bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing Interprofessional Primary Care Teams: Alumni Evaluation of the Department of Veterans Affairs Centers of Excellence in Primary Care Education Program
Authors: Harada Nancy D , Rajashekara Shruthi , Sansgiry Shubhada , Wirtz Rugen Kathryn , King Samuel , Gilman Stuart C , Davila Jessica A
Published: September 2019

Purpose:

The Centers of Excellence in Primary Care Education (CoEPCE) is an interprofessional graduate training program within the Department of Veterans Affairs (VA). In this project, we describe career paths of CoEPCE graduates, their perceptions of CoEPCE program value, their overall satisfaction with the training, and suggestions for program improvement to enhance interprofessional education and workforce development.

Methods:

The Graduate Participant Survey was developed and administered in 2018 to CoEPCE graduates from 2012 to 2017. Quantitative data from closed-ended questions were analyzed through descriptive and non-parametric statistics to test for significant differences by profession. Qualitative data from the single open-ended question were analyzed using content analysis with inductive and deductive approaches.

Results:

The survey was completed by 180 graduates. Greater proportions of pharmacists and psychologists than nurse practitioners and physicians were employed in VA, and greater proportions of nurse practitioners and pharmacists than physicians and psychologists were employed in primary care. Although smaller proportions of physicians were currently employed in primary care ( P < .0001), a greater proportion completed advanced training programs ( P < .0001). Overall, graduates perceived that their CoEPCE training was highly valued by advanced training programs and employers and improved their chances of finding a job. They reported high levels of satisfaction (mean = 4.3 ± 0.9 out of 5 total) with the training program, continued to use skills they learned during training, and believe their CoEPCE experiences made them better health care providers.

Conclusions:

Ninety-four percent of the CoEPCE graduates were employed at the VA and/or primary care at the completion of their training, although there were significant differences by profession. Graduates continued to practice interprofessional skills learned during their training and were highly satisfied with the program. Taken together, the findings indicate that continued enhancements to the interprofessional clinical learning environment are warranted.
Shifts in Organizational Culture When Implementing Agility
Authors: Holbeche Linda Susan
Published: September 2019

The present article is premised on the argument that a combination of drive from the top and other business pressures is demanding that organizations take an Agile approach to the planning, delivery and continual adaptation of their business models. Notions of culture change, the role and purpose of business, flexibility, resilience, the nature of leadership, the employment relationship and talent are themselves embedded in this macro context and in need of revision. The range of working practices and related values associated with Agile, and the changing expectations of workers and customers, suggests that new approaches to leadership and change management are needed.

Attempts to scale up Agile to an enterprise level generally meet with little success typically due to cultural barriers, with conventional leadership approaches, linear thinking and mechanistic change management being particular stumbling blocks. It is often assumed that, as people engage and start using agile methodologies, they will feel committed to sustain the benefits of agility, including innovation. However, tackling only one aspect of cultural change is unlikely to produce lasting value. The article suggests various ways in which organizational cultures, leadership behaviours and change management practices may need to shift to deliver sustainable value through a better balance of organizational and employee needs. The role of senior leaders in committing to, and enabling these shifts, is pivotal.
Neoliberal energy transitions: The renewable energy boom in the Chilean mining economy
Authors: Furnaro Andrea
Published: September 2019

Political-economic approaches are increasingly used in the study of low-carbon energy transitions. This article brings attention to two dimensions that have been less explored by this scholarship. First, research on the political economy of energy transitions, which has centered on the fossil fuel industry and to a lesser degree on the residential sector, has not sufficiently considered the role that industrial energy users play in resisting and in shaping energy transitions. Second, empirical analyses have focused on the limitations to a transition toward low-carbon energy systems that neoliberal forms of energy governance generate, thereby leaving unexplored cases in which neoliberal restructurings enacted by the state accelerate energy transitions. By analyzing the relationship between the recent boom in renewables energy investments in Chile and the energy consumption practices of the copper mining industry, I show the importance that changes in energy systems can have in the reproduction of specific regimes of accumulation. Drawing on insights from the political economy of energy and the scholarship on the role of socio-natural reconfigurations in addressing capitalist crisis tendencies, I argue that the recent changes in the energy sector in Chile can be understood as a “socioecological fix” to alleviate the threatened accumulation process of its mining economy. I describe the new energy policy implemented in Chile to show how the neoliberal model for promoting renewable energies and the increased financialization of the renewable energy sector, while successful in quickly stimulating a utility-scale renewable energy sector, has also created socioecological impacts and uncertainties in energy forecasts.
Environmentality judiciously fired – Burning questions of forest conservation and subject transformation in the Himalayan foothills
Authors: MacKinnon Iain
Published: September 2019

