bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rotator Cuff Healing Index: A New Scoring System to Predict Rotator Cuff Healing After Surgical Repair
Authors: Kwon Jieun , Kim Sae Hoon , Lee Ye Hyun , Kim Tae In , Oh Joo Han
Published: November 2018

Background:

Scoring systems integrating possible prognostic factors and predicting rotator cuff healing after surgical repair could provide valuable information for clinical practice.

Purpose:

To determine the prognostic factors predictive of rotator cuff healing after surgical repair and to integrate these factors into a scoring system.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The authors reviewed the records of 603 patients who, at least 12 months after primary rotator cuff repair by a single surgeon, had magnetic resonance imaging or computed tomographic arthrography to assess repair integrity. The mean age at the time of surgery was 60 years (range, 39-81 years), and 378 patients were women (62.7%). Previous known or suggested factors affecting cuff integrity were analyzed through univariate and multivariate analyses. Factors identified in the multivariate analysis were integrated in a scoring system based on odds ratios (ORs).

Results:

The overall healing failure rate was 24%. The following independent risk factors were identified in the multivariate analysis: age >70 years at the time of surgery ( P = .003, OR = 2.71), size of the tear in anteroposterior dimension ( P = .033, OR = 1.94) and retraction ( P = .000, OR = 4.56), fatty infiltration of infraspinatus exceeding grade 2 ( P = .001, OR = 2.91), low bone mineral density (T score ≤ –2.5, P = .04, OR = 1.95), and high level of work activity ( P = .036, OR = 2.18). A 15-point scoring system comprised the following: 4 points for retraction; 3 points for fatty infiltration of infraspinatus; and 2 points for anteroposterior tear size, age, bone mineral density, and work activity, weighted according to multivariate analysis ORs. Patients with ≤4 points had a 6.0% healing failure rate, and those with ≥5 and ≥10 points had 55.2% and 86.2% healing failure rates, respectively.

Conclusion:

A numerical scoring system including significant clinical and radiological factors was designed to predict healing of the rotator cuff after surgical repair. This scoring system helped predict the adequacy of the repair and assist in deciding the appropriate treatment options.
An Analysis of Protein Consumption in India Through Plant and Animal Sources
Authors: Rampal Priya
Published: November 2018

Background:

India became self-sufficient in food because of the Green Revolution in the 1960s. However, both the technological innovation and policy support have been biased toward cereals. It is expected that cereals are the major source of proteins in the diet. In recent years, the consumption of cereals is declining in spite of increasing output due to declining preference. Therefore, the country needs to increase production and consumption of pulses to meet the nutritional requirements of the population.

Objectives:

This article discusses the trends in pulse and protein consumption over the years. Further, it focuses on the substitutability and complementarity between various sources of proteins.

Methods:

A seemingly unrelated regression estimation (SURE) framework is used to study the price and income effect on proteins from different sources—cereals and pulses (plant sources), milk and milk products, animal sources such as eggs, fish, and meat, and other sources of protein.

Results:

It is found that the expenditure on proteins is large and significant. As income increases, consumption of proteins increases. Higher disposable incomes have led to higher demand of animal sources of proteins. There are significant food price effects in our analysis—negative for cereals and positive for eggs. As the price of pulses increases, consumption of animal sources of proteins increases.

Conclusion:

It becomes important to contain volatility in pulse prices given that it is a major source of plant protein. States distributing pulses in the Public Distribution System show higher consumption of proteins than other states.
Development of a simvastatin loaded injectable porous scaffold in situ formed by phase inversion method for bone tissue regeneration
Authors: Hajihasani Biouki Mina , Mobedi Hamid , Karkhaneh Akbar , Daliri Joupari Morteza
Published: November 2018

Introduction:

The use of injectable scaffolds as a minimally invasive method is a good choice in tissue engineering applications. A critical parameter for the tissue engineering scaffolds is a suitable morphology with interconnected pores. We present the development of a simvastatin loaded scaffold that forms in situ and provides the porous structure with interconnected pores.

Methods:

The formulation of these scaffolds includes a polymeric solution of poly lactic-co-glycolic acid (25 wt%) in N-methyl-2-pyrrolidone containing 6 wt% deionized water and porogen (mannitol, four times the weight of the polymer). We have grafted simvastatin to poly lactic-co-glycolic acid by the esterification reactions. Simvastatin or simvastatin-grafted poly lactic-co-glycolic acid in different levels was added to polymer solution and finally the solution was injected into phosphate buffered saline. The simvastatin-grafted poly lactic-co-glycolic acid was characterized by attenuated total reflection Fourier-transform infra-red and 1H-nuclear magnetic resonance spectroscopy. The morphology, porosity, and biocompatibility of the scaffolds were evaluated. The in vitro simvastatin release from the various formulations was studied. Osteogenic differentiation of the adipose-derived stem cells was investigated using alkaline phosphatase activity assay and cell mineralization was evaluated using Alizarin red staining.

