in symptomatic patients at low and high risk of colorectal cancer.

Material and methods

Between November 2016 and October 2017, consecutive symptomatic patients within a multicultural part of London were recruited to perform a faecal immunochemical test prior to colonoscopy. Analysis was performed on the HM-JACKarc analyser.

Results

Faecal immunochemical test samples were returned by 298 patients who underwent colonoscopy. There was no significant variation in faecal haemoglobin levels by age, sex, ethnicity or deprivation. The overall detection rate for colorectal cancer was 100% at 2 µg/g and 92% at 10 µg/g. If a faecal haemoglobin threshold for investigation of 2 µg/g (ie detectable) or 10 µg/g had been employed, the number of colonoscopies would have been reduced by 70% and 84%, respectively, in all symptomatic patients. For low-risk patients, the sensitivity of the faecal immunochemical test for colorectal cancer at both thresholds of 2 µg/g or 10 µg/g remained 100%, with the number of colonoscopies reduced by 80% and 91%, respectively.

Conclusion

This study shows that the faecal immunochemical test is a promising technology that detected colorectal cancer in all high- or low-risk symptomatic patients in our cohort at a threshold of detectable faecal haemoglobin. Data from adequately powered cohort studies will elucidate the true diagnostic accuracy of the test and the rate and patterns of undetected colorectal cancer.
The ultimate definition of marketing
Authors: Godwin Lynn R
Published: November 2019

An examination of the overly changed definition of marketing is provided. A rationale for the cessation of future such changes is proposed, although not validated empirically. Finally, the most ultimate parsimonious, least wordy, simplistic, most basic, generalisable, utilitarian, non-obsolete-becoming
definition of marketing (or anything remotely marketing-like) in the history of business and the world in general is modestly proposed.
Corporate brand identity and employee brand citizenship behaviour: A conceptual framework
Authors: Gilani Hasan
Published: November 2019

This research paper aims to explore and identify the impact of corporate identity on brand citizenship behaviour within retail organisations. The study analyses the influence of corporate identity of an organisation, and more particularly on the employees' desire to engage in brand
supporting behaviours. Relationships were identified between corporate identity, internal communication and composites of employee perception of corporate identity - resulting as determining influences on employee behaviour intentions. These relationships are presented as a conceptual model
that depicts the influence of corporate identity on employee brand citizenship behaviours. The study makes contributions to the employee branding, services marketing, and organisational citizenship literature, but its main contribution is to extend the corporate identity literature into a
new area of employee behaviour through internal communication.