bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategic Alliance and Its Influence on the Performance of Small- and Medium-scale Enterprises in Enugu State, Nigeria
Authors: Nwokocha Victor Chukwunweike , Madu Ignatius Ani
Published: January 2020

Small- and medium-scale enterprises (SMEs) are the engine of economic growth and equitable development in emerging economies such as Nigeria. Their role in emerging market development can be seen in the areas of capital saving, utilization of local resources, and job creation among others. Enugu State is one of the emerging industrial hubs in Nigeria with SME base of 1,366. The activities of these enterprises have significantly increased the revenue base of the government, making the area an emerging market economy. This study assessed the influence of strategic alliance on the performance of SMEs in Enugu State. A quantitative approach comprising of field observations, reference to relevant literature, and questionnaire survey of 137 SMEs was adopted for the study. Data were analyzed using multiple linear regression. The results revealed that strategic alliance cumulatively led to 0.55 unit increase in sales growth, 0.58 unit increase in growth in market share, and 0.56 unit increase in product success. The result also revealed that that strategic alliance led to 0.76 unit increase in growth in profit, 0.62 unit increase in the number of employees, and 0.73 unit increase in labor productivity at 0.05 level of confidence. The article suggests that institutionalization of strategic alliance would encourage cooperation and interfirm linkages among SMEs and create a niche market for them.
Survey for pestiviruses in backyard pigs in southern Brazil
Authors: Mósena Ana C. S. , Weber Matheus N. , Cibulski Samuel P. , Silva Mariana S. , Paim Willian P. , Silva Gustavo S. , Medeiros Antônio A. , Viana Nathália A. , Baumbach Letícia F. , Puhl Daniela E. , Silveira Simone , Corbellini Luis G. , Canal Cláudio W.
Published: January 2020

The Pestivirus genus comprises species that affect animal health and productivity worldwide. Members of the Suidae family are hosts for classical swine fever virus (CSFV), an important pathogen tracked by the World Organization for Animal Health (OIE). However, swine are also susceptible to other pestivirus species that can result in disease or compromise CSFV detection. We searched for pestivirus infection in swine sera collected from 320 backyard pig herds in southern Brazil. We used reverse-transcription PCR primers for Bungowannah virus; atypical porcine pestivirus (APPV); and a panpestivirus pair that detects bovine viral diarrhea virus (BVDV)-1, -2, and HoBi-like pestivirus (HoBiPeV), border disease virus (BDV), and CSFV. Two samples were positive using the panpestivirus primer pair and were classified as BVDV-1d and -2a, respectively. Serum samples were tested for virus neutralization against BVDV-1a, -1b, and -2 strains, resulting in 28 (4.4%) positive samples. Of those, 16 samples had the highest titers against BVDV-1a (2), BVDV-1b (5), and BVDV-2 (9). Our results indicate that Bungowannah virus, APPV, CSFV, BDV, and HoBiPeV have not been circulating in these specific backyard swine populations. However, ruminant pestiviruses were detected and must be considered in future pestivirus control programs conducted in Brazil.
Effectiveness of Extracorporeal Shockwave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy
Authors: Pinitkwamdee Siwadol , Laohajaroensombat Sukij , Orapin Jakrapong , Woratanarat Patarawan
Published: January 2020

Background:

Extracorporeal shockwave therapy (ESWT) has been proposed as a conservative treatment for insertional Achilles tendinopathy from limited evidence without placebo controls. Our objective was to assess the effectiveness of ESWT compared with sham controls in chronic insertional Achilles tendinopathy.

Methods:

A double-blind, randomized sham-controlled trial was conducted between 2016 and 2018. The inclusion criteria were patients aged 18 to 70 years diagnosed with chronic insertional Achilles tendinopathy who failed standard conservative treatment. After computerized randomization, patients were allocated into either low-energy ESWT or sham control. Pain, function, and other complaints were assessed using visual analog scale (VAS) and VAS foot and ankle (VAS-FA) at preintervention and weeks 2, 3, 4, 6, 12, and 24. Intention-to-treat analysis and repeated measurement were performed using STATA 15.0.

Results:

Sixteen patients in ESWT and 15 patients in sham control groups had nonsignificant different baseline characteristics with preintervention VAS (6.0 ± 2.6 vs 5.2 ± 2.2) and VAS-FA (64.8 ± 16.6 vs 65.3 ± 12.7). There was no significant difference in VAS, VAS-FA, and its domains in the long term between the 2 groups. In addition, the ESWT group had significant improvement in VAS (2.9 ± 2.2) at weeks 4 to 12, and sham controls group had significantly improved VAS (2.3 ± 2.6) at weeks 12 to 24. Complications were found only after ESWT treatment.

Conclusion:

There was no difference at 24 weeks with the use of low-energy ESWT for chronic insertional Achilles tendinopathy, especially in elderly patients. However, it may provide a short period of therapeutic effects as early as weeks 4 to 12.

