bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Level of Thrombotic Biomarkers in Patients with Atrial Fibrillation Despite Traditional and New Anticoagulant Therapy
Authors: Liles Jeffrey , Liles Jordan , Wanderling Christopher , Syed Mushabbar , Hoppensteadt Debra , Fareed Jawed
Published: May 2016

The aim of this study was to examine the effect of the traditional oral anticoagulant, warfarin (W), and new anticoagulants, apixaban (A) and rivaroxaban (R), on the level of thrombotic biomarkers in patients with atrial fibrillation (AF). Circulating plasma levels of von Willebrand factor (vWF), prothrombin fragment 1.2 (F1.2), microparticle tissue factor (MP-TF), and plasminogen activator inhibitor (PAI-1) were analyzed as potential markers of clot formation in 30 patients with AF prior to ablation surgery. Patients with AF were divided into 2 groups based on their usage (n = 21) and nonusage (n = 9) of any oral anticoagulant. Furthermore, those on anticoagulants were divided based on their use of newer (R and A, 16) or traditional (W, 4) anticoagulants. A statistical increase ( P < .05) in the levels of vWF, MP-TF, and PAI-1 were seen in anticoagulated patients with AF, whereas F1.2 and PAI-1 were increased in nonanticoagulated patients with AF compared to normal. There was no statistical difference ( P > .05) in levels of any thrombotic biomarker between patients treated with the traditional anticoagulant, W, and those treated with new anticoagulants, R and A. Our data suggest that, despite the use of traditional or newer anticoagulants, prothrombotic biomarkers are still generated at increased levels in patients with AF. Further studies to confirm these findings are warranted.
Fractionalization and Economic Freedom
Authors: Heckelman Jac C. , Wilson Bonnie
Published: May 2016

Diversity is often thought to create conflict and harm economic institutions. We hypothesize, however, that the impact of diversity on economic institutions is conditional on political institutions, and may be negative in some settings but positive in others, due to differences in the nature of rent seeking in different regimes. To test this hypothesis, we estimate the impact of ethnic and linguistic fractionalization on economic freedom, conditional on the level of political rights. We find that the marginal impact of ethnic and linguistic fractionalization on economic freedom is positive in the most democratic nations and that the marginal impact of ethnic fractionalization is negative in the most autocratic nations. Our results suggest that the nature of the relation between diversity and economic institutions may be more complicated than prior literature conveys.
Assessment of platelet function in healthy cats in response to commonly prescribed antiplatelet drugs using three point-of-care platelet function tests
Authors: Ho Kimberly K , Abrams-Ogg Anthony CG , Wood R Darren , O’Sullivan M Lynne , Kirby Gordon M , Blois Shauna L
Published: May 2016

Objectives

The objective was to determine if decreased platelet function could be detected after treatment with aspirin and/or clopidogrel in healthy cats using three point-of-care platelet function tests that evaluate platelet function by different methods: Multiplate (by impedance), Platelet Function Analyzer 100 (by mechanical aperture closure) and Plateletworks (by platelet counting).

Methods

Thirty-six healthy cats were randomly assigned to receive one of three oral treatments over an 8 day period: (1) aspirin 5 mg q72h; (2) aspirin 20.25 mg q72h; or (3) clopidogrel 18.75 mg q24h. Cats treated with 5 and 20.25 mg aspirin also received clopidogrel on days 4–8. Platelet aggregation in response to adenosine diphosphate and collagen ± arachidonic acid was assessed on days 1 (baseline), 4 and 8. Aspirin and clopidogrel metabolites were measured by high-performance liquid chromatography. Platelet function in response to treatment was analyzed by ANCOVA, linear regression and Spearman correlation.

Results

The only solitary aspirin effect was detected using Plateletworks with collagen in cats treated with 20.25 mg. The only effect detected by Multiplate was using arachidonic acid in cats treated with both aspirin 20.25 mg and clopidogrel. All clopidogrel treatment effects were detected by Platelet Function Analyzer 100, Plateletworks (adenosine diphosphate) and Plateletworks (collagen). Drug metabolites were present in all cats, but concentrations were minimally correlated to platelet function test results.

Conclusions and relevance

Platelet Function Analyzer 100 and Plateletworks using adenosine diphosphate ± collagen agonists may be used to detect decreased platelet function in response to clopidogrel treatment. Either aspirin is not as effective an antiplatelet drug as clopidogrel, or the tests used were not optimal to measure aspirin effect. Cats with heart disease are commonly prescribed antiplatelet drugs to decrease the risk of aortic thromboembolism. Platelet Function Analyzer 100 and Plateletworks may be useful for confirming clopidogrel treatment in these cats.
Elevated CSF neurofilament proteins predict brain atrophy: A 15-year follow-up study
Authors: Petzold Axel , Steenwijk Martijn D , Eikelenboom Judith M , Wattjes Mike P , Uitdehaag Bernard MJ
Published: May 2016

Background:

Body fluid and structural imaging biomarkers give information on neurodegeneration. The relationship over time is not known in multiple sclerosis.

