bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Sensitivity Troponin and the Application of Risk Stratification Thresholds in Patients With Suspected Acute Coronary Syndrome
Authors: Bularga Anda , Lee Kuan Ken , Stewart Stacey , Ferry Amy V. , Chapman Andrew R. , Marshall Lucy , Strachan Fiona E. , Cruickshank Anne , Maguire Donogh , Berry Colin , Findlay Iain , Shah Anoop S.V. , Newby David E. , Mills Nicholas L. , Anand Atul ,   On behalf of the High-STEACS Investigators
Published: September 2019

Background:

Guidelines acknowledge the emerging role of high-sensitivity cardiac troponin (hs-cTnl) for risk stratification and the early rule-out of myocardial infarction, but multiple thresholds have been described. We evaluate the safety and effectiveness of risk stratification thresholds in patients with suspected acute coronary syndrome.

Methods:

Consecutive patients with suspected acute coronary syndrome (n=48 282) were enrolled in a multicenter trial across 10 hospitals in Scotland. In a prespecified secondary and observational analysis, we compared the performance of the limit of detection (<2 ng/L) and an optimized risk stratification threshold (<5 ng/L) using the Abbott high-sensitivity troponin I assay. Patients with myocardial injury at presentation, with ≤2 hours of symptoms or with ST-segment elevation myocardial infarction were excluded. The negative predictive value was determined in all patients and in subgroups for a primary outcome of myocardial infarction or cardiac death within 30 days. The secondary outcome was myocardial infarction or cardiac death at 12 months, with risk modeled using logistic regression adjusted for age and sex.

Results:

In total, 32 837 consecutive patients (61±17 years, 47% female) were included, of whom 23 260 (71%) and 12,716 (39%) had hs-cTnl concentrations of <5 ng/L and <2 ng/L at presentation. The negative predictive value for the primary outcome was 99.8% (95% CI, 99.7%–99.8%) and 99.9% (95% CI, 99.8%–99.9%) in those with hs-cTnl concentrations of <5 ng/L and <2 ng/L, respectively. At both thresholds, the negative predictive value was consistent in men and women and across all age groups, although the proportion of patients identified as low risk fell with increasing age. Compared with patients with hs-cTnl concentrations of ≥5 ng/L but <99th centile, the risk of myocardial infarction or cardiac death at 12 months was 77% lower in those <5 ng/L (5.3% vs 0.7%; adjusted odds ratio, 0.23 [95% CI, 0.19–0.28]) and 80% lower in those <2 ng/L (5.3% vs 0.3%; adjusted odds ratio, 0.20 [95% CI, 0.14–0.29]).

Conclusions:

Use of risk stratification thresholds for hs-cTnl identify patients with suspected acute coronary syndrome and at least 2 hours of symptoms as low risk at presentation irrespective of age and sex.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01852123.
Improving the quality of life of people with advanced respiratory disease and severe breathlessness
Authors: Booth Sara , Johnson Miriam J.
Published: September 2019

Advanced respiratory disease imposes a greater symptom burden than many cancers but not does have comparable recognition of the need for supportive and palliative care or the infrastructure for its systematic delivery. Consequently, many people with advanced respiratory disease (and those closest to them) have a poor quality of life, disabled by chronic breathlessness, fatigue and other symptoms. They are socially isolated by the consequences of long-term illness and are often financially impoverished. The past decade has seen an increasing realisation that care for this group must improve and that symptom management must be prioritised. Clinical guidelines recommend person-centred care, including access to supportive and palliative care as needed, as part of standard medical practice. Advanced lung disease clinics and specialist breathlessness services (pioneered within palliative care) are developing within respiratory medicine services but are provided inconsistently.

This review covers the comprehensive assessment of the patient with advanced respiratory disease, the importance of supporting carers and the current best practice in the management of breathlessness, fatigue and cough. It also suggests ways to incorporate person-centred care into the general respiratory clinic, assisted by better liaison with specialist palliative and primary care. Emerging evidence shows that excellent symptom management leads to better clinical outcomes and reduces inappropriate use of emergency medical services.

Key points

People living with advanced respiratory disease and severe chronic breathlessness (and those closest to them) have a poor quality of life.

Chronic breathlessness is a disabling symptom, and acute-on-chronic/episodic breathlessness is frightening to experience and observe.

Chronic breathlessness imposes profound physical limitations and psychosocial burdens on those suffering from it or living with someone experiencing it.

Fatigue and cough are two other cardinal symptoms of advanced respiratory disease, with very detrimental effects on quality of life.

The impact of all these symptoms can be alleviated to a variable extent by a predominantly non-drug complex intervention.

Many of the interventions are delivered primarily by allied health or nursing professionals.

Doctors, nurses and other health professionals also need to play an active part in promoting quality of life as part of excellent medical care.

