bluuebunny/crossref_metadata_2025 huggingface dataset:
Extravasation of [177Lu]Lu-DOTATOC: case report and discussion
Authors: Arveschoug Anne Kirstine , Bekker Anne Charlotte , Iversen Peter , Bluhme Henrik , Villadsen Gerda Elisabeth , Staanum Peter Frøhlich
Published: June 2020

Background

In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation.

Case presentation

A case of extravasation of [177Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [177Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects.

Conclusions

The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.
Bioinformatics analysis and characterization of a secretory cystatin from Thelohanellus kitauei
Authors: Zhang Fengli , Yang Yalin , Gao Chenchen , Yao Yuanyuan , Xia Rui , Hu Juan , Ran Chao , Zhang Zhen , Zhou Zhigang
Published: June 2020

Thelohanellus kitauei, is a member of obligate parasitic myxozoans, which causes intestinal giant-cystic disease of common carp (Cyprinus carpio) and has resulted in significant economic losses in carp farms. Cystatin secreted by parasites can regulate the immune response of host to facilitate parasite’s survival. In this study, the secretory TK-cystatin gene, encoding a protein of 120 amino acid residues (13.65 kDa), was cloned fromT. kitaueigenome. Phylogenetic analysis showed that TK-cystatin gene is closely related to the cystatin-A fromHydra vulgaris. Multiple sequence alignment revealed that TK-cystatin had three conserved motifs: N-terminal G19G20, Q73VVAG77, and C-terminal L102P103. Molecular docking between TK-cystatin and three cysteine proteases showed a lower binding energy (− 13 KJ/mol) with cathepsin L whereas a higher binding energy (− 8.6 KJ/mol) with cathepsin B. TK-cystatin gene was expressed inEscherichia coli. Activity assays revealed that TK-cystatin has stronger inhibitory activity on endopeptidases (papain and cathepsin L) and weaker inhibitory activity on exopeptidase (cathepsin B). TK-cystatin was stable under the condition of acidity or alkalinity or below 57 °C. This study laid a foundation for the design and development of the anti-T. kitaueivaccine in carp culture in the future.
Simplified clustering and improved intercluster cooperation approach for wireless sensor network energy balanced routing
Authors: Yao Yanxin , Chen Wei , Guo Jie , He Xiaoyu , Li Ruixuan
Published: June 2020

The equilibrium use of energy is very important for wireless sensor networks (WSN) with limited energy in order to avoid premature network collapse. The existing methods either need too complex calculations for precise clustering, or are too simple to overburden a few cluster heads. In order to solve these problems, we proposed energy balanced clustering routing (EBCR) in this paper. It could maximize the WSN life in energy non-harvesting scenario or improve energy utilization efficiency in energy harvesting scenario without increasing the amount of calculations. It gives a complete solution to the process of cluster head election, clustering, and intercluster routing algorithm. Firstly, a light weight cluster head election and a distributed cluttering method are proposed by introducing dynamic cluster radius and intersection region node division schemes with new principles. Thus, lightweight distributed clustering achieves the advantages of balancing the burden of cluster heads and alleviating hot zone problem. Then we optimized the cluster cooperative routing algorithm by analyzing cooperation and competition among cluster heads. The intercluster cooperative routing algorithm greatly improves the transmission efficiency between cluster heads. Moreover, this paper analyzes the reasons why the algorithm achieves more balanced energy usage, higher energy efficiency, and fewer calculations compared to the existing mainstream algorithms. At last, simulation results show that EBCR algorithm has advantages in terms of network energy consumption, number of surviving nodes in energy non-harvesting scenario compared with the delay-constrained energy-efficient cluster-based multi-hop routing (DCEM) method. Simulation also gives EBCR algorithm performance under various energy harvesting scenarios, which is quite satisfactory in energy utilization efficiency comparing with DCEM method. EBCR algorithm has superior performance in terms of balanced energy usage, low computation complexity, and high energy efficiency.
Harms associated with gambling: abbreviated systematic review protocol
Authors: Beynon Caryl , Pearce-Smith Nicola , Clark Rachel
Published: June 2020

Background

According to the Gambling Commission, in 2018, almost half of the general population aged 16 and over had participated in gambling in the 4 weeks before being surveyed. Such surveys suggest that the proportion of people who are classed as ‘problem’ gamblers is relatively small; however, this may be related to the ways data are collected and gambling behaviour is classified. Concern about the harms associated with gambling is rising, and in response, Public Health England (PHE) has initiated this review to identify the harms associated with this activity. Harms to the gambler, their close associates and the wider society will all be included.

