bluuebunny/crossref_metadata_2025 huggingface dataset:
Subjective and objective evaluation of frontal smile esthetics in patients with facial asymmetry—a comparative cross‐sectional study
Authors: Singh H. , Maurya R. K. , Kapoor P. , Sharma P. , Srivastava D.
Published: November 2016

Structured Abstract

Aim and Objectives

To analyze the relationship between subjective and objective evaluations of pre‐treatment posed smiles in patients with facial asymmetry and to assess the influence of dentofacial structures involved in asymmetry on the perception of smile attractiveness.

Sample

Thirty‐five patients (25 males and 10 females) between 18 and 25 years of age with facial asymmetry were selected.

Materials and Methods

Pre‐treatment clinical photographs of posed smiles were subjectively evaluated by a panel of 20 orthodontists, 20 oral surgeons, and 20 laypersons. A customized Smile Mesh program was used for objective evaluation of the same smiles. Direct comparison among three smile groups (unattractive, slightly attractive, and attractive) for different Smile Mesh measurements was carried out using two‐way anova test. Additionally, linear regression was performed to evaluate whether these measurements could predict the attractiveness of captured smiles.

Results

Patients with ‘slightly attractive’ smiles had a significantly greater distance between the incisal margin of the maxillary central incisor and the lower lip during smiling. The Smile Index was significantly greater in attractive smiles. However, based on the coefficients of linear regression, no objectively gathered measurement could predict smile attractiveness.

Conclusions

Attractiveness or unattractiveness of smiles in patients with facial asymmetry could not be predicted by any measurement of Smile Mesh. The presence of facial asymmetry did not significantly influence the perception of smile esthetics.
The wheat NB‐LRR gene TaRCR1 is required for host defence response to the necrotrophic fungal pathogen Rhizoctonia cerealis
Authors: Zhu Xiuliang , Lu Chungui , Du Lipu , Ye Xingguo , Liu Xin , Coules Anne , Zhang Zengyan
Published: November 2016

The necrotrophic fungus Rhizoctonia cerealis is the major pathogen causing sharp eyespot disease in wheat (Triticum aestivum). Nucleotide‐binding leucine‐rich repeat (NB‐LRR) proteins often mediate plant disease resistance to biotrophic pathogens. Little is known about the role of NB‐LRR genes involved in wheat response to R. cerealis. In this study, a wheat NB‐LRR gene, named TaRCR1, was identified in response to R. cerealis infection using Artificial Neural Network analysis based on comparative transcriptomics and its defence role was characterized. The transcriptional level of TaRCR1 was enhanced after R. cerealis inoculation and associated with the resistance level of wheat. TaRCR1 was located on wheat chromosome 3BS and encoded an NB‐LRR protein that was consisting of a coiled‐coil domain, an NB‐ARC domain and 13 imperfect leucine‐rich repeats. TaRCR1 was localized in both the cytoplasm and the nucleus. Silencing of TaRCR1 impaired wheat resistance to R. cerealis, whereas TaRCR1 overexpression significantly increased the resistance in transgenic wheat. TaRCR1 regulated certain reactive oxygen species (ROS)‐scavenging and production, and defence‐related genes, and peroxidase activity. Furthermore, H2O2 pretreatment for 12‐h elevated expression levels of TaRCR1 and the above defence‐related genes, whereas treatment with a peroxidase inhibitor for 12 h reduced the resistance of TaRCR1‐overexpressing transgenic plants and expression levels of these defence‐related genes. Taken together, TaRCR1 positively contributes to defence response to R. cerealis through maintaining ROS homoeostasis and regulating the expression of defence‐related genes.
Transgenic switchgrass (Panicum virgatum L.) targeted for reduced recalcitrance to bioconversion: a 2‐year comparative analysis of field‐grown lines modified for target gene or genetic element expression
Authors: Dumitrache Alexandru , Natzke Jace , Rodriguez Miguel , Yee Kelsey L. , Thompson Olivia A. , Poovaiah Charleson R. , Shen Hui , Mazarei Mitra , Baxter Holly L. , Fu Chunxiang , Wang Zeng‐Yu , Biswal Ajaya K. , Li Guifen , Srivastava Avinash C. , Tang Yuhong , Stewart Charles Neal , Dixon Richard A. , Nelson Richard S. , Mohnen Debra , Mielenz Jonathan , Brown Steven D. , Davison Brian H.
Published: November 2016

Transgenic Panicum virgatum L. silencing (KD) or overexpressing (OE) specific genes or a small RNA (GAUT4‐KD, miRNA156‐OE, MYB4‐OE, COMT‐KD and FPGS‐KD) was grown in the field and aerial tissue analysed for biofuel production traits. Clones representing independent transgenic lines were established and senesced tissue was sampled after year 1 and 2 growth cycles. Biomass was analysed for wall sugars, recalcitrance to enzymatic digestibility and biofuel production using separate hydrolysis and fermentation. No correlation was found between plant carbohydrate content and biofuel production pointing to overriding structural and compositional elements that influence recalcitrance. Biomass yields were greater for all lines in the second year as plants establish in the field and standard amounts of biomass analysed from each line had more glucan, xylan and less ethanol (g/g basis) in the second‐ versus the first‐year samples, pointing to a broad increase in tissue recalcitrance after regrowth from the perennial root. However, biomass from second‐year growth of transgenics targeted for wall modification, GAUT4‐KD, MYB4‐OE, COMT‐KD and FPGS‐KD, had increased carbohydrate and ethanol yields (up to 12% and 21%, respectively) compared with control samples. The parental plant lines were found to have a significant impact on recalcitrance which can be exploited in future strategies. This summarizes progress towards generating next‐generation bio‐feedstocks with improved properties for microbial and enzymatic deconstruction, while providing a comprehensive quantitative analysis for the bioconversion of multiple plant lines in five transgenic strategies.
Knowledge, Attitudes, and Practices for Respiratory and Hearing Health among Midwestern Farmers
Authors: Cramer Mary E. , Wendl Mary J. , Sayles Harlan , Duysen Ellen , Achutan Chandran
Published: November 2016

