bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for Intracranial Aneurysms in Coarctation of the Aorta
Authors: Pickard Sarah S. , Prakash Ashwin , Newburger Jane W. , Malek Adel M. , Wong John B.
Published: July 2020

Background:

Patients with coarctation of the aorta have a high prevalence of intracranial aneurysms (IA) and suffer subarachnoid hemorrhage (SAH) at younger ages than the general population. American Heart Association/American College of Cardiology guidelines recommend IA screening, but appropriate age and interval of screening and its effectiveness remain a critical knowledge gap.

Methods and Results:

To evaluate the benefits and cost-effectiveness of magnetic resonance angiography screening for IA in patients with coarctation of the aorta, we developed and calibrated a Markov model to match published IA prevalence estimates. The primary outcome was the incremental cost-effectiveness ratio. Secondary outcomes included lifetime cumulative incidence of prophylactic IA treatment and mortality and SAH deaths prevented. Using a payer perspective, a lifetime horizon, and a willingness-to-pay of $150 000 per quality-adjusted life-year gained, we applied a 3% annual discounting rate to costs and effects and performed 1-way, 2-way, and probabilistic sensitivity analyses. In a simulated cohort of 10 000 patients, no screening resulted in a 10.1% lifetime incidence of SAH and 183 SAH-related deaths. Screening at ages 10, 20, and 30 years led to 978 prophylactic treatments for unruptured aneurysms, 19 procedure-related deaths, and 65 SAH-related deaths. Screening at ages 10, 20, and 30 years was cost-effective compared with screening at ages 10 and 20 years (incremental cost-effectiveness ratio $106 841/quality-adjusted life-year). Uncertainty in the outcome after aneurysm treatment and quality of life after SAH influenced the preferred screening strategy. In probabilistic sensitivity analysis, screening at ages 10, 20, and 30 years was cost-effective in 41% of simulations and at ages 10 and 20 in 59% of simulations.

Conclusions:

Our model supports the American Heart Association/American College of Cardiology recommendation to screen patients with coarctation of the aorta for IA and suggests screening at ages 10 and 20 or at 10, 20, and 30 years would extend life and be cost-effective.
Gut Microbiota and Cardiovascular Disease
Authors: Witkowski Marco , Weeks Taylor L. , Hazen Stanley L.
Published: July 2020

Fecal microbial community changes are associated with numerous disease states, including cardiovascular disease (CVD). However, such data are merely associative. A causal contribution for gut microbiota in CVD has been further supported by a multitude of more direct experimental evidence. Indeed, gut microbiota transplantation studies, specific gut microbiota–dependent pathways, and downstream metabolites have all been shown to influence host metabolism and CVD, sometimes through specific identified host receptors. Multiple metaorganismal pathways (involving both microbe and host) both impact CVD in animal models and show striking clinical associations in human studies. For example, trimethylamine N-oxide and, more recently, phenylacetylglutamine are gut microbiota–dependent metabolites whose blood levels are associated with incident CVD risks in large-scale clinical studies. Importantly, a causal link to CVD for these and other specific gut microbial metabolites/pathways has been shown through numerous mechanistic animal model studies. Phenylacetylglutamine, for example, was recently shown to promote adverse cardiovascular phenotypes in the host via interaction with multiple ARs (adrenergic receptors)—a class of key receptors that regulate cardiovascular homeostasis. In this review, we summarize recent advances of microbiome research in CVD and related cardiometabolic phenotypes that have helped to move the field forward from associative to causative results. We focus on microbiota and metaorganismal compounds/pathways, with specific attention paid to short-chain fatty acids, secondary bile acids, trimethylamine N-oxide, and phenylacetylglutamine. We also discuss novel therapeutic strategies for directly targeting the gut microbiome to improve cardiovascular outcomes.
CD84 Links T Cell and Platelet Activity in Cerebral Thrombo-Inflammation in Acute Stroke
Authors: Schuhmann Michael K. , Stoll Guido , Bieber Michael , Vögtle Timo , Hofmann Sebastian , Klaus Vanessa , Kraft Peter , Seyhan Mert , Kollikowski Alexander M. , Papp Lena , Heuschmann Peter U. , Pham Mirko , Nieswandt Bernhard , Stegner David
Published: July 2020

Rationale:

Ischemic stroke is a leading cause of morbidity and mortality worldwide. Recanalization of the occluded vessel is essential but not sufficient to guarantee brain salvage. Experimental and clinical data suggest that infarcts often develop further due to a thromboinflammatory process critically involving platelets and T cells, but the underlying mechanisms are unknown.

Objective:

We aimed to determine the role of CD (cluster of differentiation)-84 in acute ischemic stroke after recanalization and to dissect the underlying molecular thromboinflammatory mechanisms.

Methods and Results:

Here, we show that mice lacking CD84—a homophilic immunoreceptor of the SLAM (signaling lymphocyte activation molecule) family—on either platelets or T cells displayed reduced cerebral CD4
+
T-cell infiltration and thrombotic activity following experimental stroke resulting in reduced neurological damage. In vitro, platelet-derived soluble CD84 enhanced motility of wild-type but not of
Cd84
−/−
CD4
+
T cells suggesting homophilic CD84 interactions to drive this process. Clinically, human arterial blood directly sampled from the ischemic cerebral circulation indicated local shedding of platelet CD84. Moreover, high platelet CD84 expression levels were associated with poor outcome in patients with stroke.