Methods

Abbreviated systematic review processes will be employed. Ovid MEDLINE, Ovid Embase, Ovid Psycinfo, NICE Evidence and EBSCO SocIndex; a range of websites (for grey literature); and reference lists of included studies will be searched. Experts will be asked to identify other relevant literature. Literature published in years 2005–2019, published in English, from a country within the Organisation for Economic Development (OECD) and following an observational, qualitative or systematic review design will be included. AMSTAR2 (systematic reviews), the Newcastle-Ottawa Scale (observational studies) and the Critical Appraisal Skills Programme (CASP) qualitative checklist (qualitative studies) will be used to assess the risk of bias. A narrative synthesis will be used to summarise the results. The body of evidence will also be assessed according to the principles laid out in the CERQual approach.

Discussion

This protocol provides details of the framework that has been set up to guide this systematic review. The results of this review will provide an extensive assessment of the breadth and magnitude of harms associated with gambling. This will be one of the most comprehensive reviews of gambling-related harms undertaken to date.

Systematic review registration

PROSPERO CRD42019154757
The optimal management of Seymour fractures in children and adolescents: a systematic review protocol
Authors: Kiely Ailbhe L. , Nolan Grant S. , Cooper Lilli R. L.
Published: June 2020

Background

Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence on the management of Seymour fractures in children and adolescents and to establish what are the most important factors pertaining to an uncomplicated recovery.

Methods

We designed and registered a study protocol for a systematic review of randomised controlled trials and observational studies. A comprehensive literature search will be conducted (from inception to present) in MEDLINE, EMBASE, CINAHL and Cochrane Library databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures will be included. The interventions (irrigation and debridement; prophylactic antibiotics) and their timings (early vs late) will be compared to no antibiotics and no debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include other adverse events such mal-union, non-union, need for re-operation, physeal disturbance and nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed. If data permits, we will conduct random-effects meta-analysis where appropriate.

Discussion

This review will provide evidence for the management of Seymour fractures, based on a cumulation of existing smaller studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence to guide clinicians.

Systematic review registration

Systematic review registration: PROSPERO CRD42020153726.
Sustainable land management interventions lead to carbon sequestration in plant biomass and soil in a mixed crop-livestock system: the case of Geda watershed, central highlands of Ethiopia
Authors: Terefe Hailu , Argaw Mekuria , Tamene Lulseged , Mekonnen Kindu
Published: June 2020

Background

Sustainable land management interventions were introduced in Geda watershed in 2012 to reduce soil erosion, improve water infiltration, and increase plant-carbon inputs into the soil. This study explored the impact of the interventions on biomass production, carbon stock, and carbon sequestration. Stratified sampling was employed in the main and the dry seasons in the treated and untreated sub-watersheds that are found adjacent to each other. Above- and below-ground plant biomass, soil bulk density and organic carbon in 0–15- and 15–30-cm depths, and soil moisture content in 0–20- and 20–40-cm depths were collected from the crop, grazing, and tree lucerne plots. All analyses were performed based on standard procedures.

Results

Plant biomass production, carbon stock, and carbon sequestration varied highly significantly (P ≤ 0.001) among sub-watersheds, landscape positions, and land uses. Higher mean values were observed for treated sub-watershed, lower landscape position, and tree lucerne plot. The higher mean values in the lower landscape position of the treated sub-watershed were due to tree lucerne plantation. Similarly, topsoil (0–15 cm) carbon stock was statistically higher (P ≤ 0.001) in the treated sub-watershed and at tree lucerne plot (P ≤ 0.05). In addition, carbon stock by sub-surface soil (15–30 cm) was significantly higher (P ≤ 0.001) in the treated sub-watershed under crop and grazing lands but the higher value was in cropland and in the upper position. This could be due to the decomposition of organic materials from biomasses of crops and biological supporting measures (tree lucerne and Phalaris) facilitated by tillage. Six years of sustainable land management interventions led to the sequestration of 12.25, 7.77, and 13.5 Mg C ha−1 under cropland, tree lucerne, and grazing plots, respectively.

