bluuebunny/crossref_metadata_2025 huggingface dataset:
An Analysis Between Search Engine Optimization Versus Social Media Marketing Affecting Individual Marketer’s Decision--Making Behavior
Authors: Bhandari Ravneet Singh , Bansal Sanjeev
Published: May 2019

Purpose

The research intended to reveal real behavioural inclination of marketer for SEO and SMM usage. This approach was developed to provide a constructive model for established marketers as well as emerging start up marketers.

Design/methodology/approach

The investigation was designed based on literature review followed by quantitative analysis of the collected data with appropriate statistical techniques based on random surveys of end users from the National Capital Region of India.

Findings

A new conceptual model is being proposed i.e. Marketer decision model, enabling a comparative framework which encourages more effective and result oriented decision-making techniques which ends up in developing better online marketing techniques. Internet users have different behavioural patterns based upon demographic profiles. The evidence based on the statistical analysis suggests that the consumer behavioural patterns need to take into consideration by online marketers while targeting and designing SEO and SMM strategies.

Research limitations/implications

The following research was based on a selected samples only but not the entire population of target consumers and there were cases where samples perhaps inaccurately representing the population.

Originality/value

The survey conducted on diversified demographic profiles, thereby providing few rich perspectives regarding online behavioural pattern.
The Impact of Formal and Informal Institutions on ART Drug Adherence
Authors: Kumsa Diribe Makonene , Tucho Gudina Terefe
Published: May 2019

A successful antiretroviral therapy (ART) drug adherence is achieved when patients follow their prescribed regimen. This is determined by patient’s motivation that is influenced by resources associated with the patient, society, and relevant institutions. The aim of this study is to assess the impact of formal and informal actors on patients’ ART drug adherence. A qualitative study approach was conducted through face-to-face in-depth interviews of HIV-infected patients and key informants. The analysis was guided by a salutogenic model focusing on generalized resistance resources and a sense of coherence. The finding shows that 76% of the study participants achieved the recommended 95% adherence level. Several resources attributed to individuals, society, and public institutions influencing patients’ day-to-day life and their drug adherence were identified. Patients who are able to use the available resources easily develop sense of coherence and follow their prescribed drug regimen. Therefore, encouraging HIV-infected patients through formal and informal actors can enhance ART drug adherence.
“It Was as Though My Spirit Left, Like They Killed Me”: The Disruptive Impact of an HIV-Positive Diagnosis among Women in the Dominican Republic
Authors: Payán Denise Diaz , Derose Kathryn Pitkin , Fulcar María Altagracia , Farías Hugo , Palar Kartika
Published: May 2019

An HIV diagnosis may be associated with severe emotional and psychological distress, which can contribute to delays in care or poor self-management. Few studies have explored the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in low-resource settings. We conducted in-depth interviews with 30 women living with HIV in the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using the biographical disruption framework. Three disruption phases emerged (impacts of a diagnosis, postdiagnosis turning points, and integration). Nearly all respondents described the news as deeply distressful and feelings of depression and loss of self-worth were common. Several reported struggling with the decision to disclose—worrying about stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood; social support (family members, friends, HIV community) promoted integration. The findings suggest a need for psychological resources and social support interventions to mitigate the negative impacts of an HIV diagnosis.
Germinoma Mimicking Brain Inflammation: A Case Report
Authors: Pierzchlewicz Katarzyna , Bilska Małgorzata , Jurkiewicz Elżbieta , Chmielewski Dariusz , Moszczyńska Elżbieta , Daszkiewicz Paweł , Ciołkowski Maciej , Grajkowska Wiesława , Kotulska Katarzyna
Published: May 2019

The authors report a case of a germinoma of the brain in the child with symptoms restricted to central nervous system. Ten-year-old girl presented initially with sight deterioration, learning difficulties, abnormal behavior, polydipsia, and polyuria. Brain magnetic resonance examination revealed T2 hyperintensity of the corpus callosum, anterior commissure, and caudate nuclei. Brain biopsy revealed extensive macrophage infiltration. Given these results and positive antinuclear antibodies in the blood, immunosuppressive and immunomodulatory treatment was implemented but it was not effective. The patient developed progressive quadriparesis, sleep disturbances, and dementia. Second brain biopsy was performed and it revealed germinoma cells. Chemotherapy was administered, but the girl died due to disseminated intravascular coagulation syndrome. The reported case shows an unusual coexistence of germinoma with prominent inflammation in the brain and highlights the importance of brain biopsy in such complex cases.
Can Type 2 Diabetes Sufferers Actually Estimate Serum Glucose Level From Interstitial Fluid Glucose Level: A Diabetes Patient’s Experience
Authors: Fried Dennis A , Fried Robert
Published: May 2019

Introduction:

The general assumption is that blood glucose (BG) and interstitial fluid glucose (IntFG) are practically the same. We aimed to determine whether the typical patient with type 2 diabetes can use IntFG to estimate BG.