A person-centred, psychologically informed approach is needed by all clinicians treating patients with advanced respiratory disease.

Educational aims

To give specialist respiratory clinicians practical clinical tools to help improve the quality of life of their patients with advanced respiratory disease and chronic breathlessness.

To outline the evidence base for these interventions with reference to definitive sources.

To highlight the importance of person-centred care in people with respiratory disease at all stages of illness.
Why is medical oxygen a challenge for people travelling by air?
Authors: Orritt Rachel , Powell Pippa , Saraiva Isabel
Published: September 2019

There are currently 3.5 million people in Europe who require medical oxygen, and as life expectancies increase, this figure is likely to grow. At the same time, air travel is becoming more accessible to a wider range of people, as costs of flights fall, and airlines and airports make improvements to the accessibility of their services.

People who need medical oxygen to fly experience a wide range of difficulties when planning to travel by plane, and sometimes during or after the flight.

A European Commission Regulation (EC No 1107/2006) sets the standard for airlines when it comes to making air travel accessible, but healthcare professionals and oxygen providers can both help patients to navigate the various requirements for using medical oxygen when travelling.

In this review, we discuss the journey of the patient planning to travel by air, from initial consultation and fit-to-fly test, through to planning their air travel and oxygen supply, travelling, and arriving at their destination. We also highlight some common problems at each stage and suggest points for healthcare professionals to discuss with patients.

Key points

Patients who require medical oxygen for air travel should begin planning their trip as far in advance as possible.

It is very advantageous for healthcare professionals to be able to advise patients on travelling with oxygen and what they need to do.

Requirements and policies can vary greatly between airlines, causing problems for patients who are trying to book their flights.

Patients or their carers need to be confident operating their oxygen equipment, as the stress of travel and lack of medical assistance on an airplane can put them at risk.

Careful arrangements need to be made by the patient to make sure that they have the correct oxygen therapy at their destination, and can access support if they need it.

Educational aims

To understand the process and potential challenges for a patient who requires oxygen to travel by plane.

To be confident in discussing air travel with patients who are affected by lung disease.
Revealing the painterly technique beneath the surface of Vermeer’s Girl with a Pearl Earring using macro- and microscale imaging
Authors: Vandivere Abbie , van Loon Annelies , Dooley Kathryn A. , Haswell Ralph , Erdmann Robert G. , Leonhardt Emilien , Delaney John K.
Published: September 2019

The initial steps that Johannes Vermeer took to create Girl with a Pearl Earring (c. 1665) are, partially or completely, hidden beneath the painted surface. Vermeer’s painting technique involved applying underlayers that vary in colour and thickness, on top of which he applied the upper paint layer(s). To investigate the painting’s genesis, the Girl was examined using non-invasive scientific imaging as part of the project The Girl in the Spotlight (2018). This was complemented by the re-examination of existing paint cross-sections using microscopic analytical techniques, including focused ion beam-scanning transmission electron microscopy (FIB-STEM). The weave of the canvas, visible in the X-radiograph, was examined using a new computer-assisted thread-level canvas analysis algorithm to measure the thread spacing and thread angles. The canvas was primed with a warm light grey ground, although probably not by Vermeer himself. The tinted ground provided neutral base tone upon which he began to lay in areas of light and shade in his composition, and some outlines around the figure. Multispectral infrared reflectography( MS-IRR) images in four spectral bands spanning the spectral range from 900 to 2500 nm were collected of the painting at high spatial resolution (50 µm/pixel). Visible 3D digital microscopy visualised the underlayers where Vermeer left them visible around the perimeter of the figure as a contour, and where the upper paint layers are thin. These infrared reflectograms and visible micrographs identified three distinct preparatory phases of Girl with a Pearl Earring: the ground, fine black outlines, and underlayers. Some pentimenti were also detected, including a change in the position of her ear. The combination of examination methods showed that the materials beneath the surface played an important role in establishing the three-dimensional space, fall of light, and the eventual colour in different areas of the painting.
Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis
Authors: Klifto Kevin M. , Elhelali Ala , Gurno Caresse F. , Seal Stella M. , Asif Mohammed , Hultman C. Scott
Published: September 2019

Background

Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. The objective of this article was to evaluate if non-surgical or surgical interventions are best for acute management of ocular and/or peri-ocular burns.

Methods

This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within 1 month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded.

Results

Eight of the 14,927 studies queried for this study were eligible for the systematic review and meta-analysis, with results from 33 of the possible 58 outcomes and complications using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. Surgery was associated with standard mean differences (SMD) 0.44 greater visual acuity on follow-up, SMD 1.63 mm shorter epithelial defect diameters on follow-up, SMD 1.55 mm greater changes in epithelial diameters from baseline, SMD 1.17 mm2 smaller epithelial defect areas on follow-up, SMD 1.37 mm2 greater changes in epithelial defect areas from baseline, risk ratios (RR) 1.22 greater numbers of healed epithelial defects, RR 11.17 more keratitis infections, and a 2.2 greater reduction in limbal ischemia compared to no surgical intervention.