Conclusion

Sustainable land management interventions revealed auspicious ecological impacts in Geda watershed in terms of improving plant biomass production, carbon stock, and correspondingly capturing higher carbon dioxide equivalent taking untreated sub-watershed as a baseline. Prohibition of free grazing was the key element of the intervention to reduce biomass export and increase carbon sequestration in the treated sub-watershed. Thus, sustaining tree lucerne plants as a conservation measure and the prohibition of free grazing practices are principally essential.
Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees
Authors: Selitsky Lea , Markowitz Norman , Baxa Dwayne M. , Kaljee Linda , Miree Cheryl A. , Islam Nishat , Burse Chez , Newaz Rehnuma , Dankerlui Doreen , Jacobsen Gordon , Joseph Christine
Published: June 2020

Background

Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population. The objective of this analysis is to determine the association of trauma, specifically, domestic violence and forced sex, to six sexual risk behaviors and a history of chlamydia among detained youth.

Methods

The analysis uses data from a convenience sample of detainees assenting to HIV testing conducted December 2016 – August 2017 using the state-certified Voluntary Counseling Testing and Referral (VCTR) process.

Results

Of the 379 youth that received VCTR at the facility, 308 (81.3%) were used in this analysis. Report of domestic violence was significantly associated with sex under the influence of alcohol and was also significantly associated with sex under the influence of marijuana. Forced sex was associated with a sexual partner of unknown HIV status.

Conclusions

Traumatic experiences were related to sexual risk behaviors in this analysis, and substance use was strongly implicated in the association. Trauma is known to be a catalyst to sexual risk behaviors, substance use, and delinquency in adolescence. Results support the findings of other investigators and re-iterate the need for trauma-informed interventions that can improve the life trajectories of detained youth.
Early detection of parenting stress in mothers of preterm infants during their first-year home
Authors: Lau C. , Turcich M. R. , Smith E. O.
Published: June 2020

Background

Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers’ parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home.

Methods

Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants’ 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants’ 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ2 square analysis, and independent t-test.

Results

There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin’s normative population, with some mothers falling below the 15th % ile.

Discussion/conclusion

The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin’s normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants’ first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help “at-risk” mothers develop more constructive parenting routines.
Natural dietary compound naringin inhibits glioblastoma cancer neoangiogenesis
Authors: Aroui Sonia , Fetoui Hamadi , Kenani Abderraouf
Published: June 2020

Background

Flavonoids, which existed nearly in all fruits and vegetables, are considered as a class of plant-secondary metabolites with a polyphenolic structure and have properties with health-improving potential. Yet, not so many experimental focus on the benefits of flavonoid in vivo after external application. Here we assessed the impacts of naringin in vitro and in vivo in the human glioma U-87 cells implanted into athymic mice.

Methods

Tumor size and animal survival time were followed in naringin-treated mice bearing subcutaneous gliomas. To define the effects of naringin on angiogenesis, in vitro, tube formation and migration were assayed using endothelial HUVEC cell line.

Results

Low concentration of naringin remarkably inhibited tubulogenesis and reduced cell invasion. Moreover, naringin has been shown to have a toxicity effect on U-87 cells in a dose-dependent way. Furthermore, naringin administration (120 mg/kg/day) applies serious anti-cancer belongings on glioblastoma, as demonstrated by a slow cancer progression.

Conclusions

Our study has provided the first evidence on the antitumor effect of naringin, which is somehow due to the inhibition of invasion and angiogenesis.
Comparing community birdwatching and professional bird monitoring with implications for avian diversity research: a case study of Suzhou, China
Authors: Zhou Yan , Chen Anping , Ouyang Jenny Q. , Liu Yanlin , Zheng Aiyu , Yang Zaixi , Zhang Yong , Wang Bin , Jia Yifei , Jiao Shengwu , Zeng Qing , Lu Changhu
Published: June 2020

Background

In the past decades, birdwatching as a hobby developed rapidly and produced ample scientific records that have aided conservation efforts. Therefore, it is increasingly attractive to promote avian research by providing data from birdwatching.

Methods

We compared records from 16 years of community birdwatching and a 1-year formalized bird monitoring in Suzhou, China to study the similarities and differences between the two monitoring methods.

Results

We showed that within the 325 bird species recorded by the two methods, an annual average of 108 species were documented by community science and 223 bird species were recorded by 1-year formalized monitoring. Measured by the number of bird species recorded per survey trip, the bird monitoring activity of community birdwatchers was significantly lower. Furthermore, the monitoring intensity of community birdwatching measured as the average survey trips per site each survey year was also lower than that of formalized bird monitoring. In addition, community birdwatchers preferred urban landscapes to rural areas.

