bluuebunny/crossref_metadata_2025 huggingface dataset:
Ability to move between self‐states and emotional experiencing and processing as predictors of symptomatic change
Authors: Fisher Hadar , HaCohen Nehama , Shimshi Sharon , Rand‐Lakritz Shira , Shapira Kineret , Tuval‐Mashiach Rivka
Published: October 2019

Objectives

Contemporary relational theories consider clients’ ability to move between multiple self‐states and clients’ ability to experience and process emotions to be two therapeutic processes inherently connected and fundamental to growth and change in psychotherapy. The current research aimed to empirically explore these theoretical assumptions by (1) examining the between‐ and within‐client temporal association between clients’ levels of ability to move between multiple self‐states and clients’ emotional experiencing and processing over the course of therapy, and by (2) testing whether this association would be more prominent for clients presenting good treatment outcomes.

Method

Based on treatment outcome measures, two contrasting groups were selected, nine successful and nine unsuccessful. Ninety session transcripts (five per client) were analysed using the Two‐Person APES (TPA), an extension of the Assimilation of Problematic Experiences Scale (APES), for the measurement of the ability to move between self‐states. Sessions were also analysed using the Experiencing Scale (EXP), for the measurement of emotional experiencing. For all predictors, we disaggregated within‐ and between‐client effects.

Results

No association was found between EXP and TPA levels. However, at the between‐client level, an interaction effect was found indicating a positive correlation between TPA and EXP only for the good‐outcome cases, whereas a negative correlation between these variables was found for the poor‐outcome cases.

Conclusions

The ability to move between multiple self‐states and accessibility to emotional experiencing may be seen as complementary processes enhancing the effectiveness of therapy. However, a high level of one process combined with a low level of the other may be a sign of poor therapeutic outcome.

Practitioner points

Clients’ capacity to negotiate between conflicted self‐states and their ability to experience and process emotions are two determinants working in a synergistic way to predict improvement in clients’ symptoms.

The presence of only one of these psychological processes without the other might be an indication of poor therapeutic outcome.

Therapists should aim to increase their clients’ progress in both the movement between self‐states and emotional experiencing.
Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry‐Based Study, 2001‐2012
Authors: Bakker Marian K. , Kancherla Vijaya , Canfield Mark A. , Bermejo‐Sanchez Eva , Cragan Janet D. , Dastgiri Saeed , De Walle Hermien E. K. , Feldkamp Marcia L. , Groisman Boris , Gatt Miriam , Hurtado‐Villa Paula , Kallen Karin , Landau Daniella , Lelong Nathalie , Lopez Camelo Jorge S. , Martínez Laura , Morgan Margery , Mutchinick Osvaldo M. , Nembhard Wendy N. , Pierini Anna , Rissmann Anke , Sipek Antonin , Szabova Elena , Tagliabue Giovanna , Wertelecki Wladimir , Zarante Ignacio , Mastroiacovo Pierpaolo
Published: October 2019

Background

Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains.

Objectives

To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries.

Methods

We conducted an observational study, using data from 24 population‐ and hospital‐based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution.

Results

Between years 2001 and 2012, the overall first‐week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first‐week mortality occurred on the first day of life. In programmes where information on long‐term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%‐96% in Europe, and 86%‐96% in North America.

Conclusions

Our multi‐country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.
Comparative metabolomics analysis reveals different metabolic responses to drought in tolerant and susceptible poplar species
Authors: Jia Huixia , Wang Lijuan , Li Jianbo , Sun Pei , Lu Mengzhu , Hu Jianjun
Published: October 2019

Drought is one of the critical factors limiting tree growth and survival. Clarifying the adaptation to drought will facilitate the cultivation of drought‐tolerant varieties. Metabolites, as direct signatures of biochemical functions, can uncover the biochemical pathways involved in drought responses. Here, we investigated the physiological and metabolic responses of drought‐tolerant Populus simonii and drought‐susceptible Populus deltoides cv. ‘Danhong’ to drought. Under drought conditions, P. simonii grew better and had a higher photosynthetic rate than P. deltoides cv. ‘Danhong’. Global untargeted metabolite profiling was analyzed using gas chromatography time‐of‐flight mass spectrometry system. A total of 69 and 53 differentially accumulated metabolites were identified in drought‐stressed P. simonii and P. deltoides cv. ‘Danhong’, respectively. The metabolisms of carbohydrate, amino acid, lipid and energy were involved in the drought responses common to both poplar species. The citric acid cycle was significantly inhibited to conserve energy, whereas multiple carbohydrates acting as osmolytes and osmoprotectants were induced to alleviate the adverse effects of drought stress. Unlike P. deltoides cv. ‘Danhong’, P. simonii underwent a specific metabolic reprogramming that enhanced non‐enzymatic antioxidants, coordinated the cellular carbon/nitrogen balance and regulated wax biosynthesis. These results provide a reference for characterizing the mechanisms involved in poplar response to drought and for enhancing the drought tolerance of forest trees.
A new insight into the mechanism for cytosolic lipid droplet degradation in senescent leaves
Authors: Zhang Chaoyue , Qu Yuangang , Lian Yuji , Chapman Mingyu , Chapman Navid , Xin Jie , Xin Huawei , Liu Lin
Published: October 2019

