bluuebunny/crossref_metadata_2025 huggingface dataset:
Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study
Authors: Al-Mughales Jamil A. , Alahwal Mahmood Shaheen
Published: November 2020

Objectives:

This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use.

Methods:

A retrospective review of patients’ electronic records was conducted over a 3-year period (2015–2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution.

Results:

A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year.

Conclusion:

Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.
Maintenance policy structure investigation and optimisation of a complex production system with intermediate buffers
Authors: Zhou Yifan , Yuan Chao , Lin Tian Ran , Ma Lin
Published: November 2020

Existing research about the maintenance optimisation of production systems with intermediate buffers largely assumed a series system structure. However, practical production systems often contain subsystems of ring structures, for example, rework and feedforward. The maintenance optimisation of these complex systems is difficult due to the complicated structure of maintenance policies and the large search space for optimisation. This paper proves the control limit property of the optimal condition-based maintenance policy. Based on the control limit property, approximate policy structures that incur a smaller policy space are proposed. Because the state space of a production system is often large, the objective function of the maintenance optimisation cannot be evaluated analytically. Consequently, a stochastic branch and bound (SB&B) algorithm embedding a sequential simulation procedure is proposed to determine a cost-efficient condition-based maintenance policy. Numerical studies show that the proposed maintenance policy structures can deliver a cost-efficient maintenance policy, and the performance of the SB&B algorithm is enhanced by the inclusion of a sequential simulation procedure.
Cellular and molecular mechanisms of IMMunE dysfunction and Recovery from SEpsis-related critical illness in adults: An observational cohort study (IMMERSE) protocol paper
Authors: Fish Matthew , Arkless Kate , Jennings Aislinn , Wilson Julie , Carter Michael J , Arbane Gill , Campos Sara , Novellas Neus , Wester Rianne , Petrov Nedyalko , Niazi Umar , Sanderson Barney , Ellis Richard , Saqi Mansoor , Spencer Jo , Singer Mervyn , Martinez-Nunez Rocio T , Pitchford Simon , Swanson Chad M , Shankar-Hari Manu
Published: November 2020

Sepsis is a common illness. Immune responses are considered major drivers of sepsis illness and outcomes. However, there are no proven immunomodulator therapies in sepsis. We hypothesised that in-depth characterisation of sepsis-specific immune trajectory may inform immunomodulation in sepsis-related critical illness. We describe the protocol of the IMMERSE study to address this hypothesis. We include critically ill sepsis patients without documented immune comorbidity and age–sex matched cardiac surgical patients as controls. We plan to perform an in-depth biological characterisation of innate and adaptive immune systems, platelet function, humoral components and transcriptional determinants of the immune system responses in sepsis. This will be done at pre-specified time points during their critical illness to generate an illness trajectory. The sample size for each biological assessment is different and is described in detail. In summary, the overall aim of the IMMERSE study is to increase the granularity of longitudinal immunology model of sepsis to inform future immunomodulation trials.
Positive role of continuous positive airway pressure for intensive care unit patients with severe hypoxaemic respiratory failure due to COVID-19 pneumonia: A single centre experience
Authors: Wozniak Dariusz R , Rubino Antonio , Tan Aileen LW , Jones Nicola L , Webb Stephen T , Vuylsteke Alain , Palas Earl , Quinnell Timothy G , Smith Ian E , Davies Michael G
Published: November 2020

Objectives

Continuous positive airway pressure (CPAP) may be a useful treatment strategy for patients with severe COVID-19 pneumonia but its effectiveness in preventing mechanical ventilation is unknown. We aimed to evaluate the outcomes of COVID-19 patients treated with CPAP and determine predictors of CPAP response.

Design

This was a retrospective observational cohort study.

Setting

The study took place in the intensive care unit (ICU) at Royal Papworth Hospital (RPH) in Cambridge, UK.

Patients

We included all consecutive patients with confirmed COVID-19 pneumonia who were transferred from neighbouring hospitals between 14th March and 6th May, 2020 for consideration of ventilatory support.

Intervention

We instituted the use of CPAP for all patients who arrived in RPH not intubated and were not making satisfactory progress on supplemental oxygen alone.

Measurements and main results

Of 33 self-ventilating patients included in this study, 22 (66.7%) were male and the mean age was 54 ± 13.23 patients received CPAP. They were more hypoxaemic than those treated with oxygen alone (PaO2/FiO2 ratio; 84.3 ± 19.0 vs 170.0 ± 46.0 mmHg, p = 0.001). There was a significant improvement in PaO2/FiO2 ratio 1–2 hours after CPAP initiation (167.4 ± 49.0 from 84.3 ± 19.0 mmHg, p = 0.001). 14 (61%) patients responded to CPAP and 9 required intubation. There was no difference between these two groups in terms of the severity of baseline hypoxaemia (PaO2/FiO2 ratio; 84.5 ± 16.0 vs 83.9 ± 23.0 mmHg, p = 0.94) but CPAP responders had significantly lower C-reactive protein (CRP) (176 ± 83 vs 274 ± 63 mg/L, p = 0.007), interleukin-6 (IL-6) (30 ± 47 vs 139 ± 148 pg/mL, p = 0.037), and D-dimer (321 ± 267 vs 941 + 1990 ng/mL, p = 0.003). CT pulmonary angiogram was performed in 6 out of 9 intubated patients and demonstrated pulmonary emboli in 5 of them. All patients were discharged from ICU and there were no fatalities.

