bluuebunny/crossref_metadata_2025 huggingface dataset:
Interlaminar Toughening of Fiber Reinforced Polymers by Synergistic Modification of Resin and Fiber
Authors: Bian Dakai , Tsui Jason C. , Kydd Robert R. , Shim D. J. , Jones Marshall , Yao Y. Lawrence
Published: September 2018

The synergistic effect of combining different modification methods was investigated in this study to improve the interlaminar toughness and delamination resistance of fiber reinforced polymers (FRP). Epoxy-compatible polysulfone (PSU) was end-capped with epoxide group through functionalization, and the fiber surface was chemically grafted with amino functional group to form a micron-size rough surface. Consequently, the long chain of PSU entangles into crosslinked thermoset epoxy network, additionally, epoxide group on PSU further improves the bonding through chemical connection to the epoxy network and amino group on fiber surface. The combined modification methods can generate both strong physical and chemical bonding. The feasibility of using this method in vacuum assisted resin transfer molding was determined by rheometer. The impact of formed chemical bonds on the crosslinking density was examined through glass transition temperatures. The chemical modifications were characterized by Raman Spectroscopy to determine the chemical structures. Synergistic effect of the modification was established by Mode I and Mode II fracture tests which quantify the improvement on composites delamination resistance and toughness. The mechanism of synergy was explained based on the fracture mode and interaction between the modification methods. Finally, Numerical simulation was used to compare samples with and without modifications. The experiment results showed that synergy is achieved at low concentration of modified PSU because the formed chemical bonds compensate the effect of low crosslinking density and interact with the modified fiber.
Scalable Detection of Defects in Additively Manufactured PLA Components
Authors: Kulkarni Amol , Vidvans Amey , Rifat Mustafa , Bicknell Gregory , Gong Xi , Manogharan Guha , Terpenny Janis , Basu Saurabh
Published: September 2018

The present work delineates a novel and scalable approach to characterization of defects in additively manufactured components. The approach is based on digital image correlation and involves characterization of surface speeds during rigid body rotation of the workpiece, followed by normalization with respect to rotation speed. Towards this, two different imaging sources were tested, viz. smartphone camera and sophisticated high-resolution/high-speed camera. The proposed approach successfully delineated horizontal and vertical notch defects in a simple FDM fabricated component. Accuracy of this approach was tested with concomitant laser based scanning. Some limitations of this approach were discussed.
Rotary Ultrasonic Machining of CFRP: Effects of Abrasive Properties
Authors: Fernando Palamandadige , Zhang Meng , Pei Zhijian
Published: September 2018

Drilling is the most common machining practice conducted on carbon fiber reinforced plastics (CFRP), which is challenging to conventional machining processes, such as twist drilling. Rotary ultrasonic machining (RUM) is a non-traditional machining process that has been successfully used to drill CFRP, many other brittle (e.g. silicon, ceramics), and ductile (e.g. titanium alloy (Ti-6Al-4V), stainless steel) materials. RUM is superior to twist drilling on CFRP hole-making in many aspects: lower cutting force and torque, better surface finish, less potential for delamination, and better tool life. Since RUM is a hybrid process of abrasive grinding and ultrasonic machining, it is important to study the effects of abrasive properties on output variables. This paper for the first time investigates the effects of abrasive properties (abrasive size and abrasive concentration) on output variables (cutting force, torque, and surface roughness) in RUM of CFRP. It is found that cutting force increased as abrasive size increased and as abrasive concentration increased; however, abrasive properties did not have significant effects on surface roughness of the machined holes.
Influence of Curvature Radius of 40Cr on Mechanical Properties of Laser Cladding Layer
Authors: Xu Mingsan , Malama Kerstern , Li Bingbing
Published: September 2018

Laser cladding utilizes a high-powered laser to fuse and solidify the metal powders, which results in a complex change of physical and mechanical properties. Selection of parameters and creative structure design are critical for laser cladding technology. High-speed steel is cladded on the base metal 40Cr by diode laser to investigate the influence of curvature radius, scanning speed, gas flow and laser power. The micro hardness and residue stress are tested while the microstructure is analyzed. According to analysis of the process parameters in orthogonal experiment, the optimal parameters are: curvature radius 100 mm, laser power 1200W, gas flow 1000 L/h, and scanning speed 16 mm/s. Under the optimal parameters, the microstructure and grid is uniform and the grain growth is along the same direction.
An Investigation on Residual Stress in 316L Stainless Steel by Selective Laser Melting
Authors: Bian Peiying , Shi Jing , Shao Xiaodong , Du Jingli , Dai Jun , Xu Kewei
Published: September 2018