‘Environmentality’ is a term used to describe the means by which regulatory processes simultaneously redefine both the environment and the subjectivity of those whose environment is being governed by regulation. Today it is considered a key concept of political ecology. Its most comprehensive and influential articulation is by way of a case-study of the development of community forestry in Kumaon in north India. The case-study argues that the decentralised regulatory system created by the British colonial regime in 1931 created an ‘environmental subjectivity’ among forest users which had not previously existed. However, this article presents evidence that suggests that concern for forest protection – and, thus, ‘environmental subjectivity’ – can be found in Kumaon before the creation of local forest governance; in addition, the article questions the case-study’s interpretation of evidence adduced for ‘environmental subjectivity’ in Kumaon today. Following a discussion on methodology, the article concludes that the case-study’s Euro-centric conception of ‘environmentality’ as an ‘analytical optic’ – derived from the narrow meaning of ‘governmentality’ proposed in the work of Michel Foucault – has resulted in an analysis which systematically elides the agency and beliefs of local people. This optical limitation has implications for other ‘environmentality’ studies. Other forms of analysis, which seek to disclose and decentre features of Western theoretical perspectives on political processes that are internally related to imperialism, are said to offer the potential for outcomes that constitute a non-imperial alternative based on dialogue and mutual understanding.
Pegylated interferon alfa-2a for polycythemia vera or essential thrombocythemia resistant or intolerant to hydroxyurea
Authors: Yacoub Abdulraheem , Mascarenhas John , Kosiorek Heidi , Prchal Josef T. , Berenzon Dmitry , Baer Maria R. , Ritchie Ellen , Silver Richard T. , Kessler Craig , Winton Elliott , Finazzi Maria Chiara , Rambaldi Alessandro , Vannucchi Alessandro M. , Leibowitz David , Rondelli Damiano , Arcasoy Murat O. , Catchatourian Rosalind , Vadakara Joseph , Rosti Vittorio , Hexner Elizabeth , Kremyanskaya Marina , Sandy Lonette , Tripodi Joseph , Najfeld Vesna , Farnoud Noushin , Papaemmanuil Elli , Salama Mohamed , Singer-Weinberg Rona , Rampal Raajit , Goldberg Judith D. , Barbui Tiziano , Mesa Ruben , Dueck Amylou C. , Hoffman Ronald
Published: September 2019

Yacoub et al report excellent responses to pegylated interferon alfa-2a in patients with hydroxyurea-resistant/intolerant polycythemia vera or essential thrombocythemia.
Cohesin-dependent regulation of gene expression during differentiation is lost in cohesin-mutated myeloid malignancies
Authors: Sasca Daniel , Yun Haiyang , Giotopoulos George , Szybinski Jakub , Evan Theo , Wilson Nicola K. , Gerstung Moritz , Gallipoli Paolo , Green Anthony R. , Hills Robert , Russell Nigel , Osborne Cameron S. , Papaemmanuil Elli , Göttgens Berthold , Campbell Peter , Huntly Brian J. P.
Published: September 2019

Cohesin mutations are common in myeloid malignancy. Sasca et al elucidate the potential role of cohesin loss in myelodysplastic syndrome and acute myeloid leukemia (MDS/AML). They demonstrate that cohesin binding is critical for erythroid-specific gene expression and that reduction in cohesin impairs terminal erythroid maturation and promotes myeloid malignancy.
Neutrophil and monocyte kinetics play critical roles in mouse peritoneal adhesion formation
Authors: Tsai Jonathan M. , Shoham Maia , Fernhoff Nathaniel B. , George Benson M. , Marjon Kristopher D. , McCracken Melissa N. , Kao Kevin S. , Sinha Rahul , Volkmer Anne Kathrin , Miyanishi Masanori , Seita Jun , Rinkevich Yuval , Weissman Irving L.
Published: September 2019

Key Points

Upon injury, the mesothelium recruits neutrophils to the peritoneal space, which contributes to adhesion formation. Neutrophil recruitment and macrophage-depletion kinetics in adhesions differ from the normal innate response.
Predisposition to childhood acute lymphoblastic leukemia caused by a constitutional translocation disrupting ETV6
Authors: Järviaho Tekla , Bang Benedicte , Zachariadis Vasilios , Taylan Fulya , Moilanen Jukka , Möttönen Merja , Smith C. I. Edvard , Harila-Saari Arja , Niinimäki Riitta , Nordgren Ann
Published: September 2019

Key Points

We report the first known family with a constitutional translocation disrupting ETV6 predisposing to ALL. Germline monoallelic expression of ETV6 contributes to leukemia predisposition without thrombocytopenia.
Complete brachial plexus palsy following shoulder dislocation due to sneeze: a case report
Authors: Middleton Austin H. , Roffers John , Ziegler Dean W.
Published: September 2019

Background

Traumatic shoulder dislocation is a frequent condition presenting to the emergency department. Due to the anatomy of the shoulder, associated neurovascular damage is not uncommon. Although clinical intuition may suggest that a higher-energy mechanism is required to produce neurovascular sequelae, the existing literature does not support this supposition.

Case presentation

A 55-year-old woman presented to the emergency department with a complete brachial plexus palsy from an acute anterior shoulder dislocation following a violent sneeze. The shoulder was reduced without difficulty in the emergency department within 90 min of dislocation, and the patient was discharged. Her neurologic deficits gradually improved through a program of supervised therapy and orthopedic care. Follow-up at 1 year revealed marked improvement of motor and sensory function of the affected extremity with mild residual weakness and paresthesias in the affected hand.

Conclusion

Neurovascular injuries in the setting of shoulder dislocation may be present despite low-energy injury mechanisms.
FBXW7 circular RNA regulates proliferation, migration and invasion of colorectal carcinoma through NEK2, mTOR, and PTEN signaling pathways in vitro and in vivo
Authors: Lu Haoran , Yao Baofu , Wen Xinyuan , Jia Baoqing
Published: September 2019

Backgrounds

A number of circular RNAs (circRNAs) have been identified in various cancer including F-box and WD repeat domain containing 7 (FBXW7) circular RNA (circ-FBXW7), which can suppress glioma cell growth. However, the role of circ-FBXW7 in colorectal cancer (CRC) remains unclear. We aimed to investigate the effect and mechanisms of circ-FBXW7 on CRC progression.