Results:

The morphology results showed the resultant scaffold was porous with the interconnected pores. The scaffolds presented 91% porosity. Non-toxic doses of simvastatin in the scaffolds were determined by methyl-thiazolyl diphenyl-tetrazolium bromide assay. The released simvastatin from the scaffolds continues over 80 days. Alkaline phosphatase activity and Alizarin red results indicated that cell osteogenic differentiation is promoted.

Conclusion:

The results demonstrated that release of simvastatin from the injectable scaffolds can have positive effects on osteogenic differentiation of the adipose-derived stem cells.
Violent Motherhood: Prevalence and Factors Affecting Violence Against Pregnant Women in India
Authors: Jungari Suresh
Published: November 2018

Violence against women is widely recognized as a serious public health problem in the world. Especially violence against pregnant women has more severe health consequences for both women and child. The objective of this study is to examine the prevalence and factors affecting violence during pregnancy in India. Data from the National Family Health Survey (NFHS)–4 are used to analyze this study. NFHS is a series of demographic health surveys conducted in India. Information on violence against pregnant women was collected for the first time in NFHS-4. Univariate and multivariate analyses are used to show the factors affecting violence during pregnancy. Study results reveal that the prevalence of violence varied among states from 0.5% to 9%, and women in South India were at a greater risk of abuse during pregnancy than that of women in other parts of India. Women with no education, women in poor household, women having three and more children, and women from rural area are at greater risk of being victims of violence during motherhood. Effective strategies such as responsive health care system, effective implementation of legal measures, and educating and engaging men in preventing violence are urgently needed.
Experimental determination and modelling of the diesel oxidation catalysts ageing effects
Authors: Guardiola Carlos , Pla Benjamin , Mora Pérez Javier , Lefebvre Damien
Published: November 2018

After-treatment systems are necessary to respect the pollutant emissions thresholds specified by regulations. However, due to system ageing, the efficiency of the after-treatment system may decrease and affect the vehicle emissions during real driving conditions. To address this issue, the model presented in this article is based on the on-engine tests performed to a set of diesel oxidation catalysts with different ageing levels, through which the ageing process is characterized. Then, the model is able to simulate the light-off temperature and slip increase due to ageing, and it is applied to a Worldwide Harmonized Light Vehicles Test Cycle for a new and a thermally aged catalysts.
Proliferation of corporate governance codes in the backdrop of divergent ownership structures
Authors: Varottil Umakanth
Published: November 2018

In the backdrop of the convergence–divergence debate, the goal of this article is to examine the proliferation of corporate governance codes in the light of a single factor, namely varying corporate ownership structures across countries. While such codes emanated and became popular in the United Kingdom where companies largely display dispersed shareholding, the concept has been disseminated to countries that carry considerably different ownership structures, i.e. mainly concentrated shareholding. This is bound to give rise to incongruities in the implementation of these codes. In order to enunciate the claim made above, the article will consider two aspects that convergence advocates have focused on, namely (i) shareholder empowerment and (ii) self-regulation. For example, corporate governance codes place considerable emphasis on the structure and independence of the boards of directors of companies as a means to ensure shareholder protection. While this approach is meant to produce results in companies with dispersed shareholding, the same cannot be said of companies with concentrated shareholding where the empowerment of shareholders through director independence or other means would only embolden the already dominant controlling shareholders. Moving to self-regulation, a voluntary code operating on a ‘comply-or-explain’ basis can ensure sufficient adherence only if certain factors are present in the jurisdiction where it is applied. Relying upon available empirical evidence, this article finds that use of self-regulation in voluntary codes of corporate governance may generate different results depending upon the ownership structures of companies, thereby exhibiting signs of divergence on this count.
Inward-Outward Connections in Internationalization
Authors: Welch Lawrence S. , Luostarinen Reijo K.
Published: November 2018

This article examines the impact of inward and outward aspects of internationalization. The effect of the inward process on outward moves has been the subject of limited research, although some evidence from studies of licensing and franchising in Australia suggests inward steps can sometimes play an important preparatory role in the outward process. Governments have for some time used inward international flows to force a reverse process—through strict countertrade policies, for example, or, as in the Australian case through its ‘partnership scheme.’ An important public policy question is how to regard international steps in any outward promotional scheme. For example, among individual firms there is a need to use inward moves in a more productive way to promote outward internationalization, perhaps by selecting foreign suppliers in part on the basis of their ability to contribute to an outward strategy.
Long-Term Export Stimuli and Firm Characteristics in a European LDC
Authors: Katsikeas S. , Piercy Nigel F.
Published: November 2018

