bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications
Authors: Tyan Paul , Taher Ali , Carey Erin , Sparks Andrew , Radwan Amr , Amdur Richard , Tamim Hani , Gu Alex , Robinson Hannah , Moawad Gaby N.
Published: August 2019

Introduction

One‐third of non‐pregnant women worldwide are anemic.1 Anemia is a known independent risk factor for postoperative morbidity.2 Given that the vast majority of hysterectomies are not performed in the emergency setting, we designed this study to evaluate the effect of preoperative anemia on postoperative morbidity following laparoscopic hysterectomy performed for benign indications. Our main goal is to encourage surgeons to use anemia‐corrective measures before surgery when feasible.

Material and methods

Retrospective cohort study of 98 813 patients who underwent a laparoscopic hysterectomy between 2005 and 2016 for benign indications identified through the American College of Surgeons National Surgical Quality Improvement Program. Anemia was examined as a function of hematocrit and was analyzed as an ordinal variable stratified by anemia severity as mild, moderate or severe. Associations between preoperative anemia and patient demographics, preoperative comorbidities and postoperative outcomes were evaluated using univariate analyses. Multivariable logistic regression models were used to identify independent associations between hematocrit level and postoperative outcomes after adjusting for confounding covariates. At the multivariable logistic regression level, anemia severity was analyzed using hematocrit as a continuous variable to assess the independent association between each 5% decrease in hematocrit level and several postoperative morbidities.

Results

Of the 98 813 patients who met our inclusion and exclusion criteria, 19.5% were anemic. A lower preoperative hematocrit was associated with higher body mass index, younger age, Black or African American race, longer operative times, and multiple other medical comorbidities. After appropriate regression modeling, anemia was identified as an independent risk factor for extended length of stay, readmission and composite morbidity after surgery.

Conclusions

Preoperative anemia is common among patients undergoing laparoscopic hysterectomy. Preoperative anemia increases patients’ risk for multiple postoperative comorbidities. Given that most hysterectomies are performed in the elective setting, gynecologic surgeons should consider the use of anemia‐corrective measures to minimize postoperative morbidity.
Geographies of expertise in the dieselgate scandal: From a politics of accuracy to a politics of acceptability?
Authors: Palmer James
Published: August 2019

Drawing on semi‐structured interviews, this paper examines the geographies of environmental expertise underpinning the “dieselgate” scandal as it has played out at the EU level. It begins by mapping the scandal as a conflict between two distinct “knowledge space‐times.” The first of these – underpinned by official off‐the‐road vehicle emissions tests – links epistemic credibility to the ideal of experimental reproducibility. The second – underpinned by the “crowdsourcing” of publicly generated fuel economy measurements – links epistemic credibility to the ideals of empirical richness and diversity. The paper argues, however, that “expertise” in this controversy should not be understood exclusively as the attribute of knowledge produced according to particular spatial or temporal logics. Instead, the boundaries of credible expertise in this case are predetermined by an “anti‐political” ontology of vehicle emissions which presumes their status as a single, homogenous object of governance. Drawing on Barry's concept of “metrological regimes,” the paper therefore contends that the full political potential of dieselgate can only be unlocked by inventing new logics of counting and categorisation that might force us to think differently about how best to partition, label, measure, and ultimately govern the inherently messy practices from which individual acts of driving – and hence vehicle emissions – emerge in the first place.
Sea Legs: Learning to Labor on the Water
Authors: Menzies Charles R.
Published: August 2019

This article is an autoethnographic account of growing up and learning to labor on a commercial fishboat. It explores the intersection of labor and masculinity in British Columbia's fishing industry of the 20th and 21st centuries.
Global identifiability of latent class models with applications to diagnostic test accuracy studies: A Gröbner basis approach
Authors: Duan Rui , Cao Ming , Ning Yang , Zhu Mingfu , Zhang Bin , McDermott Aidan , Chu Haitao , Zhou Xiaohua , Moore Jason H. , Ibrahim Joseph G. , Scharfstein Daniel O. , Chen Yong
Published: August 2019

Identifiability of statistical models is a fundamental regularity condition that is required for valid statistical inference. Investigation of model identifiability is mathematically challenging for complex models such as latent class models. Jones et al. used Goodman's technique to investigate the identifiability of latent class models with applications to diagnostic tests in the absence of a gold standard test. The tool they used was based on examining the singularity of the Jacobian or the Fisher information matrix, in order to obtain insights into local identifiability (ie, there exists a neighborhood of a parameter such that no other parameter in the neighborhood leads to the same probability distribution as the parameter). In this paper, we investigate a stronger condition: global identifiability (ie, no two parameters in the parameter space give rise to the same probability distribution), by introducing a powerful mathematical tool from computational algebra: the Gröbner basis. With several existing well‐known examples, we argue that the Gröbner basis method is easy to implement and powerful to study global identifiability of latent class models, and is an attractive alternative to the information matrix analysis by Rothenberg and the Jacobian analysis by Goodman and Jones et al.
Trajectories of Adjustment in a Brazilian Sample of Street‐Involved Youth
Authors: Lima Rebeca Fernandes Ferreira , Raffaelli Marcela , Morais Normanda Araujo de , Santana Juliana P. , Nieto Carlos J. , Koller Silvia H.
Published: August 2019

