bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Wastewater Systems Adapting to Climate Change?
Authors: Kirchhoff Christine J. , Watson Peter L. 
Published: April 2019

AbstractWastewater (WW) systems are vulnerable to extreme precipitation events; storm‐induced WW system failures pollute the environment and put public health at risk. Despite these vulnerabilities, we know very little about how WW managers are responding to current climate risks or to future climate change. This study aims to fill this critical gap in the literature. Data from surveys and interviews were used to understand what WW managers are doing to adapt to the current climate, what facilitates those adaptations, and if they are adapting to future climate change. Findings show most WW managers (78%) are making changes to build resiliency to storms they have experienced in the past (e.g., extra fuel on site, extra staff on call, more training, better communication, adding generators, elevating components, adding capacity); most are not adapting to future climate change. Our work suggests organizational leadership, concern about future climate‐related impacts, and experiencing storm impacts drive resiliency changes while regulatory requirements drive adaptation to future climate change. Beyond advancing science, our work offers practical suggestions for building WW system resilience and for increasing WW system's consideration of future climate impacts in their resiliency building efforts.
Clinical manifestations, immunological features and prognosis of Chinese pediatric systemic lupus erythematosus: A single‐center study
Authors: Zhang Chen‐xing , Cai Li , Zhou Zheng‐yu , Mao You‐ying , Huang Hua , Yin Lei , Chen Tong‐xin , Zhou Wei 
Published: April 2019

AbstractAimSince there are only a few reports on pediatric systemic lupus erythematosus (pSLE) in Chinese populations, therefore we retrospectively report the clinical and immunological features as well as renal outcome in Chinese pSLE.MethodsPatients diagnosed with pSLE at Shanghai Children's Medical Center between 2001 and 2016 were evaluated and clinical data were retrospectively collected.ResultsA total of 102 pSLE patients were analyzed. Renal disorder including proteinuria (81.37%) and hematuria (65.69%) were most commonly identified. Class IV was the most common finding on renal biopsy. In lupus nephritis (LN), 67.21%, 78.0%, 86.0% and 94.55% achieved complete remission within 6, 12, 18 and 24 months, respectively. Furthermore, 16.67% of LN patients suffered at least one renal flare. Antinuclear antibodies were detected in nearly all patients (97.62%), followed by anti‐double‐stranded DNA (anti‐dsDNA) antibodies (70.0%) and anti‐Sjögren's syndrome A (anti‐SSA) antibodies (60.64%). Oral corticosteroid (93.14%) and mycophenolate mofetil (64.71%) was used in the majority of patients. Infection (32.35%) was the main side effect caused by the medications.ConclusionsOur population‐based pSLE cohort indicated that compared to other international cohorts, there was a higher prevalence of LN in Chinese pSLE. Proteinuria was the most frequent manifestation both at disease onset and during the entire clinical course. Class IV LN was the dominant renal pathological type. Nevertheless, there was a favorable renal remission rate and relatively low incidence of renal flare in our cohort. Apart from antinuclear antibodies and anti‐dsDNA antibodies, anti‐SSA antibodies were most frequently detected. Infection was the leading complication caused by the medications.
Radiotherapy for oligometastatic tumor improved the prognosis of patients with non‐small cell lung cancer (NSCLC)
Authors: Gong Hong‐yun , Wang Yi , Han Guang , Song Qi‐bin 
Published: April 2019

BackgroundThis study was conducted to investigate if radiotherapy improved the overall survival (OS) of patients with oligometastatic non‐small cell lung cancer (NSCLC).MethodsFrom January 2012 to August 2015, 323 NSCLC patients with distant metastasis were administered radiotherapy. Ninety‐five patients with oligometastatic NSCLC who were sensitive to the initial chemotherapy were treated with radiotherapy for the residual lesions. Initial treatment consisted of four to six cycles of induction chemotherapy. If the patients responded to the initial treatment without developing new metastases, the residual sites were radiated at a total dose of 56–66 Gy, including the primary and metastatic sites. OS, progression‐free survival, and sites of progression were assessed. The Kaplan–Meier method was used to estimate the OS and progression‐free survival probabilities.ResultsThe median survival of the whole cohort was 15 months (95% confidence interval 6–40) and the median time to progression was 11 months (95% confidence interval 4–24). Sixty‐seven patients had died by the end of follow‐up. The one‐year and two‐year OS rates were 58% and 23%, respectively. Patients progressed either with brain (n = 14), bone (n = 11), lung (n = 10), liver (n = 7), adrenal gland (n = 5), or seven other sites of metastases (n = 3). Acute grade III esophageal toxicity was observed in 17 patients (18%) and grade III pulmonary toxicity in seven patients (7%).ConclusionOligometastatic non‐progressive NSCLC patients may benefit from aggressive radiotherapy to the residual lesions with acceptable toxicity after systemic chemotherapy.
P40 expression in small cell lung cancer: The presence of p40‐positive cells does not always indicate squamous differentiation
Authors: Nakajima Naoki , Yoshizawa Akihiko , Moriyoshi Koki , Sonobe Makoto , Menju Toshi , Sumiyoshi Shinji , Date Hiroshi , Haga Hironori 
Published: April 2019

