bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune Function in Critically Ill Dogs
Authors: Hoffman D. , Amorim J. , DeClue A.
Published: November 2017

Background

People with critical illness (CI) commonly develop various forms of immune dysfunction, however, there is limited information concerning immune dysfunction in dogs with CI.

Hypothesis

The immune response in CI dogs differs from that of healthy dogs.

Animals

Immunologic variables were compared between 14 dogs with CI, defined as APPLEfast score of >20 points, admitted to the University of Missouri Veterinary Health Center Small Animal Clinic Intensive Care Unit and healthy controls (n = 15).

Methods

Cohort study evaluating constitutive and lipopolysaccharide (LPS)‐stimulated TNF‐α, IL‐6, and IL‐10 production, phagocytosis of opsonized E. coli and respiratory burst capacity after opsonized E. coli or phorbol 12‐myristate 13‐acetate (PMA) stimulation, peripheral blood lymphocyte phenotype, and monocyte expressions of HLA‐DR and TLR‐4.

Results

Lipopolysaccharide‐stimulated leukocyte TNF‐α (median, Q1, Q3; CI, 49, 49, 120; control, 655, 446, 1174 pg/mL; P = < 0.001), IL‐6 (median, Q1, Q3; CI, 49, 49, 64; control, 100, 49, 166 pg/mL; P = 0.029), and IL‐10 (CI, 49, 49, 56; control, 96, 49, 203 pg/mL; P = 0.014) production and both E. coli (median, Q1, Q3; CI, 60.5, 43, 88.5; control, 86.6, 81, 89.2%; P = 0.047) and PMA (CI, 40, 11.7, 70; control, 93, 83, 97.6%; P = < 0.001)‐stimulated respiratory burst capacity significantly decreased in CI dogs. Percentage of monocytes expressing TLR‐4 greater in the CI dogs (median, Q1, Q3; CI, 46.9, 24.3, 64.2; control, 16.4, 9.4, 26.2%; P = 0.005).

Conclusion

These findings suggest dogs with CI develop immune system alterations that result in reduced respiratory burst function and cytokine production despite upregulation of TLR‐4.
Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004–2014)
Authors: Harrison J.L. , Turek B.J. , Brown D.C. , Bradley C. , Callahan Clark J.
Published: November 2017

Background

Cholangitis in dogs appears to be more common than previously thought, but understanding of the disease remains incomplete.

Objective

To describe a population of dogs with cholangitis or cholangiohepatitis.

Animals

Fifty‐four client‐owned dogs with cholangitis or cholangiohepatitis.

Methods

Medical records of dogs with cholangitis or cholangiohepatitis confirmed by histopathology between January 2004 and December 2014 were identified using a computer‐based search and retrospectively reviewed.

Results

Clinical signs included vomiting (72.2%), lethargy (70.4%), and inappetence (64.8%). Most dogs (49/50) had increased liver enzyme activities, hyperbilirubinemia (32/50), and hypercholesterolemia (24/43). Ultrasonographic abnormalities of the hepatobiliary system were seen in 84% of cases. On histopathology, 53 of 54 affected dogs had neutrophilic cholangitis (NC) or cholangiohepatitis, whereas 1 dog had lymphocytic cholangitis. Most cases (42/54) were chronic. Evidence of concurrent biliary disease (46.2%) and biliary tract obstruction (42.6%) was common. Seventeen of 36 biliary and 11 of 25 liver cultures were positive for bacterial growth;Escherichia coliandEnterococcus spp. were most common. Median patient survival was 671 days (95% confidence interval [CI]: 114–1,426). On Cox regression, dogs that did not have a cholecystectomy performed had a 2.1 greater hazard for death (P= 0.037; 95% CI: 1.0–4.3) compared to cholecystectomized dogs. Dogs >13 years old had a 5.0 greater hazard for death (P= 0.001; 95% CI: 1.9–13.2) compared to younger dogs.

Conclusions and Clinical Significance

Chronic NC or cholangiohepatitis was most common. Cholecystitis and biliary tract obstruction often occurred in conjunction with cholangitis. Cholecystectomized dogs had decreased risk of death; thus, cholecystectomy may improve patient outcome.
Does fuel type influence the amount of charcoal produced in wildfires? Implications for the fossil record
Authors: Hudspith Victoria A. , Hadden Rory M. , Bartlett Alastair I. , Belcher Claire M.
Published: November 2017