Objective

The purpose of this study was to assess knowledge, attitudes, and practices for hearing and respiratory health/safety among farmers in seven Midwestern states served by a federally funded Agricultural Center. Findings provided a baseline to longitudinally track the Agricultural Center's program outcomes and to design community education to improve safety and health among farmers.

Design and Sample

This was a cross‐sectional study using a 30 item mailed survey to describe farmers' operations, demographics, health conditions, related information sources, and knowledge/attitude/practices for personal protective equipment (PPE) (i.e., ear plugs/muffs and dust masks/respirators).

Measures

Frequencies and percentages were calculated for each item and according to responses from younger versus older farmers. The unit of study was farm operators (N = 280) randomly selected from a publicly available database of corn/soybean and hog farmers in seven Midwestern states.

Results

Findings revealed important knowledge gaps among respondents regarding (1) hazardous exposure sources; (2) long‐term health consequences of noise/dust exposure; (3) proper selection/fitting of PPE.

Conclusions

Public health nurses and primary care providers in rural communities should address specific knowledge gaps in order to enhance farmers' perceived understanding of their susceptibility to hazardous exposures. Increasing farmers' knowledge through preferred venues may help to improve PPE effectiveness.
Molecular and biological characterization of two potyviruses infecting lettuce in southeastern France
Authors: Desbiez C. , Schoeny A. , Maisonneuve B. , Berthier K. , Bornard I. , Chandeysson C. , Fabre F. , Girardot G. , Gognalons P. , Lecoq H. , Lot H. , Millot P. , Nozeran K. , Simon V. , Tepfer M. , Verdin E. , Wipf‐Scheibel C. , Moury B.
Published: November 2016

Several potyviruses affect lettuce (Lactuca sativa) and chicory (Cichorium spp.) crops worldwide and are important constraints for production because of the direct losses that they induce and/or because of their seed transmission. Here, the molecular and biological properties are described of two potyviruses that were recently isolated from lettuce plants showing mosaic or strong necrotic symptoms in an experimental field in southeastern France. The first potyvirus belongs to the species Endive necrotic mosaic virus and is present in a large number of wild plant species, especially Tragopogon pratensis. It is unable to infect lettuce cultivars with a resistance to Turnip mosaic virus that is present in many European cultivars and probably conferred by the Tu gene. The second potyvirus belongs to the tentative species lettuce Italian necrotic virus and was not observed in wild plants. It infected all tested lettuce cultivars. Wild accessions of Lactuca serriola, Lactuca saligna, Lactuca virosa and Lactuca perennis were identified as resistant to one or the other potyvirus and could be used for resistance breeding in lettuce. No resistance against these two potyviruses was observed in the tested Cichorium endivia cultivars. In contrast, all tested Cichorium intybus cultivars or accessions were resistant.
Developing and Testing an Integrative Framework for Open Government Adoption in Local Governments
Authors: Grimmelikhuijsen Stephan G. , Feeney Mary K.
Published: November 2016

Open government is an important innovation to foster trustworthy and inclusive governments. The authors develop and test an integrative theoretical framework drawing from theories on policy diffusion and innovation adoption. Based on this, they investigate how structural, cultural, and environmental variables explain three dimensions of open government: accessibility, transparency, and participation. The framework is tested by combining 2014 survey data and observational data from 500 local U.S. government websites. Organizational structure, including technological and organizational capacity, is a determinant shared by all dimensions of open government. Furthermore, accessibility is affected by a mixture of an innovative and participative culture and external pressures. A flexible and innovative culture positively relates to higher levels of transparency, whereas capacity is a strong predictor of adopting participatory features. The main conclusion is that there is no one‐size‐fits‐all solution to fostering the three dimensions of open government, as each dimension is subject to a unique combination of determinants.
The impact of cross‐breeding Egyptian and Italian buffalo on reproductive and productive performance under a subtropical environment
Authors: Nasr MAF
Published: November 2016

