bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Fluid Preswirl and Swirl Brakes Design on the Performance of Labyrinth Seals
Authors: Untaroiu Alexandrina , Jin Hanxiang , Fu Gen , Hayrapetiau Vahe , Elebiary Kariem
Published: January 2018

In noncontact annular labyrinth seals used in turbomachinery, fluid prerotation in the direction of shaft rotation effectively increases fluid velocity in the circumferential direction and generates fluid forces with potential destabilizing effects to be exerted on the rotor. Swirl brakes are typically employed to reduce the fluid prerotation at the inlet of the seal. The inlet flow separates as it follows the swirl brakes, and the ratio between tangential component of the velocity at the seal, and the velocity of the rotor surface varies consequently. Effective swirl brakes can significantly suppress the destabilizing fluid forces as it is effectively reducing the tangential velocity. The literature shows that leakage rate can also be reduced by using swirl brakes with “negative-swirl.” In this study, a labyrinth seal with inlet swirl brakes is selected from the literature and considered the baseline design. The seal performance is evaluated using ANSYS-cfx. The design of experiments (DOEs) approach is used to investigate the effects of various design variables on the seal performance. The design space consists of the swirl brake's length, width, curvature at the ends, the tilt angle, as well as the number of swirl brakes in the circumferential direction. Simple random sampling method with Euclidean distances for the design matrix is used to generate the design points. Steady-state computational fluid dynamics simulations are then performed for each design point to analyze the performance of the swirl brakes. Quadratic polynomial fitting is used to evaluate the sensitivity of the average circumferential velocity with respect to the design variables, which gives a qualitative estimation for the performance of the swirl brakes. These results assist in creating a better understanding of which design variables are critical and more effective in reduction of the destabilizing forces acting on the rotor, and thus will support the swirl brake design for annular pressure seals.
The Homogeneous Cooling State as a Verification Test for Kinetic Theory-Based Continuum Models of Gas–Solid Flows
Authors: Fullmer William D. , Hrenya Christine M.
Published: January 2018

Granular and multiphase (gas–solids) kinetic theory-based models have emerged a leading modeling strategy for the simulation of particle flows. Similar to the Navier–Stokes equations of single-phase flow, although substantially more complex, kinetic theory-based continuum models are typically solved with computational fluid dynamic (CFD) codes. Under the assumptions of the so-called homogeneous cooling state (HCS), the governing equations simplify to an analytical solution describing the “cooling” of fluctuating particle velocity, or granular temperature. The HCS is used here to verify the implementation of a recent multiphase kinetic theory-based model in the open source mfix code. Results from the partial verification test show that the available implicit (backward) Euler time integration scheme converges to the analytical solution with the expected first-order rate. A second-order accurate backward differentiation formula (BDF) is also implemented and observed to converge at a rate consistent with its formal accuracy.
Determining Fair Market Value for Duke’s Sporting Goods Store
Authors: Rascher Daniel A. , Goldman Michael M.
Published: January 2018

Shelley Valdez is a recent finance team hire at Duke’s Sporting Goods Store. She has 1 week to identify, gather, and analyze relevant information to calculate the financial value of the business, using the income and market approaches. She has also been asked to consider Duke’s liquidation value, and comment on the strategic options these calculations point to, before a board meeting of the owners next week.
Who’s Stealing Cookies From the Cookie Jar?: A Case Study in Sport Financial Fraud
Authors: Keiper Margaret , Williams Dylan , Fried Gil
Published: January 2018

Fraud is a very broad term, but the underlying theme is the intentional act of deception for personal financial gain. This case study highlights three examples of fraud at different levels of sport: youth, collegiate, and professional. Students are provided a broad perspective of financial fraud and are exposed to differing types of criminal activity at each level of sport. Furthermore, the authors provide an understanding of financial fraud, illegal activities related to fraud, and the responsibilities that all sport management professionals have within various positions at each respective level. Finally, this case provides students with an opportunity to suggest solutions and deterrents for dealing with financial fraud at each level. Specifically, the authors provide a rationale for the use of internal controls within an organization to segregate an organization’s financial responsibilities and reduce the risk of financial fraud.
Anderson localizations and photonic band-tail states observed in compositionally disordered platform
Authors: Lee Myungjae , Lee Jeongkug , Kim Sunghwan , Callard Ségolène , Seassal Christian , Jeon Heonsu
Published: January 2018

The strength of photon localization in the band-tail states is determined by the degree of disorder and state energy.
Heralded quantum steering over a high-loss channel
Authors: Weston Morgan M. , Slussarenko Sergei , Chrzanowski Helen M. , Wollmann Sabine , Shalm Lynden K. , Verma Varun B. , Allman Michael S. , Nam Sae Woo , Pryde Geoff J.
Published: January 2018

Entanglement swapping enables verified nonlocal correlations over a high-loss channel with the detection loophole closed.
Ultrafast rotation of magnetically levitated macroscopic steel spheres
Authors: Schuck Marcel , Steinert Daniel , Nussbaumer Thomas , Kolar Johann W.
Published: January 2018

