bluuebunny/crossref_metadata_2025 huggingface dataset:
Training doctors briefly and in situ to involve their patients in making medical decisions—Preliminary testing of a newly developed module
Authors: Kasper Jürgen , Liethmann Katrin , Heesen Christoph , Reissmann Daniel R , Geiger Friedemann
Published: May 2017

Objective

To carry out preliminary evaluation of a training module for doctors to enhance their ability to involve their patients in medical decision making. The training refers to the shared decision‐making (SDM) communication concept.

Methods

The training module includes a comprehensive manual, a corresponding video tutorial with communication examples and a 15‐minute face‐to‐face feedback session based on an SDM analysis of a consultation recording provided by the trainee. Ten trainees (four neurologists, three dentists, and three general practitioners) participating in the pretest each recorded four clinical consultations (total sample: N=40) and received three training components. After the training, doctors provided feedback on the module's feasibility in a questionnaire. Communication performance of doctors, patients and doctor–patient dyads was assessed by trained observers and self‐assessed by doctors and patients using the MAPPIN’SDM approach. Training effects were determined using Wilcoxon signed‐rank tests comparing baseline values with post‐intervention performance as assessed in the fourth consultations.

Results

The face‐to‐face training sessions were short and feasible with regard to clinical reality. Participants considered the training supportive for acquiring SDM skills and recommended more emphasis on the face‐to‐face feedback. Communication improved according to observers rating doctors (P=.05) and doctor–patient dyads (P=.07) and to doctors’ own judgements (P=.02). No improvement was observed in patients’ SDM behaviour (P=.11); accordingly, patients’ judgements did not indicate improvement (P=.14).

Conclusions

The training is designed to meet clinicians’ needs. Improvement of risk communication after training encourages optimization according to doctors’ feedback. Following this study, the efficacy of the training is now being examined in a randomized controlled trial.
STAT4 expression and activation is increased during mitosis in vitro and in vivo in skin‐ and mucosa‐derived cell types: implications in neoplastic and inflammatory skin diseases
Authors: Ferreli C. , Lai C. , August S. , Buggy Y. , Kumar P. , Brownlow N. , Parker P. , Friedmann P.S. , Ardern‐Jones M. , Pickard C. , Healy E.
Published: May 2017

Background

The signal transducer and activator of transcription‐4 (STAT4/Stat4) is a transcription factor known to convey signals from interleukin‐12, interleukin‐23, and interferon‐alpha/beta to the nucleus, resulting in activation of dendritic cells, T‐helper cell differentiation and production of interferon‐gamma.

Objective

To demonstrate a novel role for STAT4 in cell mitosis.

Results

Phosphoserine STAT4 (pSerSTAT4) is increased in cells undergoing mitosis and is distributed throughout the cytoplasm during this stage of the cell cycle, whilst phosphotyrosine STAT4 (pTyrSTAT4) is confined to the chromosomal compartment. This distinct pattern of pSerSTAT4 during mitosis is seen in vitro in human keratinocytes and in other cell types. This is also present in vivo in cells undergoing mitosis in normal skin, psoriasis and squamous cell carcinoma.

Inhibition of STAT4 phosphorylation by lisofylline and depletion of STAT4 by RNA interference results in a delay in progression of mitosis and leads to a reduction in cells completing cytokinesis.

Conclusion

Our data demonstrate that STAT4 plays a role in enabling the normal and timely division of cells undergoing mitosis.
Determination of occlusal vertical dimension for complete dentures patients: an updated review
Authors: Alhajj M. N. , Khalifa N. , Abduo J. , Amran A. G. , Ismail I. A.
Published: May 2017

Determination of the occlusal vertical dimension (OVD) is an integral part of complete dentures fabrication. Due to the lack of teeth, the clinician faces the challenge of how to accurately establish the OVD of the new denture. Therefore, the purpose of this review article was to present, discuss and critique the available methods used in determining the OVD for complete dentures patients. This review identified two main streams to determine the OVD: (i) pre‐extraction methods and (ii) post‐extraction methods. For the pre‐extraction methods, the OVD of the natural dentition is transferred to the new dentures mainly by intra‐oral measurements, profile tracing and cephalometric analysis. The post‐extraction methods rely on mandibular rest position, facial aesthetic appearance, swallowing pattern, craniofacial landmarks measurements, cephalometric analysis, phonetics and existing dentures. In general, all the available techniques have merits and are helpful for routine clinical use. However, they are empirical in nature, controversial and lack the scientific support. Further, there is no single accurate method for OVD determination. To overcome the limitations of the techniques, the clinician will benefit from applying combination of techniques to approximate the OVD.
Can an NTI‐tss device be effective as a first‐line therapy in patients with TMD myofascial pain?
Authors: Hasanoglu Erbasar G. N. , Alpaslan C. , Eroglu Inan G.
Published: May 2017