Trajectories of adjustment were examined in a sample of street‐involved youth across a 1‐year period. Participants (N = 113; Mage = 14.18 years; 80.5% male, 91% non‐White) were recruited in three Brazilian cities. Interviews conducted at three time points included six measures of physical and psychological adjustment. Unconditional growth models revealed linear declines over time (i.e., improved adjustment) on three indicators: health symptoms, sexual risk behaviors, and negative affect. There were no linear changes in drug use, positive affect, or life satisfaction. Conditional growth models revealed few significant effects for age or gender, but ratings of stressful life events moderated longitudinal changes in health symptoms, drug use, and negative affect. Implications for practice, policy, and theory are discussed.
Causative and common PHOX2B variants define a broad phenotypic spectrum
Authors: Bachetti Tiziana , Ceccherini Isabella
Published: August 2019

Paired Like homeobox 2B (PHOX2B) is a gene crucial for the differentiation of the neural lineages of the autonomic nervous system (ANS), whose coding mutations cause congenital central hypoventilation syndrome (CCHS). The vast majority of PHOX2B mutations in CCHS is represented by expansions of a polyalanine region in exon 3, collectively defined PARMs (PolyAlanine Repeat Mutations), the minority being frameshift, missense and nonsense mutations, defined as NPARMs (Non‐PARMs). While PARMs are nearly exclusively associated with isolated CCHS, most of NPARMs is detected in syndromic CCHS, presenting with neuroblastoma and/or Hirschsprung disease. More recently, evidence of a complex role of PHOX2B in the pathogenesis of a wider spectrum of ANS disorders has emerged. Indeed, common and hypomorphic PHOX2B variants, including synonymous, polyalanine‐contractions, gene deletions may influence the occurrence of either apparent life‐threatening event (ALTE), Sudden Infant Death Syndrome (SIDS), neuroblastoma, or isolated HSCR, likely through small effects on PHOX2B expression levels. After an introduction to the role of PHOX2B in the ANS development, causative mutations, common variants, and gene expression deregulation of the PHOX2B gene are discussed, though the involvement of synonymous variants and contractions requires further confirmations with respect to ANS disorders and molecular mechanisms underlying the PHOX2B phenotypic heterogeneity.
The genome empowerment scale: An assessment of parental empowerment in families with undiagnosed disease
Authors: McConkie‐Rosell Allyn , Schoch Kelly , Sullivan Jennifer , Cope Heidi , Spillmann Rebecca , Palmer Christina G.S. , Pena Loren , Jiang Yong‐Hui , Daniels Nicole , Walley Nicole , Tan Khoon G. ,   Undiagnosed Diseases Network, Hooper Stephen R. , Shashi Vandana
Published: August 2019

While genomic sequencing (ES/GS) has the potential to diagnose children with difficult to diagnose phenotypes, the goal should be not only a diagnosis, but also to empower parents to seek next steps for their children and to emotionally manage the outcome, whether or not a diagnosis is secured. To help achieve this goal, objective measures are needed to assess the process of parental empowerment related to genome sequencing. We present the validity and reliability of the Genome Empowerment Scale (GEmS), developed using a healthcare empowerment theoretical model. To evaluate its psychometric properties, 158 parents of 117 children with an undiagnosed condition undergoing genomic sequencing completed the GEmS, measures for criterion validity and for depression and anxiety. Factor analysis resulted in a four factor solution: (a) meaning of a diagnosis; (b) emotional management of the process; (c) seeking information and support and (d) implications and planning. Reliability and validity analyses show that the GEmS has good psychometric properties. The inter‐relationships among the factors revealed a profile that may identify parents at risk for a poorer outcome who may benefit from targeted genetic counseling. The GEmS, an objective measure of parental genomic empowerment, can be utilized for future research and translational applications.
The importance of CT quantitative evaluation of emphysema in lung cancer screening cohort with negative findings by visual evaluation
Authors: Li Zhaobin , Xia Yi , Fang Yuan , Guan Yu , Wang Yun , Liu Shiyuan , Fan Li
Published: August 2019

Introduction

One‐stop quantitative evaluation of emphysema and lung nodule in lung cancer screening is very important for patient.

Objective

To evaluate the quantitative emphysema in the large‐sample low‐dose CT lung cancer screening cohort with negative CT findings by subjective visual assessment.

Methods

One thousand, two hundred and thirty‐one participants with negative visual evaluation were included in this retrospective study. The lungs were automatically segmented and the following were calculated: total lung volume (TLV), total emphysema volume (TEV), emphysema index (EI), 15th percentile lung density and mean lung density. EI ≥6% was defined as emphysema. The quantitative parameters were compared between different genders and ages. The quantitative parameters and risk factors were compared between emphysema and non‐emphysema groups.