Objective:

To investigate the temporal relationship of elevated cerebrospinal fluid (CSF) neurofilament (Nf) protein levels, a biomarker for axonal loss, with magnetic resonance imaging (MRI) atrophy measures.

Methods:

In patients with multiple sclerosis, CSF Nf heavy chain (NfH) phosphoform levels were quantified at baseline and dichotomised into ‘normal’ and ‘high’. Atrophy was assessed by MRI at baseline and 15-year follow-up using SIENAX and FreeSurfer software.

Results:

High baseline CSF NfH SMI35 levels predicted pronounced atrophy at 15-year follow-up (odds ratio (OR): 36, p < 0.01), in the absence of baseline brain atrophy (OR: 28, p < 0.05), for the averaged MRI normalised brain volume (1.44 L vs 1.33 L, p < 0.05), normalised grey matter volume (0.77 L vs 0.69 L, p < 0.01) and putamen (12.7 mL vs 10.7 mL, p < 0.05). Region-specific calculations including the spinal cord showed that a power of >80% is reached with 14–50 patients.

Conclusion:

These data suggest that high CSF NfH levels are an early predictor of later brain and spinal cord atrophy using structural imaging biomarkers and can be investigated in reasonably sized patient cohorts.
The four stages of on-site behavior for a long-stay relaxation holiday
Authors: Anantamongkolkul Chidchanok , Butcher Ken , Wang Ying
Published: May 2016

Previous studies largely treat the on-site travel experience as a single stage of homogenous tourist behavior, despite widespread recognition that tourist behavior is complex and consists of temporal decision processes. In particular, little attention has been given to what changes during the course of the long-stay holiday. The purpose of this exploratory study is to understand changes in tourist behavior, if any, from point of arrival through to the end of a long-stay relaxation holiday. In-depth interviews were conducted with mature-aged international travelers from the United States, Europe, and Australia visiting Phuket, Thailand. The findings illustrate changes that can be characterized, into four distinct stages of on-site behavior, through key activities, uncertainty levels, intercultural interactions, information needs, and sources of information. Important implications for destination marketing organizations are suggested which require innovative strategies to match the changing needs and activities of long-stay tourists at various stages of the holiday.
Re-segmenting a gaming destination market
Authors: Li Jun (Justin) , Wong IpKin Anthony , Kim Woo Gon
Published: May 2016

The so-called ‘Monte Carlo of the Orient’, Macau, has an economy that relies heavily on gambling. By 2006, Macau’s gambling revenue had exceeded that of Las Vegas. Mainland Chinese gamblers are a major source of customers for many Macau casinos. However, the nationwide crackdown on corruption in China has resulted in a tremendous revenue decrease in Macau. As a result, tourist managers need to learn how to adapt to these new changes and begin to segment tourists markets and address the different market segments more systematically by providing a varied range of services. This study aims to gain insight into Mainland Chinese travelers and to categorize these travelers according to their motivations. Three clusters of tourists emerged: ‘freedom seekers’, ‘multipurpose seekers,’ and ‘entertainment and gambling seekers’. Each cluster had a different sociodemographic profile and assessment regarding the gambling destination attributes. To attract tourists from these heterogeneous categories, managers should incorporate the corresponding responses into their marketing strategies.
Perception and experience of urban areas for cultural tourism: A social constructivist approach in Covent Garden
Authors: Guachalla Adrian
Published: May 2016

Covent Garden is firmly established in London’s tourism landscape due to its commercial sector, distinctive architecture and provision of different forms of performing arts including the UK’s leading Opera House at its core. This study aims to understand the factors that shape the tourists’ perception and experience of this long standing urban precinct and the influence that the Royal Opera House exerts on these processes. It contributes to the understanding of how a well-established area is perceived and experienced by tourists exposed to a range of stimulating factors including a cultural flagship for the performing arts. A social constructivist approach was adopted to address this complex area of study from a non-foundational perspective. A total of 306 semi-structured interviews were conducted in a variety of locations revealing that age and nationality are fundamental elements underpinning the tourists’ perception and experience of place leading to a process of cultural appraisal.
Enhancing community participation in tourism planning associated with protected areas in developing countries: Lessons from Malawi
Authors: Bello Felix G , Lovelock Brent , Carr Neil
Published: May 2016