Methods

The expression of circ-FBXW7 in CRC patients was detected by PCR. Stably knockdown of circ-FBXW7 (si circ-FBXW7) cell lines and overexpression of circ-FBXW7 (oe circ-FBXW7) cell lines were constructed by small interfering RNA method and plasmids transfection in CRC SW480 and SW620 cells. The functional experiments including cell proliferation, migration and invasion were carried out by cell counting kit-8 (CCK-8) assay, wound healing assay and trans well assay. The xenograft animal models were established to evaluate the effect and the underlying molecular mechanisms of circ-FBXW7 on CRC progression.

Results

CRC samples had a significantly lower level of circ-FBXW7 compared to normal tissue. si circ-FBXW7 notably promoted the proliferation, colony formation, cell migration and invasion of CRC cell in vitro. On contrast, circ-FBXW7 overexpressed significantly suppressed CRC cell proliferation, migration and invasion. Similarly, si circ-FBXW7 stimulated the tumor growth and circ-FBXW7 overexpression repressed the tumor progression in SW480 and SW620 tumor models, which suggested that circ-FBXW7 could serve as a target biomarker of CRC. Further study found that si circ-FBXW7 up-regulated the mRNA and protein expressions of NEK2 and mTOR, and diminished the PTEN expression. Whereas, overexpressed circ-FBXW7 induced the tumor suppression via reversing the expressions of NEK2, mTOR, and PTEN.

Conclusion

circ-FBXW7 plays a major role in controlling the progression of CRC through NEK2, mTOR, and PTEN signaling pathways and may be a potential therapeutic target for CRC treatment.

Graphical abstract

Circ-FBXW7 controls the progression of CRC through NEK2, mTOR, and PTEN signaling pathways and its overexpression inhibits colorectal cancer cell migration and invasion, suggesting the potential therapeutic target for CRC treatment.
Impact of snus use in teenage boys on tobacco use in young adulthood; a cohort from the HUNT Study Norway
Authors: Grøtvedt Liv , Forsén Lisa , Ariansen Inger , Graff-Iversen Sidsel , Lingaas Holmen Turid
Published: September 2019

Background

As smoking rates decreased, the use of Swedish snus (smokeless tobacco) concordantly increased in Norway. The role of snus as possible contributor to the reduction of smoking has been widely discussed. Our aim was to quantitate transitions in snus use, smoking and dual use of snus and cigarettes in a young male population.

Methods

This prospective cohort study includes 1346 boys participating in the Nord-Trøndelag Health Study in Young-HUNT1 1995–97, age 13–19 and in HUNT3 2006–08, age 23–30. Participants reported on tobacco use at both points of time. Models with binominal regression were applied to examine relative risks (RRs), of adolescent ever snus users, dual users or smokers (reference: never tobacco use), to be current snus only users, smokers (including dual users), or tobacco free in adulthood.

Results

Current tobacco use in this male cohort increased from 27% in adolescence to 49% in adulthood, increasing more for snus only use and dual use than for smoking only.

The adjusted RR (95% CI) of becoming a smoker as young adult, was 2.2 (CI 1.7–2.7) for adolescent snus users, 3.6 (CI 3.0–4.3) for adolescent dual users, and 2.7 (CI 2.2–3.3) for adolescent smokers. RR to become snus only users as adults was 3.1 (2.5–3.9) for adolescent dual users, 2.8 (2.2–3.4) for adolescent snus users and 1.5 (1.0–2.2) for adolescent smokers. The adjusted RR for the transition from adolescent tobacco use to no tobacco use in adulthood was similar for snus users and smokers with RR 0.5 (CI 0.4–0.7), but considerably lower for dual users with RR 0.2 (CI 0.2–0.3).

Conclusions

The use of snus, with or without concurrent smoking, carried a high risk of adult smoking as well as adult snus only use. Dual use seemed to promote the opportunity to become snus only users in adulthood, but made it also more difficult to quit. The benefit of snus use for harm reduction is not evident in our cohort, as the combination of smoking and dual use resulted in high smoking rates among the young adults.
Relationship between plasma Atherogenic index and final pathology of Bosniak III-IV renal masses: a retrospective, single-center study
Authors: Karabay Emre , Karsiyakali Nejdet , Duvar Serdar , Tosun Cagatay , Aslan Ahmet Ruknettin , Yucebas Omer Ergin
Published: September 2019

Background

There is an increased incidence of renal cell carcinoma (RCC) in patients with metabolic syndrome who usually have high levels of serum triglyceride (TG) and low high-density lipoprotein-cholesterol (HDL-C). Plasma atherogenic index (PAI) is the logarithmic ratio of serum TG level to HDL-C and related to cardiovascular diseases. In this study, we aimed to determine the accuracy of PAI in determining renal malignancy in localized renal masses preoperatively.

Methods

Totally 169 patients who were diagnosed with Bosniak III-IV lesions by imaging modalities and treated in our hospital with partial or radical nephrectomy were retrospectively analyzed using institutional renal cancer database between 2013 and 2018. Preoperative images were evaluated by two experienced radiologists. The patients were divided into two groups according to their postoperative pathological diagnosis as malignant or benign tumors. The PAI of each patient was calculated and the statistical significance of PAI in predicting malignancy for renal masses was analyzed using uni- and multivariable analyses.