Conclusions:

These results establish CD84 as a critical pathogenic effector and thus a potential pharmacological target in ischemic stroke.
Atrial Myocyte NLRP3/CaMKII Nexus Forms a Substrate for Postoperative Atrial Fibrillation
Authors: Heijman Jordi , Muna Azinwi Phina , Veleva Tina , Molina Cristina E. , Sutanto Henry , Tekook Marcel , Wang Qiongling , Abu-Taha Issam H. , Gorka Marcel , Künzel Stephan , El-Armouche Ali , Reichenspurner Hermann , Kamler Markus , Nikolaev Viacheslav , Ravens Ursula , Li Na , Nattel Stanley , Wehrens Xander H.T. , Dobrev Dobromir
Published: July 2020

Rationale:

Postoperative atrial fibrillation (POAF) is a common and troublesome complication of cardiac surgery. POAF is generally believed to occur when postoperative triggers act on a preexisting vulnerable substrate, but the underlying cellular and molecular mechanisms are largely unknown.

Objective:

To identify cellular POAF mechanisms in right atrial samples from patients without a history of atrial fibrillation undergoing open-heart surgery.

Methods and Results:

Multicellular action potentials, membrane ion-currents (perforated patch-clamp), or simultaneous membrane-current (ruptured patch-clamp) and [Ca
2+
]
i
-recordings in atrial cardiomyocytes, along with protein-expression levels in tissue homogenates or cardiomyocytes, were assessed in 265 atrial samples from patients without or with POAF. No indices of electrical, profibrotic, or connexin remodeling were noted in POAF, but Ca
2+
-transient amplitude was smaller, although spontaneous sarcoplasmic reticulum (SR) Ca
2+
-release events and L-type Ca
2+
-current alternans occurred more frequently. CaMKII (Ca
2+
/calmodulin-dependent protein kinase-II) protein-expression, CaMKII-dependent phosphorylation of the cardiac RyR2 (ryanodine-receptor channel type-2), and RyR2 single-channel open-probability were significantly increased in POAF. SR Ca
2+
-content was unchanged in POAF despite greater SR Ca
2+
-leak, with a trend towards increased SR Ca
2+
-ATPase activity. Patients with POAF also showed stronger expression of activated components of the NLRP3 (NACHT, LRR, and PYD domains-containing protein-3)-inflammasome system in atrial whole-tissue homogenates and cardiomyocytes. Acute application of interleukin-1β caused NLRP3-signaling activation and CaMKII-dependent RyR2/phospholamban hyperphosphorylation in an immortalized mouse atrial cardiomyocyte cell-line (HL-1-cardiomyocytes) and enhanced spontaneous SR Ca
2+
-release events in both POAF cardiomyocytes and HL-1-cardiomyocytes. Computational modeling showed that RyR2 dysfunction and increased SR Ca
2+
-uptake are sufficient to reproduce the Ca
2+
-handling phenotype and indicated an increased risk of proarrhythmic delayed afterdepolarizations in POAF subjects in response to interleukin-1β.

Conclusions:

Preexisting Ca
2+
-handling abnormalities and activation of NLRP3-inflammasome/CaMKII signaling are evident in atrial cardiomyocytes from patients who subsequently develop POAF. These molecular substrates sensitize cardiomyocytes to spontaneous Ca
2+
-releases and arrhythmogenic afterdepolarizations, particularly upon exposure to inflammatory mediators. Our data reveal a potential cellular and molecular substrate for this important clinical problem.
Parallel Murine and Human Plaque Proteomics Reveals Pathways of Plaque Rupture
Authors: Vaisar Tomáš , Hu Jie H. , Airhart Nathan , Fox Kate , Heinecke Jay , Nicosia Roberto F. , Kohler Ted , Potter Zachary E. , Simon Gabriel M. , Dix Melissa M. , Cravatt Benjamin F. , Gharib Sina A. , Dichek David A.
Published: July 2020

Rationale:

Plaque rupture is the proximate cause of most myocardial infarctions and many strokes. However, the molecular mechanisms that precipitate plaque rupture are unknown.

Objective:

By applying proteomic and bioinformatic approaches in mouse models of protease-induced plaque rupture and in ruptured human plaques, we aimed to illuminate biochemical pathways through which proteolysis causes plaque rupture and identify substrates that are cleaved in ruptured plaques.