BackgroundSmall cell lung cancer (SCLC) is normally diagnosed with hematoxylin and eosin stains, although some cases require immunohistochemistry (IHC). P40 is highly sensitive and specific for squamous cell carcinoma and is thus considered the best marker for this cancer. However, the status of p40 expression in SCLC is not well known. The aim of this study was to analyze p40 expression in resected SCLC using IHC.MethodsForty‐four surgically resected SCLC cases were enrolled. Clinical data were obtained from the patients’ medical records. Pathologists blinded to the patients’ clinical data reviewed the SCLC slides. IHC was performed on a representative slide of each case.ResultsAlthough p40 was not diffusely expressed in any of the SCLC cases, p40‐positive cells were observed in the tumors in 15 cases (34.1%). Ten of these exhibited p40 in < 1% of tumor cells. In the remaining five cases, 1–5% of tumor cells expressed p40, and in three of these, the cells expressing p40 also expressed TTF‐1 and neuroendocrine markers. There was no statistically significant relationship between p40 positivity and any other clinicopathological characteristics.ConclusionsSome resected SCLCs express p40 focally. This result suggests that the presence of positive p40 cells does not exclude a diagnosis of SCLC. Thus, small biopsy or cytology specimens with p40‐positive cells must be diagnosed carefully.
The emergence of management controls in an entrepreneurial company
Authors: Akroyd Chris , Kober Ralph , Li Danni 
Published: April 2019

AbstractThe dilemma faced by founders of entrepreneurial companies is how to scale their business while staying in control. While the accounting literature has found that financial controls are important to rapidly scale a business, we do not know how these controls emerge in entrepreneurial companies in relation to other management controls. Using a case study of an entrepreneurial company that rapidly scaled its business, this study examines the management controls that emerged to become a package of controls. We highlight the importance of the management control package remaining in balance, with controls working together interdependently in a complementary fashion.
Analgesic efficacy of the Pecs II block: a systematic review and meta‐analysis
Authors: Versyck B. , van Geffen G.‐J. , Chin K.‐J. 
Published: April 2019

SummarySurgery is the primary therapeutic intervention for breast cancer and can result in significant postoperative pain. We searched the current literature and performed a meta‐analysis in order to compare the analgesic efficacy of the pectoral type‐2 (Pecs II) block with systemic analgesia alone and with a thoracic paravertebral block for breast cancer surgery. Primary outcome was postoperative opioid consumption in the first 24 h after surgery. Secondary outcomes were pain scores at 0, 3, 6, 9 and 24 h after surgery, intra‐operative opioid consumption, time to first analgesic request and incidence of postoperative nausea and vomiting. We identified 13 randomised controlled trials that included 815 patients. The Pecs II block significantly reduced postoperative opioid consumption (standardised difference in means: −13.64 mg oral morphine equivalents; 95%CI: −21.22 to −6.05; p < 0.01) and acute postoperative pain at all intervals in the first 24 h after surgery compared with systemic analgesia alone. Compared with the thoracic paravertebral block, the Pecs II block resulted in similar postoperative opioid consumption (standardised difference in means: −8.73 mg oral morphine equivalents; 95%CI: −18.16 to 0.69; p = 0.07) and postoperative pain scores after first measurement. In conclusion, the Pecs II block offers improved analgesic efficacy compared with systemic analgesia alone and comparable analgesic efficacy to a thoracic paravertebral block for breast cancer surgery.
Outcomes of paediatric septic arthritis of the hip and knee at 1–20 years in an Australian urban centre
Authors: Hoswell Roseanna L. , Johns Brenton P. , Loewenthal Mark R. , Dewar David C. 
Published: April 2019

