bluuebunny/crossref_metadata_2025_split huggingface dataset:
From global policy to tertiary pedagogy: Transformational thresholds for creative arts degrees
Authors: Rowe Nicholas 
Published: April 2019

Performing arts teachers, in diverse regions of the world, recognise that globalisation has indelibly influenced how the arts are valued, practiced and taught (Rowe, Martin, Buck, et al., 2018). As illustrated by three key United Nations Education, Science and Culture Organisation (UNESCO) policies on arts and culture in the 21st century (UNESCO, 2003, 2006, 2011), global mandates can present contrasting imperatives, prompting shifts within regional, national and institutional strategies. So how do tertiary arts educators respond to shifts in global policies? After a brief historical analysis of three UNESCO strategic documents associated with arts education, this article considers how the contrasts within these strategies have presented challenging learning moments for arts educationalists. ‘Threshold concept’ theory is presented as a means of framing such learning challenges, to highlight the professional development needs of designers of tertiary curricula. Critically reflecting on the author’s experiences of codesigning tertiary degree programmes in New Zealand, China and Fiji, this article identifies key conceptual thresholds that can challenge tertiary educators when seeking to align institutional teaching practices with contemporary global policies on arts education.
Long-term stroke incidence in proximal thoracic aorta aneurysm survivors
Authors: Hsu Jin-Yi , Su Yuan-Chih , Wang Jen-Hung , Tee Boon Lead 
Published: April 2019

Background Aneurysm of proximal thoracic aorta (pTAA) is an often indolent, yet fatal disease. Although advancements in aneurysmal repair techniques have increased long-term survival rates, studies have proven that there are increases in perioperative risk for stroke incidence after pTAA surgery. Conversely, there is little evidence regarding the long-term stroke incidence in pTAA individuals, which strongly influences the morbidity, mortality, and usage of antithrombotic agents. Methods Using the Taiwan National Health Insurance Research Database, a nationwide population-based cohort, we recruited 3013 pTAA survivors hospitalized from 1 January 2000 to 31 December 2012. To ensure study cohort quality, only patients aged 20 years and above who underwent aneurysmal repair surgery are included. The control cohort is identified by matching background features (comorbidities, age, gender) at a 1:4 ratio through the use of frequency matching. The primary outcomes include incidence of ischemic stroke and intracranial hemorrhage one month after aneurysmal repair surgery. Results The mortality of pTAA survivors is nearly twice of the matched controls despite aneurysmal repair (28.5 % vs. 15.2%, p < 0.001). Long-term follow-up of participants indicated that pTAA survivors had a higher risk for hemorrhage stroke (adjusted hazard ratio (aHR): 1.93; 95% confidence interval (CI): 1.47–2.53), but no significant increase in risk for ischemic stroke (aHR: 1.07; 95% CI: 0.92–1.25). Hemorrhagic stroke occurrence was found to be associated with age and diabetes mellitus. Comparison on hemorrhagic stroke subtypes between study and matched cohorts showed no statistical differences in intracerebral hemorrhage and subarachnoid hemorrhage. Conclusions Despite the advancement of aneurysmal repair surgery, this study suggests that pTAA patients may still face an increased risk of hemorrhage stroke. Further investigation is warranted to provide better long-term care for the pTAA population.
Impact of Built Design on Nighttime Family Presence in the Intensive Care Unit
Authors: Huynh Truong-Giang , Owens Robert L. , Davidson Judy E. 
Published: April 2019