Charcoal occurrence is extensively used as a tool for understanding wildfires over geological timescales. Yet, the fossil charcoal literature to date rarely considers that fire alone is capable of creating a bias in the abundance and nature of charcoal it creates, before it even becomes incorporated into the fossil record. In this study we have used state‐of‐the‐art calorimetry to experimentally produce charcoal from 20 species that represent a range of surface fuels and growth habits, as a preliminary step towards assessing whether different fuel types (and plant organs) are equally likely to remain as charcoal post‐fire. We observe that charcoal production appears to be species specific, and is related to the intrinsic physical and chemical properties of a given fuel. Our observations therefore suggest that some taxa are likely to be overrepresented in fossil charcoal assemblages (i.e. needle‐shed conifers, tree ferns) and others poorly represented, or not preserved at all (i.e. broad shoot‐shed conifers, weedy angiosperms, shrub angiosperms, some ferns). Our study highlights the complexity of charcoal production in modern fuels and we consider what a bias in charcoal production may mean for our understanding of palaeowildfires.
Foundation of statistical mechanics: The auxiliary hypotheses
Authors: Shenker Orly
Published: November 2017

Statistical mechanics is the name of the ongoing attempt to explain and predict certain phenomena, above all those described by thermodynamics on the basis of the fundamental theories of physics, in particular mechanics (classical or quantum), together with certain auxiliary assumptions. In another paper in this journal, Foundations of statistical mechanics: Mechanics by itself, I have shown that some of the thermodynamic regularities, including the probabilistic ones, can be described in terms of mechanics by itself. But in order to prove those regularities, in particular the time asymmetric ones, it is necessary to add to mechanics assumptions of three kinds, all of which are under debate in contemporary literature. One kind of assumptions concerns measure and probability, and here, a major debate is around the notion of “typicality.” A second assumption concerns initial conditions, and here, the debate is about the nature and status of the so‐called past hypothesis. The third kind of assumptions concerns the dynamics, and here, the possibility and significance of “Maxwell's Demon” is the main topic of discussions. This article describes these assumptions and examines the justification for introducing them, emphasizing the contemporary debates around them.
Foundation of statistical mechanics: Mechanics by itself
Authors: Shenker Orly
Published: November 2017

Statistical mechanics is a strange theory. Its aims are debated, its methods are contested, its main claims have never been fully proven, and their very truth is challenged, yet at the same time, it enjoys huge empirical success and gives us the feeling that we understand important phenomena. What is this weird theory, exactly? Statistical mechanics is the name of the ongoing attempt to apply mechanics (classical, as discussed in this paper, or quantum), together with some auxiliary hypotheses, to explain and predict certain phenomena, above all those described by thermodynamics. This paper shows what parts of this objective can be achieved with mechanics by itself. It thus clarifies what roles remain for the auxiliary assumptions that are needed to achieve the rest of the desiderata. Those auxiliary hypotheses are described in another paper in this journal, Foundations of statistical mechanics: The auxiliary hypotheses.
Gaussian Unitary Ensemble with Boundary Spectrum Singularity and σ‐Form of the Painlevé II Equation
Authors: Wu Xiao‐Bo , Xu Shuai‐Xia , Zhao Yu‐Qiu
Published: November 2017

We consider the Gaussian unitary ensemble perturbed by a Fisher–Hartwig singularity simultaneously of both root type and jump type. In the critical regime where the singularity approaches the soft edge, namely, the edge of the support of the equilibrium measure for the Gaussian weight, the asymptotics of the Hankel determinant and the recurrence coefficients, for the orthogonal polynomials associated with the perturbed Gaussian weight, are obtained and expressed in terms of a family of smooth solutions to the Painlevé XXXIV equation and the σ‐form of the Painlevé II equation. In addition, we further obtain the double scaling limit of the distribution of the largest eigenvalue in a thinning procedure of the conditioning Gaussian unitary ensemble, and the double scaling limit of the correlation kernel for the critical perturbed Gaussian unitary ensemble. The asymptotic properties of the Painlevé XXXIV functions and the σ‐form of the Painlevé II equation are also studied.
Physiological benefits to parents from undertaking skin‐to‐skin contact with their neonate, in a neonatal intensive special care unit
Authors: Jones Hannah , Santamaria Nick
Published: November 2017

There has been increased focus on the use of family‐centred care interventions, such as skin‐to‐skin contact (SSC) in Neonatal Intensive Special Care (NISC) Units over the past two decades. SSC between a parent and their neonate has previously shown to promote positive mental and emotional health in parents and assist in bonding and attachment between parent and neonate. The purpose of this study was to investigate the effect that SSC between parent and their neonate has on the parent's heart rate (HR) and blood pressure (BP). There has been a lack of prior research investigating the physiological responses from SSC on parents, hence the need to conduct this study. The study was conducted as an observational cohort study at The Royal Women's Hospital NISC Unit in Melbourne, Australia. One SSC between parent and neonate was recorded, and three repeated measures analysis of variance (anova) were conducted to investigate the relationship between SSC and the parent's HR, systolic BP and diastolic BP. The study found statistically significant differences between the parent's initial HR and BP, to measurements taken during the SSC (p < 0.05). This may suggest that parents’ find SSC with their neonate to be a stress‐reducing intervention, whilst they are in a NISC Unit. This may in turn promote associated benefits, such as a decrease in parental depression and anxiety, whilst they are in the NISC Unit, physical health benefits, as well as increased feelings of bonding between parent and their neonate. Based on the findings, it is suggested that SSC should be promoted in NISC Units as a family‐centred care intervention that lowers parent's HR and BP and may provide associated health benefits.
Economic and Innovative Factors Influence on Funding of the Supply-Side of Housing in Nairobi, Kenya
Authors: Kanjumba Faith Wambui
Published: November 2017