Leaf senescence involves lipid droplet (LD) degradation that produces toxic fatty acids, but little is known about how the toxic metabolites are isolated from the rest of the cellular components. Our ultramicroscopic characterization of cytosolic LD degradation in central vacuole‐absent cells and central vacuole‐containing cells of senescent watermelon leaves demonstrated two degradation pathways: the small vacuole‐associated pathway and the central vacuole‐associated pathway. This provided an insight into the subcellular mechanisms for the isolation of the fatty acids derived from LDs. The central vacuole‐containing cells, including mesophyll cells and vascular parenchyma cells, adopted the central vacuole‐associated pathway, indicated by the presence of LDs in the central vacuole, which is believed to play a crucial role in scavenging toxic metabolites. The central vacuole‐absent intermediary cells, where senescence caused the occurrence of numerous small vacuoles, adopted the small vacuole‐associated pathway, evidenced by the occurrence of LDs in the small vacuoles. The assembly of organelles, including LDs, small vacuoles, mitochondria and peroxisome‐like organelles, occurred in the central vacuole‐absent intermediary cell in response to leaf senescence.
Working memory capacity does not always promote dual‐task motor performance: The case of juggling in soccer
Authors: Laurin Raphaël , Finez Lucie
Published: October 2019

The aim of this research was to refine our understanding of the role of working memory capacity (WMC) on motor performances that require attentional control in dual‐task situations. Three studies were carried out on soccer players. Each participant had to perform a juggling task in both normal and dual‐task conditions. In Study 1, the interfering task was a mental calculation test performed under time pressure (strong cognitive load). In Study 2, the interfering task was a count‐down test (low cognitive load). In Study 3 an intra‐individual design in which participants perform dual‐tasks increasingly complex has been proposed. Results showed a positive relationship between participants’ WMC and their dual‐task motor performance when the cognitive load was low and a negative relationship when the cognitive load was high. This paper highlights the role of the WMC in the activation of different modes of processing and its importance on the performance in dual‐task.
Haptoglobin therapy has differential effects depending on severity of canine septic shock and cell‐free hemoglobin level
Authors: Remy Kenneth E. , Cortés‐Puch Irene , Sun Junfeng , Feng Jing , Lertora Juan J. , Risoleo Thomas , Katz Julia , Basu Swati , Liu Xiaohua , Perlegas Andreas , Kim‐Shapiro Daniel B. , Klein Harvey G. , Natanson Charles , Solomon Steven B.
Published: October 2019

BACKGROUND

During sepsis, higher plasma cell‐free hemoglobin (CFH) levels portend worse outcomes. In sepsis models, plasma proteins that bind CFH improve survival. In our canine antibiotic‐treated Staphylococcus aureus pneumonia model, with and without red blood cell (RBC) exchange transfusion, commercial human haptoglobin (Hp) concentrates bound and compartmentalized CFH intravascularly, increased CFH clearance, and lowered iron levels, improving shock, lung injury, and survival. We now investigate in our model how very high CFH levels and treatment time affect Hp's beneficial effects.

MATERIALS AND METHODS

Two separate canine pneumonia sepsis Hp studies were undertaken: one with exchange transfusion of RBCs after prolonged storage to raise CFH to very high levels and another with rapidly lethal sepsis alone to shorten time to treat. All animals received continuous standard intensive care unit supportive care for 96 hours.

RESULTS

Older RBCs markedly elevated plasma CFH levels and, when combined with Hp therapy, created supraphysiologic CFH‐Hp complexes that did not increase CFH or iron clearance or improve lung injury and survival. In a rapidly lethal bacterial challenge model without RBC transfusion, Hp binding did not increase clearance of complexes or iron or show benefits seen previously in the less lethal model.

DISCUSSION

High‐level CFH‐Hp complexes may impair clearance mechanisms and eliminate Hp's beneficial effect during sepsis. Rapidly lethal sepsis narrows the therapeutic window for CFH and iron clearance, also decreasing Hp's beneficial effects. In designing clinical trials, dosing and kinetics may be critical factors if Hp infusion is used to treat sepsis.
Acute chlorfenapyr toxicity in 3 dogs from a single household
Authors: Davy Rachel B. , Campos Samantha , Lynch Alex M.
Published: October 2019

Objective

To describe the clinical characteristics of acute chlorfenapyr toxicity in 3 dogs from a single household.

Case Summary

A 4‐year‐old neutered female Labrador Retriever was presented with severe hyperthermia (42.6°C [108.6°F]). Emergency management consisting of fluid resuscitation, active cooling, general anesthesia, gastric lavage, activated charcoal administration, and intravenous lipid emulsion was started immediately on the suspicion of toxin exposure. The dog developed symptoms following peracute death in 2 other small breed dog housemates. All dogs had a rapid onset of gastrointestinal signs, neurologic signs, and panting. The dog made a rapid and complete recovery and was discharged 48 hours later. Examination of gastric contents collected from the deceased dogs identified the presence of chlorfenapyr.