BackgroundSeptic arthritis in children is a joint threatening condition with potentially severe consequences; however, long‐term outcome data is lacking. This study aims to determine 1–20‐year outcomes following septic arthritis of hip and knee joints in children in an Australian population.MethodsAll paediatric patients with septic arthritis of the hip or knee from 1995 to 2015 treated at our Australian institution were retrospectively assessed. Clinical features, treatment and investigation results were recorded. Long‐term functional and radiological outcomes, infection recurrence and reoperation rate at final follow‐up (mean 8.5 years, range 1.0–20.3; hip versus mean 7.7 years, range 1.1–20.3; knee) were recorded.ResultsSixty‐four patients (37 hip, 27 knee) met inclusion criteria. Fifty‐two patients (81.3%) attended follow‐up. No mortalities or late infection recurrence occurred. Three patients (1; hip versus 2; knee) had a later operation. Median Oxford scores were excellent (48; hip versus 48; knee); however, a significant proportion had a degree of impaired function (31.3%; hip versus 42.1%; knee). Radiological outcomes were excellent in knees more commonly than hips (81.3%; hip versus 100%; knee).ConclusionsOutcomes at 1–20 years for the majority of patients following septic arthritis of the hip and knee are excellent with early joint irrigation and intravenous antibiotics. Our results demonstrate a significant proportion of patients following septic hip arthritis have mild to moderately poor functional and radiological outcomes. Those with septic knee arthritis demonstrated universally excellent radiological outcomes and mild functional impairment in approximately one‐third of cases.
[Ca2+] changes in sympathetic varicosities and Schwann cells in rat mesenteric arteries—Relation to noradrenaline release and contraction
Authors: Hansen Thomas , Tarasova Olga S. , Khammy Makhala M. , Ferreira Avelino , Kennard James A. , Andresen Jørgen , Staehr Christian , Brain Keith L. , Nilsson Holger , Aalkjær Christian 
Published: April 2019

AbstractAimThis study aimed to assess intracellular Ca2+ dynamics in nerve cells and Schwann cells in isolated rat resistance arteries and determine how these dynamics modify noradrenaline release from the nerves and consequent force development.MethodsCa2+ in nerves was assessed with confocal imaging, noradrenaline release with amperometry and artery tone with wire myography. Ca2+ in axons was assessed after loading with Oregon Green 488 BAPTA‐1 dextran. In other experiments, arteries were incubated with Calcium Green‐1‐AM which loads both axons and Schwann cells.ResultsSchwann cells but not axons responded with a Ca2+ increase to ATP. Electrical field stimulation of nerves caused a frequency‐dependent increase in varicose [Ca2+] ([Ca2+]v). ω‐conotoxin‐GVIA (100 nmol/L) reduced the [Ca2+]v transient to 2 and 16 Hz by 60% and 27%, respectively; in contrast ω‐conotoxin GVIA inhibited more than 80% of the noradrenaline release and force development at 2 and 16 Hz. The KV channel blocker, 4‐aminopyridine (10 µmol/L), increased [Ca2+]v, noradrenaline release and force development both in the absence and presence of ω‐conotoxin‐GVIA. Yohimbine (1 µmol/L) increased both [Ca2+]v and noradrenaline release but reduced force development. Acetylcholine (10 µmol/L) caused atropine‐sensitive inhibition of [Ca2+]v, noradrenaline release and force. In the presence of ω‐conotoxin‐GVIA, acetylcholine caused a further inhibition of all parameters.ConclusionModification of [Ca2+] in arterial sympathetic axons and Schwann cells was assessed separately. KV3.1 channels may be important regulators of [Ca2+]v, noradrenaline release and force development. Presynaptic adrenoceptor and muscarinic receptor activation modify transmitter release through modification of [Ca2+]v.
Clinical course and mortality by etiology of liver cirrhosis in Sweden: a population based, long‐term follow‐up study of 1317 patients
Authors: Nilsson Emma , Anderson Harald , Sargenti Konstantina , Lindgren Stefan , Prytz Hanne 
Published: April 2019