Housing impact on an economy is undisputed. Economic factors comprising market forces, cost of inputs, the macro economy and the cost of funding are one set of factors that impacts on the funding of the supply-side of housing.  Financiers’ reactionary actions to encourage uptake of credit is undertaken by use of innovation and technology. This paper sets to establish the relationships between both economic and innovative factors, and funding of the supply-side of housing in Kenya and also the moderating effect of the major stakeholders. Using an explanatory form of approach in research design a survey was conducted using questionnaires to collect data from a random sample of 212 branches in Nairobi of financial institutions drawn from a population of 43 commercial banks, 9 deposit-taking MFIs and three major financiers of housing. Factor analysis, correlation analysis and ordinal logit regression were used to determine the relationships. A negative relationship between economic factors and funding of housing was found, while innovative financing and technological factors were found to have no influence. A positive moderating effect of stakeholders on the relationships between both economic factors, and innovative financing and technological factors on one side, and funding of housing was established. The implication being that economic factors play a bigger role in impacting housing and a stable economy is conducive in encouraging investments in housing, with government acting more as an enabler. Innovative financing and technology act as facilitators only.
An Experimental Investigation of Churning Power Losses of a Gearbox
Authors: Polly J. , Talbot D. , Kahraman A. , Singh A. , Xu H.
Published: November 2017

In this study, load-independent (spin) power losses of a gearbox operating under dip-lubrication conditions are investigated experimentally using a final-drive helical gear pair from an automotive transmission as the example system. A dedicated gearbox is developed to operate a single gear or a gear pair under given speed and temperature conditions. A test matrix that consists of sets of tests with: (i) a single spur, helical gears, or disks with no teeth and (ii) helical gear pairs is executed at various temperatures, immersion depths, and pinion positions relative to its mating gear. Power losses from single gear and gear pair at identical operating conditions are compared to quantify the components of the total spin loss in the form of losses due to gear drag, gear mesh pocketing, and bearings and seals.
Catalytic Influence of Water Vapor on Lean Blow-Off and NOx Reduction for Pressurized Swirling Syngas Flames
Authors: Pugh Daniel , Bowen Philip , Crayford Andrew , Marsh Richard , Runyon Jon , Morris Steven , Giles Anthony
Published: November 2017

It has become increasingly cost-effective for the steel industry to invest in the capture of heavily carbonaceous basic oxygen furnace or converter gas, and use it to support the intensive energy demands of the integrated facility, or for surplus energy conversion in power plants. As industry strives for greater efficiency via ever more complex technologies, increased attention is being paid to investigate the complex behavior of by-product syngases. Recent studies have described and evidenced the enhancement of fundamental combustion parameters such as laminar flame speed due to the catalytic influence of H2O on heavily carbonaceous syngas mixtures. Direct formation of CO2 from CO is slow due to its high activation energy, and the presence of disassociated radical hydrogen facilitates chain branching species (such as OH), changing the dominant path for oxidation. The observed catalytic effect is nonmonotonic, with the reduction in flame temperature eventually prevailing, and overall reaction rate quenched. The potential benefits of changes in water loading are explored in terms of delayed lean blow-off (LBO), and primary emission reduction in a premixed turbulent swirling flame, scaled for practical relevance at conditions of elevated temperature (423 K) and pressure (0.1–0.3 MPa). Chemical kinetic models are used initially to characterize the influence that H2O has on the burning characteristics of the fuel blend employed, modeling laminar flame speed and extinction strain rate across an experimental range with H2O vapor fraction increased to eventually diminish the catalytic effect. These modeled predictions are used as a foundation to investigate the experimental flame. OH* chemiluminescence and OH planar laser-induced fluorescence (PLIF) are employed as optical diagnostic techniques to analyze changes in heat release structure resulting from the experimental variation in water loading. A comparison is made with a CH4/air flame and changes in LBO stability limits are quantified, measuring the incremental increase in air flow and again compared against chemical models. The compound benefit of CO and NOx reduction is quantified also, with production first decreasing due to the thermal effect of H2O addition from a reduction in flame temperature, coupled with the potential for further reduction from the change in lean stability limit. Power law correlations have been derived for change in pressure, and equivalent water loading. Hence, the catalytic effect of H2O on reaction pathways and reaction rate predicted and observed for laminar flames are appraised within the challenging environment of turbulent, swirl-stabilized flames at elevated temperature and pressure, characteristic of practical systems.
Real-Time Observations of Density Anomaly Driven Convection and Front Instability During Solidification of Water
Authors: Kumar Virkeshwar , Srivastava Atul , Karagadde Shyamprasad
Published: November 2017