New or Unique Information Provided

This is the first reported case of chlorfenapyr toxicity in dogs. Previous case reports in human medicine have reported a variable mortality rate, although 1 of 3 dogs described here made a complete recovery. Chlorfenapyr should be considered in cases of suspected toxicity with similar presenting signs.
Evaluation of serum 25‐hydroxyvitamin D concentrations in a heterogeneous canine ICU population
Authors: Cazzolli Dava M. , Prittie Jennifer E. , Fox Philip R. , Lamb Ken
Published: October 2019

Objective

To identify the prevalence of low serum 25‐hydroxyvitamin D (25‐OH‐D) concentrations in critically ill dogs and determine whether vitamin D concentration measured at admission correlates with illness severity and patient outcome.

Design

Prospective observational study from December 2013 to July 2014.

Setting

Private referral teaching hospital ICU.

Animals

One hundred eleven critically ill dogs admitted to the ICU, and 28 apparently healthy control dogs.

Interventions

Measurement of 25‐OH‐D concentration and assessment of physiological parameters required to calculate illness severity scores.

Measurements and Main Results

Blood was sampled to measure serum 25‐OH‐D concentration, point‐of‐care laboratory data (packed cell volume, total plasma protein, venous blood gas, electrolytes, plasma lactate, and blood glucose concentration), platelet count, and serum albumin within 12 hours of admission. Primary disease etiologies were determined. Mentation score, Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score, length of ICU hospitalization, and survival to discharge were recorded. Low serum 25‐OH‐D concentrations were detected in 25% (28/111) of the ICU cohort; 25‐OH‐D concentrations (median; IQR) (89.2; 26.3 ng/mL [222; 140.0 nmol/L]) were significantly lower in hospitalized dogs compared with the healthy cohort (127.5; 44.5 ng/mL [318; 111.0 nmol/L]) (P < 0.0001). Serum 25‐OH‐D concentrations had a weak positive correlation with albumin (r = 0.34, P = 0.0003), but not with any other blood analyte evaluated. Serum concentration of 25‐OH‐D was also weakly correlated with APPLEfast score (r = 0.31, P = 0.001). 25‐OH‐D concentrations (median; IQR) were significantly higher in ICU dogs that survived to discharge (95.5; 55 ng/mL [238; 137 nmol/L]) compared with nonsurvivors (60.0; 54 ng/mL [149; 135 nmol/L]; P < 0.001).

Conclusions

Low serum 25‐OH‐D was recorded in one‐quarter of critically ill dogs, and was significantly lower in nonsurvivors in comparison to survivors. There was weak correlation between serum 25‐OH‐D and illness severity. Further studies are required to clarify relationships between vitamin D status and outcome.
Acute kidney injury, seizures, and hypertonic hyponatremia secondary to mannitol intoxication in a dog
Authors: Clabots Maëlle F. , Gaillard Elodie , Aumann Marcel
Published: October 2019

Objective

To describe a case of mannitol overdose associated with acute kidney injury (AKI), hypertonic hyponatremia, and neurologic abnormalities in a dog.

Case Summary

A 10‐year‐old intact male Shiba Inu dog was referred to the emergency service of a veterinary teaching hospital for inappetence and acute onset of seizures. The dog had received 2 IV boluses of 3 g/kg of mannitol in less than 24 hours for a glaucoma crisis. Twelve hours after the second injection, the dog became inappetant and developed 2 generalized seizures. Seizure activity was treated with diazepam (0.5 mg/kg IV). Serum biochemistry profile showed severe hyponatremia and hypochloremia, mild hypokalemia, marked increased creatinine (381 µmol/L [44–133 µmol/L]) and moderately increased BUN (13.8 mmol/L [1.6–10.9 mmol/L]). Urinalysis revealed a urine specific gravity of 1.018, glucosuria, proteinuria, pigmenturia and the presence of vacuolized tubular epithelial cells. A presumptive diagnosis of mannitol intoxication was made based on the high dose of mannitol, severe hyponatremia, neurological abnormalities suggestive of intracranial disease, AKI, and urine cytology. Initial calculated plasma osmolality was 263.4 mOsm/kg and measured plasma osmolality was 332 mOsm/kg with an osmolal gap of 68.6 mOsm/kg, confirming the presence of an unmeasured solute attributed to mannitol. Treatment consisted of fluid therapy and supportive care. On day 3, osmolal gap had resolved and serum creatinine concentration returned to normal within 12 days.