Level of Evidence:

Level I, randomized controlled study.
Shifting the Lens: An Implementation Study of a Community-Based and Social Network Intervention to Gender-Based Violence
Authors: Kim Mimi E.
Published: January 2020

Responding to the call to “shift the lens” and expand gender-based violence remedies beyond individualized direct services and law enforcement remedies, anti-violence providers have struggled to redefine and redirect intervention approaches. This implementation study leverages the framework of implementation science to investigate an exploratory statewide initiative based on the Creative Interventions model and aimed to build organizational and regional capacity to implement community-based or social network interventions within provider organizations. Using data from nine organizations, this mixed-methods study identifies factors related to implementation of this innovative approach including organizational motivation, capacity, and perceived needs related to adoption and implementation.
Reliability and minimal detectable change of the 2-minute walk test and Timed Up and Go test in patients with total hip arthroplasty
Authors: Yuksel Ertugrul , Unver Bayram , Kalkan Serpil , Karatosun Vasfi
Published: January 2020

Purpose:

Performance-based outcome measures are becoming increasingly important in health care. The 2-minute walk test (2MWT) and the Timed Up and Go test (TUG) are frequently used in clinical trials as performance-based tests in many diseases including osteoarthritis. The purposes of this study were: (1) to determine test-retest reliability of data for the 2MWT and the TUG; (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with total hip arthroplasty (THA).

Methods:

37 patients, who had undergone primary THA, were included. Patients twice performed trials for the 2MWT and TUG on the same day. In addition to demographic data of patients, the Harris Hip Score, 2MWT and TUG scores were recorded.

Results:

The TUG and 2MWT showed excellent test-retest reliability. The Intraclass correlation coefficient ICC (2,1), Standard error of measurement (SEM) and minimal detectable chance at the 95% CI (MDC95) for TUG were 0.96, 0.59 seconds and 1.62 seconds respectively. The ICC (2,1), SEM and MDC95 for 2MWT were 0.96, 6.37 m and 17.56 m respectively.

Conclusion:

Clinicians and researchers can be confident that greater changes than 1.62 seconds for TUG and 17.56 m for the 2MWT over time represent a real clinical change in rehabilitation process in patients with THA. Both the 2MWT and TUG may assist in early identification of patients who may need additional rehabilitation to reduce the potential for poor outcomes after THA. Therefore, both of these tests can be used in a clinical setting with a small measurement error.
Heavy Metals Uptake of Salty Soils by Ornamental Sunflower, Using Cow Manure and Biosolids: A Case Study in Alborz city, Iran
Authors: Yazdanbakhsh Ahmadreza , Alavi Seyed Nadali , Valadabadi Seyed Alireza , Karimi Fatemeh , Karimi Zainab
Published: January 2020

Heavy metals are among the most critical environmental pollutants close to industrial areas. One example is the cultivated fields in the south of Alborz industrial city in Iran, which is irrigated by treated industrial wastewater. It is contaminated by heavy metals and irrigation with wastewater treatment plants effluent, which made it salty. In this study, the application of 2 amendments, biosolids and cow manure, in improving the heavy metal accumulation in the ornamental sunflower from these types of soils was investigated. A greenhouse experiment using a completely randomized design with 4 replications and applying cow manure and biosolids in 3 weight ratios (6%, 12%, 25%) was conducted to evaluate the efficiency of sunflower in removing Pb, Ni, and Zn from the soil. Adding the amendments increased the rate of germination by 50% to 176%. Although the simultaneous utilization of cow manure in high ratios with biosolids and cow manure with low biosolids decreased the sunflower survival, nonetheless, the simultaneous addition of these organic amendments could increase the survival rate in other treatments. Moreover, the plants’ biomass was increased by adding modifiers such as cow manure and biosolids. The results showed that in treatments with 2 modifiers, the remediation factor of Pb, Zn, and Ni has increased 83.7 to 95.5, 78.4 to 87.5, and 74.9 to 94.9, respectively, in comparison to the control one. Therefore, we conclude that adding biosolids and cow manure simultaneously could improve the ornamental sunflower ability to accumulate heavy metals.
Insecticide Resistance Profile of Anopheles gambiae Mosquitoes: A Study of a Residential and Industrial Breeding Sites in Kano Metropolis, Nigeria
Authors: Ononamadu Chimaobi J , Datit John T , Imam Abdullahi A
Published: January 2020