Conclusions

This systematic review and meta-analysis found that compared to non-surgical interventions, acute surgical interventions for ocular, eyelid, and/or eyelash burns were found to have greater visual acuity on follow-up, shorter epithelial defect diameters on follow-up, greater changes in epithelial diameters from baseline, smaller epithelial defect areas on follow-up, greater changes in epithelial defect areas from baseline, greater numbers of healed epithelial defects, more keratitis infections, and a greater reduction in limbal ischemia, possibility preventing the need of a future limbal stem cell transplantation.
The strengths and weaknesses of gross and histopathological evaluation in hepatocellular carcinoma: a brief review
Authors: Martins-Filho Sebastião N. , Alves Venâncio Avancini Ferreira
Published: September 2019

Careful pathological analysis of hepatocellular carcinoma (HCC) specimens is essential for definitive diagnosis and patient prognostication. Tumor size and focality, gross patterns, macro- and microvascular invasion, degree of histological differentiation and expression of Keratin 19 (K19) are relevant features for risk stratification in this cancer and have been validated by multiple independent cohorts. However, there are important limitations to pathological analyses in HCC. First, liver biopsies are not recommended for diagnosis according to current clinical guidelines. Second, there is limited morphological data from patients at intermediate, advanced and terminal disease stages. Finally, there is little consensus on the evaluation of key histopathological features, notably histological grading (degree of differentiation). Here, we review important morphological aspects of HCC, provide insights to molecular events in relation to phenotypic findings and explore the current limitations to pathological analyses in this cancer.
Global Consensus Position Statement on the Use of Testosterone Therapy for Women
Authors: Davis Susan R , Baber Rodney , Panay Nicholas , Bitzer Johannes , Perez Sonia Cerdas , Islam Rakibul M , Kaunitz Andrew M , Kingsberg Sheryl A , Lambrinoudaki Irene , Liu James , Parish Sharon J , Pinkerton JoAnn , Rymer Janice , Simon James A , Vignozzi Linda , Wierman Margaret E
Published: September 2019

This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynecologists.*
Opportunities & Challenges for Operations Management – A point of view from the 2018 POMS International Conference in Rio
Authors: Leiras Adriana , Cotta Fontainha Tharcisio
Published: September 2019

This thematic issue called Opportunities & Challenges for Operations Management of the Brazilian Journal of Operations and Production Management (BJO&PM) presents contemporaneous discussions of operations management, which is valuable for both the Brazilian and international audience. The papers presented in this thematic issue are selected based on articles and presentations performed in the “2018 POMS International Conference in Rio”, held under the theme “Operations Management for social good”. This introductory paper evaluates and summarizes the selected contributions of all papers presented in this thematic issue. The key topics emphasized in these papers are a real options approach for investment decision, business management, supply chain management, humanitarian logistics, and operations management.
The use of Airpower on Humanitarian Operations: a case study in Brazil
Authors: Santos Rodrigo Antônio Silveira
Published: September 2019

Goal: The main purpose of this research is to present the benefits reached with the use of airpower resources during humanitarian operations, in order to verify how the main airpower’s characteristics influenced the response stage of a natural disaster in Brazil.

Design / Methodology / Approach: A qualitative case study was conducted to evaluate benefits reached with the use of airpower during humanitarian operations. Primary and secondary data were gathered from operational reports provided by the Brazilian Air Force, from media coverage about the flood and waterlogging events happened in November 2008, in Itajai Valley, Santa Catarina State, Brazil. Interviews with three informants involved in crisis response were also conducted. Data analysis processes were conducted to search codes about airpower engagement during humanitarian operations. Data coding followed an inductive approach and the codes emerged from data.

Results: The research concludes that the use of airpower can leverage crisis response capabilities during humanitarian operations, as airpower’s characteristics of speed, mobility, flexibility, penetration, range, and readiness meet the needs of humanitarian operations to respond to a natural disaster. The case study demonstrates an increase of operational capabilities after airpower engagement.

Limitations of the investigation: Only one crisis situation was studied, because the access to operational data provided by the Brazilian Air Force is restricted. Besides, it was not possible to analyze values and budgetary costs derived from airpower engagement.

Practical implications: The results of this research demonstrate that it is highly important to involve airpower during humanitarian operations, as it can leverage crisis response capabilities. In this way, humanitarian organizations can stablish new forms of relationship to national and local governments in order to quickly engage airpower resources on the response phase of natural disasters.

Originality/Value: This research presents an original contribution to the field of humanitarian operations as it presents real data in terms of the engagement of airpower resources during humanitarian operations.
Impact of the urban logistics and pedestrian mobility: Gamarra case, Peru
Authors: De Brito Junior Irineu , Huivin Jaime , Chong Mario
Published: September 2019

Goals: This study focuses on assessing disaster risks in a typical inmegacity in Latin America. The baseline focuses on the logistics characteristics of the last mile, the vulnerability of buildings and the mobility of pedestrians.