New or Unique Information Provided

Mannitol intoxication has been reported in human medicine. This case report is, to our knowledge, the first to describe AKI, hypertonic hyponatremia, and neurological abnormalities secondary to mannitol overdose in a dog.
Not all red cell concentrate units are equivalent: international survey of processing and in vitro quality data
Authors: Shih Andrew W. , Apelseth Torunn Oveland , Cardigan Rebecca , Marks Denese C. , Bégué Stéphane , Greinacher Andreas , de Korte Dirk , Seltsam Axel , Shaz Beth H. , Wikman Agneta , Barty Rebecca L. , Heddle Nancy M. , Acker Jason P. ,   The QMiP Investigators on behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Published: October 2019

Introduction

In vitro qualitative differences exist in red cell concentrates (RCCs) units processed from whole blood (WB) depending on the method of processing. Minimal literature exists on differences in processing and variability in quality data. Therefore, we collected information from blood manufacturers worldwide regarding (1) details of WB collection and processing used to produce RCCs and (2) quality parameters and testing as part of routine quality programmes.

Methods

A secure web‐based survey was developed, refined after pilot data collection and distributed to blood centres. Descriptive analyses were performed.

Results

Data from ten blood centres in nine countries were collected. Six blood centres (60%) processed RCCs using the top‐and‐top (TAT) method which produces RCCs and plasma, and eight centres (80%) used the bottom‐and‐top (BAT) which additionally produces buffy coat platelets. Five of the centres used both processing methods; however, four favoured BAT processing. One centre utilized the Reveos automated system exclusively. All centres performed pre‐storage leucoreduction. Other parameters demonstrated variability, including active cooling at collection, length of hold before processing, donor haemoglobin limits, acceptable collection weights, collection sets, time to leucoreduction, centrifugation speeds, extraction devices and maximum RCC shelf life. Quality marker testing also differed amongst blood centres. Trends towards higher RCC unit volume, haemolysis and residual leucoctyes were seen in the TAT compared with BAT processing across centres.

Conclusion

Methods and parameters of WB processing and quality testing of RCCs differ amongst surveyed blood manufacturers. Further studies are needed to assess variations and to potentially improve methods and product quality.
Reconceptualizing Aunty as an address term in urban multilingual Malaysia
Authors: Lee Sarah , Shanmuganathan Thilagavathi
Published: October 2019

This paper explores contact reconceptualizations of English Aunty as an address term in Greater Kuala Lumpur, Malaysia. In this multiethnic and multilingual city, Aunty is used in local discourses to address older females across different languages and regardless of whether Addressee is related to the Addresser. Moreover, usage of Aunty is extensive, covering a range of social roles, identities, and interpersonal relations that reflect acculturations to a context where diverse traditional cultural norms, multilanguage mixing, and modernity effects, are simultaneously salient. Using the Cultural Linguistics framework (Sharifian, 2017a, 2017b), it is demonstrated that long‐established Malaysian cultural priorities, race (ethnicity) and modern as status (modernity values) can help account for the potential range of usages of Malaysian Aunty.
EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care
Authors: Shuman Clayton J. , Ehrhart Mark G. , Torres Elisa M. , Veliz Philip , Kath Lisa M. , VanAntwerp Katherine , Banaszak‐Holl Jane , Titler Marita G. , Aarons Gregory A.
Published: October 2019

Background

Frontline nurse managers influence the implementation of evidence‐based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings.

Aim

The aim of this study was to evaluate the validity and reliability of the Implementation Leadership Scale (ILS) in acute care settings using two unique nurse samples.

Methods

This study is a secondary analysis of ILS data obtained through two distinct multisite cross‐sectional studies. Sample 1 included 200 registered nurses from one large Californian health system. Sample 2 was 284 registered nurses from seven Midwest and Northeast U.S. hospitals. Two separate studies by different research teams collected responses using written and electronic questionnaires. We analyzed each sample independently. Descriptive statistics described individual item, total, and subscale scores. We analyzed validity using confirmatory factor analysis and within‐unit agreement (awg). We evaluated factorial invariance using multigroup confirmatory factor analyses and evaluating change in chi‐square and comparative fit index values. We evaluated reliability using Cronbach's alpha.

Results

Confirmatory factor analyses in both samples provided strong support for first‐ and second‐order factor structure of the ILS. The factor structure did not differ between the two samples. Across both samples, internal consistency reliability was strong (Cronbach's alpha: 0.91–0.98), as was within‐unit agreement (awg: 0.70–0.80).

Linking Evidence to Action

Frontline manager implementation leadership is a critical contextual factor influencing EBP implementation. This study provides strong evidence supporting the validity and reliability of the ILS to measure implementation leadership behaviors of nursing frontline managers in acute care. The ILS can help clinicians, researchers, and leaders in nursing contexts assess frontline manager implementation leadership, deliver interventions to target areas needing improvement, and improve implementation of EBP.
K-Factor Solution for Combined Braced–Unbraced Offshore Jacket Frames
Authors: Ku Albert , Chen Jieyan , Gunzelman Stephen
Published: October 2019