Conclusions

In this cohort, CPAP was an effective treatment modality to improve hypoxaemia and prevent invasive ventilation in a substantial proportion of patients with severe respiratory failure. Accepting the small sample size, we also found raised biomarkers of inflammation (CRP and IL-6) and coagulopathy (D-Dimer) to be more useful predictors of CPAP responsiveness than the severity of hypoxaemia, and could help to guide intubation decisions in this clinical setting.
Challenging the dogma: anterior transposition of the ulnar nerve is indicated in recurrent cubital tunnel syndrome
Authors: Ruettermann Mike
Published: November 2020

The current evidence for treatment of primary idiopathic cubital tunnel syndrome favours an in situ release. However, anterior transposition of the ulnar nerve remains a popular procedure in recurrent cubital tunnel syndrome. For more than 20 years, I have performed an extended in situ release only, and achieved similar or better results than with nerve transposition. In performing a systematic review of the evidence for surgery for recurrent cubital tunnel syndrome, I could only include 16 out of 296 studies regarding treatment of recurrent cases of cubital tunnel syndrome. A meta-analysis was not possible, due to selection bias and disparity of outcome measurements of the studies. However, I could not find robust evidence that supports the need of an anterior transposition of the ulnar nerve in recurrent cubital tunnel syndrome over an in situ decompression. My own experience of an extended in situ release with complete neurolysis with reasonable outcomes, in combination with the lack of literature support of anterior transposition in recurrent cases, have led me to the consideration that this dogma should be revised.
Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis
Authors: Yeh Jen-Hao , Huang Ru-Yi , Lee Ching-Tai , Lin Chih-Wen , Hsu Ming-Hung , Wu Tsung-Chin , Hsiao Po-Jen , Wang Wen-Lun
Published: November 2020

Aim:

The aim of this study was to investigate the long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cancer.

Methods:

A literature search was conducted using PubMed, ProQuest and Cochrane Library databases. Primary outcomes were overall survival, disease-specific survival and recurrence-free survival at 5 years. Secondary outcomes included adverse events, recurrence and metastasis. Hazard ratios were calculated based on time to events for survival analysis, and odds radios were used to compare discrete variables.

Results:

A total of 3796 patients in 21 retrospective studies, including 5 comparative studies for ESD and esophagectomy were enrolled. The invasion depth was 52.0% for M1–M2, 43.2% for M3–SM1 and 4.7% for SM2 or deeper. The 5-year survival rate was: overall survival 87.3%, disease-specific survival 97.7%, and recurrence-free survival 85.1%, respectively. Pooled local recurrence of ESD was 1.8% and metastasis was 3.3%. In terms of the comparison between ESD and esophagectomy, there was no difference in the overall survival (86.4% versus 81.8%, hazard ratio = 0.66, 95% CI = 0.39–1.11) as well as disease-specific and recurrence-free survival. In addition, ESD was associated with fewer adverse events (19.8 % versus 44.0%, odds ratio = 0.3, 95% CI = 0.23–0.39).

Conclusions:

For superficial esophageal squamous cancer, ESD may be considered as the primary treatment of for mucosal lesions, and additional treatment should be available for submucosal invasive cancers.
An operating room audit to examine for patterns of staff entry/exit: pattern sequencing as a method of traffic reduction
Authors: Anderson Rachel L , Lipps Jodi A , Pritchard Carrie L , Venkatachalam Aardhra M , Olson DaiWai M
Published: November 2020

Background:

Surgical site infections (SSIs) are estimated at over 16,000 annually and cost hospitals an estimated $1.6 billion per year. Therefore, most operating rooms (ORs) seek methods to reduce the risk of SSI, especially during the intraoperative period. Prior work has established a link between excess traffic through the OR and increased microbial counts, which create a higher risk for SSIs.

Aim/Objectives:

To identify patterns of staff entry into the OR to further reduce the risk of SSIs after total joint arthroplasties.

Methods:

Researchers directly observed 31 total joint arthroplasties, recording every instance the door to the OR suite opened and the personnel, reason for opening and timing during surgical incision. Researchers then utilised the sequential data analysis to search for patterns.

Results:

Despite expected patterns in staff movement during the patterned surgery, researchers found no significant patterns to staff movement during total joint arthroplasty.

Discussion:

This study’s results suggest purposeful education targeted to circulating registered nurses could induce purposeful creation of traffic flow patterns to further decrease traffic and risk of SSI.