Pushing the limits of ultrahigh-speed electrical machines.
Nanometer-precision linear sorting with synchronized optofluidic dual barriers
Authors: Shi Yuzhi , Xiong Sha , Chin Lip Ket , Zhang Jingbo , Ser Wee , Wu Jiuhui , Chen Tianning , Yang Zhenchuan , Hao Yilong , Liedberg Bo , Yap Peng Huat , Tsai Din Ping , Qiu Cheng-Wei , Liu Ai Qun
Published: January 2018

Researchers explore loosely overdamped system with extreme low stiffness for nanoparticle sorting with nanometer precision.
Electrically switchable metadevices via graphene
Authors: Balci Osman , Kakenov Nurbek , Karademir Ertugrul , Balci Sinan , Cakmakyapan Semih , Polat Emre O. , Caglayan Humeyra , Özbay Ekmel , Kocabas Coskun
Published: January 2018

We investigate metadevices working in microwave frequencies by integrating passive metamaterials with active graphene devices.
Observation of spin-orbit magnetoresistance in metallic thin films on magnetic insulators
Authors: Zhou Lifan , Song Hongkang , Liu Kai , Luan Zhongzhi , Wang Peng , Sun Lei , Jiang Shengwei , Xiang Hongjun , Chen Yanbin , Du Jun , Ding Haifeng , Xia Ke , Xiao Jiang , Wu Di
Published: January 2018

A new type of spin-orbit magnetoresistance effect is observed in Cu/YIG with interface decorated with nanosize Pt islands.
Discovery of slow magnetic fluctuations and critical slowing down in the pseudogap phase of YBa
2
Cu
3
O

y
Authors: Zhang Jian , Ding Zhaofeng , Tan Cheng , Huang Kevin , Bernal Oscar O. , Ho Pei-Chun , Morris Gerald D. , Hillier Adrian D. , Biswas Pabitra K. , Cottrell Stephen P. , Xiang Hui , Yao Xin , MacLaughlin Douglas E. , Shu Lei
Published: January 2018

Muon relaxation experiments reveal a slowly fluctuating magnetic field in the pseudogap phase of a cuprate superconductor.
Resident memory T cells: Runx and hide
Authors: Clark Rachael A.
Published: January 2018

The transcription factor Runx3 enhances the differentiation and survival of CD8
+
resident memory T cells; enhancing Runx3 expression in responding T cells could lead to better therapies for infection and cancer.
Getting with the program in type 1 diabetes mellitus
Authors: Perugino Cory , Pillai Shiv
Published: January 2018

Transcriptomic studies reveal defective costimulation via PD-L1 to explain the autoreactive phenotype seen in type 1 diabetes mellitus.
Comparative Transcriptome Analysis Reveals the Mechanism Underlying 3,5-Dibromo-4-Hydroxybenzoate Catabolism via a New Oxidative Decarboxylation Pathway
Authors: Chen Kai , Mu Yang , Jian Shanshan , Zang Xiaoxia , Chen Qing , Jia Weibin , Ke Zhuang , Gao Yanzheng , Jiang Jiandong
Published: January 2018

The compound 3,5-dibromo-4-hydroxybenzoate (DBHB) is both anthropogenically released into and naturally produced in the environment, and its environmental fate is of great concern. Aerobic and anaerobic reductive dehalogenations are the only two reported pathways for DBHB catabolism. In this study, a new oxidative decarboxylation pathway for DBHB catabolism was identified in a DBHB-utilizing strain,
Pigmentiphaga
sp. strain H8. The genetic determinants underlying this pathway were elucidated based on comparative transcriptome analysis and subsequent experimental validation. A gene cluster comprising
orf420
to
orf426
, with transcripts that were about 33- to 4,400-fold upregulated in DBHB-induced cells compared with those in uninduced cells, was suspected to be involved in DBHB catabolism. The gene
odcA
(
orf420
), which is essential for the initial catabolism of DBHB, encodes a novel NAD(P)H-dependent flavin monooxygenase that mediates the oxidative decarboxylation of DBHB to 2,6-dibromohydroquinone (2,6-DBHQ). The substrate specificity of the purified OdcA indicated that the 4-hydroxyl group and its
ortho
-halogen(s) are important for hydroxylation of the C-1 site carboxyl group by OdcA. 2,6-DBHQ is then ring cleaved by the dioxygenase OdcB (Orf425) to 2-bromomaleylacetate, which is finally transformed to β-ketoadipate by the maleylacetate reductase OdcC (Orf426). These results provide a better understanding of the molecular mechanism underlying the catabolic diversity of halogenated
para
-hydroxybenzoates.

IMPORTANCE
Halogenated hydroxybenzoates (HBs), which are widely used synthetic precursors for chemical products and common metabolic intermediates from halogenated aromatics, exert considerable adverse effects on human health and ecological security. Microbial catabolism plays key roles in the dissipation of halogenated HBs in the environment. In this study, the discovery of a new catabolic pathway for 3,5-dibromo-4-hydroxybenzoate (DBHB) and clarification of the genetic determinants underlying the pathway broaden our knowledge of the catabolic diversity of halogenated HBs in microorganisms. Furthermore, the NAD(P)H-dependent flavin monooxygenase OdcA identified in
Pigmentiphaga
sp. strain H8 represents a novel 1-monooxygenase for halogenated
para
-HBs found in prokaryotes and enhances our knowledge of the decarboxylative hydroxylation of (halogenated)
para
-HBs.
Contribution of YthA, a PspC Family Transcriptional Regulator of Lactococcus lactis F44 Acid Tolerance and Nisin Yield: a Transcriptomic Approach
Authors: Wu Hao , Liu Jingui , Miao Sen , Zhao Yue , Zhu Hongji , Qiao Mingqiang , Saris Per Erik Joakim , Qiao Jianjun
Published: January 2018