Contents

The aim of this study was to investigate the reproductive and productive performance of pure Egyptian (PE) buffaloes and their crosses with Italian buffaloes. In this study, 2969 dairy buffaloes were used (1599 PE; 615 F1 crosses, 50% PE and 50% Italian buffaloes; and 755 backcross [BC], 75% PE and 25% Italian buffaloes). When compared to PE, the BC and F1 had a significantly lower incidence of calving difficulty (odds ratio [OR] = 0.18, p < .0001 and .34, p < .0001, respectively) in conjunction with a lesser incidence of stillbirth (OR = 0.06, p < .0001 and 0.43, p < .0001, respectively). Backcross buffaloes were also noted to have a lower rate of not conceived after first insemination (OR = 0.74, p < .0001) in comparison with PE. The cross F1 buffaloes were superior in terms of productive traits, whereas PE buffaloes were best in most of the reproductive traits (days of non‐pregnant p = .001, service per conception p < .0001 and calf weight p = .01). Although the study results appeared to indicate towards a contrary association between milk production and reproductive traits, BC was similar to F1 in terms of production and similar to PE in terms of reproductive traits. Thus, the farmers should be encouraged to breed BC animals in their herds for enhancing milk yield to meet with the market demands.
Lesion heterogeneity and risk of infectious complications following peripheral endobronchial ultrasound
Authors: Fortin Marc , Taghizadeh Niloofar , Chee Alex , Hergott Christopher A. , Dumoulin Elaine , Tremblay Alain , MacEachern Paul
Published: November 2016

ABSTRACT

Background and objective

The reported incidence of peripheral endobronchial ultrasound (pEBUS)‐related infectious complications is below 1%, although studies have never focused solely on them or reported their risk factors. The goal of this study is to describe our local pEBUS infectious complication rate and characterize patient, lesion and procedural factors associated with infectious complications.

Methods

All charts, computed tomography scans and electronic records of patients who underwent a pEBUS at the Foothills Medical Center and South Health Campus Hospital in Calgary between 1 May 2014 and 1 October 2015 were reviewed.

Results

One hundred and ninety‐nine pEBUS procedures were included in our study. The local infectious complication rate was 4.0% (8/199). Two lesion characteristics were more frequent in patients who suffered infectious complications: larger lesion diameter (P = 0.016) and lesion heterogeneity on imaging suggestive of areas of necrosis (P < 0.001). In a multivariate analysis, only the presence of lesion heterogeneity was significantly associated with infectious complications (OR = 16.74 (2.95–95.08)). The rate of infectious complications in lesions with a heterogeneous appearance was 20.7% (6/29).

Conclusion

The rate of infectious complications after pEBUS is elevated when biopsying heterogeneous appearing lesions. This may not have previously been reported as studies of pEBUS focused on smaller and probably rarely necrotic lesions. Future studies of methods to prevent infections complications in pEBUS‐guided biopsies of heterogeneous appearing lesions are warranted.
Modelling Illegal Drug Participation
Authors: Brown Sarah , Harris Mark N. , Srivastava Preety , Zhang Xiaohui
Published: November 2016

We contribute to the small, but important, literature exploring the incidence and implications of misreporting in survey data. Specifically, when modelling ‘social bads’, such as illegal drug consumption, researchers are often faced with exceptionally low reported participation rates. We propose a modelling framework where firstly an individual decides whether to participate or not and, secondly, for participants there is a subsequent decision to misreport or not. We explore misreporting in the context of the consumption of a system of drugs and specify a multivariate inflated probit model. Compared with observed participation rates of 12.2%, 3.2% and 1.3% (for use of marijuana, speed and cocaine respectively) the true participation rates are estimated to be almost double for marijuana (23%), and more than double for speed (8%) and cocaine (5%). The estimated chances that a user would misreport their participation is a staggering 65% for a hard drug like cocaine, and still about 31% and 17%, for the softer drugs of marijuana and speed.
The Monterey Event within the Central Mediterranean area: The shallow‐water record
Authors: Brandano Marco , Cornacchia Irene , Raffi Isabella , Tomassetti Laura , Agostini Samuele
Published: November 2016

The middle Miocene is an important time to understand modern global climate evolution and its consequences on marine systems. The Mid‐Miocene Climatic Optimum (between 17·0 Ma and 13·5 Ma) was the warmest time interval of the past 35 million years during which atmospheric CO2 concentrations were lower than today. In the Mid‐Miocene Climatic Optimum, a significant carbon cycle perturbation occurred, expressed as a last long‐term positive carbon isotope shift, known in literature as the Monterey Carbon Isotope Excursion and recorded in open‐ocean settings. In this work, the lower to middle Miocene carbon isotope records from three different domains of the Central Mediterranean are analysed with the aim of identifying the local carbonate platform response to the major global carbon cycle perturbation of the Monterey Event. Carbon and oxygen isotope ratios have been measured on samples belonging to three different stratigraphic sections, two of them are representative of shallow‐water settings (Latium–Abruzzi and Apula platforms), and the latter of a hemipelagic setting (Umbria–Marche Basin). A well‐defined Monterey Carbon Isotope Excursion is recorded also in these shallow‐water sections. Despite their expected problematic stratigraphic constraints, a reliable age model is provided by calcareous nannofossil biostratigraphy and strontium isotope stratigraphy. In both of the carbonate platform successions examined, the Monterey Carbon Isotope Excursion coincides with a spread of bryozoans over other carbonate‐producing biota. The high productivity of the bryozoan‐dominated factory in the aphotic zone had an important control on the platform depositional profile. The high rates of sediment production in the deeper aphotic and oligophotic zones produced a depositional profile of a low‐angle ramp.
Thyrotropin Alters T Cell Development in the Thymus in Subclinical Hypothyroidism Mouse Model
Authors: Wu K. , Zhao M. , Ma C. , Zhang H. , Liu X. , Zhou L. , Zhao J. , Gao L. , Wang D.
Published: November 2016