Description:

The study was conducted on an 83-year-old white male with type 2 diabetes. One hundred pairs of IntFG and BG observations mg/dL (n = 50 simultaneous; n = 50 with 15-minute lag) were made over a 10-day period. We used paired t tests, correlation coefficients, and linear regression to predict relationships between IntFG and BG.

Results:

There were significant ( P < .0001) mean differences between IntFG and BG (simultaneous: 53.8 mg/dL; 15-minute time lag: 46.4 mg/dL). There were significant ( P < .0001) positive correlations between IntFG and BG (simultaneous: r = 0.641; 15-minute time lag: r = 0.712). Linear regression revealed that increased IntFG was significantly ( P < .0001) associated with declines in mean predicted BG.

Conclusion:

The typical type 2 diabetes patient cannot use IntFG level to estimate BG.
Persistent memories of long-term potentiation and the N-methyl-d-aspartate receptor
Authors: Bliss TVP , Collingridge GL
Published: May 2019

In this article, we describe our involvement in the early days of research into long-term potentiation. We start with a description of the early experiments conducted in Oslo and London where long-term potentiation was first characterised. We discuss the ways in which the molecular pharmacology of glutamate receptors control the induction and expression of long-term potentiation and its counterpart, long-term depression. We then go on to summarise the extraordinary advances in understanding the cellular mechanisms of synaptic plasticity that have taken place in the subsequent half century. Finally, the increasing evidence that impaired long-term potentiation is a core feature of many brain disorders (LToPathies) is addressed by way of a few selected examples.
Executive Education in India: Current State and What Next?
Authors: Nagar Kankana , Shee Anindya Kumar
Published: May 2019

Executive education that has metamorphosed itself as the convergence of technology, rich media and on-the-go learning has created an array of exciting choices before the busy executive to upskill herself at different stages of her career. The range of choices and price points does not necessarily come with a compromise in quality as world-class cutting-edge content is being beamed in on the mobile, in classroom and through the satellite. It is now possible for the executive to take both technical and non-technical courses at a place, time and duration of her choosing. The blended options allow on-campus classroom immersion along with virtual distance learning with a global learning cohort.
Executive Education in India: Now and in the Future
Authors: Sripada Chandrasekhar
Published: May 2019

In the interview, Professor Sripada reflects on his experience of close to 40 years at the top level in human capital function of major public, private and MNC companies. He outlines the evolution of executive education (EE) since the 1980s, the need to integrate it with other HR subsystems and the importance of measuring business outcomes. He elucidates the difference between education and training to understand where the value-add of EE comes from. He recommends three steps to improve the impact of EE in India. Additionally, he gives his views on how to allocate budgets and the role of top management in leveraging EE.
Neutrophilic inflammation in asthma and defective epithelial translational control
Authors: Ravi Abilash , Chowdhury Saheli , Dijkhuis Annemiek , Bonta Peter I. , Sterk Peter J. , Lutter René
Published: May 2019

Neutrophilic inflammation in asthma is associated with interleukin (IL)-17A, corticosteroid-insensitivity and bronchodilator-induced forced expiratory volume in 1 s (FEV1) reversibility. IL-17A synergises with tumour necrosis factor (TNF)-α in the production of the neutrophil chemokine CXCL-8 by primary bronchial epithelial cells (PBECs).

We hypothesised that local neutrophilic inflammation in asthma correlates with IL-17A and TNF-α-induced CXCL-8 production by PBECs from asthma patients.

PBECs from most asthma patients displayed an exaggerated CXCL-8 production in response to TNF-α and IL-17A, but not to TNF-α alone, and which was also insensitive to corticosteroids. This hyperresponsiveness of PBECs strongly correlated with CXCL-8 levels and neutrophil numbers in bronchoalveolar lavage from the corresponding patients, but not with that of eosinophils. In addition, this hyperresponsiveness also correlated with bronchodilator-induced FEV1% reversibility. At the molecular level, epithelial hyperresponsiveness was associated with failure of the translational repressor T-cell internal antigen-1 related protein (TiAR) to translocate to the cytoplasm to halt CXCL-8 production, as confirmed by TiAR knockdown. This is in line with the finding that hyperresponsive PBECs also produced enhanced levels of other inflammatory mediators.