Monitoring and understanding the trend and dynamics of insecticide resistance is very key to devising efficient control strategies. This study was carried out to characterize the mosquito population, its insecticide resistance profile, and the physicochemical properties of their breeding sites in Sharada and Wailari of Kano State, Nigeria. Six breeding sites from the 2 study areas were sampled and their physicochemical parameters determined. Mosquito larvae were sampled from the sites and reared to adult. The emergent adults were morphologically and molecularly identified to species level. The World Health Organization (WHO) susceptibility assay was carried out on the adult mosquitoes using different classes of insecticides in WHO discriminating concentrations. kdr-mutation was detected by polymerase chain reaction (PCR)-based method using the permethrin (pyrethroid) resistant and susceptible adult mosquitoes. Most of the determined physicochemical parameters were significantly higher in the industrial area, Sharada. Morphologically, the mosquitoes from the 2 sites were identified as Anopheles gambiae and 100% of the randomly sampled population were found to be Anopheles coluzzii by PCR-based molecular technique. The WHO susceptible assay revealed a graded level of resistance to bendiocarb, dichlorodiphenyltrichloroethane (DDT), and permethrin with mortalities of 78.36%, 75.74%; 43.44%, 56.96%; and 37.50%, 37.50% in both Sharada and Wailari, respectively. Pre-exposure to piperonyl butoxide (PBO) resulted in a significant but minor recovery of susceptibility to permethrin. The kdr mutation frequency was higher in Sharada (45.71%) relative to Wailari (31.43%). Higher kdr mutation frequency was also observed in the resistant population (48.56%) relative to the susceptible (28.54%). The kdr mutation frequency was weakly associated with the resistance status (odds ratio [OR]: 5.9, χ2:3.58, P = .058) and the breeding sites (OR: 3.46, χ2:2.90, P = .088). In conclusion, the study revealed a highly pyrethroid-resistant A coluzzii population with low PBO recovery rate. Furthermore, the data suggested the involvement of kdr mutation, detoxification enzyme, and possibly abiotic factors of the breeding sites.
Party systems and ideological cleavages in the Middle East and North Africa
Authors: Aydogan Abdullah
Published: January 2020

Previous studies have contrasted the political party systems in the Middle East and North Africa (MENA) with those in more democratic countries, raising three important points: (1) the religious–secular dimension, rather than the economic or social left–right, explains the underlying political party competition; (2) left-wing politics is relatively weaker than right-wing politics; and (3) parties that are traditionally known as rightist take left-leaning positions on numerous issue dimensions, and vice versa. Even though this particular literature on party politics in the MENA has greatly improved our understanding of political dynamics in the region, these studies have either lacked quantitative evidence to support these points or their evidence was limited to single-country cases. This study aims to address this issue by analyzing original expert survey data of the ideological positions of political parties in the MENA region. Results show that in addition to the religious–secular dimension, the economic left–right divide and the pace of political reforms are highly important dimensions. The study also provides numerous examples showing that the policy stances of leftist and rightist parties are significantly reversed when MENA countries are compared with more developed democracies.
Exploring the value of the double source CT angiography in diagnosing in-stent restenosis in lower limb artery
Authors: Yun Jian , Shen Ye , He Yun , Gong Bo , Liu Minhai , Wu Xiaosong , Xu Jianxing
Published: January 2020

Objectives

This paper is aimed to explore the value of double source CT angiography (DS-CTA) for diagnosing in-stent restenosis in lower limb artery.

Methods

From January 2016 to October 2018, all patients with stent in lower limb artery in our hospital were investigated by both DS-CTA and digital subtraction angiography. We measured the minimum lumen diameter and the diameter of the proximal normal vessels under each stent placement. The in-stent restenosis is defined as restenosis when the lumen area decreased by more than 50%. Digital subtraction angiography was performed within 1 week after DS-CT scan. Relationship between DS-CTA and digital subtraction angiography for diagnosing in-stent restenosis in lower limb artery was analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DS-CTA for diagnosis of in-stent restenosis were analyzed with digital subtraction angiography as the reference standard. A total of 68 stents were placed in 51 patients. Among these patients, 27 cases were diagnosed as in-stent restenosis, presenting as endovascular contrast agent bias or crescent filling defect with the lumen area reducing over 50%, 6 cases of which had no significant in-stent restenosis by digital subtraction angiography analysis. Furthermore, 12 cases were occlusion, in which there was no high density contrast agent in stents; the remaining 41 stents were unobstructed and the contrast agent was filled well, 8 cases of which had significant in-stent restenosis by digital subtraction angiography analysis. In addition, four stents were deformed or distorted. Statistical analysis demonstrated the concentrations of DS-CTA and digital subtraction angiography in diagnosing in-stent restenosis for lower limb artery were closely related, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DS-CTA were 72.4%, 84.6%, 77.8%, 80.5%, and 79.4%, respectively.

