bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Participation of Local Community Members in Schools Managerial Activities and Decisions Making: A Case of Community Secondary Schools in Coast and Kagera Regions, Tanzania
Authors: Ngonge Rweyendera Gosbert 
Published: November 2024

This paper explores the participation of local community members in the managerial activities and decision-making processes of community secondary schools in the Coast and Kagera regions of Tanzania. The study objective was to explore the decisions and managerial activities of the school in which local community members were meaningfully involved. Despite the critical role that community involvement plays in enhancing educational outcomes, there is scanty information about the nature of school managerial activities and decision-making the communities are involved in. Through a qualitative approach and case study design data was collected using interviews, and triangulated from school board members, councilors, school heads, village/street leaders, community members, and education officials. The findings reveal that while community members are recognized as key stakeholders, their involvement in decision-making is often limited to passive roles, with real authority concentrated among school board members and heads of schools. External factors such as government policies which do not provide clear guidance and specify mechanisms through which community members can collaborate with the administration of the ward secondary schools hinder effective participation. Thus, this study advocates for collaborative measures between the government and communities to empower both communities and school management, enabling meaningful participation in school governance.
Patient and Rheumatologist Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis
Authors: Owensby Justin K. , Chen Lang , O'Beirne Ronan , Ruderman Eric M. , Harrold Leslie R. , Melnick Joshua A. , Safford Monika M. , Curtis Jeffrey R. , Danila Maria I. 
Published: April 2019

ObjectiveTo identify and prioritize patient‐ and rheumatologist‐perceived barriers to achieving disease control.MethodsPatients with rheumatoid arthritis (RA) and rheumatologists from the Corrona registry were invited by e‐mail to participate in nominal groups. Two separate lists of barriers were created, 1 from RA patient–only nominal groups and the other from rheumatologist‐only nominal groups, and barriers were sorted into themes. Next, using an online survey, a random sample of RA patients from the Corrona registry were asked to rank their top 3 barriers to achieving disease control.ResultsFour nominal groups totaling 37 RA patients identified patient barriers to achieving control of RA activity that were classified into 17 themes. Three nominal groups totaling 25 rheumatologists identified barriers that were classified into 11 themes. The financial aspects of RA care ranked first for both types of nominal groups, while medication risk aversion ranked second among the perceived barriers of the physician nominal group and third among those of the RA patient nominal group. Among the 450 RA patients surveyed, 77% considered RA a top health priority, and 51% reported being aware of the treat‐to‐target strategy for RA care; the 3 most important patient‐perceived challenges to achieving disease control were RA prognosis uncertainty, medication risk aversion, and the financial/administrative burden associated with RA care.ConclusionThere are common, potentially modifiable, patient‐ and rheumatologist‐reported barriers to achieving RA disease control, including perceived medication risk aversion, suboptimal treatment adherence, and suboptimal patient–physician communication regarding the benefits of tight control of disease activity in RA. Addressing these obstacles may improve adherence to goal‐directed RA care.
Clinical and Molecular Phenotyping in Scleromyxedema Pretreatment and Posttreatment With Intravenous Immunoglobulin
Authors: Mecoli Christopher A. , Talbot C. Conover , Fava Andrea , Cheadle Christopher , Boin Francesco , Wigley Fredrick M. , Hummers Laura K. 
Published: April 2019