Most studies on community participation in tourism planning only advocate the importance of the concept and/or identify barriers without articulating the required actions or strategies to actually promote community participation. Based on a study in two protected areas in Malawi, this paper identifies and discusses possible strategies that can enhance community participation in tourism planning associated with protected areas in developing countries. Data were collected through in-depth interviews and focus group discussions. The study participants were from protected area management agencies, government departments, non-governmental organisations, tourism operators and the local population surrounding the two protected areas. The findings suggest the need for a rethink on how local communities around protected areas are involved in tourism planning in developing country contexts. Six strategies emerged as major prerequisites to achieve full and active community participation: public awareness and education; capacity building; creation of linkages; use of appropriate participation methods; involvement of appropriate local community organisations and decentralisation and coordination of relevant management organisations.
The GoPro gaze
Authors: Vannini Phillip , Stewart Lindsay M
Published: May 2016

During 2014–2015, we produced a short video documentary, titled The Art of Wild, which focused on the audiovisual practices of outdoor adventurers. This short written report reflects on an idea inspired by the video: the GoPro gaze. Enacted by increasingly sophisticated, portable and affordable recording audiovisual technologies such as the GoPro Hero camera, the ‘GoPro gaze’ entails not just the pursuit of pleasures derived from adventure and nature-based travel, but also the production and distribution of professional-quality independent videos for Internet audiences. Based on a series of ‘go-along’ interviews with adventure travelers/athletes/artists, this article and the accompanying video prompt us to reflect on how the affective pleasures and technological affordances of the ‘GoPro gaze’ trouble the established idea of the ‘tourist gaze’.
A robust extension to the triple plane pressure mode matching method by filtering convective perturbations
Authors: Wohlbrandt Attila , Weckmüller Christian , Guérin Sébastien
Published: May 2016

Time-periodic computational fluid dynamics simulations are widely used to investigate turbomachinery components. The triple plane pressure mode matching method developed by Ovenden and Rienstra extracts the acoustic part in such simulations. Experience shows that this method is subject to significant errors when the amplitude of pseudo-sound is high compared to sound. Pseudo-sounds are unsteady pressure fluctuations with a convective character. The presented extension to the triple plane pressure improves the splitting between acoustics and the rest of the unsteady flow field. The method is simple: (i) the acoustic eigenmodes are analytically determined for a uniform mean flow as in the original triple plane pressure mode matching method; (ii) the suggested model for convective pressure perturbations uses the convective wavenumber as axial wavenumber and the same orthogonal radial shape functions as for the acoustic modes. The reliability is demonstrated on the simulation data of a low-pressure fan. As acoustic and convective perturbations are separated, the accuracy of the results increases close to sources, allowing a reduction of the computational costs by shortening the simulation domain. The extended method is as robust as the original one–giving the same results for the acoustic modes in absence of convective perturbations.
Numerical assessment of the tonal noise of Counter-Rotating Open Rotors at approach
Authors: Soulat Laurent , Kernemp Irwin , Sanjose Marlène , Moreau Stéphane , Fernando Rasika
Published: May 2016

A hybrid method combining a three-dimensional unsteady Reynolds-Averaged Navier–Stokes simulation of a cropped Counter-Rotating Open Rotors at approach conditions and an acoustic analogy either based on a time formulation, an advanced-time formulation of Ffowcs-Williams and Hawkings’ analogy, or on a frequency formulation, an extension of Hanson’s model to non compact chord length, has shown three main sources, the impacts of the front-rotor wakes on the aft-rotor, of the front-rotor tip vortex on the aft-rotor tip, and of the front-rotor hub horse-shoe vortex on the aft-rotor blade foot. Consequently, this study confirms that the aft-rotor is the dominant tonal noise source and has identified another potential noise source when the Counter-Rotating Open Rotors is installed caused by the strong tip vortex of the highly loaded cropped aft-rotor. The present rotor–rotor distance should not be reduced as the potential effect from the aft rotor is already felt on the front rotor. The influence of several numerical parameters including grid refinement, data sampling, and simulation length has been evaluated on both aerodynamic and acoustic performances.
One-Year Outcomes of Endovascular Aneurysm Repair in High-Risk Patients Using the Endurant Stent-Graft
Authors: Dijkstra Martijn L. , van Sterkenburg Steven M. M. , Lardenoye Jan-Willem , Zeebregts Clark J. , Reijnen Michel M. P. J. ,   for the ENGAGE Investigators
Published: May 2016