Conclusion

DS-CTA has a potential reliability for diagnosis of in-stent restenosis in lower limb artery, which may be further improved to be used for clinical interventional treatment of vascular diseases.
Connecting the Dots on the Origins of Social Knowledge
Authors: Tasimi Arber
Published: January 2020

Understanding what infants know about social life is a growing enterprise. Indeed, one of the most exciting developments within psychological science over the past decade is the view that infants may come equipped with knowledge about “good” and “bad” and about “us” and “them.” At the heart of this view is a seminal set of studies indicating that infants prefer helpers to hinderers and similar to dissimilar others. What a growing number of researchers now believe is that these preferences may be based on innate (i.e., unlearned) social knowledge. In this article, I consider how decades of research in developmental psychology can lead to a different way to make sense of this popular body of work. As I make connections between old observations and new theorizing—and between classic findings and contemporary research—I consider how the same preferences that are thought to emanate from innate social knowledge may instead reflect social knowledge that infants can rapidly build as they pursue relationships with their caregivers. I offer this perspective with hopes that it will inspire future work that supports or questions the ideas sketched out here and, by doing so, will broaden an understanding of the origins of social knowledge.
Relay transmission under mobile edge computing in energy-limited networks with real-time constraints
Authors: Wu Guilu , Xu Pingping , Wang Shujun , Jiang Huilin
Published: January 2020

For energy-limited networks with real-time constraints, long-distance transmission, complex calculations, and limited delay are problems to be faced in service applications. The cloud-based mobile edge computing framework is proposed in energy-limited networks to solve these problems. Under certain power and delay conditions, source node and destination node in adjacent cells, respectively, can select the appropriate relay node to complete the communication process. The mobile edge computing brings a novel idea for the application of auto-regressive and moving average model and further improves transmission efficiency and reduces transmission delay. Historical energy information of potential relay nodes can be predicted through auto-regressive and moving average model in edge computing server. Then, source node selects appropriate relay node by the proposed relay selection algorithm. Power objective function with signal-to-noise ratio that satisfies the limited delay is formulated to optimize the power allocation of nodes in terms of reducing energy consumption. The results show that our proposed relay selection algorithm under mobile edge computing architecture in energy-limited networks with real-time constraints could effectively improve the performance of networks on energy consumption and delay.
Change in plasma concentration of clozapine and norclozapine following a switch of oral formulation
Authors: Keshavarzi Farinaz , Fox Tony , Whiskey Eromona , Taylor David
Published: January 2020

Background:

Clozapine formulation has been shown to affect plasma concentrations of clozapine and norclozapine. Changes in formulation might result in toxicity or treatment failure.

Methods:

We identified, from electronic records, patients who switched from clozapine tablets to oral liquid or vice versa and compared plasma concentrations before and after the switch.

Results:

We identified 13 patients with 85 blood samples who changed formulation of clozapine. Overall mean standardized clozapine plasma level was 0.67 mg/l daily dose on liquid and 0.87 mg/l daily dose on tablets ( p = 0.035).

Conclusion:

Use of clozapine liquid results in lower plasma clozapine concentration than the same dose of tablets.
A deeper meaning of sustainability: Insights from indigenous knowledge
Authors: Mazzocchi Fulvio
Published: January 2020

This article argues that different cultures and their respective knowledge systems should partake to the sustainability debate. The focus is on insights that indigenous knowledge may provide, analyzing the principles which oversee indigenous relationship with nature, like reciprocity and caretaking. These principles move from a profound sense of unity and interconnectedness and put emphasis on the importance of giving back to nature. They offer an alternative perspective on sustainability that challenges the Western view. Such a view is still focused on maintaining the possibility of exploitation and embedded in a sense of separation from nature. The article discusses the need of creating a laboratory for sustainability, that is, a genuinely pluralist space in which multiple cultural expertise can interact and mutually enrich, yet maintaining their distinction and integrity. The main motivation of such an endevor should be to redefine the notion of sustainability in a more refined and thoughtful way: this is something vital for present and future generations.
A Note on the Relationship of the Shannon Entropy Procedure and the Jensen–Shannon Divergence in Cognitive Diagnostic Computerized Adaptive Testing
Authors: Wang Wenyi , Song Lihong , Wang Teng , Gao Peng , Xiong Jian
Published: January 2020

The purpose of this study is to investigate the relationship between the Shannon entropy procedure and the Jensen–Shannon divergence (JSD) that are used as item selection criteria in cognitive diagnostic computerized adaptive testing (CD-CAT). Because the JSD itself is defined by the Shannon entropy, we apply the well-known relationship between the JSD and Shannon entropy to establish a relationship between the item selection criteria that are based on these two measures. To understand the relationship between these two item selection criteria better, an alternative way is also provided. Theoretical derivations and empirical examples have shown that the Shannon entropy procedure and the JSD in CD-CAT have a linear relation under cognitive diagnostic models. Consistent with our theoretical conclusions, simulation results have shown that two item selection criteria behaved quite similarly in terms of attribute-level and pattern recovery rates under all conditions and they selected the same set of items for each examinee from an item bank with item parameters drawn from a uniform distribution U(0.1, 0.3) under post hoc simulations. We provide some suggestions for future studies and a discussion of relationship between the modified posterior-weighted Kullback–Leibler index and the G-DINA (generalized deterministic inputs, noisy “and” gate) discrimination index.
Leading by Example: Corporate Social Responsibility Initiatives by Dabur India Limited in North India
Authors: Sekhon Amritjot Kaur , Kathuria Lalit Mohan
Published: January 2020