Conclusion:

There is no singular pattern to entering and exiting the OR during surgery. Thus, a single-solution approach is not recommended.
The convergence of water, electricity and gas industries: Implications for PPP design and regulation
Authors: Phang Sock-Yong
Published: November 2020

In several countries that have privatised their utilities, power and water are separate industries regulated by sector-specific regulators. In a parallel development, desalination has become an important source of water supply in countries where there is a shortage of cheap and clean freshwater. Where the energy source is gas, the use of gas-fired power plants to supply electricity for desalination links the water, electricity and gas industries. We use the case of the financial collapse of an integrated water and power project to illustrate the problems that can arise from such convergence, and to draw lessons for firms, Public-Private Partnerships (PPPs) and regulators. A water company had successfully tendered to build a desalination plant for a water agency that would deliver an agreed volume of water per day for a 25-year period. The technology proposed was an integrated on-site power plant to supply electricity to the desalination plant as well as to the electricity grid. The business model was for profits from electricity sales to cross-subsidise water desalination costs. However, a combination of take-or-pay LNG contracts and low spot prices in a competitive electricity market led to deep operating losses. The reasons for the collapse of the business were neither technological nor operational but arose from failure to adequately manage the market risks arising from infrastructure convergence, competition, long-term rigid contractual arrangements and missing markets. The case highlights the importance of risk assessment at bidding stage and, in particular, the risks that a cross-subsidy can create. Viewed in this context, our recommendations are for regulatory convergence for converging infrastructure sectors, multi-sector risk assessments for PPP contracts, crafting flexible PPP contracts in anticipation of future adjustments, development of more liquid hedging markets and promoting competition where feasible in infrastructure sectors.
Underrepresentation in Gifted Education in the Context of Rurality and Socioeconomic Status
Authors: Hodges Jaret , Gentry Marcia
Published: November 2020

Proportional identification of students for gifted services in Florida school districts is an important goal. A multi-level model was used to analyze school district data from the Florida Department of Education from the 2011–2016 academic years. Results from the study indicate that the likelihood of identification of students varied by their socioeconomic status. Students who were Black were 59% more likely to be identified for gifted services if they participated in federal meal subsidy programs. However, the likelihood of identification for students who are Latinx or Native American decreased by 47% and 38%, respectively, when compared with peers who did not participate in federal meal subsidy programs.
Stereoselective Synthesis of Spiroacetal Domain Derivatives of the Plant Glycoside Ranuncoside and of Okadaic Acid and Dinophysistoxins-1 and 2 From Marine Algae
Authors: Cuny Eckehard
Published: November 2020

Spiroacetals constitute the central structural core element of numerous natural products and are mostly represented as bicyclic or tricyclic domains. Typical natural products with tricyclic spiroacetals are (+)-ranuncoside 1, a glycoside isolated from plants of the Ranuncalaceae family, and the algal toxins (+)-okadaic acid 2 and the (+)-dinophysistoxins-1 and 2 (3 and 4). These substances possess a spiro furan-dioxane-pyran ring system 5 and a spiro furan-pyran-pyran scaffold 6, which are both essential for biological activity. Corresponding analogs with spiro furan-dioxane-cyclohexane framework 7 or ( ent)-7 have so far neither been found in living organisms nor been synthesized. To close this gap and to generate candidates for structure-activity relationship studies which could lead to the discovery of novel antibiotics and selective anticancer agents, we have developed an efficient and stereocontrolled synthetic route to analogous domains of the above natural products. Pyran-dioxane-cyclohexane tricycles 12, 17, and 25 were used as starting materials and, via ring contraction, yielded the 2 derivatives 16 and 29, with spiro ( R)- and spiro ( S)-configuration and tricyclic ring system 7 and ( ent)-7, respectively. The stereochemistry and conformation of all novel products were solved by nuclear magnetic resonance spectroscopy.
Sodium Houttuyfonate and Sodium New Houttuyfonate Affect the Composition of Gut Microbiota and Production of Inflammatory Factors in Mice
Authors: Yan Guiming , Si Yuanqing , Shao Jing , Wang Tianming , Wang Changzhong , Wu Daqiang
Published: November 2020

Houttuynia drugs, including sodium houttuyfonate (SH) and sodium new houttuyfonate (SNH), are derivatives of the active ingredient of Houttuynia cordata, which can be used as both a vegetable and medicine in China. We aimed to explore the regulation effects of SH and SNH on the gut microbiota and production of inflammatory factors in mice. Here, we found that SH and SNH led to an increase in the production of interferon gamma and nuclear factor κ, and decreased the production of lipocalin-2 in the mice. The alpha diversity results of gut microbiota of the mice showed that the gut microbiota of the SH, SNH, and azithromycin treatment groups were significantly different from the control group, but the effects of reduced abundance and diversity of the SH and SNH groups were relatively lower than that of the azithromycin group. The beta diversity results indicated that the samples of each group were significantly grouped, and distribution of SH and SNH groups was more similar to the control group than the azithromycin group. Furthermore, SH and SNH groups had significant differences in the abundance of specific bacteria such as Escherichia–Shigella and Odoribacter, which might be associated with the increase of inflammatory factors. Therefore, our results suggested that SH and SNH may significantly affect the gut microbiota and production of inflammatory factors in the mice.
Early Catastrophic Failure of a Synthetic Cartilage Implant for Hallux Rigidus
Authors: Reddy Sudheer C.
Published: November 2020

Hallux rigidus is a common arthritic disorder of the foot. Surgical treatments are varied, from isolated cheilectomy to arthrodesis. A synthetic cartilage implant has been embraced recently as a joint-sparing alternative to arthrodesis, with good early and midterm outcomes. However, early clinical failures have been described relating to implant subsidence. This case report focuses on another mode of failure consisting of early catastrophic wear resulting in conversion to a lengthening arthrodesis at short-term follow-up.