SummaryBackgroundLiver cirrhosis is characterized by a silent phase until decompensation, which is defined by ascites, bleeding from esophageal varices or hepatic encephalopathy.AimTo compare the clinical course, patterns of survival and causes of death by etiology during long‐term follow‐up in a large population‐based cohort of patients with incident cirrhosis.MethodsWe used population‐based medical registries for a cohort study of patients with liver cirrhosis diagnosed January 2001 to December 2010, in the Scania region of Sweden. Medical records were reviewed. Patients were classified according to etiology and clinical parameters were registered. Patients were followed until December 2017.ResultsThe cohort comprised 1317 patients, 631 were decompensated at diagnosis and 387 decompensated during follow‐up. The cumulative 10‐year incidence of decompensation, with death and transplantation as competing risks, was 89% in alcoholic cirrhosis, 58% in hepatitis C and 75% in cryptogenic cirrhosis. The lowest 10‐year transplantation‐free survival rates were found in cryptogenic cirrhosis (11%), alcohol‐related cirrhosis (18%) and alcohol combined with hepatitis C (12%). Autoimmune hepatitis cirrhosis showed the best 10‐year survival (53%) and hepatitis C, non‐alcoholic steatohepatitis, primary biliary cholangitis, and primary sclerosing cholangitis and other causes averaged 30%. Decompensation at diagnosis was an important predictor for death in all etiologies apart from alcoholic cirrhosis. 991 patients died and 91 were transplanted.ConclusionOur results show that the clinical course and survival in cirrhosis differ considerably by both etiology and state at diagnosis.
Blockade of myeloid differentiation 2 attenuates diabetic nephropathy by reducing activation of the renin‐angiotensin system in mouse kidneys
Authors: Wang Yi , Fang Qilu , Jin Yiyi , Liu Zhoudi , Zou Chunpeng , Yu Weihui , Li Weixin , Shan Xiaoou , Chen Ruijie , Khan Zia , Liang Guang 
Published: April 2019

Background and PurposeBoth innate immunity and the renin‐angiotensin system (RAS) play important roles in the pathogenesis of diabetic nephropathy (DN). Myeloid differentiation factor 2 (MD2) is a co‐receptor of toll‐like receptor 4 (TLR4) in innate immunity. While TLR4 is involved in the development of DN, the role of MD2 in DN has not been characterized. It also remains unclear whether the MD2/TLR4 signalling pathway is associated with RAS activation in diabetes.Experimental ApproachMD2 was blocked using siRNA or the low MW inhibitor, L6H9, in renal proximal tubular cells (NRK‐52E cells) exposed to high concentrations of glucose (HG). In vivo, C57BL/6 and MD2−/− mice were injected with streptozotocin to induce Type 1 diabetes and nephropathy.Key ResultsInhibition of MD2 by genetic knockdown or the inhibitor L6H9 suppressed HG‐induced expression of ACE and angiotensin receptors and production of angiotensin II in NRK‐52E cells, along with decreased fibrosis markers (TGF‐β and collagen IV). Inhibition of the MD2/TLR4‐MAPKs pathway did not affect HG‐induced renin overproduction. In vivo, using the streptozotocin‐induced diabetic mice, MD2 was overexpressed in diabetic kidney. MD2 gene knockout or L6H9 attenuated renal fibrosis and dysfunction by suppressing local RAS activation and inflammation.Conclusions and ImplicationsHyperglycaemia activated the MD2/TLR4‐MAPKs signalling cascade to induce renal RAS activation, leading to renal fibrosis and dysfunction. Pharmacological inhibition of MD2 may be considered as a therapeutic approach to mitigate DN and the low MW inhibitor L6H9 could be a candidate for such therapy.
Long‐term follow up of nivolumab in previously untreated Japanese patients with advanced or recurrent malignant melanoma
Authors: Yamazaki Naoya , Kiyohara Yoshio , Uhara Hisashi , Uehara Jiro , Fujisawa Yasuhiro , Takenouchi Tatsuya , Otsuka Masaki , Uchi Hiroshi , Ihn Hironobu , Hatsumichi Masahiro , Minami Hironobu 
Published: April 2019

AbstractThe immune checkpoint inhibitor nivolumab inhibits the programmed death 1 receptor and suppresses the immune resistance of cancer cells. This is a long‐term follow up of a single‐arm, open‐label, multicenter, phase II study of nivolumab in untreated Japanese patients with stage III/IV or recurrent melanoma. In addition, a post–hoc subgroup analysis stratified by melanoma types was performed. Nivolumab was administered intravenously at a dose of 3 mg/kg every 2 weeks. The primary endpoint was the overall response rate (ORR), and secondary endpoints included overall survival (OS), progression‐free survival (PFS), best overall response, the disease control rate and change in tumor diameter. Safety was assessed by recording treatment‐related adverse events (TRAE), including select immune‐related adverse events. Of the 24 patients initially included in the primary phase II study, 10 survived for over 3 years (41.7%). The ORR was 34.8% (90% confidence interval [CI]: 20.8, 51.9) for all patients. When analyzing by melanoma type, the ORR was 66.7% (90% CI: 34.7, 88.3) for superficial spreading, 33.3% (90% CI: 11.7, 65.3) for mucosal, and 28.6% (90% CI: 10.0, 59.1) for acral lentiginous tumors. The median OS was 32.9 months, the 3‐year OS rate was 43.5%, and the 3‐year PFS rate was 17.2%. A long‐term response was observed in all the tumor types. The most common TRAE included skin toxicity (45.8%) and endocrine disorders (29.2%). This study demonstrated the long‐term efficacy and tolerability of nivolumab in patients with advanced or recurrent melanoma, irrespective of melanoma type.
Storytelling, Science, and Religion: Promoting Reflection and Conversation about Societal Issues
Authors: Ostman Rae , Zirulnik Michael L. , McCullough Cosgrove Jenny 
Published: April 2019

