bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Challenge in Governance: A Case of Higher Education in Pakistan
Authors: Butt Arif Nazir , Hemani Shezeen Salim 
Published: August 2019

This case documents the governance challenges faced by Namal’s Board of Governors. Namal College (Namal) was the brainchild and dream project of Imran Khan—world-renowned cricketer, philanthropist and one of the most popular politicians of Pakistan. This case narrates the journey of Namal College from its inception in 2002 until August 2014. At this juncture, Abdul Razak Dawood (ARD), the Vice Chairman of Namal’s Board, contemplated the challenges that Namal faced and the role the Board and its members could play in taking the college closer to its vision. From its humble beginnings as a technical training and diploma-awarding institute, Namal managed to achieve several milestones in one decade of its existence. One of the most notable achievement was the acquisition of a 1,000-acre land. ARD, a graduate from Columbia University, a leading industrialist and the founder of one of Pakistan’s largest engineering company, Descon Engineering, wondered what would it take to create a high-powered and effective Board? ARD was concerned about addressing Namal’s challenges, which included governance, management, funding, academics and construction issues. The question was what role could the Board play in doing so? More explicitly, what role could each Board member play? Was there a possibility of creating committees within the Board to ensure efficient functioning and accountability? In sum, the case revolves around critical governance issues that needed to be addressed to ensure Namal’s sustainability and growth.
Development and preliminary results of an Electronic Medical Record (EMR)-integrated smartphone telemedicine program to deliver asthma care remotely
Authors: Mammen Jennifer R , Java James J , Halterman Jill , Berliant Marc N , Crowley Amber , Frey Sean M , Reznik Marina , Feldman Jonathan M , Schoonmaker Judith D , Arcoleo Kimberly 
Published: August 2019

Introduction Technology-based interventions that can function within real-world practice and improve outcomes without increasing provider burden are needed, yet few successfully cross the research-to-practice divide. This paper describes the process of developing a clinically integrated smartphone-telemedicine program for adults with asthma and results from proof-of-concept testing. Methods We used a contextually grounded intervention development approach and May's implementation theory to design the intervention, with emphasis on systems capabilities and stakeholder needs. The intervention incorporated symptom monitoring by smartphone, smartphone telemedicine visits and self-management training with a nurse, and clinical decision-support software, which provided automated calculations of asthma severity, control and step-wise therapy. Seven adults (aged 18–40 y) engaged in a 3-month beta-test. Asthma outcomes (control, quality of life, FEV1) and healthcare utilisation patterns were measured at baseline and end-of-study. Results Each participant averaged four telemedicine visits (94% patient satisfaction). All participants had uncontrolled asthma at baseline; end-of-study 5/7 classified as well-controlled. Mean asthma control improved 1.55 points (CI = 0.59–2.51); quality of life improved 1.91 points (CI = 0.50–3.31), FEV1 percent predicted increased 14.86% (CI = −3.09–32.80): effect sizes of d = 1.16, 1.09, and 0.96, respectively. Preventive healthcare utilisation increased significantly (1.86 visits/year vs. 0.28/year prior, CI 0.67–2.47) as did prescriptions for controller medications (9.29 prescriptions/year vs. 1.57 prescriptions/year, CI 4.85–10.58). Discussion Smartphone telemedicine may be an effective means to improve outcomes and deliver asthma care remotely. However, careful attention to systems capabilities and stakeholder acceptability is needed to ensure successful integration with practice. Clinical Trials registration #: NCT03648203
Finally, Nebraska: A Synthetic Control Analysis of Legislative Structure
Authors: Hankins William B. 
Published: August 2019

AbstractI estimate the impact of Nebraska's 1937 switch from a bicameral to a unicameral legislature on state-level government expenditures. Using the synthetic control method I create a counterfactual Nebraska from a weighted average of other potential control states and compare spending in this “synthetic Nebraska” to spending in the real Nebraska. Relative to the synthetic control, Nebraska experiences a sharp decrease in expenditures per capita immediately following the switch to a unicameral legislature; however, the difference appears to diminish over time. Placebo tests show that if the change in Nebraska's legislative structure were randomly assigned among the sample of states, and legislative structure had no real impact on spending, the likelihood of obtaining a treatment-effect estimate as large as Nebraska's would be 0.0213. While the initial drop in expenditures per capita lends support to the theory that bicameralism, by requiring more veto players, is associated with higher levels of government spending, the fact that the difference between Nebraska and synthetic Nebraska diminishes suggests that legislators are able to circumvent this constraint.
Patient Input for Design of a Decision Support Smartphone Application for Type 1 Diabetes
Authors: Wilson Leah M. , Tyler Nichole , Jacobs Peter G. , Gabo Virginia , Senf Brian , Reddy Ravi , Castle Jessica R. 
Published: August 2019