Conclusions

Community birdwatching could record the majority of local birds and complements the professional surveys in avian research. Well designed and coordinated community science can be used to expand the knowledge about avian distribution and population dynamics. These findings are critical for the development of conservation science with regard to community involvement.
Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction
Authors: Lee Dong-Hun , Kim Seong Ryoung , Jang Sam , Ahn Kang-Min , Lee Jee-Ho
Published: June 2020

Background

Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.

Case presentation

Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability.

Conclusion

We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.
Work stress and sleep disturbances among internship nursing students
Authors: Rabei Samah , Mourad Ghada , Hamed Alaa El Din
Published: June 2020

Background

Nurses are one of the most vulnerable professional groups to occupational stress and sleep problem. A relation between occupational stress and sleep problem is suggested and needs to be investigated. The aim of this descriptive study is designed to assess work stress and sleep disturbances among internship nursing students and the relation between them.

Results

A total of 95 nursing internship students were subjected to Pittsburgh Sleep Quality Index (PSQI) and Expanded Nursing Stress Scale (ENSS). The greater the number of patients a nurse cares for, the greater the nursing stress. Greater number and duration of shifts worsen sleep. Problems related to peers worsen sleep quality. Demanding patients and their families lessen the actual sleep duration of nurses. Demanding patients and their families, work load, discrimination, and uncertainty regarding treatment lessen the habitual sleep efficiency of nurses.

Conclusion

Nurses with higher workload experience more sleep disturbances.
Type VI Choledochal Cyst; A Case Report and Review of the Literature
Authors: Aslan Serdar , Görgel Ömer , Çakır İsmet Miraç
Published: June 2020

Background

Choledochal or common bile duct (CBD) cysts are congenital cystic dilatation of any part of the bile ducts. It has been classified into five main types by Todani et al. Isolated cystic duct cysts are not included in this classification. It is extremely rare, and there are a limited number of cases in the literature.

Case presentation

A 34-year-old male patient was admitted to our hospital with right upper quadrant (RUQ) pain experienced intermittently for the past year. His medical history and laboratory findings were normal. Physical examination revealed tenderness in the RUQ. Abdominal ultrasonography shows that a thin, tubular, cystic lesion was associated with the CBD. On magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), a saccular dilatation was observed in the middle part of the cystic duct. Isolated cystic duct dilatation was considered with current imaging findings. Laparoscopic cholecystectomy and cyst excision were performed. Surgery findings and histopathological examination of the excised cyst confirmed the diagnosis.

Conclusion

Isolated dilatations of the cystic duct are extremely rare, and familiarity with this anatomic variation and its early diagnosis can prevent complications such as inflammation and malignancy and guide the surgery. The most effective noninvasive imaging method in diagnosis is MRCP. Also, we recommend that it be classified as a new type with the name type VI biliary cyst, in addition to Todani classification.
Randomized Trial Comparing Double Versus Triple Bortezomib-Based Regimen in Patients With Multiple Myeloma and Acute Kidney Injury Due to Cast Nephropathy
Authors: Bridoux Frank , Arnulf Bertrand , Karlin Lionel , Blin Nicolas , Rabot Nolwenn , Macro Margaret , Audard Vincent , Belhadj Karim , Pegourie Brigitte , Gobert Pierre , Cornec Le Gall Emilie , Joly Bertrand , Karras Alexandre , Jaccard Arnaud , Augeul-Meunier Karine , Manier Salomon , Royer Bruno , Caillot Denis , Tiab Mourad , Delbes Sébastien , Suarez Felipe , Vigneau Cécile , Caillard Sophie , Arakelyan-Laboure Nina , Roos-Weil Damien , Chevret Sylvie , Fermand Jean Paul ,   for the MYRE study group
Published: June 2020

PURPOSE

We report a multicenter controlled trial comparing renal recovery and tolerance profile of doublet versus triplet bortezomib-based regimens in patients with initial myeloma cast nephropathy (CN) and acute kidney injury (AKI) without need for dialysis.

METHODS

After symptomatic measures and high-dose dexamethasone, patients were randomly assigned to receive bortezomib plus dexamethasone (BD), or BD plus cyclophosphamide (C-BD). In patients with < 50% reduction of serum free light chains (sFLCs) after 3 cycles, chemotherapy was reinforced with either cyclophosphamide (BD group) or thalidomide (C-BD group).