Objective: Determine whether dedicated family space changes family presence at night in the intensive care unit (ICU). Purpose: To measure family presence at night before and after moving to an ICU with in-room family space. Background: The safeguarding phenomenon families experience may lead to the desire to sit vigil at the bedside. Lack of dedicated family sleep space may exacerbate sleep deprivation for those who wish to be present at night. Sleep deprivation decreases cognition and capacity for decision-making. Traditionally, ICU rooms have not included dedicated family areas or sleep surfaces. National recommendations include designing new hospital ICU rooms with dedicated family space. It is not known if the built design changes family presence at night. Method: Family presence was measured for 30 nights pre- and postmove to a newly built ICU with dedicated family space. The policy for open flexible family presence remained the same before and after the move. Results: There was a statistically significant increase in proportion of occupied patient rooms with visitors following the move to the new ICU designed with family space (31% difference, x2= 5.675, 95% CI [5.74, 51.29], p = .0172). Conclusions: Families utilize the space when available. Further research is needed to quantify quality and quantity of family sleep and impact on decision-making and interactions with the care team. Sleep deprivation may decrease for families who would have remained in the unit without available family space and sleep surface.
Using the pCANvas neck-bridging device in treating a wide-necked aneurysm of the basilar tip
Authors: Sirakov Stanimir , Panayotova Adriana , Sirakov Alexander , Penkov Marin , Minkin Krasimir , Hristov Hristo 
Published: April 2019

Background and importance The endovascular treatment of recurrent wide-necked bifurcation aneurysms at the basilar tip remains very challenging. Many different techniques and devices have emerged in recent years as potential options but results remain less than controversial. The pCANvas is a relatively new device wielding neck-bridging properties with a haemodynamically active membrane acting as blood flow disrupter. Clinical presentation We present the clinical case of a patient in whom multiple endovascular and microsurgical attempts failed to achieve the definitive treatment of a large and wide-necked basilar tip aneurysm. The patient underwent successful endovascular implantation of the novel pCANvas device across the recurrent aneurysm neck. The device limited the blood flow to the anerysmal lumen and thus promoted faster thrombosis. Third month follow-up confirmed complete obliteration of the aneurysm. Conclusion The application of the pCANvas device offers a potential treatment option in difficult and recurrent aneurysms. The endovascular flow disruption is a relatively new feature aiming to create conditions for intraluminal thrombosis and is certainly promising for the treatment of complex bifurcation aneurysms.
Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique
Authors: Eldabe Sam , Tariq Anisah , Nath Sherdil , Gulve Ashish , Antrobus Hugh , Baloch Mohjir , Buczkowski Piotr , Collighan Neil , Fernandez Tacson , Fritz Ann-Katrin , Humble Stephen , Huygen Frank , Krishnan Murali , Mehta Vivek , Mishra Sailesh , Muthukrishnan Sundar , Snidvongs Saz , Tamosauskas Rokas , Underwood Martin 
Published: April 2019

Background: Radiofrequency denervation is used to treat selected people with low back pain. Recent trials have been criticised for using a sub-optimal intervention technique. Objectives: To achieve consensus on a best practice technique for administering radiofrequency denervation of the lumbar facet joints to selected people with low back pain. Study design: A consensus of expert professionals in the area of radiofrequency denervation of the lumbar facet joints. Methods: We invited a clinical member from the 30 most active UK departments in radiofrequency pain procedures and two overseas clinicians with specific expertise to a 1 day consensus meeting. Drawing on the known anatomy of the medial branch, the theoretical basis of radiofrequency procedures, a survey of current practice and collective expertise, delegates were facilitated to reach consensus on the best practice technique. Results: The day was attended by 24 UK and international clinical experts. Attendees agreed a best practice technique for the conduct of radiofrequency denervation of the lumbar facet joints. Limitations: This consensus was based on a 1 day meeting of 24 clinical experts who attended and took part in the discussions. The agreed technique has not been subject to input from a wider community of experts. Conclusions: Current best practice for radiofrequency denervation has been agreed for use in a UK trial. Group members intend immediate implementation in their respective trusts. We propose using this in a planned Randomised Controlled Trial (RCT) of radiofrequency denervation for selected people with low back pain.
Morphine promotes neovascularizing retinopathy in sickle transgeneic mice
Authors: Gupta Kalpna , Chen Chunsheng , Lutty Gerard A. , Hebbel Robert P. 
Published: April 2019