In this paper, the residual stress of 316L stainless steel obtained from selective laser melting process is measured, and the process factors that influence residual stress are analyzed. Two levels of laser power, two levels of scanning speed, and other auxiliary factors such as height of support structure are considered. For each combination of condition, the residual stress is measured at three in-depth positions, and the microstructure is also observed. The results show that the as-built 316L samples have fine microstructure with no clear grain boundaries, and the residual stresses at all measuring depths are tensile for all as-built SLM specimens. Meanwhile, it is found that the higher laser power and the lower scanning speed lead to the increase of tensile residual stress. Also, the tensile residual stress tends to increase with the depth into surface. In addition, the increase in position symmetry of specimen on the build platform appears to be able to reduce the magnitude of tensile residual stress. On the other hand, the effects of specimen location with respect to powder spreading and height of support are less conclusive.
Cell Wall Glycans Mediate Recognition of the Dairy Bacterium Streptococcus thermophilus by Bacteriophages
Authors: Szymczak Paula , Filipe Sérgio Raposo , Covas Gonçalo , Vogensen Finn Kvist , Neves Ana Rute , Janzen Thomas
Published: September 2018

Streptococcus thermophilus
is widely used in starter cultures for cheese and yoghurt production. During dairy fermentations, infections of bacteria with bacteriophages result in acidification failures and a lower quality of the final products. An understanding of the molecular factors involved in phage-host interactions, in particular, the phage receptors in dairy bacteria, is a crucial step for developing better strategies to prevent phage infections in dairy plants.
Engineering Kluyveromyces marxianus as a Robust Synthetic Biology Platform Host
Authors: Cernak Paul , Estrela Raissa , Poddar Snigdha , Skerker Jeffrey M. , Cheng Ya-Fang , Carlson Annika K. , Chen Berling , Glynn Victoria M. , Furlan Monique , Ryan Owen W. , Donnelly Marie K. , Arkin Adam P. , Taylor John W. , Cate Jamie H. D.
Published: September 2018

The yeast
Kluyveromyces marxianus
grows at high temperatures and on a wide range of carbon sources, making it a promising host for industrial biotechnology to produce renewable chemicals from plant biomass feedstocks. However, major genetic engineering limitations have kept this yeast from replacing the commonly used yeast
Saccharomyces cerevisiae
in industrial applications. Here, we describe genetic tools for genome editing and breeding
K. marxianus
strains, which we use to create a new thermotolerant strain with promising fatty acid production. These results open the door to using
K. marxianus
as a versatile synthetic biology platform organism for industrial applications.
Significant cephalad lead migration with use of externally powered spinal cord stimulator
Authors: Jain Sameer , Fishman Michael A , Wu Chengyuan
Published: September 2018

Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.
Haemorrhagic cholecystitis: a rare entity not to be forgotten
Authors: Ng Zi Qin , Pradhan Sharin , Cheah Kim , Wijesuriya Ruwan
Published: September 2018

Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
Increasing participation in a vector control campaign: a cluster randomised controlled evaluation of behavioural economic interventions in Peru
Authors: Buttenheim Alison M , Paz-Soldán Valerie A , Castillo-Neyra Ricardo , Toledo Vizcarra Amparo M , Borrini-Mayori Katty , McGuire Molly , Arevalo-Nieto Claudia , Volpp Kevin G , Small Dylan S , Behrman Jere R , Naquira-Verlarde Cesar , Levy Michael Z
Published: September 2018

Objective

To assess the efficacy of strategies informed by behavioural economics for increasing participation in a vector control campaign, compared with current practice.

Design

Pragmatic cluster randomised controlled trial.

Setting

Arequipa, Peru.

Participants

4922 households.

Interventions

Households were randomised to one of four arms: advanced planning, leader recruitment, contingent group lotteries, or control.

Main outcome measures

Participation (allowing the house to be sprayed with insecticide) during the vector control campaign.

Results

In intent-to-treat analyses, none of the interventions increased participation compared with control (advanced planning adjusted OR (aOR) 1.07 (95% CI 0.87 to 1.32); leader recruitment aOR 0.95 (95% CI 0.78 to 1.15); group lotteries aOR 1.12 (95% CI 0.89 to 1.39)). The interventions did not improve the efficiency of the campaign (additional minutes needed to spray house from generalised estimating equation regressions: advanced planning 1.08 (95% CI −1.02 to 3.17); leader recruitment 3.91 (95% CI 1.85 to 5.97); group lotteries 3.51 (95% CI 1.38 to 5.64)) nor did it increase the odds that houses would be sprayed in an earlier versus a later stage of the campaign cycle (advanced planning aOR 0.94 (95% CI 0.76 to 1.25); leader recruitment aOR 0.68 (95% CI 0.55 to 0.83); group lotteries aOR 1.19 (95% CI 0.96 to 1.47)). A post hoc analysis suggested that advanced planning increased odds of participation compared with control among households who had declined to participate previously (aOR 2.50 (95% CI 1.41 to 4.43)).

Conclusions

Achieving high levels of household participation is crucial for many disease prevention efforts. Our trial was not successful in improving participation compared with the existing campaign. The trial highlights persistent challenges to field experiments as well as lessons about the intervention design process, particularly understanding barriers to participation through a behavioural lens.

