bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of inspiratory muscle strength and inspiratory resistance on neck inspiratory muscle activation during controlled inspirations
Authors: Washino Sohei , Mankyu Hirotoshi , Kanehisa Hiroaki , Mayfield Dean L. , Cresswell Andrew G. , Yoshitake Yasuhide
Published: February 2019

New Findings

What is the central question of this study?

What factors influence the onset and magnitude of activation of the neck inspiratory muscles during inspiration?

What is the main finding and its importance?

Recruitment of the sternocleidomastoid and scalene muscles during inspiration, measured by means of surface EMG, was strongly correlated with maximal inspiratory pressure. This result indicates that muscle recruitment depends on the capacity of an individual to generate inspiratory pressure. Surface measurements of neck inspiratory muscle EMG activity might complement tests currently used for the screening of respiratory‐related disease.

The aims of the present study were as follows: (i) to examine the relationship between the onset of recruitment of the neck inspiratory muscles and inspiratory muscle strength; and (ii) to clarify the effect of inspiratory resistance on neck inspiratory muscle activation during inspiration at specific flow rates and to specific lung volumes. Inspiratory muscle strength, as indicated by maximal inspiratory pressure (MIP), and peak inspiratory flow rate (PFR) were measured in healthy participants. Subsequently, participants inspired at target inspiratory flow rates between 20 and 100% of PFR as closely as possible, with and without artificial inspiratory resistance. Electromyographic activity (EMGRMS) of the sternocleidomastoid and scalene muscles was measured from surface electrodes at each target flow rate for each 10% increment of forced vital capacity (FVC) between 20 and 50% of FVC. Recruitment onset for each muscle was determined from %PFR–EMGRMS curves at each lung volume (%FVC). Finally, linear regression analyses were performed for MIP and recruitment onset for each muscle at each %FVC. Recruitment onset during inspiration without inspiratory resistance was strongly correlated with MIP (r > 0.60, P < 0.040). Specifically, a lower MIP was associated with earlier muscle recruitment (i.e. recruitment at a lower flow rate), especially for the sternocleidomastoid muscle (r > 0.75, P < 0.005). Recruitment of both neck inspiratory muscles at a given flow rate was also earlier when inspiratory resistance was added (P = 0.002). These results indicate that the recruitment and activation of the neck inspiratory muscles depends on both inspiratory muscle strength and inspiratory resistance.
A computational investigation of the ventilation structure and maximum rate of metabolism for a physiologically based pharmacokinetic (PBPK) model of inhaled xylene
Authors: Yokley Karen A , Ashcraft Jaclyn , Luke Nicholas S
Published: February 2019

Physiologically based pharmacokinetic (PBPK) models are systems of ordinary differential equations that estimate internal doses following exposure to toxicants. Most PBPK models use standard equations to describe inhalation and concentrations in blood. This study extends previous work investigating the effect of the structure of air and blood concentration equations on PBPK predictions. The current study uses an existing PBPK model of xylene to investigate if different values for the maximum rate of toxicant metabolismВ can result in similar compartmental predictions when used with different equations describing inhalation. Simulations are performed using values based on existing literature. Simulated data is also used to determine specific values that result in similar predictions from different ventilation structures. Differences in ventilation equation structure may affect parameter estimates found through inverse problems, although further investigation is needed with more complicated models.
Numerical Solution of Nonlinear Reaction–Advection–Diffusion Equation
Authors: Singh Anup , Das S. , Ong S. H. , Jafari H.
Published: February 2019

In the present article, the advection–diffusion equation (ADE) having a nonlinear type source/sink term with initial and boundary conditions is solved using finite difference method (FDM). The solution of solute concentration is calculated numerically and also presented graphically for conservative and nonconservative cases. The emphasis is given for the stability analysis, which is an important aspect of the proposed mathematical model. The accuracy and efficiency of the proposed method are validated by comparing the results obtained with existing analytical solutions for a conservative system. The novelty of the article is to show the damping nature of the solution profile due to the presence of the nonlinear reaction term for different particular cases in less computational time by using the reliable and efficient finite difference method.
Numerical Nonlinear Analysis for Dynamic Stability of an Ankle-Hip Model of Balance on a Balance Board
Authors: Chumacero-Polanco Erik , Yang James , Chagdes James
Published: February 2019

Study of human upright posture (UP) stability is of great relevance to fall prevention and rehabilitation, especially for those with balance deficits for whom a balance board (BB) is a widely used mechanism to improve balance. The stability of the human-BB system has been widely investigated from a dynamical system point of view. However, most studies assume small disturbances, which allow to linearize the nonlinear human-BB dynamical system, neglecting the effect of the nonlinear terms on the stability. Such assumption has been useful to simplify the system and use bifurcation analyses to determine local dynamic stability properties. However, dynamic stability analysis results through such linearization of the system have not been verified. Moreover, bifurcation analyses cannot provide insight on dynamical behaviors for different points within the stable and unstable regions. In this study, we numerically solve the nonlinear delay differential equation that describes the human-BB dynamics for a range of selected parameters (proprioceptive feedback and time-delays). The resulting solutions in time domain are used to verify the stability properties given by the bifurcation analyses and to compare different dynamical behaviors within the regions. Results show that the selected bifurcation parameters have significant impacts not only on UP stability but also on the amplitude, frequency, and increasing or decaying rate of the resulting trajectory solutions.
Frequency Response-Based Indirect Load Identification Using Optimum Placement of Strain Gages and Accelerometers
Authors: Alqam Hana'a M. , Dhingra Anoop K.
Published: February 2019