Abstract
Neovascularizing retinopathy is a significant complication of sickle cell disease (SCD), occurring more frequently in HbSC than HbSS disease. This risk difference is concordant with a divergence of angiogenesis risk, as identified by levels of pro- vs anti-angiogenic factors in the sickle patient’s blood. Because our prior studies documented that morphine promotes angiogenesis in both malignancy and wound healing, we tested whether chronic opioid treatment would promote retinopathy in NY1DD sickle transgenic mice. After 10 to 15 months of treatment, sickle mice treated with morphine developed neovascularizing retinopathy to a far greater extent than either of the controls (sickle mice treated with saline and wild-type mice treated identically with morphine). Our dissection of the mechanistic linkage between morphine and retinopathy revealed a complex interplay among morphine engagement with its μ opioid receptor (MOR) on retinal endothelial cells (RECs); morphine-induced production of tumor necrosis factor α and interleukin-6 (IL-6), causing increased expression of both MOR and vascular endothelial growth factor receptor 2 (VEGFR2) on RECs; morphine/MOR engagement transactivating VEGFR2; and convergence of MOR, VEGFR2, and IL-6 activation on JAK/STAT3-dependent REC proliferation and angiogenesis. In the NY1DD mice, the result was increased angiogenesis, seen as neovascularizing retinopathy, similar to the retinal pathology occurring in humans with SCD. Therefore, we conclude that chronic opioid exposure, superimposed on the already angiogenic sickle milieu, might enhance risk for retinopathy. These results provide an additional reason for development and application of opioid alternatives for pain control in SCD.
The natural history of vascular and other complications in patients treated with nilotinib for chronic myeloid leukemia
Authors: Minson Adrian G. , Cummins Katherine , Fox Lucy , Costello Ben , Yeung David , Cleary Rebecca , Forsyth Cecily , Tatarczuch Maciek , Burbury Kate , Motorna Olga , Shortt Jake , Fleming Shaun , McQuillan Andrew , Schwarer Anthony , Harrup Rosemary , Holmes Amy , Ratnasingam Sumita , Chan Kah-Lok , Hsu Wei-Hsun , Ashraf Asma , Putt Faye , Grigg Andrew 
Published: April 2019

Abstract
Although second-generation tyrosine kinase inhibitors (TKIs) show superiority in achieving deep molecular responses in chronic myeloid leukemia in chronic phase (CML-CP) compared with imatinib, the differing adverse effect (AE) profiles need consideration when deciding the best drug for individual patients. Long-term data from randomized trials of nilotinib demonstrate an increased risk of vascular AEs (VAEs) compared with other TKIs, although the natural history of these events in response to dose modifications or cessation has not been fully characterized. We retrospectively reviewed the incidence of nilotinib-associated AEs in 220 patients with CML-CP at 17 Australian institutions. Overall, AEs of any grade were reported in 95 patients (43%) and prompted nilotinib cessation in 46 (21%). VAEs occurred in 26 patients (12%), with an incidence of 4.1 events per 100 patient-years. Multivariate analysis identified age (P = .022) and dyslipidemia (P = .007) as independent variables for their development. There was 1 fatal first VAE, whereas the remaining patients either continued nilotinib (14 patients) or stopped it immediately (11 patients). Recurrent VAEs were associated with ongoing therapy in 7 of 14 who continued (with 2 fatal VAEs) vs 1 of 11 who discontinued (P = .04). Nineteen of the 23 evaluable patients surviving a VAE ultimately stopped nilotinib, of whom 14 received an alternative TKI. Dose reduction or cessation because of VAEs did not adversely affect maintenance of major molecular response. These findings demonstrate that in contrast to other AEs, VAEs are ideally managed with nilotinib cessation because of the increased risk of additional events with its ongoing use.
Hematopoietic cytokines mediate resistance to targeted therapy in FLT3-ITD acute myeloid leukemia
Authors: Sung Pamela J. , Sugita Mayumi , Koblish Holly , Perl Alexander E. , Carroll Martin 
Published: April 2019