Methods and Results:

We performed shotgun proteomics analyses of aortas of transgenic mice with macrophage-specific overexpression of urokinase (SR-uPA
+/0
mice) and of SR-uPA
+/0
bone marrow transplant recipients, and we used bioinformatic tools to evaluate protein abundance and functional category enrichment in these aortas. In parallel, we performed shotgun proteomics and bioinformatics studies on extracts of ruptured and stable areas of freshly harvested human carotid plaques. We also applied a separate protein-analysis method (protein topography and migration analysis platform) to attempt to identify substrates and proteolytic fragments in mouse and human plaque extracts. Approximately 10% of extracted aortic proteins were reproducibly altered in SR-uPA
+/0
aortas. Proteases, inflammatory signaling molecules, as well as proteins involved with cell adhesion, the cytoskeleton, and apoptosis, were increased. ECM (Extracellular matrix) proteins, including basement-membrane proteins, were decreased. Approximately 40% of proteins were altered in ruptured versus stable areas of human carotid plaques, including many of the same functional categories that were altered in SR-uPA
+/0
aortas. Collagens were minimally altered in SR-uPA
+/0
aortas and ruptured human plaques; however, several basement-membrane proteins were reduced in both SR-uPA
+/0
aortas and ruptured human plaques. Protein topography and migration analysis platform did not detect robust increases in proteolytic fragments of ECM proteins in either setting.

Conclusions:

Parallel studies of SR-uPA
+/0
mouse aortas and human plaques identify mechanisms that connect proteolysis with plaque rupture, including inflammation, basement-membrane protein loss, and apoptosis. Basement-membrane protein loss is a prominent feature of ruptured human plaques, suggesting a major role for basement-membrane proteins in maintaining plaque stability.
Serum Activity Against G Protein–Coupled Receptors and Severity of Orthostatic Symptoms in Postural Orthostatic Tachycardia Syndrome
Authors: Kharraziha Isabella , Axelsson Jonas , Ricci Fabrizio , Di Martino Giuseppe , Persson Margaretha , Sutton Richard , Fedorowski Artur , Hamrefors Viktor
Published: July 2020

Background

Postural orthostatic tachycardia syndrome (POTS) is characterized by excessive heart rate increase on standing and orthostatic intolerance. Previous data indicate autoimmune involvement. We studied serum activity against G protein–coupled receptors in relation to symptoms in patients with POTS and controls using a commercial cell‐based assay.

Methods and Results

Forty‐eight patients with POTS (aged 28.6±10.5 years; 44 women) and 25 healthy individuals (aged 30.7±8.6 years; 21 women) were included. The 10‐item Orthostatic Hypotension Questionnaire (OHQ) was completed by 33 patients with POTS and all controls. Human embryonic kidney 293 cells overexpressing one G protein–coupled receptor: adrenergic α
1
receptor, adrenergic β
2
receptor, cholinergic muscarinic type 2 receptor, and opioid receptor‐like 1 were treated with sera from all patients. Receptor response was analyzed using a β‐arrestin–linked transcription factor driving transgenic β‐lactamase transcription by fluorescence resonance energy transfer method. Receiver operating characteristic curves were constructed. G protein–coupled receptor activation was related to OHQ indices in linear regression models. Sera from patients with POTS activated all 4 receptors to a higher degree compared with controls (
P
<0.01 for all). The area under the curve was 0.88 (0.80–0.97,
P
<0.001) combining all 4 receptors. Adrenergic α
1
receptor activation associated with OHQ composite score (β=0.77 OHQ points per SD of activity,
P
=0.009) and with reduced tolerability for prolonged standing (
P
=0.037) and walking for short (
P
=0.042) or long (
P
=0.001) periods. All 4 receptors were associated with vision problems (
P
<0.05 for all).

Conclusions

Our results indicate the presence of circulating proteins activating adrenergic, muscarinic, and nociceptin receptors in patients with POTS. Serum‐mediated activation of these receptors has high predictive value for POTS. Activation of adrenergic α
1
receptor is associated with orthostatic symptoms severity in patients with POTS.
The Multiple Dimensions of Multiple Determination
Authors: Coko Klodian
Published: July 2020

Multiple determination is the epistemic strategy of establishing the same result by means of multiple, independent procedures. It is an important strategy praised by both philosophers of science and practicing scientists. Despite the heavy appeal to multiple determination, little analysis has been provided regarding the specific grounds upon which its epistemic virtues rest. This article distinguishes between the various dimensions of multiple determination and shows how they can be used to evaluate the epistemic force of the strategy in particular cases. Distinguishing between the various dimensions helps to resolve the disagreements regarding the relevance and epistemic import of multiple determination for scientific research. It also suggests a fruitful mode of interaction between the philosophy of science and (historical) accounts of scientific practice.
Notes on some lesser known crickets of the tribe Podoscirtini (Podoscirtinae: Gryllidae: Orthoptera) from India
Authors: MEENA ASHOK KUMAR , SWAMINATHAN RAJAMANI , NAGAR RAJENDRA
Published: July 2020

The present paper deals with a description of two new species of crickets of the subfamily Podoscirtinae (Orthoptera: Gryllidae), Trelleora khasiana sp. nov. and Indotrella maculata sp. nov., from India; besides, some additional morphological characteristics of the already reported species, Indotrella angusta Gorochov, 2003 is also presented. The morphological characterization of these two new species is supported with suitable line diagrams and plates. A checklist of crickets of Podoscirtinae for the Asia-tropical region is included.
On the systematic status of Calliophis macclellandi nigriventer Wall, 1908 (Reptilia: Serpentes: Elapidae)
Authors: MIRZA ZEESHAN A. , VARMA VISHAL , CAMPBELL PATRICK D
Published: July 2020