This study was conducted to evaluate whether integrating a nociceptive trigeminal inhibition–tension suppression system (NTI‐tss) device with first‐line therapy of myofascial pain, which includes guidance, assurance, counselling and behavioural changes, would be more effective in alleviating symptoms. This randomised controlled clinical trial included 40 patients who were clinically diagnosed with myofascial pain according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were randomly divided into two groups: the first group comprised patients who received guidance, assurance, counselling and behavioural changes; an NTI‐tss device was integrated to this protocol in the second group. Both groups exhibited reduction in pain levels and improvement of jaw function compared with baseline values, but the difference was not significant. Both groups demonstrated improvements in 6 weeks; however, the integration of NTI‐tss device into the therapy protocol did not provide any additional benefit in relieving symptoms of myofascial pain.
AIC identifies optimal representation of longitudinal dietary variables
Authors: VanBuren John , Cavanaugh Joseph , Marshall Teresa , Warren John , Levy Steven M.
Published: May 2017

Objectives

The Akaike Information Criterion (AIC) is a well‐known tool for variable selection in multivariable modeling as well as a tool to help identify the optimal representation of explanatory variables. However, it has been discussed infrequently in the dental literature. The purpose of this paper is to demonstrate the use of AIC in determining the optimal representation of dietary variables in a longitudinal dental study.

Methods

The Iowa Fluoride Study enrolled children at birth and dental examinations were conducted at ages 5, 9, 13, and 17. Decayed or filled surfaces (DFS) trend clusters were created based on age 13 DFS counts and age 13‐17 DFS increments. Dietary intake data (water, milk, 100 percent‐juice, and sugar sweetened beverages) were collected semiannually using a food frequency questionnaire. Multinomial logistic regression models were fit to predict DFS cluster membership (n=344). Multiple approaches could be used to represent the dietary data including averaging across all collected surveys or over different shorter time periods to capture age‐specific trends or using the individual time points of dietary data.

Results

AIC helped identify the optimal representation. Averaging data for all four dietary variables for the whole period from age 9.0 to 17.0 provided a better representation in the multivariable full model (AIC=745.0) compared to other methods assessed in full models (AICs=750.6 for age 9 and 9‐13 increment dietary measurements and AIC=762.3 for age 9, 13, and 17 individual measurements). The results illustrate that AIC can help researchers identify the optimal way to summarize information for inclusion in a statistical model.

Conclusions

The method presented here can be used by researchers performing statistical modeling in dental research. This method provides an alternative approach for assessing the propriety of variable representation to significance‐based procedures, which could potentially lead to improved research in the dental community.
High‐throughput sequencing of transposable element insertions suggests adaptive evolution of the invasive Asian tiger mosquito towards temperate environments
Authors: Goubert Clement , Henri Helene , Minard Guillaume , Valiente Moro Claire , Mavingui Patrick , Vieira Cristina , Boulesteix Matthieu
Published: May 2017

Invasive species represent unique opportunities to evaluate the role of local adaptation during colonization of new environments. Among these species, the Asian tiger mosquito, Aedes albopictus, is a threatening vector of several human viral diseases, including dengue and chikungunya, and raises concerns about the Zika fever. Its broad presence in both temperate and tropical environments has been considered the reflection of great “ecological plasticity.” However, no study has been conducted to assess the role of adaptive evolution in the ecological success of Ae. albopictus at the molecular level. In the present study, we performed a genomic scan to search for potential signatures of selection leading to local adaptation in one‐hundred‐forty field‐collected mosquitoes from native populations of Vietnam and temperate invasive populations of Europe. High‐throughput genotyping of transposable element insertions led to the discovery of more than 120,000 polymorphic loci, which, in their great majority, revealed a virtual absence of structure between the biogeographic areas. Nevertheless, 92 outlier loci showed a high level of differentiation between temperate and tropical populations. The majority of these loci segregate at high insertion frequencies among European populations, indicating that this pattern could have been caused by recent adaptive evolution events in temperate areas. An analysis of the overlapping and neighbouring genes highlighted several candidates, including diapause, lipid and juvenile hormone pathways.
Shifts in water availability mediate plant–pollinator interactions
Authors: Gallagher M. Kate , Campbell Diane R.
Published: May 2017

Altered precipitation patterns associated with anthropogenic climate change are expected to have many effects on plants and insect pollinators, but it is unknown if effects on pollination are mediated by changes in water availability. We tested the hypothesis that impacts of climate on plant–pollinator interactions operate through changes in water availability, and specifically that such effects occur through alteration of floral attractants.