Design / Methodology / Approach: A risk assessment procedure is developed using logistic metrics through a methodology that captures the most relevant urban information within a square kilometer, and two complementary methods that provide support to obtain metrics associated with the occurrence of disasters.

Results: The results show that the majority of blocks in the analyzed area have levels of precautionary risk due to their high level of store density, structure’s vulnerability, pedestrian movement and freight flow.

Limitations of the research: The main limitations for the data collection were the insecurity, the level of informality and the chaos presented in the studied area.

Practical implications: The main findings allow decision makers to know the most vulnerable areas of the place and, thus, propose recommendations for public policies based on urban knowledge. In addition, the proposed method can be taken as a reference to be applied to other zones of similar characteristics.

Originality / Value: This research develops a methodology that evaluates the risks and mitigates the impact on a specific unstudied commercial area, combining three existing methodologies to correctly asses risk on certain zones. This work is an extension of the work of Huivin et al. (2020); the added value is that it provides deeper literature reviewing that help decision-makers and researchers to know the actual state of the art.
Investment decisions in an oil refinery in Brazil under a real option approach
Authors: Lopes Carolina De Castro , Blank Frances Fischberg , Thomé Antonio Marcio Tavares , Valladão Davi Michel
Published: September 2019

Goal: The objective of this article is twofold: (i) analyze the investment in a new refinery in Brazil and identify the optimal moment to invest; and (ii) model the crack spread adjusted to the Brazilian market.

Design / Methodology / Approach: The main uncertainties given by the crack spread and the foreign exchange rate were modeled as a continuous mean reversion model and geometric Brownian motion, respectively. The project was valued based on a real-option approach, including the option to postpone and the option to temporarily shut down. The first was assessed from analytical solution of the differential equation, while the latter was obtained from Monte Carlo simulation.    

Results: The investment decision changes depending on the expiration date of the postponement option and the stochastic treatment of the initial investment. The temporary shutdown option increases the value of the refinery and may change the decision of postponement.

Limitations of the investigation: The crack spread was modeled based on international market because of limited availability of data from the Brazilian market. Additionally, results are dependent on the uncertainties and flexibilities modeled.

Practical implications: The analysis comprising both options is especially relevant because there are refinery projects discontinued in Brazil, and the country is an oil products’ importer.

Originality / Value: The paper contributes with an analysis in the refining industry considering the optimal moment to invest based on the interaction of two different options. Especially original is the crack spread modeling adapted to the Brazilian market.
Evaluation of green transport corridors of Brazilian soybean exports to China
Authors: Péra Thiago Guilherme , Bartholomeu Daniela Bacchi , Su Connie Tenin , Caixeta Filho José Vicente
Published: September 2019

Goal: To evaluate the potential of strategies to promote green corridors of soybean exports from Brazil to China.

Design / Methodology / Approach: The best transportation corridors are evaluated in terms of minimum transportation cost and minimum CO2 emissions in transport. This problem was modelled as a linear programming problem and was solved by GAMS. It involves transporting soybeans from the producing farms in the Brazilian Center-West to the main Brazilian export ports and, subsequently, to China, through the various logistical infrastructures available.

Results: In general, strategies aimed to reduce CO2 emissions in the Brazilian soybean exports to China, and also promote the reduction of transport costs, as presented in the results of the different scenarios. Since the greatest impact on both indicators came from the use of Capesize ships, the study suggests that investments in port infrastructure to increase its vessel berthing capacity generate positive impacts, both in terms of lower transportation costs and CO2 emissions.

Limitations of the investigation: The producing regions were divided in mesoregions. The road distance considered is between the centroid of the producing region to the destination.

Practical implications: Especially in the scenarios of unrestricted transport infrastructure, the study suggests the configuration of optimum soybean flows, as well as the respective level of utilization of multimodal terminals. From the findings of the study, agents involved in the logistics of exporting soy to China can identify the investments in rail and port terminals necessary to a greener logistics.

Originality / Value: This work will contribute to the literature in the Green Supply Chain Management field of study, especially in a Brazilian perspective.
A sales and operations planning application in the Brazilian subsidiary of a multinational chemical company
Authors: Seeling Marcelo Xavier , Scavarda Luiz Felipe , Thomé Antonio Márcio Tavares
Published: September 2019

Goal: the goal of this paper is to investigate how Sales and Operations Planning (S&OP) is conducted in the Brazilian subsidiary of a global corporation of the chemical industry that manufactures and commercializes a variety of hygiene and cleaning consumer products.