Sinomicrurus macclellandi (Reinhardt, 1844) is a species of coral snakes distributed across the forests of Southeast Asia and the Himalayas. The species exhibits distinct forms across its range, and it has been classified into four subspecies. Calliophis macclellandi nigriventer Wall, 1908 a population from Western Himalayas, which was described as a variety, has not been attended to until now. Our study of a recently collected specimen from near Solan, Himachal Pradesh, India and existing museum material has allowed us to assess the validity of this population based on molecular and morphological data and has given us enough evidence to suggest its elevation to a species rank. Sinomicrurus nigriventer comb. nov. was found to be embedded within a clade comprising S. peinani, but not S. macclellandi s. l., with a genetic distance of 7–16% from its congeners. Morphologically, it differs from its congeners in having a reddish brown dorsum and a mid-dorsal black vertebral strip extending from the nape to the vent and with three thin bands on the tail, belly white with black smear up to the vent, tail dorsum with a few band-like blotches, and males with 230–235 ventral scales.
Multi-Class Skin Cancer Detection and Classification Using Hybrid Features Extraction Techniques
Authors: Masood Mahnoor , Iqbal Khalid , Khan Qasim , Alowayr Ali Saeed , Awan Khalid Mahmood , Saleem Muhammad Qaiser , Habib Elturabi Osman Ahmed
Published: July 2020

Skin cancer is measured as one of the fatal types of cancer diseases in humans, among numerous kinds of malignancy. Current diagnostic classifications are lacking in finding an effective treatment. The effective and early stage treatment of skin disease can increase the survival rate
of patients. Substantial investigative work has been developed to improve computer aided diagnosis system to detect cancer at early stage. However, early detection of skin cancer still requires better accuracy through experiment on digital skin lesion images as a multiclass classification,
rather than using biopsy methods. This paper presents an intelligent framework to detect and classify four types of skin cancer. Before classification, noise removal from skin lesion is performed by gaussian filter. Textural and colour features are extracted from skin lesion to detect and
classify cancer into four types. Support vector Machine is trained to classify Melanoma, Nevus, Basal and Squamous skin cancer types. Extensive experiments are performed on standard benchmark skin cancer images dataset with an improvement in accuracy of 92.41% after comparison with the well-known
methods.
Biological Data Classification and Analysis Using Convolutional Neural Network
Authors: Ahmad Iftikhar , Iqbal Muhammad Javed , Basheri Mohammad
Published: July 2020

The size of data gathered from various ongoing biological and clinically studies is increasing at an exponential rate. The bio-inspired data mainly comprises of genes of DNA, protein and variety of proteomics and genetic diseases. Additionally, DNA microarray data is also available
for early diagnosis and prediction of various types of cancer diseases. Interestingly, this data may store very vital information about genes, their structure and important biological function. The huge volume and constant increase in the extracted bio data has opened several challenges. Many
bioinformatics and machine learning models have been developed but those fail to address key challenges presents in the efficient and accurate analysis of variety of complex biologically inspired data such as genetic diseases etc. The reliable and robust process of classifying the extracted
data into different classes based on the information hidden in the sample data is also a very interesting and open problem. This research work mainly focuses to overcome major challenges in the accurate protein classification keeping in view of the success of deep learning models in natural
language processing since it assumes the proteins sequences as a language. The learning ability and overall classification performance of the proposed system can be validated with deep learning classification models. The proposed system can have the superior ability to accurately classify
the mentioned datasets than previous approaches and shows better results. The in-depth analysis of multifaceted biological data may also help in the early diagnosis of diseases that causes due to mutation of genes and to overcome arising challenges in the development of large-scale healthcare
systems.
An Efficient Retinal Vessels Biometric Recognition System by Using Multi-Scale Local Binary Pattern Descriptor
Authors: Malik Muhammad Sheraz Arshad , Zahra Qoseen , Khan Imran Ullah , Awais Muhammad , Qiao Gang
Published: July 2020

Biometric systems are technically used for human recognition by identifying the unique features of an individual. Many security issues are found related to biometric systems such as voice, fingerprints, face, iris, signatures, etc., but the retina is a unique and efficient method to
identify valid one. The aim of this paper is provided with an efficient method to recognize someone based on unique retina features. A proposed system based on retinal blood vessel pattern by using multi-scale local binary pattern (MSLBP) and random forest (Bagging tree) as feature extraction
and classification. MSLBP is an efficient method to extracted features at six scales perpixel level, earlier work found the deficiency based on simple binary pattern with coverage of small areas and per-pixel level in the surrounding. MSLBP and random forest classifier suggested approach use
for improving usability, perceivability, and sensitivity on large scale areas. It is the fastest method to get features accurately in an efficient way at every level of pixels. This method based on deep learning evaluation (criteria) parameter selection that provides more significant influence
with sharp feature extraction on large scale areas based on seconds and improves the efficiency of images. MSLBP overcomes the problem of image sizing, pixel levels and efficiently provide accurate results.
A Feature-Based Evaluation of Model Merge Methods for e-Health Solutions
Authors: Mehmood Waqar , Shafiq Muhammad , Saleem Muhammad Qaiser , Alowayr Ali Saeed , Aslam Waqar
Published: July 2020