Hyperresponsive PBECs in asthma patients may underlie neutrophilic and corticosteroid-insensitive inflammation and a reduced FEV1, irrespective of eosinophilic inflammation. Normalising cytoplasmic translocation of TiAR is a potential therapeutic target in neutrophilic, corticosteroid-insensitive asthma.
Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy
Authors: Bauer Philippe R. , Chevret Sylvie , Yadav Hemang , Mehta Sangeeta , Pickkers Peter , Bukan Ramin B. , Rello Jordi , van de Louw Andry , Klouche Kada , Meert Anne-Pascale , Martin-Loeches Ignacio , Marsh Brian , Socias Crespi Lorenzo , Moreno-Gonzalez Gabriel , Buchtele Nina , Amrein Karin , Balik Martin , Antonelli Massimo , Nyunga Martine , Barratt-Due Andreas , Bergmans Dennis C.J.J. , Spoelstra-de Man Angélique M.E. , Kuitunen Anne , Wallet Florent , Seguin Amelie , Metaxa Victoria , Lemiale Virginie , Burghi Gaston , Demoule Alexandre , Karvunidis Thomas , Cotoia Antonella , Klepstad Pål , Møller Ann M. , Mokart Djamel , Azoulay Elie
Published: May 2019

Objective

We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain.

Patients and methods

This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching.

Results

Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40%versus28%; p<0.0001) and hospital mortality (49%versus41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08–1.81).

Conclusions

Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
Factors influencing behavioural intention to use a smart shoe insole in regionally based adults with diabetes: a mixed methods study
Authors: Macdonald Emma M. , Perrin Byron M. , Hyett Nerida , Kingsley Michael I. C.
Published: May 2019

Background

Smart insole technologies that provide biofeedback on foot health can support foot‐care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed‐methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles.

Methods

Fifty‐three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology.

Results

The multiple regression model that best predicted intention to adopt the smart insole (adjusted R2 = 0.51, p < 0.001) identified that self‐efficacy (β = 0.67, p = 0.001) and attitude (β = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (β = − 0.52, p = 0.003) and performance expectancy (β = − 0.40, p = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self‐efficacy on participants' behavioural intentions, influenced by participant's belief in the device's clinical efficacy and anticipated effort expectancy.

Conclusions

This mixed‐methods study demonstrates that attitude, self‐efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration.
A novel application of strain sonoelastography can detect changes in Achilles tendon elasticity during isometric contractions of increasing intensity
Authors: Schneebeli Alessandro , Del Grande Filippo , Falla Deborah , Cescon Corrado , Clijsen Ron , Barbero Marco
Published: May 2019

Background

Mechanical and morphological properties of the Achilles tendon are altered in disease and in response to changes in mechanical loading. In the last few years different ultrasound based technologies have been used to detect tendon mechanical properties changes mainly in resting condition. Therefore the aim of this study was to evaluate if strain sonoelastography can identify changes in Achilles tendon elasticity during isometric contractions of increasing intensity.

Methods

This cross‐sectional study enrolled 37 healthy volunteers (19 women) with mean (±SD) age of 27.1 (±7.0) years between January and June 2017. Strain sonoelastography images of the Achilles tendon were acquired during an isometric ramp force (0 kg, 0.5 kg, 1 kg, 2 kg, 5 kg and, 10 kg). An external reference material was used to provide a comparison between the examined tissue and a material of constant elasticity. Friedman test with post hoc pairwise comparison were used to determine the correlation between the difference contraction levels.

Results

The median and interquartile range (IQR) values for the strain ratio were 1.61 (1.5–2.9) in a relaxed state and 1.30 (1.07–2.02), 1.00 (0.76–1.66), 0.81 (0.70–1.19), 0.47 (0.39–0.73) and 0.33 (0.28–0.40) for 0.5 kg, 1 kg, 2 kg, 5 kg and 10 kg, respectively revealing increased tendon hardness with increasing contraction intensities. Friedman test revealed significant differences (p < 0.05) in the strain ratio between all contractions except between 0.5 kg – 1 kg (p = 0.41); 1 kg – 2 kg (p = 0.12) and 5 kg – 10 kg (p = 0.12).

Conclusion

Strain sonoelastography can detect changes in Achilles tendon elasticity between different contraction intensities. The results provide an original force‐elasticity curve for the Achilles tendon in a healthy, asymptomatic population.

Trial registration

The study was approved by the Ethics Committee of Canton Ticino.
Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy
Authors: Clark Jessica M. , Rychlik Shannon , Harris Jeffrey , Seikaly Hadi , Biron Vincent L. , O'Connell Daniel A.
Published: May 2019

Background

Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD.

Methods

Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications.

Results

Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively ( P = 0.016). Flexion at seven days was improved in NPD group ( P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation.