This study presents an investigation of factors that stimulate the decision-making process of exporting firms from a European Lesser Developed Country (LDC) to continue and sustain export activities. The paper explores the existence of dimensions underlying export motivation and identifies potentially significant differences in perceptions of export stimuli based on firm size, degree of export involvement, and exporting experience. The findings point to a more proactive (than reactive) motivation structure underlying the export activities of these manufacturers. While no relationship is found between perceptions of export motivation and firm size, a number of significant differences in ongoing export stimuli are identified between different groups of firms in terms of export involvement and, to a lesser extent, exporting experience. Managerial and public policy implications are discussed, and suggestions for future research directions are outlined.
Export Opportunities in a Crumbling Economy: The Soviet Union in 1990
Authors: Larsen Trina L. , Green Robert T.
Published: November 2018

Economic liberalization is underway in many countries that had previously been relatively closed to outside commercial relations. This includes former East Bloc nations and LDCs that had long attempted to protect their inefficient industries from foreign competition. Perhaps the most spectacular example of this trend is the former Soviet Union. This article reports a study of the changes that occurred in the former Soviet Union's trade relations with non-communist countries in the critical period during which trade ‘openness’ was being established. The results provide insights that may be useful to exporters in their assessment of market opportunities in countries undergoing the difficult transition to a market economy.
Successful Operating Strategies in the Performance of U.S.-China Joint Ventures
Authors: Osland Gregory E.
Published: November 2018

Evaluations of the performance of international joint ventures (IJVs) in China have produced mixed conclusions. This study sought to uncover performance criteria used by various groups of managers and to identify critical factors in IJV performance in China. Using in-depth case studies, matched data were collected from personal interviews with managers from Chinese and U.S. parent companies, joint venture operating managers from both partners, and government officials from both countries. The performance criteria used by joint venture participants appear to be converging, with profitability emerging as the dominant element. This exploratory study uncovered four important strategic factors in the performance of large, established U.S.-China manufacturing joint ventures. These are controlling decision making, establishing a sales network, retaining interpartner learning, and influencing government officials. The results suggest that the importance of decision-making control is moderated by size of the venture and nationality. Whether the IJV is a part of the government's National Plan also appears to be an important contingency. Managerial implications and directions for future research are provided.
Facing Foreign Market Turbulence: Three Swedish Multinationals in Iran
Authors: Hadjikhani Amjad , Johanson Jan
Published: November 2018

While foreign market entry and expansion has attracted much international business research, few have studied the contraction of foreign market operations and exit from foreign markets when MNCs face market turbulence and decline. This article uses a process perspective to examine the responses of three Swedish MNCs to the dramatic changes in the Iranian market during the turbulent period 1975 - 1992. It bases a view of foreign market contraction and exit on the theory of the internationalization process of the firm, and asks whether this can help us understand the firm's behavior in the face of a turbulent foreign market environment.
Executive Insights: Roles of R&D and Manufacturing in Global Marketing Management
Authors: Bermingham John A.
Published: November 2018

In today's world of global competition and high-speed product development, linkage among R&D, manufacturing, and marketing is more vital to successful business than ever before. Delivering a competitive product to the market at the right time, with the right specifications and feature benefits, all at a manufacturing cost that allows for profit, is one tough assignment. Add to this the global complexity of marketing, R&D, and manufacturing not being located in the same place, along with competing in an environment where world-class product development time is under 50 weeks, and you have a challenge that few companies are dealing with appropriately today.

International marketing executives can no longer have the luxury of time to consider R&D and manufacturing as activities remotely related and remotely relevant to them. They have to deal with all of this complexity and be fully aware that without adequate understanding of the linkages necessary among marketing, R&D, and manufacturing, their businesses run a very high risk of failure ( Kotabe 1992 ). Based on my executive experience at three different companies, I have seen the same lingering problems. In this article, I will explore the essence of these problems and solutions based on my own experiences.
Educator Insights: Globalization of Fragmentation—A Framework for Understanding Contemporary Global Markets
Authors: Firat A. Fuat
Published: November 2018

The article presents several arguments and evidence that the globalization process, which has become of great interest to many scholars, is not a uniform and universalizing process, but a fragmented one. The characteristics of this globalization of fragmentation are discussed and some reasons for its development are provided. Four major reasons discussed are: (1) the nature of the modern market, (2) the transforming consumers, (3) global communications, and (4) increasing multilayeredness of cultures. Implications of these factors for globalization of fragmentation and for international marketing are briefly discussed.
Executive Insights: Marketing Issues and Challenges in Transitional Economies
Authors: Batra Rajeev
Published: November 2018