Model-driven engineering (MDE) paradigm considers models as central artifacts for software development lifecycle during which models evolve. Developing an e-health solution using MDE poses challenges of model version control, model differencing and model merging, which requires appropriate
software configuration management (SCM). In this paper we focus on model-driven merging, which refers to combining two or more versions of a model into a single consolidated version. SCM for model-driven merging leverages evolution of valid configurations, which is a highly desired behavior.
Our investigation is based on the features that are required for model-driven SCM realization. Initially, we identify these features using which the existing model-driven merging techniques are evaluated. It is observed that though various proposals are made by academia and research community,
a standard model-driven SCM solution that can cater to the needs of industry is still absent. This is in contrary to the situation of traditional SCM systems where standard solutions exist. We also present the usefulness of each technique along with the tradeoffs involved. Finally, guidelines
are provided to select techniques appropriate for given circumstances.
Punctuated temporalities: Temporal borders in student-migrants’ everyday lives
Authors: Maury Olivia
Published: July 2020

The punctuation of time through visas and residence permits intimately affects temporary migrants’ everyday lives. The temporal forms of control engendered through the global border and visa regime and their impact on fragmenting lived time have received little attention in comparison to the extensively studied spatial aspects of migration, particularly in the research context of mobility conceptualised as skilled migration. By drawing on in-depth interviews with migrants holding a temporary student status in Finland, the article examines the ways in which temporal borders bring about punctuated temporalities among non-EU/EEA student-migrants. Moreover, it demonstrates how the time limits of the student permit offer fruitful ground for the production of a low-paid labour force and how temporal borders assist in hierarchising this labour force in terms of mobility and rights. The article contributes to the sociological literature on migration and precarious labour markets by emphasising the analytical relevance of examining temporal borders as engendering a hierarchising function of the border regime and the role of temporal borders in facilitating the production of precarious migrant labour.
Post-traumatic embitterment symptoms among woman victims of February 28th post-modern coup of Turkey after two decades: A comparative cross-sectional study
Authors: Görmez Aynur , Yeni Elbay Rümeysa , Karatepe Hasan Turan
Published: July 2020

Background:

Post-traumatic embitterment disorder (PTED) is characterized by embitterment reaction to stressful life events, which are seen as unjust and as a violation of basic beliefs. On 28 February 1997, a so-called post-modern coup took place in Turkey, declaring a ban on hijab which had a significant impact on women’s lives by eliminating them from public sphere if they were to wear hijab.

Aim:

The aim of this study was to assess the frequency of PTED symptoms among woman victims of the coup after two decades, and to investigate its correlations. Embitterment reaction was also examined in woman victims of 1999 earthquakes of Turkey, and the findings were compared.

Method:

We used PTED, Beck Anxiety Inventory, Beck Depression Inventory and Brief Resilience Scale, and a purpose-designed socio-demographic form.

Results:

Out of eligible 101 hijab ban victims responded, substantial proportion of them (48%) were suffering from chronic embitterment as well as experiencing symptoms of anxiety (37.6%) and depression (26.8%) of moderate-to-severe intensity. There was no difference in the levels of anxiety, depression and resilience between the victims of the coup and earthquake ( N = 20), but hijab ban victims were significantly more likely to present with PTED symptoms ( p < .05). Women who had family support were more resilient with less likelihood of PTED ( p < .05).

Conclusion:

This study provides some important insights into psychopathology of PTED as well as suggesting that it is more likely to manifest in people whose suffering is brought upon by fellow human beings.
Two-level simulation approach to evaluate the performance of autonomous wheelchairs in a hospital
Authors: Castilla-Rodríguez Iván , Arnay Rafael , Rodríguez Raquel , Rodríguez Jonel
Published: July 2020

In this paper, we present the combined usage of two different simulation levels to evaluate the economic and quality-of-service impact of deploying a fleet of autonomous wheelchairs in a hospital. The first simulation level deals with the physical world and takes into account the characteristics of a real robot, such as dimensions, sensor configuration, and speed. We simulate different trajectories in order to obtain realistic transportation times that are subsequently used in the high-level simulation. This high-level simulation considers those hospital resources that are affected by the inclusion of automated wheelchairs, and computes the economic implications of partially or totally substituting the current fleet of manual wheelchairs. Our results show that switching to automated wheelchairs may be beneficial in terms not only of reduced waiting times for patients, but also of economic savings.
Melioidosis: distinctive clinico-epidemiological characteristics in southern India
Authors: Basheer Aneesh , Iqbal Nayyar , C Sheeladevi , Kanungo Reba , Kandasamy Ravichandran
Published: July 2020

As it is increasingly being reported from India, we carried out a prospective study of patients with culture-proven melioidosis from south India, examining clinical, laboratory features, epidemiological data, risk factors, treatments, outcomes at three and six months, and factors associated with mortality.