Natural convection during solidification of liquids is known to impact the freezing characteristics and also lead to defect formation. In this study, we report the findings of real-time interferometric observation of bottom-cooled solidification of pure water in a cubical cavity. The results show first quantitative evidence of full-field thermal history during solidification, clearly depicting the anomalous expansion of water below 4 °C. Furthermore, based on the strength of natural convection, characterized by the Rayleigh number, we identify and report four distinct regimes of solidification, namely—conduction dominated, early convection, front instability, and sustained convection. A critical Rayleigh number that initiates instability in the solidifying front has been proposed, which is significantly different from conventional calculations of Rayleigh number relating to the initiation of flow. The study shows full-field quantitative evidence of a well-known phenomenon and provides a further understanding of flow driven nonhomogeneities in the solidifying interfaces.
Use of Detailed Particle Melt Modeling to Calculate Effective Melt Properties for Powders
Authors: Moser Daniel , Yuksel Anil , Cullinan Michael , Murthy Jayathi
Published: November 2017

Selective laser melting (SLM) is a widely used powder-based additive manufacturing process. However, it can be difficult to predict how process inputs affect the quality of parts produced. Computational modeling has been used to address some of these difficulties, but a challenge has been accurately capturing the behavior of the powder in a large, bed-scale model. In this work, a multiscale melting model is implemented to simulate the melting of powder particles for SLM. The approach employs a particle-scale model for powder melting to develop a melt fraction–temperature relationship for use in bed-scale simulations of SLM. Additionally, uncertainties from the particle-scale are propagated through the relationship to the bed scale, thus allowing particle-scale uncertainties to be included in the bed-scale uncertainty estimation. Relations, with uncertainty, are developed for the average melt fraction of the powder as a function of the average temperature of the powder. The utility of these melt fraction–temperature relations is established by using them to model phase change using a continuum bed-scale model of the SLM process. It is shown that the use of the developed relations captures partial melt behavior of the powder that a simple melting model cannot. Furthermore, the model accounts for both uncertainty in material properties and packing structure in the final melt fraction–temperature relationship, unlike simple melting models. The developed melt fraction–temperature relations may be used for bed-scale SLM simulations with uncertainty due to particle effects.
A Long Wavelength Model for Manufacturing of Continuous Metal Microwires by Thermal Fiber Drawing From a Preform
Authors: Zhao Jingzhou , Li Xiaochun
Published: November 2017

Thermal drawing from a preform recently emerges as a scalable manufacturing method for the high volume production of continuous metal microwires for numerous applications. However, no model can yet satisfactorily provide effective understanding of core diameter and continuity from process parameters and material properties during thermal drawing. In this paper, a long wavelength model is derived to describe the dynamics of a molten metal micro-jet entrained within an immiscible, viscous, nonlinear free surface extensional flow. The model requires numerical data (e.g., drawing force and cladding profile) be measured in real time. Examination of the boundary conditions reveals that the diameter control mechanism is essentially volume conservation. The flow rate of molten metal is controlled upstream while the flow velocity is controlled downstream realized by solidification of the molten metal. The dynamics of the molten metal jet are found to be dominated by interfacial tension, stress in the cladding, and pressure in the molten metal. Taylor's conical fluid interface solution (Taylor, 1966, “Conical Free Surfaces and Fluid Interfaces,” Applied Mechanics, Springer, Berlin, pp. 790–796.) is found to be a special case of this model. A dimensionless capillary number Ca=2Fa/γA(0) is suggested to be used as the indicator for the transition from continuous mode (i.e., viscous stress dominating) to dripping mode (i.e., interfacial tension dominating). Experimental results showed the existence of a critical capillary number Cacr, above which continuous metal microwires can be produced, providing the first ever quantitative predictor of the core continuity during preform drawing of metal microwires.
Poro-acoustoelastic constants based on Padé approximation
Authors: Fu Bo-Ye , Fu Li-Yun
Published: November 2017