Trial registration number

American Economic Association AEARCTR-0000620.
Integration of academic and health education for the prevention of physical aggression and violence in young people: systematic review, narrative synthesis and intervention components analysis
Authors: Melendez-Torres G.J. , Tancred Tara , Fletcher Adam , Campbell Rona , Thomas James , Bonell Christopher
Published: September 2018

Objectives

To systematically review evidence on the effectiveness of interventions including integration of academic and health education for reducing physical aggression and violence, and describe the content of these interventions.

Data sources

Between November and December 2015, we searched 19 databases and 32 websites and consulted key experts in the field. We updated our search in February 2018.

Eligibility criteria

We included randomised trials of school-based interventions integrating academic and health education in students aged 4–18 and not targeted at health-related subpopulations (eg, learning or developmental difficulties). We included evaluations reporting a measure of interpersonal violence or aggression.

Data extraction and analysis

Data were extracted independently in duplicate, interventions were analysed to understand similarities and differences and outcomes were narratively synthesised by key stage (KS).

Results

We included 13 evaluations of 10 interventions reported in 20 papers. Interventions included either full or partial integration, incorporated a variety of domains beyond the classroom, and used literature, local development or linking of study skills and health promoting skills. Evidence was concentrated in KS2, with few evaluations in KS3 or KS4, and evaluations had few consistent effects; evaluations in KS3 and KS4 did not suggest effectiveness.

Discussion

Integration of academic and health education may be a promising approach, but more evidence is needed. Future research should consider the ‘lifecourse’ aspects of these interventions; that is, do they have a longitudinal effect? Evaluations did not shed light on the value of different approaches to integration.
Perceptions of French general practitioners and patients regarding dextropropoxyphene withdrawal: a qualitative study
Authors: Combier Aurélie , Bon Lucile , Van Ganse Eric , Aubrun Frédéric , Letrilliart Laurent
Published: September 2018

Objectives

Dextropropoxyphene (DXP), a step 2 analgesic commonly prescribed in France, was withdrawn from the French market in 2011 following a European decision due to its poor risk-benefit ratio. The purpose of this study was to explore the perceptions of French general practitioners (GPs) and patients regarding DXP withdrawal.

Design

Qualitative study based on 26 individual semi-structured interviews.

Setting

Rhône-Alpes region of France.

Participants

Thirteen patients and 13 GPs.

Methods

Interviews were conducted to collect data concerning the status of DXP, its efficacy and safety, the conditions of DXP’s withdrawal and its potential impact. The transcripts were analysed using NVivo software.

Results

DXP was a very popular drug among both patients and GPs. Its withdrawal was a bad experience for patients and many GPs; these misunderstood the reasons for its withdrawal and several contested them. They generally recognised more benefits than risks of DXP and considered alternative drugs unsatisfactory. In the same period, a French court case regarding another drug led to distrust towards the pharmaceutical industry and healthcare institutions, which contributed to the negative feelings reported. However, the experience was positive for the GPs who had been alerted to the poor DXP risk-benefit ratio well before its withdrawal.

Conclusions

Apart from physicians who were previously informed of its poor risk-benefit ratio, DXP withdrawal was not a good experience for patients and GPs. Better anticipation by the health authorities, in terms of pharmacoepidemiological surveillance and communication to healthcare professionals as well as the general public, should provide better acceptance of such a decision in the future.
Role of supplementary material in biomedical journal articles: surveys of authors, reviewers and readers
Authors: Price Amy , Schroter Sara , Clarke Mike , McAneney Helen
Published: September 2018

Objective

Many journals permit authors to submit supplementary material for publication alongside the article. We explore the value, use and role of this material in biomedical journal articles from the perspectives of authors, peer reviewers and readers.

Design and setting

We conducted online surveys (November–December 2016) of corresponding authors and peer reviewers at 17 BMJ Publishing Group journals in a range of specialities.

Participants

Participants were asked to respond to one of three surveys: as authors, peer reviewers or readers.

Results

We received 2872/20340 (14%) responses: authors 819/6892 (12%), peer reviewers 1142/6682 (17%) and readers 911/6766 (14%). Most authors submitted (711/819, 87%) and 80% (724/911) of readers reported reading supplementary material with their last article, while 95% (1086/1142) of reviewers reported seeing these materials sometimes. Additional data tables were the most common supplementary material reported (authors: 74%; reviewers: 89%; readers: 67%). A majority in each group indicated additional tables were most useful to readers (61%–77%); 20%–36% and 3%–4% indicated they were most useful to peer reviewers and journal editors, respectively. Checklists and reporting guidelines showed the opposite: higher proportions of each group regarded these as most useful to journal editors. All three groups favoured the publication of additional tables and figures on the journal’s website (80%–83%), with <4% of each group responding that these do not need to be available. Approximately one-fifth (16%–23%) responded that raw study data should be available on the journal’s website, while 24%–33% said that these materials should not be made available anywhere.