Between 2014 and 2018, 31 cases were identified. Diabetes (83.9%) and alcohol abuse (58.1%) were common risk factors. Musculoskeletal, skin and soft tissue manifestations together constituted 48.4% of presentations, while 29% had pneumonia. During the intensive phase, 74.2% received one of three recommended antibiotic regimes, but 51.6% did not receive continuation treatment. Pneumonia and lack of continuation treatment were independently associated with a high mortality of 25.8%. Hot spots for melioidosis exist in India, and there is considerable diversity of presentation, including skin, soft tissue, musculoskeletal and neurological involvement. High rates of bacteraemia are shown.
Three Alternatives for Graphing Behavioral Data: A Comparison of Usability and Acceptability
Authors: Kinney Chad E. L. , Begeny John C. , Stage Scott A. , Patterson Sierra , Johnson Amirra
Published: July 2020

Making treatment decisions based upon graphed data is important in helping professions. A small amount of research has compared usability between equal-interval and semi-log graphs, but no prior studies have compared different types of semi-log graphs. Using a randomized, cross-over, experimental design with 72 participants, this study examined the relative usability and acceptability of three types of graphs: Regular (equal-interval), Standard Celeration Chart (SCC; semi-log), and Standard Behavior Graph (SBG; semi-log). All participants used each graph across three usability tasks (Plotting Data, Writing Values, and Interpreting Trends). For the Plotting and Writing tasks, the equal-interval graph produced the greatest rate of correct responses. However, for the Interpreting task the SBG produced the greatest rate of corrects, while the equal-interval graph produced the smallest rate. User acceptability mainly favored the equal-interval and SBG graphs. Study findings and implications are discussed with respect to graph usability and acceptability during day-to-day practice.
The Pecking Order and Financing Decisions: Evidence From Changes to Financial-Reporting Regulation
Authors: Naranjo Patricia , Saavedra Daniel , Verdi Rodrigo S.
Published: July 2020

We use the staggered introduction of a major financial-reporting regulation worldwide to study whether firms make financing decisions consistent with the pecking order theory. Exploiting cross-country and within country-year variation, we document that treated firms increase their issuance of external financing (and ultimately increase investment) after the new regime. Furthermore, firms make different leverage decisions (debt vs equity) around the new regulation depending on their ex-ante debt capacity, which allows them to adjust their capital structure. Our findings highlight the importance of the pecking order theory in explaining financing as well as investment policies.
How do academia and society react to erroneous or deceitful claims? The case of retracted articles’ recognition
Authors: Sotudeh Hajar , Barahmand Nilofar , Yousefi Zahra , Yaghtin Maryam
Published: July 2020

Researchers give credit to peer-reviewed, and thus, credible publications through citations. Despite a rigorous reviewing process, certain articles undergo retraction due to disclosure of their ethical or scientific deficiencies. It is, therefore, important to understand how society and academia react to the erroneous or deceitful claims and purge the science of their unreliable results. Applying a matched-pairs research design, this study examined a sample of medicine-related retracted and non-retracted articles matched by their content similarity. The regression analysis revealed similarities in obsolescence trends of the retracted and non-retracted groups. The Generalized Estimating Equations showed that citations are affected by the retraction status, life after retraction, life cycle and the journals’ previous reputation, with the two formers being the strongest in positively predicting the citations. The retracted papers obtain fewer citations either before or after retraction, implying academia’s watchful reaction to the low-quality papers even before official announcement of their fallibility. They exhibit an equal or higher social recognition level regarding Tweets and Blog Mentions, while a lower status regarding Mendeley Readership. This could signify social users’ sensibility regarding scientific quality since they probably publicise the retraction and warn against the retracted items in their tweets or blogs, while avoiding recording them in their Mendeley profiles. Further scrutiny is required to gain insight into the sensibility, if any, about scientific quality. The study’s originality relies on matching the retracted and non-retracted papers with their topics and neutralising variations in their citation potentials. It is also the first study comparing the groups’ social impacts.
Beyond cold feet: Experiences of ending engagements and canceling weddings
Authors: Monk J. Kale , Kanter Jeremy B. , Jamison Tyler B. , Russell Luke T.
Published: July 2020

The engagement period is a critical window to understand stay–leave decisions because it marks a stage when individuals are moving toward lifelong commitment, but do not have the obligations of legal marriage that make dissolution more difficult. According to Inertia Theory, felt momentum can propel couples through relationship transitions without sufficient consideration of their dedication, which could constrain partners in poor quality relationships. Drawing from this perspective, we examined how individuals reduce relationship momentum and end a marital engagement. We conducted interviews with individuals who made the decision to end their engagements and cancel their weddings ( N = 30). Experiences were analyzed using grounded theory techniques. The core concept we identified, visualizing, consisted of imagining a relational future (or alternative present) that became heightened during the engagement period. Rituals of wedding planning (e.g., trying on a dress and selecting a venue) appear to serve as a catalyst for this process. This cognitive shift prompted individuals to slow relational momentum (e.g., through trial separations and the returning of rings) and reconsider “red flags” and constraints to leaving the relationship. Once participants decided to leave, they described the process of breaking off the engagement and uncoupling from their partners. Family members and friends who assisted in managing the emotional fallout and logistics of ending the engagement (e.g., canceling with vendors and informing guests) were reported as particularly helpful supports. Visualizing married life beyond the wedding may be leveraged to help individuals navigate premarital doubts.
Management of HER2-positive breast cancer during pregnancy: a case report
Authors: Berwart Julia , Buonomo Barbara , Peccatori Fedro A. , Marioni Anabel , Lescano Juliana , Pressel Coretto Emilia
Published: July 2020

Introduction:

Breast cancer is one of the most common malignancies diagnosed during pregnancy, with an incidence of 1:3000 pregnancies. Its rising incidence is related to the trend to postpone childbearing during the last 30 years. Breast cancer during pregnancy should not be managed differently from the nonpregnant setting. Chemotherapy is reported to be safe after the first trimester, whereas trastuzumab and tamoxifen are contraindicated regardless of the trimester.