ObjectiveScleromyxedema (SMX) is a rare systemic sclerosis mimic that often responds to intravenous immunoglobulin (IVIG) therapy, yet the resulting clinical and biochemical changes have not been well characterized. To better understand the pathogenesis of the disease and the efficacy of IVIG, we sought to explore whether IVIG would introduce a measurable biologic effect corresponding with clinical improvement.MethodsFifteen patients with SMX were recruited for the study. Clinical information and peripheral blood mononuclear cells for flow cytometry were obtained immediately before and again 1–2 weeks after patients received IVIG therapy. Ten patients also underwent skin biopsies for gene expression analysis both before and after IVIG therapy. Clinical data included measures of skin involvement (modification of the modified Rodnan skin thickness score [MMRSS] and percentage of body surface area) and several patient‐reported outcome measures assessing patients’ skin.ResultsPosttreatment, the average MMRSS score decreased from mean ± SD 13.6 ± 2.6 to 10.3 ± 1.9; P = 0.003. There were also significant improvements in skin flexibility (mean ± SD 5.4 ± 0.8 to 3.2 ± 0.7; P = 0.003) and softening (mean ± SD 4.9 ± 0.9 to 2.6 ± 0.6; P = 0.022). Baseline levels of Tc17 cells (CD8+CCR6+CXCR3+CCR4–) correlated with the extent of skin involvement as measured by MMRSS pretreatment (r = 0.69, P = 0.012) and decreased after IVIG therapy (mean ± SD 3.4% ± 3.2% to 1.3% ± 1.7%; P = 0.008). Posttreatment analysis of RNA in skin tissue revealed a decrease in gene expression of transforming growth factor β (TGFβ) cytokines as well as several interferon‐inducible proteins.ConclusionThis open‐label study further supports the evidence that patients with SMX respond both objectively and subjectively to IVIG therapy. Biologic studies suggest a role for T lymphocytes in the pathogenesis of the disease and reveal the potential significance of TGFβ and interferon pathways.
“…Not Having the Real Support That We Need”: Patients’ Experiences With Ambiguity of Systemic Lupus Erythematosus and Erosion of Social Support
Authors: Leung Jerik , Ra Jennifer , Baker Elizabeth A. , Kim Alfred H. J. 
Published: April 2019

ObjectiveThe patient‐specific experience of living with systemic lupus erythematosus (SLE) is underreported, particularly when studying factors associated with health‐related quality of life (HRQOL). Recent work has suggested that biomedical interventions are only partially predictive of HRQOL measures. A qualitative analysis of patient‐specific experiences can uncover additional root causes of impaired HRQOL in populations with SLE beyond the scope of quantitative questionnaires.MethodsConsented adult patients with SLE classified by the American College of Rheumatology or Systemic Lupus International Collaborating Clinics were recruited. Ten semistructured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analyzed using an iterative process. Findings were presented to an interactive public forum with patients with SLE, family members and friends of patients, and health care professionals to assess accuracy.ResultsFour themes emerged from the interviews: 1) ambiguity, inconsistency, and lack of symptom predictability due to SLE disease courses; 2) poor communication with family, friends, and/or partners and poor bidirectional communication between health care providers and patients (informational support); 3) lack of validation for patients’ experiences (appraisal support); and 4) problematic aspects of social support, including negative support and patients’ inability to reciprocate support because of role changes. Data also indicate a reciprocal association between appraisal and informational sources of support.ConclusionFindings indicate that inadequate appraisal and informational support from informal and formal sources are salient factors influencing HRQOL among patients with SLE. Findings also point to the necessity of integrating community organizations, physicians, and friends and family of patients with SLE into capacity‐building interventions aimed at enhancing these sources of social support.
Characterization of a Subset of Patients With Rheumatoid Arthritis for Whom Current Management Strategies are Inadequate
Authors: Bradford Claire M. , McDonnell Thomas , Raj Divya , Robinson George A. , Cole Andrew , Ramakrishnan Shashank , González‐Serrano Rosa , Mak Jasper , Eskiocak Yusuf Cem , Isenberg David A. , Ciurtin Coziana , Jury Elizabeth C. , Manson Jessica J. 
Published: April 2019

AbstractObjectiveA subset of patients with seropositive rheumatoid arthritis (RA) do not mount a C‐reactive protein (CRP) response during flares. We hypothesize that these patients are more likely to experience poor clinical care and less likely to respond to traditional therapy. This study questioned whether this presentation was associated with worse disease outcome and distinct immunological features.MethodsUsing Power Doppler ultrasound, 48 RA patients with active synovitis were recruited; 30 had normal (n)CRP (5 mg/L or less) and 18 had high (h)CRP (more than 5 mg/L) levels. All had equivalent disease burden assessed by other clinical and laboratory parameters.ResultsTime to diagnosis and time to first disease‐modifying antirheumatic drug were significantly longer in nCRP compared with hCRP patients (P < 0.05). Significantly more nCRP patients needed escalation to biologics after 2‐year follow‐up (P = 0.01). The inflammatory milieu was also different between the two subgroups. Synergy between inflammatory cytokines observed in hCRP patients was lost in nCRP patients, and nCRP patients had significantly increased regulatory T‐cell (Treg) frequencies that correlated positively with predictors of poor disease outcome. Conversely, hCRP but not nCRP patients demonstrated a significant upregulation of alternative complement pathway factors that correlated negatively with Treg frequency.ConclusionPatients with nCRP during flares of RA had an altered immunological profile compared with hCRP patients and experienced diagnostic delays and responded less favorably to conventional treatment.
Robustness of linear time‐varying systems with relaxed excitation
Authors: Efimov Denis , Barabanov Nikita , Ortega Romeo 
Published: April 2019