Results

Of patients, 109 (64.5%) were males and 60 (35.5%) were females with a median age of 61 (33–84) years. Median tumor size was 6.5 (2–18) cm. Pathological diagnosis was malignant in 145 (85.8%) and benign in 24 (14.2%) patients. There was no statistically significant difference in serum TG levels between malignant and benign cases (p > 0.05). The HDL-C levels were significantly lower in malignant cases (p = 0.001). Median PAI value was 0.63 (0.34–1.58) and significantly higher in malignant cases (p = 0.003). The PAI cut-off value for malignancy was ≥0.34. The sensitivity was calculated as 88.2% and specificity as 45.8%, the positive predictive value as 90.8, negative predictive value as 39.3, and odds ratio as 6.37 (95% CI: 2.466–16.458). In multivariable analysis, gender, smoking status, and hypertension had no effect on malignancy, whereas PAI and HDL-C were independent risk factors (p = 0.003 and p = 0.003, respectively). The risk of malignancy was 5.019 times higher, when PAI was > 0.34 (95% CI: 1.744–14.445) in multivariable logistic regression analysis.

Conclusions

The PAI can be used as a predictive tool in suspicion of malignant renal masses. In case of a benign pathology, PAI levels may be encouraging for surgeons for nephron-sparing surgery.
Perception, knowledge, and interest of urologic surgery: a medical student survey
Authors: Whiles Bristol B. , Thompson Jeffrey A. , Griebling Tomas L. , Thurmon Kerri L.
Published: September 2019

Background

Although only a limited number of medical schools require a formal educational rotation in urologic surgery, urology as a medical specialty continues to attract a large number of students into the match each year. The purpose of this study was to describe medical student awareness, perception, and knowledge of urology, to determine factors influencing students’ consideration of urology as a career, and to determine if prior urology clerkship experience is associated with differences in these variables.

Methods

In this cross-sectional study, medical students were electronically surveyed in 07/2016. Self-reported and question-based knowledge of urology were determined. A total of 25 factors were assessed with a five-point Likert scale to determine their influence on students’ consideration of urology as a career. Data analysis was performed using R.

Results

The survey was completed by 114 students (13.5% of all medical students). A total of 11(9.65%)students had previously participated in a urology clerkship. All students reported awareness of urology; however, only 74 students (64.9%) correctly identified the training pathway and job duties of urologists. Self-perceived knowledge of urology was poor but improved with increased medical school training. Question-based assessment also demonstrated increased knowledge with advanced medical school training (27% per year; p < 0.01). Prior urology clerkship experience appeared to be associated with increased urologic knowledge; however, this was confounded by year in medical school training. When assessing factors impacting students’ consideration of a career in urology, ‘combination of medicine and surgery’ was the most positively influential and ‘competitiveness of the specialty’ was the most negatively influential.

Conclusions

Although medical students are aware of urology as a specialty, they perceive their knowledge of urology as poor. However, knowledge of urology increases throughout medical school training. Multiple factors influence students’ consideration of urology as a career choice. Additional studies are needed to further explore how participation in a formal urology experience alters students’ perceptions and influences their consideration of urology as a career choice.

Trial registration

Retrospectively registered.
Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions
Authors: Alqudah Abdelrahim , McMullan Paul , Todd Anna , O’Doherty Conor , McVey Anne , McConnell Mae , O’Donoghue John , Gallagher Joe , Watson Chris J. , McClements Lana
Published: September 2019

Background

Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients’ experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring.

Methods

The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland.

Results

The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy.

Conclusions

Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.
Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients
Authors: Barthélémy Romain , Roy Xavier , Javanainen Tujia , Mebazaa Alexandre , Chousterman Benjamin Glenn
Published: September 2019

Background

Though echocardiographic evaluation assesses the right ventricular systolic function, which of the existing parameters best reflects the right ventricular ejection fraction (RVEF) in the critically ill patients is still uncertain. We aimed to determine the relationship between echocardiographic indices of right ventricular systolic function and RVEF.

Methods

Prospective observational study was conducted in a mixed Surgical Intensive Care Unit (Hôpital Lariboisière, Paris, France) from November 2017 to November 2018. All critically ill patients monitored with a pulmonary artery catheter were assessed. We collected echocardiographic indices of right ventricular function (tricuspid annular plane systolic excursion, TAPSE; peak systolic velocity of pulsed tissue Doppler at lateral tricuspid annulus, S′; fractional area change, FAC; right ventricular index of myocardial performance, RIMP; isovolumic acceleration, IVA; end-diastolic diameter ratio, EDDr) and compared them with the RVEF obtained from continuous volumetric pulmonary artery catheter.

Results

Twenty-five patients were analyzed. Admission diagnosis was acute heart failure in 11 patients and septic shock in 14 patients. Median age was 70 years [57–80], norepinephrine median dose was 0.29 μg/kg/min [0.14–0.50], median Sequential Organ Failure Assessment score was 12 [10–14], and mortality at day 28 was 56%. When compared to RVEF, TAPSE had the highest correlation coefficient (rho = 0.78, 95% CI 0.52 to 0.89, p < 0.001). S′ was also correlated to RVEF (rho = 0.64, 95% CI 0.60 to 0.80, p = 0.001) whereas FAC, RIMP, IVA, and EDDr did not. TAPSE lower than 16 mm, S′ lower than 11 cm/s, and EDDr higher than 1 were always associated with a reduced RVEF.