To overcome the adverse impacts of environmental stresses during growth, different adaptive regulation mechanisms can be activated in
Lactococcus lactis
. In this study, the transcription levels of eight transcriptional regulators of
L. lactis
subsp.
lactis
F44 under acid stress were analyzed using quantitative reverse transcription-PCR. Eight gene-overexpressing strains were then constructed to examine their influences on acid-resistant capability. Overexpressing
ythA
, a PspC family transcriptional regulator, increased the survival rate by 3.2-fold compared to the control at the lethal pH 3.0 acid shock. Moreover, the nisin yield was increased by 45.50%. The
ythA
-overexpressing strain FythA appeared to have higher intracellular pH stability and nisin-resistant ability. Subsequently, transcriptome analysis revealed that the vast majority of genes associated with amino acid biosynthesis, including arginine, serine, phenylalanine, and tyrosine, were predominantly upregulated in FythA. Arginine biosynthesis (
argG
and
argH
), arginine deiminase pathway, and polar amino acid transport (
ysfE
and
ysfF
) were proposed to be the main regulation mechanisms of YthA. Furthermore, the transcription of genes associated with pyrimidine and exopolysaccharide biosynthesis were upregulated. The transcriptional levels of
nisIPRKFEG
genes were substantially higher in FythA, which directly contributed to the yield and resistance of nisin. Three potential DNA-binding sequences were predicted by computer analysis using the upstream regions of genes with prominent changes. This study showed that YthA could increase acid resistance and nisin yield and revealed a putative regulation mechanism of YthA.

IMPORTANCE
Nisin, produced by
Lactococcus lactis
subsp.
lactis
, is widely used as a safe food preservative. Acid stress becomes the primary restrictive factor of cell growth and nisin yield. In this research, we found that the transcriptional regulator YthA was conducive to enhancing the acid resistance of
L. lactis
F44. Overexpressing
ythA
could significantly improve the survival rate and nisin yield. The stability of intracellular pH and nisin resistance were also increased. Transcriptome analysis showed that nisin immunity and the biosynthesis of some amino acids, pyrimidine, and exopolysaccharides were enhanced in the engineered strain. This study elucidates the regulation mechanism of YthA and provides a novel strategy for constructing robust industrial
L. lactis
strains.
Bacterial Pathogen Emergence Requires More than Direct Contact with a Novel Passerine Host
Authors: Staley Molly , Hill Geoffrey E. , Josefson Chloe C. , Armbruster Jonathan W. , Bonneaud Camille
Published: January 2018

While direct contact may sometimes be sufficient to allow a pathogen to jump into a new host species, in other cases, fortuitously adaptive mutations that arise in the original donor host are also necessary. Viruses have been the focus of most host shift studies, so less is known about the importance of ecological versus evolutionary processes to successful bacterial host shifts. Here we tested whether direct contact with the novel host was sufficient to enable the mid-1990s jump of the bacterium
Mycoplasma gallisepticum
from domestic poultry to house finches (
Haemorhous mexicanus
). We experimentally inoculated house finches with two genetically distinct
M. gallisepticum
strains obtained either from poultry (Rlow) or from house finches (HF1995) during an epizootic outbreak. All 15 house finches inoculated with HF1995 became infected, whereas Rlow successfully infected 12 of 15 (80%) inoculated house finches. Comparisons among infected birds showed that, relative to HF1995, Rlow achieved substantially lower bacterial loads in the host respiratory mucosa and was cleared faster. Furthermore, Rlow-infected finches were less likely to develop clinical symptoms than HF1995-infected birds and, when they did, displayed milder conjunctivitis. The lower infection success of Rlow relative to HF1995 was not, however, due to a heightened host antibody response to Rlow. Taken together, our results indicate that contact between infected poultry and house finches was not, by itself, sufficient to explain the jump of
M. gallisepticum
to house finches. Instead, mutations arising in the original poultry host would have been necessary for successful pathogen emergence in the novel finch host.
Vaccine-Linked Chemotherapy Improves Benznidazole Efficacy for Acute Chagas Disease
Authors: Jones Kathryn , Versteeg Leroy , Damania Ashish , Keegan Brian , Kendricks April , Pollet Jeroen , Cruz-Chan Julio Vladimir , Gusovsky Fabian , Hotez Peter J. , Bottazzi Maria Elena
Published: January 2018