Conclusions

Authors, peer reviewers and readers agree that supplementary materials are useful. Supplementary tables and figures were favoured over reporting checklists or raw data for reading but not for study replication. Journals should consider the roles, resource costs and strategic placement of supplementary materials to ensure optimal usage and minimise waste.

Trial registration number

NCT02961036.
Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review
Authors: Gates Michelle , Wingert Aireen , Featherstone Robin , Samuels Charles , Simon Christopher , Dyson Michele P
Published: September 2018

Objectives

For physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.

Design

We systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.

Data sources

We searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.

Eligibility criteria for selecting studies

English or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.

Results

Of 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.

Conclusions

Fatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.
Impact of group practices on patients, physicians and healthcare systems: protocol for a scoping review
Authors: Zwiep Terry M , Greenberg Joshua A , Balaa Fady , McIsaac Daniel I , Musselman Reilly P , Raiche Isabelle , Williams Lara , Moloo Husein
Published: September 2018

Introduction

Group practices have potential benefits for patients, physicians and healthcare systems. Although group practices have been around for many years, research in this area is lacking and generally is centred around the economic benefits that may be realised from group practice. The aim of this scoping review is to identify the impact that group practices have on patients, physicians and healthcare systems to guide further research in this area.

Methods and analysis

A scoping review will be performed based on the methodology proposed by Arksey and O’Malley and refined by Levac and colleagues. MEDLINE, EMBASE, Cochrane Central and Cochrane Economic Database will be searched from inception to present day to identify relevant studies that assess the impact of group practices on patient care, satisfaction and outcomes; physician quality of life, satisfaction and income and healthcare systems. Titles and abstracts will be screened by two members and the abstraction results charted and verified. Qualitative and quantitative analyses will be performed to identify key themes.

Ethics and dissemination

Research ethics board approval is not required for this scoping review. A consultation phase will be used to discuss the results with key stakeholders followed by dissemination at local and national levels. We will also publish the results in a peer-reviewed journal.
Efficacy and tolerability of novel triple combination therapy in drug-naïve patients with type 2 diabetes from the TRIPLE-AXEL trial: protocol for an open-label randomised controlled trial
Authors: Kim Nam Hoon , Lim Soo , Kwak Soo Heon , Moon Min Kyong , Moon Jun Sung , Lee Yong-ho , Cho Ho Chan , Lee Juneyoung , Kim Sin Gon
Published: September 2018

Introduction

Patients with type 2 diabetes are at risk of microvascular and macrovascular complications. Intensive glycaemic control, especially in patients with short duration of diabetes, is the mainstay of management of type 2 diabetes to lower the risk of complications. However, despite the improvement in the understanding of the pathophysiology of type 2 diabetes and development of novel glucose-lowering agents, long-term durable glycaemic control remains a difficult goal to achieve. Several challenging clinical trials proved that an early combination therapy with a variety of glucose-lowering agents had a more favourable effect than conventional stepwise therapy in terms of glycaemic control. We aim to evaluate the efficacy and tolerability of a novel, initial triple combination therapy with metformin, sodium glucose cotransporter 2 inhibitor (dapagliflozin) and dipeptidyl peptidase-4 inhibitor (saxagliptin) compared with conventional stepwise add-on therapy in drug-naïve patients with recent-onset type 2 diabetes.

Methods and analysis

This study is a multicentre, prospective, randomised, open-label, parallel group, comparator-controlled trial. A total of 104 eligible participants will be randomised to either the initial combination therapy group or the conventional stepwise add-on therapy group for 104 weeks. The primary endpoint is the proportion of patients who achieved haemoglobin A1c level<6.5% without hypoglycaemia, weight gain or discontinuation due to adverse events at 104 weeks. This trial will determine whether a novel triple combination therapy with metformin, dapagliflozin and saxagliptin has a beneficial effect on durable glycaemic control compared with conventional therapy in drug-naïve patients with type 2 diabetes.

Ethics and dissemination

This study protocol was approved by the local institutional review boards and independent ethics committees over the recruitment sites. Results of this study will be disseminated in scientific journals and scientific conferences.

Trial registration number

NCT02946632; Pre-results.
Education, sex and risk of stroke: a prospective cohort study in New South Wales, Australia
Authors: Jackson Caroline A , Sudlow Cathie L M , Mishra Gita D
Published: September 2018

Objective

To determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.

Design

Prospective cohort study.

Setting

Population based, New South Wales, Australia.

Participants

253 657 stroke-free participants from the New South Wales 45 and Up Study.

Outcome measures

First-ever stroke events, identified through linkage to hospital and mortality records.