RESULTS

Ninety-two patients were enrolled in each group. At random assignment, characteristics of the 2 groups were similar, including median age (68 years) and serum creatinine level (305.5 and 273.5 µmol/L in BD and C-BD group, respectively). At 3 months, renal response rate (primary end point) was not different (41 v 47 responders in the BD and C-BD groups, respectively; relative risk [RR], 0.87; P = .46). Very good partial response (free light chain reduction ≥ 90%) or more was achieved in 36 and 47 patients, respectively (RR, 0.76; P = .10). After 1 cycle of chemotherapy, 69 in the BD group and 67 patients in the C-BD group had achieved sFLC level ≤ 500 mg/L. Serious adverse events were recorded in 30 and 40 patients, respectively. At 12 months, 19 patients had died (9 in the BD group v 10 in the C-BD group), including 10 (6 in the BD group and 4 in the C-BD group) from myeloma progression and 3 (0 in the BD group and 3 in the C-BD group) from infection. Within median follow-up of 27 months, 43 and 42 patients switched to new therapy, respectively. Overall, 50 patients (24 in the BD group and 26 in the C-BD group) had died.

CONCLUSION

This randomized study did not show any benefit of C-BD compared with BD on renal recovery of patients with initial CN not requiring dialysis. Adding cyclophosphamide did not sufficiently improve the efficacy-toxicity balance. Patients with myeloma with AKI are fragile, and indication for doublet or triplet regimen should be adapted to frailty.
Nurse-Led Vital Signs Monitoring Can Safely Identify Low-Risk Hematology-Oncology Patients For De-Escalation
Authors: Tham Sai Meng , Kasinathan Sharmilla , Lui Pak Ling , Lim Bee Kuan , Yap Rose Anne Pepito , Montanez Felma Bacabac , Ow Samuel G. W.
Published: June 2020

PURPOSE:

It is routine practice for patients to be on vital signs monitoring (VSM) once every 4 hours, which is laborious and disruptive. VSM de-escalation has been demonstrated to be safe in low-risk (LR) patients, but it has not been well studied in the hematology-oncology setting.

METHODS:

A quality improvement project was conducted in 3 hematology-oncology inpatient wards within a comprehensive cancer center, from March 2017 to July 2017 (pilot phase) and from October 2017 to Sept 2018 (maintenance phase). Root causes for frequent VSM identified via problem analysis include (1) perception of VSM, (2) lack of concise clinical guidelines, and (3) lack of nurse empowerment. Consensus criteria to define suitable LR patients and a nurse-led VSM de-escalation protocol were formulated.

RESULTS:

Of 1,065 patients who underwent nurse-led VSM de-escalation, there was a 50% reduction in the mean number of nurse encounters (NE) per month ( P < .01), with total savings of 2,731.5 NE-minutes per month. VSM re-escalation was required by 10.1% of patients; all were deemed unpreventable with more frequent VSM and none resulted in severe adverse outcomes. With additional interventions such as spot audits and retraining, recruitment for de-escalation improved from 51.7% of LR admissions in the pilot phase to 93.8% in the maintenance phase ( P < .01). The time saved was used to enhance other aspects of patient care, such as patient education. One hundred thirty-nine of 169 doctors and nurses surveyed after implementation (96.5%) supported continuing this protocol.

CONCLUSION:

A well-defined protocol allows safe nurse-led de-escalation of VSM for LR patients without adverse outcomes and was shown to be sustainable in this cohort of hematology-oncology patients.
Anogenital Distance in Healthy Infants: Method-, Age- and Sex-related Reference Ranges
Authors: Fischer Margit Bistrup , Ljubicic Marie Lindhardt , Hagen Casper P , Thankamony Ajay , Ong Ken , Hughes Ieuan , Jensen Tina Kold , Main Katharina M , Petersen Jørgen Holm , Busch Alexander S , Upners Emmie N , Sathyanarayana Sheela , Swan Shanna H , Juul Anders
Published: June 2020

Context

The use of anogenital distance (AGD) in clinical and epidemiological settings is increasing; however, sex-specific reference data on AGD and data on longitudinal changes in AGD in children is scarce.

Objective

To create age-, sex-, and method-related reference ranges of AGD in healthy boys and girls aged 0–24 months, to assess the age-related changes in AGD and to evaluate the 2 predominantly used methods of AGD measurement.

Design

The International AGD consortium comprising 4 centers compiled data from 1 cross-sectional and 3 longitudinal cohort studies (clinicaltrials.gov [NCT02497209]).

Setting

All data were collected from population-based studies, recruiting from 4 maternity or obstetric centers (United States, Cambridge [United Kingdom], Odense, and Copenhagen [Denmark]).