Case description:

A patient diagnosed with breast cancer recurrence during pregnancy was exposed to both tamoxifen and trastuzumab during the first two trimesters of pregnancy. In addition, docetaxel was administered during the second and third trimesters, without subsequent fetal malformations or obstetric complications.

Conclusions:

When conception occurs inadvertently during assumption of tamoxifen or anti-HER2 agents, their effects on the fetus and on the course of pregnancy are not completely understood. Further studies are needed in this setting, highlighting the importance to share clinical experiences.
Predictors of Severe Intimate Partner Violence Among Antisocial and Family-Only Perpetrators: Victims’ and Offenders’ Characteristics
Authors: Aguilar Ruiz Raúl , González-Calderón María José
Published: July 2020

The objective of this study was to determine the variables that predict severe intimate partner violence (S-IPV) according to the typology of abusers. The data were derived from 1,610 police reports on intimate partner violence (IPV) in Catalonia (Spain) between 2016 and 2017 obtained through the Police Risk Assessment Questionnaire. The study has compared a group of antisocial aggressors ( n = 613) with a group of family-only perpetrators ( n = 997). The chi-square test shows significant differences between antisocial and family-only groups for most of the variables analyzed. To determine the predictive variables of S-IPV in both groups, binary regression analyses were performed. In the antisocial group, death threats and degrading treatment by the aggressor significantly increased the probability of S-IPV, as did the victim’s minimization or justification of the abuse, living together with the aggressor, isolation, and drug or alcohol abuse. In the family-only group, an increase in the severity of the abuse and death threats against partners significantly increased the likelihood of perpetrating S-IPV. For the victims, being abused by a previous partner and fear for her physical integrity were found to increase the probability of suffering S-IPV. On the other hand, having filed a prior complaint appears to protect women from S-IPV, but only when the victims have antisocial perpetrators. The findings show that S-IPV risk factors are common regardless of the sociocultural context. Modifying the weighting of the factors that make up the risk assessment tools according to the typology of the abuser is suggested, as well as improving knowledge of these factors to increase the accuracy of the estimated risk. Finally, adapting supervision and monitoring measures according to the type of aggressor and taking into consideration the woman’s own perception of the danger she is in are also suggested.
Impact of time-varying center volume on technique failure and mortality in peritoneal dialysis
Authors: Yao Yen-Hung , Chen Chyong-Mei , Chou Yiing-Jenq , Huang Nicole
Published: July 2020

Background:

Most studies on volume–outcome association used the number of patients at a particular period as the independent variable. However, peritoneal dialysis (PD) is a chronic treatment, and center volume usually changes over a patient’s treatment period. Accordingly, this study used the time-varying center volume to explore the volume–outcome association in PD.

Methods:

We conducted a nationwide population-based retrospective cohort study, which included patients who began chronic PD between 2001 and 2010. The risk factors of 5-year technique failure and mortality were analyzed using cause-specific and subdistribution hazard models, respectively. The annual number of patients initiating PD in each patient’s treatment center was modeled as a time-varying variable with four categories.

Results:

We included 9071 patients who started PD in 100 centers where the number of incident patients ranged from 1 to 107 patients per year (median, 25; interquartile range, 13–42). The estimated 5-year patient and technique survival rates were 64.7% and 66.6%, respectively. Being treated in centers in the largest volume category (the number of incident PD patients ≥43 per year) was associated with significantly lower cause-specific and cumulative hazards for technique failure. No association was found between facility volume and hazards of mortality.

Conclusions:

Receiving PD in high-volume facilities was associated with a lower risk in technique failure. No association was found between facility volume and mortality risk.
Comparison of Individual Tissue-Engineered Bones and Allogeneic Bone in Treating Bone Defects: A Long-Term Follow-Up Study
Authors: Yang Peng , Zhou Jiangling , Ai Qiuchi , Yu Bo , Deng Moyuan , Luo Fei , Xie Zhao , Xing Junchao , Hou Tianyong
Published: July 2020