Drawing both on the literature as well as field research on companies operating in transitional economies, this article describes the ways in which marketing environments in transitional economies are typically different from those in more developed countries, as well as recent trends in these environments. Managerial implications concerning appropriate marketing strategies and tactics are then drawn, both for multinationals operating in transitional economy markets as well as local companies.
Changes in Japan's Post-Bubble Business Environment: Implications for Foreign-Affiliated Companies
Authors: Reid David McHardy
Published: November 2018

Long noted as highly competitive, the Japanese market has become even more cutthroat in the “post-bubble” era, the period following the Japanese economic collapse. Only the fittest are likely to survive the correction taking place as Japan grapples with a severe recession that is threatening to extend worldwide. The research question pursued is how these “moment-in-time” market changes affect foreign-affiliated companies in Japan. The study examines whether lessons that may be learned from those foreign companies that have successfully negotiated the minefield of Japan's business culture can be applied to other world markets. It then aims to induce, from their responses, some implications for international marketing strategy. It is based on a study of the post-bubble changes in the Japanese market from 1990 to 1998. Using a Grounded Theory approach, the research process involves 58 personal interviews with executives of 52 successful foreign firms operating in Japan. A framework distilled from a previous article by the author is used to compare and contrast the pre- and post-bubble situations.
Materials failure theory, strain energy, and the principal stresses eigenvalue problem: how these three historical areas are interrelated and mutually reinforcing, thus enabling new results for materials failure
Authors: Christensen Richard M
Published: November 2018

The three sub-disciplines of principal stresses, strain energy, and failure theory are shown to depend upon four basic invariants. These four invariants are derived from the eigenvalue problem of the principal stress formulation. Thus, the most basic form of all three areas is that of the eigenvalue problem for the principal stresses. The proper forms for the strain energy and the failure problem follow from the eigenvalue problem, both being appropriate to isotropic materials. After further showing the specific relationship between the failure theory and the strain energy, some implications of the failure theory are examined.
Water transport during bread baking: Impact of the baking temperature and the baking time
Authors: Ureta M Micaela , Diascorn Yves , Cambert Mireille , Flick Denis , Salvadori Viviana O , Lucas Tiphaine
Published: November 2018

The impact of the baking temperature on the moisture profile (in terms of water content), during bread baking was analyzed using a convection oven (three oven temperatures and different baking times). During baking, local water content and temperature were measured at different regions of the crust and crumb. There was found an increase in water content at the core. Water content reached a maximum level (at about 2.5%), with no effect of the baking temperature, and decreased slowly at advanced baking times. Regarding the crust, a theoretical model relating water flux to the driven force (temperature difference between the oven environment and the vaporization front) and the crust thermal resistance was validated with experimental values. Water losses were also reported. The water lost by bread contributes significantly to the energy consumption by this process and its reduction is of concern for conducting the process in a more sustainable manner. A better optimization of heat transfer between the surface (for coloration purposes) and the core (for inflation purposes) could help in this way, together with shorter baking duration and hence higher yield.
Reducing the Cost of Medicaid: A Multistate Simulation
Authors: Linder Stephen H , Aguillard Kimberly , French Kelsey , Garson Arthur
Published: November 2018

According to some estimates, the United States wastes as much as 30% of health care dollars. Some of that waste can be mitigated by reducing certain costs associated with Medicaid. We chose 5 areas of savings applicable to Medicaid: (1) modification of physician payment models to reduce unnecessary care, (2) development of a medication adherence program for patients dually eligible for Medicaid and Medicare support (“dual eligibles”), (3) improvement in unnecessary admissions and readmissions for dual eligibles, (4) reduction in emergency department visits among children in Medicaid and dual-eligible beneficiaries, and (5) improvement in adoption of end-of-life advance directives. We chose the states from both ends of the spending spectrum: the 5 with the lowest annual Medicaid expenditures: Wyoming, South Dakota, Montana, Vermont, and Alaska, and those with the highest: California, New York, Texas, Pennsylvania, and Florida. This spectrum demonstrates the range of potential cost-saving measures, from US $23.6 million in Wyoming to US $3.4 billion in California. We conclude that there are a number of ways to reduce Medicaid spending and improve quality. To the extent that states have already adopted programs addressing the same problems, our approach may be supplementary but the total savings may be achieved with a combination of current initiative and those described here. As Medicaid creates savings, physician payment could be increased to attract more physicians into caring for Medicaid patients.
The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review
Authors: Massetti Thais , da Silva Talita Dias , Crocetta Tânia Brusque , Guarnieri Regiani , de Freitas Bruna Leal , Bianchi Lopes Priscila , Watson Suzanna , Tonks James , de Mello Monteiro Carlos Bandeira
Published: November 2018

Background:

Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established.