Subjects

This study included a total of 3705 healthy, mainly Caucasian children aged 0–24 months on whom 7295 measurements were recorded.

Main Outcome Measures

AGDAS (ano-scrotal), AGDAF (ano-fourchette), AGDAP (ano-penile), AGDAC (ano-clitoral), AGD body size indices (weight, body mass index [BMI], body surface area, and length), and intra- and interobserver biases.

Results

We created age-specific reference ranges by centers. We found that AGD increased from birth to 6 months of age and thereafter reached a plateau. Changes in AGD/BMI during the first year of life were minor (0–6% and 0–11% in boys and girls, respectively).

Conclusions

Reference ranges for AGD can be used in future epidemiological research and may be utilized clinically to evaluate prenatal androgen action in differences-in-sex-development patients. The increase in AGD during the first year of life was age-related, while AGD/BMI was fairly stable. The TIDES and Cambridge methods were equally reproducible.
Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality
Authors: Lapin Brittany R , Pantalone Kevin M , Milinovich Alex , Morrison Shannon , Schuster Andrew , Boulos Fernanda , Johnson Kristen , Thakore Nimish J
Published: June 2020

Purpose

Type 2 diabetes–related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P).

Methods

A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities.

Results

Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61).

Conclusions

Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.
H3K9me3 maintenance on a human artificial chromosome is required for segregation but not centromere epigenetic memory
Authors: Martins Nuno M. C. , Cisneros-Soberanis Fernanda , Pesenti Elisa , Kochanova Natalia Y. , Shang Wei-Hao , Hori Tetsuya , Nagase Takahiro , Kimura Hiroshi , Larionov Vladimir , Masumoto Hiroshi , Fukagawa Tatsuo , Earnshaw William C.
Published: June 2020

Most eukaryotic centromeres are located within heterochromatic regions. Paradoxically, heterochromatin can also antagonize de novo centromere formation, and some centromeres lack it altogether. In order to investigate the importance of heterochromatin at centromeres, we used epigenetic engineering of a synthetic alphoidtetO human artificial chromosome (HAC), to which chimeric proteins can be targeted. By tethering the JMJD2D demethylase (also known as KDM4D), we removed heterochromatin mark H3K9me3 (histone 3 lysine 9 trimethylation) specifically from the HAC centromere. This caused no short-term defects, but long-term tethering reduced HAC centromere protein levels and triggered HAC mis-segregation. However, centromeric CENP-A was maintained at a reduced level. Furthermore, HAC centromere function was compatible with an alternative low-H3K9me3, high-H3K27me3 chromatin signature, as long as residual levels of H3K9me3 remained. When JMJD2D was released from the HAC, H3K9me3 levels recovered over several days back to initial levels along with CENP-A and CENP-C centromere levels, and mitotic segregation fidelity. Our results suggest that a minimal level of heterochromatin is required to stabilize mitotic centromere function but not for maintaining centromere epigenetic memory, and that a homeostatic pathway maintains heterochromatin at centromeres.

This article has an associated First Person interview with the first authors of the paper.
Primary synovial sarcoma of parotid gland with intravenous extension into the heart
Authors: Gautam Avinash D , Jain Shweta , Ravi Sankar M , Jain Neeraj
Published: June 2020

We are reporting a case of a 47-year-old male with primary synovial sarcoma of the right parotid gland with tumor thrombus extension in the right internal jugular vein and right atrium. The rarity of this occurrence as documented in the review of the literature provides for uncertainty about proper management. Our case represents a rare occurrence with the unique radiological finding that has implications for management.
Epidemiology of mental health problems in COVID-19: a review
Authors: Hossain Md Mahbub , Tasnim Samia , Sultana Abida , Faizah Farah , Mazumder Hoimonty , Zou Liye , McKyer E. Lisako J. , Ahmed Helal Uddin , Ma Ping
Published: June 2020