Results

The proportion of smokers, TLV, TEV and EI of men were greater than that of women (P < 0.001). No correlation was found between age and volumes; the TEV and EI of people older than 60 years were greater than those younger than 60 years (P < 0.05) by age categorisation. One hundred and two participants showed emphysema, accounting for 8.29%. The incidence of emphysema in men was greater than that in women in total (P < 0.05). All the CT quantitative parameters were significantly different between emphysema and non‐emphysema groups. The ratio of male, secondhand smoke exposure and chronic bronchitis history was greater in emphysema than that in the non‐emphysema group (P < 0.05).

Conclusion

CT quantitative emphysema evaluation is recommended in people older than 60 years, especially in males, providing more precise information, aiding the early diagnosis of emphysema and informing early intervention.
Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists
Authors: Elvira Ruiz Ginés , Caro Martínez César , Flores Blanco Pedro J. , Cerezo Manchado Juan José , Albendín Iglesias Helena , Lova Navarro Alejandro , Arregui Montoya Francisco , García Alberola Arcadio , Pascual Figal Domingo A. , Bailén Lorenzo José Luis , Manzano‐Fernández Sergio
Published: August 2019

Background

Antiplatelet therapy (APT) use in combination with oral anticoagulation is common among patients with atrial fibrillation, but there is scarce information regarding its effect on outcomes in patients on non‐vitamin K antagonist oral anticoagulants (NOAC). We aimed to evaluate the safety and efficacy of APT use in a ‘real‐world’ cohort of nonvalvular atrial fibrillation (NVAF) patients initiating NOAC.

Design

We conducted a retrospective multicentre study including 2361 consecutive NVAF patients initiating NOAC between January 2013 and December 2016. Patients with an acute ischaemic event within the last 12 months (acute coronary syndrome, stroke or revascularization) were excluded. Patients were followed up, and all clinical events were recorded at 3 months. The primary outcome of the study was major bleeding, and the secondary outcomes were stroke, nonfatal myocardial infarction, intracranial bleeding and death.

Results

One hundred forty‐five (6.1%) patients received concomitant APT, and aspirin was the more common (79%). At 3 months, 25 (1.1%) patients had major bleeding, 8 (0.3%) had nonfatal myocardial infarction, 7 (0.3%) had ischaemic stroke, and 40 (1.7%) died. After multivariate adjustment, concomitant APT was associated with higher risk for major bleeding (HR = 3.62, 95% CI 1.32‐9.89; P = .012), but was not associated with a higher risk of other clinical outcomes.

Conclusions

Concomitant APT use is uncommon among these patients and does not seem to be associated with lower rates of ischaemic events or death. However, there are signals for an increased risk of bleeding, which reinforces current guideline recommendations.
Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease‐specific effects
Authors: Sundermann Benedikt , Dehghan Nayyeri Mahboobeh , Pfleiderer Bettina , Stahlberg Kim , Jünke Leonie , Baie Lara , Dieckmann Ralf , Liem Dennis , Happe Thomas , Burgmer Markus
Published: August 2019

Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel‐based morphometry and additional ROI‐analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS‐specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS‐specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.
Composition of the arbuscular mycorrhizal fungal community and changes in diversity of the rhizosphere of Clematis fruticosa over three seasons across different elevations
Authors: Liu Min , Yue Yongjie , Wang Zuhua , Li Long , Duan Guozhen , Bai Shulan , Li Tao
Published: August 2019

Clematis fruticosa Turcz. is a dominant native shrub with the potential for spontaneous vegetation succession for restoration of the ecologically fragile and arid Daqing Mountains of Inner Mongolia, which represent an important ecological transition zone in northern China. However, knowledge regarding the interactions between native species and their root‐associated arbuscular mycorrhizal (AM) fungi across different seasons and elevation gradients remains obscure. High AM fungal spore density, root colonization and arbuscular richness suggested that C. fruticosa could establish intimate symbiotic associations with AM fungi. A total of 174 AM fungal virtual taxa were identified from rhizosphere soil samples, and Glomus was dominant. The most distinct AM fungal community composition and the greatest richness and diversity were observed in the spring and at the highest elevation. Seasons • elevation interactions significantly affected Simpson diversity but not AM fungal community composition, observed richness and Shannon index. Seasons had a significant direct on AM fungal observed richness and Shannon index, and elevation had a significant direct on AM fungal observed richness. Soil available phosphorus was the most important driving factor in AM fungal richness and diversity, followed by seasons and soil moisture content. These results provied new insights suggesting that there are active and diverse “functional ingredients”, for example root‐associated AM fungi during the growing season, particularly with an earlier onset in the spring. They are potentially major contributors to the re‐vegetation of degraded lands and the maintenance of soil structure in arid and semiarid ecosystems, which is attributable to seasonal variation in host physiology in stressful environments.

Highlights

We studied the effects of seasons and elevation on AM fungal richness, diversity and community in ecologically fragile mountain areas.

Distinct community composition and greater richness and diversity of AM fungi were detected in the spring and at the highest elevation.