Purpose: To evaluate the outcome and survival of patients with extensive comorbid conditions after endovascular aneurysm repair (EVAR) and objectify which of 2 medical comorbidity classifications is more accurate in predicting adverse outcomes. Methods: All 1263 patients (mean age 73.1 years; 1129 men) treated using the Endurant Stent Graft system and entered in the prospective global postmarketing ENGAGE registry ( ClinicalTrials.gov identifier NCT00870051) were grouped using the American Society of Anesthesiologists (ASA) classification and the Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) medical comorbidity grading system. Patients assigned to ASA III and IV and SVS/AAVS 2 and 3 categories were considered high risk. Primary outcome was 1-year all-cause mortality. Secondary outcomes included technical and clinical success, major adverse events (MAE), aneurysm rupture, endoleaks, and secondary endovascular procedures. One-year follow-up of the entire ENGAGE cohort was the endpoint of the study. Results: A total of 1263 patients were included. The overall technical success rate was high, the lowest being 97.4% in the ASA I group. The overall 30-day and 1-year Kaplan-Meier survival estimates were 98.7% and 92.5%, respectively. All cause 1-year mortality was higher in the ASA III and IV groups, but this did not reach statistical significance (5.2% and 5.7% for ASA I and II vs 9.0% and 9.9% for ASA III and IV, p=0.12). In the SVS/AAVS groups, 1-year all-cause mortality significantly increased with the SVS/AAVS score to 11.3% in the SVS/AAVS 3 group (p=0.002). There were significantly more MAEs in the SVS/AAVS 3 group at 1 year (p<0.001 for group 1 vs 3 and group 2 vs 3). Conclusion: Endovascular aneurysm repair has evolved, and high technical success and low mortality and morbidity can be achieved in high-risk patients. When treating high-risk patients, the perioperative risks should always be weighed against the expected gains. In contrast to the ASA classification, the SVS/AAVS medical comorbidity grading system is a useful tool to predict occurrence of MAEs and 1-year survival in patients undergoing EVAR.
Development of a Duplex Ultrasound Simulator and Preliminary Validation of Velocity Measurements in Carotid Artery Models
Authors: Zierler R. Eugene , Leotta Daniel F. , Sansom Kurt , Aliseda Alberto , Anderson Mark D. , Sheehan Florence H.
Published: May 2016

Objective:

Duplex ultrasound scanning with B-mode imaging and both color Doppler and Doppler spectral waveforms is relied upon for diagnosis of vascular pathology and selection of patients for further evaluation and treatment. In most duplex ultrasound applications, classification of disease severity is based primarily on alterations in blood flow velocities, particularly the peak systolic velocity (PSV) obtained from Doppler spectral waveforms. We developed a duplex ultrasound simulator for training and assessment of scanning skills.

Methods:

Duplex ultrasound cases were prepared from 2-dimensional (2D) images of normal and stenotic carotid arteries by reconstructing the common carotid, internal carotid, and external carotid arteries in 3 dimensions and computationally simulating blood flow velocity fields within the lumen. The simulator displays a 2D B-mode image corresponding to transducer position on a mannequin, overlaid by color coding of velocity data. A spectral waveform is generated according to examiner-defined settings (depth and size of the Doppler sample volume, beam steering, Doppler beam angle, and pulse repetition frequency or scale). The accuracy of the simulator was assessed by comparing the PSV measured from the spectral waveforms with the true PSV which was derived from the computational flow model based on the size and location of the sample volume within the artery.

Results:

Three expert examiners made a total of 36 carotid artery PSV measurements based on the simulated cases. The PSV measured by the examiners deviated from true PSV by 8% ± 5% (N = 36). The deviation in PSV did not differ significantly between artery segments, normal and stenotic arteries, or examiners.

Conclusion:

To our knowledge, this is the first simulation of duplex ultrasound that can create and display real-time color Doppler images and Doppler spectral waveforms. The results demonstrate that an examiner can measure PSV from the spectral waveforms using the settings on the simulator with a mean absolute error in the velocity measurement of less than 10%. With the addition of cases with a range of pathologies, this duplex ultrasound simulator will be a useful tool for training health-care providers in vascular ultrasound applications and for assessing their skills in an objective and quantitative manner.
The Rhythm of Game Interactions: Player Experience and Rhythm in Minecraft and Don’t Starve
Authors: Costello Brigid Mary
Published: May 2016

This article investigates the impact that the rhythms of game interactions can have on a player’s experience of a computer game. Using a phenomenological approach, the research focuses on rhythmic experience within games and, in particular, on the rhythm of tree chopping within the games Minecraft and Don’t Starve. Graphic, aural, and embodied representations are used to closely analyze and compare a single-player experience within the two games. The analysis reflects on the efficacy of these methods and suggests some possible key factors for designing rhythmically expressive play experiences. It is suggested that combining real-time control with perceivable and performable repetition and variety can give the player expressive creative control over the rhythms of their performed interactions, potentially enriching their experience of repetitive tasks and extending the play life of a game.
Rural Men’s Health, Health Information Seeking, and Gender Identities: A Conceptual Theoretical Review of the Literature
Authors: Hiebert Bradley , Leipert Beverly , Regan Sandra , Burkell Jacquelyn
Published: May 2016