Many offshore jackets have no braces between the top of jacket and the bottom of topsides deck. This can be either due to the installation requirement and/or an effort to reduce wave loads. This kind of jacket bay is a portal frame. For the design of portal frame columns, the current offshore standards point to the unbraced frame alignment chart solution from onshore standards such as the American Institute of Steel Construction (AISC). In this paper, we will show that the AISC alignment chart unbraced frame K-factor solution is conservative for offshore applications, and perhaps too conservative. This is because the traditional alignment chart assumes that the entire structure is a moment frame. In offshore applications, the unbraced frame is almost always combined with braced frames from above and/or below. In this paper, we will derive a K-factor solution that is suitable for a braced/unbraced frame combination. This solution is validated with structural buckling finite element method (FEM) analyses of typical offshore frames. Design implications from using the traditional alignment chart versus current new K-factor solution are also discussed.
Influence of the Friction Block Shape and Installation Angle of High-Speed Train Brakes on Brake Noise
Authors: Quan Xin , Mo Jiliang , Huang Bo , Tang Bin , Ouyang Huajiang , Zhou Zhongrong
Published: October 2019

In this study, experiments are conducted to evaluate the effects of friction block shapes and installation angles on the brake noise of high-speed trains on a customized small-scale brake dynamometer. Friction blocks in three different shapes (circle, triangle, and hexagon) and triangular/hexagonal friction blocks at different installation angles are used in the tests. The results indicate that the circular and triangular blocks exhibit low sound pressure with multiple harmonics, whereas the hexagonal friction block produces the highest sound pressure with a single dominant frequency. This difference is attributed to the high contact pressure and severe wear on the surface of the hexagonal friction block. Differences in the installation angle of the triangular/hexagonal friction blocks affect wear debris behavior, distribution of contact pressure, and contact state of the friction interface, consequently influencing noise performance.
Co-Integration-Based Compensation Technique for Dynamic Load Effects on the Electro-mechanical Impedance Method
Authors: Jie Xiaoluo , Qu Wenzhong , Xiao Li , Lu Ye
Published: October 2019

The electro-mechanical (EM) admittance signals acquired from piezoelectric transducers (PZT) surface bonded to the host structure are often used for structural health monitoring (SHM). However, it is well known that the method is susceptible to contamination from environmental and operational conditions. This paper introduces a co-integration method to remove dynamic load effects from electro-mechanical admittance data. The proposed method is based on the concept of co-integration that is partially built on the analysis of the non-stationary behavior of time series. Instead of directly using admittance signatures of PZT for damage detection, the analysis of the co-integrated residual obtained from the co-integration procedure of EM admittance responses and the resonant peaks frequency of the real part of admittance (conductance) are chosen as co-integrated variables. The experiments of aluminum beam bolt loosening identification, which is under dynamic stress, were carried out to verify the effectiveness of the proposed method. The results showed that the method can isolate damage-sensitive features from stress variations, so as to successfully detect the existence of damage.
Optimum Design of a New Tuned Inerter-Torsional-Mass-Damper Passive Vibration Control for Stochastically Motion-Excited Structures
Authors: Tai Wei-Che
Published: October 2019

The inerter is referred to as a two-terminal device that provides inertial forces proportional to the relative accelerations between its two terminals. It has been widely applied in vibration control due to its mass amplification effect. In this paper, a new inerter-based damper is proposed to take advantage of the mass amplification effect, which consists of the classic rack-pinion inerter in conjunction with a torsional tuned mass damper. Unlike any other topologies of inerter-based dampers, the torsional mass damper is connected to the pinion of the inerter via a rotational spring and viscous damper. As a result, the weight of the torsional mass damper can be significantly reduced. The proposed damper is applied to single-degree-of-freedom primary structures and a two degrees-of-freedom structure, and the H2 optimization is conducted to obtain the optimum tuning ratio and damping ratio analytically. When comparing the proposed damper with its counterpart reported in the literature, the proposed damper achieves 20–70% improvement when their weights are identical.
Operational Control of Mixing Enhancement and Far-Field Jet Noise Suppression Using Downstream Fluidic Injection
Authors: Rajput Pankaj , Kumar Sunil
Published: October 2019

A novel fluid injection scheme is analyzed for its ability to suppress the far-field jet noise using multiple radial microjets placed downstream from the nozzle exhaust. Contrary to other previous research studies, which injected fluid either inside the nozzle or just at the nozzle exhaust, this injection scheme uses a coaxial injector tube to inject multiple equally spaced microjets perpendicular to the jet axis at an axial location downstream from the nozzle exhaust. Microjet injection closer to the jet axis leads to the formation of a counter rotating vortex pair (CVP) close to the injection location which subsequently breaks down into streamwise vortices as the microjet bends and follows the flow direction. Microjet injection pressure and angle of injection play a crucial role in determining the jet trajectory, penetration, and the strength of the CVP formed. The effect of these parameters on the far-field acoustic radiation is evaluated in this study. Detailed large eddy simulations are performed for a nozzle–injector setup operating at Mach 0.9 jet with Reynolds number ≈106 to help understand the aerodynamic and acoustic features of the interaction of this fluid injection scheme with the main jet.
Temperature dependent Seebeck coefficient and thermal conductivity properties of graphene undoped and doped Ca-Pr-Co oxide thermoelectric nanocomposites
Authors: Koçyiğit Serhat , Aytimur Arda , Uslu Ibrahim
Published: October 2019