Design/Methodology/Approach: the case study approach was adopted. Data was gathered during four months by means of visits to the organization for direct observation, interviews with key executives, and internal and public documents, guaranteeing data triangulation. A well-known framework from the literature is applied to analyze the S&OP practices performed by the organization.

Results: Findings contribute to aid in the understanding of the S&OP process. The case study indicates that S&OP has been a central process to organize and to align the enterprise’s efforts and deliver its business objectives.

Limitations of the investigation: the research is conducted within one single company, a Brazilian subsidiary of a multinational chemical corporation, which limits the generalization of the findings.

Practical implications: The research findings enhance the knowledge about S&OP providing practitioners with valuable information to understand better its phenomenon, such as how the process is performed, and the best practices and benefits.

Originality/Value: S&OP has been an object of interest of scholars and practitioners for decades. However, the process is far from being completely understood and there is a call for more empirical studies. Thus the academic literature can benefit from this in-depth research that sheds light on an S&OP industry application.
Lessons from empirical studies in supply chain flexibility: a maturity perspective
Authors: Mello Raquel , Hellingrath Bernd , Martins Roberto Antonio
Published: September 2019

Goal: To analyze supply chain flexibility (SCF) within real-life settings from a maturity perspective and provide a discussion on the importance of a maturity model for SCF.

Design/Methodology/Approach: A multiple case study was conducted in multinational manufacturing companies from different business sectors, offering a within-case and cross-case analysis.

Results: The empirical evidence revealed that the studied companies do not consider flexibility measures. This absence renders difficulties when striving for external flexibility, for instance, affecting planning and control activities. Furthermore, the conducted analysis showed that sharing information among supply chain members has a significant impact on the identification of changes in the processes, enabling a correct and quick reaction to these changes.

Limitations of the investigation: The results are restricted to the studied companies; therefore, the SCF maturity model deserves more application through the development of more empirical investigations.

Practical implications: This is a guide for practitioners to identify the current maturity level of their SCF, and subsequently improve the processes, aiming to achieve the desired result.

Originality/Value: This paper addresses the lack of theoretical and empirical studies in the literature regarding the analysis of SCF maturity and its different levels, thus enabling practitioners and researchers to improve the understanding of maturity in the SCF context.
Social license to operate – the perspective of professionals from Brazilian extractive companies
Authors: Faria Marcio Carapeto Silveira , Neto Julio Vieira , Quelhas Adriane Domingues
Published: September 2019

Goal: Contribute to the academic literature on the theme social license to operate, of the perception and experience of professionals from Brazilian extractive companies involved in the process.

Design / Methodology / Approach: In-depth interviews with professionals with great experience in community relations processes, evaluating their perception regarding social license to operate, especially with the companies they work.

Results: Two products are presented: a) illustration with a conceptual analysis of the terms related to the social license process to operate; b) basic model of community relationship based on recommendations of the professionals to obtain and maintain the social license to operate and the literature visited.

Limitations of the investigation: the survey heard 12 professionals with extensive experience in the extractive sector in Brazilian companies to understand how companies act and their perceptions regarding Social License to Operate (SLO). However, other important actors, such as communities, Nonprofit Organizations and community leaders were not heard throughout the research, and a corporate vision was presented throughout the article, but only against the literary review.

Practical implications: It presents a consistent picture regarding the behavior of companies in relation to SLO. It allows a better understanding of the relationship of concepts and terms that overlap in company practice and proposes a community relationship management model.

Originality / Value: The research brings an important contribution to the academic literature, when evaluating, from interviews with professionals in the extractive industry involved in the management of community relations, the way Brazilian extractive companies operate in this segment and the understanding with regard to SLO.
Avaliação da influência da liderança transformacional do diretor de escola sobre o desempenho dos alunos: Análise a partir de microdados da Prova Brasil
Authors: Pinto Vera Regina Ramos , Zouain Deborah Moraes , Duarte André Luís Faria , Souza Luiz Alexandre Valadão
Published: September 2019

Este artigo apresenta pesquisa cujo objetivo foi verificar em que medida a liderança dos diretores de escolas brasileiras tem contribuído para a melhoria do desempenho dos estudantes, refletido nos resultados das avaliações externas das escolas. Buscou-se: mensurar dimensões da liderança, a partir dos microdados dos questionários contextuais respondidos por diretores e professores; propor um modelo que relacione dimensões de liderança ao desempenho dos educandos, refletido nos resultados de IDEB da escola; e verificar as relações entre as dimensões da liderança e o desempenho dos alunos. Para este fim foram realizadas análises multivariadas, especificamente modelagem de equações estruturais, em base de dados formada por microdados da Prova Brasil e valores do IDEB. Os resultados mostram que é possível mensurar dimensões de liderança utilizando-se os referidos microdados. A partir do modelo conceitual desenvolvido, há evidências de que as relações desenvolvidas pelo diretor, no âmbito interno à escola, têm efeito maior no comprometimento dos professores quanto ao seu empenho no aprimoramento do ensino e da aprendizagem, influenciando indiretamente no desempenho da escola. Além disso, o diretor de escola tem buscado exercer a liderança transformacional combinada com a liderança pedagógica, o que representa um desafio para este profissional, por abranger inúmeras áreas de conhecimento.
How well do Croatian laboratories adhere to national recommendations for laboratory diagnostics of chronic kidney disease (CKD)?
Authors: Radišić Biljak Vanja , Honović Lorena , Matica Jasminka , Krešić Branka , Šimić Vojak Sanela
Published: September 2019