The novel coronavirus disease 2019 (COVID-19) has become a pandemic affecting health and wellbeing globally. In addition to the physical health, economic, and social implications, the psychological impacts of this pandemic are increasingly being reported in the scientific literature. This narrative review reflected on scholarly articles on the epidemiology of mental health problems in COVID-19. The current literature suggests that people affected by COVID-19 may have a high burden of mental health problems, including depression, anxiety disorders, stress, panic attack, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, posttraumatic stress symptoms, and suicidal behavior. Moreover, several factors associated with mental health problems in COVID-19 are found, which include age, gender, marital status, education, occupation, income, place of living, close contact with people with COVID-19, comorbid physical and mental health problems, exposure to COVID-19 related news and social media, coping styles, stigma, psychosocial support, health communication, confidence in health services, personal protective measures, risk of contracting COVID-19, and perceived likelihood of survival. Furthermore, the epidemiological distribution of mental health problems and associated factors were heterogeneous among the general public, COVID-19 patients, and healthcare providers. The current evidence suggests that a psychiatric epidemic is cooccurring with the COVID-19 pandemic, which necessitates the attention of the global health community. Future epidemiological studies should emphasize on psychopathological variations and temporality of mental health problems in different populations. Nonetheless, multipronged interventions should be developed and adopted to address the existing psychosocial challenges and promote mental health amid the COVID-19 pandemic.
Analysis of patient with cervical discopathy treated surgically on the own material of neurosurgical department
Authors: Siedlecki Zygmunt , Kuriga Kinga , Bereźnicka Weronika , Śniegocki Maciej
Published: June 2020

Cervical discopathy is an important medical problem widespread in society. Symptoms are often upper limbs radicular pain, local pain in the cervical spine, and vetrebrobasilar cerebrovascular insufficiency. In the case of ineffective conservative treatment and severe pressure on nerve structures, surgical treatment is indicated. Cervical discopathy is most common at the age of 30 - 60 with a predominance of women. The authors of this manuscript analyzed the medical data of patients operated on due to cervical discopathy on their own material. Cervical discopathy was found to be more common in women, which is consistent with world references. A relationship was found between cervical myelopathy and critical spinal canal stenosis and C4-C5 stenosis. Stenosis on C3-C4 has also been rare in female patients and more common in men. Obtained data on own material are generally consistent with reports from world literature and constitute its complement in reference to the region of the Kuyavian-Pomeranian Voivodeship.
The use of peppermint oil in the treatment of irritable bowel syndrome
Authors: Mazur Karol , Machaj Dominik , Mazur Dominika , Baran Marlena , Płaczek Alicja
Published: June 2020

Irritable bowel syndrome (IBS) is a a chronic functional gastrointestinal disorder, that affects large intestine. The symptoms of IBS include: abdominal pain, discomfort, change in bowel habits and disordered defecation. The causes of irritable bowel syndrome  have not yet been fully investigated and determined.Peppermint (Mentha ×piperita) is a hybrid type of mint, a cross between watermint (Mentha aquatica) and spearmint (Mentha spicata). Peppermint oil is produced in the proces of steam distillation of fresh leaves of peppermint.The aim of this study was to evaluate the use of peppermint oil in the treatment of irritable bowel syndrome. Our study material consisted of publications, which were found in PubMed, ResearchGate and Google Scholar databases. The first step was to find proper publications from the last 30 years. The second step was to carry out an overview of the found publications.Based on the results of mentioned studies it can be concluded that peppermin oil is effective in the treatment of irritable bowel syndrome due to providing global symptom improvement  and significant reduction of abdominal pain, and its short-term use is safe. However, further research is needed to estabilish the role of peppermint oil in the treatment of irritable bowel syndrome and to determine the optimal duration of treatment, dosage of peppermint oil, and its possible side effects related to long-term usage.
Morphological and motor skills condition among 10-11 year old children engaged in cross-country skiing attending Sports Primary School in Suprasl
Authors: Roczniak Katarzyna , Babuśka–Roczniak Magdalena , Wojtanowska–Kaczka Magdalena , Racz Oliver , Roczniak Anna , Lyubinets Oleh , Widuchowski Wojciech , Roczniak Wojciech
Published: June 2020

Introduction. Cross-country skiing is a sport discipline with different applications in the modern world. It is used in recreation, rehabilitation, tourism and sport as a phycical movement.             Objective of the work. The aim of the study was to estimate physical fitness of children aged 10 - 11 years attending sports classes (cross-country skiing profile) with the results of the efficiency grade among students attending unsportsmanlike classes in Sports Primary School in Suprasl.            Material and methods. The study involved 50 children attending the Sports School in Suprasl -  class 4 students.  Each student was supposed to take part in the International Physical Fitness Test. There were the following attempts: 50 metres run, long jump, sitting position from lying down during 30 seconds, the trunkbend in front and 600 metres run. The results of completed studies are presented in tables and figures below.            Results. The analysis show that girls practising cross-country skiing are characterized by higher efficiency motor skill compared to their peers, as well as it is easier for them to acquire new motor skills than for boys of their class. For boys the differences that occurred between sports and unsportsmanlike classes  was insignificant. Perhaps, it may change in future.            Conclusions. Children attending sports classes (cross country-skiing profile) have better motor abilities and acquire new motor skills faster than pupils in unsportsmanlike classes.
The Beneficial Effects of Ad Blockers
Authors: Despotakis Stylianos , Ravi R. , Srinivasan Kannan
Published: June 2020