AM fungal richness and diversity depended on certain soil variation related to seasons and elevation.
Periodic density fluctuations in sputtered aluminum‐doped silicon oxynitride layers
Authors: Roch Tomáš , Šimurka Lukáš , Ow‐Yang Cleva W. , Sezen Meltem , Satrapinskyy Leonid , Turutoğlu Tuncay
Published: August 2019

Magnetron sputtering is widely used for deposition of silicon oxynitride (SiOxNy) coatings on glass in large‐area applications. Since repeated deposition simulates the factory‐scale in‐line processing, amorphous aluminum‐doped SiOxNy layers with thickness of about 250 nm were deposited by reactive pulsed DC sputtering in a multi‐pass process with repeated linear movement of a glass substrate under an Al‐alloyed Si target. Using specular X‐ray reflectivity we show periodic fluctuations of the material density throughout the entire thickness of the resulting coating. The number of periods corresponds to the number of passes of the substrate through the plasma of the magnetron. Fitting results suggest a model consistent with a periodic alternation of the O/N ratio. These subtle stoichiometric fluctuations in the SiOxNy layer composition were confirmed by scanning transmission electron microscopy analysis with nanoscale resolution, and with detailed elemental maps of characteristic X‐rays of the layered cross‐section. Our study demonstrates the superior sensitivity of the relatively simple nondestructive X‐ray reflectivity method for industrial line‐process inspection compared to ellipsometry.
Evaluation of flavonoid and polyphenol constituents in mulberry leaves using HPLC fingerprint analysis
Authors: He Xiaoyun , Chen Xu , Ou Xiaoqun , Ma Liyan , Xu Wentao , Huang Kunlun
Published: August 2019

The mulberry leaf is a promising dietary source of antioxidants due to its high levels of beneficial compounds. To further examine its antioxidant properties, twelve batches of authenticated mulberry leaf, with total flavonoid contents (TFC) ranging from 24.34 mg g−1 DW to 58.42 mg g−1 DW and total polyphenol content (TPC) ranging from 11.49 mg g−1 DW to 30.03 mg g−1 DW, were investigated. According to Spearman’s coefficient, antioxidant activities, including the DPPH radical scavenging assay and the ferric reducing antioxidant power (FRAP), were positively correlated with TFC and TPC. The HPLC‐DAD analysis results identified the characteristic fingerprint peaks in mulberry leaves as chlorogenic acid, rutin, quercetin 3‐O‐glucoside and kaempferol 3‐O‐glucoside, all of which directly contribute to the antioxidant capacity of mulberry leaves. Notably, young mulberry leaves showed higher antioxidant capacity than those of mature leaves. These promising results help create a compelling case for future development of mulberry leaf products.
Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis
Authors: Gogna Gauri , Broadbent Andrew , Baade Ingrid
Published: August 2019

Background

The highest healthcare expenditures occur towards the end of life. Costs relate to hospital admissions and investigations to diagnose, prognosticate and direct treatment.

Aims

AnAustralian study to compare the cost of investigations in the last 72 h of life between an inpatient palliative care unit (PCU) and a tertiary hospital.

Method

We retrospectively reviewed 50 adult medical and surgical patients (admitted for >72 h and who died in hospital) from the PCU and referring tertiary centre between March and July 2016. Patients in the emergency department, intensive care, medical assessment and paediatric and obstetric units were excluded. All patients had an acute resuscitation plan and were on the 'Care of the Dying' pathway.

Results

Expenditure was less if palliative care were the primary caregivers, with statistically significant differences in the amount of imaging (P < 0.001) and pathology (P < 0.001) ordered. There was no difference in microbiology (P = 0.172) and histology (P ~ 1) ordered. Total cost of investigations for PCU patients was $1340.60 (4 of 50 patients) compared with $9467.78 (29 of 50 patients) in the tertiary hospital. PCU patients had longer lengths of stay (15.54 days vs 11.06 days) but cost less per bed day ($868.32 vs $878.79 respectively).

Conclusion

Inpatient PCU are less likely to order investigations and are more cost‐effective. A prospective study comparing an inpatient PCU and patients at a tertiary centre, with and without consult liaison palliative care input, would be worthwhile to see if outcomes remain the same and if consult liaison palliative care affects the investigative burden.
Fabrication, tunable fluorescence emission and energy transfer of Tm3+‐Dy3+ co‐activated P2O5–B2O3–SrO–K2O glasses
Authors: Cui Sanchuan , Chen Guohua , Chen Yong , Jin Lei , Shang Fei , Xu Jiwen
Published: August 2019