We manipulated water availability in two naturally occurringMertensia ciliata(Boraginaceae) populations using water addition, water reduction and control plots and measured effects on vegetative and floral traits, pollinator visitation and seed set.

While most floral trait values, including corolla size and nectar, increased linearly with increasing water availability, in this bumblebee‐pollinated species, pollinator visitation peaked at intermediate water levels. Visitation also peaked at an intermediate corolla length, while its relationship to corolla width varied across sites. Seed set, however, increased linearly with water.

These results demonstrate the potential for changes in water availability to impact plant–pollinator interactions through pollinator responses to differences in floral attractants, and that the effects of water on pollinator visitation can be nonlinear. Plant responses to changes in resource availability may be an important mechanism by which climate change will affect species interactions.
Associations between nursing home performance and hospital 30‐day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States
Authors: Pandolfi Michelle M. , Wang Yun , Spenard Ann , Johnson Florence , Bonner Alice , Ho Shih‐Yieh , Elwell Timothy , Bakullari Anila , Galusha Deron , Leifheit‐Limson Erica , Lichtman Judith H. , Krumholz Harlan M.
Published: May 2017

Objectives

To evaluate community‐specific nursing home performance with community‐specific hospital 30‐day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia.

Design

Cross‐sectional study using 2009–2012 hospital risk‐standardised 30‐day readmission data for Medicare fee‐for‐service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five‐Star Quality Rating System.

Setting

Medicare‐certified nursing homes and acute care hospitals.

Participants

12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee‐for‐service patients for all three conditions across 2,032 hospital service areas in the United States.

Measurements

Community‐specific hospital 30‐day risk‐standardised readmission rates. Community‐specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed‐effects models evaluated associations between nursing home performance and hospital 30‐day risk‐standardised readmission rates for all three conditions.

Results

The relationship between community‐specific hospital risk‐standardised readmission rates and community‐specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12–0.47), 0.78% point (95% CI: 0.60–0.95) and 0.46% point (95% CI: 0.33–0.59) of risk‐standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community‐specific nursing home performance was observed.

Conclusion

Community‐specific nursing home performance is associated with community‐specific hospital 30‐day readmission rates for Medicare fee‐for‐service patients for acute myocardial infarction, heart failure or pneumonia.

Implications for practice

Coordinated care between hospitals and nursing homes is essential to reduce readmissions. Nursing homes can improve performance and reduce readmissions by increasing registered nursing homes. Further, communities can work together to create cross‐continuum care teams comprised of hospitals, nursing homes, patients and their families, and other community‐based service providers to reduce unplanned readmissions.
An Assessment of Factors Important to Legislators in Budget Decisions; How Much Impact Can Agencies Have?
Authors: Smith Arvy , Jensen Jason L.
Published: May 2017

Budget deliberations represent a dynamic interaction between many actors, including agency officials and legislators. There may be opposing perceptions about the relative importance of various types of information and there are likely many priority items that legislators base their decisions on, which budget officials may, or may not, have the ability to impact or control. Through a survey of state legislators, we first determined the relative importance of 27 items in approving budget proposals. Agency officials were surveyed and asked to rate the degree that they can impact each of the 27 items. We considered how the difference in party affiliation of legislators relates to the type of information they view as important in budget decisions. We then compared the importance ratings of legislators with the impact ratings of budget officials, which led to some recommendations aimed at agency officials.
The Real at the Origin of Sovereignty
Authors: Burgess J. Peter
Published: May 2017