Levels of Evidence: Level V
Self-Reported Pain Tolerance and Opioid Pain Medication Use After Foot and Ankle Surgery
Authors: Sokil Laura E. , Rogero Ryan G. , McDonald Elizabeth L. , Corr Daniel , Fuchs Daniel , Winters Brian S. , Pedowitz David I. , Daniel Joseph N. , Raikin Steven M. , Shakked Rachel J.
Published: November 2020

Background:

Orthopaedic surgeons must consider their postoperative pain management strategies to minimize harm from prescription opioid use. Patients often reference their pain threshold to predict how they will tolerate surgical pain and the need for postoperative analgesia, but the direct relationship between these factors has not yet been studied. The purpose of this study was to determine the relationship between patients’ self-reported pain tolerance and prescription opioid usage after foot and ankle surgery.

Methods:

This is a retrospective follow-up of a prospective cohort study of adult patients who underwent outpatient foot and ankle surgeries. Patient and procedural demographics, opioid pills dispensed, and opioid pills consumed by the first postoperative visit were obtained. Patients were contacted at a mean of 13.1 ± 4.0 months postoperatively and asked to respond to the qualitative statement “Pain doesn’t bother me as much as it does most people.” Patients were also asked their quantitative pain threshold (0-100), with 0 being “very pain intolerant” and 100 being a “very high pain tolerance,” as well other questions regarding past surgical and narcotic consumption history.

Results:

Of the 700 survey respondents, the average age was 50.9 years and 34.7% were male. Bivariate analysis determined that predictors of lower postoperative opioid consumption included higher quantitative ( P = .047) and qualitative ( P = .005) pain tolerance scores. Multivariate analysis for the entire cohort demonstrated that higher qualitative pain threshold was associated with lower postoperative opioid consumption ( P = .005) but this did not meet statistical significance as an independent predictor of the top quartile of pill consumers.

Conclusion:

Assessment of both qualitative and quantitative score of patients’ pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control. Additionally, asking this question can create an opportunity for educating patients regarding responsible utilization of narcotic medication.

Levels of Evidence:

Level III
Preparation and In Vitro Analysis of Craniofacial Titanium Implants Surfaces Produced by Additive 3D Printing and Conventional Manufacturing
Authors: Hatamleh Muhanad M.
Published: November 2020

Study Design:

Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol.

Objectives:

This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium implants following non-contact 3D laser profile-meter analysis.

Methods:

Seven groups of titanium specimens (n = 10) were prepared and their surfaces were treated differently and included sole or combined treatment of mechanical polishing, gritting with 50 micron AL2O3, cold acid treatment using nitric acid for 20 hours (70% w/w), etching using acidic solution (69% nitric and 48% hydrofluoric acids) for 10 minutes and then electro-chemically anodized in another acidic solution (85% orthophosphoric and 98%sulphuric acid). Eighth group included specimens that were 3D printed. 3D micro-roughness parameters Sa, Sp, Sv, and Sz were determined (μm) for each specimen. Data was analyzed using one way ANOVA and Dunett T3 post-hoc tests (p < 0.05).

Results:

There were statistically significant effects of surface finishing protocols (p < 0.05). Sa values were 2.72-13.75 and specimens which were electroplated or mechanically polished and acid treated were the smoothest (p < 0.05). Sp was in the range 9.07-43.56 as sandblasting significantly roughened surfaces (p < 0.05). The same inferior effect was evident for the Sv (p < 0.05). The Sz values were 19.46-107.05 and was the highest for sandblasted surfaces (p < 0.05) and the lowest for surfaces of electro-chemical treatment (p < 0.05).

Conclusion:

Titanium surfaces are affected by the finishing procedure and electro-chemical treatment or mechanical polishing combined with acid treatment produced clinically-favorable smooth surfaces.
Effects of Omalizumab Treatment in Patients With Recalcitrant Nasal Polyposis and Mild Asthma: A Multicenter Retrospective Study
Authors: Armengot-Carceller Miguel , Gómez-Gómez María José , García-Navalón Carmen , Doménech-Campos Encarna , Muñoz-Fernández Noelia , Miguel Ainhoa García-Lliberós de , Marco-Algarra Jaime , Palop-Cervera Marta , Piñero Alfonso García
Published: November 2020

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a clinical entity with specific features that impacts significantly on patient quality of life (QoL). CRSwNP is often associated with asthma and is difficult to control and manage despite pharmacological and/or surgical treatment. Omalizumab, a monoclonal anti-IgE antibody, has emerged as a putative therapeutic option.