Results

During mean follow-up of 4.7 years, 2031 and 1528 strokes occurred among men and women, respectively. Age-standardised stroke rate was inversely associated with education level, with the absolute risk difference between the lowest and highest education group greater among women than men. In relative terms, stroke risk was slightly more pronounced in women than men when comparing low versus high education (age-adjusted HRs: 1.41, 95% CI 1.16 to 1.71 and 1.25, 95% CI 1.07 to 1.46, respectively), but there was no clear evidence of statistical interaction. This association persisted into older age, but attenuated. Much of the increased stroke risk was explained by modifiable lifestyle factors, in both men and women.

Conclusion

Low education is associated with increased stroke risk in men and women, and may be marginally steeper in women than men. This disadvantage attenuates but persists into older age, particularly for women. Modifiable risk factors account for much of the excess risk from low education level. Public health policy and governmental decision-making should reflect the importance of education, for both men and women, for positive health throughout the life course.
Protocol for the insight study: a randomised controlled trial of single-dose tocilizumab in patients with depression and low-grade inflammation
Authors: Khandaker Golam M , Oltean Bianca P , Kaser Muzaffer , Dibben Claire R M , Ramana Rajini , Jadon Deepak R , Dantzer Robert , Coles Alasdair J , Lewis Glyn , Jones Peter B
Published: September 2018

Introduction

Observational studies indicate a potentially causal role for interleukin 6 (IL-6), a proinflammatory cytokine, in pathogenesis of depression, but interventional studies based on patients with depression have not been conducted. Tocilizumab, anti-inflammatory drug, is a humanised monoclonal antibody that inhibits IL-6 signalling and is licensed in the UK for treatment of rheumatoid arthritis. The main objectives of this study are to test whether IL-6 contributes to the pathogenesis of depression and to examine potential mechanisms by which IL-6 affects mood and cognition. A secondary objective is to compare depressed participants with and without evidence of low-grade systemic inflammation.

Methods and analysis

This is a proof-of-concept, randomised, parallel-group, double-blind, placebo-controlled clinical trial. Approximately 50 participants with International Classification of Diseases 10th revision (ICD-10) diagnosis of depression who have evidence of low-grade inflammation, defined as serum high-sensitivity C reactive protein (hs-CRP) level ≥3 mg/L, will receive either a single intravenous infusion of tocilizumab or normal saline. Blood samples, behavioural and cognitive measures will be collected at baseline and after infusion around day 7, 14 and 28. The primary outcome is somatic symptoms score around day 14 postinfusion. In addition, approximately, 50 depressed participants without low-grade inflammation (serum hs-CRP level <3 mg/L) will complete the same baseline assessments as the randomised cohort.

Ethics and dissemination

The study has been approved by the South Central—Oxford B Research Ethics Committee (REC) (Reference: 18/SC/0118). Study findings will be published in peer-review journals. Findings will be also disseminated by conference/departmental presentations and by social and traditional media.

Trial registration number

ISRCTN16942542; Pre-results.
Health economics and quality of life in a feasibility RCT of paediatric acute appendicitis: a protocol study
Authors: Chorozoglou Maria , Reading Isabel , Eaton Simon , Hutchings Natalie , Hall Nigel J
Published: September 2018

Background

Acute appendicitis is one of the most common acute surgical emergencies in children and accounts for an annual cost of approximately £50 million to the National Health Service. Investigating alternative treatment options offers the best prospect of enhancing the quality of care for patients and potential opportunities for cost savings through better allocative efficiency. A feasibility randomised controlled trial (RCT) comparing a non-operative treatment pathway with appendicectomy for children with acute uncomplicated appendicitis is underway (CONTRACT feasibility RCT).

Aims

The prime objective of this economic substudy conducted alongside the CONTRACT feasibility RCT is to better understand and assess: (1) cost data collection tools and cost drivers by identifying patients’ pathways and (2) patient quality of life by assessing alternative paediatric health-related quality of life (HRQoL) instruments. Outcomes from this study will inform a future efficacy RCT assessing the effectiveness and cost-effectiveness of non-operative treatment pathway for the treatment of acute uncomplicated appendicitis in children.

Methods

The economic substudy will use individual-level data and will be conducted from the health system perspective over the study’s 6-month follow-up period. Microcosting will include health resource and service use, while potential benefits acquired will be measured using the HRQoL measures, Child Health Utility 9D (CHU-9D) and Euroqol-5 dimensions and 5 levels (EQ-5D-5L). We will assess the appropriateness of using the cost per quality-adjusted life year framework in the future RCT, as well as testing and identifying the most suitable HRQoL instrument.

Conclusions

The outcomes of the investigational economic substudy will be used to inform the design of our future definitive RCT. However, the result from this economic study will also provide a detailed description and account of the issues inherent in paediatric Economic Evaluations Alongside Clinical Trials with an emphasis on costing methods of interventions taking place in secondary care settings.

Trial registration number

ISRCTN1583043.
Cross-sectional survey of the undergraduate rheumatology curriculum in European medical schools: a EULAR School of Rheumatology initiative
Authors: Abhishek Abhishek , Iagnocco Annamaria , Bijlsma J W J , Doherty Michael , Lioté Frédéric
Published: September 2018

Objectives

To survey the undergraduate rheumatic and musculoskeletal diseases (RMDs) curriculum content in a sample of medical schools across Europe.