Subclinical hypothyroidism (SCH) is highly prevalent in the general population and is associated with potential deleterious effects. Although developing T cells express thyroid‐stimulating hormone receptor (TSH‐R), the changes of T cell development in thymus in SCH have not been fully clarified. SCH mouse model, which is characterized by elevated serum TSH but similar thyroid hormone levels, was used to study the role of TSH in T cell development. Thymus weight of SCH mice increased 18% compared with controls. Importantly, the frequencies of CD4+ and CD8+ single‐positive (SP) thymocytes increased 38% and 44%, respectively. We demonstrated that TSH protected thymocytes from apoptosis as evidenced by a significant decrease of Annexin V‐positive thymocytes in SCH mice. Further analysis showed that extracellular‐regulated kinases (ERK) 1/2 in thymus were activated in SCH mice. With analysis of T cell receptor excision circles (TREC), we found that TSH increased recent thymic emigrants (RTE) in spleen tissue in SCH mice. Thus, these results suggest that TSH promoted T cell development and enhanced the thymic recent output in SCH mice, possibly by suppression of apoptosis of thymocytes, indicating that modification of the ERK signalling pathways.
Human Secretory IgM Antibodies Activate Human Complement and Offer Protection at Mucosal Surface
Authors: Michaelsen T. E. , Emilsen S. , Sandin R. H. , Granerud B. K. , Bratlie D. , Ihle O. , Sandlie I.
Published: November 2016

IgM molecules circulate in serum as large polymers, mainly pentamers, which can be transported by the poly‐Ig receptor (pIgR) across epithelial cells to mucosal surfaces and released as secretory IgM (SIgM). The mucosal SIgM molecules have non‐covalently attached secretory component (SC), which is the extracellular part of pIgR which is cleaved from the epithelial cell membrane. Serum IgM antibodies do not contain SC and have previously been shown to make a conformational change from ‘a star’ to a ‘staple’ conformation upon reaction with antigens on a cell surface, enabling them to activate complement. However, it is not clear whether SIgM similarly can induce complement activation. To clarify this issue, we constructed recombinant chimeric (mouse/human) IgM antibodies against hapten 5‐iodo‐4‐hydroxy‐3‐nitro‐phenacetyl (NIP) and in addition studied polyclonal IgM formed after immunization with a meningococcal group B vaccine. The monoclonal and polyclonal IgM molecules were purified by affinity chromatography on a column containing human SC in order to isolate joining‐chain (J‐chain) containing IgM, followed by addition of excess amounts of soluble SC to create SIgM (IgM J+ SC+). These SIgM preparations were tested for complement activation ability and shown to be nearly as active as the parental IgM J+ molecules. Thus, SIgM may offer protection against pathogens at mucosal surface by complement‐mediated cell lysis or by phagocytosis mediated by complement receptors present on effector cells on mucosa.
Effects of menthol application on the skin during prolonged immersion in swimmers and controls
Authors: Botonis P. G. , Geladas N. D. , Kounalakis S. N. , Cherouveim E. D. , Koskolou M. D.
Published: November 2016

We hypothesized that menthol application on the skin would enhance vasoconstriction of subjects immersed in cool water, which would reduce heat loss and rectal temperature (Tre) cooling rate. Furthermore, it was hypothesized that this effect would be greater in individuals acclimatized to immersion in 24 °C water, such as swimmers. Seven swimmers (SW) and seven physical education students (CON) cycled at 60% VO2 max until Tre attained 38 °C, and were then immediately immersed in stirred water maintained at 24 °C on two occasions: without (NM) and with (M; 4.6 g per 100 mL of water) whole‐body skin application of menthol cream. Heart rate, Tre, proximal–distal skin temperature gradient, oxygen uptake (VO2), electromyographic activity (EMG), and thermal sensation were measured. Tre reduction was similar among SW and CON in NM and CON in M (−0.71±0.31 °C in average), while it was smaller for SW in M (−0.37±0.18 °C, P < 0.01). VO2 and heart rate were greater in M compared with NM condition (P = 0.01). SW in M exhibited a shift of the threshold for shivering, as reflected in increased VO2 and EMG activity, toward a higher Tre compared with the other trials. Menthol application on the skin before immersion reduces heat loss, but defends Tre decline more effectively in swimmers than in non‐swimmers.
The Application of the Engineering Design Process to Curriculum Revision: A Collaborative Approach to STEM Curriculum Refinement in an Urban District
Authors: Parker Carolyn , Smith Erica L. , McKinney David , Laurier Amanda
Published: November 2016

This study describes how student unit assessment data helped support ongoing curriculum revisions in the Baltimore City School District. This project is situated in the STEM Achievement in Baltimore Elementary Schools (SABES) project, which is a National Science Foundation funded multi‐year Math Science Partnership between the Johns Hopkins University and the Baltimore City School District. The project focuses on improving STEM education in grades three through five. The study modeled the process of curriculum revision after the engineering design process. One of the units developed by the partnership was analyzed using this revision process. Areas of unit revision and modification were identified utilizing the analysis of pre‐ and post‐assessment data from the implementation of the unit. Constraints represented by standards, unit objectives, and student‐reading levels further informed the revision process. The process resulted in modifications to aspects of the unit and assessment. Findings from this work will help inform collaborative curriculum initiatives between institutions of higher education public school districts.
Role of African–Eurasian plate setting in the felt areas of intermediate‐depth earthquakes: an investigation using crowdsourced data
Authors: Sbarra Paola , Tosi Patrizia , De Rubeis Valerio
Published: November 2016