Abstract
Activating mutations in Fms-like tyrosine kinase 3 (FLT3) occur in ∼30% of adult cases of acute myeloid leukemia (AML). Selective second- and third-generation FLT3 inhibitors have shown significant clinical activity in patients with relapsed FLT3-mutant AML. However, clearance of FLT3-mutant clones does not consistently occur, and disease will progress in most patients after an initial response. This scenario challenges the model of FLT3-mutant AML being oncogene addicted, and it suggests that redundant signaling pathways regulate AML cell survival after FLT3 inhibition. We show that primary FLT3-mutant AML cells escape apoptosis induced by FLT3 inhibition in vitro in the presence of cytokines produced normally in the bone marrow, particularly granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-3 (IL-3). Despite reactivating canonical FLT3-signaling pathways, GM-CSF and IL-3 maintain cell survival without rescuing proliferation. Cytokine-mediated resistance through GM-CSF and IL-3 is dependent on JAK kinase, STAT5, and proviral integration site of Moloney murine leukemia virus (PIM) but not MAPK or mammalian target of rapamycin signaling. Cotreatment with FLT3 inhibitors and inhibitors of JAK or PIM kinases blocks GM-CSF and IL-3 rescue of cell survival in vitro and in vivo. Altogether, these data provide a strong rationale for combination therapy with FLT3 inhibitors to potentially improve clinical responses in AML.
Willingness to Stop Growing Tobacco in Uganda
Authors: Karemani Adelaine , Nuwaha Fred 
Published: April 2019

PURPOSETobacco use is the leading cause of premature death worldwide. One aspect of tobacco control is convincing farmers to stop tobacco production. We assessed the willingness of tobacco farmers in Uganda to stop growing tobacco.METHODSWe conducted a cross-sectional interview survey with an interviewer-administered questionnaire. Participants were active tobacco farmers in 12 villages of Kanungu district (N = 528) and were interviewed in 2013 to assess their willingness to stop growing tobacco.RESULTSMost farmers (61.7%) grew tobacco only as a cash crop with no supplemental income. A total of 198 farmers (37.5%) were willing to stop growing tobacco. Ninety-two respondents cited coffee as a potential replacement crop for tobacco and 106 mentioned rice. Barriers to growing replacement crops were that tobacco is highly profitable (n = 172) and that the soil (n = 175) and/or weather (n = 22) cannot sustain any crops other than tobacco. Willingness to stop growing tobacco was 1.32 times as likely among farmers who said that tobacco use causes respiratory diseases and 1.16 times as likely among farmers who received less than less than $300 USD from tobacco sales in the previous season. Agreeing that tobacco is profitable decreased the likelihood of willingness to stop growing tobacco by 36%.CONCLUSIONOnly one in three farmers were willing to stop growing tobacco. To increase their willingness to stop growing tobacco, farmers must be educated on the health consequences of tobacco and we must demonstrate to farmers that other crops may be more profitable than tobacco.
Capacitation of human naïve pluripotent stem cells for multi-lineage differentiation
Authors: Rostovskaya Maria , Stirparo Giuliano G. , Smith Austin 
Published: April 2019

ABSTRACT
Human naïve pluripotent stem cells (PSCs) share features with the pre-implantation epiblast. They therefore provide an unmatched opportunity for characterising the developmental programme of pluripotency in Homo sapiens. Here, we confirm that naïve PSCs do not respond directly to germ layer induction, but must first acquire competence. Capacitation for multi-lineage differentiation occurs without exogenous growth factor stimulation and is facilitated by inhibition of Wnt signalling. Whole-transcriptome profiling during this formative transition highlights dynamic changes in gene expression, which affect many cellular properties including metabolism and epithelial features. Notably, naïve pluripotency factors are exchanged for postimplantation factors, but competent cells remain devoid of lineage-specific transcription. The gradual pace of transition for human naïve PSCs is consistent with the timespan of primate development from blastocyst to gastrulation. Transcriptome trajectory during in vitro capacitation of human naïve cells tracks the progression of the epiblast during embryogenesis in Macaca fascicularis, but shows greater divergence from mouse development. Thus, the formative transition of naïve PSCs in a simple culture system may recapitulate essential and specific features of pluripotency dynamics during an inaccessible period of human embryogenesis.
Advancing contraceptive security, availability, and choice in Malawi using a quality improvement methodology
Authors: Gausman Jewel , Schmitt Megan E. , Wickstrom Jane 
Published: April 2019