Background

In 2014, the Joint Croatian Working Group (JCWG) for laboratory diagnostic of chronic kidney disease (CKD) conducted a survey across medical-biochemistry laboratories which demonstrated a large heterogeneity in this area of laboratory medicine. To ensure the tools for the standardization process, in 2017 the JCWG-CKD published the first Croatian recommendations for laboratory diagnostics of CKD. To assess the implementation process, we have repeated a survey to explore how well laboratories adhere to the recommendations.

Methods

An invitation to the survey was sent to all Croatian medical-biochemistry laboratories (n = 196). The questionnaire was designed in a form of 19 questions and statements, with possible multiple answers.

Results

The response rate was 98/196 (50.0%). The predominant method for serum creatinine measurement was the standardized compensated Jaffe method (79.2%). There was substantial decrease in the number of laboratories which measure creatinine with the non-standardized uncompensated Jaffe method, compared with the initial 2014 assessment; 7% vs. 40%, respectively. The number of the laboratories that did not report estimated glomerular filtration rate (eGFR) values decreased almost by half compared to the initial data (37.6% vs. 74.4%). However, compared to the 2014 initial assessment, a similar number of laboratories (54/98 vs. 58/80) did not measure urine albumin or protein.

Conclusions

The collected data showed a substantial improvement in the standardization of the serum creatinine measurement, as well as in the reporting of eGFR. However, albuminuria or proteinuria assessment is still not implemented nationwide, mainly in primary health care laboratories. This demonstrates the importance of promoting and monitoring implementation of guidelines after publication.
Calcium state estimation by total calcium: the evidence to end the never-ending story
Authors: Pekar Jean-David , Grzych Guillaume , Durand Gatien , Haas Joël , Lionet Arnaud , Brousseau Thierry , Glowacki François , Maboudou Patrice
Published: September 2019

Background

Total blood calcium (TCa) is routinely used to diagnose and manage mineral and bone metabolism disorders. Numerous laboratories adjust TCa by albumin, though literature suggests there are some limits to this approach. Here we report a large retrospective study on agreement rate between ionized calcium (iCa) measurement and TCa or albumin-adjusted calcium measurements.

Methods

We retrospectively selected 5055 samples with simultaneous measurements of iCa, TCa, albumin and pH. We subgrouped our patients according to their estimated glomerular filtration rate (eGFR), albumin levels and pH. We analyzed each patient’s calcium state with iCa as reference to determine agreement rate with TCa and albumin-adjusted calcium using Payne, Clase, Jain and Ridefelt formulas.

Results

The Payne formula performed poorly in patients with abnormal albumin, eGFR or pH levels. In patients with low albumin levels or blood pH disorders, Payne-adjusted calcium may overestimate the calcium state in up to 80% of cases. Similarly, TCa has better agreement with iCa in the case of hypoalbuminemia, but performed similarly to the Payne formula in patients with physiological albumin levels. The global agreement rate for Clase, Jain and Ridefelt formulas suggests significant improvement compared to Payne calcium adjustment but no significant improvement compared to TCa.

Conclusions

Total and albumin-adjusted calcium measurement leads to a misclassification of calcium status. Moreover, accurate calcium state determination depends on blood pH levels, whose measurement requires the same pre-analytical restrictions as iCa measurement. We propose that iCa should instead become the reference method to determine the real calcium state.
Impact of xanthan gum addition on phenolic acids composition and selected properties of new gluten-free maize-field bean pasta
Authors: Widelska Gabriela , Wójtowicz Agnieszka , Kasprzak Kamila , Dib Ahlem , Oniszczuk Tomasz , Olech Marta , Wojtunik-Kulesza Karolina , Nowak Renata , Sujak Agnieszka , Dobrzański Bohdan , Oniszczuk Anna
Published: September 2019