Greek intermediate‐depth earthquakes, occurring in the subducted plate of the Hellenic Arc, are felt at greater distances than expected, reaching Italy in some cases. We study in detail macroseismic intensity data from intermediate‐depth Italian and Greek earthquakes collected from Internet users who felt the shaking in Italy. The huge amount of data allowed us to outline the felt/not‐felt limit and to find a correspondence between attenuation areas and the presence of asthenospheric material at shallow depths. We show that plate boundaries, known to produce the majority of earthquakes, are, in some specific cases, the boundaries of areas in which earthquakes are felt. The Ionian subducted lithosphere propagates seismic waves with low attenuation over large distances, whereas high‐attenuation zones in Italy, linked to asthenospheric upwelling, limit the propagation, as evidenced also by PGA values. We identify a typical pattern that can be used to recognize intermediate‐depth earthquakes, and to properly locate historical events.
Strongyloides hyperinfection following hematopoietic stem cell transplant in a patient with HTLV‐1‐associated T‐cell leukemia
Authors: Alpern Jonathan D. , Arbefeville Sophie S. , Vercellotti Gregory , Ferrieri Patricia , Green Jaime S.
Published: November 2016

Strongyloides stercoralis has the potential to cause accelerated autoinfection in immunocompromised hosts. Screening tests for strongyloidiasis may be falsely negative in the setting of immunosuppression. We report a case of Strongyloides hyperinfection syndrome in a patient with human T‐lymphotropic virus type 1‐associated T‐cell leukemia early after hematopoietic stem cell transplant. The diagnosis was made by stool ova and parasite examination, despite a negative screening enzyme‐linked immunosorbent assay. Because of anticipated prolonged neutropenia, an extended course of treatment was utilized.
Recurrence of Plasmodium falciparum after treatment with quinine and doxycycline in the Amazon basin
Authors: Gomes Margarete do Socorro Mendonça , Vieira José Luiz Fernandes , Couto Álvaro Augusto Ribeiro D'Almeida , Couto Vanja Suely Calvosa D'Almeida , Vieira Michelle Valéria Dias Ferreira , Pereira Francis Christian da Silva , Machado Ricado Luiz Dantas
Published: November 2016

Objective

To investigate whether the recurrence of infection by Plasmodium falciparum in patients from the Brazilian Amazon was caused by an inadequate exposure to quinine.

Methods

A retrospective study was carried out using blood samples from patients with slide‐confirmed infection by P. falciparum, classified according to the parasitological response after 28 days of follow‐up. Quinine and doxycycline were measured in plasma samples by high‐performance liquid chromatography. A statistical model was used to estimate parasite clearance rates.

Results

Six of 40 patients who met the criteria for inclusion in the study showed recurrence of parasitaemia within 28 days after the commencement of treatment. A group of six patients with adequate parasitological response was formed to avoid bias when the variables were compared. Parasitaemia at admission was similar in both groups. Plasma quinine concentrations were similar in both groups on days 1, 2 and 3 and ranged from 1.07 to 4.35 μg/ml in cured patients and from 1.1 to 3.2 μg/ml in patients with parasite recurrence. Concentrations of doxycycline were similar in both groups on day 3. The parasite clearance rate constant was 0.131 ± 0.16 h in the cured patients and 0.117 ± 0.02 h in those showing recurrence. The slope half‐life in the cured patients was 4.8 h and 5.4 h in recurrence cases. The hillslope of the cured group (14.24) increased sharply compared to the recurrence group (4.13).

Conclusion

There is evidence of a decreased in vivo sensitivity to quinine of P. falciparum strains in the Brazilian Amazon basin.
Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger
Authors: Maïnassara Halima Boubacar , Oumarou Garba Idé , Issaka Bassira , Sidiki Ali , Idi Issa , Pelat Jean‐Paul Moulia , Fontanet Arnaud , Mueller Judith E.
Published: November 2016

Objective

To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger.

Methods

We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine‐preventable cases and number of vaccine doses needed per epidemic signal.

Results

A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine‐preventable cases was 29 with district‐level surveillance and vaccine response, 141 with health area‐level surveillance and vaccination and 339 with health area‐level surveillance and district‐level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district‐level surveillance and highest for health area‐level surveillance with district‐level vaccination.

Conclusion

In this analysis, we found that effectiveness and efficiency were higher at health area‐level surveillance and district‐level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.
Retention in care and reasons for discontinuation of lifelong antiretroviral therapy in a cohort of Cameroonian pregnant and breastfeeding HIV‐positive women initiating ‘Option B+’ in the South West Region
Authors: Atanga Pascal N. , Ndetan Harrison T. , Achidi Eric A. , Meriki Henry D. , Hoelscher Michael , Kroidl Arne
Published: November 2016

Objective

To assess linkage and retention in care along the PMTCT cascade in HIV‐positive pregnant and breastfeeding women initiating Option B+ in Cameroon.