This paper presents an approach for indirect identification of dynamic loads acting on a structure through measurement of structural response at a finite number of optimally selected locations. Using the concept of frequency response function (FRF), the structure itself is considered as a load transducer. Two different types of sensors are investigated to measure the structural response. These include a use of accelerometers that leads to the identification of the displacement mode shapes. The second measurement approach involves a use of strain gages since strain measurements are directly related to imposed loads. A use of mixed strain-acceleration measurements is also considered in this work. Optimum sensor locations are determined herein using the D-optimal design algorithm that provides most precise load estimates. The concepts of indirect load identification, strain frequency response function (SFRF), displacement frequency response function (DFRF), along with the optimal locations for sensors are used in this paper. The fundamental theory for strain-based modal analysis is applied to help estimate imposed harmonic loads. The similarities and differences between acceleration-based load identification and strain-based load identification are discussed through numerical examples.
Effects of Dilute Phosphoric Acid Treatment on Structure and Burning Characteristics of Lignocellulosic Biomass
Authors: Haykiri-Acma H. , Yaman S.
Published: February 2019

Pretreatment of biomass with phosphoric acid (H3PO4) has been a popular method since it facilitates the generation of biofuels and mitigates the problems arising from the use of corrosive sulfuric acid that is otherwise commonly employed for pretreatment. However, variations took place in the structure of biomass through this treatment have not so far been investigated in detail. This paper focuses on the effects of aqueous H3PO4 treatment on the lignocellulosic residue of corn (CR) considering the fuel properties, ash fusion temperatures, combustion characteristics and kinetics, mineral phases, surface functionalities, and the morphology of the treated biomass. It was determined that interaction of biomass with 5% H3PO4 solution led to important variations from cellulose crystallinity to thermal reactivity of this lignocellulosic material. Although elements such as Na, K, Ca, Mg, and Fe could be effectively removed by treatment, formation of phosphorus containing new phases caused to increase in ash yield. Also, the change in mineral matter composition led to an increase in ash fusion temperatures along with reduction in the burning rates. Thus, the combustibility and combustion performance indices dropped.
An Enhanced Fuel Cell Dynamic Model With Electrochemical Phenomena Parameterization as Test Bed for Control System Analysis
Authors: Fontalvo Victor M. , Nelson George J. , Gomez Humberto A. , Sanjuan Marco E.
Published: February 2019

In this work, a model of a proton exchange membrane fuel cell (PEMFC) is presented. A dynamic performance characterization is performed to assess the cell transient response to input variables. The model used in the simulation considers three different phenomena: mass transfer, thermodynamics, and electrochemistry. The main sources of voltage loss are presented: activation, electrical resistance, and concentration. The model is constructed to avoid the use of fitted parameters, reducing the experimentation required for its validation. Hence, the electrochemical model is parameterized by physical variables, including material properties and geometrical characteristics. The model is demonstrated as a test-bed for PEMFC control system design and evaluation. Results demonstrate that the steady-state and dynamic behavior of the system are represented accurately. A case study is included to show the functionality of the model. In the case study, the effect of the purge valves at the fuel cell discharges is analyzed under different scenarios. Regular purges of the cathode and the anode are shown to achieve a good performance in the system avoiding reactant starvation in the cell. A closed-loop dynamic response is included as an example of the model capabilities for the design of fuel cell control strategies. Two variables were selected to be controlled: voltage and pressure difference across the membrane. A multivariate control strategy was tested and its dynamic response was analyzed. It was found that there was a strong interaction between the control loops, making the control of the system a challenge.
Hole pocket–driven superconductivity and its universal features in the electron-doped cuprates
Authors: Li Yangmu , Tabis W. , Tang Y. , Yu G. , Jaroszynski J. , Barišić N. , Greven M.
Published: February 2019

Charge transport measurements reveal hole superconductivity in electron-doped high-temperature superconductors.
Imaging of local structures affecting electrical transport properties of large graphene sheets by lock-in thermography
Authors: Nakajima H. , Morimoto T. , Okigawa Y. , Yamada T. , Ikuta Y. , Kawahara K. , Ago H. , Okazaki T.
Published: February 2019

A novel technique for fast and precise quality evaluations of graphene devices.
Conjoined-network rendered stiff and tough hydrogels from biogenic molecules
Authors: Xu Liju , Wang Chen , Cui Yang , Li Ailing , Qiao Yan , Qiu Dong
Published: February 2019

