bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Combined Leukocyte-Poor Platelet-Rich Plasma and Hyaluronic Acid on Bone Marrow–Derived Mesenchymal Stem Cell and Chondrocyte Metabolism
Authors: Satin Alexander M. , Norelli Jolanta B. , Sgaglione Nicholas A. , Grande Daniel A.
Published: July 2019

Objective

Given the potential applications of combined biologics, the authors sought to evaluate the in vitro effect of combined platelet-rich plasma (PRP) and hyaluronic acid (HA) on cellular metabolism.

Design

Bone marrow–derived mesenchymal stem cells (BMSCs) and chondrocytes were obtained from the femurs of Sprague-Dawley rats. An inflammatory model was created by adding 10 ng/mL interleukin-1-beta to culture media. Non-crosslinked high-molecular-weight HA, activated-PRP (aPRP), and unactivated-PRP (uPRP) were tested. Cellular proliferation and gene expression were measured at 1 week. Genes of interest included aggrecan, matrix metalloproteinase (MMP)-9, and MMP-13.

Results

Combined uPRP-HA was associated with a significant increase in chondrocyte and BMSC proliferation at numerous preparations. There was a trend of increased chondrocyte aggrecan expression with combined PRP-HA. The greatest and only significant decrease in BMSC MMP-9 expression was observed with combined PRP-HA. While a significant reduction of BMSC MMP-13 expression was seen with PRP and HA-alone, a greater reduction was observed with PRP-HA. MMP-9 chondrocyte expression was significantly reduced in cells treated with PRP-HA. PRP-alone and HA-alone at identical concentrations did not result in a significant reduction. The greatest reduction of MMP-13 chondrocyte expression was observed in chondrocytes plus combined PRP-HA.

Conclusions

We demonstrated a statistically significant increase in BMSC and chondrocyte proliferation and decreased expression of catabolic enzymes with combined PRP-HA. These results demonstrate the additive in vitro effect of combined PRP-HA to stimulate cellular growth, restore components of the articular extracellular matrix, and reduce inflammation.
Ceftolozane–tazobactam for the treatment of osteomyelitis caused by multidrug-resistant pathogens: a case series
Authors: Tan Xing , Moenster Ryan P.
Published: July 2019

Ceftolozane–tazobactam (CT) is a recently approved novel cephalosporin and β-lactamase inhibitor combination agent with in vitro activity against various Gram-positive and Gram-negative pathogens, including several multidrug-resistant (MDR) Gram-negative organisms. CT is currently approved by the US Food and Drug Administration for the treatment of complicated intrabdominal infection and complicated urinary tract infection at a dose of 1.5 g intravenously every 8 h. This agent is an attractive option for MDR osteomyelitis (OM) treatment, but clinical data is limited to case reports and series. Here we report a series of five patients with MDR OM who were treated with CT. Pathogens involved in these infections were MDR Acinetobacter baumannii (two isolates) and MDR Pseudomonas aeruginosa (four isolates). Two patients were disease free 6 months after therapy was discontinued, one required an additional curative surgical procedure, and two (both on high-dose therapy) developed adverse reactions likely related to CT that necessitated early antibiotic discontinuation.
What combinations of agomelatine with other antidepressants could be successful during the treatment of major depressive disorder or anxiety disorders in clinical practice?
Authors: Potměšil Petr
Published: July 2019

Even with many antidepressant and anxiolytic drugs available on the market, there are still patients who do not respond well to the standard first or second line treatments for affective or anxiety disorders. The antidepressant agomelatine has been used in Europe for several years. Agomelatine, an agonist at melatonin receptors and an antagonist at serotonin receptors, can be particularly useful in patients suffering from a major depressive disorder associated with insomnia. Some clinical data have shown a limited effect for agomelatine in a subset of patients with major depression. A number of case reports published in 2011-2016 describe the effect of agomelatine in combination with an established antidepressant, such as escitalopram, venlafaxine, duloxetine, moclobemide or bupropion. A successful combination of agomelatine was reported after adjunctive use of agomelatine combined with clomipramine, escitalopram, and venlafaxine in patients with major depression or obsessive–compulsive disorder. Moreover, bupropion or moclobemide augmentation with agomelatine in patients with major depressive disorder led to a significant improvement. Other supportive data have been published, such as analysis of the VIVALDI study, although it should be noted that the study was supported by the manufacturer of agomelatine. In this study, agomelatine in combination with other antidepressants was shown to be effective and well tolerated in practice, although the most effective antidepressant treatment in the study consisted of agomelatine alone and not in combination with other antidepressants. There have also been two published case reports about the concomitant use of duloxetine and agomelatine which were not efficacious. The positive results of agomelatine augmentation with other antidepressants should be confirmed through randomized, double-blind clinical trials.
Prospective trial of single-use, flexible cystoscope for ureteric double-J stent removal: Cost and utility analysis
Authors: Donato Peter , Honore Matthew , Zana Tafadzwa , Pokorny Morgan , Bowes William , Meyer Jon Paul , Rukin Nicholas
Published: July 2019

Objective:

The objective of this study is to evaluate the costs and benefits of Isiris (Coloplast, Denmark), a mobile, single-use, flexible cystoscope with a built-in stent grasper.