Beginning as early as 2009, recent shifts in Canadian health care delivery indicate that access to health information is essential to promote and maintain a healthy population. It is important to understand how and where various populations, such as underresourced rural populations, access health information so that public health agencies can develop and deliver appropriate information with, for, and in these contexts. There is a paucity of research that specifically examines how rural Canadian men seek health information; therefore, this review aimed to conceptualize this process based on three dynamic key constructs: health patterns of rural Canadians, health information–seeking behaviors, and rural gender identities. This conceptual theoretical literature review included 91 articles at the intersection of these three constructs. Discussion focuses on how residing in a rural region influences men’s health and health care access. Health information–seeking behaviors are discussed in terms of social networks and framed with a rural context. Connell’s theory of masculinity provides a useful approach to dissecting how rural men’s gender identities influence their health attitudes, and how such attitudes are embedded in rural social and cultural norms. Each major construct—health in rural Canada, health information seeking, and rural gender identities—is discussed to highlight how specific embodiments of masculinity may promote and inhibit men’s health information–seeking and positive health behaviors.
New model of enterprises resource planning implementation planning process in manufacturing enterprises
Authors: Misita Mirjana , Lapcevic Nebojsa , Tadic Danijela , Milanovic Dragan D , Borota-Tisma Ankica
Published: May 2016

This article presents new model of enterprises resource planning implementation planning process in manufacturing enterprises based on assessment of risk sources. This assessment was performed by applying analytic hierarchy process. Analytic hierarchy process method allows variation of relative importance of specific risk sources dependent on the section from which the risk source originates (organizational environment, technical issues, people issues, adoption process management, and external support). Survey was conducted on 85 manufacturing enterprises involved with an enterprises resource planning solution. Ranking of risk sources assessments returns most frequent risks of enterprises resource planning implementation success in manufacturing enterprises, and representative factors were isolated through factor analysis by risk source origin. Finally, results indicate that there are hidden causes of failed implementation, for example, risk source “top management training and education,” from risk origin “adoption process management.”
Numerical study of heat transfer enhancement by rectangular winglet vortex generator pair in a channel
Authors: Zhang Qiang , Wang Liang-Bi
Published: May 2016

A numerical simulation was performed to investigate the effects of longitudinal vortices on the heat transfer enhancement of a laminar flow in a rectangle duct mounted with rectangular winglet pair on the bottom wall. The studied Reynolds number which was defined using the hydraulic diameter twice the channel height ranges from 500 to 7000. The comparisons of the fluid flow and heat transfer characteristics for the cases with and without rectangular winglet pair were carried out. The effects of the height and attack angle of vortex generator pair on the heat transfer performance were investigated. The results show that mounting rectangular winglet pair on the bottom wall of the channel can significantly enhance heat transfer. The distributions of secondary flow on the cross sections are consistent with the distributions of Nu and J for different attack angles. The maximum heat transfer performance is obtained when the attack angle is 29° due to the maximum value of secondary flow generated by rectangular winglet pair.
Parent perspectives of the challenging aspects of disclosing a child’s epilepsy diagnosis to others: Why don’t they tell?
Authors: Benson Ailbhe , Lambert Veronica , Gallagher Pamela , Shahwan Amre , Austin Joan K
Published: May 2016

Objectives

This study aimed to explore the challenges parents of children with epilepsy (CWE) experienced when deciding to disclose their child’s epilepsy diagnosis to others.

Methods

Using a qualitative exploratory design, interviews were conducted with 34 parents (27 mothers and 7 fathers) of 29 CWE (aged 6–16 years). Parents were recruited from a neurology clinic of a specialist children’s hospital and from a national epilepsy association. Interviews were directed by a semi-structured guide informed by a review of the literature. Data were transcribed verbatim, imported into NVivo, coded and thematically analysed.

Results

Findings revealed five themes representative of the core disclosure challenges parents encountered, many of which promoted concealment and/or selective disclosure, namely: seeking normalcy for the child, the invisibility of epilepsy, negative reactions to disclosure, contending with poor public perceptions of epilepsy and coming to terms with the diagnosis.

Discussion

This study presents crucial information for healthcare professionals (HCPs) who help families to navigate the disclosure decision-making process. Providing HCPs working with families living with epilepsy with insight into diagnosis disclosure challenges will enable them to recognise the support needs of parents and work collaboratively with families to tackle such difficulties, ultimately improving their psychosocial wellbeing.
Introducing new datasets on Northern Ireland’s media in the peace process and a test of newsworthiness in times of ‘troubles’
Authors: Armoudian Maria
Published: May 2016