Chagas disease affects 6 to 7 million people worldwide, resulting in significant disease burdens and health care costs in countries of endemicity. Chemotherapeutic treatment is restricted to two parasiticidal drugs, benznidazole and nifurtimox. Both drugs are highly effective during acute disease but are only minimally effective during chronic disease and fraught with significant adverse clinical effects. In experimental models, vaccines can be used to induce parasite-specific balanced TH1/TH2 immune responses that effectively reduce parasite burdens and associated inflammation while minimizing adverse effects. The objective of this study was to determine the feasibility of vaccine-linked chemotherapy for reducing the amount of benznidazole required to significantly reduce blood and tissue parasite burdens. In this study, we were able to achieve a 4-fold reduction in the amount of benznidazole required to significantly reduce blood and tissue parasite burdens by combining the low-dose benznidazole with a recombinant vaccine candidate, Tc24 C4, formulated with a synthetic Toll-like 4 receptor agonist, E6020, in a squalene oil-in-water emulsion. Additionally, vaccination induced a robust parasite-specific balanced TH1/TH2 immune response. We concluded that vaccine-linked chemotherapy is a feasible option for advancement to clinical use for improving the tolerability and efficacy of benznidazole.
Activities of Thrombin and Factor Xa Are Essential for Replication of Hepatitis E Virus and Are Possibly Implicated in ORF1 Polyprotein Processing
Authors: Kanade Gayatri D. , Pingale Kunal D. , Karpe Yogesh A.
Published: January 2018

Hepatitis E virus (HEV) is a clinically important positive-sense RNA virus. The ORF1 of HEV encodes a nonstructural polyprotein of 1,693 amino acids. It is not clear whether the ORF1 polyprotein (pORF1) is processed into distinct enzymatic domains. Many researchers have attempted to understand the mechanisms of pORF1 processing. However, these studies gave various results and could never convincingly establish the mechanism of pORF1 processing. In this study, we demonstrated the possible role of thrombin and factor Xa in pORF1 processing. We observed that the HEV pORF1 polyprotein bears conserved cleavage sites of thrombin and factor Xa. Using a reverse genetics approach, we demonstrated that an HEV replicon having mutations in the cleavage sites of either thrombin or factor Xa could not replicate efficiently in cell culture. Further, we demonstrated
in vitro
processing when we incubated recombinant pORF1 fragments with thrombin, and we observed the processing of pORF1 polyprotein. The treatment of a liver cell line with a serine protease inhibitor as well as small interfering RNA (siRNA) knockdown of thrombin and factor Xa resulted in significant reduction in the replication of HEV. Thrombin and factor Xa have been well studied for their roles in blood clotting. Both of these proteins are believed to be present in the active form in the blood plasma. Interestingly, in this report, we demonstrated the presence of biologically active thrombin and factor Xa in a liver cell line. The results suggest that factor Xa and thrombin are essential for the replication of HEV and may be involved in pORF1 polyprotein processing of HEV.

IMPORTANCE
Hepatitis E virus (HEV) causes a liver disorder called hepatitis in humans, which is mostly an acute and self-limiting infection in adults. A high mortality rate of about 30% is observed in HEV-infected pregnant women in developing countries. There is no convincing opinion about HEV ORF1 polyprotein processing owing to the variability of study results obtained so far. HEV pORF1 has cleavage sites for two host cellular serine proteases, thrombin and factor Xa, that are conserved among HEV genotypes. For the first time, this study demonstrated that thrombin and factor Xa cleavage sites on HEV pORF1 are obligatory for HEV replication. Intracellular biochemical activities of the said serine proteases are also essential for efficient HEV replication in cell culture and must be involved in pORF1 processing. This study sheds light on the presence and roles of clotting factors with respect to virus replication in the cells.
Evidence that the Plasmodium falciparum Protein Sortilin Potentially Acts as an Escorter for the Trafficking of the Rhoptry-Associated Membrane Antigen to the Rhoptries
Authors: Hallée Stéphanie , Boddey Justin A. , Cowman Alan F. , Richard Dave
Published: January 2018

The malaria parasite is a massive burden in several parts of the world. Worryingly, the parasite has become resistant to several of the drugs commonly used to treat the disease, and at this time, there is no commercial vaccine. It is therefore critical to identify new targets for the development of antimalarials. To survive in the human body, the malaria parasite needs to invade red blood cells. For this, it uses a variety of effectors stored in organelles forming a structure called the apical complex. The mechanisms behind how the parasite generates the apical complex are poorly understood. In this study, we present evidence that a transmembrane protein called sortilin potentially acts as an escorter to transport proteins from the Golgi apparatus to the rhoptries, a component of the apical complex. Our study provides new insight into the biogenesis of a critical structure of the malaria parasite.
Mechanical stress potentiates the differentiation of periodontal ligament stem cells into keratocytes
Authors: Chen Jialin , Zhang Wei , Backman Ludvig J , Kelk Peyman , Danielson Patrik
Published: January 2018

Aims

To explore the role of corneal-shaped static mechanical strain on the differentiation of human periodontal ligament stem cells (PDLSCs) into keratocytes and the possible synergistic effects of mechanics and inducing medium.

Methods

PDLSCs were exposed to 3% static dome-shaped mechanical strain in a Flexcell Tension System for 3 days and 7 days. Keratocyte phenotype was determined by gene expression of keratocyte markers. Keratocyte differentiation (inducing) medium was introduced in the Flexcell system, either continuously or intermittently combined with mechanical stimulation. The synergistic effects of mechanics and inducing medium on keratocyte differentiation was evaluated by gene and protein expression of keratocyte markers. Finally, a multilamellar cell sheet was assembled by seeding PDLSCs on a collagen membrane and inducing keratocyte differentiation. The transparency of the cell sheet was assessed, and typical markers of native human corneal stroma were evaluated by immunofluorescence staining.