Methods:

A prospectively collected database was reviewed to define procedural outcomes for Isiris ureteric stent removal. Variables assessed included stent duration and location of removal. A cost assessment was performed evaluating the impact on costs, funding and facility use.

Results:

Seventy-five procedures were performed using Isiris between April and September 2017. There were no complications. Two procedures failed because of encrustation and poor visibility secondary to haematuria. The mean (SD), median (interquartile range) and range of delay were 2.1 (0–5.3), 0 (0–2) and 0–40 days, respectively. Only one patient was delayed more than two weeks; this occurred because he was placed on a theatre waiting list, which resulted in the 40-day delay. Overall, the cost benefit for our department with the introduction of the Isiris system has been a surplus of $104,434, with an extra 65 elective spaces free for diagnostic flexible cystoscopy cases.

Conclusion:

Isiris flexible stent removal offers our patients a rapid stent-removal service with low rates of removal delay. Savings have been made in scope repair costs, sterilisation and scope maintenance, as well as optimisation of theatre and procedure room space. Level of evidence: 1c
Producing and projecting data: Aesthetic practices of government data portals
Authors: Ratner Helene , Ruppert Evelyn
Published: July 2019

We develop the concept of ‘aesthetic practices’ to capture the work needed for population data to be disseminated via government data portals. Specifically, we look at the Census Hub of the European Statistical System and the Danish Ministry of Education’s Data Warehouse. These portals form part of open government data initiatives, which we understand as governing technologies. We argue that to function as such, aesthetic practices are required so that data produced at dispersed sites can be brought into relation and projected as populations in forms such as bar charts, heat maps and tables. Two examples of aesthetic practices are analysed based on ethnographic studies we have conducted on the production of data for the Hub and Warehouse: metadata and data cleaning. Metadata enables data to come into relation by containing and accounting for (some of) the differences between data. Data cleaning deals with the indeterminacies and absences of data and involves algorithms to determine what values data can obtain so they can be brought into relation. We attend to how both aesthetic practices involve normative decisions that make absent what exceeds them: embodied knowledge that cannot or has not been documented as well as data that cannot meet the forms required of data portals. While these aesthetic practices are necessary to sustain data portals as ‘sites of projection,’ we also bring critical attention to their performative effects for knowing, enacting and governing populations.
Occluded algorithms
Authors: Burke Adam
Published: July 2019

Two definitions of algorithm, their uses, and their implied models of computing in society, are reviewed. The first, termed the structural programming definition, aligns more with usage in computer science, and as the name suggests, the intellectual project of structured programming. The second, termed the systemic definition, is more informal and emerges from ethnographic observations of discussions of software in both professional and everyday settings. Specific examples of locating algorithms within modern codebases are shared, as well as code directly impacting social and ethical concerns. The structural distinction between algorithms and social concerns is explained as mirroring the engineering construct of algorithms and data structures. It is proposed that, rather than this separation being an attempt to enforce a professional boundary and evade social responsibility, it is a crucial technical distinction within code which makes it clearer and more transparent. The power structures reinforced by the broader, cultural interpretations of algorithm are reconsidered, along with what it would mean for software to have an inclusive design culture.
Primary prostate lymphoma: A case report and literature review
Authors: Wang Kai , Wang Ning , Sun Ji , Fan Yi , Chen Lu
Published: July 2019

Primary prostate lymphoma (PPL) is rare. This article reports a case of PPL by retrospective analysis of the clinical data and review of the literature, in an attempt to explore the diagnosis, treatment, and prognosis of this rare disease. The present case involves a male patient who came to our hospital for medical consultation of dysuria. Serum prostate-specific antigen (PSA) was not remarkable. Pelvic computed tomography (CT) scan suggested obvious enlargement of the prostate and a tumor in the prostate, but the tumor was not significantly enhanced on contrast-enhanced CT scan. Ultrasound suggested obvious enlargement of the prostate with multiple local low-density echoes and rich blood flow signals inside. Histopathology of prostate biopsy suggested prostate diffuse large B-cell lymphoma (DLBCL). The patient refused chemotherapy but agreed to receive radiotherapy. After radiotherapy, the tumor became smaller and the International Prostate Symptom Score (IPSS) score was reduced. Our experience, together with literature review, suggests that prostate puncture biopsy is an important method for the diagnosis of PPL, and imaging examination can assist the diagnosis. Radiotherapy is able to reduce the tumor volume and relieve the symptoms of urinary tract obstruction, and chemotherapy can help achieve a better therapeutic outcome.
Relationship Between Physical Activity and Motor Vehicle Crashes Among Older Adult Drivers
Authors: Talwar Amish , Mielenz Thelma J. , Hill Linda L. , Andrews Howard F. , Li Guohua , Molnar Lisa J. , Eby David W. , Betz Marian E. , Strogatz David , DiGuiseppi Carolyn
Published: July 2019