SummaryIt is a well‐known fact that linear time‐varying systems with a persistently excited state matrix are exponentially converging and input‐to‐state stable with respect to additive perturbations. Recently, several relaxed conditions of persistent excitation have been presented, which ensure an asymptotic convergence rate in the system. In the present work, it is shown that these conditions are similar and that, under such a relaxed excitation, only nonuniform in time input‐to‐state stability and integral input‐to‐state stability properties can be obtained. The results are illustrated by simulations for a problem of estimation in the linear regression model.
Detection of extranodal and spleen involvement by FDG‐PET imaging predicts adverse survival in untreated follicular lymphoma
Authors: St‐Pierre Frédérique , Broski Stephen M. , LaPlant Betsy R. , Ristow Kay , Maurer Matthew J. , Macon William R. , Habermann Thomas M. , Ansell Stephen M. , Thompson Carrie A. , Micallef Ivana N. M. , Nowakowski Grzegorz S. , Witzig Thomas E. 
Published: April 2019

AbstractPredicting early clinical failure in patients with untreated follicular lymphoma (FL) is important but difficult. This study aimed to determine the incidence and patterns of extranodal (EN) and spleen disease using PET/CT, and assess their utility in predicting early clinical failure. PET/CT images from 613 cases of untreated FL (2003‐2016) were reviewed. The location and number of EN sites, patterns of bone involvement, and splenic involvement were recorded. Outcomes were assessed using event‐free survival (EFS), overall survival (OS), and early clinical failure at 24 months (EFS24). So, 49% (301/613) of patients had PET/CT‐detected EN involvement, and 28% (171/613) had spleen involvement. The presence of ≥2 EN sites, spleen, bone or soft tissue involvement all predicted failure to achieve EFS24. Presence of ≥2 EN sites and bone involvement pattern were also predictive of OS in a univariate analysis. In a multivariate analysis with FLIPI‐2 factors, spleen involvement, pattern of bone involvement, and soft tissue involvement independently predicted a lower EFS (HR 1.49 (1.11‐2.00),P= .007; HR 1.71 (1.10‐2.65),P= .017; and HR 1.67 (1.06‐2.62),P= .026, respectively). When the multivariate analysis was performed using PRIMA‐PI factors (marrow and B2M), the number of EN sites was an independent prognostic factor for inferior OS (HR 2.28;P= .05). Baseline PET/CT identifies EN involvement in nearly half of patients with untreated FL. The presence of ≥2 EN sites, bone, soft tissue, or splenic involvement predicts early clinical failure. These results, when combined with other factors, may better identify high‐risk patients and guide therapy.
Tuning the In Vivo Transport of Anticancer Drugs Using Renal‐Clearable Gold Nanoparticles
Authors: Peng Chuanqi , Xu Jing , Yu Mengxiao , Ning Xuhui , Huang Yingyu , Du Bujie , Hernandez Elizabeth , Kapur Payal , Hsieh Jer‐Tsong , Zheng Jie 
Published: April 2019

AbstractPrecise control of in vivo transport of anticancer drugs in normal and cancerous tissues with engineered nanoparticles is key to the future success of cancer nanomedicines in clinics. This requires a fundamental understanding of how engineered nanoparticles impact the targeting‐clearance and permeation‐retention paradoxes in the anticancer‐drug delivery. Herein, we systematically investigated how renal‐clearable gold nanoparticles (AuNPs) affect the permeation, distribution, and retention of the anticancer drug doxorubicin in both cancerous and normal tissues. Renal‐clearable AuNPs retain the advantages of the free drug, including rapid tumor targeting and high tumor vascular permeability. The renal‐clearable AuNPs also accelerated body clearance of off‐target drug via renal elimination. These results clearly indicate that diverse in vivo transport behaviors of engineered nanoparticles can be used to reconcile long‐standing paradoxes in the anticancer drug delivery.
Stable, Wavelength‐Tunable Fluorescent Dyes in the NIR‐II Region for In Vivo High‐Contrast Bioimaging and Multiplexed Biosensing
Authors: Lei Zuhai , Sun Caixia , Pei Peng , Wang Shangfeng , Li Dandan , Zhang Xin , Zhang Fan 
Published: April 2019