By constructing a conjoined-network, we tackled the challenge in developing stiff and tough hydrogels of biogenic molecules.
Block copolymer–based porous carbon fibers
Authors: Zhou Zhengping , Liu Tianyu , Khan Assad U. , Liu Guoliang
Published: February 2019

The use of block copolymers as precursors revolutionizes the synthesis of porous carbon fibers with highly uniform pores.
Fully rubbery integrated electronics from high effective mobility intrinsically stretchable semiconductors
Authors: Sim Kyoseung , Rao Zhoulyu , Kim Hae-Jin , Thukral Anish , Shim Hyunseok , Yu Cunjiang
Published: February 2019

Rubbery stretchable semiconductor with high effective mobility and its rubbery integrated electronics are demonstrated.
Primer Design for an Accurate View of Picocyanobacterial Community Structure by Using High-Throughput Sequencing
Authors: Huber Paula , Cornejo-Castillo Francisco M. , Ferrera Isabel , Sánchez Pablo , Logares Ramiro , Metz Sebastián , Balagué Vanessa , Acinas Silvia G. , Gasol Josep M. , Unrein Fernando
Published: February 2019

The molecular diversity of the aquatic picocyanobacterial community cannot be accurately described using only the available universal 16S rRNA gene primers that target the whole bacterial and archaeal community. We show that the hypervariable regions V5, V6, and V7 of the 16S rRNA gene are better suited to study the diversity, community structure, and dynamics of picocyanobacterial communities at a fine scale using Illumina MiSeq sequencing. Due to its variability, it allows reconstructing phylogenies featuring topologies comparable to those generated when using the complete 16S rRNA gene sequence. Further, we successfully designed a new set of primers flanking the V5 to V7 region whose specificity for picocyanobacterial genera was tested
in silico
and validated in several freshwater and marine aquatic communities. This work represents a step forward for understanding the diversity and ecology of aquatic picocyanobacteria and sets the path for future studies on picocyanobacterial diversity.
Genome-Wide Mutagenesis Links Multiple Metabolic Pathways with Actinorhodin Production in Streptomyces coelicolor
Authors: Xu Zhong , Li Yuanyuan , Wang Yemin , Deng Zixin , Tao Meifeng
Published: February 2019

Previous studies have shown that various genes can influence antibiotic production in
Streptomyces
and that intercommunication between regulators can complicate antibiotic production. Therefore, to gain a better understanding of antibiotic regulation, a genome-wide perspective on genes that influence antibiotic production was needed. We searched for genes that affected production of the antibiotic actinorhodin using a genome-wide gene disruption system. We identified 551 genes that altered actinorhodin levels, and more than half of these genes were newly identified effectors. Some of these genes may be candidates for engineering
Streptomyces
strains to improve antibiotic production levels.
Virulence Traits of a Serogroup C Meningococcus and Isogenic
cssA
Mutant, Defective in Surface-Exposed Sialic Acid, in a Murine Model of Meningitis
Authors: Colicchio Roberta , Pagliuca Chiara , Ricci Susanna , Scaglione Elena , Grandgirard Denis , Masouris Ilias , Farina Fabrizio , Pagliarulo Caterina , Mantova Giuseppe , Paragliola Laura , Leib Stephen L. , Koedel Uwe , Pozzi Gianni , Alifano Pietro , Salvatore Paola
Published: February 2019

In serogroup C
Neisseria meningitidis
, the
cssA
(
siaA
) gene codes for an UDP-
N
-acetylglucosamine 2-epimerase that catalyzes the conversion of UDP-
N
-acetyl-α-
d
-glucosamine into
N
-acetyl-
d
-mannosamine and UDP in the first step in sialic acid biosynthesis. This enzyme is required for the biosynthesis of the (α2→9)-linked polysialic acid capsule and for lipooligosaccharide (LOS) sialylation.
Pseudomonas aeruginosa Can Inhibit Growth of Streptococcal Species via Siderophore Production
Authors: Scott Jessie E. , Li Kewei , Filkins Laura M. , Zhu Bin , Kuchma Sherry L. , Schwartzman Joseph D. , O’Toole George A.
Published: February 2019

Cystic fibrosis (CF) lung infections are increasingly recognized for their polymicrobial nature. These polymicrobial infections may alter the biology of the organisms involved in CF-related infections, leading to changes in growth, virulence, and/or antibiotic tolerance, and could thereby affect patient health and response to treatment. In this study, we demonstrate interactions between
P. aeruginosa
and streptococci using a coculture model and show that one interaction between these microbes is likely competition for iron. Thus, these data indicate that one CF pathogen may influence the growth of another, and they add to our limited knowledge of polymicrobial interactions in the CF airway.
One Basic Blueprint, Many Different Motors
Authors: Manson Michael D.
Published: February 2019

The cytoplasmic C ring of the bacterial flagellum is known as the switch complex. It binds the response regulator phospho-CheY to control the direction of flagellar rotation.
Bridging the Holistic-Reductionist Divide in Microbial Ecology
Authors: Tecon Robin , Mitri Sara , Ciccarese Davide , Or Dani , van der Meer Jan Roelof , Johnson David R.
Published: February 2019

Microbial communities are inherently complex systems. To address this complexity, microbial ecologists are developing new, more elaborate laboratory models at an ever-increasing pace.
Clinical risk factors for Achilles tendinopathy: a systematic review
Authors: van der Vlist Arco C , Breda Stephan J , Oei Edwin H G , Verhaar Jan A N , de Vos Robert-Jan
Published: February 2019

Background

Achilles tendinopathy is a common problem, but its exact aetiology remains unclear.