Results

Dome-shaped mechanical stimulation promoted PDLSCs to differentiate into keratocytes, as shown by the upregulation of ALDH3A1, CD34, LUM, COL I and COL V. The expression of integrins were also upregulated after mechanical stimulation, including integrin alpha 1, alpha 2, beta 1 and non-muscle myosin II B. A synergistic effect of mechanics and inducing medium was found on keratocyte differentiation. The cell sheets were assembled under the treatment of mechanics and inducing medium simultaneously. The cell sheets were transparent, multilamellar and expressed typical markers of corneal stroma.

Conclusion

Dome-shaped mechanical stimulation promotes differentiation of PDLSCs into keratocytes and has synergistic effects with inducing medium. Multilamellar cell sheets that resemble native human corneal stroma show potential for future clinical applications.
Risk factors for incidence of trachomatous scarring in a cohort of women in low endemic district
Authors: Karani Rabia , Wolle Meraf , Mkocha Harran , Muñoz Beatriz , West Sheila K
Published: January 2018

Background/aims

To determine the incidence of scarring in women in a trachoma low endemic district of rural Tanzania and to determine the effects of lifetime cooking fire exposure and markers of lower socioeconomic status on incidence of scarring in these women.

Methods

A prospective cohort study was conducted over a 3.5-year period from 2013 to 2016 in 48 villages in Kongwa, Tanzania where trachoma at baseline was 5.2% in children. A random sample of 2966 women aged 15 and older who were at risk for incident scarring were eligible for follow-up. Data on demographic factors, cooking fire exposure and trachomatous scarring were gathered at baseline and follow-up. An index of lifetime exposure to cooking fire exposure was created and bivariate analysis, age-adjusted logistic regression and multivariable logistic models were used to look for associations of demographic factors and cooking fire exposure with incident trachomatous scarring.

Results

The cumulative incidence of scarring was 7.1% or 2.0% per year. Incidence of scarring increased with age and exposure to markers of lower socioeconomic status. A multivariable logistic regression model adjusting for confounding factors did not find an association between lifetime cooking fire exposure and incidence of scarring (OR=0.92; 95% CI 0.68 to 1.24, P=0.58).

Conclusions

There was still incident scarring in women in Tanzania despite low rates of active trachoma. There was no association between exposure to cooking fires and incident scarring. More research is needed to understand the factors that contribute to new scarring in these women.
Binocular stereo acuity affects monocular three-dimensional shape perception in patients with strabismus
Authors: Sawamura Hiromasa , Gillebert Céline R , Todd James T , Orban Guy A
Published: January 2018

Background/aims

To evaluate the perception of three-dimensional (3D) shape in patients with strabismus and the contributions of stereopsis and monocular cues to this perception.

Methods

Twenty-one patients with strabismus with and 20 without stereo acuity as well as 25 age-matched normal volunteers performed two tasks: (1) identifying the closest vertices of 3D shapes from monocular shading (3D-SfS), texture (3D-SfT) or motion cues (3D-SfM) and from binocular disparity (3D-SfD), (2) discriminating 1D elementary features of these cues.

Results

Discrimination of the elementary features of luminance, texture and motion did not differ across groups. When the distances between reported and actual closest vertices were resolved into sagittal and frontoparallel plane components, sagittal components in 3D-SfS and frontoparallel components in 3D-SfT indicated larger errors in patients with strabismus without stereo acuity than in normal subjects. These patients could not discriminate one-dimensional elementary features of binocular disparity. Patients with strabismus with stereo acuity performed worse for both components of 3D-SfD and frontoparallel components of 3D-SfT compared with normal subjects. No differences were observed in the perception of 3D-SfM across groups. A comparison between normal subjects and patients with strabismus with normal stereopsis revealed no deficit in 3D shape perception from any cue.

Conclusions

Binocular stereopsis is essential for fine perception of 3D shape, even when 3D shape is defined by monocular static cues. Interaction between these cues may occur in ventral occipitotemporal regions, where 3D-SfS, 3D-SfT and 3D-SfD are processed in the same or neighbouring cortical regions. Our findings demonstrate the perceptual benefit of binocular stereopsis in patients with strabismus.
Implementation of medical retina virtual clinics in a tertiary eye care referral centre
Authors: Kortuem Karsten , Fasler Katrin , Charnley Amanda , Khambati Hussain , Fasolo Sandro , Katz Menachem , Balaskas Konstantinos , Rajendram Ranjan , Hamilton Robin , Keane Pearse A , Sim Dawn A
Published: January 2018

Background

The increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashion

Methods

First attendances in the VMRC (September 2016–May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed.

Results

A total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%).

Conclusion

VMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment.
Characteristic optical coherence tomography findings in patients with primary vitreoretinal lymphoma: a novel aid to early diagnosis
Authors: Barry Robert J , Tasiopoulou Anastasia , Murray Philip I , Patel Praveen J , Sagoo Mandeep S , Denniston Alastair K , Keane Pearse A
Published: January 2018

Background

The diagnosis of primary vitreoretinal lymphoma (PVRL) poses significant difficulties; presenting features are non-specific and confirmation usually necessitates invasive vitreoretinal biopsy. Diagnosis is often delayed, resulting in increased morbidity and mortality. Non-invasive imaging modalities such as spectral domain optical coherence tomography (SD-OCT) offer simple and rapid aids to diagnosis. We present characteristic SD-OCT images of patients with biopsy-positive PVRL and propose a number of typical features, which we believe are useful in identifying these lesions at an early stage.