AbstractSmall‐molecule organic fluorophores, spectrally active in the 900–1700 nm region, with tunable wavelength and sensing properties are sought‐after for in vivo optical imaging and biosensing. A panel of fluorescent dyes (CX) has been developed to meet this challenge. CX dyes exhibit the wavelength tunability of cyanine dyes and have a rigidified polymethine chain to guarantee their stability. They are chemo‐ and photo‐stable in an aqueous environment and have tunable optical properties with maximal absorbing/emitting wavelength at 1089/1140 nm. They show great potential in high‐contrast in vivo bioimaging and multicolor detection with negligible optical cross talk. Förster resonance energy transfer (FRET) between CX dyes was demonstrated in deep tissue, providing an approach for monitoring drug‐induced hepatotoxicity by detection of OONO−. This report presents a series of NIR‐II dyes with promising spectroscopic properties for high‐contrast bioimaging and multiplexed biosensing.
Molecular simulation of hydrodesulfurization of coal tar using Pd/ZSM‐5/γ‐Al2O3 catalyst
Authors: Chu Ruizhi , Wang Jian , Meng Xianliang , Yu Shi , Zhang Guifeng , Wang Minglei , Li Xiao , Wu Guoguang , Bai Lei 
Published: April 2019

AbstractIn this study, all‐atom model of Pd/ZSM‐5/γ‐Al2O3 was developed and validated by comparing the experimental results of nitrogen adsorption isotherm, pore structure parameters, and powder X‐ray diffraction to our simulation results. Coal tar was simulated using dibenzothiophene (DBT), and tetralin (THN) in our study, and the product of coal tar hydrodesulfurization was modeled by H2S and n‐hexane (Hex). The adsorption and diffusion of the DBT, THN, and Hex on Pd/ZSM‐5/γ‐Al2O3 were investigated, and the simulation results were verified by differential thermogravimetric and X‐ray photoelectron spectroscopy results. The results demonstrated that DBT and THN mainly adsorbed to mesopores, and part of THN could also adsorb to micropores. Note that the mesopores allow the reactions of DBT, THN, and Hex to take place as they have large enough size, and micropores limit those reactions as those model molecules hardly adsorbed to micropores. In addition the acidity of the carrier weakens the heat of adsorption of H2S, making it easier to diffuse out of the catalyst and protect the active site. And our simulation results also show that the diffusion coefficient of H2S was much higher than other chemicals. As a consequence, the multichannel design and the choice of acidic carrier improved the sulfur tolerance of the catalyst.
Long‐Term Outcome of Ustekinumab Therapy for Behçet's Disease
Authors: Mirouse Adrien , Barete Stéphane , Desbois Anne‐Claire , Comarmond Cloé , Sène Damien , Domont Fanny , Bodaghi Bahram , Ferfar Yasmina , Cacoub Patrice , Saadoun David ,   for the French Behçet's Network
Published: April 2019

ObjectiveOral ulcers, the hallmark lesion of Behçet's disease (BD), can be disabling and resistant to conventional treatment, and there is a need for safe and effective treatment. We undertook this study to investigate the long‐term safety and efficacy of ustekinumab therapy for BD‐related oral ulcers that are resistant to colchicine.MethodsThis multicenter, prospective, open‐label study included 30 patients who fulfilled the criteria of the International Study Group for BD and who were diagnosed as having active oral ulcers resistant to colchicine. Patients were treated subcutaneously with ustekinumab 90 mg at inclusion, at week 4, and then once every 12 weeks. Each patient was assessed longitudinally for the presence and number of oral ulcers, and median numbers of oral ulcers (with interquartile range [IQR]) were calculated. The primary efficacy end point was the proportion of patients at week 12 who experienced complete response, defined as having no oral ulcers.ResultsThe median number of oral ulcers per patient during ustekinumab therapy was significantly lower at week 12 compared to baseline (0 [IQR 0–1] versus 2 [IQR 2–3]; P < 0.0001). Complete response was achieved in 60.0% and 88.9% of patients at weeks 12 and 24, respectively. The median Behçet's Syndrome Activity Score (in which higher scores indicate more active disease) was significantly lower at weeks 12 and 24 (17.5 [IQR 10–42.5] and 10 [IQR 8–11], respectively) versus baseline (70 [IQR 50–70]; P < 0.0001). After a median follow‐up of 12 months (IQR 6–16 months), 26 patients (86.7%) were still receiving ustekinumab treatment. Reasons for ustekinumab discontinuation included BD flare (n = 3) and side effects (n = 1). Seven patients (23.3%) experienced adverse events, including headaches (n = 4) and asthenia (n = 2), with no serious side effects.ConclusionUstekinumab seems to be effective in treating BD‐related oral ulcers that are resistant to treatment with colchicine.
Identification of Novel Adenosine Deaminase 2 Gene Variants and Varied Clinical Phenotype in Pediatric Vasculitis
Authors: Gibson Kristen M. , Morishita Kimberly A. , Dancey Paul , Moorehead Paul , Drögemöller Britt , Han Xiaohua , Graham Jinko , Hancock Robert E. W. , Foell Dirk , Benseler Susanne , Luqmani Rashid , Yeung Rae S. M. , Shenoi Susan , Bohm Marek , Rosenberg Alan M. , Ross Colin J. , Cabral David A. , Brown Kelly L. ,   on behalf of the PedVas Investigators Network
Published: April 2019