The treatment of bone defects has always been a challenge for orthopedic surgeons. The development of tissue engineering technology provides a novel method for repairing bone defects and has been used in animal experiments and clinical trials. However, there are few clinical studies on comparing the long-term outcomes of tissue-engineered bones (TEBs) and other bone grafts in treating bone defects, and the long-term efficiency of TEBs remains controversial. Therefore, a study designed by us was aimed to compare the long-term efficacy and safety of individual tissue-engineered bones (iTEBs) and allogeneic bone granules (ABGs) in treating bone defects caused by curettage of benign bone tumors and tumor-like lesions. From September 2003 to November 2009, 48 patients who received tumor curettage and bone grafting were analyzed with a mean follow-up of 122 mo (range 60 to 173 mo). Based on implant style, patients were divided into groups of iTEBs ( n = 23) and ABGs ( n = 25). Postoperatively, the healing time, healing quality, incidence of complications, and functional scores were compared between the two groups. The Musculoskeletal Tumor Society functional evaluation system and Activities of Daily Living Scale scores were significantly improved in both groups with no significant difference. The average healing time of ABGs was longer than that of iTEBs ( P < 0.05). At the final follow-up, iTEBs had a better performance in the bone healing quality evaluated by modified Neer classification ( P < 0.05). In the group of iTEBs, the complication and reoperation rate was lower than that in the group of ABGs, with no tumorigenesis or immune rejection observed. In summary, for treating bone defects caused by tumor curettage, iTEBs were safe, effective, and tagged with more rapid healing speed, better healing outcome, and lower complication and reoperation rate, in comparison with ABGs.
Effects of using standardized patients on nursing students’ moral skills
Authors: Kucukkelepce Gulhan Erkus , Dinc Leyla , Elcin Melih
Published: July 2020

Background:

Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills.

Aim:

This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students’ moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses.

Research design:

This is a quasi-experimental study.

Participants and research context:

The sample comprised 89 students in Hacettepe University’s Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest’s Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23.

Ethical considerations:

Ethical approval and official permission were obtained. All participating students completed informed consent forms.

Findings:

According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant.

Conclusion:

Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education.
Ethics reflection groups for school nurses
Authors: Heggestad Anne Kari Tolo , Førde Reidun , Magelssen Morten , Arnekleiv Birgit
Published: July 2020

Background:

School nurses have great responsibilities as the connecting link between school, children/adolescents, parents, and other healthcare services. Being in this middle position, and handling complex situations and problems related to children in school, may be demanding and also lead to ethical challenges. Clinical ethics support, such as ethics reflection groups, may be of help when dealing with ethical challenges. However, there is little research on experiences with ethics reflection groups among school nurses.

Aim:

The aim of this research was to explore how nurses in school healthcare experience their role, and how they experience participation in ethics reflection groups, using a model for systematic ethics reflection, the Centre for Medical Ethics model.

Research design:

The project had a qualitative design, using focus group interviews and thematic analysis.

Ethical considerations:

The study was evaluated by the Data Protection Official at the Norwegian Centre for Research Data (project no. 57373). The participants were given oral and written information about the study and signed a written consent.

Participants and context:

Twelve participants from school healthcare were recruited to the interviews.

Findings:

School nurses described their role as extremely challenging. How the school nurses experienced their role also influenced how they experienced participating in ethics reflection groups. The Centre for Medical Ethics model was experienced as both challenging and comprehensive. However, they also experienced that the model helped them to clarify their role and could also help them to find better solutions.

Conclusion:

The role as school nurse is complex and demanding, with several ethical challenges. Ethics reflection groups may be of great help when dealing with these challenges. However, it is of great importance that the methods used are adjusted to the professionals’ needs and context.
Health Care–Seeking Behavior of Children With Acute Respiratory Infections Symptoms: Analysis of the 2012 and 2017 Indonesia Demographic and Health Surveys
Authors: Titaley Christiana Rialine , Que Bertha J. , de Lima Filda V. I. , Angkejaya Ony W. , de Lima Felmi V. I. , Maelissa Merlin M. , Latuconsina Vina Z. , Taihuttu Yuniasih M. J. , van Afflen Zadrach , Radjabaycolle Jefri E. T. , Mutyara Kuswandewi , Agustian Dwi , Atik Nur
Published: July 2020

Our study examined factors associated with the utilization of health services in children younger than 5 years with acute respiratory infections (ARIs) symptoms in Indonesia. Data were derived from the 2012 and 2017 Indonesia Demographic and Health Survey. Information from 1408 children younger than 5 years showing ARI symptoms in the past 2 weeks before the survey was analyzed using logistic regression analyses. Around 25% of children younger than 5 years with ARI symptoms did not receive medical care. The odds of receiving care increased in mothers from rich households. The odds reduced in children aged 2 or more years; children of mothers not assisted by trained delivery attendants; mothers attending none or <4 antenatal visits; mothers delivering at home, and mothers reporting that permission to visit health services was a problem. Efforts to improve care-seeking behavior are required. Health promotion strategies and interventions to improve access to reach community not regularly exposed to health services are important.
Actionable 10: A Checklist to Boost Mathematics Teaching for Students With Learning Disabilities
Authors: Park Soyoung , Bryant Diane Pedrotty , Dougherty Barbara
Published: July 2020

This article presents a checklist of 10 evidence-based practices for educators to apply in mathematics instruction for students with learning disabilities. The checklist is “actionable,” meaning the items on the checklist can be put into action immediately. It provides practical strategies teachers can adopt to fit their lessons regardless of their specific mathematical domain areas or student grade level. The focus of this article is translating research of evidence-based strategies into practice for mathematics instruction.