Stress-induced velocity variations for porous rocks are generally characterized by a strong nonlinear dependence on stress associated with complex deformations under loading. The classical theory of poro-acoustoelasticity with high-order elastic constants is based on the Taylor expansion of the strain energy function, encountering problems of divergence and limitless elastic wave velocities in describing stress-associated velocity variations, especially for high effective stresses. The extension of the theory beyond the high-order elastic constants based on the Padé approximation to the strain energy function is addressed in this article. The resultant acoustoelastic constants are characteristics of a reasonable theoretical limit in elastic wave velocities with increasing effective stresses, avoiding some of the problems associated with high-order elastic constants such as decreasing moduli with increasing effective pressure at high effective pressure, possibly implying the microstructural dependence of elastic constants. That is, the loading stress increases strain energy and wave velocity, but also induces frame-related attenuation, which in turn reduces stiffness and elastic constants. The Padé nonlinear constants can be reduced for low effective stresses to the conventional acoustoelastic constants based on the Taylor expansion. Theoretical results are compared with ultrasonic measurements for a perfectly elastic crystal, topaz (Al2SiO4F2), and a porous rock, demonstrating that the Padé-approximation-based acoustoelasticity gives a more accurate description of stress-associated velocity variations, especially for higher effective stresses.
Development of Protective Immunity in New Zealand White Rabbits Challenged with Bacillus anthracis Spores and Treated with Antibiotics and Obiltoxaximab, a Monoclonal Antibody against Protective Antigen
Authors: Henning Lisa N. , Carpenter Sarah , Stark Gregory V. , Serbina Natalya V.
Published: November 2017

The recommended management of inhalational anthrax, a high-priority bioterrorist threat, includes antibiotics and antitoxins. Obiltoxaximab, a chimeric monoclonal antibody against anthrax protective antigen (PA), is licensed under the U.S. Food and Drug Administration's (FDA's) Animal Rule for the treatment of inhalational anthrax. Because of spore latency, disease reemergence after treatment cessation is a concern, and there is a need to understand the development of endogenous protective immune responses following antitoxin-containing anthrax treatment regimens. Here, acquired protective immunity was examined in New Zealand White (NZW) rabbits challenged with a targeted lethal dose of
Bacillus anthracis
spores and treated with antibiotics, obiltoxaximab, or a combination of both. Survivors of the primary challenge were rechallenged 9 months later and monitored for survival. Survival rates after primary and rechallenge for controls and animals treated with obiltoxaximab, levofloxacin, or a combination of both were 0, 65, 100, and 95%, and 0, 100, 95, and 89%, respectively. All surviving immune animals had circulating antibodies to PA and serum toxin-neutralizing titers prior to rechallenge. Following rechallenge, systemic bacteremia and toxemia were not detected in most animals, and the levels of circulating anti-PA IgG titers increased starting at 5 days postrechallenge. We conclude that treatment with obiltoxaximab, alone or combined with antibiotics, significantly improves the survival of rabbits that received a lethal inhalation
B. anthracis
spore challenge dose and does not interfere with the development of immunity. Survivors of primary challenge are protected against reexposure, have rare incidents of systemic bacteremia and toxemia, and have evidence of an anamnestic response.
Activity of Ceftolozane-Tazobactam against Carbapenem-Resistant, Non-Carbapenemase-Producing Pseudomonas aeruginosa and Associated Resistance Mechanisms
Authors: Wi Yu Mi , Greenwood-Quaintance Kerryl E. , Schuetz Audrey N. , Ko Kwan Soo , Peck Kyong Ran , Song Jae-Hoon , Patel Robin
Published: November 2017

Although carbapenems are effective for treating serious multidrug-resistant
Pseudomonas aeruginosa
infections, carbapenem-resistant
P. aeruginosa
(CRPA) is now being reported worldwide. Ceftolozane-tazobactam (C/T) demonstrates activity against many multidrug-resistant isolates. We evaluated the activity of C/T and compared its activity to that of ceftazidime-avibactam (C/A) using a well-characterized collection of non-carbapenemase-producing CRPA isolates. Forty-two non-carbapenemase-producing CRPA isolates from a previous study (J. Y. Lee and K. S. Ko, Int J Antimicrob Agents 40:168–172, 2012,
https://doi.org/10.1016/j.ijantimicag.2012.04.004
) were included. All had been previously shown to be negative for
bla
IMP
,
bla
VIM
,
bla
SPM
,
bla
GIM
,
bla
SIM
, and
bla
KPC
by PCR. In the prior study, expression of
oprD
,
ampC
, and several efflux pump genes had been defined by quantitative reverse transcription-PCR. Here, antimicrobial susceptibility was determined by broth microdilution according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Time-kill curve assays were performed using three C/T- and C/A-susceptible CRPA isolates. Among 42 non-carbapenemase-producing CRPA isolates, overall susceptibility to C/T was 95.2%, compared to 71.4%, 42.9%, 23.8%, 21.4%, and 2.4% for C/A, ceftazidime, piperacillin-tazobactam, cefepime, and meropenem, respectively. The C/T resistance rate was significantly lower than that of C/A among isolates showing decreased
oprD
and increased
mexB
expression (5.1% versus 25.6%,
P
= 0.025, and 4.3% versus 34.8%,
P
= 0.022, respectively). In time-kill curve studies, C/T was less bactericidal than C/A against an isolate with decreased
oprD
and increased
ampC
expression. C/T was active against 95.2% of non-carbapenemase-producing CRPA clinical isolates. No apparent correlation of C/T MIC values with specific mutation-driven resistance mechanisms was noted.
Mycobacterium tuberculosis GroEL2 Modulates Dendritic Cell Responses
Authors: Georgieva Maria , Sia Jonathan Kevin , Bizzell Erica , Madan-Lala Ranjna , Rengarajan Jyothi
Published: November 2017