This article revisits the concept of sovereignty in political theory by applying tools adapted from Lacanian psychoanalytic theory. It critically reviews the premises of political subjects assumed by sovereignty and formulates a widened concept of sovereignty based on a general understanding of the “self,” “self‐relation,” and “identity” as the fundamental components of sovereignty. With this concept in hand, the article then focuses on the concept of the “Sovereign Good” common to French histories of political thought and of particular interest to Jacques Lacan in his 1959–60 seminar on the Ethics of Psychoanalysis and his 1963 article “Kant with Sade.” By reinterpreting the sovereignty of the Sovereign Good, Lacan points to a path according to which an idealized and universalized notion of the sovereign is made possible and energized through an identification of the real with the Sovereign Good. By understanding sovereignty as supported by the Lacanian real, we can better understand both the forces that drive it to self‐preservation and the insecurities that make its survival and longevity powerful hindrances to its dissolution
Association of tenofovir disoproxil fumarate with primary allograft survival in HIV‐positive kidney transplant recipients
Authors: Boyle Suzanne M. , Malat Gregory , Harhay Meera N. , Lee Dong H. , Pang Lisa , Talluri Sindhura , Sharma Akshay , Bias Tiffany E. , Ranganna Karthik , Doyle Alden M.
Published: May 2017

Background

Tenofovir disoproxil fumarate (TDF) is an antiretroviral agent frequently used to treat human immunodeficiency virus (HIV). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF‐based antiretroviral therapy (ART) after kidney transplantation adversely affects allograft survival.

Methods

We examined 104 HIV+ kidney transplant (KT) recipients at our center between 2001 and 2014. We generated a propensity score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF treatment and 3‐year, death‐censored primary allograft failure, adjusting for the propensity score and delayed graft function (DGF).

Results

Of the 104 HIV+ KT candidates who underwent transplantation during the study period, 23 (22%) were maintained on TDF‐based ART at the time of transplantation, and 81 (78%) were on non‐TDF‐based ART. Median age of the cohort was 48 years; 87% were male; 88% were black; and median CD4 count at transplantation was 450 cells/mm3. Median kidney donor risk index was 1.2. At 3 years post transplantation, primary allograft failure occurred in 26% of patients on TDF‐based ART and in 28% of patients on non‐TDF‐based ART (P=.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41‐10.9).

Conclusions

In a large single‐center experience of HIV+ kidney transplantation, TDF use following kidney transplantation was not significantly associated with primary allograft failure. These results may help inform management for HIV+ KT recipients in need of TDF therapy for adequate viral suppression.
Postdonation iron replacement for maintaining iron stores in female whole blood donors in routine donor practice: results of two feasibility studies in Australia
Authors: Pasricha Sant‐Rayn , Marks Denese C. , Salvin Hannah , Brama Tania , Keller Anthony J. , Pink Joanne , Speedy Joanna
Published: May 2017

BACKGROUND

Iron deficiency represents a risk to donor health and the blood supply. Efficacy trials indicate that postdonation iron replacement improves iron stores but they do not account for complexities of implementation in the routine collection context. We therefore conducted two prospective feasibility studies in Australian donor centers.

STUDY DESIGN AND METHODS

In both studies we recruited female donors between 18 and 45 years who had made at least one donation in the previous 12 months. In READ (replacement advice), female donors were given a recommendation to self‐procure postdonation iron. In DIRECT (donor iron replacement), donors were provided with a course of iron supplements. Donors could return to donate at their discretion and were surveyed after the recruitment visit and again toward the end of the 13‐month follow‐up. Donor uptake, adverse effects, effectiveness in maintaining iron stores, and workflow impact were assessed.

RESULTS

We recruited 1404 (70.9% of invited) donors to READ and 768 (53.2% of invited) to DIRECT. READ and DIRECT extended predonation interviews by 1 and 5 minutes, respectively. Among participants, 44 and 88% took iron in READ and DIRECT, respectively. Adverse effects were common but usually mild. READ failed to maintain iron stores in the population, but was effective in donors who consumed more than 75% of the recommended dose. DIRECT was effective in preventing declines in ferritin concentration.