Background: There are approximately 42 million licensed drivers aged 65 years or older in the United States, who face unique age-related risks while driving. While physical activity affects several chronic conditions thought to be associated with motor vehicle crashes (MVCs), it is unclear if increased physical activity leads to fewer MVCs. This study explores whether self-reported vigorous and moderate physical activity is associated with MVCs in the previous year. Methods: Using cross-sectional data from the LongROAD study, a large multisite prospective cohort study of 2990 older adult drivers, we examined variables related to physical activity and performed a multivariate regression analysis to examine the association of physical activity health behaviors with self-reported MVCs. Results: Overall, 41.2% of participants reported vigorous and 69.6% of participants reported moderate exercise at least once per week. Eleven percent of participants reported at least 1 MVC in the previous year. Neither vigorous nor moderate physical activity was significantly associated with self-reported MVCs in the previous year. Select variables that were significantly associated with self-reported MVC included self-reported unsafe driving practices (odds ratio [OR] 1.55, confidence interval [CI] 1.05-2.29), and fall in the past 12 months (OR 1.46, CI 1.14-1.85). Conclusions: We were unable to detect a significant association between self-reported physical activity and MVCs in the past year among this group of older drivers. Use of objective measures of activity may better clarify this relationship.
Anxiety/Uncertainty Management and Communication Accommodation in Women’s Brief Dyadic Conversations With a Stranger: An Idiodynamic Approach
Authors: MacIntyre Peter D.
Published: July 2019

This study uses a combination of anxiety/uncertainty management theory and communication accommodation theory perspective to examine differences in the ways women converse with men or with other women. The study uses an innovative approach, the idiodynamic method, to gather detailed data on a per-second timescale. Participants ( n = 24) were randomly assigned to one of the two types of dyads: female–female or male–female. They then engaged in a videotaped conversation lasting approximately 2 to 5 min. Immediately afterward, participants watched the video of their conversation in separate rooms, during which each provided continuous, dynamic ratings of their anxiety level, and that of their partner, throughout the conversation. Participants were interviewed about the reasons for changes in their ratings of both themselves and their conversational partner. Following a grounded theory approach to analysis, six themes emerged from the interviews: awareness of the camera and researchers, comparison of self and partners, self-judgment, worry about other’s judgment, disinterest, and reaction to miscommunication. The data show that communication accommodation was done differently in the female-only versus female–male pairs, which might reflect processes involving uncertainty, group identification, and continuously negotiated meaning. There is value in using methods that investigate communication processes in real time because doing so allows instances of proposed theoretical differences between genders to emerge in actual conversation between persons.
The Role of Emotion Regulation and Age in Experiencing Mediated Sports
Authors: van Driel Irene I. , Gantz Walter
Published: July 2019

Recent research indicates that sports fanship decreases with age. Socioemotional selectivity theory (SST) posits that older adults, with time limited, shift their focus on positive experiences. Entertainment media choices reflect this proactive emotion regulation strategy. This study applied that perspective to mediated sports content, itself characterized by emotional intensity and unknown outcomes. Using an online survey containing an experimental condition ( N = 433), the current study investigated whether the unpredictability and emotional intensity of sports contribute to older people disengaging from viewing it. The results are mixed: Older adults consume less sports media than younger adults and value the outcome less but are equally likely to be sports fans or watch highly exciting sports contests. It seems that fanship may contribute to happiness for some and thus reflect an active choice. Future research should investigate individual differences among older sports fans and nonfans to expand knowledge on their (emotional) viewing experiences.
Financial Behavior Change and Progress Toward Self-Sufficiency: A Goal-Framing Theory Application
Authors: Serido Joyce , Tang Chuanyi , Ahn Sun Young , Shim Soyeon
Published: July 2019

We applied goal-framing theory to determine whether there were discernible patterns in emerging adults’ financial behavior from college to career and whether those patterns were associated with progress toward self-sufficiency. Using longitudinal data collected over 5 years from a college cohort of emerging adults ( N = 968) in the United States, we estimated latent growth curve models and identified three financial-behavior patterns suggestive of the overarching motivations in the theory: planful (gain), present focused (hedonic), and socially compliant (normative). Using multinomial logistic regression analysis, we found that higher perceived financial control, more positive financial attitudes, higher perceived parental expectations, and more exposure to financial education were predictive of a gain pattern. Analyses of variance showed that the gain financial-behavior pattern was associated with the most progress toward self-sufficiency (adult stability, career status, and well-being). We discuss the findings as they pertain to the connection between emerging adults’ financial behavior and progress toward self-sufficiency.
Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics
Authors: Almufarrij Ibrahim , Munro Kevin J. , Dawes Piers , Stone Michael A. , Dillon Harvey
Published: July 2019