Conclusions

We found that amongst indices of right ventricular systolic function, TAPSE and S′ were well correlated with thermodilution-derived RVEF in critically ill patients.
Longitudinal variation in human immunodeficiency virus long terminal repeat methylation in individuals on suppressive antiretroviral therapy
Authors: Cortés-Rubio César N. , Salgado-Montes de Oca Gonzalo , Prado-Galbarro Francisco J. , Matías-Florentino Margarita , Murakami-Ogasawara Akio , Kuri-Cervantes Leticia , Carranco-Arenas Ana P. , Ormsby Christopher E. , Cortés-Rubio Ivette K. , Reyes-Terán Gustavo , Ávila-Ríos Santiago
Published: September 2019

Background

Persistence of latent, replication-competent provirus in CD4+T cells of human immunodeficiency virus (HIV)-infected individuals on antiretroviral treatment (ART) is the main obstacle for virus eradication. Methylation of the proviral 5′ long terminal repeat (LTR) promoter region has been proposed as a possible mechanism contributing to HIV latency; however, conflicting observations exist regarding its relevance. We assessed 5′-LTR methylation profiles in total CD4+T cells from blood of 12 participants on short-term ART (30 months) followed up for 2 years, and a cross-sectional group of participants with long-term ART (6–15 years), using next generation sequencing. We then looked for associations between specific 5′-LTR methylation patterns and baseline and follow-up clinical characteristics.

Results

5′-LTR methylation was observed in all participants and behaved dynamically. The number of 5′-LTR variants found per sample ranged from 1 to 13, with median sequencing depth of 16270× (IQR 4107×-46760×). An overall significant 5′-LTR methylation increase was observed at month 42 compared to month 30 (median CpG Methylation Index: 74.7% vs. 0%,p= 0.025). This methylation increase was evident in a subset of participants (methylation increase group), while the rest maintained fairly high and constant methylation (constant methylation group). Persons in the methylation increase group were younger, had higher CD4+T cell gain, larger CD8% decrease, and larger CD4/CD8 ratio change after 48 months on ART (allp< 0.001). Using principal component analysis, the constant methylation and methylation increase groups showed low evidence of separation along time (factor 2:p= 0.04). Variance was largely explained (21%) by age, CD4+/CD8+T cell change, and CD4+T cell subpopulation proportions. Persons with long-term ART showed overall high methylation (median CpG Methylation Index: 78%; IQR 71–87%). No differences were observed in residual plasma viral load or proviral load comparing individuals on short-term (both at 30 or 42 months) and long-term ART.

Conclusions

Our study shows evidence that HIV 5′-LTR methylation in total CD4+ T cells is dynamic along time and that it can follow different temporal patterns that are associated with a combination of baseline and follow-up clinical characteristics. These observations may account for differences observed between previous contrasting studies.
Unexpected rapid increase in bone mineral density by bisphosphonate therapy after multiple spinal fractures: a case report
Authors: Koiwai Hidefumi , Kamimura Mikio , Takahashi Jun , Nakamura Yukio , Kato Hiroyuki
Published: September 2019

Background

Osteoporosis is a serious disease that causes bone fragility fractures and increases mortality. Bisphosphonates are the first-line drugs for osteoporosis. However, the gains in bone mineral density by use of bisphosphonates alone are limited.

Case presentation

We describe the clinical outcome of a Japanese woman with osteoporosis treated with bisphosphonates after multiple spinal fractures. After 3 years of treatment with the bisphosphonate alendronate, her lumbar bone mineral density and bilateral hip bone mineral density markedly increased by 61.9% and 32.5%, respectively.

Conclusion

We considered that our patient’s multiple fractures had caused a decrease in bone mineral density, which naturally improved with fracture healing to enhance the increase in bone mineral density with bisphosphonate treatment.
Study on a silver box unearthed from the Tang Dynasty (AD 618–907) tomb at Xiaolizhuang Site, Henan Province, China
Authors: Yao Zhihui , Gong Yuxuan
Published: September 2019

Over the years, numerous gold and silver artifacts were excavated from tombs of the Tang Dynasty which gave evidence of the sophisticated metalworking techniques at that time. However, very few of them were studied and the manufacturing process was barely known. In this research, the microstructural analyses including microscopy and SEM–EDS were conducted on a delicate silver cosmetics box excavated from a Tang Dynasty tomb of Xiaolizhuang site. The silver artifact is made up of two symmetrical cambered pieces which were fabricated by alternating hammering and annealing. The shape and surface features were further modified through plastic forming. Afterwards, spinning technique was employed to ensure the interior surface is smooth and has consistent thickness. The surface of the silver box is fully decorated with multiple fine engraving including petals, fish-toe circles, flower pattern, twine pattern and the Tang grass pattern. According to the overlapping status of the notches, the patterns were processed in a certain order by using various gravers. The artifact was brought in its final appearance by gilding to form a thin gold film on the surface. These results overall reveal the sophisticated techniques applied in making the artifact and further enhance the understanding of metalworking practices in the Tang Dynasty.
Effect of feedstock and microwave pyrolysis temperature on physio-chemical and nano-scale mechanical properties of biochar
Authors: Wallace Chase A. , Afzal Muhammad T. , Saha Gobinda C.
Published: September 2019