Background: Decision support smartphone applications integrated with continuous glucose monitors may improve glycemic control in type 1 diabetes (T1D). We conducted a survey to understand trends and needs of potential users to inform the design of decision support technology. Methods: A 70-question survey was distributed October 2017 through May 2018 to adults aged 18-80 with T1D from a specialty clinic and T1D Exchange online health community ( myglu.org ). The survey responses were used to evaluate potential features of a diabetes decision support tool by Likert scale and open responses. Results: There were 1542 responses (mean age 46.1 years [SD 15.2], mean duration of diabetes 26.5 years [SD 15.8]). The majority (84.2%) have never used an app to manage diabetes; however, a large majority (77.8%) expressed interest in using a decision support app. The ability to predict and avoid hypoglycemia was the most important feature identified by a majority of the respondents, with 91% of respondents indicating the highest level of interest in these features. The task that respondents find most difficult was management of glucose during exercise (only 47% of participants were confident in glucose management during exercise). The respondents also highly desired features that help manage glucose during exercise (85% of respondents were interested). The responses identified integration and interoperability with peripheral devices/apps and customization of alerts as important. Responses from participants were generally consistent across stratified categories. Conclusions: These results provide valuable insight into patient needs in decision support applications for management of T1D.
The Impact of Externally Worn Diabetes Technology on Sexual Behavior and Activity, Body Image, and Anxiety in Type 1 Diabetes
Authors: Robertson Courtney , Lin Ashleigh , Smith Grant , Yeung Anna , Strauss Penelope , Nicholas Jennifer , Davis Elizabeth , Jones Tim , Gibson Lisa , Richters Juliet , Bock Martin de 
Published: August 2019

Background: We aimed to explore the impact of externally worn diabetes technologies on sexual behavior and activity, body image, and anxiety in adopters and nonadopters of these devices. Methods: People with type 1 diabetes aged 16-60 years living in Western Australia were invited to complete an online survey. Results: Of the 289 respondents (mean age 34.3 years), 45% used continuous subcutaneous insulin infusion (CSII) and 35% used continuous glucose monitoring (CGM). Approximately half of CSII users stated that the pump interferes with sex. Of these, 75% disconnect their pump during sexual activity to avoid this issue. Comfort during sex influenced the location of the CSII insertion site in 22% of respondents, with the abdomen being preferred. One in four non-CSII users cited sex-related concerns as a factor for not adopting the technology. CGM interfered with sexual activity in 20% of users, but did not commonly affect CGM placement (only 18%). Sexual activity was reported as a factor for not adopting the technology in 10% of non-CGM users. No differences in body dissatisfaction ( P = .514) or anxiety ( P = .304) between CSII and non-CSII users were observed. No differences in sexual activity and behavior between technology users and nontechnology users were observed. Conclusion: Wearable technologies impact upon sexual activity and this influences the decision to adopt the technology. Despite this, technology users are similar in terms of sexual behavior, anxiety, and body image compared to nontechnology users. Where appropriate, these data can be used to identify potential concerns, address strategies to mitigate them, and inform people with diabetes when considering adopting external technologies.
The Effects of Halofuginone on Wound Healing in the Rat Nasal Mucosa
Authors: Ceylan Seyit Mehmet , Uysal Erdal , Sokucu Mehmet , Sezgin Efe , Kanmaz Mahmut Alper , Yurtseven Duygu Gok , Bilal Nagihan 
Published: August 2019