Direct-to-consumer (DTC) hearing devices can be purchased without consulting a hearing health professional. This project aims to compare 28 DTC devices with the most popular hearing aid supplied by the U.K. National Health Service (NHS). The comparison was based on technical performance, cosmetic acceptability, and the ability to match commonly used gain and slope targets. Electroacoustic performance was evaluated in a 2-cc coupler. Match to prescription target for both gain and slope was measured on a Knowles Electronic Manikin for Acoustic Research using a mild and also a moderate sloping hearing loss. Using an online blinded paired comparison of each DTC and the NHS reference device, 126 participants (50 were hearing aid users and 76 were nonhearing aid users) assessed the cosmetic appearance and rated their willingness-to-wear the DTC devices. The results revealed that higher purchase prices were generally associated with a better match to prescribed gain–frequency response shapes, lower distortion, wider bandwidth, better cosmetic acceptability, and higher willingness-to-wear. On every parameter measured, there were devices that performed worse than the NHS device. Most of the devices were rated lower in terms of aesthetic design than the NHS device and provided gain–frequency responses and maximum output levels that were markedly different from those prescribed for commonly encountered audiograms. Because of the absence or inflexibility of most of the devices, they have the potential to deliver poor sound quality and uncomfortably loud sounds. The challenge for manufacturers is to develop low-cost products with cosmetic appeal and appropriate electroacoustic characteristics.
Restoration of Tangible and Intangible Artefacts in the Tunisian Landscape: ‘Boutique Hotels’ and the Entrepreneurial Project of Dar Ben-Gacem
Authors: Faleh Majdi
Published: July 2019

This research stems from a theoretical study of the Medina of Tunis, as a continuity of the author’s doctoral research. The broader study from which the concepts are drawn is part of a PhD project, in architecture and humanities, focused on the effects of globalization on the Medina of Tunis. Studies and publications of the houses of the Medina of Tunis are lacking from the literature, in the Anglo-Saxon world, thus the interest of the author is to build a new body of knowledge examining historical restoration projects in Tunisia. This research article traces the challenges faced by the Medina of Tunis in the twenty-first century. It does so by evaluating a restoration and conversion project of seventeenth century Dar Ben-Gacem into a boutique hotel or ‘Hotel de Charme’. The project is unique as it reflects an architectural and entrepreneurial initiative of its owners aiming to work alongside the Medina’s small businesses, local artisans and the community at large. In this context, this research examines the architectural and socio-cultural challenges faced by the owners as well as the architects to preserve the identity of the building while diversifying the use of its spaces.

This study first examines the history of Dar Ben-Gacem and the transition of the traditional courtyard house into a ‘cosmopolitan’ guest house that attracts visitors and tourists from all cultures and nationalities. Later, it explores the motivations and commitments of the owners to revive tangible and intangible artefacts through architecture as well as the social and cultural entrepreneurship of Tunisia’s rich cultural history. Ultimately, this theoretical study evaluates the challenges faced in such projects to revive the cultural heritage of the house while shaping a ‘story’ of a generation. Restoration projects in the Medina vary in scale and purpose. The consideration of both tangible and intangible artefacts in this historical context is highly important as it delves into the question of heritage in the age of tourism and globalization.
How REDD+ governs: Multiple forest environmentalities in Guyana and Suriname
Authors: Collins Yolanda Ariadne
Published: July 2019

The Reducing Emissions from Deforestation and forest Degradation mechanism is a policy instrument intended to achieve environmental conservation and utilization simultaneously. Recently, researchers have adopted ‘environmentality’, a theoretical approach that recognizes the different strategies for the ‘conduct of conduct’ embodied in environmental governance, to parse the diverse governing logics supporting Reducing Emissions from Deforestation and forest Degradation implementation. Thus far, use of this lens has focused predominantly on how Reducing Emissions from Deforestation and forest Degradation introduces new forms of environmentality, overlooking the pre-existing, context-specific approaches to governance on which the mechanism builds, and hence potentially overstating the novelty of its governance techniques. Challenging this dominant use of the environmentality lens, I further develop its critical potential by demonstrating how environmentality's temporal dimensions illuminate the shifts, continuities and disruptions in how environmental governance evolves over time. I do this by demonstrating how Reducing Emissions from Deforestation and forest Degradation builds on pre-existing forest governance interventions in Guyana and neighbouring Suriname. I argue that while Reducing Emissions from Deforestation and forest Degradation remains a global expression of neoliberal environmentality, it builds on a pre-existing sovereign environmentality established throughout the overlapping histories of Guyana and Suriname, draws on but also subverts context-specific truth environmentality in the spiritual relations of forest dependent communities with the forests, and is made palatable for resistant communities through disciplinary environmentality. In this way, these four forms of environmentality help to explain how Reducing Emissions from Deforestation and forest Degradation implementation in the two countries assumes its current character, while demonstrating how environmental projects work towards shaping the subjects of their governance.
COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
Authors: Capron Thibaut , Bourdin Arnaud , Perez Thierry , Chanez Pascal
Published: July 2019

Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment.

Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.

Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.
Interdisciplinary multimodality management of stage III nonsmall cell lung cancer
Authors: Huber Rudolf M. , De Ruysscher Dirk , Hoffmann Hans , Reu Simone , Tufman Amanda
Published: July 2019

Stage III nonsmall cell lung cancer (NSCLC) comprises about one-third of NSCLC patients and is very heterogeneous with varying and mostly poor prognosis. It is also called “locoregionally or locally advanced disease”. Due to its heterogeneity a general schematic management approach is not appropriate. Usually a combination of local therapy (surgery or radiotherapy, depending on functional, technical and oncological operability) with systemic platinum-based doublet chemotherapy and, recently, followed by immune therapy is used. A more aggressive approach of triple agent chemotherapy or two local therapies (surgery and radiotherapy, except for specific indications) has no benefit for overall survival. Until now tumour stage and the general condition of the patient are the most relevant prognostic factors. Characterising the tumour molecularly and immunologically may lead to a more personalised and effective approach. At the moment, after an exact staging and functional evaluation, an interdisciplinary discussion amongst the tumour board is warranted and offers the best management strategy.
The contribution of infection and the respiratory microbiome in acute exacerbations of idiopathic pulmonary fibrosis
Authors: Invernizzi Rachele , Molyneaux Philip L.
Published: July 2019

Idiopathic pulmonary fibrosis (IPF) arises in genetically susceptible individuals as a result of an aberrant wound-healing response following repetitive alveolar injury. The clinical course of the disease remains both variable and unpredictable with periods of more rapid decline, termed acute exacerbation of IPF (AE-IPF), often punctuating the disease trajectory. Exacerbations carry a significant morbidity and mortality, and their exact pathogenesis remains unclear. Given the emerging evidence that disruption and alteration in the lung microbiome plays a role in the pathogenesis and progression of IPF, this review discusses the current knowledge of the contribution of infection and the respiratory microbiome to AE-IPF.
Severe T2-high asthma in the biologics era: European experts' opinion
Authors: Pavord Ian , Bahmer Thomas , Braido Fulvio , Cosío Borja G. , Humbert Marc , Idzko Marco , Adamek Lukasz
Published: July 2019

The European Respiratory Biologics Forum gathered participants from 21 countries in Madrid, Spain, to discuss the management and treatment of severe asthma in the era of biologics. The current insights on the pathophysiology of severe asthma were discussed, as well as the role of respiratory biologics in clinical practice and strategies for eliminating chronic use of oral corticosteroids. The participants also highlighted the key challenges in identifying patients with severe asthma based on phenotypes, biomarkers and treatable traits, and the existing problems in patient referral to specialist care. The monitoring of treatment was debated and the need for a change towards precision medicine and personalised care was emphasised throughout the meeting. This review provides a summary of the discussions and highlights important concerns identified by the participants regarding the current management of severe asthma.
Living well with severe asthma
Authors: Stubbs Michelle A. , Clark Vanessa L. , McDonald Vanessa M.
Published: July 2019

Living well with severe asthma can be challenging. People with severe asthma can be refractory to treatment, can experience poor symptom control and are at a heightened risk of death. Patients experience symptoms of shortness of breath, chest tightness, cough and wheeze. These symptoms influence many aspects of an individual's life, resulting in emotional, financial, functional and medication-related burdens that negatively impact quality of life. Quality of life is known to be influenced by individual levels of satisfaction that stem from real-life treatment experiences. This experience is portrayed through the lens of the patient, which is commonly referred to as the patient perspective.

The patient perspective is only one element of the patient experience. It influences health status, which, in severe asthma, is commonly assessed using validated health-related quality of life measures. A positive patient perspective may be achieved with implementation of management strategies tailored to individual needs. Management strategies developed in partnership between the patient, the severe asthma multidisciplinary team and the general practitioner may minimise disease-related impairment, allowing patients to live well with severe asthma.

Key points

Despite advances in treatment over the past decade, the experience of living with severe asthma has not significantly improved, with high levels of burden influencing the patient perspective.

The impact of severe disease is not only restricted to asthma symptoms and acute attacks. It causes significant emotional, financial, functional and medication-related burdens, leading to impaired health-related quality of life.