The purpose of this study is to explore the corporate social responsibility (CSR) initiatives undertaken by Dabur India Limited, the biggest Ayurvedic company in the world, at areas close to its manufacturing plant. It also explores the perception of Dabur’s stakeholders with respect to its social responsibility behaviour. For the purpose of this study, both primary as well as secondary data have been used. The primary data have been collected by conducting unstructured interviews and a field visit within the premises of the company’s manufacturing plant in Baddi district as well as in the surrounding villages. The secondary data have been collected from annual reports of the company and the company website. On investigating, it was be observed that Dabur, through years of social involvement and local community partnership projects, has established a special bond of trust with all its stakeholders. Also, as the expenditure made by Dabur on its CSR activities has always exceeded the stipulated amount as per government recommendations, this evidently supports its dedication towards its vision statement, on creating value for society. As after a revision in CSR policies there have not been many research studies examining the CSR practices by companies in India, this study, therefore, addresses this knowledge gap and provides new insights on the compliance by Dabur with regard to new CSR guidelines by the Companies Act, 2013.
Analysis of Internal Knee Forces Allows for the Prediction of Rupture Events in a Clinically Relevant Model of Anterior Cruciate Ligament Injuries
Authors: Ueno Ryo , Navacchia Alessandro , Bates Nathaniel A. , Schilaty Nathan D. , Krych Aaron J. , Hewett Timothy E.
Published: January 2020

Background:

A recently developed mechanical impact simulator induced an anterior cruciate ligament (ACL) rupture via the application of a combination of inverse dynamics–based knee abduction moment (KAM), anterior tibial shear force (ATS), and internal tibial rotation moment with impulsive compression in a cohort of cadaveric limbs. However, there remains an opportunity to further define the interaction of internal forces and moments at the knee and their respective influence on injury events.

Purpose:

To identify the influence of internal knee loads on an ACL injury event using a cadaveric impact simulator.

Study Design:

Controlled laboratory study.

Methods:

Drop-landing simulations were performed and analyzed on 30 fresh-frozen cadaveric knees with a validated mechanical impact simulator. Internal forces and moments at the knee joint center were calculated using data from a 6-axis load cell recorded on the femur during testing. Kinetic data from a total of 1083 trials that included 30 ACL injury trials were used as inputs for principal component (PC) analysis to identify the most critical features of loading waveforms. Logistic regression analysis with a stepwise selection was used to select the PCs that predicted an ACL injury. Injurious waveforms were reconstructed with selected PCs in logistic regression analysis.

Results:

A total of 3 PCs were selected in logistic regression analysis that developed a significant model ( P < .001). The external loading of KAM was highly correlated with PC1 (ρ < –0.8; P < .001), which explained the majority (>69%) of the injurious waveforms reconstructed with the 3 selected PCs. The injurious waveforms demonstrated a larger internal knee adduction moment and lateral tibial force. After the ACL was ruptured, decreased posterior tibial force was observed in injury trials.

Conclusion:

These findings give us a better understanding of ACL injury mechanisms using 6-axis kinetics from an in vitro simulator. An ACL rupture was correlated with an internal knee adduction moment (external KAM) and was augmented by ATS and lateral tibial force induced by an impact, which distorted the ACL insertion orientation.

Clinical Relevance:

The ACL injury mechanism explained in this study may help target injury prevention programs to decrease injurious knee loading (KAM, ATS, and lateral tibial force) during landing tasks.
Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report
Authors: Stone Nicholas , McKinnon Victoria E. , Wismer Judy , McRae Mark H.
Published: January 2020

Pyoderma gangrenosum (PG) is a rare dermatologic condition manifesting as sterile, rapidly progressing painful skin ulcerations. It is commonly associated with autoimmune disorders such as inflammatory bowel disease. This case report illustrates a severe case of post-surgical pyoderma gangrenosum (PSPG) following bilateral deep inferior epigastric perforator flap breast reconstruction in a 56-year-old Caucasian woman. Factors delaying diagnosis included negative personal/family history of inflammatory disorders and a clinical presentation more suggestive of breast cellulitis. Refractory antibiotic therapy, subsequent ulceration at multiple breast and abdominal incisions, and pathergic response to tissue biopsy supported an eventual clinical diagnosis of PSPG, 12 days postoperatively, despite equivocal histopathologic findings. Initiation of intravenous immunoglobulin, prednisone therapy, local wound care, and avoidance of debridement led to a full resolution by 5 months postoperatively. This study raises awareness for PSPG and highlights the importance of early recognition and urgent dermatology consultation to expedite optimal treatment and minimize subsequent fat necrosis.
Damage assessment and seismic behavior of steel buildings during the Mexico earthquake of 19 September 2017
Authors: Tapia-Hernández Edgar , García-Carrera J. Salvador
Published: January 2020