To assist researchers studying the relationships between mass media messages and escalating conflict or peace-building, this article introduces two new datasets generated from Belfast, Northern Ireland, during the critical period before the Belfast Peace Agreement’s ratification. The first, the Northern Ireland Media Dataset (NIMD), contains coded data from a stratified, systematic random sample of articles from the three daily newspapers plus available articles from two paramilitary-related publications. The second, the Northern Ireland Community Relations Dataset (NICRD), resulted from merging one existing database – the Northern Ireland section of the Global Terrorism Database from the University of Maryland (College Park) – with the University of Ulster’s Chronology of the Conflict and coding the combined data for new variables that signify degrees of antagonism, non-antagonism, or peace-building. The latter set contains significant events, such as acts of violence, demonstrations, ceasefires, elections and peace rallies. Together and with other datasets, the NIMD and NICRD help researchers analyze and measure different aspects of mass media messages in either the escalation of violence or building peace in one conflict region. As a small showcase of the data, the research tests one hypothesis of newsworthiness in times of conflict and peacemaking, demonstrating that news norms of drama, conflict and events favor coverage of political parties like Sinn Fein, which used these norms to become the most covered political party during this time.
Media coverage and the escalation of militarized interstate disputes, 1992–2001
Authors: Miller Ross A , Bokemper Scott E
Published: May 2016

Some international crises – such as the Cuban Missile Crisis – receive widespread media coverage, while others are barely reported at all. Does this matter for the behavior of the dispute participants? Can widespread media coverage change the course of history? The authors’ goal is to assess how varying levels of coverage in elite news sources – The New York Times and The Times of London – influence the outcomes of international crises. Their analysis of over 300 dispute dyads indicates that, even after controlling for potential endogeneity and standard explanations of dispute outcomes, higher levels of media exposure make it more likely that targets of threats will escalate crises.
Ipilimumab-induced colitis: experience from a tertiary referral center
Authors: O’Connor Anthony , Marples Maria , Mulatero Clive , Hamlin John , Ford Alexander C.
Published: May 2016

Background:

Ipilimumab is an anticytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody used for the treatment of malignant melanoma. It can cause immune-mediated inflammatory adverse events, including diarrhoea and even intestinal perforation or death in clinical trials but there is a dearth of data on postmarketing outcomes.

Methods:

A total of 546 patients attending for treatment of metastatic melanoma between 1 January 2009 and 31 August 2015 were identified by interrogation of the oncology database. A total of 83 of these patients received ipilimumab. Clinical information was extracted from chart reviews, endoscopy and radiology reports, and prescription data.

Results:

A total of 83 patients received ipilimumab. Only 19.3% ( n = 16) of patients developed a diarrhoeal illness not attributable to other causes. The median grade of diarrhoea among included patients was 2 (range 1–4). In two cases, diarrhoea settled spontaneously without any specific treatment. A total of 87.5% of patients received antidiarrhoeal agents such as loperamide or codeine. These resolved symptoms in all patients with grade 1 diarrhoea. For other treatment, 50% patients received systemic glucocorticosteroids and 31.3% required infliximab. Infliximab resolved symptoms in 100% of cases compared with 50% for systemic glucocorticosteroids.

Conclusions:

The rate of diarrhoea related to ipilimumab in real-world practice is substantial, but below the range observed in data from RCTs. Grade 1 colitis can usually be managed symptomatically, without recourse to stopping ipilimumab. When diarrhoea was grade 2 or above, results from glucocorticosteroids use proved disappointing; but infliximab has been shown to work well. Further research is required into the earlier use of infliximab as an effective treatment for ipilimumab-induced diarrhoea.
Targeting intratumoral androgens: statins and beyond
Authors: Schweizer Michael T. , Yu Evan Y.
Published: May 2016

While initially effective, androgen deprivation therapy (ADT) is not curative, and nearly all men with advanced prostate cancer will eventually progress to the more resistant, and ultimately lethal form of the disease, so called castration-resistant prostate cancer (CRPC). The maintenance of androgens within the prostate cancer microenvironment likely represents one of the key mechanisms by which this transition from hormone-sensitive to CRPC occurs. This can be accomplished either through intratumoral androgen biosynthesis or the active transport of androgens and androgenic precursors into the tumor microenvironment. More recently, preclinical and clinical data supported therapeutic strategies that seek to target these two mechanisms, either through the use of drugs that impair androgen biosynthesis (e.g. inhibiting the steroidogenic enzymes CYP17 and AKR1C3 with abiraterone and indomethacin, respectively) or drugs that inhibit the SLCO transporters responsible for importing androgens (e.g. statins).
Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans
Authors: Liu Winnie , Saxon David R. , McNair Bryan , Sanagorski Rebecca , Rasouli Neda
Published: May 2016

Background:

Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations.

Methods:

This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period.

Results:

A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) ( P < .0001) for the TH group and from 9.56% (9.16% to 9.95%) to 8.62% (8.22% to 9.01%) ( P < .0001) for the FTF group after 1 visit. This change in HbA1c was not significantly different in the TH and FTF groups ( P = .24). TH visits were associated with a hypothetical savings in median distance traveled of 231.2 miles per trip (which equates to $94.79 saved per trip).