Replacing the gluten network to produce high quality pasta is a great technological challenge. One of known solutions to the problem is the addition of xanthan gum. This paper focuses on the possibility of obtaining a new type of gluten-free maize-field bean pasta and explores the characteristics of phenolics content, antioxidant activity, cooking quality, textural and thermotropic behavior as well as the microstructure of pasta products with the various levels of added xanthan gum. The obtained results revealed that 0.25, 0.50 and 0.75% addition of xanthan gum to pasta did not have significant influence on its phenolics content and antioxidant activity, whereas 1.00% addition caused a decrease in the tested parameters. On the other hand, the opposite effect of gum addition on the cooking quality, texture characteristic and microstructure was observed. The addition of xanthan gum to the formulation improved pasta quality while reducing the leaching of its components into the cooking water. Pasta prepared with 1.00% xanthan gum showed the lowest cooking loss, the highest firmness, and the lowest adhesiveness. These results revealed a significant influence of xanthan gum content on pasta properties as confirmed by the thermal analysis and SEM microstructure observations.
The effect of selected substances on the stability of standard solutions in voltammetric analysis of ascorbic acid in fruit juices
Authors: Kowalski Radosław , Mazurek Artur , Pankiewicz Urszula , Włodarczyk-Stasiak Marzena , Sujka Monika , Wyrostek Jakub , Kałwa Klaudia
Published: September 2019

The objective of the study was to identify suitable additives stabilizing standard solutions of ascorbic acid (AA) that would not cause interference in the analytical process with the use of voltammetry in the determination of the AA content in food products. In addition, the effect of various conditions of storage of selected fruit juices and drinks on the concentration of vitamin C was studied. The study demonstrated that AA degradation was inhibited the most effectively by tartaric acid and its optimum concentration was set to 200 mg L-1. Analysis of selected fruit juices stored in various temperature conditions confirmed that an elevation of temperature and extension of the time of storage caused a decrease in the content of vitamin C in the analyzed samples, while closing the packages caused a limitation of the changes in concentration of this vitamin. On the basis of literature data and of the results obtained in the present study it can be concluded that fruit juices should be stored at a temperature lower than room temperature to retain their nutritive value.
Mapping of IDUA gene variants in Pakistani patients with mucopolysaccharidosis type 1
Authors: Zahoor Muhammad Yasir , Cheema Huma Arshad , Ijaz Sadaqat , Anjum Muhammad Nadeem , Ramzan Khushnooda , Bhinder Munir Ahmad
Published: September 2019

Background

Mucopolysaccharidosis type 1 (MPS1) is a rare debilitating multisystem lysosomal disorder resulting due to the deficiency of α-L-iduronidase enzyme (IDUA), caused by recessive mutations in the IDUA gene. Lack or improper amount of the IDUA enzyme results in the improper metabolism of mucopolysaccharides or glycosaminoglycans (GAGs). These large sugar molecules accumulate in lysosomes within cells leading to different systemic complications. The estimated global incidence of MPS1 is 1:100,000 live births for the Hurler and 1:800,000 for the Scheie phenotypes.

Methods

Thirteen MPS1-affected children from 12 unrelated cohorts were enrolled. All coding and flanking regions of the IDUA gene were sequenced. Bioinformatics tools were used for data analysis and protein prediction for clinical correlations.

Results

Six IDUA gene mutations were mapped co-segregating with the recessive pattern of inheritance including a novel variant. A novel missense variant c.908T > C (p.L303P) was mapped in two affected siblings in a cohort in the homozygous form. The variant c.1469T > C (p.L490P) was mapped in five unrelated patients and c.784delC (p.H262Tfs*55) was mapped in three unrelated patients, while mutations c.1598C > G (p.P533R), c.314G > A (p.R105Q) and c.1277ins9 (p.[A394-L395-L396]) were mapped in a single patient each.

Conclusions

Multisystem disorders and a wide range of clinical presentation impede the evaluation of patients as well as make it difficult to differentiate between different phenotypes of MPS. Early and accurate diagnosis is crucial for the disease management and implementation of an expanded new-born genetic screening program for inborn errors of metabolism including MPS1. We recommend c.784delC (p.H262Tfs*55) and c.1469T > C (p.L490P) as first-line genetic markers for the molecular diagnosis of MPS1 in Pakistan.
Successful treatment of infantile-onset ACAD9-related cardiomyopathy with a combination of sodium pyruvate, beta-blocker, and coenzyme Q10
Authors: Kadoya Takumi , Sakakibara Azumi , Kitayama Kana , Yamada Yuki , Higuchi Shinji , Kawakita Rie , Kawasaki Yuki , Fujino Mitsuhiro , Murakami Yosuke , Shimura Masaru , Murayama Kei , Ohtake Akira , Okazaki Yasushi , Koga Yasutoshi , Yorifuji Tohru
Published: September 2019