A growing demand for white light‐emitting diodes (W‐LEDs) gives rise to continuous exploration of functional fluorescence glasses. In this paper, Tm3+/Dy3+ single‐ and co‐doped glasses with composition (in mol%) of 30P2O5–10B2O3–23SrO–37K2O were synthesized using the melt‐quenching method in air. The physical properties, glass structure, luminescence characteristics and energy transfer mechanism of the glasses were systematically studied. As glass network modifiers, Tm3+ and Dy3+ ions can densify the glass structure. Excitation wavelength and doping concentration of Tm3+/Dy3+ ions have a direct impact on the emission intensities of blue and orange light as well as the color coordinate of the as‐prepared glasses. A white light very close to standard white light can be obtained under 354 nm excitation when the content of Tm3+ and Dy3+ is 0.2 mol% and 1.0 mol%, respectively. The results of the emission spectra and decay curves reveal the existence of energy transfer from Tm3+ to Dy3+. The analytic results based on the Inokuti‐Hirayama model indicate that the electrical dipole‐dipole interaction may be the main mechanism of energy transfer. Moreover, Tm3+/Dy3+ co‐activated glass phosphor has good thermal stability and chrominance stability and it is a promising candidate for white LEDs and display device.
Macroecology of ground beetles: Species richness, range size and body size show different geographical patterns across a climatically heterogeneous area
Authors: Heino Jani , Alahuhta Janne , Fattorini Simone
Published: August 2019

Aim

Ecogeographical patterns have been widely studied in endothermic vertebrates, but relatively few studies have simultaneously examined patterns and causes of gradients in species richness, range size and body size in ectothermic insects. We examined patterns in species richness, mean range size and mean body size of ground beetle assemblages across the biogeographical provinces of Northern Europe, a region that was mostly covered by ice sheets during the latest Ice Age and that presents strong contemporary climatic gradients.

Location

Northern Europe.

Methods

We used literature information on the occurrence of ground beetles, and analysed patterns in species richness, mean range size and mean body size across the provinces using generalized linear models and boosted regression tree (BRT) analysis.

Results

We found a strongly decreasing gradient in species richness with increasing latitude, a strongly unimodal range size‐latitude relationship, and a weak unimodal body size‐latitude relationship in entire ground beetle assemblages. These gradients also varied among four major genera, suggesting that the overall patterns result from the nuances of smaller clades of ground beetles. The relative importance of contemporary environmental drivers also varied between species richness, mean range size and mean body size in BRT analysis. While species richness increased with mean annual temperature, mean range size showed an opposite relationship. Mean body size was most clearly associated with the precipitation of the driest month.

Main Conclusions

Our findings showed that the latitudinal species richness gradient was strong, and it was closely related to concomitant variation in temperature, whereas variations in mean range size and mean body size were more complex. These findings suggest that the causes for range size and body size variation in insects may be complex, requiring additional insights from studies conducted at local, regional and continental scales.
Cancer stem cell markers ALDH1 and Bmi1 expression in oral erythroplakia revisited: Implication for driving the process of field cancerization
Authors: Feng Jinqiu , Zhou Zengtong , Shi Linjun , Yang Xi , Liu Wei
Published: August 2019

The correlation of ALDH1 and Bmi1 expression in potentially malignant oral erythroplakia (OE) with oral carcinoma development was reported in our earlier study. Interestingly, a model of field cancerization orchestrated by the cancer stem cells (CSC) was proposed and suggested the identification of CSC‐specific markers is useful for prognosis and providing novel targets for prevention and treatment of field cancerization. We revisited the correlation of ALDH1 and Bmi1 expression in OE with the second and multiple carcinomas development. Strikingly, we observed that the expression of ALDH1 and Bmi1 within a single potentially malignant OE lesion significantly correlate with subsequently developing multiple and multifocal carcinomas, which parallels the process of oral field cancerization. Significantly, ALDH1 and Bmi1 are well‐defined markers of CSC for head and neck cancer. Consequently, we provided a preliminary evidence for CSC driving the process of field cancerization.
Time to thrombectomy is associated with increased risk for dialysis catheter placement
Authors: Hall Damian , Shaughnessy Daniel , Drawz Paul , Akkina Sunil , Esten Andrew , Foley Robert N. , Reule Scott
Published: August 2019

Background

Arteriovenous dialysis access, fistulae (AVF) or grafts (AVG), are associated with significant rates of thrombosis. Timely thrombectomy may have a significant impact on immediate and long‐term access survival. However, switching to a catheter is associated with higher rates of morbidity and mortality compared with those who have an AVF or AVG.

Objectives

The goal of this study was to evaluate whether time to thrombectomy increases the risk for loss of dialysis access and subsequent placement of a dialysis catheter at hospital discharge, at 6 months, 12 months, and data at any time after discharge.

Methods

Using retrospective data, 444 patients were identified as having undergone thrombectomy for dialysis access dysfunction between January 2008 and April 2015, with 122 hospital admissions primarily for thrombectomy.

Results

The mean age was 60.4 years, 65% were male, and 44.3% had an arteriovenous fistula as their dialysis access. The mean time to thrombectomy was 10.8 hours, and 14 patients utilised a catheter for haemodialysis as primary access upon discharge. After adjustment for prior access intervention, access type, and time to thrombectomy, the adjusted odds ratios (AOR) of a one‐day delay in thrombectomy was associated with a twofold increase in requirement for catheter at discharge and at 6 months. This association remained present at any time after discharge.