Method:

We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.”

Results:

We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function.

Conclusions:

The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.
Research on Home Care Nursing in Japan Using Geographic Information Systems: A Literature Review
Authors: Kuwayama Takashi , Hamabata Kenji , Kamesaki Toyomi , Koike Soichi , Kotani Kazuhiko
Published: November 2018

Given Japan’s super-ageing society and its need for developing community-based integrated care system, the role of home care nursing is becoming increasingly important. A central concern in home care nursing is regional/spatial placement of home nursing stations and accessibility for patients. Analysis based on geographic information systems (GIS) may be useful in home care nursing research. We conducted a literature review of home care nursing research based on GIS in Japan. A total of 4 articles were selected following a search of medical literature databases. The first report was published in 2014. Most subjects in the identified studies were older people. Most studies were implemented at a municipal level. Key themes in the identified studies were “placement of specialists and home nursing stations” and “placement of home nursing stations and target patients.” Despite the paucity of research, as all identified studies examined the community areas with an aged population, it may point to the need to consider community-based integrated care systems, including home care nursing, in Japan. More GIS-based research on home care nursing is called for.
Microarray analysis of long non-coding RNA and mRNA expression profiles in diabetic cardiomyopathy using human induced pluripotent stem cell–derived cardiomyocytes
Authors: Pant Tarun , Mishra Manoj K , Bai Xiaowen , Ge Zhi-Dong , Bosnjak Zeljko J , Dhanasekaran Anuradha
Published: November 2018

Aim:

This study aims to investigate the altered expression signature of long non-coding RNAs, mRNAs and deregulated pathways related to diabetic cardiomyopathy disease pathogenesis.

Method:

We utilize the previously established in vitro diabetic cardiomyopathy model of human induced pluripotent stem cell–derived human cardiomyocytes to perform long non-coding RNA and mRNA expression analysis on glucose (11 mM), endothelin-1 (10 nM) and cortisol (1 µM) stimulated human induced pluripotent stem cell–derived human cardiomyocytes to interrogate diabetic cardiomyopathy associated RNA expression profile.

Result:

Out of 20,730 mRNAs and 40,173 long non-coding RNAs being screened, 2046 long non-coding RNAs and 1582 mRNAs were differentially regulated (fold change > 2, p < 0.05) between diabetic cardiomyopathy and control group, of which more than half were intergenic and antisense long non-coding RNAs. Most of the coding transcripts were associated with processes like inflammation, structural reorganization, metabolism, smooth muscle contraction, focal adhesion and repair contributing towards the development of diabetic cardiomyopathy. The subgroup analysis further revealed 411 long non-coding RNAs being co-expressed with neighbouring genes. However, our coding–non-coding co-expression analysis showed an overall 48,155 co-expression network connections. In addition to that, the long non-coding RNAs with highest network connections were profoundly enriched for focal adhesion, cell-matrix adhesion and muscle contraction.

Conclusion:

These results provide comprehensive data about the pathways and regulatory mechanisms associated with diabetic cardiomyopathy and indicate that long non-coding RNAs may play a crucial role in diabetic cardiomyopathy.
The Effects of Polarization on Ideological Certainty: An Application to Executive Order Issuance
Authors: Brockway Mark , Hollibaugh Gary E.
Published: November 2018

Many standard models of political institutions frame outcomes as a function of the preferences of key decision makers. However, these models, and the empirical analyses they inspire, typically assume decision makers can infer the identities and ideological locations of other decision makers without error. Here, we reveal the substantive importance of this assumption. We show that partisan sorting, a common cause of polarization, can result in reduced uncertainty about the ideologies of key decision makers and the identities of key pivots. When we incorporate estimates of pivot uncertainty into empirical models of executive order issuance, we find lower levels of uncertainty are associated with higher rates of policy-relevant executive order issuance. These results have implications for the study of polarization and the use of models of institutions in political science.
Seismic behavior study on a space double-layer lattice structure with a lower supporting structure
Authors: Nie Gui-bo , Zhang Chen-xiao , Dai Jun-wu
Published: November 2018