Biochars were produced from softwood chips (spruce–fir mix) and hemp stalk biomasses in an in-house-developed microwave pyrolysis reactor. A kilogram batch raw biomass mixed with 10 wt% microwave absorber was pyrolyzed at 60-min residence time. Microwave power levels were set at 2100, 2400, and 2700 W with optimum heating rates ranging 25–50 °C/min. The proximate analysis indicated a progressive gain in biochar carbon content with power level increase. Both biochars showed a H:C ratio of < 1.2 with a graphite-like structure, which is an important observation for their potential use as a filler in bio-composites structural strength increase. Fourier Transfer Infrared (FT-IR) spectra showed a major loss of functional groups as the power level increased. Brunauer–Emmett–Teller (BET) surface area and porosity distribution contained higher volume of smaller pores in the hemp biochar. The char hardness and Young’s modulus, obtained via nanoindentation technique and load–depth curve analysis, indicated that hemp biochar possessed a higher Young’s modulus and lower hardness than softwood chip biochar.
Portal venous gas in intestinal malrotation with mild midgut volvulus
Authors: Hirose Ryuichiro , Kai Hiroki , Inatomi Kaori , Iwanaka Tsuyoshi , Morishima Naomi , Ikeda Momotoshi , Masaki Reiko , Iwasaki Akinori
Published: September 2019

Background

Portal venous gas has been considered as a radiological sign requiring urgent operative intervention; however, the reports concerning portal venous gas associated with favorable outcome are recently increasing.

Case presentation

We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd’s procedure were completed laparoscopically.

Conclusions

Transient portal venous gas bubbles may be generated even in the mild intestinal volvulus with no bowel ischemia. Ultrasonography can be a sensitive detector to visualize such small amounts of gas.
Proximal small bowel obstruction in a patient with cystic fibrosis: a case report
Authors: Alattar Zana , Thornley Caitlin , Behbahaninia Milad , Sisley Amy
Published: September 2019

Background

As advancements are made in the management of cystic fibrosis (CF), survival of the CF patient into adulthood has increased, leading to the discovery of previously unknown CF complications. Though gastrointestinal complications of CF, such as distal intestinal obstruction syndrome, are common, this case demonstrates a variant presentation of small bowel obstruction in this population.

Case presentation

We describe a 42-year-old male with CF who presented with 2 days of worsening upper abdominal pain, emesis, and loss of bowel function. The patient had no history of any prior abdominal surgeries; however, imaging was concerning for high-grade mechanical small bowel obstruction possibly related to internal hernia. Given leukocytosis and diffusely tender abdomen found on further workup, the decision was made to proceed with diagnostic laparoscopy after a brief period of intravenous fluid resuscitation. Intraoperatively, the transition point was found in the mid-jejunum and was noted to be due to kinking of the bowel causing vascular congestion in the proximal portion. Surgical manipulation of the bowel was required for return of normal perfusion and patency.

Conclusion

Though the exact mechanism cannot be definitively delineated, we speculate that the increased viscosity and prolonged intestinal transit time, characteristic of CF, resulted in inspissated fecal content in the proximal small bowel, which then acted as a lead point for obstruction. Thus, though small bowel obstruction in patients with CF is often attributed to distal intestinal obstruction syndrome, a broader differential must be considered. Early surgical intervention may be necessary to prevent bowel ischemia and subsequent small bowel resection in a patient presenting with concerning clinical and image findings, as was seen in this patient.
Patient-initiated versus fixed-interval patient-reported outcome-based follow-up in outpatients with epilepsy: a pragmatic randomized controlled trial
Authors: Schougaard Liv Marit Valen , Mejdahl Caroline Trillingsgaard , Christensen Jakob , Lomborg Kirsten , Maindal Helle Terkildsen , de Thurah Annette , Hjollund Niels Henrik
Published: September 2019

Background

The use of patient-reported outcome (PRO) could potentially contribute to the reorganization of the health care system. AmbuFlex is a PRO system used in remote patient monitoring, in which questionnaires are sent to patients at fixed intervals. The PRO data are used by clinicians to decide whether patients need clinical attention. Better self-management and cost-saving follow-up activities may be achieved by letting patients initiate need of contact. We evaluated the effects of patient-initiated PRO-based outpatient follow-up on health care resource utilization, quality of care, and the patient perspective.

Methods

We conducted a parallel two-arm pragmatic randomized controlled trial at the Department of Neurology, Aarhus University Hospital, Denmark. Outpatients with epilepsy (≥ 15 years old), attending fixed-interval PRO-based follow-up with web-based questionnaires, were randomly assigned in a ratio of 0.55:0.45 to either 1) patient-initiated PRO-based follow-up (open access telePRO) or 2) fixed-interval PRO-based follow-up (standard telePRO). The primary outcome was the number of outpatient hospital contacts related to epilepsy retrieved from a regional registry. Hospitals admissions and emergency room visits were also assessed. Secondary self-reported outcomes including general health, well-being, health literacy, self-efficacy, number of seizures, side effects, confidence, safety, and satisfaction were retrieved from questionnaires. Data were analyzed by the intention-to-treat and per-protocol approaches.

Results

Between January 2016 and July 2016, 593 patients were randomized to either open access telePRO (n = 346) or standard telePRO (n = 247). At 18 months, no statistically significant differences were found between the arms regarding number of telephone consultations or outpatient visits. Patients in the open access arm had a slightly lower, statistically significant number of emergency room visits than patients in the standard arm. Self-reported mental well-being in the open access arm was slightly, statistically significantly lower than in the standard arm. Other secondary outcomes did not differ statistically significantly between arms.

Conclusion

This study did not find, as hypothesized, less use of health care resources or improved patient self-management or satisfaction in the patient-initiated PRO-based initiative compared to fixed-interval PRO-based follow-up. Patient-initiated PRO-based follow-up may be used as an alternative to fixed-interval PRO-based follow-up in patients who prefer this approach, but there is insufficient evidence for recommending a system-wide shift to patient-initiated PRO-based follow-up.