Objective

To evaluate the association between potential clinical risk factors and Achilles tendinopathy.

Design

Systematic review.

Data sources

The databases Embase, MEDLINE Ovid, Web of Science, Cochrane Library and Google Scholar were searched up to February 2018.

Eligibility criteria

To answer our research question, cohort studies investigating risk factors for Achilles tendinopathy in humans were included. We restricted our search to potential clinical risk factors (imaging studies were excluded).

Results

We included 10 cohort studies, all with a high risk of bias, from 5111 publications identified. There is limited evidence for nine risk factors: (1) prior lower limb tendinopathy or fracture, (2) use of ofloxacin (quinolone) antibiotics, (3) an increased time between heart transplantation and initiation of quinolone treatment for infectious disease, (4) moderate alcohol use, (5) training during cold weather, (6) decreased isokinetic plantar flexor strength, (7) abnormal gait pattern with decreased forward progression of propulsion, (8) more lateral foot roll-over at the forefoot flat phase and (9) creatinine clearance of <60 mL/min in heart transplant patients. Twenty-six other putative risk factors were not associated with Achilles tendinopathy, including being overweight, static foot posture and physical activity level.

Conclusion

From an ocean of studies with high levels of bias, we extracted nine clinical risk factors that may increase a person’s risk of Achilles tendinopathy. Clinicians may consider ofloxacin use, alcohol consumption and a reduced plantar flexor strength as modifiable risk factors when treating patients with Achilles tendinopathy.

Trial registration number

CRD42017053258.
Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study
Authors: Richter Lindsay L , Ting Joseph , Muraca Giulia M , Synnes Anne , Lim Kenneth I , Lisonkova Sarka
Published: February 2019

Objective

After a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.

Design, setting and participants

This retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.

Outcome measures

The primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.

Results

The rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p<0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).

Conclusions

Timing of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.
Association between maternal passive smoking and increased risk of delivering small-for-gestational-age infants at full-term using plasma cotinine levels from The Hokkaido Study: a prospective birth cohort
Authors: Kobayashi Sumitaka , Sata Fumihiro , Hanaoka Tomoyuki , Braimoh Titilola Serifat , Ito Kumiko , Tamura Naomi , Araki Atsuko , Itoh Sachiko , Miyashita Chihiro , Kishi Reiko
Published: February 2019

Objectives

To investigate the association between plasma cotinine level measured at the 8th gestational month and the delivery of small-for-gestational-age (SGA) infants, using a highly sensitive ELISA method.

Design

Prospective birth cohort study from The Hokkaido Study on Environment and Children’s Health.

Setting

Hokkaido, Japan.

Participants

Our sample included 15 198 mother-infant pairs enrolled in 2003–2012.

Main outcome measures

SGA, defined as a gestational age-specific weight Z-score below −2.

Results

The number of SGA infants was 192 (1.3%). The cotinine cut-off level that differentiated SGA infants from other infants was 3.03 ng/mL for both the total population and the full-term births subgroup (sensitivity 0.307; positive predictive value 2.3%). Compared with infants of mothers with a plasma cotinine level of <3.03 ng/mL, infants of mothers with a plasma cotinine level of ≥3.03 ng/mL showed an increased OR for SGA in the total population and the full-term infant group (2.02(95% CI 1.45 to 2.83) and 2.44(95% CI 1.73 to 3.44), respectively).

Conclusion

A plasma cotinine level of ≥3.03 ng/mL, which included both passive and active smokers, was associated with an increased risk of SGA. This finding is of important relevance when educating pregnant women about avoiding prenatal passive and active smoking due to the adverse effects on their infants, even those born at full-term.
Impact of the great recession on self-perceived health in Spain: a longitudinal study with individual data
Authors: Saez Marc , Vidiella-Martin Joaquim , Casasnovas Guillem López
Published: February 2019

Objectives

Our objective in this study is to evaluate the impact the Great Recession (2008–2014) had on self-perceived health in Spain.

Design

We use a longitudinal database (four waves of the Bank of Spain’s Survey of Household Finances (2005, 2008, 2011 and 2014)) with repeated observations of the same individuals before and after the Great Recession.

Interventions

We consider the Great Recession in a natural experiment and we introduce it as an explanatory variable in a mixed logistic regression model in which we explain the probability of a subject declaring poor health (fair, bad and very bad). In the model we control for both observed and unobserved confounders at both individual and family level.