Conclusions:

Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes.
Neurological Prognostication of Cardiac Arrest in an Era of Extracorporeal Membrane Oxygenation
Authors: Sahai Supreet K. , Majic Tamara , Patel Jignesh , Nurok Michael , Moheet Asma M. , Rosengart Axel J. , Lahiri Shouri
Published: May 2016

A neuron-specific enolase level greater than 33 ng/mL at days 1 to 3 or status myoclonus within 1 day are traditional indicators of poor neurological prognosis in survivors of cardiac arrest. We report the case of a 70-year-old man who received extracorporeal membrane oxygenation following cardiac arrest. Despite having both an elevated neuron-specific enolase concentration of 68 ng/mL and status myoclonus, he made an excellent neurological recovery. The value of traditional markers of poor prognosis such as elevated neuron-specific enolase or status myoclonus has not been systematically validated in patients treated with extracorporeal membrane oxygenation or therapeutic hypothermia. Straightforward application of practice guidelines in these cases may result in tragic outcomes. This case underscores the need for reliable prognostic markers that account for recent advances in cardiopulmonary and neurological therapies.
Osteoarthritis in Football
Authors: Salzmann Gian M. , Preiss Stefan , Zenobi-Wong Marcy , Harder Laurent P. , Maier Dirk , Dvorák Jirí
Published: May 2016

Football is currently the most popular sporting activity in the world. Multiple reports have shown that a high incidence of osteoarthritis is found in football players. Evidence clearly shows that traumatic injury significantly predisposes players for such pathophysiology. Injuries are frequent in amateur as well as professional football players, with knee and ankle accounting for the most severe injuries. Many professional athletes lose playing time due to injuries and many are forced into early retirement. Posttraumatic osteoarthritis is a common finding among ex-football players with numbers well above the normal population. Today’s surgical techniques are advanced and capable of restoring the joint to a certain extent. However, a restitution ad integrum is reached only in very rare cases. Professional football players that return to play after serious injuries perform their extremely strenuous activity on morphologically compromised joints. Incomplete rehabilitation and pressure to return to play after an injurious event clearly put the athlete at an even higher risk for joint degeneration. Prevention strategies, improved surgical management, strict rehabilitation, as well as future aspects such as early suppression of inflammation, personalized medicine, and predictive genomics DNA profiling are needed to reduce incidence and improve the health perspectives of football players.
A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia
Authors: Rowell David , Gordon Louisa G , Olsen Catherine M , Whiteman David C
Published: May 2016

Objectives:

The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers.

Methods:

We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers.

Results:

Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis.

Conclusion:

Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference.
Zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost
Authors: Arat Ozkan Alev , Sinan Umit Yasar , Gurmen Aziz T
Published: May 2016

Stent fracture is a rare complication of drug-eluting stent implantation with a reported rate of 0.84%–3.2% in various clinical studies with first-generation drug-eluting stents and 29% in autopsy studies. Sirolimus-eluting stents with their closed cell design were reported to be more prone to fracture compared to paclitaxel-eluting stents. Other risk factors for stent fracture are multiple stenting, longer stent length, chronic renal failure, right coronary artery intervention, and a higher maximal inflation pressure. The role of angiography in diagnosing stent fracture is limited, a fact also questioning the reliability of angiographic data. Image enhancement techniques like StentBoost are widely available in new-generation angiography systems and are used to assess stent expansion, overlap size, or to localize the postdilation balloon. Here, we report a case of zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost.
NTC and Ncell: Telecommunication and Strategies
Authors: Gautam Dhruba Kumar
Published: May 2016

Over the last decade, with the liberalization policies of the Government of Nepal, telecommunication business has significantly leaped and become easily available to the general public at affordable prices when private sector started to challenge government monopoly. Currently, Nepal Telecommunication (NTC) and Ncell are the two dominant players in the telecom space in Nepal. While NTC provides all type of the phone services, Ncell has been exclusively focusing on providing Global System for Mobile (GSM) mobile lines. Over the past few years, Ncell, with its aggressive marketing and better services, has been chipping away at NTC’s market share. While NTC continues to lead in terms of number of total subscribers, Ncell recently overtook NTC to become the leading provider of GSM mobile lines in the country. Based on this, the present case study of two dominant telecommunication service providers of Nepal highlights the current scenario and attempts to explore the possible strategies to manage them effectively.
Modular reorganization of the global network of gene regulatory interactions during perinatal human brain development
Authors: Monzón-Sandoval Jimena , Castillo-Morales Atahualpa , Urrutia Araxi O. , Gutierrez Humberto
Published: May 2016

Background

During early development of the nervous system, gene expression patterns are known to vary widely depending on the specific developmental trajectories of different structures. Observable changes in gene expression profiles throughout development are determined by an underlying network of precise regulatory interactions between individual genes. Elucidating the organizing principles that shape this gene regulatory network is one of the central goals of developmental biology. Whether the developmental programme is the result of a dynamic driven by a fixed architecture of regulatory interactions, or alternatively, the result of waves of regulatory reorganization is not known.