Background Halofuginone is an alkaloid febrifugine analogue and bioactive molecule that was isolated incidentally from the Dichroa febrifuga plant. The therapeutic efficacy of halofuginone in parasitic infections, scleroderma, inflammation, and fibrosis-related diseases, as well as in some types of cancer, has been previously reported. The effects of halofuginone on nasal mucosal damage are not yet known. Objective The aim of this study was to investigate the potential effect of topically applied halofuginone on wound healing in the mechanically injured nasal mucosa of rats. Methods A unilateral mucosal wound was created in the nasal cavity of 32 rats (aged 4 weeks) using the brushing technique. These rats were randomly divided into 4 groups. Although the control group did not receive an intervention, a dry pad, a saline-impregnated pad, or a pad impregnated with halofuginone were placed in the rats of the other 3 groups and left for 5 minutes. Rats were sacrificed on the 14th day, and a histological examination was performed. The nasal mucosa was assessed via hematoxylin-eosin and Masson’s trichrome staining. Results There were no statistically significant differences in epithelial thickness, inflammation, goblet cell formation, and epithelial disarray values between the halofuginone group and the control group ( P > .05). The subepithelial thickness was significantly decreased in the saline-treated group and the halofuginone-treated group ( P < .05), but a significantly lower level of subepithelial fibrosis was only observed in the halofuginone group compared to the other groups ( P < .05). Conclusions Topical halofuginone administration reduces the development of fibrosis and subepithelial edema after experimentally induced nasal mucosal injury, but it does not exert therapeutic or preventive effects on epithelial damage, inflammation, and goblet cell hyperplasia.
Time-Loss Injuries in Karate: A Prospective Cohort Study of 4 Consecutive World Karate Championships
Authors: Augustovičová Dušana , Lystad Reidar P. , Arriaza Rafael 
Published: August 2019

Background: Prospective studies on injuries in martial arts competitions are scarce, especially those involving time-loss injuries. The upsurge of karate athletes competing in top-level karate competitions warrants elucidation of the time-loss injury risk. Purpose: To determine the time-loss injury proportion and incidence rate, describe the injury pattern among elite senior karate athletes, and compare the risk of time-loss injuries in male versus female athletes and in individual (ie, weight categories) versus team competitions (free-weight category). Study Design: Descriptive epidemiology study. Methods: Data were collected at 4 consecutive World Karate Championships (2010, 2012, 2014, and 2016). Injury incidence rates were calculated per 1000 athlete-exposures (IIRAE) and per 1000 minutes of exposure (IIRME), with 95% CIs. Subgroups were compared by calculating their rate ratios with 95% CIs. Results: A total of 506 injuries were recorded, of which 51 were time-loss injuries (10%). The overall time-loss injury rate was significantly lower for female versus male athletes and slightly lower for team versus individual competitions. Overall, 1.4% of all athletes sustained a time-loss injury, and the IIRAE and IIRME were 5.13 (95% CI, 3.82-6.74) and 1.98 (95% CI, 1.47-2.60), respectively. The most common type of time-loss injury was fracture (41%), followed by dislocation (20%) and concussion (12%). Conclusion: The time-loss injury incidence rate for top-level karate competitions found in this prospective study was relatively low. Comprehensive knowledge about the incidence of time-loss injuries during karate competitions represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of a uniform injury surveillance system in martial arts is of utmost importance.
Automatic glioma segmentation based on adaptive superpixel
Authors: Wu Yaping , Zhao Zhe , Wu Weiguo , Lin Yusong , Wang Meiyun 
Published: August 2019

Abstract

Background
The automatic glioma segmentation is of great significance for clinical practice. This study aims to propose an automatic method based on superpixel for glioma segmentation from the T2 weighted Magnetic Resonance Imaging.

Methods
The proposed method mainly includes three steps. First, we propose an adaptive superpixel generation algorithm based on simple linear iterative clustering version with 0 parameter (ASLIC0). This algorithm can acquire a superpixel image with fewer superpixels and better fit the boundary of region of interest (ROI) by automatically selecting the optimal number of superpixels. Second, we compose a training set by calculating the statistical, texture, curvature and fractal features for each superpixel. Third, Support Vector Machine (SVM) is used to train classification model based on the features of the second step.

Results
The experimental results on Multimodal Brain Tumor Image Segmentation Benchmark 2017 (BraTS2017) show that the proposed method has good segmentation performance. The average Dice, Hausdorff distance, sensitivity, and specificity for the segmented tumor against the ground truth are 0.8492, 3.4697 pixels, 81.47, and 99.64%, respectively. The proposed method shows good stability on high- and low-grade glioma samples. Comparative experimental results show that the proposed method has superior performance.