Methods

Medical records of all patients attending Moorfields Eye Hospital between April 2010 and April 2016 with biopsy-positive PVRL were reviewed. Pretreatment SD-OCT images were collected for all eyes and were reviewed independently by two researchers for features suggestive of PVRL.

Results

Pretreatment SD-OCT images of 32 eyes of 22 patients with biopsy-proven PVRL were reviewed. Observed features included hyper-reflective subretinal infiltrates (17/32), hyper-reflective infiltration in inner retinal layers (6/32), retinal pigment epithelium (RPE) undulation (5/32), clumps of vitreous cells (5/32) and sub-RPE deposits (3/32). Of these, the hyper-reflective subretinal infiltrates have an appearance unique to PVRL, with features not seen in other diseases.

Conclusion

We have identified a range of SD-OCT features, which we believe to be consistent with a diagnosis of PVRL. We propose that the observation of hyper-reflective subretinal infiltrates as described is highly suggestive of PVRL. This case series further demonstrates the utility of SD-OCT as a non-invasive and rapid aid to diagnosis, which may improve both visual outcomes and survival of patients with intraocular malignancies such as PVRL.
Serum lactate cut-offs asarisk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis
Authors: Shetty Amith L , Thompson Kelly , Byth Karen , Macaskill Petra , Green Malcolm , Fullick Mary , Lander Harvey , Iredell Jonathan
Published: January 2018

Objectives

We investigated specific lactate thresholds for adverse outcomes in patients presenting to emergency departments (EDs) with suspected sepsis identified based on the performance of a sepsis screening algorithm.

Design and setting

A standardised sepsis bundle was implemented across public hospitals in New South Wales, Australia, as a quality improvement initiative. A register of all adult ED presentations (≥18 years) meeting predefined criteria for sepsis was created, using a combination of data linkage and direct reporting from 97 participating sites.

Participants

A total of 12 349 adult ED presentations with 8310 (67.3%) having serum lactate analysis on arrival. Analysis of outcomes was based on dataset for 12 349 subjects obtained through multiple imputation for missing data.

Interventions

A sepsis management bundle including early antibiotic prescribing, fluid therapy and referral to intensive care unit (ICU) services was implemented.

Outcome measures

A primary composite adverse event (AE) outcome of inhospital mortality (IHM) and/or prolonged ICU stay ≥72 hours (ICU 72 hours) was used for this study.

Results

There was statistically significant increase both in the ORs of AE and IHM with each integer increase in serum lactate values. After adjusting for the presence of hypotension, the estimated ORs for the combined AE outcome were 2.71 (95% CI 2.05 to 3.57), 2.65 (95% CI 2.29 to 3.08), 3.10 (95% CI 2.71 to 3.53) and 3.89 (95% CI 3.36 to 4.50) for serum lactate levels at or above 1, 2, 3 and 4 mmol/L, respectively. The corresponding ORs for IHM were 2.93 (95% CI 2.08 to 4.13), 2.77 (95% CI 2.34 to 3.29), 3.26 (95% CI 2.80 to 3.80) and 4.01 (95% CI 3.40 to 4.73), respectively (all P<0.0001). More than 10% of patients with suspected sepsis and with serum lactate ≥2 mmol/L experienced a prolonged ICU stay or died in hospital.

Conclusions

ED sepsis screening algorithms intended to identify patient adverse outcomes should incorporate a serum lactate cut-off of ≥2 mmol/L as a threshold for the initiation of specific interventions and increased monitoring.
Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: quantitative examination of variation between practices in recruitment, implementation and effectiveness
Authors: Dreischulte Tobias , Grant Aileen , Hapca Adrian , Guthrie Bruce
Published: January 2018

Objectives

The cluster randomised trial of the Data-driven Quality Improvement in Primary Care (DQIP) intervention showed that education, informatics and financial incentives for general medical practices to review patients with ongoing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets reduced the primary end point of high-risk prescribing by 37%, where both ongoing and new high-risk prescribing were significantly reduced. This quantitative process evaluation examined practice factors associated with (1) participation in the DQIP trial, (2) review activity (extent and nature of documented reviews) and (3) practice level effectiveness (relative reductions in the primary end point).

Setting/participants

Invited practices recruited (n=33) and not recruited (n=32) to the DQIP trial in Scotland, UK.

Outcome measures

(1) Characteristics of recruited versus non-recruited practices. Associations of (2) practice characteristics and ‘adoption’ (self-reported implementation work done by practices) with documented review activity and (3) of practice characteristics, DQIP adoption and review activity with effectiveness.

Results

(1) Recruited practices had lower performance in the quality and outcomes framework than those declining participation. (2) Not being an approved general practitioner training practice and higher self-reported adoption were significantly associated with higher review activity. (3) Effectiveness ranged from a relative increase in high-risk prescribing of 24.1% to a relative reduction of 77.2%. High-risk prescribing and DQIP adoption (but not documented review activity) were significantly associated with greater effectiveness in the final multivariate model, explaining 64.0% of variation in effectiveness.