This study aims to observe the changes in the structural characterization and physical properties of calcium-praseodymium-cobalt oxide thermoelectric materials with graphene doping. Structural characterizations were examined via X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), Energy Dispersive X-ray (EDX), and Fourier Transformed Infrared Spectroscopy (FTIR) measurements. Temperature-dependent thermal conductivity and Seebeck coefficient were measured by Physical Properties Measurement System (PPMS). In the SEM images, the samples were observed to be crystalline and showed enhanced fusion with graphene doping. There were no impurities in the samples according to the EDX results and all sample components were observed in these results. The properties and structures of the bonds in the XRD results were also visible in the FTIR results. According to the PPMS results, it was determined by measurements and graphs that graphene doping provided a significant and changeable effect to the thermoelectric materials.
Experiment-based modeling of a vapor draw ampoule used for low-volatility precursors
Authors: Sperling Brent A. , Maslar James E.
Published: October 2019

Delivery of low-volatility precursors is a continuing challenge for chemical vapor deposition and atomic layer deposition processes used for microelectronics manufacturing. To aid in addressing this problem, we have recently developed an inline measurement capable of monitoring precursor delivery. Motivated by a desire to better understand the origins of what is now observable, this study uses computational fluid dynamics and a relatively simple model to simulate the delivery of pentakis(dimethylamido)tantalum (PDMAT) from a commercial vapor draw ampoule. Parameters used in the model are obtained by fitting the performance of the ampoule to a limited dataset of PDMAT delivery rates obtained experimentally using a nondispersive infrared sensor. The model shows good agreement with a much larger experimental dataset over a range of conditions in both pulsed and continuously flowing operations. The combined approach of experiment and simulation provides a means to understand the phenomena occurring during precursor delivery, both quantitatively and qualitatively.
Football Team Social Structure and Perceived Support for Reporting Concussion Symptoms: Insights from a Social Network Analysis
Authors: Wayment Heidi A. , Huffman Ann H. , Lininger Monica , Doyle Patrick C.
Published: October 2019

Social network analysis (SNA) is a uniquely situated methodology to examine the social connections between players on a team, and how team structure may be related to self-reported team cohesion and perceived support for reporting concussion symptoms. Team belonging was positively associated with number of friendship ties (degree; r = .23, p < .05), intermediate ties between teammates (betweenness; r = .21, p < .05), and support from both teammates (r = .21, p < .05) and important others (r = .21, p < .05) for reporting concussion symptoms. Additionally, an SNA-derived measure of social influence, eigenvector centrality, was associated with football identity (r = .34, p < .01), and less support from important others (r = –.24, p < .05) regarding symptom reporting. Discussion focuses on why consideration of social influence dynamics may help improve concussion-related education efforts.
CD45 functions as a signaling gatekeeper in T cells
Authors: Courtney Adam H. , Shvets Alexey A. , Lu Wen , Griffante Gloria , Mollenauer Marianne , Horkova Veronika , Lo Wan-Lin , Yu Steven , Stepanek Ondrej , Chakraborty Arup K. , Weiss Arthur
Published: October 2019

CD45 promotes strong but suppresses weak antigen-induced T cell receptor activation.
An engineered pathway for
N
-hydroxy-pipecolic acid synthesis enhances systemic acquired resistance in tomato
Authors: Holmes Eric C. , Chen Yun-Chu , Sattely Elizabeth S. , Mudgett Mary Beth
Published: October 2019

Engineering a metabolite biosynthesis pathway in crop plants enhances systemic acquired resistance to pathogens.
A smoky path to diabetes
Authors: Wong Wei
Published: October 2019

A nicotine-activated brain-pancreas circuit could explain why smokers are more likely to develop type 2 diabetes.
A toddler with a persisting limp after a minor trauma
Authors: Trombetta Andrea , Conversano Ester , Cozzi Giorgio , Taddio Andrea , Murru Flora Maria , Barbi Egidio
Published: October 2019

­

A 3-year-old toddler was admitted for a 5-day history of worsening painful limping on his left leg. History was remarkable only for a minor trauma 2 days before the onset of symptoms; the boy fell on his buttocks but was walking normally in the following days. No fever was reported. Pain was also present at night, with no response to oral ibuprofen.

On physical examination, the patient refused to stand on his left leg, palpation of the left buttock evoked pain, and exorotation and abduction of the left hip were only moderately limited, without local signs of inflammation such as redness, swelling or skin warming. Blood tests showed elevated erythrocyte sedimentation rate (ESR) (98 mm/hour, normal value <20 mm/hour) with normal C reactive protein (CRP) level (0.5 mg/dL, normal value <0.5 mg/dL). His white cell count was 12 110 x 109/L, haemoglobin was 127 g/L and PLT was 430 x 109/L. Creatine kinase values were within the normal range.

An X-ray of the pelvis was unremarkable. An ultrasound of the left hip showed a 2 mm articular effusion.