Clinical outcomes should not be stand-alone measures in severe asthma. Nonclinical measures should also be considered when evaluating health-related quality of life.

Disease burden may be minimised and quality of life improvedviaself-management strategies, including education sessions, written asthma action plans, symptom monitoring, breathing exercises, physical activity and psychotherapeutic interventions.

Educational aims

To demonstrate the importance of the patient perspective in severe asthma.

To identify the significant levels of disease burden associated with severe asthma.

To discuss quality of life in severe asthma.

To outline strategies that increase well-being in severe asthma.
Highlights from the 2018 European Respiratory Society International Congress: sleep and clinical physiology
Authors: Almendros Isaac , Baillieul Sébastien , Caballero Candela , Degani-Costa Luiza Helena , Furian Michael , Hirotsu Camila , Louvaris Zafeiris , Thiel Sira , Turnbull Christopher D.
Published: July 2019

The 2018 European Respiratory Society (ERS) International Congress held in Paris, France, served as a platform to discover the latest research on respiratory diseases, the improvement in their treatments and patient care. Specifically, the scientific sessions organised by ERS Assembly 4 provided novel insights into sleep disordered breathing and fresh knowledge in respiratory physiology, stressing its importance to understanding and treating respiratory diseases. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each session has been written by early career members specialised in the different fields of this interdisciplinary assembly.
Microscopic observations of paper and parchment: the archaeology of small objects
Authors: Bicchieri Marina , Biocca Paola , Colaizzi Piero , Pinzari Flavia
Published: July 2019

The study of micro-objects, both inorganic and organic, which can be found associated to parchment or cellulose fibres of books and documents, or in the inks and the dirt, accumulated over the centuries between the pages, can unravel important information on the manufacture of the ancient documents, on their past vicissitudes or on the causes of aging and deterioration of the materials they contain. The results of a critical observation of micrometric objects and structures with a diagnostic or archaeological significance have in some cases been surprising. Apart from the curiosity that certain findings may or may not raise, what needs to be discussed is the fact that some chemical components, usually attributed to the manufacture of materials or the inks may instead have a particular origin and nature, and therefore lead, if not properly highlighted, to some erroneous diagnostics. Examples are given where the information obtained by means of scanning electron microscope imaging and Raman microscopy were coupled with dispersive X-ray microanalysis and Fourier Transform Infrared Spectroscopy.
A hybrid learning-based framework for seismic denoising
Authors: Li Chengbo , Zhang Yu , Mosher Charles C.
Published: July 2019

Noise attenuation has been a long-standing problem in seismic data processing. It presents unique challenges on land due to a complex near surface coupled with unavoidable environmental noise sources. In many cases, weak signals are embedded in much stronger noise, which makes conventional methods less effective at extracting those signals. In addition, conventional methods may lack adaptability to various noise types and patterns. Machine learning has shown great promise in solving geophysical problems including seismic data processing and interpretation. Here, we propose a novel method that is applicable to attenuating both incoherent noise, such as environmental noise, and coherent noise, such as ground roll and scattered noise, under a unified learning-based framework. This framework takes advantage of conventional methods to build the initial models and then employs dictionary learning and sparse inversion to invert both signal and noise simultaneously. The proposed method augments conventional methods by leveraging learning to recover residual weak signals from strong noise. We have applied this hybrid learning-based method successfully to some of the most difficult data areas where conventional denoising methods underperformed. Synthetic and real data examples demonstrate the effectiveness of the method for various noise types.
Reviews
Authors: Green William R. , Bevc Dimitri
Published: July 2019

The Politics of Fossil Fuel Subsidies and their Reform, edited by Jakob Skovgaard and Harro van Asselt, ISBN 978-1-108-41679-5, 2018, Cambridge University Press, 362 p. Windfall: How the New Energy Abundance Upends Global Politics and Strengthens America's Power, by Meghan L. O'Sullivan, ISBN 978-1-501-10794-8, 2018, Simon & Schuster, 480 p.
Safe prescribing in cognitively vulnerable patients: the use of the anticholinergic effect on cognition (AEC) tool in older adult mental health services
Authors: Bishara Delia , Scott Charlotte , Stewart Robert , Taylor David , Harwood Daniel , Codling David , Banwell Christine , Sauer Justin
Published: July 2019

Aims and method

Medication with anticholinergic action is associated with potentially serious adverse effects in older people. We present an evaluation of a novel anticholinergic burden scale introduced into routine practice in older adult services in the South London and Maudsley (SLaM) NHS Foundation Trust. Our aim was to assess whether this tool improved the accurate identification of anticholinergic medication and guided safer prescribing in cognitively vulnerable older people.

Results

The introduction of the anticholinergic effect on cognition (AEC) tool into clinical practice led to an increase in the identification and reporting to general practitioners of anticholinergic medication from 11 to 85% of cases (P = 0.0015).