Results

We find an average downward trend in self-perceived health during the most severe period of the Great Recession (2009–2011). However, the fact that the adjusted measures are less volatile than the crude ones shows that variation in health status can be captured by either demographic or socioeconomic controls. In fact, there are significant differences in the impact the economic crisis had on health in terms of gender and age group. In particular, the (adjusted) risk of declaring poor health increases after the crisis began but only in those families in which the reference person is a woman younger than 45 years of age or a man aged 75 years or older.

Conclusions

Given our results, we discuss the link between financial wealth and self-rated health and how policy-makers could address the health inequalities that arise from adverse economic and financial shocks.
‘I did not check if the teacher gave feedback’: a qualitative analysis of Taiwanese postgraduate year 1 trainees’ talk around e-portfolio feedback-seeking behaviours
Authors: Fu Ren-Huei , Cho Yu-Hsueh , Quattri Francesca , Monrouxe Lynn V
Published: February 2019

Objectives

Despite feedback being an extensively researched and essential component of teaching and learning, there is a paucity of research examining feedback within a medical education e-portfolio setting including feedback-seeking behaviours (FSBs). FSBs can be understood within a cost–value perspective. The objective of this research is to explore the factors that influence postgraduate year 1 (PGY1) trainee doctors’ FSBs via e-portfolios.

Setting

Postgraduate education provision in the largest teaching hospital in Taiwan.

Participants

Seventy-one PGY1s (66% male).

Methods

A qualitative semistructured one-to-one interview method was adopted. Interviews were audio recorded, transcribed verbatim, anonymised and checked for completeness. Data were analysed inductively via thematic framework analysis and deductively informed using FSB theory. The process comprised data familiarisation, identification of the themes, charting and data interpretation.

Results

Two main themes of FSB related and e-portfolio related were identified. We present the theme focussing on FSB here to which n=32 (22 males, 10 females) of the n=71 participants contributed meaningfully. Subthemes include factors variously affecting PGY1s’ positive and negative FSBs via e-portfolios at the individual, process and technological levels. These factors include learner-related (internal values vs social influence, forced reflection); teacher-related (committed educators vs superficial feedback); technology-related (face-saving vs lagging systems; inadequate user-interface) and process-related (delayed feedback, too frequent feedback) factors.

Conclusions

Our findings reveal the complexity of PGY1s’ FSBs in an e-portfolio context and the interaction of numerous facilitating and inhibiting factors. Further research is required to understand the range of facilitating and inhibiting factors involved in healthcare learners’ FSBs across different learning, social, institutional and national cultural settings.
Evaluating a custom-designed aid to improve communication of genetic results in families with hypertrophic cardiomyopathy: study protocol for a randomised controlled trial
Authors: Burns Charlotte , Yeates Laura , Semsarian Christopher , Ingles Jodie
Published: February 2019

Introduction

Genetic testing for hypertrophic cardiomyopathy (HCM) in the era of genomics brings unique challenges for genetic counselling. The number of genes routinely included in an HCM gene panel has increased markedly, many with minimal if any robust evidence of gene–disease association. Subsequently, there is a greater chance of uncertain genetic findings. The responsibility of communicating this information with at-risk relatives lies with the index case (proband). We have developed a communication aid to assist with the delivery of genetic results to the proband. We have previously shown the aid is feasible and acceptable and have now developed a study protocol for a randomised controlled trial of a genetic counsellor-led intervention incorporating the communication aid.

Methods and analysis

This is a prospective randomised controlled trial. We will investigate the impact of a genetic counsellor-led intervention to return proband genetic results using a custom-designed communication aid. We aim to improve knowledge and empowerment. The primary outcome of this trial is the ability and confidence of the proband to communicate genetic results to at-risk relatives. Secondary outcomes will assess genetic knowledge, satisfaction with services, outcomes from genetic counselling and psychological adaptation to genetic information.

Ethics and dissemination

This study has been approved by and is in strict accordance with the Sydney Local Health District Ethics Review Committee (X16-0030; 22/01/2016; version 1). Results from this trial will be prepared as a manuscript and submitted to peer-reviewed journals for publication as well as submission for presentation at national and international meetings.

Trial registration number

ACTRN12617000706370.
Unravelling the interaction between theDRD2andDRD4genes, personality traits and concussion risk
Authors: Abrahams Shameemah , McFie Sarah , Lacerda Miguel , Patricios Jon , Suter Jason , September Alison V , Posthumus Michael
Published: February 2019

Background

Concussion occurs when biomechanical forces transmitted to the head result in neurological deficits. Personality may affect the balance between safe and dangerous play potentially influencing concussion risk. Dopamine receptor D2 (DRD2) and dopamine receptor D4 (DRD4) genetic polymorphisms were previously associated with personality traits.

Objectives

This case–control genetic association study investigated the associations of (1)DRD2andDRD4genotypes with concussion susceptibility and personality, (2) personality with concussion susceptibility and (3) the statistical model of genotype, personality and concussion susceptibility.