Objective

To evaluate the effects of omalizumab on nasal polyp (NP) size and QoL assessed by Sino-Nasal Outcome Test-22 (SNOT-22) in patients with recalcitrant CRSwNP and mild asthma.

Methods

A multicenter retrospective analysis of patient data from the Community of Valencia (Spain) was performed. Adult patients with recalcitrant CRSwNP and comorbid mild asthma receiving compassionate use of omalizumab were included. NP size measured by total nasal endoscopic polyp score (TPS) and QoL evaluated through the SNOT-22 questionnaire were assessed at baseline and monthly over 12 months. An ordinal regression model was built to analyze the results.

Results

A total of 23 CRSwNP patients with a mean age (± SD) of 54.78 ± 9.46 years were included. Nineteen suffered from aspirin-exacerbated respiratory disease (AERD). In all patients, a significant and sustained reduction in TPS was observed over time, accompanied by improvements in QoL reflected in lower SNOT-22 scores. In the ordinal regression model, time but not total IgE, age or tissue eosinophilia impacted on NP size and SNOT-22 outcomes. Additionally, improvements in QoL were not explained by reductions in the size of polyps.

Conclusion

Omalizumab was effective for the treatment of patients with recalcitrant CRSwNP and mild asthma, even when AERD was present, by reducing NP size and improving QoL; treatment time was a key factor. SNOT-22 improvements were not explained by decreases in TPS, indicating that omalizumab may be effective in all patients, regardless of polyp size.
Who influences employees’ dark side: A multi-foci meta-analysis of counterproductive workplace behaviors
Authors: Liao Eko Yi , Wang Amy Yamei , Zhang Cheryl Qianru
Published: November 2020

We adopt a multi-foci perspective to provide a theory-driven quantitative review of employee counterproductive workplace behaviors (CWBs) by meta-analyzing the relationships between CWB and four groups of antecedents. Specifically, CWB antecedents stemming from four sources—supervisors, organization, coworkers, and private life—were included to investigate differences in their relationships with employee CWB. Based on the Conservation of Resources Theory, we argue that favorable and unfavorable correlates relate to employee CWB to different degrees. The meta-analysis included 181 field studies with 223 independent samples. Results indicated that unfavorable antecedents correlate more strongly with CWB than favorable antecedents. We also found that supervisor- and organization-related antecedents have stronger relationships with CWB than those from the two other groups. Implications include a deeper understanding of which situational factors relate the most—or least—to CWB which can help better address CWB in the workplace.
Colors and Things
Authors: Koenderink Jan , Doorn Andrea van , Gegenfurtner Karl
Published: November 2020

How many colors are there? Quoted numbers range from ten million to a dozen. Are colors object properties? Opinions range all the way from of course they are to no, colors are just mental paint. These questions are ill-posed. We submit that the way to tackle such questions is to adopt a biological approach, based on the evolutionary past of hominins. Hunter-gatherers in tundra or savannah environments have various, mutually distinct uses for color. Color differences aid in segmenting the visual field, whereas color qualia aid in recognizing objects. Classical psychophysics targets the former, but mostly ignores the latter, whereas experimental phenomenology, for instance in color naming, is relevant for recognition. Ecological factors, not anatomical/physiological ones, limit the validity of qualia as distinguishing signs. Spectral databases for varieties of daylight and object reflectance factors allow one to model this. The two questions are really one. A valid question that may replace both is how many distinguishing signs does color vision offer in the hominin Umwelt? The answer turns out to be about a thousand. The reason is that colors are formally not object properties but pragmatically are useful distinguishing signs.
Porous polylactic acid scaffolds for bone regeneration: A study of additively manufactured triply periodic minimal surfaces and their osteogenic potential
Authors: Diez-Escudero Anna , Harlin Hugo , Isaksson Per , Persson Cecilia
Published: November 2020

Three different triply periodic minimal surfaces (TPMS) with three levels of porosity within those of cancellous bone were investigated as potential bone scaffolds. TPMS have emerged as potential designs to resemble the complex mechanical and mass transport properties of bone. Diamond, Schwarz, and Gyroid structures were 3D printed in polylactic acid, a resorbable medical grade material. The 3D printed structures were investigated for printing feasibility, and assessed by morphometric studies. Mechanical properties and permeability investigations resulted in similar values to cancellous bone. The morphometric analyses showed three different patterns of pore distribution: mono-, bi-, and multimodal pores. Subsequently, biological activity investigated with pre-osteoblastic cell lines showed no signs of cytotoxicity, and the scaffolds supported cell proliferation up to 3 weeks. Cell differentiation investigated by alkaline phosphatase showed an improvement for higher porosities and multimodal pore distributions, suggesting a higher dependency on pore distribution and size than the level of interconnectivity.
Withdrawal effects confounding in clinical trials: another sign of a needed paradigm shift in psychopharmacology research
Authors: Cohen David , Recalt Alexander
Published: November 2020