Clinical implications

Application of the AEC tool led to improved detection of anticholinergic medication and advice to primary care on when a medication review is necessary. This is an important step towards improving the safety of prescribing in this patient group.
Mental Health in Somaliland: a critical situation
Authors: Abdi Abdillahi Fatumo , Ismail Edna Adan , Singh Swaran P.
Published: July 2019

Somaliland is experiencing an explosion of mental health problems that has received little coverage. The country has experienced devastating civil wars that have resulted in widespread trauma, and the lack of necessary mental health infrastructure is an obstacle to allowing the population to heal and recover. War trauma, poverty, unemployment and widespread substance misuse (khat) have all negatively affected the mental health of its citizens. This report provides an overview of a rapid needs assessment carried out across Somaliland that examined current service provision, gaps in services, and interviews with mental health professionals and caregivers.
Outcome of Infants Younger Than 1 Year With Acute Lymphoblastic Leukemia Treated With the Interfant-06 Protocol: Results From an International Phase III Randomized Study
Authors: Pieters Rob , De Lorenzo Paola , Ancliffe Philip , Aversa Luis Alberto , Brethon Benoit , Biondi Andrea , Campbell Myriam , Escherich Gabriele , Ferster Alina , Gardner Rebecca A , Kotecha Rishi Sury , Lausen Birgitte , Li Chi Kong , Locatelli Franco , Attarbaschi Andishe , Peters Christina , Rubnitz Jeffrey E. , Silverman Lewis B. , Stary Jan , Szczepanski Tomasz , Vora Ajay , Schrappe Martin , Valsecchi Maria Grazia
Published: July 2019

PURPOSE

Infant acute lymphoblastic leukemia (ALL) is characterized by KMT2A ( MLL) gene rearrangements and coexpression of myeloid markers. The Interfant-06 study, comprising 18 national and international study groups, tested whether myeloid-style consolidation chemotherapy is superior to lymphoid style, the role of stem-cell transplantation (SCT), and which factors had independent prognostic value.

MATERIALS AND METHODS

Three risk groups were defined: low risk (LR): KMT2A germline; high risk (HR): KMT2A-rearranged and older than 6 months with WBC count 300 × 109/L or more or a poor prednisone response; and medium risk (MR): all other KMT2A-rearranged cases. Patients in the MR and HR groups were randomly assigned to receive the lymphoid course low-dose cytosine arabinoside [araC], 6-mercaptopurine, cyclophosphamide (IB) or experimental myeloid courses, namely araC, daunorubicin, etoposide (ADE) and mitoxantrone, araC, etoposide (MAE).

RESULTS

A total of 651 infants were included, with 6-year event-free survival (EFS) and overall survival of 46.1% (SE, 2.1) and 58.2% (SE, 2.0). In West European/North American groups, 6-year EFS and overall survival were 49.4% (SE, 2.5) and 62.1% (SE, 2.4), which were 10% to 12% higher than in other countries. The 6-year probability of disease-free survival was comparable for the randomized arms (ADE+MAE 39.3% [SE 4.0; n = 169] v IB 36.8% [SE, 3.9; n = 161]; log-rank P = .47). The 6-year EFS rate of patients in the HR group was 20.9% (SE, 3.4) with the intention to undergo SCT; only 46% of them received SCT, because many had early events. KMT2A rearrangement was the strongest prognostic factor for EFS, followed by age, WBC count, and prednisone response.

CONCLUSION

Early intensification with postinduction myeloid-type chemotherapy courses did not significantly improve outcome for infant ALL compared with the lymphoid-type course IB. Outcome for infant ALL in Interfant-06 did not improve compared with that in Interfant-99.
Fallopian Tube Carcinoma
Authors: Stasenko Marina , Fillipova Olga , Tew William P.
Published: July 2019

Primary fallopian tube carcinoma is a rare and difficult to cure disease. It is often grouped under the epithelial ovarian cancer umbrella, together with primary ovarian and peritoneal carcinomas. More recent evidence has suggested that epithelial ovarian cancers originate from a fallopian tube precursor. The mainstay of treatment is surgical cytoreduction and platinum-based chemotherapy. There is much debate over the best timing for surgery and the best approach to delivering the chemotherapy: traditional intravenous once every 3 weeks regimen, versus intraperitoneal, versus dose-dense intravenous regimens. Although these debates continue, novel targeted therapies, including bevacizumab and poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors, have emerged. PARP inhibitors are particularly efficacious in patients with BRCA1/2 gene mutations, and their use has been shown to prolong patient survival. This article reviews the pathologic etiology; describes the heredity, treatment challenges, and controversies; and summarizes novel therapies in primary fallopian tube carcinoma.
Initial Postoperative Hemoglobin Values and Clinical Outcomes in Transfused Patients Undergoing Noncardiac Surgery
Authors: Will Nicholas D. , Kor Daryl J. , Frank Ryan D. , Passe Melissa A. , Weister Timothy J. , Zielinski Martin D. , Warner Matthew A.
Published: July 2019

BACKGROUND:

Intraoperative red blood cell (RBC) transfusion is common, yet transfusion strategies remain controversial as pretransfusion hemoglobin triggers are difficult to utilize during acute bleeding. Alternatively, postoperative hemoglobin values may provide useful information regarding transfusion practices, though optimal targets remain undefined.