Methods

In total, 138 non-concussed controls and 163 previously concussed cases were recruited from high school (n=135, junior), club and professional rugby teams (n=166, senior). Participants were genotyped forDRD2rs12364283 (A>G),DRD2rs1076560 (C>A) andDRD4rs1800955 (T>C) genetic variants. Statistical analyses including structural equation modelling were performed using the R environment and STATA.

Results

The rs1800955 CC genotype (p=0.014) and inferredDRD2(rs12364283–rs1076560)–DRD4(rs1800955) A–C–C allele combination (p=0.019) were associated with decreased concussion susceptibility in juniors. The rs1800955 TT and CT genotypes were associated with low reward dependence in juniors (p<0.001) and seniors (p=0.010), respectively. High harm avoidance was associated with decreased concussion susceptibility in juniors (p=0.009) and increased susceptibility in seniors (p=0.001). The model showed that a genetic variant was associated with personality while personality was associated with concussion susceptibility.

Conclusion

These findings highlight the linear relationship between genetics, personality and concussion susceptibility. Identifying a genetic profile of ‘high risk’ behaviour, together with the development of personalised behavioural training, can potentially reduce concussion risk.
Impact of therapeutic drug level monitoring on outcomes of patients with Crohn’s disease treated with Infliximab: real world data from a retrospective single centre cohort study
Authors: Kamperidis Nikolaos , Middleton Paul , Tyrrell Tracey , Stasinos Ioannis , Arebi Naila
Published: February 2019

Background

Therapeutic drug monitoring (TDM) by measuring infliximab (IFX) trough levels and antibodies to infliximab (ATI) is used to optimise treatment in inflammatory bowel disease. We aimed to explore the clinical outcomes of TDM for patients with Crohn’s disease on IFX in real life setting.

Methods

This is a retrospective observational study. Primary outcomes were the clinicians’ response to each TDM result and the rate of IFX discontinuation due to secondary loss of response or serious adverse event. Secondary outcomes included the intestinal surgery rate after IFX initiation and remission 6 months after TDM. Multivariate logistic regression was performed to identify factors associated with IFX discontinuation and abdominal surgery.

Results

291 patients were included. 238 (81.8%) patients were tested for TDM at least once during their follow-up with 672 TDM results. 95/238 patients (39.9%) had undetectable levels and 76 (31.9%) had positive ATI at least once. The median infliximab trough level was 3.4 µg/mL. IFX was discontinued in 109 patients (37.5%). 526/672 (78.3%) TDMs results were not followed by altered patient management. Treatment was discontinued in 40 (75.5%) patients never tested for TDM compared with 69 (29.0%) of those tested (p<0.01). Fewer TDM tested patients (29; 12.2%) required intestinal surgery post IFX initiation compared with TDM not-tested (15; 28.3%). Not being TDM tested was independently associated with IFX discontinuation and abdominal surgery.

Conclusions

IFX discontinuation and intestinal surgery were significantly less frequent with TDM. TDM requested to investigate loss of response resulted in change in patient management.
Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum
Authors: Wright Lydia K , Knight Jessica H , Thomas Amanda S , Oster Matthew E , St Louis James D , Kochilas Lazaros K
Published: February 2019

Objective

Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by various operative and catheter-based interventions. We aim to understand the long-term transplant-free survival of patients with PA/IVS by treatment strategy.

Methods

Cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional registry with prospectively acquired outcome data after linkage with the National Death Index and the Organ Procurement and Transplantation Network.

Results

Eligible patients underwent neonatal surgery or catheter-based intervention for PA/IVS between 1982 and 2003 (median follow-up of 16.7 years, IQR: 12.6–22.7). Over the study period, 616 patients with PA/IVS underwent one of three initial interventions: aortopulmonary shunt, right ventricular decompression or both. Risk factors for death at initial intervention included earlier birth era (1982–1992), chromosomal abnormality and atresia of one or both coronary ostia. Among survivors of neonatal hospitalisation (n=491), there were 99 deaths (4 post-transplant) and 10 transplants (median age of death or transplant 0.7 years, IQR: 0.3–1.8 years). Definite repair or last-stage palliation was achieved in the form of completed two-ventricle repair (n=201), one-and-a-half ventricle (n=39) or Fontan (n=96). Overall 20-year survival was 66%, but for patients discharged alive after definitive repair, it reached 97.6% for single-ventricle patients, 90.9% for those with one-and-a-half ventricle and 98.0% for those with complete two-ventricle repair (log-rank p=0.052).

Conclusions

Transplant-free survival in PA/IVS is poor due to significant infantile and interstage mortality. Survival into early adulthood is excellent for patients reaching completion of their intended path independent of type of repair.
Outcome of participants with nephrotic syndrome in combined clinical trials of lupus nephritis
Authors: Gomez Mendez Liliana Michelle , Cascino Matthew D , Katsumoto Tamiko R , Brakeman Paul , Brunetta Paul , Jayne David , Dall’Era Maria , Rovin Brad , Garg Jay
Published: February 2019

Objective

The outcome of participants with nephrotic syndrome in clinical trials of lupus nephritis has not been studied in detail.