Randomized controlled trials’ ability to produce evidence useful for people to decide whether to take, continue taking, or stop taking psychotropic drugs has been intensely critiqued, along with the trials’ commercial, ideological, and regulatory contexts. This article applies the critique to the topic of withdrawal effects confounding the outcomes of relapse-prevention trials where prescribed psychotropic drugs are discontinued. Until recently, the complexity and reach of withdrawal and post-withdrawal effects were neglected by mainstream psychiatry, but not by lay users of prescribed psychotropics. This article discusses withdrawal effects as part of the pharmacology of psychotropic drugs but shaped by psychosocial factors, and possibly shaping the presentation of psychological distress generally. It outlines biases and misconceptions in assumptions, design, and reporting of general efficacy trials and findings from a recent review of 80 discontinuation trials. In theory, relapse-prevention trials are tautological and exaggerate efficacy. In publications, they pay little attention to the central feature of their design, favor abrupt or rapid discontinuations, do not attend to environmental factors, and provide insufficient data to allow re-analyses. Thus, relapse-prevention RCTs likely confound the detection of their main outcome of interest: “relapse.” Using slower tapers, active placebo controls, and specific covariates in analyses would reduce the risk of withdrawal confounding, and better reporting would reduce the opaqueness of trials. The crisis in psychopharmacology is fueled partly by the disconnect between claims of therapeutic efficacy from so-called best-evidence methods despite unchanging population-level indicators of psychiatric sickness. Only by “stacking the deck” against trial sponsors’ hoped-for outcomes can psychopharmacology trials regain scientific credibility.
Diagnostic performance of virtual fractional flow reserve derived from routine coronary angiography using segmentation free reduced order (1-dimensional) flow modelling
Authors: Mohee Kevin , Mynard Jonathan P , Dhunnoo Gauravsingh , Davies Rhodri , Nithiarasu Perumal , Halcox Julian P , Obaid Daniel R
Published: November 2020

Introduction

Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model.

Methods

Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC).

Results

QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = −0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity – 58% and specificity – 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity – 92% and specificity - 29% at a 1D-vFFR of 0.7).

Conclusions

1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation.
The territoriality of teams: Assembling power through the playing of Pokémon Go
Authors: Woods Orlando
Published: November 2020

This paper explores how the playing of Pokémon Go can cause power to be assembled, and team-based expressions of territoriality to manifest. By playing the game, players become embedded within digital assemblages of power, which they reproduce through their interactions with other players, game features, and public spaces. When digital assets—such as gyms—are indexed to public spaces, players work together in teams to compete for digital ownership, and control, of these assets. In turn, this leads to the forging of a team-based sense of territoriality that is pervasive, and maximized by consolidating the power of the assemblage. Qualitative data are presented to empirically explore how playing Pokémon Go in Singapore can encourage players to forge a team-based sense of territoriality, which in turn results in the (dis)assembling of power. To conclude, I call for closer consideration of the implications of digital assemblages of power for everyday life.
Entomophthoramycosis: A diagnostically challenging presentation of liver space–occupying lesion
Authors: Peyam Srinivasan , Thirunavukkarasu Balamurugan , Gupta Kirti , Trehan Amita
Published: November 2020

Entomophthoramycosis, a rare fungal infection, can mimic various clinical entities. We present a case of entomophthoramycosis affecting a 3-year-old male masquerading as liver tumour, diagnosed on stereotactic biopsy and later on resected specimen. He improved following partial hepatectomy and antifungal therapy. A high index of suspicion and heightened awareness regarding its unique morphological characteristics are required for appropriate management.
Tubercular arthritis presenting as osteonecrosis of the femoral head: A case report
Authors: Nawatthakul Anuchit , Yuenyongviwat Varah
Published: November 2020

A tuberculosis hip that presents as osteonecrosis of the femoral head is an extremely rare condition. There are no previous reports of this condition, and there is no consensus on the method of total hip arthroplasty for this group of patients. We present a case of a 72-year-old man who had clinical gradual hip pain in both hips for 1 year. He was diagnosed with post-collapsed osteonecrosis of the femoral head in both hips and was scheduled for total hip arthroplasty of the left hip. During his clinical follow-up, he suddenly experienced excruciating acute pain. Investigation to rule out infection was positive for only C-reactive proteins, but his synovial fluid work-up was negative. An intraoperative finding revealed that there was collapse of the femoral head with eroded acetabular cartilage and rice body–like synovitis. Total hip arthroplasty was performed, and the tissue was sent for diagnosis. Tissue acid-fast bacilli were positive, so the patient received anti-tuberculosis drugs for 9 months, with no recurrent infection. Tuberculosis arthritis presenting as osteonecrosis of the femoral head is a complex condition that is difficult to diagnose due to the radiographic pictures of femoral head collapse and arthritic change being similar in both diseases. Acute pain onset with rapid collapse of the femoral head should be a consideration or suspect for this infectious condition. Hence, investigation to rule out infection is important. Anti-tuberculosis drugs are the standard treatment for early or advanced arthritis, and one-stage or two-stage total hip arthroplasty is the choice of treatment for advanced arthritis.
Perception of the implementation of the nurse practitioner role in a Norwegian out-of-hours primary clinic: An email survey among healthcare professionals and patients
Authors: Hansen Elisabeth Holm , Boman Erika , Fagerström Lisbeth
Published: November 2020