Methods

The undergraduate musculoskeletal diseases and disability curriculum of University of Nottingham, UK, was used as a template to develop a questionnaire on curriculum content. The questionnaire elicited binary (yes/no) responses and included the option to provide additional information as free text. The survey was mailed to members of the European League Against Rheumatism (EULAR) School of Rheumatology (Undergraduate Classroom) and to EULAR Standing Committee on Education and Training members in January 2017, with a reminder in February 2017.

Results

Responses were received from 21 schools belonging to 11 countries. Assessment of gait, hyperalgesic tender site response and hypermobility were not included in many curricula. Similarly, interpretation of investigations undertaken on synovial fluid was taught in only 16 schools. While disease-modifying anti-rheumatic drugs and biological agents, and urate-lowering treatment were included in the curricula of 20 and 21 institutions, respectively, only curricula from 18 schools included core non-pharmacological interventions. Osteoarthritis, gout, rheumatoid arthritis, spondyloarthropathy, polymyalgia rheumatica and lupus were included in the curriculum of all institutions. However, common RMDs such as calcium pyrophosphate deposition, fibromyalgia, giant cell arteritis and bone and joint infection were included in 19 curricula.

Conclusion

This survey highlights areas of similarities and differences in undergraduate curricula across Europe. It is hoped that the results of this survey will catalyse the development and agreement of a minimum core European Curriculum for undergraduate education in RMDs.
Sputum exosomes: promising biomarkers for idiopathic pulmonary fibrosis
Authors: Njock Makon-Sébastien , Guiot Julien , Henket Monique A , Nivelles Olivier , Thiry Marc , Dequiedt Franck , Corhay Jean-Louis , Louis Renaud E , Struman Ingrid
Published: September 2018

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease of unknown aetiology which leads rapidly to death. As diagnosis of IPF is complex, we aimed to characterise microRNA (miRNA) content of exosomes from sputum of patients with IPF. Using miRNA quantitative PCR array, we found a substantial dysregulation of sputum exosomal miRNA levels between patients with IPF and healthy subjects and identified a unique signature of three miRNAs. Interestingly, we found a negative correlation between miR-142-3p and diffusing capacity of the lungs for carbon monoxide/alveolar volume. This is the first characterisation of miRNA content of sputum-derived exosomes in IPF that identified promising biomarkers for diagnosis and disease severity.
Synthesis and characterization of novel bis(pyridine-2(1H)-thiones) and their bis(2-methylsulfanylpyridines) incorporating 2,6-dibromophenoxy moiety
Authors: Sanad Sherif M.H. , Abdel-Fattah Azza M. , Attaby Fawzy A. , Elneairy Mohamed A.A.
Published: September 2018

The novel 1,4-bis(2,6-dibromo-4-formylphenoxy)butane (3), prepared from 3,5-dibromobenzaldehyde (1), reacted with different hydrazines 4a–4d and active methylene containing compounds 9a–9d to give the corresponding bis(hydrazones) 5a–5d and bis(cinnamonitriles) 11a–11d, respectively. Both bis(2-cyanoacetic acid hydrazide) derivative 5d and bis(thioacrylamide) derivative 11a were taken as synthetic precursors for the synthesis of the target molecules bis(pyridine-2(1H)-thione) derivative 10 and 13a–13c and their bis(2-methylsulfanylpyridine) derivative 14 and 17a–17c. Another synthetic route was designed to prepare the target molecules 14 and 17a–17c in a better yield using pyridine-2(1H)-thione) derivative 15 and 19a–19c. Characterization of the newly prepared compounds via elemental analyses and spectral data are established.
Method for quantification of antioxidant capacity of processed fruit juices exploring the formation of the Fe(II)/3-hydroxy-4-nitroso-2,7-naphthalenedisulfonic complex
Authors: de Souza Maryane Woth , Moya Horacio Dorigan
Published: September 2018

The formation of the Fe(NRS)34− complex was used in a modified spectrophotometric method to quantify the total antioxidant capacity (TAC) of processed fruit juice samples. The procedure is based on the reduction of Fe(III) to Fe(II) in aqueous buffered solution (Tris; pH 8.0) containing the 3-hydroxy-4-nitroso-2,7-naphthalenedisulfonic acid (H2NRS). The absorbance values at 730 nm (A730 nm) of the Fe(NRS)34− complex obtained with juice samples were compared with A730 nm values obtained with a standard ascorbic acid solution and then subsequently used to quantify and express the TAC of the samples. Good positive relationship between TAC values in the analysed samples (grape, orange, passion fruit, cashew, peach, and strawberry) was found for both the Fe(NRS)34− complex method (proposed method) and ABTS•+ radical-free method (used as reference method). The TAC values obtained with Fe(NRS)34− and ABTS•+ also showed a positive correlation with the Folin–Ciocalteu index values. Fructose, glucose, BHT, and BHA did not interfere in the TAC quantification of the processed fruit juice samples with the proposed method. However, ascorbic acid (natural or added as additive, E300) and its derivatives (E301, E302, E303, E315, and E316) did interfere positively. As a 10-fold dilution is required and the absorbance measurements are performed at 730 nm, the proposed method was not subject to colour interference from the tested samples. The procedure suggested here is simple, easy to perform, reproducible, does not use organic solvents, and does not need expensive equipment.
Optimal dynamic pairs trading of futures under a two-factor mean-reverting model
Authors: Leung Tim , Yan Raphael
Published: September 2018