Questions

Based on the clinical picture and laboratory tests, what is the most likely diagnosis?

Perthes disease.

Pyomyositis.

Septic arthritis.

Bone fracture.

Leukaemia.

What test could confirm the diagnosis?

Bone scintigraphy.

CT.

Bone marrow aspirate.

MRI.

Intra-articular puncture.

What is the mainstay of management of this condition?

Wait and see.

Surgical excision.

Antibiotic course.

Antineoplastic treatment.

Answers can be found on page 2.
Glaucoma management in the era of artificial intelligence
Authors: Devalla Sripad Krishna , Liang Zhang , Pham Tan Hung , Boote Craig , Strouthidis Nicholas G , Thiery Alexandre H , Girard Michael J A
Published: October 2019

Glaucoma is a result of irreversible damage to the retinal ganglion cells. While an early intervention could minimise the risk of vision loss in glaucoma, its asymptomatic nature makes it difficult to diagnose until a late stage. The diagnosis of glaucoma is a complicated and expensive effort that is heavily dependent on the experience and expertise of a clinician. The application of artificial intelligence (AI) algorithms in ophthalmology has improved our understanding of many retinal, macular, choroidal and corneal pathologies. With the advent of deep learning, a number of tools for the classification, segmentation and enhancement of ocular images have been developed. Over the years, several AI techniques have been proposed to help detect glaucoma by analysis of functional and/or structural evaluations of the eye. Moreover, the use of AI has also been explored to improve the reliability of ascribing disease prognosis. This review summarises the role of AI in the diagnosis and prognosis of glaucoma, discusses the advantages and challenges of using AI systems in clinics and predicts likely areas of future progress.
Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case–control study
Authors: Spritzer Poli Mara , Marchesan Lucas B , Santos Betânia R , Cureau Felipe V , Oppermann Karen , Reis Rosana Maria dos , Ferriani Rui A , Weiss Rita , Meirelles Ricardo , Candido Ana Lucia , Reis Fernando M
Published: October 2019

Introduction

Brazil is a large country, with a population of mixed ethnic background and broad variation in dietary and physical activity traits across its five main regions. Because data on Brazilian women with polycystic ovary syndrome (PCOS) are still scarce, a nation-wide collaborative study was designed to determine the prevalence of metabolic and reproductive abnormalities and the presence of anxiety and depression in Brazilian women with PCOS. In addition, the study aims at describing how these characteristics are distributed across PCOS phenotypes and at detecting associations with regional demographic and lifestyle aspects, genetic variants, and epigenetic markers.

Methods and analysis

The Brazilian PCOS study is being conducted in the outpatient clinics of eight university hospitals within the public healthcare network (Unified Health System) across the country. Additional centres will be included following completion of the research ethics approval process. The sample includes women with PCOS according to Rotterdam criteria at inclusion in the study and a control group of healthy women matched by age, socioeconomic status and geographical region. Data will be collected in each centre and incorporated into a unified cloud database. Clinical, demographic, socioeconomic, psychological, metabolic, epigenetic and genotypic variables will be evaluated. The data resulting from this study will be useful to guide specific public strategies for primary and secondary prevention of metabolic and reproductive comorbidities in the PCOS population of Brazil.

Ethics and dissemination

The study protocol was approved by each local Research Ethics Committee. Written informed consent will be obtained from each participant. During data collection, analysis and publication, care will be taken to ensure confidentiality of participant information. Study results will be published in peer-reviewed journals and disseminated at international conferences. This research protocol was registered with the Research Ethics Committee of HCPA, through Plataforma Brasil.

Trial registration number

CAAE 18082413.9.1001.5327
Association between the number of teeth and frailty among Chinese older adults: a nationwide cross-sectional study
Authors: Gu Yaohua , Wu Wenwen , Bai Jinbing , Chen Xuyu , Chen Xiaoli , Yu Liping , Zhang Qing , Zou Zhijie , Luo Xianwu , Pei Xianbo , Liu Xin , Tan Xiaodong
Published: October 2019

Objectives

To explore the association between the number of teeth and frailty among older Chinese adults using a nationally representative sample.

Design

Cross-sectional analysis was carried out using the 2014 wave data from the Chinese Longitudinal Healthy Longevity Survey, which used a targeted random-sampling design.

Setting

This research was conducted in communities from nearly half of the counties and cities in 22 out of 31 provinces throughout China.

Participants

Of the 6934 interviewees aged ≥65 years, the final analysis included 3635 older adults who had completed the 2014 wave survey on the variables included in the study.

Primary and secondary outcome measures

Outcome variables included frailty, measured by the Frailty Index, and number of teeth. Covariates included demographic characteristics (ie, age, sex, co-residence, marital status, years of education and financial support), body mass index (BMI) and health behaviours (ie, smoking, drinking and exercise). A univariate logistic regression was used to test the factors associated with frailty. A multiple logistic regression model was used, using the frailty score as the dependent variable and the number of teeth together with significant covariates as the independent variables.