Methods

We prospectively determined uptake of HIV testing and counselling (HTC), uptake of ART and retention in care after Option B+ initiation between October 2013 and December 2014 in pregnant and breastfeeding women from five sites within the Kumba Health District. Retention in care was assessed over at least 12 months follow‐up and estimated by Kaplan–Meier analysis. During follow‐up, tracing outcomes and reasons for discontinuing treatment were documented.

Results

The uptake of HTC of 5813 women with unknown HIV status was 98.5%, 251 (4.4%) were newly diagnosed HIV positive, and ART uptake in women eligible to start Option B+ was 96.8%. We enrolled 268 women initiating lifelong ART in the follow‐up. Overall, 65 (24.3%) discontinued treatment, either defined by loss to follow‐up (44.6%) or actively stopped treatment (55.8%). Retention in care was 88.0% and 81.1% at 6 and 12 months, respectively. Discontinuation was significantly associated in multivariate analysis with small sites and high staff turnover [aOR 2.5 (95% CI 1.6, 3.9), P < 0.001]. Main reasons for stopping treatment were HIV status denial and stigma (52.8%), religious reasons (25.0%) and lack of transport fare (11.1%).

Conclusion

We observed good uptake of HTC, ART and retention in care, which declined over time. Discontinuation of Option B+ was highest at small sites with a high staff turnover. Improved staffing, adequate task shifting and community interventions to track defaulters including reducing stigma and religious beliefs may improve Option B+ retention.
Dynamic and rapid changes in the transcriptome and epigenome during germination and in developing rice (Oryza sativa) coleoptiles under anoxia and re‐oxygenation
Authors: Narsai Reena , Secco David , Schultz Matthew D. , Ecker Joseph R. , Lister Ryan , Whelan James
Published: November 2016

Detailed molecular profiling of Oryza sativa (rice) was carried out to uncover the features that are essential for germination and early seedling growth under anoxic conditions. Temporal analysis of the transcriptome and methylome from germination to young seedlings under aerobic and anaerobic conditions revealed 82% similarity in the transcriptome and no differences in the epigenome up to 24 h. Following germination, significant changes in the transcriptome and DNA methylation were observed between 4‐day aerobically and anaerobically grown coleoptiles. A link between the epigenomic state and cell division versus cell elongation is suggested, as no differences in DNA methylation were observed between 24‐h aerobically and anaerobically germinating embryos, when there is little cell division. After that, epigenetic changes appear to correlate with differences between cell elongation (anaerobic conditions) versus cell division (aerobic conditions) in the coleoptiles. Re‐oxygenation of 3‐day anaerobically grown seedlings resulted in rapid transcriptomic changes in DNA methylation in these coleoptiles. Unlike the transcriptome, changes in DNA methylation upon re‐oxygenation did not reflect those seen in aerobic coleoptiles, but instead, reverted to a pattern similar to dry seeds. Reversion to the ‘dry seed’ state of DNA methylation upon re‐oxygenation may act to ‘reset the clock’ for the rapid molecular changes and cell division that result upon re‐oxygenation.
Reduced MHC alloimmunization and partial tolerance protection with pathogen reduction of whole blood
Authors: Jackman Rachael P. , Muench Marcus O. , Inglis Heather , Heitman John W. , Marschner Susanne , Goodrich Raymond P. , Norris Philip J.
Published: November 2016

BACKGROUND

Allogeneic blood transfusion can result in an immune response against major histocompatibility complex (MHC) antigens, potentially complicating future transfusions or transplants. We previously demonstrated that pathogen reduction of platelet‐rich plasma (PRP) with riboflavin and ultraviolet light (UV+R) can prevent alloimmunization in mice. A similar pathogen‐reduction treatment is currently under development for the treatment of whole blood using riboflavin and a higher dose of UV light. We sought to determine the effectiveness of this treatment in the prevention of alloimmunization.

STUDY DESIGN AND METHODS

BALB/cJ mice were transfused with untreated or UV+R‐treated, allogeneic C57Bl/6J whole blood with or without leukoreduction. Mice were evaluated for donor‐specific antibodies, ex vivo splenocyte cytokine responses, and changes in the frequency of regulatory T (Treg) cells.

RESULTS

UV+R treatment blocked cytokine priming and reduced anti‐MHC alloantibody responses to transfused whole blood. Leukoreduction reduced alloantibody levels in both the untreated and UV+R‐treated groups. Mice transfused with UV+R‐treated whole blood had reduced alloantibody and cytokine responses when subsequently transfused with untreated blood from the same donor type. This reduction in responses was not associated with increased Treg cells.

CONCLUSIONS

Pathogen reduction of whole blood with UV+R significantly reduces, but does not eliminate, the alloimmune response. Exposure to UV+R‐treated whole blood transfusion does appear to induce tolerance to alloantigens, resulting in reduced anti‐MHC alloantibody and cytokine responses to subsequent exposures to the same alloantigens. This tolerance does not appear to be driven by an increase in Treg cells.
Blood transfusion in hematologic intensive care unit
Authors: Chantepie Sylvain P. , Mear Jean‐Baptiste , Parienti Jean‐Jacques , Bazin Agnès , Benabed Khaled , Cheze Stéphane , Gac Anne‐Claire , Johnson‐Ansah Hyacinthe , Macro Margaret , Cabrera Quentin , Reboursiere Emilie , Lancesseur Charles , Damaj Gandhi , Reman Oumedaly
Published: November 2016

BACKGROUND

There is increasing evidence that excessive blood transfusion may be associated with impaired survival or cardiovascular events. One way to reduce the number of red blood cells (RBCs) is to transfuse 1 unit (1RBC) instead of 2 units of RBCs (2RBC).