We study the problem of dynamically trading a pair of futures contracts. We consider a two-factor mean-reverting model, where the spot price tends to evolve around its stochastic equilibrium that is also mean-reverting. We derive the futures price dynamics and determine the optimal futures trading strategy by solving a utility maximization problem. By analyzing the associated Hamilton–Jacobi–Bellman equation, we solve the utility maximization explicitly and provide the optimal trading strategies in closed form. Our strategies are applied to volatility (VIX) futures trading, and illustrated in a series of numerical examples.
Weighted average price management of manufacturer sales on commodity exchanges
Authors: Vavilov Sergey A. , Kuznetsov Konstantin S.
Published: September 2018

This paper proposed a method to control the weighted average price of manufacturer sales. The study of the posed problem is necessary to hedge manufacturer profits from price slumps in commodity markets. The elaborated method is applied to managing the trading process on real world commodity exchanges to prove its effectiveness.
Identification of Lutzomyia longipalpis Odorant Binding Protein Modulators by Comparative Modeling, Hierarchical Virtual Screening, and Molecular Dynamics
Authors: Santana Isis Bugia , Leite Franco Henrique Andrade , Santos Junior Manoelito Coelho
Published: September 2018

Visceral leishmaniasis (VL) is the second most important vector-borne disease in the world. It is transmitted by Lutzomyia longipalpis in America; therefore, controlling the vector is essential to prevent the disease, especially using traps with chemical attractants. It is known that odorant binding proteins (OBPs) act at the first odor selection level, so in silico methodology was used to identify putative vector chemical modulators based on OBPs on known ligand structures. Therefore, 3D structures of L. longipalpis OBP were predicted through different comparative modeling methods. The best model was subjected to molecular dynamics studies. Then, a hierarchical virtual screening approach filtered OBP modulator-like compounds from ZINC12 biogenic database based in global chemical space, using principal components from ChemGPS-NP server. Such compounds then were evaluated and ranked according to their affinity with the OBP orthosteric site by molecular docking in DOCK 6.7. The compounds were scored by Grid Score function and top five ranked poses had their intermolecular complex interactions analyzed in PLIP server. Most ligands in the top of the rank were lysophospholipids, which could potentially interact with the OBP hydrophobic pocket through Phe72, Tyr76, Ile79, Ala87, Lys88, Asp92, Phe61, Leu75, Trp113, His120, and Phe122 residues and H-bonding with His120 and Phe122. Next, compounds in the top of the rank were evaluated by 50 ns MD and the results showed that the phosphate group of these compounds could set a salt bridge with His110. Additionally, Tyr76, Ala87, Met91, Trp113, and Phe122 were important to hydrophobic interactions with the ligand. These results highlight the importance of accurate assessments such as MD studies in order to analyze the docking results in the identification of new odorant modulators.
Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review
Authors: Anghelescu Aurelian
Published: September 2018

Background. The unilateral fetal variant of the posterior cerebral artery (FPCA) is characterized by the congenital absence of the P1 arterial segment. The artery of Percheron (AOP) is an uncommon vascular variant, in which a single dominant thalamoperforating arterial trunk arises from one P1 segment, bifurcates, and provides bilateral supply to the paramedian thalami and rostral midbrain. Case Presentation. This is a retrospective case study of a 37-year-old man with multiple lifestyle risk factors (chronic marijuana and tobacco abuse), who suffered a thalamomesencephalic stroke, rapidly worsening to comatose state. After restoration of consciousness, he clinically manifested with left paramedian midbrain syndrome. Imaging demonstrated an asymmetric paramedian thalamic infarction with mesencephalon extension, patency of the basilar, vertebral arteries, and left PCA and right-sided FPCA, respectively. Left-sided thalamoperforating arterioles were not differentiated; AOP was inferred. Neither evident clinical source of embolus nor prothrombotic states were found. Mobile cardiac telemetry and transesophageal echocardiography were not available. The diagnosis was established too late for thrombolytic treatment. Anticoagulation was indicated during the acute and subacute stages, followed by low dose of antiplatelet. Discussion. This uncommon cerebrovascular configuration (FPCA+AOP) might be the fourth case described in the literature. Sustained rehabilitation and abstinence from tobacco and cannabis led to favorable outcomes.
Cellular and Molecular Evidence of Acetaldehyde Elimination and Intracellular Environment Antioxidation by L-Cysteine
Authors: Li Zhenjing , Zhang Xiaohong , Xue Yibin , Zhang Jingkai , Li Meiling , Luo Cheng
Published: September 2018