Conclusion

In this study of patients cared for within an academic health system, a single day delay in thrombectomy nearly doubled the risk of needing a dialysis catheter at hospital discharge, 6 months, or any time after discharge.
The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals
Authors: Bartlett Sofia R. , Yu Amanda , Chapinal Nuria , Rossi Carmine , Butt Zahid , Wong Stanley , Darvishian Maryam , Gilbert Mark , Wong Jason , Binka Mawuena , Alvarez Maria , Tyndall Mark , Krajden Mel , Janjua Naveed Z.
Published: August 2019

Background

Population‐level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population‐level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment.

Methods

BC Hepatitis Testers Cohort (BC‐HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR).

Results

We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR. Individuals from older birth cohorts had lower progression to HCV RNA testing. While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake.

Conclusions

Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.
Prevalence of and risk factors for anaemia in patients with advanced chronic liver disease
Authors: Scheiner Bernhard , Semmler Georg , Maurer Florian , Schwabl Philipp , Bucsics Theresa A. , Paternostro Rafael , Bauer David , Simbrunner Benedikt , Trauner Michael , Mandorfer Mattias , Reiberger Thomas
Published: August 2019

Background

Anaemia is common in advanced chronic liver disease (ACLD) as a result of various risk factors.

Aims & Methods

We evaluated the prevalence and severity of anaemia as well as the impact of anaemia on clinical outcomes in consecutive patients with ACLD and portal hypertension.

Results

Among 494 patients, 324 (66%) patients had anaemia. Anaemic patients showed higher MELD (12 ± 4 vs 9 ± 3; P < .001), lower albumin (34 ± 6 vs 39 ± 5 g/dL; P < .001) and more often Child‐Pugh B/C stage (56% vs 17%; P < .001). The prevalence of moderate‐severe anaemia (haemoglobin <10 g/dL) increased with the degree of portal hypertension (HVPG: 6‐9 mm Hg: 22% vs HVPG: 10‐19 mm Hg: 24% vs HVPG ≥ 20 mm Hg: 36%; P = .031). The most common aetiologies of anaemia were gastrointestinal bleeding (25%) and iron deficiency (9%), while reason for anaemia remained unclear in 53% of cases. Male gender (odds ratio [OR]: 1.94 [95% CI: 1.09‐3.47]; P = .025), MELD (OR: 1.20 [95% CI: 1.09‐1.32]; P < .001), hepatic decompensation (OR: 4.40 [95% CI: 2.48‐7.82]; P < .001) and HVPG (OR per mm Hg: 1.07 [95% CI: 1.02‐1.13]; P = .004) were independent risk factors for anaemia. Anaemia was associated with hepatic decompensation (1 year: 25.1% vs 8.1%; 5 years: 60.3% vs 32.9%; P < .0001), hospitalization (73% vs 57%; P < .001) and a higher incidence rate of acute‐on‐chronic liver failure (0.05 [95% CI: 0.04‐0.07] vs 0.03 [95% CI: 0.01‐0.04]). Anaemic patients had worse overall survival (1 year: 87.1% vs 93.7%, 5 year survival: 50.5% vs 68.6%; P < .0001) and increased liver‐related mortality (1 year mortality: 9.7% vs 5.7%, 5 year mortality: 38.0% vs 26.9%; P = .003).

Conclusion

Two‐thirds of patients with ACLD suffer from anaemia. The degree of hepatic dysfunction and of portal hypertension correlate with severity of anaemia. Anaemia is associated with decompensation, ACLF and increased mortality in patients with ACLD.
An amino‐terminal threonine/serine motif is necessary for activity of the Crp/Fnr homolog, MrpC and forMyxococcus xanthusdevelopmental robustness
Authors: Feeley Brooke E. , Bhardwaj Vidhi , McLaughlin Maeve , Diggs Stephen , Blaha Gregor M. , Higgs Penelope I.
Published: August 2019

The Crp/Fnr family of transcriptional regulators play central roles in transcriptional control of diverse physiological responses, and are activated by a surprising diversity of mechanisms. MrpC is a Crp/Fnr homolog that controls theMyxococcus xanthusdevelopmental program. A long‐standing model proposed that MrpC activity is controlled by the Pkn8/Pkn14 serine/threonine kinase cascade, which phosphorylates MrpC on threonine residue(s) located in its extreme amino‐terminus. In this study, we demonstrate that a stretch of consecutive threonine and serine residues, T21T22S23S24,is necessary for MrpC activity by promoting efficient DNA binding. Mass spectrometry analysis indicated the TTSS motif is not directly phosphorylated by Pkn14in vitrobut is necessary for efficient Pkn14‐dependent phosphorylation on several residues in the remainder of the protein. In an important correction to a long‐standing model, we show Pkn8 and Pkn14 kinase activities do not play obvious roles in controlling MrpC activity in wild‐typeM. xanthusunder laboratory conditions. Instead, we propose Pkn14 modulates MrpC DNA binding in response to unknown environmental conditions. Interestingly, substitutions in the TTSS motif caused developmental defects that varied between biological replicates, revealing that MrpC plays a role in promoting a robust developmental phenotype.
An atypical case of KMT2B‐related dystonia manifesting asterixis and effect of deep brain stimulation of the globus pallidus
Authors: Miyata Yohane , Hamanaka Kohei , Kumada Satoko , Uchino Shumpei , Yokochi Fusako , Taniguchi Makoto , Miyatake Satoko , Matsumoto Naomichi
Published: August 2019