Conclusions

In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.
EBV-positive mucocutaneous ulcers: a presentation of two cases and a brief literature review
Authors: Wanderlei Karolinne Correia , Quintella Danielle Carvalho , Cuzzi Tullia , D’Azambuja Ramos Denize , Morais José Carlos , Romañach Mário , Milito Cristiane Bedran
Published: May 2019

Mucocutaneous ulcers associated with the Epstein Barr virus constitute an EBV-induced B-cell lymphoproliferative disorder first described in 2010 by Stefan D. Dojcinov et al. These lesions can occur in association with a spectrum of immunosuppressive conditions, including primary immune deficiency, Human Immunodeficiency Virus (HIV) infection, post-transplantation and the use of methotrexate or tumor necrosis factor-alpha (TNF-a) antagonists. Patients clinically present with slowly developing indurated cutaneous and/or mucosal ulcers, especially in the oropharynx. Histopathology reveals circumscribed ulcers containing a mixture of lymphocytes, plasma cells, histiocytes, eosinophils and large transformed cells resembling Hodgkin and Reed-Sternberg cells. The adjacent squamous epithelium presents reactive nuclear atypia and pseudoepitheliomatous hyperplasia. The large transformed cells show positivity for CD20, CD30, Oct-2, PAX5 and EBV. These cells are also positive for MUM1, yet lack CD10 expression, with absent or focal positivity for BCL6. Despite the presence of highly atypical cells, the clinical course is indolent, without progression to disseminated disease. We report herein two cases of diagnosed EBV-positive mucocutaneous ulcers to add to the relatively few cases previously described in the literature.
Nivolumab for Newly Diagnosed Advanced-Stage Classic Hodgkin Lymphoma: Safety and Efficacy in the Phase II CheckMate 205 Study
Authors: Ramchandren Radhakrishnan , Domingo-Domènech Eva , Rueda Antonio , Trněný Marek , Feldman Tatyana A. , Lee Hun Ju , Provencio Mariano , Sillaber Christian , Cohen Jonathon B. , Savage Kerry J. , Willenbacher Wolfgang , Ligon Azra H. , Ouyang Jing , Redd Robert , Rodig Scott J. , Shipp Margaret A. , Sacchi Mariana , Sumbul Anne , Armand Philippe , Ansell Stephen M.
Published: May 2019

PURPOSE

Nivolumab, an anti–programmed death-1 monoclonal antibody, has demonstrated frequent and durable responses in relapsed/refractory classic Hodgkin lymphoma (cHL). We report results from Cohort D of the CheckMate 205 trial, which assessed nivolumab monotherapy followed by nivolumab plus doxorubicin, vinblastine, and dacarbazine (N-AVD) for newly diagnosed cHL.

METHODS

Patients 18 years of age or older with untreated, advanced-stage (defined as III to IV and IIB with unfavorable risk factors) cHL were eligible for Cohort D of this multicenter, noncomparative, phase II trial. Patients received nivolumab monotherapy for four doses, followed by 12 doses of N-AVD; all doses were every 2 weeks, and nivolumab was administered at 240 mg intravenously. The primary end point was safety. Efficacy end points included objective response rate and modified progression-free survival, defined as time to disease progression/relapse, death, or next therapy. Chromosome 9p24.1 alterations and programmed death-ligand 1 expression were assessed in Hodgkin Reed-Sternberg cells in evaluable patients.

RESULTS

A total of 51 patients were enrolled and treated. At diagnosis, 49% of patients had an International Prognostic Score of 3 or greater. Overall, 59% experienced a grade 3 to 4 treatment-related adverse event. Treatment-related febrile neutropenia was reported in 10% of patients. Endocrine immune-mediated adverse events were all grade 1 to 2 and did not require high-dose corticosteroids; all nonendocrine immune-mediated adverse events resolved (most commonly, rash; 5.9%). At the end of therapy, the objective response rate (95% CI) per independent radiology review committee was 84% (71% to 93%), with 67% (52% to 79%), achieving complete remission (five patients [10%] were nonevaluable and counted as nonresponders). With a minimum follow-up of 9.4 months, 9-month modified progression-free survival was 92%. Patients with higher-level Hodgkin Reed-Sternberg programmed death-ligand 1 expression had more favorable responses to N-AVD ( P = .041).