METHODS:

This is a single-center observational cohort study of adults receiving allogeneic RBCs during noncardiac surgery from 2010 through 2014. Multivariable regression analyses adjusting for patient illness, laboratory derangements, and surgical features were used to assess relationships between initial postoperative hemoglobin values and a primary outcome of hospital-free days.

RESULTS:

A total of 8060 patients were included. Those with initial postoperative hemoglobin <7.5 or ≥11.5 g/dL had decreased hospital-free days [mean (95% confidence interval [CI]), −1.45 (−2.50 to −0.41) and −0.83 (−1.42 to −0.24), respectively] compared to a reference range of 9.5–10.4 g/dL (overall P value .003). For those with hemoglobin <7.5 g/dL, the odds (95% CI) for secondary outcomes included acute kidney injury (AKI) 1.43 (1.03–1.99), mortality 2.10 (1.18–3.74), and cerebral ischemia 3.12 (1.08–9.01). The odds for postoperative mechanical ventilation with hemoglobin ≥11.5 g/dL were 1.33 (1.07–1.65). Secondary outcome associations were not significant after multiple comparisons adjustment (Bonferroni P < .0056).

CONCLUSIONS:

In transfused patients, postoperative hemoglobin values between 7.5 and 11.5 g/dL were associated with superior outcomes compared to more extreme values. This range may represent a target for intraoperative transfusions, particularly during active bleeding when pretransfusion hemoglobin thresholds may be impractical or inaccurate. Given similar outcomes within this range, targeting hemoglobin at the lower aspect may be preferable, though prospective validation is warranted.
Postpartum Thyroid Storm in Poorly Controlled Graves’ Disease: A Case Report
Authors: Peace Jack M. , Hire Matthew G. , Peralta Feyce M.
Published: July 2019

Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. One of the most feared sequelae of hyperthyroidism is thyroid storm, which has a mortality rate >10%. Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.
Reduced mTORC1-signaling in retinal progenitor cells leads to visual pathway dysfunction
Authors: Jones Iwan , Hägglund Anna-Carin , Carlsson Leif
Published: July 2019

Development of the vertebrate central nervous system involves the co-ordinated differentiation of progenitor cells and the establishment of functional neural networks. This neurogenic process is driven by both intracellular and extracellular cues that converge on the mammalian target of rapamycin complex 1 (mTORC1). Here we demonstrate that mTORC1-signaling mediates multi-faceted roles during central nervous system development using the mouse retina as a model system. Down-regulation of mTORC1-signaling in retinal progenitor cells by conditional ablation of Rptor leads to proliferation deficits and an over-production of retinal ganglion cells during embryonic development. In contrast, reduced mTORC1-signaling in postnatal animals leads to temporal deviations in programmed cell death and the consequent production of asymmetric retinal ganglion cell mosaics and associated loss of axonal termination topographies in the dorsal lateral geniculate nucleus of adult mice. In combination these developmental defects induce visually mediated behavioural deficits. These collective observations demonstrate that mTORC1-signaling mediates critical roles during visual pathway development and function.
Modular tissue-specific regulation of doublesex underpins sexually dimorphic development in Drosophila
Authors: Rice Gavin R. , Barmina Olga , Luecke David , Hu Kevin , Arbeitman Michelle , Kopp Artyom
Published: July 2019

The ability of a single genome to produce distinct and often dramatically different male and female forms is one of the wonders of animal development. In Drosophila melanogaster, most sexually dimorphic traits are controlled by sex-specific isoforms of the doublesex (dsx) transcription factor, and dsx expression is mostly limited to cells that give rise to sexually dimorphic traits. However, it is unknown how this mosaic of sexually dimorphic and monomorphic organs arises. Here, we characterize the cis-regulatory sequences that control dsx expression in the foreleg, which contains multiple types of sex-specific sensory organs. We find that separate modular enhancers are responsible for dsx expression in each sexually dimorphic organ. Expression of dsx in the sex comb is co-regulated by two enhancers with distinct spatial and temporal specificities that are separated by a genitalia-specific enhancer. The sex comb-specific enhancer from D. willistoni, a species that primitively lacks sex combs, is not active in the foreleg. Thus, the mosaic of sexually dimorphic and monomorphic organs depends on modular regulation of dsx transcription by dedicated cell type-specific enhancers.