Methods

Collated data from two randomised controlled trials in lupus nephritis, Lupus Nephritis Assessment of Rituximab (LUNAR) and A Study to Evaluate Ocrelizumab in Patients With Nephritis due to Systemic Lupus Erythematosus (BELONG) were analysed. Nephrotic syndrome was defined as albumin <3 g/dL and urine protein/creatinine ratio ≥3.5 g/g at start of trial. Renal response was defined as a first morning urine protein/creatinine ratio ≤0.5 g/g in addition to ≤25% increase in creatinine from trial entry assessed at week 48. Logistic regression was used to evaluate the association of nephrotic syndrome with renal response while adjusting for treatment received and ACE inhibitor or angiotensin receptor blocker use.

Results

28 (26%) participants with nephrotic syndrome achieved renal response as compared with 130 (52.5%) of those without (p<0.001). Having nephrotic syndrome at baseline significantly lowered the likelihood of achieving renal response (OR 0.32, 95 % CI 0.19 to 0.54, p<0.001). 125 (80%) participants achieved resolution of their nephrotic syndrome in a median time of 16 weeks.

Conclusions

Nephrotic syndrome at baseline decreases the likelihood of renal response at 1 year. Longer clinical trials or better short-term predictors of long-term outcomes may better assess the effect of novel therapeutic approaches on subjects with nephrotic syndrome.
Differences in hemodynamic characteristics under high packing density between the porous media model and finite element analysis in computational fluid dynamics of intracranial aneurysm virtual treatment
Authors: Jiang Yeqing , Ge Liang , Di Ruoyu , Lu Gang , Huang Lei , Li Gaohui , Leng Xiaochang , Zhang Sufang , Wan Hailin , Geng Daoying , Xiang Jianping , Zhang Xiaolong
Published: February 2019

Objective

This study aimed to compare the hemodynamic differences among no sac (NOS), porous media (POM) and finite element analysis (FEA) models to investigate the recurrence-related risks for coiled intracranial aneurysms (IAs).

Methods

The study enrolled 10 patients with 11 IAs who received simple coiling treatment and hemodynamic simulations were performed for all IAs using the above three models. Velocity, wall shear stress (WSS) and residual flow volume (RFV) were calculated and compared in order to assess the model differences for both aneurysm sac and parent vessel regions.

Results

For parent artery regions, all three models produced similar flow patterns and quantification analysis did not indicate differences in velocity and WSS (p>0.05). For aneurysm sac regions, the FEA model resulted in higher sac-maximized (0.18 m/s vs 0.06 m/s) and sac-averaged velocity (0.013 m/s vs 0.007 m/s), and higher sac-averaged (0.55 Pa vs 0.36 Pa, p=0.006) and sac-maximized WSS (12.1 Pa vs 6.6 Pa) than the POM model. The differences in RFV between the POM and FEA models under 11 different isovelocity thresholds (0.0001 m/s, 0.001 m/s, 0.002 m/s, 0.005 m/s, 0.01 m/s, 0.02 m/s, 0.05 m/s, 0.1 m/s, 0.2 m/s, 0.5 m/s, and 1 m/s) showed that the POM RFV was generally larger than those of the FEA model.

Conclusions

Compared with the FEA model, the POM model provides a lower velocity and WSS and higher RFV for the aneurysm sac, which could lead to incorrect estimates of the recurrent risk of coiled IAs under high packing density.
Standard operating procedure reduces interoperator variation and improves accuracy when measuring packed cell volume
Authors: Breheny Craig R , Perez‐Accino Salgado Jorge , Bommer Nicholas X , Handel Ian , Gow Adam G
Published: February 2019

Objective

To evaluate whether a standard operating procedure (SOP) for canine packed cell volume (PCV) measurement reduces operator‐dependent variation and improves accuracy within a veterinary teaching hospital environment.

Materials and methods

Clinical staff and final‐year undergraduate veterinary students were recruited to perform PCV measurements in blinded duplicate samples. Participants were randomly allocated to perform this with or without an SOP. Participants’ results were compared against a reference, generated by the authors following the World Health Organization guidelines.

Results

The study population comprised 18 clinical staff and 39 students. Three clinical staff and seven students displayed errors consistent with inaccurate reading, only one of whom had access to the SOP. Five students and two clinical staff had errors attributable to incorrect preparation, with only one having access to the SOP. Interoperator variation was significantly less using the SOP. Using the SOP, 95 per cent of the results were within 0.0125 l/l of the reference value, in comparison with within 0.09 l/l without SOP. Interoperator variation was significantly less in the SOP group (P=0.0025).