CONCLUSION

Nivolumab followed by N-AVD was associated with promising efficacy and safety profiles for newly diagnosed, advanced-stage cHL.
Latching of the click beetle (Coleoptera: Elateridae) thoracic hinge enabled by the morphology and mechanics of conformal structures
Authors: Bolmin O. , Wei L. , Hazel A. M. , Dunn A. C. , Wissa A. , Alleyne M.
Published: May 2019

Elaterid beetles have evolved to “click” their bodies in a unique maneuver. When this maneuver is initiated from a stationary position on a solid substrate, it results in a jump not carried out by the traditional means of jointed appendages (i.e. legs). Elaterid beetles belong to a group of organisms that amplify muscle power through morphology to produce extremely fast movements. Elaterids achieve power amplifications through a hinge situated in the thoracic region. The actuating components of the hinge are a peg and mesosternal lip, two conformal parts that latch to keep the body in a brace position until their release, the “click,” that is the fast launch maneuver. While prior studies have identified this mechanism, they were focused on the ballistics of the launched body or limited to a single species. In this work, we identify specific morphological details of the hinges of four click beetle species, namely Alaus oculatus (L.), Paralellosthetus attenuatus (Say), Lacon discoideus (Weber) and Melanotus spp. (Eschscholtz), which vary in overall length from 11.3 to 38.8 mm. The measurements from Environmental Scanning Electron Microscopy (ESEM) and Computerized Tomography (CT) were combined to provide comparative structural information on both exterior and interior features of the peg and mesosternal lip. Specifically, ESEM and CT reveal the morphology of the peg, which is modeled as an Euler-Bernoulli beam. In the model, the externally applied force is estimated using a micromechanical experiment. The equivalent stiffness, defined as the ratio between the applied force and the peg tip deflection is estimated for all 4 species. The estimated peg tip deformation indicates that, under the applied forces, the peg is able to maintain the braced position of the hinge. This work comprehensively describes the critical function of the hinge anatomy through an integration of specific anatomical architecture and engineering mechanics for the first time.
Applications and limitations of machine learning in radiation oncology
Authors: Jarrett Daniel , Stride Eleanor , Vallis Katherine , Gooding Mark J.
Published: May 2019

Machine learning approaches to problem-solving are growing rapidly within healthcare, and radiation oncology is no exception. With the burgeoning interest in machine learning comes the significant risk of misaligned expectations as to what it can and cannot accomplish. This paper evaluates the role of machine learning and the problems it solves within the context of current clinical challenges in radiation oncology. The role of learning algorithms within the workflow for external beam radiation therapy are surveyed, considering simulation imaging, multimodal fusion, image segmentation, treatment planning, quality assurance, and treatment delivery and adaptation. For each aspect, the clinical challenges faced, the learning algorithms proposed, and the successes and limitations of various approaches are analyzed. It is observed that machine learning has largely thrived on reproducibly mimicking conventional human-driven solutions with more efficiency and consistency. On the other hand, since algorithms are generally trained using expert opinion as ground truth, machine learning is of limited utility where problems or ground truths are not well-defined, or if suitable measures of correctness are not available. As a result, machines may excel at replicating, automating and standardizing human behaviour on manual chores, meanwhile the conceptual clinical challenges relating to definition, evaluation, and judgement remain in the realm of human intelligence and insight.
Efficacy of fine focal spot technique in CT angiography of neck
Authors: Oh Lawrence Chia-Wei , Lau Kenneth Kwok-Pan , Devapalasundaram Ashwini , Buchan Kevin , Kuganesan Ahilan , Huynh Minh
Published: May 2019

Objectives:

Focal spot size partially defines spatial resolution of a CT system. Many CT tubes have two focal spot sizes, with the finer one allowing more detailed imaging at the cost of photon intensity and increased heat production. Improved X-ray technology and advancement of various generations of iterative reconstruction allow the use of fine focal spot technique in CT angiography. CT neck angiography (CTNA) has been commonly performed as part of stroke imaging or in the trauma setting. This prospective study aimed to assess the efficacy of fine focal spot scanning in vessel clarity improvement, vessel calcification and arterial pulsation artefact reduction on CTNA.

Methods and materials:

Consecutive adult patients of all ages and genders who presented for CTNA were included. All CTNA were scanned with standard focal spot size (SFSS) of 1 × 1 mm in first 4 months while the CTNA in the following 4 months with fine focal spot size (FFSS) of 0.5 × 1 mm. Vessel clarity, calcification and arterial pulsation artefact of arch of aorta, brachiocephalic, subclavian, common carotid, carotid bifurcation, internal carotid, external carotid and vertebral arteries were assessed randomly using a 5-point scale by two blinded radiologists. Results were compared.

Results:

There were 43 patients (mean age 60) with 97 calcified arterial segments in SFSS and 48 patients (mean age 62) with 113 calcified arterial segments in FFSS. 30 % of patients had > 50% carotid artery stenosis. No occlusion or dissection was found in the remaining arteries. Mann-Whitney test showed FFSS performed significantly better for vessel clarity (U: 48238.50, p < .001,r: 0.556) and calcification artefact reduction (U: 2040.50, p < .001,r: 0.564). There was no significant reduction for arterial pulsation artefact.

Conclusion:

Fine focal spot technique improves vessel clarity and reduces calcification blooming artefact in CTNA. These benefits may potentially improve the assessment of arterial luminal stenosis and vessel wall pathology, including plaque morphology.