In Norway, more patients are visiting the out-of-hours primary clinic than before, and with a higher urgency level. As the first out-of-hours clinic in Norway, the leader at one medium/large clinic wanted to introduce the role of nurse practitioner (NP) for more effective and safer service for patients. The aim of this study was to explore challenges in the current model of care and whether NPs can perform new tasks in an out-of-hours clinic seen from both care providers’ and patients’ perspectives. All general practitioners and registered nurses who took part in out-of-hours shifts and patients classified as urgent priority during one week were invited to participate in a survey. Descriptive statistics and a chi-square test were used to identify statistically significant differences between groups. Long waiting times in the clinic and lack of patient information during waiting time were identified. General practitioners (GPs) were skeptical about task shifting, while the registered nurses and patients were more positive. All groups agreed that nurse practitioners could perform advanced assessment of patients until a GP took over. Possible new tasks were stitching wounds, referral to X-ray and treating lower urinary tract infections.
A Critical Appraisal of Interreligious Dialogue in Islam
Authors: Khan Issa , Elius Mohammad , Mohd Nor Mohd Roslan , Yakub zulkifli Bin Mohd yusoff Mohd , Noordin Kamaruzaman , Mansor Fadillah
Published: November 2020

This study evaluates the concept of interreligious dialogue and its relation to Islam. It engages in textual analysis and the historical interpretation of the Qur’an and Sunnah. The analysis includes the treatment of early Muslim rulers, especially the second caliph of Islam “Umar,” for the followers of other religions in an attempt to understand the nature of interreligious dialogue in Islam. The research shows how Islam plays a unique role in promoting interreligious dialogue by providing justice, equal rights, and the freedom of religious beliefs and practices of any religion, culture, and civilization as well as accepting all previous prophets as the Prophets of Islam. The study concludes with the strongest emphasis that Islam is a comprehensive religion that advocates harmonious interreligious relationships. It can be taken as a model for mitigating interreligious conflicts and for promoting interreligious harmony and peaceful co-existence in this world of diverse faiths and traditions.
The Role of Shared Leadership in Managing Conflicts in Multigenerational Teams: A Research Framework
Authors: Bhayana Chayanika , Gupta Vishal , Sharda Kirti
Published: November 2020

With multigenerational teams becoming ubiquitous in contemporary organisations, this article aims to address the need to understand the dynamics within such teams. The study proposes a conceptual framework to examine the role of shared leadership in multigenerational teams in promoting positive team outcomes for such teams. Potential differences in work values, attitudes and behaviours among different generations are likely to predispose multigenerational teams to a higher probability of conflicts, which may negatively impact team outcomes. The study posits that if shared leadership emerges in multigenerational teams, it is likely to promote the adoption of cooperative conflict management styles and inhibit the adoption of competitive and avoidant styles, thereby leading to positive outcomes like team performance and team member satisfaction. By proposing conflict management styles as an important mechanism through which shared leadership promotes positive team outcomes, the study intends to contribute to the emerging literature on shared leadership and conflict management in multigenerational teams.
Brinzolamide loaded core-shell nanoparticles for enhanced coronial penetration in the treatment of glaucoma
Authors: Song Jing , Zhang Ziping
Published: November 2020