ObjectiveIndividuals with deficiency of adenosine deaminase 2 (DADA2), a recently recognized autosomal recessive disease, present with various systemic vascular and inflammatory manifestations, often with young age at disease onset or with early onset of recurrent strokes. Their clinical features and histologic findings overlap with those of childhood‐onset polyarteritis nodosa (PAN), a primary “idiopathic” systemic vasculitis. Despite similar clinical presentation, individuals with DADA2 may respond better to biologic therapy than to traditional immunosuppression. The aim of this study was to screen an international registry of children with systemic primary vasculitis for variants in ADA2.MethodsThe coding exons of ADA2 were sequenced in 60 children and adolescents with a diagnosis of PAN, cutaneous PAN, or unclassifiable vasculitis (UCV), any chronic vasculitis with onset at age 5 years or younger, or history of stroke. The functional consequences of the identified variants were assessed by ADA2 enzyme assay and immunoblotting.ResultsNine children with DADA2 (5 with PAN, 3 with UCV, and 1 with antineutrophil cytoplasmic antibody–associated vasculitis) were identified. Among them, 1 patient had no rare variants in the coding region of ADA2 and 8 had biallelic, rare variants (minor allele frequency <0.01) with a known association with DADA2 (p.Gly47Arg and p.Gly47Ala) or a novel association (p.Arg9Trp, p.Leu351Gln, and p.Ala357Thr). The clinical phenotype varied widely.ConclusionThese findings support previous observations indicating that DADA2 has extensive genotypic and phenotypic variability. Thus, screening ADA2 among children with vasculitic rash, UCV, PAN, or unexplained, early‐onset central nervous system disease with systemic inflammation may enable an earlier diagnosis of DADA2.
Effect of flurbiprofen axetil on postoperative delirium for elderly patients
Authors: Wang Xifan , Wang Yu , Hu Yanan , Wang Liping , Zhao Wenshuai , Wei Lanying , Chen Hong , Han Fei 
Published: April 2019

AbstractObjectivesProinflammatory cytokines triggered by surgery and postoperative pain are major causes of postoperative delirium (POD). This study investigated the effects of flurbiprofen axetil on POD when used for postoperative analgesia after major noncardiac surgery in elderly patients.MethodsPatients over 65 years old were randomly divided into two groups: the sufentanil group (S group), in which 150 μg of sufentanil was used in the patient‐controlled analgesia (PCA) pump for 3 days; the sufentanil combined with flurbiprofen axetil group (SF group), in which 150 μg of sufentanil was combined with 300 mg of flurbiprofen axetil in the PCA pump for 3 days. The Confusion Assessment Method scale was used for POD evaluation. The pain intensity, side effects, and risk factors (age, gender, surgical position, and category of surgery) for POD were evaluated.ResultsUltimately, 140 patients were included. The overall incidence of POD was not significantly different between the S and SF groups. The incidence of POD was significantly lower in the SF group than in the S group among patients over 70 years (5.1% vs. 20.7%, p = 0.045, odds ratio = 0.146, 95% confidence interval = 0.020–1.041). The incidence of POD was no difference in patients classified by the category of surgery, surgical position, or gender between groups. Sufentanil and flurbiprofen axetil in the PCA pump was completely used within 72 hr. The pain intensity, consumed sufentanil dosage of the PCA, and the side effects was not different between groups.ConclusionsFlurbiprofen axetil might reduce POD in patients over 70 years undergoing major noncardiac surgery.