AbstractThe Science & Religion project explored the relationship of science and religion through creative nonfiction stories and public programs. The overarching goal of this work was to investigate whether and how museums can encourage reflection and conversation around big, important, and difficult questions. In this paper, we contextualize the project in the movement to address societal issues in museums, describe some of the design and delivery strategies we used to create public programs that were inclusive of diverse points of view, report the programs’ impact on participants, and offer lessons learned for museum practitioners interested in similar programmatic approaches or topics. We also reflect on our own attitudes and preconceptions as museum educators, considering why we felt this was a controversial topic and why we were surprised to discover that audiences were so receptive to it.
Weight loss induced by deep transcranial magnetic stimulation in obesity: A randomized, double‐blind, sham‐controlled study
Authors: Ferrulli Anna , Macrì Concetta , Terruzzi Ileana , Massarini Stefano , Ambrogi Federico , Adamo Michela , Milani Valentina , Luzi Livio 
Published: April 2019

AbstractAimTo test the hypothesis that deep transcranial magnetic stimulation (dTMS) reduces food craving and causes weight loss via neuromodulation.Materials and methodsThis pilot study was designed as a randomized, double‐blind, sham‐controlled study. A total of 33 obese people (nine men, 24 women, mean age 48.1 ± 10.6 years, body mass index [BMI] 36.9 ± 4.7 kg/m2) were randomized and completed the study: 13 participants underwent a 5‐week treatment with high‐frequency (HF) dTMS (18 Hz; HF group), 10 were treated with low‐frequency (LF) dTMS (1 Hz; LF group), and 10 were sham‐treated (sham group). Food craving, and metabolic and neuro‐endocrine variables were evaluated at baseline, after the 5‐week treatment, and at follow‐up visits (1 month, 6 months, 1 year after the end of treatment).ResultsThe mixed‐model analysis for repeated measures showed a significant interaction of time and groups for body weight (P = 0.001) and BMI (P = 0.001), with a significant body weight (−7.83 ± 2.28 kg; P = 0.0009) and BMI (−2.83 ± 0.83, P = 0.0009) decrease in the HF versus the sham group. A decreasing trend in food craving in the HF versus the LF and sham groups (P = 0.073) was observed. A significant improvement of metabolic and physical activity variables was found (P < 0.05) in the HF group.ConclusionsWe demonstrated the safety and efficacy of dTMS, in addition to physical exercise and a hypocaloric diet, in reducing body weight for up to 1 year in obese people. We hypothesize that a possible mechanism of HF dTMS treatment is modulation of the dopaminergic pathway and stimulation of physical activity.
Predicting and reducing “hospital‐acquired infections” using a knowledge‐based e‐surveillance system
Authors: Noaman Amin Y. , Ragab Abdul Hamid M. , Al‐Abdullah Nabeela , Jamjoom Arwa , Nadeem Farrukh , Ali Anser G. 
Published: April 2019

AbstractThe use of automated computer methods when detecting hospital‐acquired infections (HAIs) enhances the validity of the surveillance in an effective manner. This is because manual infection control systems used by hospitals are time consuming and are often restricted to intensive care units. This paper proposes a new knowledge‐based electronic surveillance system to predict and reduce HAIs. The system can gather patient‐associated data from hospital databanks to automatically predict patient injury based on the standard central line‐associated bloodstream infection algorithm for HAI detection rules. The application of the proposed electronic system reduces the number of central lines associated with infection of the bloodstream and reduces the length of stay for patient treatment and thus reduces costs. The proposed system has several advantages: (a) It is a web‐based system that collects actual data from patients from several IT sources, which will help collect patient data safely and quickly, thereby predicting HAIs effectively. (b) It has an integrated simulator to generate patient records, providing the ability to train medical personnel and nurses to enhance their skills. (c) It is a multimedia‐based system to improve patient health reporting. (d) It assists policymakers in reviewing and approving control plans and policies to reduce and prevent hospital injuries. (e) The investigational results of the system showed an enhancement value equal to 87%.