A neurodegenerative disorder, glaucoma is a leading cause of blindness in the world. The conventional treatment strategies do not allow the significant penetration of the drug in the cornea. Therefore, we prepare a brinzolamide (Brz) loaded core-shell nanoparticles (NPs) to enhance the coronial penetration of the drug and thus treating the glaucoma. The shell of the NPs was composed of phosphatidylserine (PS; 1,2-diacyl-sn-glycero-3-phospho-L-serine), whereas the core of the NPs contains the Brz encapsulated in brinzolamide–phosphatidylserine–polymer poly-(DL-lactic acid-co-glycolic acid)–phosphatidylserine (Brz-PS-PLGA). The synthesis of Brz-PS-PLGA was achieved by using a coaxial electrospray process (CEP), which allows the preparation of the particles in a single step. The size of Brz-PS-PLGA with PS shell and brinzolamide–poly (lactic-co-glycolic) acid (Brz-PLGA) without shell was 571 ± 27.02 nm and 456 ± 19.17 nm, respectively. The charges on the surface of Brz-PS-PLGA and Brz-PLGA were (-) 27.45 ± 2.98 mV and (-) 19.47 ± 2.83 mV. The transmission electron microscopy images clearly reveal the PS shell as a light black layer over the dark black PLGA core. The CEP allows the high encapsulation of Brz in Brz-PS-PLGA where percentage of entrapment efficiency for Brz-PS-PLGA was 88.13 ± 6.43%. The release study conducted in a simulated tear fluid revealed the sustained release patterns of Brz from Brz-PS-PLGA and these were nontoxic to the cells as revealed by the cytotoxicity studies. Further, the Brz-PS-PLGA enhanced the coronial penetration of Brz and was capable of significantly reducing the intraocular pressure (IOP) after administration to the rabbit eye in comparison to the Brz-PLGA and free Brz. The results clearly suggest that the PS coating significantly enhances the capability of the particles in reducing IOP.
Influence of the degree of conversion and Bis-GMA residues of bulk fill resins on tissue toxicity in an subcutaneous model in rats
Authors: Barreto Girão Liliana , Ohana de Lima Martins Joyce , Lemos José Vitor Mota , Pinto Marcílio Rodrigues , Rolim Juliana Paiva Marques Lima , Alves e Silva Francisco Cláudio Fernandes , Saboia Vicente de Paulo Aragão , Bitu Sousa Fabrício , de Barros Silva Paulo Goberlânio
Published: November 2020

Aim:

To analyse the influence of the degree of conversion (DC) and light curing residues of different bulk fills (BFs) composites on the inflammatory profile in the subcutaneous tissue of rats.

Materials and methods:

Resin disks of BF-resins and their active conventional resins (CR; 3M®, Ivoclar®, and Kerr®) were light-cured at 2 mm (BF-superficial) and 4 mm (BF-deep) thicknesses and analyzed by infrared spectroscopy (FTIR; n = 3/group; DC and light curing residues). Then, the disks were implanted in four quadrants in the subcutaneous tissue of Wistar rats (sham, CR, BF-superficial and RF-deep), and after 7, 14, and 28 days, the animals ( n = 6/day) were euthanized for histological analysis of the intensity of the inflammatory process (scores 0–3). Kruskal–Wallis/Dunn and ANOVA/Bonferroni tests were used ( p < 0.05, Graph Pad Prism 5.0).

Results:

The DC of CR 3M® did not differ significantly compared to BF-superficial and BF-deep resins ( p = 0.235). The Ivoclar® and Kerr® resins showed a higher DC with CR and BF-superficial compared to the BF-deep ( p = 0.005 and p = 0.011, rctively). Kerr® resins showed a higher Bis-GMA/UDMA ratio, especially in BF-deep resin ( p < 0.05). 3M® and Ivoclar resins did not show high inflammation scores, but for Kerr® BF resins (superficial and deep), the inflammatory process was significantly higher than that in the CR and sham quadrants ( p = 0.031).

Conclusion:

The tissue inflammatory response after resin inoculation depends on the DC and light curing residues of Bis-GMA.
Folate-conjugated hydrophobicity modified glycol chitosan nanoparticles for targeted delivery of methotrexate in rheumatoid arthritis
Authors: Wu Zhongqing , Xu Kanna , Min Jikang , Chen Minchang , Shen Liping , Xu Jianxue , Jiang Qi , Han Guohong , Pan Le , Li Haidong
Published: November 2020

Background:

Targeted delivery to the Rheumatoid arthritis (RA) which is characterized by destruction and degeneration of bones due to chronic inflammation is of great need. RA being a chronic autoimmune disorder might result in severe disability and morbidity. A targeted delivery system is designed to deliver methotrexate (MTX) for RA.

Methods:

Here, we synthesized folic acid (FA) conjugated hydrophobically modified glycol chitosan (GC) self-assembled nanoparticles (FA-GC-SA) for the targeted delivery of MTX to RA. The FA conjugation and hydrophobic modification of GC by stearic acid (SA) was confirmed by Fourier-transform infrared spectroscopy (FTIR). The FA-GC-SA was exploited for developing targeted nanoparticles encapsulating MTX by the ionic gelation method. The particles were characterized and evaluated for their targeting potential in in vitro cell culture studies. Further their in vivo efficacy in arthritis induced rats using collagen was also evaluated.

Results:

FTIR confirms the successful modification of GC-SA and FA-GC-SA. The FA-GC-SA-MTX of size 153 ± 9 nm were prepared with high encapsulation efficiency of MTX. The FA-GC-SA-MTX size was further confirmed by transmission electron microscopy (TEM). In vitro cell studies revealed the superior efficacy of FA-GC-SA-MTX in cell cytotoxicity. Also, significantly higher cellular uptake of FA functionalized FA-GC-SA-MTX was observed in comparison to non-functionalized GC-SA-MTX attributed to folate receptors (FRs) mediated endocytosis. In vivo results confirms the potential of FA-GC-SA-MTX which reduces reduces the pro-inflammatory cytokines, paw thickness, and arthritis score in collagen induced rats.

Conclusion:

The results shows that FRs targeted FA-GC-SA-MTX has superior efficacy in the treatment of RA.