Advances in knowledge:

Beam hardening artefact from calcification particularly in the vessel wall can often reduce the clarity of vessel lumen thus affect accurate assessment of luminal stenosis. Fine focal spot technique has the advantages of reducing beam-hardening artefact of vessel wall calcifications and improving vessel wall clarity, thus it may potentially improve the assessment of arterial luminal stenosis and vessel wall pathology, including plaque morphology. It may become an important CT imaging technique in near future.
SOlution Focused brief therapy In post-stroke Aphasia (SOFIA Trial): protocol for a feasibility randomised controlled trial
Authors: Northcott Sarah , Simpson Alan , Thomas Shirley A. , Hirani Shashivadan P. , Flood Chris , Hilari Katerina
Published: May 2019

Background: Around a quarter of people post stroke will experience aphasia, a language disability. Having aphasia places someone at risk of becoming depressed and isolated. There is limited evidence for effective interventions to enhance psychological well-being for this client group. A potential intervention is Solution Focused Brief Therapy (SFBT), which supports a person to build meaningful, achievable change through focusing on a person’s skills and resources rather than their deficits. The SOFIA Trial aims to explore the acceptability of SFBT to people with varying presentations of aphasia, including severe aphasia, and to assess the feasibility of conducting a future definitive trial investigating clinical and cost effectiveness.

Methods: The trial is a single-blind, randomised, wait-list controlled feasibility trial with nested qualitative research and pilot economic evaluation comparing SFBT plus usual care to usual care alone. The study will recruit 32 participants with aphasia who are ≥6 months post stroke. All participants will be assessed on psychosocial outcome measures at baseline, three, and six months post randomisation by assessors blinded to treatment allocation. Participants will be randomly assigned to intervention group (start intervention immediately post randomisation) or wait-list group (start intervention six months post randomisation). Wait-list group will additionally be assessed nine months post randomisation. The intervention consists of up to six SFBT sessions delivered over three months by speech and language therapists. Participants and therapists will also take part in in-depth interviews exploring their experiences of the study. The pilot economic evaluation will use the EQ-5D-5L measure and an adapted Client Service Receipt Inventory. People with aphasia have been involved in designing and monitoring the trial.

Discussion: Given the high levels of depression and isolation, there is a need to investigate effective interventions that enhance the psychological wellbeing of people with aphasia.

Trial registration: ClinicalTrials.gov NCT03245060 10/08/2017.
Considerations related to vaping as a possible gateway into cigarette smoking: an analytical review
Authors: Lee Peter N. , Coombs Katharine J. , Afolalu Esther F.
Published: May 2019

Background: Toxicant levels are much lower in e-cigarettes than cigarettes. Therefore, introducing e-cigarettes into the market seems likely to reduce smoking-related diseases (SRD). However, vaping might provide a gateway into cigarette smoking for those who otherwise would never have smoked, a concern fuelled by cohort studies showing vaping predicts subsequent smoking initiation in young people.

Methods: In this discussion paper, we consider various aspects of the gateway issue in youths. We provide a descriptive critical review of results from prospective studies relating to the gateway effect and the extent to which the studies considered other potential confounding variables associated with smoking initiation. We then estimate the effects of omitting a confounding variable, or misclassifying it, on the association between vaping and subsequent smoking initiation, and determine how the prevalence of smoking might be affected by any true gateway effects of vaping. Finally, we examine trends in e-cigarette and smoking prevalence in youths based on national surveys.

Results: First, we demonstrate that although studies report that vaping significantly predicts smoking initiation following adjustment for various other predictors, the sets of predictors considered are quite incomplete. Furthermore, no study considered residual confounding arising from inaccurate measurement of predictors. More precise adjustment may substantially reduce the association. Second, we show any true gateway effect would likely affect smoking prevalence only modestly. Third, we show smoking prevalence in U.S. and U.K. youths in 2014–2016 declined somewhat faster than predicted by the preceding trend; a substantial gateway effect suggests the opposite. Finally, we argue that even if some gateway effect exists, introducing e-cigarettes still likely reduces SRDs.