Results

The prevalence of frailty was 27.68%. The mean number of teeth present was 9.23 (SD=10.03). The multiple logistic regression showed that older adults’ demographic variables, health behaviours, BMI, tooth number and chewing pain were significantly associated with frailty. After adjusting for the covariates, older adults with fewer teeth had significantly higher odds of frailty than those with 20 or more teeth (no teeth: OR=2.07, 95% CI 1.53 to 2.80; 1 to 10 teeth: OR=1.77, 95% CI 1.31 to 2.38), except for older adults with 11 to 20 teeth (OR=1.30, 95% CI 0.93 to 1.82).

Conclusions

The presence of fewer teeth is significantly associated with frailty status among older Chinese adults. Future studies are needed to explain the specific mechanisms underlying how oral health status is associated with frailty.
Resilience Against Depression Disparities (RADD): a protocol for a randomised comparative effectiveness trial for depression among predominantly low-income, racial/ethnic, sexual and gender minorities
Authors: Vargas Sylvanna Maria , Wennerstrom Ashley , Alfaro Nancy , Belin Thomas , Griffith Krystal , Haywood Catherine , Jones Felica , Lunn Mitchell R , Meyers Diana , Miranda Jeanne , Obedin-Maliver Juno , Pollock Miranda , Sherbourne Cathy D , Springgate Benjamin F , Sugarman Olivia K , Rey Emily , Williams Clarence , Williams Pluscedia , Chung Bowen
Published: October 2019

Introduction

Depression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement (QI) and delivery of cognitive behavioural therapy (CBT) skills provided by community health workers in reducing depression. Depression QI approaches across healthcare and social/community services in safety-net settings have shown improvements in mental wellness, mental health quality of life and depression over 12 months. Further, a randomised study showed improved depression among low-income racial/ethnic minorities enrolled in a CBT-informed resiliency class (Building Resilience and Increasing Community Hope (B-RICH)). The current protocol describes a comparativeness effectiveness study to evaluate whether predominantly low-income, SGM racial/ethnic minority adults randomised to a CBT-informed resiliency class have improvements in depressive symptoms over and above community-engaged QI resources and training only.

Methods and analysis

The study approached three clusters of four to five programs serving predominantly SGM and racial/ethnic minority communities in the USA: two clusters in Los Angeles, California, and one in New Orleans, Louisiana. Clusters are comprised of one primary care, one mental health and two to three community agencies (eg, faith-based, social services/support, advocacy). All programs received depression QI training. The current study employed a community-partnered participatory research model to adapt the CBT-informed resiliency class, B-RICH+, to SGM communities. Study participants were screened and recruited in person from participating programs, and will complete baseline, 6- and 12-month survey follow-ups. Participants were depressed adults (8-item Patient Health Questionnaire ≥10; ≥18 years of age) who provided contact information. Enrolled participants were individually randomised to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms; secondary outcomes are mental health quality of life, mental wellness and physical health quality of life. Data collection for this study is ongoing.

Ethics and dissemination

The current study was approved by the UCLA Institutional Review Board. Study findings will be disseminated through scientific publications and community conferences.

Trial registration number

https://clinicaltrials.gov/ct2/show/NCT02986126
Passing the acid test? Evaluating the impact of national education initiatives to reduce proton pump inhibitor use in Australia
Authors: Bruno Claudia , Pearson Sallie-Anne , Daniels Benjamin , Buckley Nicholas A , Schaffer Andrea , Zoega Helga
Published: October 2019

Background

Proton pump inhibitor (PPI) use is widespread. There have been increasing concerns about overuse of high-dose PPIs for durations longer than clinically necessary.

Objective

To evaluate the impact of national education initiatives on reducing PPI use in Australia.

Design

Population-based, controlled interrupted time series analysis of PPI dispensing claims data for Australian adults from July 2012 to June 2018; we used statin dispensing as a control.

Interventions

A year-long educational initiative led by NPS MedicineWise (previously the National Prescribing Service) from April 2015. Simultaneously, Choosing Wisely released recommendations in April 2015 and May 2016. Both promoted review of prolonged PPI use and encouraged stepping down or ceasing treatment, where appropriate.

Measurements

We examined monthly changes in PPI (and statin) dispensing (stratified by high, standard and low tablet strength), rates of switching from higher to lower strength PPIs and rates of PPI (and statin) discontinuation.

Results

We observed 12 040 021 PPI dispensings to 579 594 people. We observed a sustained −1.7% (95% CI: −2.7 to −0.7%) decline in monthly dispensing of standard strength PPIs following the initiatives until the end of the study period. There were no significant changes in high or low strength PPI (or statin) dispensings, switching to lower strength PPIs, or PPI (and statin) treatment discontinuation.

Conclusion

Our findings suggest that these educational initiatives alone were insufficient in curbing overuse of PPIs on a national level. Concerted efforts with policy levers such as imposing tighter restrictions on subsidised use of PPIs may be more effective. Noting low strength esomeprazole is not publicly subsidised in Australia, availability of these preparations may also facilitate more appropriate practice