STUDY DESIGN AND METHODS

Patients requiring blood transfusions in hematologic intensive care unit were included in a prospective study using a single RBC unit per transfusion and were compared with an historical cohort who received 2 RBC units per transfusion.

RESULTS

A total of 1323 units were transfused to 126 patients between 2013 and 2014. The 186 patients in the comparative cohort received a total of 1824 RBC units in a 2‐RBC‐unit policy between 2010 and 2012. The mean number of units was 7.35 (SD, 5.9 units; 95% confidence interval [CI], 6.5‐8.2 units) in the 1RBC group and 8.14 units (SD, 6.2 units; 95% CI, 7.3‐8.9 units) in the 2RBC group. The absolute mean difference was −0.79 (95% CI, −1.98 to 0.40; p = 0.09). In the 1RBC allogeneic hematopoietic stem cell transplantation (allo‐HSCT) subgroup, a significant reduction in the number of RBC units transfused was observed in comparison with the historical 2RBC allo‐HSCT group (5 units vs. 7.7 units; p = 0.01). No anemia‐related side effects were reported. Overall survival did not differ between the two groups.

CONCLUSION

The 1RBC transfusion policy made is feasible in patients with transient hematologic toxicity after chemotherapy. The number of units transfused between the two groups was not different. However, in the allo‐HSCT group, the use of a single RBC unit reduced significantly RBC consumption. A randomized trial comparing the two strategies is planned with a medicoeconomic evaluation.
Use of a 350‐mm2Baerveldt glaucoma drainage device to maintain vision and control intraocular pressure in dogs with glaucoma: a retrospective study (2013–2016)
Authors: Graham Kathleen L. , Donaldson David , Billson Francis A. , Billson F. Mark
Published: November 2016

Objective

To evaluate the 350‐mm2Baerveldt glaucoma drainage device (GDD) in dogs with refractory glaucoma when modifications to address postoperative hypotony (extraluminal ligature; intraluminal stent) and the fibroproliferative response (intraoperative Mitomycin‐C; postoperative oral colchicine and prednisolone) are implemented as reported in human ophthalmology.

Design

Retrospective case series.

Animals

Twenty‐eight client‐owned dogs (32 eyes) including seven dogs (nine eyes) with primary glaucoma and 21 dogs (23 eyes) with secondary glaucoma.

Methods

The medical records of all dogs undergoing placement of a 350‐mm2BaerveldtGDDat a veterinary ophthalmology referral service between 2013 and 2016 were reviewed. Signalment, diagnosis, duration and previous treatment of glaucoma, previous intraocular surgery,IOP, visual, and surgical outcomes were recorded.

Results

IOPwas maintained <20mmHg in 24 of 32 (75.0%) eyes. Fourteen eyes (43.8%) required no adjunctive treatments to maintain thisIOPcontrol. Fewer doses of glaucoma medication were required following surgery. Vision was retained in 18 of 27 (66.7%) eyes with vision at the time of surgery. No eyes that were blind at the time of surgery (n= 5) had restoration of functional vision. Complications following surgery included hypotony (26/32; 81.3%), intraocular hypertension (24/32; 75.0%), and fibrin formation within the anterior chamber (20/32; 62.5%). The average follow‐up after placement of theGDDwas 361.1 days (median 395.6 days).

Conclusion

Efforts to minimize postoperative hypotony and address the fibroproliferative response following placement of a 350‐mm2BaerveldtGDDshowed an increased success rate to other reports of this device in dogs and offers an alternative surgical treatment for controlling intraocular pressure in dogs with glaucoma.
Ethical aspects of medical products of human origin
Authors: Martin D. E.
Published: November 2016

Medical products of human origin (MPHOs) are ‘substances derived wholly or in part from human biological materials and intended for clinical application’. In 2014, the World Health Organization launched an Initiative for MPHOs. One of the primary goals of this Initiative is to establish global consensus on core principles that should guide policies and practices involving MPHO, particularly with regard to the procurement, distribution and use of these products. Like any medical products with therapeutic value for humans, the sufficiency of their supply, risks and benefits for recipients and equity in their allocation present ethical concerns for health policymakers, professionals and patients. Unlike other medical products, however, MPHOs present additional ethical concerns because their source materials are procured from living or deceased human beings. The clinical and psychosocial risks and benefits of donating specific materials for use in MPHOs vary according to characteristics of the donor, the material procured and the procurement process used. Risks and benefits, for example, continue to evolve as new procurement technologies, standards of donor care, and new donor populations emerge. Nevertheless, several core ethical concerns remain constant, distinguishing MPHOs as ‘exceptional’ health products. They include concerns about care of donors, inequities in donation and commercialization of ‘donation’ and MPHOs. In this article, I explore some major donor‐related ethical concerns and argue that these provide a rationale for seeking to establish global consensus on ethical governance of all MPHOs, and a foundation for consensus on issues of donor care, and equity in donation and allocation of these exceptional health products.
Global challenges of malaria risk – perspectives from transfusion‐transmitted malaria
Authors: Owusu‐Ofori A. , Owusu‐Ofori S. , Bates I.
Published: November 2016