During the 19 September 2017 earthquake, steel buildings in the States of Morelos, Puebla, Mexico, and Mexico City were subjected to severe ground shaking. Despite in some cases, moderate damages in non-structural elements were developed; generally, null or minor structural damage was reported. The notable exceptions are (1) a three-stories building located at the southern area of Mexico City and (2) some schools near to the epicentral region in the State of Morelos. The behavior of these buildings is analyzed in detail. Conclusions are drawn on the demands imposed on steel structures considering the actual demands in order to underline the relevance of the normative design procedures.
Complement blockade for TA-TMA: lessons learned from large pediatric cohort treated with eculizumab
Authors: Jodele Sonata , Dandoy Christopher E , Lane Adam , Laskin Benjamin L , Teusink-Cross Ashley , Myers Kasiani C , Wallace Gregory H , Nelson Adam , Bleesing Jack , Chima Ranjit S , Hirsch Russel , Ryan Thomas D , Benoit Stefanie Woolridge , Mizuno Kana , Warren Mikako , Davies Stella M
Published: January 2020

Overactivated complement is a high-risk feature in HSCT recipients with transplant associated thrombotic microangiopathy (TA-TMA), and untreated patients have dismal outcomes. We present our experience of 64 pediatric HSCT recipients with high risk TA-TMA and multi-organ injury treated with the complement blocker eculizumab. We demonstrate significant improvement in 1y post-HSCT survival to 66% in treated patients from our previously reported untreated cohort with same high-risk TA-TMA features that had 1y post-HSCT survival of 16.7%. Responding patients benefited from a brief but intensive eculizumab therapy course using PK/PD guided dosing, requiring a median of 11 doses of eculizumab (IQR 7-20). Therapy was discontinued due to resolution of TA-TMA at a median of 66 days (IQR 41-110). Subjects with higher complement activation measured by elevated blood sC5b-9 at the start of therapy were less likely to respond to treatment (OR =0.15, p-value 0.0014), and required more doses of eculizumab [r = 0.43, p-value = 0.0004]. Patients with intestinal bleeding had the fastest eculizumab clearance, required the highest number of eculizumab doses (20 vs 9, p=0.0015), and had lower 1y survival (44% vs 78%, p=0.01). Over 70% of survivors had proteinuria on long term follow up. The best GFR recovery in survivors was a median 20% lower (IQR 7.3-40.3%) than their pre-HSCT GFR. In summary, complement blockade with eculizumab is an effective therapeutic strategy for high risk TA-TMA, but some patients with severe disease lack a complete response, prompting us to propose early intervention strategies and search for additional targetable endothelial injury pathways.
Volatile organic compound breath signatures of children with cystic fibrosis by real-time SESI-HRMS
Authors: Weber Ronja , Haas Naemi , Baghdasaryan Astghik , Bruderer Tobias , Inci Demet , Micic Srdjan , Perkins Nathan , Spinas Renate , Zenobi Renato , Moeller Alexander
Published: January 2020

Early pulmonary infection and inflammation result in irreversible lung damage and are major contributors to cystic fibrosis (CF)-related morbidity. An easy to apply and noninvasive assessment for the timely detection of disease-associated complications would be of high value. We aimed to detect volatile organic compound (VOC) breath signatures of children with CF by real-time secondary electrospray ionisation high-resolution mass spectrometry (SESI-HRMS).

A total of 101 children, aged 4–18 years (CF=52; healthy controls=49) and comparable for sex, body mass index and lung function were included in this prospective cross-sectional study. Exhaled air was analysed by a SESI-source linked to a high-resolution time-of-flight mass spectrometer. Mass spectra ranging from m/z 50 to 500 were recorded.

Out of 3468 m/z features, 171 were significantly different in children with CF (false discovery rate adjusted p-value of 0.05). The predictive ability (CFversushealthy) was assessed by using a support-vector machine classifier and showed an average accuracy (repeated cross-validation) of 72.1% (sensitivity of 77.2% and specificity of 67.7%).

This is the first study to assess entire breath profiles of children with SESI-HRMS and to extract sets of VOCs that are associated with CF. We have detected a large set of exhaled molecules that are potentially related to CF, indicating that the molecular breath of children with CF is diverse and informative.
Analysing long-term change in small benthos: geomorphological dynamics affects method selection
Authors: Armonies Werner
Published: January 2020