Many initiatives to improve contraceptive security (CS) rightly focus on strengthening national and regional systems. However, local health facilities are often under-resourced and lack technical capacity that feed into the larger supply chain. This study’s objective was to assess whether changes in facility CS indicators were associated with participation in 2014-2016 implementation and scale-up of a quality improvement methodology—Client-Oriented, Provider efficient services (COPE®) for Contraceptive Security—in 60 facilities across 10 districts of Malawi. The intervention included facility self-assessment guides and action plans to address local challenges. Results showed significant improvements in facilities having both a trained provider and contraceptive supplies. The percentage of health centers with all requirements for implant services increased significantly, including implant removal (from 26.5%; 95% CI: 14.9-41.1 to 77.6%; 95% CI: 63.4-88.2, p<.001). Health centers (from 0.0%; 95% CI: 0.0-7.3 to 10.2%; 95% CI: 3.4-22.2, p<0.05) and hospitals (from 45.5%; 95% CI: 16.7-76.7 to 90.9%; 95% CI: 58.7-99.8, p<0.05) significantly improved in the percentage of facilities able to insert intrauterine devices. Hospitals improved their ability to offer female sterilizations (27.2%; 95% CI: 6.0-61.0 to 63.6%; 95% CI: 30.7-89.1, p<0.05) and male sterilizations. Low performing health centers showed significant improvement in staff capacity, logistics management information systems, equipment, and total CS performance. The percentage of facilities placing emergency orders for contraceptives during the three months prior to an assessment showed a decreasing, non-significant trend among hospitals but was significant among health centers (from 69.2%; 95% CI: 54.6-81.7 to 36.7%; 95% CI: 23.4-51.7; p<0.001). Facility staff commitment was associated with action item completion. Improvements tended to be sustained over time. Community engagement is thought to be important to intervention success. COPE for CS may be an effective intervention and future research/programs can build off of this preliminary programmatic experience when seeking to address last mile challenges.
Adopting a logical framework model to help achieve a balanced and healthy vaccine R&D portfolio
Authors: Lalani Bhoomi , Sobti Sourabh 
Published: April 2019

Vaccines are currently the 5th biggest therapy area with global sales for prophylactic and therapeutic vaccines to be ~ $30B, which is expected to increase to $45B by 2024. Immunization is globally recognized as one of the best investments to improve health, with impact lasting beyond saving 2-3M lives every year with benefits accrued over a lifetime. Enterprise value of any R&D company is a cumulative sum of its projects and proprietary technologies. Hence organizations need to continuously evaluate their portfolios to review the health of projects as changes in external environment may impact project viability. Simultaneously, addition of any new project in a company’s portfolio is a significant investment and needs to be evaluated using an objective multi-parametric framework. In this pursuit, Hilleman Labs, an equal joint venture by MSD and Wellcome Trust, has created a logical framework to evaluate potential vaccine candidates before they are added to the portfolio.
What enables or prevents women with depressive symptoms seeking help in the postnatal period?
Authors: Newman Tabitha Claire , Hirst Janet , Darwin Zoe 
Published: April 2019

BackgroundPerinatal mental health problems affect approximately 20% of women. The most common condition is postnatal depression; however, many women do not seek help.AimsTo identify and synthesise evidence on factors that enable or prevent help-seeking in women with depressive symptoms in the postnatal period.MethodsA qualitative systematic review was conducted using electronic databases and pre-determined eligibility criteria.FindingsThematic synthesis of the included studies (n=4) identified the following themes: the influence of healthcare services, the influence of others and the influence of women themselves. Help-seeking was shaped by women's ability to recognise their symptoms, the reactions (experienced or anticipated) of others and the organisation of services.ConclusionAn improved interface between maternity and mental health services and enhanced health professional interactions are needed. However, meaningful change may require empowering women's self-assessment and public health messages to improve understanding of postnatal depression.