Conclusions: Given that the existence of any true gateway effect in youth is not yet clearly demonstrated the population health impact of introducing e-cigarettes is still likely to be beneficial.
FaceSync: Open source framework for recording facial expressions with head-mounted cameras
Authors: Cheong Jin Hyun , Brooks Sawyer , Chang Luke J.
Published: May 2019

Advances in computer vision and machine learning algorithms have enabled researchers to extract facial expression data from face video recordings with greater ease and speed than standard manual coding methods, which has led to a dramatic increase in the pace of facial expression research. However, there are many limitations in recording facial expressions in laboratory settings.  Conventional video recording setups using webcams, tripod-mounted cameras, or pan-tilt-zoom cameras require making compromises between cost, reliability, and flexibility. As an alternative, we propose the use of a mobile head-mounted camera that can be easily constructed from our open-source instructions and blueprints at a fraction of the cost of conventional setups. The head-mounted camera framework is supported by the open source Python toolboxFaceSync, which provides an automated method for synchronizing videos. We provide four proof-of-concept studies demonstrating the benefits of this recording system in reliably measuring and analyzing facial expressions in diverse experimental setups, including group interaction experiments.
Recent advances in understanding Candida albicans hyphal growth
Authors: Arkowitz Robert A. , Bassilana Martine
Published: May 2019

Morphological changes are critical for the virulence of a range of plant and human fungal pathogens. Candida albicans is a major human fungal pathogen whose ability to switch between different morphological states is associated with its adaptability and pathogenicity. In particular, C. albicans can switch from an oval yeast form to a filamentous hyphal form, which is characteristic of filamentous fungi. What mechanisms underlie hyphal growth and how are they affected by environmental stimuli from the host or resident microbiota? These questions are the focus of intensive research, as understanding C. albicans hyphal growth has broad implications for cell biological and medical research.
A recall-by-genotype study on polymorphisms in the TMPRSS6 gene and oral iron absorption: a study protocol
Authors: Jallow Momodou W. , Campino Susana , Prentice Andrew M. , Cerami Carla
Published: May 2019

Background: Oral iron supplementation is commonly used to treat and prevent anaemia. The transmembrane protease serine 6 gene (TMPRSS6), which encodes matriptase 2, is a negative regulator of hepcidin, the key controller of iron homeostasis. Genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) in the TMPRSS6 gene that are associated with an increased risk of iron-deficiency anaemia.  We will investigate the in vivo effects of three previously reported TMPRSS6 variants (rs855791, rs4820268 and rs2235321) on oral iron absorption in non-anaemic volunteers in The Gambia.

Methods: A recall-by-genotype study design will be employed. Pre-genotyped participants will be recruited from the West African BioResouce (WABR), which currently contains over 3000 genotyped individuals. Male and female volunteers will be selected based on polymorphisms (rs855791, rs4820268 and rs2235321) in the TMPRSS6 gene in the Gambian population. The effects of a single variant allele at one SNP and the additive effect of two or three variant alleles from either two or all three SNPs will be investigated. Study participants will be given a single oral dose of 400mg ferrous sulfate, and blood samples will be collected at baseline, two hours and five hours post supplementation. Differences in iron absorption between genotype groups will be assessed by measuring the increase in serum iron concentration at five hours post iron ingestion.

Discussion: This study will increase understanding of the role of genetic variations in TMPRSS6 on oral iron absorption in subjects of West African origin. This will test for the biological basis for the association of each of the three TMPRSS6 variants with iron absorption. This may help in guiding future iron intervention strategies, particularly in populations with a high frequency of these SNPs and a high frequency of anaemia.

Study registration: ClinicalTrials.gov NCT03341338 14/11/17.
Exploring the optimal duration of video recording in a post-discharge eLearning platform for cardiac patients
Authors: Kirn Borut
Published: May 2019

Background: On a post-discharge eLearning platform for patients with coronary artery disease, videos are used as the main educational media. Medical content takes a long time to be thoroughly explained, frequently exceeding the viewer’s attention span. To find the optimal duration for such an educational video, we studied the retention of video watching.

Methods: In this study, 135 (88% male; age 62±9 years) patients with coronary artery disease actively used eLearning platform which included 60 video recordings with duration ranging from 21 sec to 303 sec. The videos were divided into two groups based on their duration (short < 100 sec and long > 100 sec). From the platform usage metadata, an average video retention rate was obtained as a ratio of video viewing time and total video duration for videos watched six times or more. Independent t-tests for mean values and f-test for variance were used to compare the groups.

Results: In total, 35 (18 short and 17 long) videos were included in the study and were viewed (mean ± SD) 22 ± 11 times. The mean duration of short videos was: 80 sec ± 14 sec and of long videos it was: 160 sec ± 51 sec. The retention rate in the short and long group was 0.99 ± 0.05 and 0.94 ± 0.19 respectively. Average values were not signi­ficantly different (P = 0.33), but variances were (P < 0.05).