In the tidal inlets of the northern Wadden Sea, species composition of selected taxa of the small benthos is compared to a study performed some 35 years before, using the same methods and sampling the same sites. Site-by-site comparisons suggest a dramatic change in community composition at a local scale. However, geomorphology is highly dynamic in this area, and sediment composition, water depth, or both, had changed during the intermediate decades in most of the sites. Since most of the species are limited to a single sediment type, a habitat approach was used for an alternative analysis of the data. This contradicted the idea of dramatic change but revealed relatively high stability of species composition at a regional scale, indicating that local change cannot be up-scaled to larger areas in this highly dynamic environment. Instead, a habitat approach is more adequate though increasing environmental dynamics requires increasing sampling effort. As a by-product of this study, 8 new taxa of Platyhelminthes are described: Karlingia septentrionalis n. sp., Paracalviria diadema n. sp., Kataplana macrobursalia n. sp., Adenorhynchus compositus n. sp., Litucivis simplex n. sp., Scoliopharyngea magnaspina n. sp., Promesostoma convolutum n. sp., and Gnathorhynchus rostellatus indivisus n. spp.
Age and growth of Glycymeris longior (Sowerby, 1832) clam at the southern edge of its distribution (Argentine Sea)
Authors: Gimenez Lucas H. , Doldan María del Socorro , Zaidman Paula C. , Morsan Enrique M.
Published: January 2020

Even thoughGlycymeris longioris a clam widely distributed in the SW Atlantic Ocean, little is known about its biology and life history. The present study assessed the periodicity of the internal growth increments ofG. longiorusing thin shell sections. Each internal growth increment was composed of two alternating bands: a translucent band (light-coloured when viewed with transmitted light) and an opaque band (dark-coloured). Annual formation for each pair of bands was demonstrated. The formation of the annual growth increments was synchronous among individuals. Growth was determined from live clams collected at El Sótano, Argentine Sea (age range = 29 to 69 years). According to the growth model,G. longiorgrows fast during the first 5 years of life and then growth becomes slower in later years; individuals reached 50% and 90% of maximum size at 5 and 13 years of age, respectively. High variability was found in shell height for the first 10 years: differences up to 5–7 mm among individuals were registered for the first 2 years of age, and up to 11 mm between the ages of 3 and 9 years. The growth performance index phi-prime (φ′) and the index of growth performance (P) ofG. longiorwere compared with those of other Glycymeris species. Our results indicate thatG. longioris a slow-growing species with a long lifespan (maximum longevity = 69 years).
Genetic architecture of quantitative traits in beef cattle revealed by genome wide association studies of imputed whole genome sequence variants: I: feed efficiency and component traits
Authors: Zhang Feng , Wang Yining , Mukiibi Robert , Chen Liuhong , Vinsky Michael , Plastow Graham , Basarab John , Stothard Paul , Li Changxi
Published: January 2020

Background

Genome wide association studies (GWAS) on residual feed intake (RFI) and its component traits including daily dry matter intake (DMI), average daily gain (ADG), and metabolic body weight (MWT) were conducted in a population of 7573 animals from multiple beef cattle breeds based on 7,853,211 imputed whole genome sequence variants. The GWAS results were used to elucidate genetic architectures of the feed efficiency related traits in beef cattle.

Results

The DNA variant allele substitution effects approximated a bell-shaped distribution for all the traits while the distribution of additive genetic variances explained by single DNA variants followed a scaled inverse chi-squared distribution to a greater extent. With a threshold ofP-value < 1.00E-05, 16, 72, 88, and 116 lead DNA variants on multiple chromosomes were significantly associated with RFI, DMI, ADG, and MWT, respectively. In addition, lead DNA variants with potentially large pleiotropic effects on DMI, ADG, and MWT were found on chromosomes 6, 14 and 20. On average, missense, 3’UTR, 5’UTR, and other regulatory region variants exhibited larger allele substitution effects in comparison to other functional classes. Intergenic and intron variants captured smaller proportions of additive genetic variance per DNA variant. Instead 3’UTR and synonymous variants explained a greater amount of genetic variance per DNA variant for all the traits examined while missense, 5’UTR and other regulatory region variants accounted for relatively more additive genetic variance per sequence variant for RFI and ADG, respectively. In total, 25 to 27 enriched cellular and molecular functions were identified with lipid metabolism and carbohydrate metabolism being the most significant for the feed efficiency traits.

Conclusions

RFI is controlled by many DNA variants with relatively small effects whereas DMI, ADG, and MWT are influenced by a few DNA variants with large effects and many DNA variants with small effects. Nucleotide polymorphisms in regulatory region and synonymous functional classes play a more important role per sequence variant in determining variation of the feed efficiency traits. The genetic architecture as revealed by the GWAS of the imputed 7,853,211 DNA variants will improve our understanding on the genetic control of feed efficiency traits in beef cattle.
Salvianolic acid a inhibits platelet activation and aggregation in patients with type 2 diabetes mellitus
Authors: Zhou Ai-ming , Xiang Yi-jia , Liu En-qian , Cai Chang-hong , Wu Yong-hui , Yang Le-bing , Zeng Chun-lai
Published: January 2020

Background

Platelets in patients with type 2 diabetes mellitus (DM2) are characterized by increased activation and aggregation, which tends to be associated with a high morbidity and mortality due to cardiovascular disease (CVD). Moreover, a large proportion of DM2 patients show an inadequate response to standard antiplatelet treatments, contributing to recurrent cardiovascular events. In our previous study, we indicated that Salvianolic acid A (SAA) presents an antiplatelet effect in healthy volunteers. However, whether it can inhibit “activated platelets” with a pathologic status has not been explored. Therefore, this study was designed to investigate the antiplatelet effect of SAA and its diabetic complication-related difference in DM2.