Mycobacterium tuberculosis
successfully subverts the host immune response to promote disease progression. In addition to its known intracellular niche in macrophages,
M. tuberculosis
interferes with the functions of dendritic cells (DCs), which are the primary antigen-presenting cells of the immune system. We previously showed that
M. tuberculosis
dampens proinflammatory responses and impairs DC functions through the cell envelope-associated serine protease Hip1. Here we present data showing that
M. tuberculosis
GroEL2, a substrate of Hip1, modulates DC functions. The full-length GroEL2 protein elicited robust proinflammatory responses from DCs and promoted DC maturation and antigen presentation to T cells. In contrast, the cleaved form of GroEL2, which predominates in
M. tuberculosis
, was poorly immunostimulatory and was unable to promote DC maturation and antigen presentation. Moreover, DCs exposed to full-length, but not cleaved, GroEL2 induced strong antigen-specific gamma interferon (IFN-γ), interleukin-2 (IL-2), and IL-17A cytokine responses from CD4
+
T cells. Moreover, the expression of cleaved GroEL2 in the
hip1
mutant restored the robust T cell responses to wild-type levels, suggesting that proteolytic cleavage of GroEL2 allows
M. tuberculosis
to prevent optimal DC-T cell cross talk during
M. tuberculosis
infection.
Small RNA teg49 Is Derived from a
sarA
Transcript and Regulates Virulence Genes Independent of SarA in Staphylococcus aureus
Authors: Manna Adhar C. , Kim Samin , Cengher Liviu , Corvaglia Anna , Leo Stefano , Francois Patrice , Cheung Ambrose L.
Published: November 2017

Expression of virulence factors in
Staphylococcus aureus
is regulated by a wide range of transcriptional regulators, including proteins and small RNAs (sRNAs), at the level of transcription and/or translation. The
sarA
locus consists of three overlapping transcripts generated from three distinct promoters, all containing the
sarA
open reading frame (ORF). The 5′ untranslated regions (UTRs) of these transcripts contain three separate regions ∼711, 409, and 146 nucleotides (nt) upstream of the
sarA
translation start, the functions of which remain unknown. Recent transcriptome-sequencing (RNA-Seq) analysis and subsequent characterization indicated that two sRNAs, teg49 and teg48, are processed and likely produced from the
sarA
P3 and
sarA
P1 transcripts of the
sarA
locus, respectively. In this report, we utilized a variety of
sarA
promoter mutants and
cshA
and
rnc
mutants to ascertain the contributions of these factors to the generation of teg49. We also defined the transcriptional regulon of teg49, including virulence genes not regulated by SarA. Phenotypically, teg49 did not impact biofilm formation or affect overall SarA expression significantly. Comparative analyses of RNA-Seq data between the wild-type, teg49 mutant, and
sarA
mutant strains indicated that ∼133 genes are significantly upregulated while 97 are downregulated in a teg49 deletion mutant in a
sarA
-independent manner. An abscess model of skin infection indicated that the teg49 mutant exhibited a reduced bacterial load compared to the wild-type
S. aureus
. Overall, these results suggest that teg49 sRNA has a regulatory role in target gene regulation independent of SarA. The exact mechanism of this regulation is yet to be dissected.
Successful downstaging of locally recurrent penile squamous cell carcinoma with neoadjuvant nanosomal docetaxel lipid suspension (NDLS) based regimen followed by curative surgery
Authors: Gupta Sameer , Pawar Shashi Singh , Bunger Deepak
Published: November 2017

Penile squamous cell carcinoma (pSCC) is a relatively rare disease in Western world but is a significant health problem in developing countries like India. We report here a case of successful multimodality management of recurrent pSCC with pelvic lymphadenopathy in a 56-year-old male patient with poorly controlled diabetes. The patient presented with ulceroproliferative growth over the residual penile stump clinically involving root of penis and with right pelvic lymphadenopathy. The patient had a history of partial penectomy done elsewhere 20 months ago. In view of the comorbidities, locally recurrent disease and presence of right Iliac lymphadenopathy, the patient was treated with nanosomal docetaxel lipid suspension (NDLS), cisplatin and 5-fluorouracil (TPF regimen) in the neoadjuvant setting followed by staged surgical resection. This is the first case report showing successful treatment of recurrent pSCC with NDLS-based TPF regimen in the neoadjuvant setting followed by staged surgery in a patient with poorly controlled diabetes.
Quantifying research output on poverty and non-communicable disease behavioural risk factors in low-income and lower middle-income countries: a bibliometric analysis
Authors: Allen Luke Nelson , Fox Nicholas , Ambrose Alissa
Published: November 2017