Trial registration

Registered 4 February 2016 with ClinicalTrials.gov: NCT02673580.
Lowering CO2 emissions in the Swiss transport sector
Authors: Thalmann Philippe , Vielle Marc
Published: September 2019

In Switzerland, transportation represents 41% of CO2 emissions from energy combustion (2016), a much higher share than in the European Union (EU) (28%) or even the USA (34%). While total Swiss CO2 emissions decreased by 10% between 1990 and 2016, CO2 emissions from transport increased by 4.5% over the same period (all data from UNFCCC database). Our projections (Vielle and Thalmann, Updated emissions scenarios without measures, 1990-2025, Tech. rep., 2017) show that the contribution of the transport sector would remain constant in a scenario taking into account climate and energy policy measures already implemented or adopted in 2016. In the EU, several initiatives have already been introduced to limit the use of petroleum products in transportation. This paper presents deep decarbonization pathways for Switzerland that demand a strong contribution from the transport sector. We find that a preferential treatment of transportation fuels raises the welfare cost of decarbonization by about 18% relative to a uniform tax on all fossil fuels. This is of similar magnitude as the preferential treatment of large CO2 emitters through an emissions trading system. We also find that the preferential treatment leads to a share of fossil fuels in total energy for road transportation in 2050 which is approximately twice as high as in the uniform treatment.
IMA Genome-F 11
Authors: Wingfield Brenda D. , Fourie Arista , Simpson Melissa C. , Bushula-Njah Vuyiswa S. , Aylward Janneke , Barnes Irene , Coetzee Martin P. A. , Dreyer Léanne L. , Duong Tuan A. , Geiser David M. , Roets Francois , Steenkamp E. T. , van der Nest Magriet A. , van Heerden Carel J. , Wingfield Michael J.
Published: September 2019

Draft genomes of the fungal species Fusarium xylarioides, Teratosphaeria gauchensis and T. zuluensis are presented. In addition an annotation of the genome of Ceratocystis fimbriata is presented. Overall these genomes provide a valuable resource for understanding the molecular processes underlying pathogenicity and potential management strategies of these economically important fungi.
Elastic Gaussian-beam migration for four-component ocean-bottom seismic data
Authors: Shi Xingchen , Mao Weijian , Li Xulei
Published: September 2019

Multimode and multicomponent elastic Gaussian-beam migration is attractive for its efficiency, flexibility, and accuracy. However, when it is used for ocean-bottom seismic data, the incomplete boundary condition will yield some nonphysical artifacts in the final migrated images. To solve this problem, we extend the elastic Gaussian-beam migration method from 3C to 4C by introducing the pressure recording to represent the stress tensor on the ocean bottom. Based on the elastic wave equation and the complete boundary condition for the ocean-bottom model, we derive effective formulas of accurate multimode wave downward continuation. With our method, different wave modes are separated and the receiver ghost is removed simultaneously by applying a decomposition matrix to 4C data during the migration without prior data separation and deghosting, which eliminates the artifacts better and reduces the processing cost. Three synthetic experiments were provided to validate the method for 4C ocean-bottom data migration.
Ανίχνευση σε τρόφιμα και σε φρούτα χημικών ουσιών
Authors: Τράπαλη Μαρία
Published: September 2019

Το θέμα της μελέτης μας είναι η ανίχνευση σε τρόφιμα και σε φρούτα διάφορων χημικών ουσιών. Το ερευνητικό ερώτημα είναι το πώς μπορούμε να ανιχνεύσουμε και πιθανόν να προσδιορίσουμε διάφορες χημικές ουσίες σε τρόφιμα και φρούτα (σάκχαρα, άμυλο, νερό, πρωτεΐνες, νερό, βιταμίνες ). Για την παραπάνω μελέτη θα χρησιμοποιηθούν αντιδραστήρια και συσκευές από το εργαστήριο φυσικών επιστημών του σχολείου μας ( ηλεκτρονικός ζυγός, ενεργός άνθρακας, διάλυμα ιωδίου, αντιδραστήριο διουρίας, αντιδραστήριο Fehling, διάλυμα αμύλου, πρότυπο διάλυμα βιταμίνης C κ.ά. ). Η μεθοδολογία που θα χρησιμοποιηθεί θα περιέχει τη διαδικασία της ογκομέτρησης,  ανίχνευση νερού με άνυδρο θειικό χαλκό, ανίχνευση σακχάρων με αντιδραστήριο Fehling, ανίχνευση πρωτεϊνών με αντιδραστήριο διουρίας, προσδιορισμός βιταμίνης C ). Στα προσδοκώμενα και πιθανά αναμενόμενα αποτελέσματα θα είναι ο επιτυχής προσδιορισμός όλων των παραπάνω, και η απόκτηση όλων των παραπάνω γνώσεων από τους μαθητές.
Αεροδυναμική και φαινόμενο Επίδρασης του Εδάφους (Ground Effect) κατά τον σχεδιασμό ενός γρήγορου οχήματος
Authors: Χρίσκος Αρσένιος-Κλέων , Σπορίδης Μάριος , Χατζηδημητρίου Θανάσης , Πιτσιάβας Αχιλλέας , Φελεσάκης Ισίδωρος-Αλέξανδρος , Τζώτζης Κωνσταντινος , Αχιλλέως Κλαίρη , Παπαδόπουλος Σταύρος
Published: September 2019