We present a boy with KMT2B‐related dystonia (DYT‐KMT2B), a recently identified early‐onset generalized dystonia. He manifested prominent asterixis, which improved following bilateral globus pallidus interna deep brain stimulation (GPi‐DBS). Although variable involuntary movements, including myoclonus and tremor, can be seen in patients with DYT‐KMT2B, asterixis has not been reported. This is also the first report which shows the beneficial effect of bilateral GPi‐DBS for asterixis, suggesting that dysfunction of the cortico‐basal ganglia‐thalamo‐cortical circuit may be involved in its pathomechanism.
The Effect of Interfirm Financial Transactions on the Credit Risk of Small and Medium-Sized Enterprises
Authors: Vinciotti Veronica , Tosetti Elisa , Moscone Francesco , Lycett Mark
Published: August 2019

Despite the recognized importance of interfirm financial links in determining a company’s performance, only a few studies have incorporated proxies for interfirm links in credit risk models, and none of these use real financial transactions. We estimate a credit risk model for small and medium-sized enterprises, augmented with information on observed interfirm financial transactions. We exploit a novel data set on about 60000 companies based in the UK and their financial transactions over the years 2015 and 2016. We develop several network-augmented credit risk models and compare their prediction performance with that of a conventional credit risk model that includes only a set of financial ratios. We find that augmenting a default risk model with information on the transaction network makes a significant contribution to increasing the default prediction power of risk models built specifically for small and medium-sized enterprises. Our results may help bankers and credit scoring agencies to improve the credit scoring of these companies, ultimately reducing their propensity to apply excessive lending restrictions.
CreC Sensor Kinase Activation Enhances Growth of Escherichia coli in the Presence of Cephalosporins and Carbapenems
Authors: Takebayashi Yuiko , Taylor Emma S. , Whitwam Sam , Avison Matthew B.
Published: August 2019

Mutants with enhanced growth in the presence of an antibiotic are more difficult to identify than mutants where the antibiotic’s MIC increases, because they are not amenable to lethal selection
in vitro
. We report that activatory mutations in the CreC signal sensor enhance growth of
Escherichia coli
in the presence of cefoxitin, cefotaxime, and meropenem, without increasing their MICs. Enhanced growth is dependent on overproduction of the inner membrane
cre
regulon protein CreD.
Heterologous Production and Functional Characterization of Ageritin, a Novel Type of Ribotoxin Highly Expressed during Fruiting of the Edible Mushroom Agrocybe aegerita
Authors: Tayyrov Annageldi , Azevedo Sophie , Herzog Robert , Vogt Eva , Arzt Simon , Lüthy Peter , Müller Pie , Rühl Martin , Hennicke Florian , Künzler Markus
Published: August 2019

Our results suggest a pronounced organismal specificity of a protein toxin with a very conserved intracellular molecular target. The molecular details of the toxin-target interaction will provide important insight into the mechanism of action of protein toxins and the ribosome. This insight might be exploited to develop novel bioinsecticides.
Duodenal atresia with familial apple peel syndrome: case study with review of literature
Authors: Kirtane Jyotsna M , Bhange Snehal A , Nabi Fazal , Shah Varshil
Published: August 2019

This is a case report of a neonate who was antenatally diagnosed with jejunal atresia which turned out to be duodenal atresia with apple peel syndrome. A previous sibling, who also had apple peel but with jejunal atresia, succumbed to sepsis after surgery. The first sibling had jejunal stenosis and had died of sepsis following surgery. Combination of duodenal atresia with apple peel is extremely rare. This coupled with a familial condition is rarer still. This case was challenging due to the short length of the gut and prolonged need for total parenteral nutrition and sepsis in postoperative period.
Massive infected ascites in an immunocompetent patient with gastrointestinal tuberculosis
Authors: Saliba Carmegie C , Tomacruz Isabelle Dominique Villegas , Javier Mary Louise Margaret M , Co Homer
Published: August 2019

Mycobacterium tuberculosisis highly endemic in the Philippines. The diagnosis is challenging with its non-specific presentation and the organism could extend to any of the organs. Interestingly, bacterial peritonitis arising spontaneously from gastrointestinal tuberculosis (TB) in an otherwise healthy, non-cirrhotic patient is quite unusual. In this paper, we discuss the case of a 27-year-old HIV-seronegative woman with massive intraperitoneal mixed bacterial and tuberculous abscess presenting 20 months after being diagnosed with bacteriologically confirmed gastrointestinal TB. Repeated large-volume paracentesis was done to drain out the infected ascites instead of inserting a percutaneously implanted catheter. Clinical improvement was noted and she was discharged after 12 days of intravenous antibiotics. She had completed 6 months of antituberculosis therapy and been well since then. The case has demonstrated that repeated paracentesis along with appropriate antibiotic regimen, may be a viable option for patients with TB and bacterial coinfected peritonitis. And possibly, peritoneal TB may increase the risk for (spontaneous) bacterial peritonitis.
Epidemiological characteristics of elevated blood pressure among middle and high school students aged 12–17 years: a cross-sectional study in Jiangsu Province, China, 2017–2018
Authors: Zhang Xiyan , Yang Jie , Wang Yan , Liu Weina , Yang Wenyi , Gao Liuwei , Schwertz Rainer , Welker Andreas , Zhang Fengyun , Zhou Yonglin
Published: August 2019