Mitochondrial acyl-CoA dehydrogenase 9 (ACAD9) deficiency is one of the common causes of respiratory chain complex I deficiency, which is characterized by cardiomyopathy, lactic acidemia, and muscle weakness. Infantile cardiomyopathy is the most common phenotype and is usually lethal by the age of 5 years. Riboflavin treatment is known to be effective in ~65% of the patients; however, the remaining are unresponsive to riboflavin and are in need of additional treatment measures. In this report, we describe a patient with ACAD9 deficiency who developed progressive cardiomyopathy at 8 months of age. As the patient’s left ventricular ejection fraction (LVEF) kept decreasing to 45.4% at 1 year 8 months, sodium pyruvate treatment was introduced together with a beta-blocker and coenzyme Q10. This resulted in a steady improvement, with full and sustained normalization of cardiac function without riboflavin. The therapy, therefore, might be a useful addition for the treatment of ACAD9 deficiency.
Association between MTHFR genetic polymorphism and Parkinson’s disease susceptibility: a meta-analysis
Authors: Diao Hong-Mei , Song Zheng-Feng , Xu Hai-Dong
Published: September 2019

Folate metabolism plays quite a critical role in Parkinson’s disease (PD). Previous published research works have studied the link existing between the folate metabolism genetic polymorphisms and PD susceptibility; nevertheless, the results continue having controversies and inconclusiveness. Accordingly, we carried out the present meta-analysis for the assessment of the potential link between the folate metabolism genetic polymorphisms and the susceptibility to PD. In addition we carried out a literature search in the PubMed, EMBASE, Cochrane Library, and WanFang databases till November 10, 2018. The odds ratios (ORs) with corresponding 95% credible interval (95%CI) were put to use for evaluating the strength of the association of three folate metabolism genetic polymorphism ( C677T, A1298C, and A2756G) with the susceptibility to PD. Each statistical analysis was carried out with the use of STATA 15.0. An aggregate of twenty-one case-control investigations were retrieved, which involved 3,944 PD patients and 4,412 controls. We discovered the existence of no substantial link between the C677T and A1298C polymorphism and PD risk in any genetic framework comparisons. With regard to A2756G polymorphism, we discovered that there was an association between the A2756G genetic polymorphism and an augmented threat of PD in the co-dominant genetic framework (GG vs. AA: OR=1.86, 95%CI=1.02-3.37, P=0.042) and the recessive genetic model (GG vs. GA+AA: OR=1.90, 95%CI=1.06-3.41, P=0.031). To summarize, our research work indicates that the A2756G polymorphism of the folate metabolism gene had an association with an augmented threat of PD. Also, A1298C polymorphisms is unlikely to significantly contribute towards the susceptibility to PD. Further large-scale case-control studies are still required.
Echocardiography evaluation of left ventricular diastolic function in elderly women with metabolic syndrome
Authors: Chung Jin-Wook , Seo Dong-il , Park Yoonjung , So Wi-Young
Published: September 2019

To date, we found no published reports on the effects of metabolic syndrome and physical activity levels on left ventricular (LV) diastolic function in elderly women aged over 65 years. Our study involved patients with echocardiographically normal LV ejection fractions (≥50%) and normal LV dilatation diameters (≤55 mm). Elderly women with metabolic syndrome (n = 20) and healthy elderly women (n = 17) were selected and assessed with the National Cholesterol Education Program Adult Treatment Panel III, a metabolic syndrome diagnostic instrument. We compared the LV function indices and physical activity levels according to the presence (metabolic syndrome group) or absence (normal group) of metabolic syndrome. The LV end-systolic (LVES) diameter was significantly smaller (p = 0.037) and LV outflow tract (LVOT) diameter was significantly larger (p = 0.030) in the metabolic syndrome group. The left arterial dimension at end-systole (p = 0.024), left arterial volume (LAV) index (p = 0.015), early peak mitral inflow velocity (E, p = 0.031), early diastolic mitral annulus motion velocity (Eʹ-septal, p = 0.044), (Eʹ-lateral, p = 0.008), and E/late peak mitral inflow velocity ratio (E/A, p = 0.006) values were significantly lower and physical activity levels (p = 0.034) were significantly higher in the metabolic syndrome group. These results indicated that the metabolic syndrome group had relatively high physical activity levels compared to the normal group, which may have positively affected the LVES, LVOT, left atrial volume index, E, Eʹ, and E/A values.
Artificial Intelligence in Basic and Clinical Neuroscience: Opportunities and Ethical Challenges
Authors: Kellmeyer Philipp
Published: September 2019

The analysis of large amounts of personal data with artificial neural networks for deep learning is the driving technology behind new artificial intelligence (AI) systems for all areas in science and technology. These AI methods have evolved from applications in computer vision, the automated analysis of images, and now include frameworks and methods for analyzing multimodal datasets that combine data from many different source, including biomedical devices, smartphones and common user behavior in cyberspace.

For neuroscience, these widening streams of personal data and machine learning methods provide many opportunities for basic data-driven research as well as for developing new tools for diagnostic, predictive and therapeutic applications for disorders of the nervous system. The increasing automation and autonomy of AI systems, however, also creates substantial ethical challenges for basic research and medical applications. Here, scientific and medical opportunities as well ethical challenges are summarized and discussed.