Clinical significance

Using the SOP resulted in less variation and more accurate results. This confirms that PCV measurement with an SOP can truly be a ‘waived’ test.
Canine dystocia in 50 UK first‐opinion emergency care veterinary practices: clinical management and outcomes
Authors: O'Neill Dan G , O'Sullivan Aoife M , Manson Erin A , Church David B , McGreevy Paul D , Boag Amanda K , Brodbelt Dave C
Published: February 2019

Canine dystocia is a relatively common veterinary presentation. First opinion emergency care clinical data from 50 Vets Now clinics across the UK were used to explore dystocia management and outcomes in bitches. Caesarean section (CS) was performed on 341/701 (48.6 per cent (95 per cent CI 44.9 to 52.4)) of dystocia cases. The bulldog (OR 7.60, 95 per cent CI 1.51 to 38.26, P=0.014), Border terrier (OR 4.89, 95 per cent CI 0.92 to 25.97, P=0.063) and golden retriever (OR 4.07, 95 per cent CI 0.97 to 17.07, P=0.055) had the highest odds of CS among dystocic bitches compared with crossbreds. Brachycephalic dystocic bitches had 1.54 (95 per cent CI 1.05 to 2.28, P=0.028) times the odds of CS compared with non‐brachycephalics. Oxytocin was administered to 380/701 (54.2 per cent) and calcium gluconate was administered to 82/701 (11.7 per cent) of dystocic bitches. 12 of 701 dystocia cases (1.7 per cent) died during emergency care. These results can help veterinary surgeons to provide better evidence on the risks to owners who may be contemplating breeding from their bitches. In addition, the results on the management and clinical trajectory of dystocia can facilitate clinical benchmarking and encourage clinical audit within primary care veterinary practice.
Composite Fasciola hepatica faecal egg sedimentation test for cattle
Authors: Graham‐Brown John , Williams Diana J L , Skuce Philip , Zadoks Ruth N , Dawes Stuart , Swales Harry , Van Dijk Jan
Published: February 2019

Options for diagnosing Fasciola hepatica infection in groups of cattle are limited. Increasing the opportunities for herd‐level diagnosis is important for disease monitoring, making informed treatment decisions and for flukicide efficacy testing. The sensitivity of a simple sedimentation method based on composite faecal samples for the detection of fluke eggs in cattle was assessed through a combination of experimental and statistical modelling techniques. Initially, a composite sample method previously developed for sheep was used to investigate the sensitivity of composite sample testing compared with individual counts on the same samples in cattle. Following this, an optimised, validated, qualitative (presence‐absence) composite sample field test was developed for cattle. Results showed that fluke egg counts obtained from a composite sample are representative of those expected from individual counts. The optimal sampling strategy was determined to be 10 individual 10 g samples (100 g composite sample) from which a 10 g subsample is taken for sedimentation. This method yielded a diagnostic sensitivity of 0.69 (95 per cent CI 0.5 to 0.85). These results demonstrate the validity and usefulness of a composite faecal egg sedimentation method for use in the diagnosis and control of F. hepatica in groups of cattle, with the caveat that a negative test should be followed up with a second test due to limitations relating to test sensitivity.
Measuring the relative performance of forest management units: a chance-constrained DEA model in the presence of the nondiscretionary factor
Authors: Zadmirzaei Majid , Mohammadi Limaei Soleiman , Amirteimoori Alireza , Olsson Leif
Published: February 2019

In this study, we develop a marginal chance-constrained data envelopment analysis (DEA) model in the presence of nondiscretionary inputs and hybrid outputs for the first time. We call it a stochastic nondiscretionary DEA model (SND-DEA), and it is developed to measure and compare the relative efficiency of forest management units under different environmental management systems. Furthermore, we apply an output-oriented DEA technology to both deterministic and stochastic scenarios. The required data are collected from 24 forest management plans (as decision-making units) and included four inputs and an equal amount of outputs. The findings of this practical research show that the modified SND-DEA model in different probability levels gives us apparently different results compared with the output from pure deterministic models. However, when we calculate the correlation measures, the probability levels give us a strong positive correlation between stochastic and deterministic models. Therefore, approximately 40% of the forest management plans based on the applied SND-DEA model should substantially increase their average efficiency score. As the major conclusion, our developed SND-DEA model is a suitable improvement over previous developed models to discriminate the efficiency and (or) inefficiency of decision-making units to hedge against risk and uncertainty in this type of forest management problem.
Uncertainty Analysis of Energy Production for a 3 × 50 MW AC Photovoltaic Project Based on Solar Resources
Authors: Jamil Irfan , Zhao Jinquan , Zhang Li , Rafique Syed Furqan , Jamil Rehan
Published: February 2019

Access to solar energy is a prerequisite to remedy CO2 and improve the standard of human living. Green solar energy is only an immediate solution to add its zero emission profile and provide carbon footprint reduction benefits. This energy does not emit greenhouse gases which means it is a renewable free source of energy when producing electricity. The purpose of this paper is to investigate the accurate annul energy production data reducing uncertainty in solar energy estimates. This work investigated the solar energy assessment taking into account a detailed solar resource and energy production assessment for a 3 × 50 MW PV project with uncertainty analysis. The authors defined a total uncertainty of energy production which is estimated at 9.5% for one year and 8.9% for ten years as well as future variability of 3.4% for one year and 1.1% for ten years. The annual power degradation and expected energy production over the plant lifespan at dissimilar 99%, 90%, 75%, 60%, 50%, and 25% probability of surplus are also observed in this paper.