Severe damage, such as support failure, global buckling of members, local buckling of members, fracture of members, dislocation at the end of members, and failure of bolted connections, were observed in space double-layer lattice structures following the Lushan earthquake (China, 2013, M 7.0). To study the seismic behavior of the space double-layer lattice structure with a lower supporting structure, a series of shaking table tests were conducted. A nonlinear numerical analysis was performed on the damage of the structure, in which the material parameters were obtained from material tests of the steel member. The numerical results were compared with the experimental results, and the difference between the test and the numerical simulation was presented and discussed. The validity and accuracy of the proposed numerical model used for predicting the structural damage was verified by the experimental results, which indicates that the modeling and analytical method was applicable for the analysis of the space double-layer lattice structure.
Contrasting Effects of Pressure Compensation on TEOAE and DPOAE in Children With Negative Middle Ear Pressure
Authors: Filipović Snezana A. , Haggard Mark P. , Spencer Helen , Trajković Goran
Published: November 2018

In children with normal cochlear acuity, middle ear fluid often abolishes otoacoustic emissions (OAEs), and negative middle ear pressure (NMEP) reduces them. No convincing evidence of beneficial pressure compensation on distortion product OAE (DPOAE) has yet been presented. Two studies aimed to document effects of NMEP on transient OAE (TEOAE) and DPOAE. In Study 1, TEOAE and DPOAE pass/fail responses were analyzed before and after pressure compensation in 50 consecutive qualifying referrals having NMEP from −100 to −299 daPa. Study 2 concentrated on DPOAE, recording both amplitude (distortion product amplitude) and signal-to-noise ratio (SNR) before and after pressure compensation. Of the 20 participants, 5 had both ears qualifying. An effect of compensation on meeting a pass criterion was present in TEOAE for both left and right ear data in Study 1 but not demonstrable in DPOAE. In Study 2, the distortion product amplitude compensation effect was marginal overall, and depended on recording frequency band. SNR values improved moderately after pressure compensation in the two (overlapping) sets of single-ear data. In the five cases with both ears qualifying, a stronger compensation effect size, over 3 dB, was seen. The absolute dependence of SNR on frequency was also strongly replicated, but in no analysis, the frequency × compensation interaction was significant. Independent of particular frequency range, the data support a limited SNR improvement in 2 to 3 dB for compensation in DPOAE, with slightly larger effects in ears giving SNRs between 0 dB and +6 dB, where pass/fail cutoffs would generally be located.
Role of Approved Ohio High School Training Programs in the Demand for Pharmacy Technicians
Authors: Hunold Rebecca L. , Powers Mary F.
Published: November 2018

Objective: To provide an overview of Ohio Administrative Code 4729 and to identify the potential role of newly approved Ohio high school training programs in preparation of registration-ready pharmacy technicians. Data Sources: Relevant sections of the Ohio Administrative Code and the Ohio public high school pharmacy technician training program application were identified through the Ohio Board of Pharmacy website. Resources on employee training and pharmacy technician demand were used from the Bureau of Labor Statistics, Forbes magazine, Association for Talent Development, and ExploreGate. Information pertaining to the approved high school training programs was identified from the program-specific websites. Related materials were searched for via PubMed and Google Scholar from 2000 to present. Study Selection and Data Extraction: Portions of the Ohio Administrative Code pertaining to pharmacy technician training and registration. Articles describing the cost of employer-based training and the growth of pharmacy technician demand. Data Synthesis: Training and registration requirements for pharmacy technicians have increased over the past decade. In Ohio, pharmacy technicians must now complete an approved training program and become either a registered or certified technician with the Board of Pharmacy. Technicians may complete either a nationally recognized, employer-based, or public high school training program prior to becoming a registered or certified pharmacy technician. Ohio public high school training programs must be Board approved and must prepare students for national certification. After completing a high school training program, pharmacy technicians are adequately prepared to enter the workforce with minimal training burden to potential employers. Conclusions: Newly approved Ohio high school training programs have the potential to fulfill the increased demand for pharmacy technicians at a decreased cost to both students and employers.
Pharmacy Technicians and Improving Onychomycosis Treatment Outcomes
Authors: Brown Sherrill J.
Published: November 2018

Objective: To provide an overview of onychomycosis and current treatments and to identify opportunities for pharmacy technicians to improve treatment outcomes. Data Sources: A MEDLINE/PubMed search (1966 to October 2018) was performed using search terms designed to identify English-language articles on onychomycosis diagnosis, treatment, and prevention, as well as articles on the impact of pharmacy technicians on onychomycosis outcomes and the use of pharmacy technicians to improve treatment adherence. Study Selection and Data Extraction: Review articles and clinical studies describing onychomycosis, risk factors, treatment efficacy, and prevention of recurrent infections were included. Data Synthesis: Although no articles on the impact of pharmacy technicians in the treatment of onychomycosis were found, the importance of treatment adherence on positive outcomes highlights a potential role of pharmacy technicians. Pharmacy technicians can identify patients with potential onychomycosis based on questions about over-the-counter products and refer patients to the pharmacist for counseling on treatment. Pharmacy technicians can also reinforce treatment adherence at refill visits. Conclusions: Pharmacy technicians can have a positive impact on onychomycosis treatment outcomes by addressing barriers to successful treatment and promoting treatment adherence.
Novel insights and therapeutic approaches in idiopathic multicentric Castleman disease
Authors: Fajgenbaum David C.
Published: November 2018