Conclusions

Intervention implementation and effectiveness of the DQIP intervention varied substantially between practices. Although the DQIP intervention primarily targeted review of ongoing high-risk prescribing, the finding that self-reported DQIP adoption was a stronger predictor of effectiveness than documented review activity supports that reducing initiation and/or re-initiation of high-risk prescribing is key to its effectiveness.

Trial registration number

NCT01425502; Post-results.
Knowledge, opinions and compliance related to the 100% smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from theKOMPLY Project
Authors: Gravely Shannon , Nyamurungi Kellen Namusisi , Kabwama Steven Ndugwa , Okello Gabriel , Robertson Lindsay , Heng Kelvin Khow Chuan , Ndikum Achiri Elvis , Oginni Adeniyi Samuel , Rusatira Jean Christophe , Kakoulides Socrates , Huffman Mark D , Yusuf Salim , Bianco Eduardo
Published: January 2018

Objective

This study evaluated knowledge, opinions and compliance related to Uganda’s comprehensive smoke-free law among hospitality venues in Kampala Uganda.

Design

This multi-method study presents cross-sectional findings of the extent of compliance in the early phase of Uganda’s comprehensive smoke-free law (2 months postimplementation; pre-enforcement).

Setting

Bars, pubs and restaurants in Kampala Uganda.

Procedure and participants

A two-stage stratified cluster sampling procedure was used to select hospitality sites stratified by all five divisions in Kampala. A total of 222 establishments were selected for the study. One hospitality representative from each of the visited sites agreed to take part in a face-to-face administered questionnaire. A subsample of hospitality venues were randomly selected for tobacco air quality testing (n=108). Data were collected between June and August 2016.

Outcome measures

Knowledge and opinions of the smoke-free law among hospitality venue staff and owners. The level of compliance with the smoke-free law in hospitality venues through: (1) systematic objective observations (eg, active smoking, the presence of designated smoking areas, ‘no smoking’ signage) and (2) air quality by measuring the levels of tobacco particulate matter (PM2.5) in both indoor and outdoor venues.

Results

Active smoking was observed in 18% of venues, 31% had visible ‘no smoking’ signage and 47% had visible cigarette remains. Among interviewed respondents, 57% agreed that they had not been adequately informed about the smoke-free law; however, 90% were supportive of the ban. Nearly all respondents (97%) agreed that the law will protect workers’ health, but 32% believed that the law would cause financial losses at their establishment. Indoor PM2.5levels were hazardous (267.6 µg/m3) in venues that allowed smoking and moderate (29.6 µg/m3) in smoke-free establishments.

Conclusions

In the early phase of Uganda’s smoke-free law, the level of compliance in hospitality venues settings in Kampala was suboptimal. Civil society and the media have strong potential to inform and educate the hospitality industry and smokers of the benefits and requirements of the smoke-free law.
Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data
Authors: Huang Chung-Ming , Chen Hsuan-Ju , Huang Po-Hao , Tsay Gregory J , Lan Joung-Liang , Sung Fung-Chang
Published: January 2018

Objectives

Population studies on hearing loss (HL) associated with rheumatoid arthritis (RA) are lacking. This study investigated the risk of developing HL in patients with RA using a nationwide population cohort.

Setting

The population-based insurance claims data in the Taiwan National Health Insurance Research Database.

Design

Retrospective cohort study followed up RA cohort and control cohort without RA frequency matched by sex, age and diagnosis year.

Study population

18 267 patients with RA newly diagnosed in 2000–2006 and 73 068 controls without RA.

Main outcomes

Incidences of HL by the end of 2011 and the RA cohort to non-RA cohort HRs after adjusting for sex, age and comorbidities.

Results

The HL incidence was higher in the RA cohort than in the non-RA cohort (3.08 vs 1.62 per 1000 person-years), with an adjusted HR (aHR) of 1.91 (95% CI 1.70 to 2.14) for the RA cohort relative to the non-RA cohort after controlling for age, sex and comorbidities. Men and the elderly are at a higher risk. Cardiovascular comorbidities were associated with a further increased HL risk for patients with RA. Medications were associated with reduced HL incidence; patients with RA who used non-steroidal anti-inflammatory drugs (NSAIDs) had an aHR of 0.12 (95% CI 0.07 to 0.20), compared with non-users.

Conclusions

This study demonstrates that patients with RA are at an increased risk of developing HL. Findings highlight the need of disease-modifying treatment and scheduled auditory examinations for HL prevention and early detection for patients with RA.
Derivation and validation of different machine-learning models in mortality prediction of trauma in motorcycle riders: a cross-sectional retrospective study in southern Taiwan
Authors: Kuo Pao-Jen , Wu Shao-Chun , Chien Peng-Chen , Rau Cheng-Shyuan , Chen Yi-Chun , Hsieh Hsiao-Yun , Hsieh Ching-Hua
Published: January 2018

Objectives

This study aimed to build and test the models of machine learning (ML) to predict the mortality of hospitalised motorcycle riders.

Setting

The study was conducted in a level-1 trauma centre in southern Taiwan.

Participants

Motorcycle riders who were hospitalised between January 2009 and December 2015 were classified into a training set (n=6306) and test set (n=946). Using the demographic information, injury characteristics and laboratory data of patients, logistic regression (LR), support vector machine (SVM) and decision tree (DT) analyses were performed to determine the mortality of individual motorcycle riders, under different conditions, using all samples or reduced samples, as well as all variables or selected features in the algorithm.