Το αντικείμενο αυτής της μελέτης είναι η συνεισφορά της Αεροδυναμικής και του φαινομένου Επίδρασης του Εδάφους στον σχεδιασμό γρήγορων οχημάτων. Η αεροδυναμική έχει ως αντικείμενο έρευνας και μελέτης τους νόμους που διέπουν τη ροή του αέρα ή άλλων αερίων γύρω από σώματα διαφορετικής μορφής. Η ιδέα μίας έρευνας σε αυτόν τον τομέα, προέκυψε όταν αναρωτηθήκαμε, ποιες θα ήταν οι διαφορές στις επιδόσεις οχημάτων με ίδια χαρακτηριστικά (π.χ. ίδια ιπποδύναμη) αλλά με διαφορετικό αεροδυναμικό προφίλ. Αφού μελετήσαμε τις κατάλληλες φυσικές αρχές και κάποια μοντέλα εφαρμογής, καταλήξαμε σε συμπεράσματα σχετικά με την επίδραση που έχει η μορφή των οχημάτων στον τρόπο με τον οποίο «συμπεριφέρονται». Όπως αναμέναμε, υπήρξε διαφορά στην ταχύτητα των σωμάτων, στην επιτάχυνσή τους αλλά και στην κατανάλωση των καυσίμων. Εργαστήκαμε σε περιβάλλον εικονικού εργαστήριου, χρησιμοποιώντας κατάλληλο λογισμικό προσομοίωσης των συνθηκών που επικρατούν κατά την διάρκεια της κίνησης ενός οχήματος και εξετάσαμε την επίδραση του αέρα.
Αξιοσημείωτες συνέπειες του Θεμελιώδους Θεωρήματος της Άλγεβρας
Authors: Καλυκάκης Δημήτριος , Βρετουδάκης Εμμανουήλ , Γλακουσάκη Θεοδοσία , Τζιράκη Βασιλική
Published: September 2019

Στην παρούσα εργασία μελετούμε ιδιότητες των πολυωνύμων και των ρητών παραστά-σεων οι οποίες συνήθως αποσιωπούνται στα σχολικά εγχειρίδια. Θεματικά, η εργασία μας εντάσσεται στο πλαίσιο της Άλγεβρας Α΄ και Β΄ Λυκείου. Τα βασικά ερωτήματα που διερευνούμε είναι τα εξής: α) πότε ένα πολυώνυμο θεωρεί-ται ότι είναι πλήρως παραγοντοποιημένο; β) πώς αναλύεται μια ρητή συνάρτηση σε απλά κλάσματα; γ) μπορεί το θεώρημα του Bolzano να αποδειχθεί με στοιχειώδη τρόπο στην πε-ρίπτωση των πολυωνύμων; δ) τί μορφή έχει η γραφική παράσταση μιας πολυωνυμικής συ-νάρτησης τρίτου βαθμού;Απαντούμε τα παραπάνω ερωτήματα με κύριο μεθοδολογικό εργαλείο το Θεμελιώδες Θεώρημα της Άλγεβρας.
Μελέτη “γαλαζοαίματων” μυρμηγκιών
Authors: Πετρίδου Ελένη , Καλτσίδης Αχιλλέας
Published: September 2019

Η παρούσα εργασία μελετάει όψεις των λειτουργιών των μυρμηγκιών με εστίαση στα μυρμήγκια βασίλισσες και στην εκκόλαψη των αυγών. Συγκεκριμένα, τα ερευνητικά ερωτήματα της εργασίας είναι α) ποιοι είναι οι τρόποι διάκρισης ενός μυρμηγκιού βασίλισσα από τα υπόλοιπα μυρμήγκια και β) ποια είναι η διαδικασία εκκόλαψης των αυγών και της ανάπτυξης των μυρμηγκιών. Το δείγμα της έρευνας αποτελούν τρία μυρμήγκια βασίλισσες, τα οποία εντοπίστηκαν στη Θεσσαλονίκη στις 12/10/2016. Το καθένα από τα τρία μυρμήγκια ζει, τρέφεται και εκκολάπτει τα αυγά του μέσα σε ειδικό γυάλινο σωλήνα, ο οποίος βρίσκεται σε σκοτεινό και ήσυχο μέρος στο σπίτι του ερευνητή. Ερευνητικά εργαλεία αποτέλεσαν η βιντεοσκόπηση των «αιχμαλωτισμένων» μυρμηγκιών και το καθημερινό ημερολόγιο του ερευνητή. Προκειμένου να αναδειχθούν στοιχεία της συμπεριφοράς των μυρμηγκιών βασιλισσών κατά τη διαδικασία εκκόλαψης των αυγών προκλήθηκαν σε αυτά ερεθίσματα, όπως αλλαγή στην τροφή τους, έντονος θόρυβος, κ.ά. Τα πρώτα αποτελέσματα δείχνουν ότι πράγματι εντοπίστηκαν μυρμήγκια βασίλισσες, αφού φέρουν τα περισσότερα από τα χαρακτηριστικά που αναφέρονται στη βιβλιογραφία και ήδη έχουν γεννήσει αυγά και αντιδρούν στα ερεθίσματα προκειμένου να προστατέψουν τις φωλιές των αυγών τους. Αναμένονται περισσότερα αποτελέσματα σε ό,τι αφορά στη συμπεριφορά των μυρμηγκιών βασιλισσών κατά τη διαδικασία της εκκόλαψης των αυγών και στη συνέχεια της ανάπτυξης των μυρμηγκιών.