Castleman disease (CD) describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. Patients of all ages present with either a solitary enlarged lymph node (unicentric CD) or multicentric lymphadenopathy (MCD) with systemic inflammation, cytopenias, and life-threatening multiple organ dysfunction resulting from a cytokine storm often driven by interleukin 6 (IL-6). Uncontrolled human herpesvirus-8 (HHV-8) infection causes approximately 50% of MCD cases, whereas the etiology is unknown in the remaining HHV-8-negative/idiopathic MCD cases (iMCD). The limited understanding of etiology, cell types, and signaling pathways involved in iMCD has slowed development of treatments and contributed to historically poor patient outcomes. Here, recent progress for diagnosing iMCD, characterizing etio-pathogenesis, and advancing treatments are reviewed. Several clinicopathological analyses provided the evidence base for the first-ever diagnostic criteria and revealed distinct clinical subtypes: thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS), which are both observed all over the world. In 2014, the anti-IL-6 therapy siltuximab became the first iMCD treatment approved by the US Food and Drug Administration, on the basis of a 34% durable response rate; consensus guidelines recommend it as front-line therapy. Recent cytokine and proteomic profiling has revealed normal IL-6 levels in many patients with iMCD and potential alternative driver cytokines. Candidate novel genomic alterations, dysregulated cell types, and signaling pathways have also been identified as candidate therapeutic targets. RNA sequencing for viral transcripts did not reveal novel viruses, HHV-8, or other viruses pathologically associated with iMCD. Despite progress, iMCD remains poorly understood. Further efforts to elucidate etiology, pathogenesis, and treatment approaches, particularly for siltuximab-refractory patients, are needed.
Surface-based shared and distinct resting functional connectivity in attention-deficit hyperactivity disorder and autism spectrum disorder
Authors: Jung Minyoung , Tu Yiheng , Park Joel , Jorgenson Kristen , Lang Courtney , Song Wenwen , Kong Jian
Published: November 2018

Background

Both attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental disorders with a high prevalence. They are often comorbid and both exhibit abnormalities in sustained attention, yet common and distinct neural patterns of ASD and ADHD remain unidentified.

Aims

To investigate shared and distinct functional connectivity patterns in a relatively large sample of boys (7- to 15-year-olds) with ADHD, ASD and typical development matched by age, gender and IQ.

Method

We applied machine learning techniques to investigate patterns of surface-based brain resting-state connectivity in 86 boys with ASD, 83 boys with ADHD and 125 boys with typical development.

Results

We observed increased functional connectivity within the limbic and somatomotor networks in boys with ASD compared with boys with typical development. We also observed increased functional connectivity within the limbic, visual, default mode, somatomotor, dorsal attention, frontoparietal and ventral attention networks in boys with ADHD compared with boys with ASD. In addition, using a machine learning approach, we were able to discriminate typical development from ASD, typical development from ADHD and ASD from ADHD with accuracy rates of 76.3%, 84.1%, and 79.3%, respectively.

Conclusions

Our results may shed new light on the underlying mechanisms of ASD and ADHD and facilitate the development of new diagnostic methods for these disorders.

Declaration of interest

J.K. holds equity in a startup company, MNT.
Evaluating the Effect of Right-Censored End Point Transformation for Radiomic Feature Selection of Data From Patients With Oropharyngeal Cancer
Authors: Zdilar Luka , Vock David M. , Marai G. Elisabeta , Fuller Clifton D. , Mohamed Abdallah S.R. , Elhalawani Hesham , Elgohari Baher Ahmed , Tiras Carly , Miller Austin , Canahuate Guadalupe
Published: November 2018

Purpose

To evaluate the effect of transforming a right-censored outcome into binary, continuous, and censored-aware representations on radiomics feature selection and subsequent prediction of overall survival (OS) and relapse-free survival (RFS) of patients with oropharyngeal cancer.

Methods and Materials

Different feature selection techniques were applied using a binary outcome indicating event occurrence before median follow-up time, a continuous outcome using the Martingale residuals from a proportional hazards model, and the raw right-censored time-to-event outcome. Radiomic signatures combined with clinical variables were used for risk prediction. Three metrics for accuracy and calibration were used to evaluate eight feature selectors and six predictive models.