Methods

Forty patients diagnosed with DM2 from January 2018 to April 2018 were recruited. Fibrinogen-binding (PAC-1) and P-selectin (CD62p) flow cytometry reagents were measured under resting and stimulated conditions by flow cytometry, while agonist-induced platelet aggregation was conducted by light transmission aggregometry. Before all these measurements were conducted, all platelet samples were preincubated with a vehicle or SAA for 10 min. Additionally, the diabetic complication-related difference in the antiplatelet effect of SAA was further studied in enrolled patients.

Results

The expressions of PAC-1 and CD62p were elevated in DM2, as well as the maximal platelet aggregation. In addition, SAA decreased the expressions of PAC-1 and CD62p, which were enhanced by ADP and thrombin (all P < 0.01). It also reduced the platelet aggregation induced by ADP (P < 0.001) and thrombin (P < 0.05). Comparing the antiplatelet effect of SAA on DM2, with and without diabetic complications, no statistically significant difference was found (all P > 0.05).

Conclusions

The present study demonstrated that SAA can inhibit platelet activation and aggregation in patients with DM2, and the inhibition did not abate for the existence of diabetic complications.
Painless retrograde type A aortic dissection followed conservative treatment of type B aortic dissection: a case report
Authors: Ruan Yongle , Wang Zhiwei , Wu Zhiyong , Ren Wei , Ren Zongli , Yu Anfeng , Rahouma Mohamed
Published: January 2020

Background

Retrograde type A aortic dissection (RTAD) is a fatal aortic disease secondary to descending aortic dissection, and might be misdiagnosed due to its atypical symptoms lead to catastrophic outcomes.

Case presentation

We herein reported a case of a 40-year old Chinese non-comorbid man who received conservative treatment for acute type B aortic dissection and progressed to RTAD in a painless manner in a week. After open surgical aortic repair with stented elephant truck technique, the patient survived without obvious complication and cured with a satisfactory outcome in a half-year follow-up.

Conclusion

This case indicates that RTAD may present without typical symptoms, early diagnosis and open surgical procedure are imperative for treating RTAD.
A woman’s worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa
Authors: Anto-Ocrah Martina , Cushman Jeremy , Sanders Mechelle , De Ver Dye Timothy
Published: January 2020

Background

Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for “timely access to emergency obstetric care.” This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region.

Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness.

Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile.

Main text

In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control.

Conclusions

The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent.
Heart failure management insights from primary care physicians and allied health care providers in Southwestern Ontario
Authors: Boa Sorte Silva Narlon C. , Pulford Roseanne W. , Lee Douglas S. , Petrella Robert J.
Published: January 2020

Background

It remains to be determined whether collaborative strategies to improve and sustain overall health in patients with heart failure (HF) are currently being adopted by health care professionals. We surveyed primary care physicians, nurses and allied health care professionals in Southwestern Ontario regarding how they currently manage HF patients and how they perceive limitations, barriers and challenges in achieving optimal management in these patients.

Methods

We developed an online survey based on field expertise and a review of pertinent literature in HF management. We analyzed quantitative data collected via an online questionnaire powered by Qualtrics®. The survey included 87 items, including multiple choice and free text questions. We collected participant demographic and educational background, and information relating to general clinical practice and specific to HF management. The survey was 25 min long and was administered in October and November of 2018.

Results

We included 118 health care professionals from network lists of affiliated physicians and clinics of the department of Family Medicine at Western University; 88.1% (n = 104) were physicians while 11.9% (n = 14) were identified as other health care professionals. Two-thirds of our respondents were females (n = 72) and nearly one-third were males (n = 38). The survey included mostly family physicians (n = 74) and family medicine residents (n = 25). Most respondents indicated co-managing their HF patients with other health care professionals, including cardiologists and internists. The vast majority of respondents reported preferring to manage their HF patients as part of a team rather than alone. As well, the majority respondents (n = 47) indicated being satisfied with the way they currently manage their HF patients; however, some indicated that practice set up and communication resources, followed by experience and education relating to HF guidelines, current drug therapy and medical management were important barriers to optimal management of HF patients.

Conclusions

Most respondents indicated HF management was satisfactory, however, a minority did identify some areas for improvement (communication systems, work more collaborative as a team, education resources and access to specialists). Future research should consider these factors in developing strategies to enhance primary care involvement in co-management of HF patients, within collaborative and multidisciplinary systems of care.