Although online advertising is the lifeline of many internet content platforms, the usage of ad blockers has surged in recent years, presenting a challenge to platforms dependent on ad revenue. Using a simple analytical model with two competing platforms, we show that the presence of ad blockers can actually benefit platforms. In particular, there are conditions under which the optimal equilibrium strategy for the platforms is to allow the use of ad blockers (rather than using an ad-block wall or charging a fee for viewing ad-free content). The key insight is that allowing ad blockers serves to differentiate platform users based on their disutility to viewing ads. This allows platforms to increase their ad intensity on those that do not use the ad blockers and achieve higher returns than in a world without ad blockers. We show robustness of these results when we allow a larger combination of platform strategies, as well as by explaining how ad white-listing schemes offered by modern ad blockers can add value. Our study provides general guidelines for what strategy a platform should follow based on the heterogeneity in the ad sensitivity of their user base.

This paper was accepted by Juanjuan Zhang, marketing.
Selling Passes to Strategic Customers
Authors: Wang Jue , Levin Yuri , Nediak Mikhail
Published: June 2020

Many service providers offer a prepaid package of credits that can be redeemed for future use, often called passes, in conjunction with regular individual sales. In dynamic pricing situations, customers can strategize on the purchase, redemption, and renewal of the pass by optimizing the timing and choices between passes and individual items based on future prices and their own changing needs. In “Selling Passes to Strategic Customers,” Wang, Levin, and Nediak integrate dynamic choice modeling and optimal control theory to study how to jointly price the passes and individual items in a dynamic setting. They endogenize an individual customer’s purchase/redemption decisions in their model and find that the seemingly complex problem has a simple (approximate) solution. The optimal prices remain nearly constant most of the time, except near the beginning and end of the sales horizon, exhibiting so-called turnpike properties. The pass, as a form of advance purchase, allows the seller to capitalize on the customer’s forward-looking behavior by exploiting the uncertainty of customer valuations.
Vehicle Routing Problems with Synchronized Visits and Stochastic Travel and Service Times: Applications in Healthcare
Authors: Hashemi Doulabi Hossein , Pesant Gilles , Rousseau Louis-Martin
Published: June 2020

This paper, for the first time, studies vehicle routing problems with synchronized visits (VRPS) and stochastic travel and service times. In addition to considering a home healthcare scheduling problem, we introduce an operating room scheduling problem with stochastic durations as a novel application of VRPS. We formulate VRPS with stochastic times as a two-stage stochastic integer programming model that, unlike the deterministic models in the VRPS literature, does not have any big-M constraints. This advantage comes at the cost of a large number of second-stage integer variables. We prove that the integrality constraints on second-stage variables can be relaxed, and therefore, we can apply the L-shaped algorithm and its branch-and-cut implementation to solve the problem. We enhance the model by developing valid inequalities and a lower bounding functional. We analyze the subproblems of the L-shaped algorithm and devise a specialized algorithm for them that is significantly faster than standard linear programming algorithms. Computational results show that the branch-and-cut algorithm optimally solves stochastic home healthcare scheduling instances with 15 patients and 10%–30% of synchronized visits. It also finds solutions with an average optimality gap of 3.57% for instances with 20 patients. Furthermore, the branch-and-cut algorithm optimally solves stochastic operating room scheduling problems with 20 surgeries.
Conceptualizing Contributory Pension Scheme Implementation and Job Commitment of University Lecturers in Nigeria
Authors: Onukwu James Nwabianke
Published: June 2020

This paper examined the concept of contributory pension scheme as it relates to lecturers’ job commitment in the university system. It adopted the Social Exchange Theory by George Casper Homans in 1958 and a review of other scholars’ findings on pension scheme implementation. It established a link between the CPS implementation procedures and the indices of university lecturers’ job commitment. The paper recommended among others that it is important for employees to see clearly the reward process at work. Concrete acts must accompany statements of intent since lecturers have expectations for good pension package after many years of service to the university.