Malaria is a protozoan disease that is transmitted by theAnophelesmosquito. It can however be transmitted by blood transfusion if the blood donor is parasitaemic. Of the five species ofPlasmodiumthat causes malaria,P. falciparumcauses the most severe form of malaria. Nearly half of the world's population is at risk of malaria. Mortality due to malaria has reduced by 48% from 839 000 deaths in 2000 to 438 000 deaths in 2015. This is largely due to a combination of two approaches, vector control and effective antimalarial drugs. There are challenges to be encountered in managing malaria risk. Some have evolved from the interventions while others may be inherent with parasite. The complex life cycle of the plasmodium parasite and the different stages it undergoes both in the mosquito and human requires a multifaceted approach to reduce or eliminate the burden of malaria. The challenges faced in transfusion‐transmitted malaria mirror the global malaria risk. The presence of parasitaemia in blood donors represents a risk for the transmission of malaria by transfusion as well as serving as a reservoir for environmental transmission. Yet, there is no ideal method for parasite detection. There is the need for institutions such as National Blood Services and Malaria Control programmes to collaborate and lead joint interventions that reduce the malaria risk. Such collaborations should also involve stakeholders such as academia, policy makers, funders, governments and international organizations.
Relationship between opioid treatment and rate of healing in chronic wounds
Authors: Shanmugam Victoria K. , Couch Kara S. , McNish Sean , Amdur Richard L.
Published: November 2016

Opioids are routinely used analgesics in patients with chronic wounds; however the impact of opioid exposure on wound healing is poorly understood. The purpose of this study was to investigate the association between opioid exposure and wound outcome in the Wound Etiology and Healing study. This longitudinal observational study was conducted on 450 subjects enrolled in the Wound Etiology and Healing biorepository. Data were collected prospectively including baseline characteristics, pain score, longitudinal opioid exposure, and total wound surface area (tWSA). Data were analyzed using static multivariate models, fixed‐effects mixed models, and time to event analysis. Using fixed‐effects models, opioid dose was significantly associated with tWSA after accounting for the effects of pain score and baseline co‐variates (p < 0.0001). For each 1‐unit increase in ln(opioid dose + 1) the ln(tWSA + 1) increased by 0.16 units (95% confidence interval 0.13–0.19, p < 0.0001). Visits where opioids were present had ln(tWSA + 1) 0.48 units larger (95% confidence interval 0.38–0.58, p < 0.0001) than visits with no opioid exposure. Using time‐to‐event analysis, patients who never received opioids healed faster than those who received opioids (log‐rank chi‐square 11.00, p  = 0.0009). Using Cox regression analysis, patients with mean opioid dose ≥10 mg were significantly less likely to heal than those with no opioid (HR 0.67 [0.49–0.91], p = 0.011) after adjusting for wound size. Patients with opioid dose >0 to <10 mg had a similar hazard of not healing as those with no opioid exposure (HR 0.88 [0.65–1.19], p = 0.40). In conclusion, opioid analgesics are commonly prescribed to patients with chronic wounds; however, the data presented suggest that opioid exposure is associated with reduced likelihood of healing in patients with chronic wounds. Whether this is a causal relationship will require further study.
Clinical outcome of design modifications to the CLS Spotorno Stem in total hip replacement
Authors: Graceffa Angelo , Indelli Pier , Latella Leonardo , Poli Paolo , Fulco Alexander , Marcucci Massimiliano
Published: November 2016

Purpose: historically, the original CLS Spotorno Stem has demonstrated excellent survival. The design of this stem was recently modified, resulting in the introduction of a shorter, modular version (CLS Brevius). The purpose of the current study was to evaluate the functional, radiological and survivorship outcomes of the cementless CLS Brevius Stem in a multi-surgeon, single center, consecutive series study at two years post-surgery.

Methods: the Authors performed 170 total hip arthroplasties in 155 patients using the shorter, tripletaper stem design (CLS Brevius). The patients’ diagnoses were primary hip osteoarthritis (OA) in 74.4%, secondary hip OA in 22.6%, and post-traumatic hip OA in 3%. All operations were performed through a mini-posterior approach, with the patient in the lateral decubitus position. The mean follow-up was 32 months (24-44 months). Outcome was assessed using the Harris Hip Score (HHS).

Results: the mean HHS improved from 32 preoperatively to 92 points at final follow-up, while the stem survival rate was 99.4%.

Overall, the results were excellent in148 hips (87%), good in 14 hips (8.2%), fair in six hips (3.6%), and poor in two hips (1.2%). Intraoperative complications included a calcar fissure in three hips (1.7%). Correct femoral offset was reproduced in 97% while the planned center of hip rotation was achieved in 98%. Only one hip underwent early stem revision; this was due to major subsidence.

Conclusions: the modified CLS stem design showed excellent short-term results with a low rate of early postoperative complications. One of the main findings of this study was the high correlation between the planned femoral offset and center of hip rotation and the final radiographic measurements. This high reproducibility, which indicates the ability of the system to restore normal hip anatomy, is indeed due to the extensive modularity that characterizes this stem system. Long-term follow-up studies are necessary to fully compare the outcomes of the new design with its highly successful predecessor.

Level of Evidence: Level IV, therapeutic cases series.