Results

Feature selection across 529 patients on more than 3,800 radiomic features resulted in increases ranging from 0.01 to 0.11 in C-index and area under the curve (AUC) scores compared with clinical features alone. The ensemble model yielded the best scores for AUC and C-index (often > 0.7) and calibration (Nam-D’Agostino test statistic often < 15.5 with 8 df). The random forest feature selectors achieved the best performance considering all metrics. Random regression forest performed the best in OS prediction with the ensemble model (AUC, 0.75; C-index, 0.76; calibration, 8.7). Random survival forest performed the best in RFS prediction with the ensemble model (AUC, 0.71; C-index, 0.68; calibration, 19.1).

Conclusion

Including a radiomic signature results in better prediction than using only clinical data. Signatures generated randomly or without considering the outcome result in poor calibration scores. The random forest feature selectors for each of the three transformations typically selected the greatest number of features and produced the best predictions at acceptable calibration levels. In particular, random regression forest and random survival forest performed best for OS and RFS, respectively.
Cancer patients’ and healthcare providers’ perceptions about supportive and integrative oncology services.
Authors: Jiang Cherry , Larbi Olivia , Feyes Denise , Momotaz Hasina , Li Ming , Daunov Kate , Daly Barbara J. , Mazanec Susan Rose , Rodgers-Melnick Samuel , Rolfe Sarah , Tamburro Nancy , Lee Richard T.
Published: November 2018

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Background: Supportive and integrative oncology services help to improve quality of life for cancer patients. This study characterizes and compares the perceptions of these services among cancer patients and healthcare providers. Methods: A cross-sectional survey was administered to Seidman Cancer Center (SCC) providers online in Spring 2018 and to SCC patients in waiting rooms March - July 2018. The survey asked about familiarity, perceived importance, frequency of use, accessibility and barriers of 19 supportive and integrative oncology services using a 5 point Likert scale. Data analysis included the Chi-square test and Spearman’s rank correlation. Results: A total of 585 surveys were obtained (421 patients and 164 healthcare providers). Patients were generally > 60 (58.2%), female (57.4%), Caucasian (64.2%) with most at > 1 year from starting treatment (59.9%). Healthcare providers were physicians (38.7%), RN partners (38.1%), and advanced practice providers (APPs) (23.2%). Most were female (74.3%), Caucasian (80%) and worked at SCC for > 5 years (56.4%). When compared with providers, many patients were not familiar with and did not perceive the supportive and integrative oncology services as important (see table). RN partners regarded physical therapy as less important than physicians and APPs (65.5% vs. 83.9% and 82.9%), while > 85% of providers from each category regarded palliative care, social work and diet & nutrition services as important. The most common barrier for both patients and providers was being unaware of the services (41.6% and 67.1%). Conclusions: Overall, healthcare providers were more familiar than patients with many supportive and integrative oncology services and considered most to be more important. Being unaware of the services was a common barrier identified by both providers and patients. [Table: see text]
Identification of pharmacogenetic markers in cancer supportive care.
Authors: Wei Min
Published: November 2018

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Background: Precision medicine has become increasingly critical in cancer supportive care, with implications for treatment selection, medication dosing, and side effect prediction. The presence of clinically actionable germline variants brought the hope that accurate prediction of drug efficacy and toxicity would be in the future. This will greatly improve the comprehensive oncology care, where supportive care treatment options can be subjective and personalized. Methods: The changes in drug effect and toxicity caused by genetic variations were characterized in 4,287 patients submitted for clinical pharmacogenetics testing using a gene panel including key pharmacokinetic and pharmacodynamic genes. For each patient, the need to select an alternate medication and adjust medication dose was determined for the treatment of pain (CYP2D6, CYP1A2, OPRM1), nausea/vomiting (CYP2D6), antifungal prophylaxis (CYP2C19), and depression (CYP2D6, CYP2C19). It is recognized that there are many other factors playing in the variations of the response and toxicity to these classes of medications. Results: Of the 4,287 patients, 964 (22%) would have a recommendation to choose alternatives of oxycodone, codeine, or tramadol therapy and 3,394 patients (79%) for a non-standard dosage. A change in certain antiemetics such as ondansetron would be suggested for 171 patients (4%). If voriconazole antifungal prophylaxis was clinical required, 1,228 (29%) would need a dose increase, while 133 (3%) should be switched to a different regimen. 2,727 patients (64%) should avoid or adjust dosage on some of the commonly used agents for depression due to reduced efficacy or heightened risk of toxicity. Conclusions: Pharmacogenetics markers associated with reduced drug efficacy and higher rate of ADRs were commonly observed for medications used in cancer supportive care. Identification of these markers would help clinicians achieve optimal treatment outcome with manageable time and cost. This provides great opportunities to apply precision medicine principles to patient management.