Results

Here we contrast these two alternative models by examining existing expression data derived from the developing human brain in prenatal and postnatal stages. We reveal a sharp change in gene expression profiles at birth across brain areas. This sharp division between foetal and postnatal profiles is not the result of pronounced changes in level of expression of existing gene networks. Instead we demonstrate that the perinatal transition is marked by the widespread regulatory rearrangement within and across existing gene clusters, leading to the emergence of new functional groups. This rearrangement is itself organized into discrete blocks of genes, each targeted by a distinct set of transcriptional regulators and associated to specific biological functions.

Conclusions

Our results provide evidence of an acute modular reorganization of the regulatory architecture of the brain transcriptome occurring at birth, reflecting the reassembly of new functional associations required for the normal transition from prenatal to postnatal brain development.
Liver-derived human mesenchymal stem cells: a novel therapeutic source for liver diseases
Authors: Wang Yini , Yu Xiaopeng , Chen Ermei , Li Lanuan
Published: May 2016

Mesenchymal stem cells (MSCs) represent an attractive cell type for research and therapy due to their ability to proliferate, differentiate, modulate immune reactions, and secrete trophic factors. MSCs exist in a multitude of tissues, including bone marrow, umbilical cord, and adipose tissues. Moreover, MSCs have recently been isolated from the liver. Compared with other MSC types, liver-derived human MSCs (LHMSCs) possess general morphologies, immune functions, and differentiation capacities. Interestingly, LHMCSs produce higher levels of pro-angiogenic, anti-inflammatory, and anti-apoptotic cytokines than those of bone marrow-derived MSCs. Thus, these cells may be a promising therapeutic source for liver diseases. This paper summarizes the biological characteristics of LHMSCs and their potential benefits and risks for the treatment of liver diseases.
Application of fractal algorithms of coastline echo’s generation on marine radar simulator
Authors: Ji Shuguang , Zhang Zhang , Yang Hongbiao , Liu Dan , Sawhney Rapinder
Published: May 2016

Background

Marine radar simulator is a useful approach endorsed by International Maritime Organization (IMO) to train the seafarers on how to operate marine radar equipment and use marine radar equipment for positioning and collision avoidance in laboratory. To fulfill all of the marine radar simulator training requirements, a high performance simulator is necessary. However, imperfections with currently available marine radar simulators require simulator developers to make improvements.

Case description

In this study, improved fractal algorithms (random Koch curve, fractional Brownian motion, and Weierstrass-Mandelbrot function) are applied to generate natural-looking radar echoes on a marine radar simulator.

Discussion and evaluation

From the results of the simulations, we can observe that the structures of the coastline echoes generated by improved fractal algorithms, especially by fractional Brownian motion algorithm, outperform the echoes generated by conventional method in representing a natural coastline feature.

Conclusions

Based on evaluations from a panel of experienced mariners, we conclude that the coastline echoes simulated by fractal algorithms better represent a natural coastline feature than those generated by conventional methods.
Pull-Out Behavior of Adhesive Connections in Unreinforced Masonry Walls
Authors: Dizhur Dmytro , Schultz Arturo , Ingham Jason
Published: May 2016

The connections between walls of unreinforced masonry (URM) buildings and flexible timber diaphragms are critical building components that must perform adequately before desirable earthquake response of URM buildings may be achieved. Field observations made during the initial reconnaissance and the subsequent damage surveys of clay brick URM buildings following the 2010/2011 Canterbury, New Zealand, earthquakes revealed numerous cases where anchor connections joining masonry walls or parapets with roof or floor diaphragms appeared to have failed prematurely. These observations were more frequent for adhesive anchor connections than for through-bolt connections (i.e., anchorages having plates on the exterior facade of the masonry walls). Subsequently, an in-field test program was undertaken in an attempt to evaluate the performance of adhesive anchor connections between unreinforced clay brick URM walls and roof or floor diaphragm. The study consisted of a total of almost 400 anchor tests conducted in eleven existing URM buildings located in Christchurch, Whanganui and Auckland. Specific objectives of the study included the identification of failure modes of adhesive anchors in existing URM walls and the influence of the following variables on anchor load-displacement response: adhesive type, strength of the masonry materials (brick and mortar), anchor embedment depth, anchor rod diameter, overburden level, anchor rod type, quality of installation, and the use of metal mesh sleeves. In addition, the comparative performance of bent anchors (installed at an angle of minimum 22.5° to the perpendicular projection from the wall surface) and anchors positioned horizontally was investigated. Observations on the performance of wall-to-diaphragm connections in the 2010/2011 Canterbury earthquakes, a summary of the performed experimental program and test results, and a proposed pull-out capacity relationship for adhesive anchors installed into multi-leaf clay brick masonry are presented herein.