Objectives

Low-income and lower middle-income countries (LLMICs) bear a disproportionate burden of non-communicable diseases (NCDs). WHO has repeatedly called for more research on poverty and NCDs in these settings, but the current situation remains unquantified. We aimed to assess research output on poverty and NCD risk factors from these countries in relation to upper middle-income and high-income countries.

Design

Bibliometric analysis of primary research published between 1 January 1990 and 4 May 2017. We searched 13 databases, combining terms for poverty and NCD behavioural risk factors (tobacco, alcohol, diet and physical activity). Independent dual review was used to screen titles, abstracts and full papers. Two-tailed t-testing and multiple linear regression analyses were used to compare differences in means.

Outcomes

(1) Proportion of lead authors affiliated with institutions based in high and upper middle-income countries vs LLMICs. (2) Mean number of citations for publications from each region. (3) Mean journal impact factor for studies from each region.

Results

Ninety-one (67%) of the 136 included studies were led by scientists affiliated with LLMIC-based institutions. These authors represented 17/83 LLMICs (20%), and their studies garnered 4.8 fewer citations per paper than studies led by high-income and upper middle-income-affiliated authors; however, this finding was non-significant (P=0.67). Papers led by authors based in high-income and upper middle-income countries were published in journals with a mean impact factor 3.1 points higher than those from LLMICs (4.9 vs 1.7) adjusting for year of publication and number of citations (P<0.001).

Conclusions

Most poverty and NCD risk factor research is led by authors from a small number of LLMICs. These studies are being published in relatively low-impact journals, and the vast majority of LLMICs are not producing any research in this area that is vital to their social and economic development. The paucity of domestic evidence must be addressed to inform global policy.
Examining the association between maternal atopy and birth outcomes using a retrospective cohort in the southeastern region of the USA
Authors: Johnson Ayesha , Mason Thomas , Kirby Russell S , Ledford Dennis , Salihu Hamisu M
Published: November 2017

Objective

To assess birth outcomes in primiparous women with diagnosis of non-asthmatic atopy (NAA). Researchers hypothesised that women with NAA would have reduced the risk of adverse birth outcomes compared with women without NAA. NAA is defined as having allergic rhinitis and/or atopic dermatitis.

Setting

Women were mostly treated in primary care settings in South Carolina, USA.

Participants

This is a retrospective cohort study in which participants were identified using a Medicaid database. Participants were primiparous women aged 19 to 25. Births occurring between 2004 and 2014 were identified using the South Carolina’s Vital Statistics (VS) records of live births. Incomplete records (ie, information on plural birth, gestational age at birth or birth weight missing), plural births or infants born before completing 24 weeks of gestation were excluded. This provided 65 650 complete maternal–infant dyads, representing 97.6% of the maternal records and 96.9% of the VS records. Women previously diagnosed with NAA were frequency matched 1:4 to non–atopic controls for a total of 9965 maternal–infant dyads used in the statistical analysis.

Primary outcome measures

Low birth weight, small for gestational age and preterm birth.

Results

Linear tests for trend were statistically significant (p<0.001), indicating that NAA was associated with improved birth weight and gestational age at birth. After controlling for potential confounders, mothers with NAA had equal risk for each outcome when compared with mothers with no diagnosis of NAA.

Conclusion

A diagnosis of NAA among women living in the southeastern region of the USA does not reduce the risk of adverse birth outcomes nor does it elevate the risk of same. Additional studies with more rigorous designs are warranted to confirm the findings in this study.
Factors contributing to medicine-related problems in adult patients with diabetes and/or cardiovascular diseases in Saudi Arabia: a qualitative study
Authors: Al Hamid Abdullah Mahdi , Ghaleb Maisoon , Aljadhey Hisham , Aslanpour Zoe
Published: November 2017

Objectives

To investigate the factors contributing to medicine-related problems (MRPs) among patients with cardiovascular diseases (CVDs) and/or diabetes in Saudi Arabia.

Design

Qualitative semistructured interviews were conducted. Interviews were audio recorded then transcribed into Microsoft Word. The transcribed interviews were then imported into the qualitative analysis software NVivo where thematic analysis was applied. Thematic synthesis was achieved by coding and developing subthemes/themes from the findings of the interviews.

Setting

Five healthcare centres in Najran, Saudi Arabia.