Conclusions
This provides a close match to expert delineation across all grades of glioma, leading to a fast and reproducible method of glioma segmentation.
30-days effects of vildagliptin on vascular function, plasma viscosity, inflammation, oxidative stress, and intestinal peptides on drug-naïve women with diabetes and obesity: a randomized head-to-head metformin-controlled study
Authors: Schiapaccassa Alessandra , Maranhão Priscila A. , de Souza Maria das Graças Coelho , Panazzolo Diogo G. , Nogueira Neto José Firmino , Bouskela Eliete , Kraemer-Aguiar Luiz Guilherme 
Published: August 2019

Abstract
Background
Obesity is the main risk factor for diabetes and excessive visceral fat triggers low-grade inflammatory process, mediated by activation and release of cytokines and high flow of free fatty acids that contribute to insulin resistance, increased oxidative stress, and impaired endothelial function. Metformin and vildagliptin have known vasculoprotective actions, but the value of these drugs on drug-naïve diabetic patients during 30 days use warrants investigation. Our purpose was to observe their effects on endothelial function, oxidative stress, inflammatory biomarkers, and plasma viscosity.

Methods
38 women with obesity and type 2 diabetes drug-naïve, aged between 19 and 50 years, BMI ≥ 30 kg/m2, were recruited and subjected to measurements of endothelial function, nutritive skin microvascular reactivity, plasma viscosity, inflammatory and oxidative stress biomarkers at baseline and randomized 1:1 to ingest metformin (850 mg twice/day) or vildagliptin (50 mg twice/day) during 30 days, and then, re-evaluated.

Results
No differences between groups were noticed at baseline. After treatment, vildagliptin promoted an improvement on endothelial-dependent and -independent vasodilatations, at arteriole level, while metformin resulted in improved nutritive microvascular reactivity, at the capillary level. Intragroup analysis showed that vildagliptin reduced insulin, C-peptide and oxidized LDL, and increased adiponectin and glucagon-like peptide-1 while metformin reduced weight, plasma glucose, total cholesterol, HDL-c, LDL-c, and dipeptidyl peptidase-4 activity, with an unexpected increase on tumor necrosis factor-α. No significant difference in plasma viscosity was noted.

Conclusions
In the vascular beds investigated, both drugs used for only 30 days improved endothelial function, through distinct, and possibly, complementary mechanisms on drug-naïve diabetic women.
Trial Registration ClinicalTrials.gov: NCT01827280
Safety and Efficacy of T-DM1 Plus Neratinib in Patients With Metastatic HER2-Positive Breast Cancer: NSABP Foundation Trial FB-10
Authors: Abraham Jame , Montero Albert J. , Jankowitz Rachel C. , Salkeni Mohamad Adham , Beumer Jan H. , Kiesel Brian F. , Piette Fanny , Adamson Laura M. , Nagy Rebecca J. , Lanman Richard B. , Sperinde Jeff , Huang Weidong , Allegra Carmen J. , Srinivasan Ashok , Wang Ying , Pogue-Geile Katherine L. , Lucas Peter C. , Jacobs Samuel A. 
Published: August 2019

PURPOSE Patients with human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer eventually develop resistance to dual-antibody therapy with trastuzumab plus pertuzumab. Mechanisms of resistance have not been well elucidated. We evaluated the safety, tolerability, and efficacy of ado-trastuzumab emtansine (T-DM1) plus neratinib in patients who progressed on trastuzumab plus pertuzumab. PATIENTS AND METHODS In this 3 + 3 dose-escalation study, patients with metastatic breast cancer who progressed on trastuzumab, pertuzumab, and a taxane were treated with T-DM1 at 3.6 mg/kg intravenously every 3 weeks and dose-escalating neratinib at 120, 160, 200, or 240 mg/d orally. RESULTS Twenty-seven patients were treated across four dose-levels of neratinib. Dose-limiting toxicity in cycle 1 was grade 3 diarrhea in six patients and grade 3 nausea in one; no patient experienced grade 4 diarrhea, and there were no grade 5 toxicities. Other grade 3 to 4 toxicities included nausea (11%), dehydration (11%), electrolyte abnormality (19%), thrombocytopenia (15%), elevated transaminase levels (7%), and fatigue (7%). Twelve (63%) of 19 evaluable patients had an objective response. Responses occurred at all neratinib doses. Plasma cell–free DNA at baseline showed ERBB2 (HER2) amplification in 10 of 27 patients. Deep and more durable responses occurred in patients with cell-free DNA ERBB2 amplification. Two complete responders had high expression of total HER2 and p95HER2 in baseline tissue. CONCLUSION We report the recommended phase II dose of T-DM1 3.6 mg/kg and neratinib 160 mg/d for this combination. Possible resistance mechanisms to HER2 antibodies may be loss of the HER2 receptor and high expression of p95HER2. These data provide the basis for an ongoing phase II study to better define the activity of this regimen.
Computed Tomography–Based Biomarker Outcomes in a Prospective Trial of Preoperative FOLFIRINOX and Chemoradiation for Borderline Resectable Pancreatic Cancer
Authors: Koay Eugene J. , Katz Matthew H.G. , Wang Huamin , Wang Xuemei , Prakash Laura , Javle Milind , Shroff Rachna , Fogelman David , Avila Santiago , Zaid Mohamed , Elganainy Dalia , Lee Yeonju , Crane Christopher H. , Krishnan Sunil , Das Prajnan , Fleming Jason B. , Lee Jeffrey E. , Tamm Eric P. , Bhosale Priya , Lee Jeffrey H. , Weston Brian , Maitra Anirban , Wolff Robert A. , Varadhachary Gauri R. 
Published: August 2019