Acetaldehyde is a harmful metabolite of smoking and drinking. This study was initially intended to facilitate the understanding of the possible injury mechanism of A549 cells damaged by acetaldehyde and the possible protective mechanism of L-cysteine (L-Cys) by analyzing the oxidative damage indicators, as well as the changes in cell morphology and gene expression. Results from the dithiodimorpholine nitrobenzoic acid colorimetric determination for glutathione peroxidase (GSH-Px) activity in L-Cys groups were significantly higher (P<0.01) than those in the acetaldehyde group in a dose-dependent manner. The expression of cytochrome c oxidase subunit II (COII) mRNA was significantly reduced compared with the control group (P<0.01) and was noticeably restored in the L-Cys groups. Scanning electronic microscopy observation, DAPI staining, and flow cytometry also indicated that L-Cys could effectively attenuate the oxidative damage to A549 cells caused by acetaldehyde and reduces the rate of apoptosis. In conclusion, the protective effects of L-Cys on A549 cells against oxidative damage by acetaldehyde were dose-dependent within the range of 10 μmol/L to 160 μmol/L. Acetaldehyde damaged the mitochondria and resulted in the apoptosis of A549 cells by reactive oxygen species (ROS), e.g., free radicals, but L-Cys reversed the release of cytochrome c from the mitochondria, reduced the rate of apoptosis, and protected cells from ROS and oxidative stress.
Thermal Stability and Luminescent Properties of Tri-cellulose Acetate Composites Containing Dy(SSA)3Phen Complex
Authors: Sun Xiangwei , Wu Feiyue , Luo Yan , Huang Mengjun , Li Yuntao , Liu Xiang , Liu Kunpeng
Published: September 2018

Dysprosium (Dy) ternary complex was prepared using 5-sulfosalicylic acid (SSA) as the first ligand and 1,10-phenanthroline (Phen) as the second ligand, denoted as Dy(SSA)3Phen. The complex was blended with tri-cellulose acetate (TCA) via a cosolvent method to obtain polymer luminescent materials. The composition and structure of the rare-earth complex were characterized by means of elemental analysis, infrared (IR) spectra, and thermogravimetric analysis (TGA). The fluorescence spectra displayed this pure Dy(SSA)3Phen complex, and the TCA/Dy(SSA)3Phen composites all emit blue light. The (90/10) composite possesses fine luminescent properties with quantum yield of 33.5% and thermal stability for potential usage as blue fluorescent materials.
miRNA Expression Profile of Saliva in Subjects of Yang Deficiency Constitution and Yin Deficiency Constitution
Authors: Chen Yu , Wu Yanling , Yao Haiqiang , Luo Hui , Lin Bing , Zhang Xiuping , Liang Xue , Sun Ranran , Zhao Shipeng , Li Yingshuai , Zheng Yanfei , Li Lingru , Wang Qi
Published: September 2018

Background/Aims: Based on the theory of constitution in Traditional Chinese Medicine (TCM), the Chinese Han population has been classified into nine constitutions. Of these, Yang deficiency constitution mainly exhibit cold intolerance while Yin deficiency constitution mainly exhibit heat intolerance. Some studies have been carried out to explore the modern genetic and biological basis of such constitution classification, but more remains to be done. MicroRNA (miRNA) serves as post-transcriptional regulators of gene expression and may play a role in the classification process. Here, we examined miRNA expression profile of saliva to further improve the comprehensiveness of constitution classification. Methods: Saliva was collected from Chinese Han individuals with Yang deficiency, Yin deficiency and Balanced constitutions (n=5 each), and miRNA expression profile was determined using the Human miRNA OneArray®v7. Based on 1.5 Fold change, means log2|Ratio|≥0.585 and P-value< 0.05, differentially expressed miRNA was screened. Target genes were predicted using DIANA-TarBasev7.0 and analysis of KEGG pathway was carried out using DIANA-mirPathv.3. Results: We found that 81 and 98 differentially expressed miRNAs were screened in Yang deficiency and Yin deficiency constitution, respectively. Among them, 16 miRNAs were identical and the others were unique. In addition, the target genes that are regulated by the unique miRNAs were significantly enriched in 27 and 20 signaling pathways in Yang deficiency and Yin deficiency constitution, respectively. Thyroid hormone signaling pathway is present in both constitutions. These unique miRNAs that regulated target genes of thyroid hormone signaling pathway may be associated with cold intolerance or heat intolerance. Conclusion: The results of our study show that Yang deficiency and Yin deficiency constitutions exhibit systematic differences in miRNA expression profile. Moreover, the distinct characteristics of TCM constitution may be explained, in part, by differentially expressed miRNAs.