Participants

25 adult patients with diabetes and/or CVDs.

Results

The study cohort included 16 men and 9 women with a median age of 61.8 years (40–85 years). Diabetes was the main condition encountered among 23 patients and CVDs were reported among 18 patients. Perceived factors leading to MRPs were of four types and related to: patient-, healthcare system-, clinical (condition-) and medicine-related factors. Patient-related factors were related to living situation, religious practices, diet/exercise and patients’ behaviour towards the condition and medicines. Healthcare system-related factors comprised sources and availability of medicines, ease of access to healthcare system and patient satisfaction with healthcare providers. Clinical (condition-) related factors associated with both the knowledge and control over condition, and effects of the condition among medicines intake. Medicine-related factors included lack of knowledge about medicines and medicine use.

Conclusions

The results of this study uncovered many factors associated with MRPs among patients with CVDs and diabetes in Saudi Arabia, especially in reference to lifestyle and medicine use. Improving communication with healthcare professional alongside the introduction of national clinical guidance would mitigate the unwanted health complications related to medicine use.
Improving best practice for patients receiving hospital discharge letters: a realist review protocol
Authors: Weetman Katharine , Wong Geoffrey , Scott Emma , Schnurr Stephanie , Dale Jeremy
Published: November 2017

Introduction

Discharge documents are important for transferring information from hospitals to the referring clinician; in the UK and many countries, this is often the patient’s general practitioner or family physician. However, patients may or may not receive their discharge letters, and whether patients should routinely receive discharge letters remains unclear.

Methods and analysis

The review will consolidate evidence on patients receiving discharge letters through the theory-driven approach of a realist review.

The review will be conducted systematically and seek to explain how, why, for whom and in what contexts does this practice ‘work’. The review will specifically explore whether therearebenefits of this practice and if so what are the important contexts for triggering the mechanisms associated with these outcome benefits. Negative effects will also be considered.

Several steps will occur: devising initial rough programme theory, searching the evidence, selecting relevant documents, extracting data, synthesising and finally programme theory refinement. As the process is viewed as iterative, this cycle of steps may be repeated as many times as is necessary to reachtheoretical saturationand may not be linear.

The initial programme theory will be tested and refined throughout the review process and by stakeholder involvement of National Health Service (NHS) policy makers, practitioners and service users.

Ethics and dissemination

Formal ethical review is not required. The resulting programme theory is anticipated to explain how the intervention of patients receiving written discharge communication may work in practice, for whom and in what contexts; this will inform best practice of patients receiving discharge communication. The review findings will be disseminated in a peer-reviewed journal and presentations and discussions with relevant organisations and stakeholders. While the review will be from the perspective of the UK NHS, its findings should be relevant to other healthcare systems.

PROSPERO registration number

CRD42017069863.
Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review
Authors: Braithwaite Jeffrey , Testa Luke , Lamprell Gina , Herkes Jessica , Ludlow Kristiana , McPherson Elise , Campbell Margie , Holt Joanna
Published: November 2017

Introduction

The sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system.

Methods and analysis

The protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies.

Ethics and dissemination

As no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.
Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study
Authors: Bunzli Samantha , Nelson Elizabeth , Scott Anthony , French Simon , Choong Peter , Dowsey Michelle
Published: November 2017

Objectives

The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons.

Design

A qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators.

Setting

One tertiary hospital in Australia.

Participants

Twenty orthopaedic surgeons performing TKA.

Outcome measures

Beliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids.

Results

While prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid.

Conclusions

Multifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.
Social work’s scope of practice in the provision of primary mental health care: protocol for a scoping review
Authors: Ashcroft Rachelle , Kourgiantakis Toula , Brown Judith Belle
Published: November 2017

Introduction

Social work is a key member of interprofessional primary healthcare teams and foundational to primary healthcare reforms that aim to improve the provision of mental healthcare. Little is known, however, about social work’s scope of practice within primary healthcare settings, particularly in the provision of mental healthcare. The objective of this study is to identify and describe social work’s scope of practice as it relates to mental healthcare in primary healthcare settings.

Methods and analysis

A scoping review will be conducted using the methodology established by Arksey and O’Malley. We will search electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Social Services Abstracts and Social Work Abstracts) to identify studies appropriate for inclusion. One reviewer will independently screen all abstracts and full-text studies for inclusion, with supervision by lead investigator. We will include any study that focuses on social work and mental healthcare within primary healthcare settings. All bibliographic data, study characteristics and range of social work practice activities will be collected and analysed using a tool developed by the research team.

Ethics and dissemination

The scoping review will synthesise social work’s scope of practice in the provision of mental healthcare within primary healthcare settings. This review will be the first step to formally develop guidelines for social work practice in primary healthcare. The results will be disseminated through a peer-reviewed publication and conference presentations.