Objective

In this study, we aimed to present the epidemiological characteristics of elevated blood pressure among middle and high school students aged 12–17 years in Jiangsu Province.

Setting

Hypertension, which is considered a rare disease in children, is an important early precursor to long-term cardiovascular damage, and elevated blood pressure in childhood is a strong predictor of hypertension in adulthood.

Participants

Physical examination and questionnaire investigation among children aged 12–17 years in Jiangsu Province were conducted from 2017 to 2018.

Main outcome measures

Physical measurements included height, weight, blood pressure and history of menarche/first spermatorrhoea. Questionnaire investigation included family type, delivery mode, lifestyle habits and psychological test.

Results

In our study we investigated 17 791 middle and high school students, consisting of 8701 female students and 9090 male students. The prevalence of screening elevated blood pressure among students aged 12–17 years was 20.0% (95% CI 19.2% to 20.9%) for female students and 22.3% (95% CI 21.5% to 23.2%) for male students. The prevalence of screening elevated blood pressure for urban male middle and high school students was higher than that of elevated blood pressure for rural male middle and high school students. However, similar phenomenon cannot be observed among female students. For both male and female students, body mass index (BMI), obesity/overweight and menarche/first spermatorrhoea can be a risk factor contributing to elevated blood pressure, and sleep time and regional distribution might be important factors that need to be investigated in depth.

Conclusion

We found a relatively high prevalence of screening elevated blood pressure among students aged 12–17 years for both female and male students in Jiangsu Province. The risk factors can be BMI, obesity/overweight and menarche/first spermatorrhoea.
Falls and Cognitive Training 2 (FaCT2) study protocol: a randomised controlled trial exploring cognitive training to reduce risk of falls in at-risk older adults
Authors: Thompson Hilaire J , McGough Ellen , Demiris George
Published: August 2019

Background

The primary cause of traumatic injury in older adults is fall. Recent reports suggest that cognitive function contributes significantly to fall risk. Therefore, by targeting cognitive function for intervention, we could potentially reduce the incidence of fall and injury.

Primary objective

To explore the effectiveness of a 16-week cognitive training (CT) intervention to reduce risk and incidence of fall in community-dwelling older adults at risk for fall.

Outcomes

Primary outcome is number of falls over a 16-week period (ascertained by fall calendar method). Secondary outcomes include: change fall risk as indicated by improvement in 10 m walk and 90 s balance tests.

Design/methods

The design is a two-group randomised controlled trial. Eligible participants are older adults (aged 65–85) residing in the community who are at risk for fall based on physical performance testing. Following completion of 1-week run-in phase, participants are randomly allocated (1:2) to either a group that is assigned to attention control or to the group that receives CT intervention for a total of 16 weeks. Participants are followed for an additional 4 weeks after intervention. Mann-Whitney U test and Student’s t-test will be used to examine between-group differences using intention-to-treat analyses.

Discussion

Limited evidence supports the potential of CT to improve cognition and gait, but no published study has evaluated whether such an intervention would reduce incidence of fall. The present trial is designed to provide initial answers to this question. CT may also improve functioning important in other activities (eg, driving), reducing overall risk of injury in elders.

Trial registration number

NCT03190460.
Knowledge in the dark: scientific challenges and ways forward
Authors: Jeschke Jonathan M. , Lokatis Sophie , Bartram Isabelle , Tockner Klement
Published: August 2019

A key dimension of our current era is Big Data, the rapid rise in produced data and information; a key frustration is that we are nonetheless living in an age of ignorance, as the real knowledge and understanding of people does not seem to be substantially increasing. This development has critical consequences, for example it limits the ability to find and apply effective solutions to pressing environmental and socioeconomic challenges. Here, we propose the concept of “knowledge in the dark”—or short: dark knowledge—and outline how it can help clarify key reasons for this development: ( i) production of biased, erroneous, or fabricated data and information; ( ii) inaccessibility and ( iii) incomprehensibility of data and information; and ( iv) loss of previous knowledge. Even in the academic realm, where financial interests are less pronounced than in the private sector, several factors lead to dark knowledge, that is they inhibit a more substantial increase in knowledge and understanding. We highlight four of these factors—loss of academic freedom, research biases, lack of reproducibility, and the Scientific tower of Babel—and offer ways to tackle them, for example establishing an international court of arbitration for research and developing advanced tools for research synthesis.