Conclusions: This study shows that the effective attention span for a video recording of this kind, based on an eLearning set-up and local population, is up to 100 sec. Videos shorter than 100sec are mostly watched fully without a break. In contrast, longer videos are often rewound, and parts watched again or not watched to the full length at all.
Neonatal iron distribution and infection susceptibility in full term, preterm and low birthweight babies in urban Gambia: study protocol for an observational study.
Authors: Cross James H. , Jarjou Ousman , Mohammed Nuredin Ibrahim , Prentice Andrew M. , Cerami Carla
Published: May 2019

Background: Neonatal infection is the third largest cause of death in children under five worldwide.  Nutritional immunity is the process by which the host innate immune system limits nutrient availability to invading organisms. Iron is an essential micronutrient for both microbial pathogens and their mammalian hosts. Changes in iron availability and distribution have significant effects on pathogen virulence and on the immune response to infection. Our previously published data shows that, during the first 24 hours of life, full-term neonates have reduced overall serum iron. Transferrin saturation decreases rapidly from 45% in cord blood to ~20% by six hours post-delivery.

Methods: To study neonatal nutritional immunity and its role in neonatal susceptibility to infection, we will conduct an observational study on 300 full-term normal birth weight (FTB+NBW), 50 preterm normal birth weight (PTB+NBW), 50 preterm low birth weight (PTB+LBW) and 50 full-term low birth weight (FTB+LBW), vaginally-delivered neonates born at Kanifing General Hospital, The Gambia. We will characterize and quantify iron-related nutritional immunity during the early neonatal period and use ex vivo sentinel bacterial growth assays to assess how differences in serum iron affect bacterial growth. Blood samples will be collected from the umbilical cord (arterial and venous) and at serial time points from the neonates over the first week of life.

Discussion: Currently, little is known about nutritional immunity in neonates. In this study, we will increase understanding of how nutritional immunity may protect neonates from infection during the first critical days of life by limiting the pathogenicity and virulence of neonatal sepsis causing organisms by reducing the availability of iron. Additionally, we will investigate the hypothesis that this protective mechanism may not be activated in preterm and low birth weight neonates, potentially putting these babies at an enhanced risk of neonatal infection.

Trial registration: clinicaltrials.gov (NCT03353051) 27/11/2017
Afforded exploration: An approach to novel yet understandable product experiences
Authors: Lee Soyeon , Self James A.
Published: May 2019

A product’s form and related affordances, together with interaction possibilities, have a significant influence on the user’s emotional response. Although interaction influences the user’s product experience, little is known of how product interaction may best provide opportunities for novel yet understandably familiar product-user experiences. The purpose of this study is to contribute to understanding the contradictory relationship between novelty and acceptability in product design, with a focus on product interaction. Adopting a research-through-design approach, four bottle designs were developed and prototyped. Two dichotomous theoretical constructs were applied to the four designs: Explanatory-Affordance, Exploratory-Affordance, Explanatory-DisAffordance and Exploratory-DisAffordance-Based designs. The four constructs broadly relate to the types of product interactions afforded through interaction with the four bottle designs. Affordance and DisAffordance-Based designs refer to the product’s ability to afford an understanding of use through form and other signifiers. Explanatory-Exploratory-Based design suggests the extent to which a user may exploratively interact with the product. The four bottle designs were used as stimuli to collect participants’ emotional response under controlled conditions. We confirmed the significant impact of an exploitive approach to product interaction for increased positive response and stimulation of novelty in product appraisal. Moreover, affordance, while not stimulating positive emotion on its own, may provide opportunity for reassurance and acceptability during product interaction when combined with an explorative design approach.

This work is licensed under Creative Commons Attribution (CC BY). To view a copy of the licence, visit https://creativecommons.org/licenses/by/4.0/
Craft-based design for innovation: Potential in novelty, quality and sustainability through hands-on interaction
Authors: Pinski Jenny , Kane Faith , Evans Mark
Published: May 2019

The industrial revolution created a rise in mass manufacture, increasing consumption to current unsustainable levels and marking a decline in hands-on craft practice. In contemporary practice, designers frequently employ digital ways of working and, whilst this may create opportunities and efficiencies, it can limit the working of materials by hand. In contrast, hands-on craft processes can develop in-depth knowledge and understanding to help solve complex and novel design problems. With increasing use of digital design methods, it is timely to reflect on the role and value of hands-on craft practices. The study explores the use of craft-based approaches to support design practice in relation to novelty and quality and considers its future potential to contribute towards design for sustainability. A design project that integrated hand weaving with sandal design was undertaken and qualitative data were collected. This was analysed through data reduction, coding, clustering and display and is presented as a case study. The findings indicate that a craft-based approach can contribute to a heightened control of materials, construction and awareness of wider design issues such as the development process, production methods and environmental impact. Difficulties were identified in inefficient use of time and a knowledge/skills gap between specialist design and craft disciplines.

This work is licensed under Creative Commons Attribution (CC BY). To view a copy of the licence, visit https://creativecommons.org/licenses/by/4.0/