PURPOSE Effective preoperative regimens and biomarkers for pancreatic ductal adenocarcinoma (PDAC) are lacking. We prospectively evaluated fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX)-based treatment and imaging-based biomarkers for borderline resectable PDAC. METHODS Eligible patients had treatment-naïve, histology-confirmed PDAC and one or more high-risk features: mesenteric vessel involvement, CA 19-9 level of 500 mg/dL or greater, and indeterminate metastatic lesions. Patients received modified FOLFIRINOX and chemoradiation before anticipated pancreatectomy. Tumors were classified on baseline computed tomography as high delta (well-defined interface with parenchyma) or low delta (ill-defined interface). We designated computed tomography interface response after therapy as type I (remained or became well defined) or type II (became ill defined). The study had 80% power to differentiate a 60% from 40% resection rate (α = .10). Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and subgroups were compared using log-rank tests. RESULTS Thirty-three patients initiated therapy; 45% underwent pancreatectomy. The median OS was 24 months (95% CI, 16.2 to 29.6 months). For patients who did and did not undergo pancreatectomy, the median OS was 42 months (95% CI, 17.7 months to not estimable) and 14 months (95% CI, 9.0 to 24.8 months), respectively. Patients with high-delta tumors had lower 3-year PFS (4% v 40%) and 3-year OS rates (20% v 60%) than those with low-delta tumors (both P < .05). Patients with type II interface responses had lower 3-year PFS (0% v 29%) and 3-year OS rates (16% v 47%) than those with type I responses (both P < .001). CONCLUSION Preoperative FOLFIRINOX followed by chemoradiation for high-risk borderline resectable PDAC was associated with a resection rate of 45% and median OS of approximately 2 years. Our imaging-based biomarker validation indicates that personalized treatment may be achieved using these biomarkers at baseline and post-treatment.
Ground reaction forces of overground galloping in ridden Thoroughbred racehorses
Authors: Self Davies Zoe T. , Spence Andrew J. , Wilson Alan M. 
Published: August 2019

ABSTRACTThe horse has evolved to gallop economically at high speed. Limb force increases with speed but direct measures of limb ground reaction forces (GRFs) at gallop are sparse. This study reports GRFs for multiple limbs, using force plates, across seven Thoroughbred racehorses during ridden galloping. The results show peak vertical GRF values of 13.6 N kg−1 (non-lead hindlimb), 12.3 N kg−1 (lead hindlimb), 14.0 N kg−1 (non-lead forelimb) and 13.6 N kg−1 (lead forelimb) at 11.4 m s−1 and recorded values are consistent with those predicted from duty factor. The distribution of body weight between the forelimbs and hindlimbs is approximated to 50:50, and is variable with speed, unlike the 60:40 commonly stated for cursorial quadrupeds in the literature. An even distribution of load on all limbs may help minimise accumulation of fatigue and assist in injury avoidance. Cranio-caudal force data concur with the observation that horses apply a net accelerative impulse with the hindlimbs and a net decelerative impulse with the forelimbs. Capturing GRFs enhances our knowledge on the mechanics of galloping in fast-moving species and provides insight into injury risk and factors limiting athletic performance.