Primary and secondary outcome measures

The predictive performance of the model was evaluated based on accuracy, sensitivity, specificity and geometric mean, and an analysis of the area under the receiver operating characteristic curves of the two different models was carried out.

Results

In the training set, both LR and SVM had a significantly higher area under the receiver operating characteristic curve (AUC) than DT. No significant difference was observed in the AUC of LR and SVM, regardless of whether all samples or reduced samples and whether all variables or selected features were used. In the test set, the performance of the SVM model for all samples with selected features was better than that of all other models, with an accuracy of 98.73%, sensitivity of 86.96%, specificity of 99.02%, geometric mean of 92.79% and AUC of 0.9517, in mortality prediction.

Conclusion

ML can provide a feasible level of accuracy in predicting the mortality of motorcycle riders. Integration of the ML model, particularly the SVM algorithm in the trauma system, may help identify high-risk patients and, therefore, guide appropriate interventions by the clinical staff.
Comparative efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents: protocol of an individual patient data meta-analysis
Authors: Zhou Xinyu , Cipriani Andrea , Furukawa Toshi A , Cuijpers Pim , Zhang Yuqing , Hetrick Sarah E , Pu Juncai , Yuan Shuai , Del Giovane Cinzia , Xie Peng
Published: January 2018

Introduction

Although previous conventional meta-analyses and network meta-analyses have provided some important findings about pharmacological treatments for children and adolescents with depressive disorders in the past decades, several questions still remain unsolved by the aggregate data from those meta-analyses. Individual participant data meta-analysis (IPD-MA) enables exploration of the impacts of individual characteristics on treatment effects, allowing matching of treatments to specific subgroups of patients. We will perform an IPD-MA to assess the efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents.

Methods and analysis

We will systematically search for all double-blind randomised controlled trials (RCTs) that have compared any new-generation antidepressant with placebo for the acute treatment of major depressive disorder in children and adolescents, in the following databases: PubMed, EMBASE, the Cochrane Library, PsycINFO, Web of Science, CINAHL, LILACS and ProQuest Dissertations. We will contact all corresponding authors of included RCTs and ask for their cooperation in this project by providing individual participant data from the original trials. The primary outcomes will include efficacy, measured as the mean change of depression symptoms by Children’s Depression Rating Scale Revised (CDRS-R), and tolerability, measured as the proportion of patients who withdrew from the trials early due to adverse effects. The secondary outcomes will include response rates, remission rates, deterioration rate, all-cause discontinuation, suicidal-related outcomes and global functioning outcome. Using the raw de-identified study data, we will use mixed-effects logistic and linear regression models to perform the IPD-MAs. The risk of bias of included studies will be assessed using the Cochrane risk of bias tool. We will also detect the publication bias and effects of non-participation of eligible studies.

Dissemination

Ethical approval is not required given that informed consent has already been obtained from the patients by the trial investigators before the included trials were conducted. This study may have considerable implications for practice and help improve patient care.

PROSPERO registration number

CRD42016051657.
Developing professional caregivers’ empathy and emotional competencies through mindfulness-based stress reduction (MBSR): results of two proof-of-concept studies
Authors: Lamothe Martin , McDuff Pierre , Pastore Yves D , Duval Michel , Sultan Serge
Published: January 2018

Objectives

To assess the feasibility and acceptability of a mindfulness-based stress reduction (MBSR)-based intervention and determine if the intervention is associated with a significant signal on empathy and emotional competencies.

Design

Two pre–post proof-of-concept studies.

Setting

Participants were recruited at the University of Montreal’s Psychology Department (Study 1) and the CHU Sainte-Justine Department of Hematology-Oncology (Study 2).

Participants

Study 1: 12 students completed the 8-week programme (mean age 24, range 18–34). Study 2: 25 professionals completed the 8-week programme (mean age 48, range 27–63).

Intervention

Standard MBSR programme including 8-week mindfulness programme consisting of 8 consecutive weekly 2-hour sessions and a full-day silent retreat.

Outcomes measures

Mindfulness as measured by the Mindful Attention Awareness Scale; empathy as measured by the Interpersonal Reactivity Index (IRI)’s Perspective Taking and Empathic Concern subscales; identification of one’s own emotions and those of others as measured by the Profile of Emotional Competence (PEC)’s Identify my Emotions and Identify Others’ Emotions subscales; emotional acceptance as measured by the Acceptance and Action Questionnaire-II (AAQ-II) and the Emotion Regulation Scale (ERQ)’s Expressive Suppression subscale; and recognition of emotions in others as measured by the Geneva Emotion Recognition Test (GERT).

Results

In both studies, retention rates (80%–81%) were acceptable. Participants who completed the programme improved on all measures except the PEC’s Identify Others’ Emotions and the IRI’s Empathic Concern (Cohen’s d median=0.92, range 45–1.72). In Study 2, favourable effects associated with the programme were maintained over 3 months on the PEC’s Identify my Emotions, the AAQ-II, the ERQ’s Expressive Suppression and the GERT.

Conclusions

The programme was feasible and acceptable. It was associated with a significant signal on the following outcomes: perspective taking, the identification of one’s own emotions and emotional acceptance, thus, justifying moving towards efficacy trials using these outcomes.