CONCLUSION

Trade‐offs between cost, complexity, uptake, and effectiveness must be considered in the implementation of postdonation iron supplementation.
Experimental Study of Heat Transfer in a Reduced Scale Cavity Incorporating Phase Change Material Into Its Vertical Walls
Authors: Gounni Ayoub , El Alami Mustapha
Published: May 2017

In order to really assess the thermal performance of a wall incorporating phase change material (PCM), a reduced scale cavity has been monitored during two heating cycles. For each cycle, the heat source inside the test cell is switched “on” for 5 h and its setpoint is 38 °C and then switched off for 4 h. The outdoor air temperature is kept constant at a low temperature of 20 °C. Two walls are equipped with a PCM layer at different depths in order to study the optimal PCM location. The two other walls are wooden and glass to model a real building. The comparison between the four walls is made based on the absorbed heat fluxes and outside surface temperatures. The results show that the location of the PCM close to the heat source reaches its melting temperature and then reduces the surface temperature. At this location, the PCM layer stores the major part of the inlet heat flux. It takes 10 h to release the absorbed heat flux. However, the PCM layer, practically, does not have an effect on the surface temperatures and absorbed heat fluxes, when it is placed far from the heat source.
Thermal Conductivity and Mechanical Properties of Low-Density Silicone Rubber Filled With Al2O3 and Graphene Nanoplatelets
Authors: Zhang Yingchun , Yu Wei , Zhang Liye , Yin Junshan , Wang Jingkang , Xie Huaqing
Published: May 2017

A simple approach is developed to obtain a multiscale network of heat conducting by filling spherical alumina (S-Al2O3) and graphene nanoplatelets (GnPs) into silicone rubber (SR). This unique structure effectively minimizes the thermal contact resistance between fillers and matrix. The physical properties of the composites are characterized by thermal conductivity, density, and tensile strength. A high thermal conductivity of 3.37 Wm−1 K−1 has been achieved, which is 47.1% higher than the single filler at the same loading. A strong and obvious synergistic effect has been observed as S-Al2O3 and GnPs filled into silicone rubber matrix. It is interesting that the composites with GnPs have the lower density (2.62 g/cm3, reduced by 6%) and the superior tensile performance, compared to silicone rubber composite with neat S-Al2O3. The composites have the potential applications in heat dissipation of light-emitting diode.
Thermal and Electrical Properties of 3.2 nm Thin Gold Films Coated on Alginate Fiber
Authors: Dong Hua , Chen Ranran , Mu Yongqiang , Liu Shouting , Zhang Jingkui , Lin Huan
Published: May 2017

The thermal transport in metallic thin films can be reduced by the electron scattering and there are very little available knowledge that can be used to explain the mechanism. In this work, we characterized the thermal and electron transport of 3.2 nm thin gold films coated on alginate fiber by the transient electrothermal (TET) technique. The results reveal that the thermal and electrical conductivities are reduced significantly from the respective values of bulk material by 76.2% and 93.9%. At the same time, the Lorenz number is calculated as 8.66 × 10−8 W Ω K−2 and it is almost three times increased from the value of bulk material. The intrinsic thermal diffusivity of alginate fiber is 3.25 × 10−7 m2 s−1 and the thermal conductivity is 0.51 W m−1 K−1.
Antibody-mediated neutralization of soluble MIC significantly enhances CTLA4 blockade therapy
Authors: Zhang Jingyu , Liu Dai , Li Guangfu , Staveley-O’Carroll Kevin F. , Graff Julie N. , Li Zihai , Wu Jennifer D.
Published: May 2017

Cooperative therapeutic effect of anti-CTLA4 and anti-sMIC antibodies.
Chiral plasmonics
Authors: Hentschel Mario , Schäferling Martin , Duan Xiaoyang , Giessen Harald , Liu Na
Published: May 2017

We present a comprehensive overview of chirality and its optical manifestation in plasmonic nanosystems and nanostructures.
Loss of Humoral and Cellular Immunity to Invasive Nontyphoidal Salmonella during Current or Convalescent Plasmodium falciparum Infection in Malawian Children
Authors: Nyirenda Tonney S. , Nyirenda James T. , Tembo Dumizulu L. , Storm Janet , Dube Queen , Msefula Chisomo L. , Jambo Kondwani C. , Mwandumba Henry C. , Heyderman Robert S. , Gordon Melita A. , Mandala Wilson L.
Published: May 2017

Invasive nontyphoidal
Salmonella
(iNTS) infections are commonly associated with
Plasmodium falciparum
infections, but the immunologic basis for this linkage is poorly understood. We hypothesized that
P. falciparum
infection compromises the humoral and cellular immunity of the host to NTS, which increases the susceptibility of the host to iNTS infection. We prospectively recruited children aged between 6 and 60 months at a Community Health Centre in Blantyre, Malawi, and allocated them to the following groups; febrile with uncomplicated malaria, febrile malaria negative, and nonfebrile malaria negative. Levels of
Salmonella enterica
serovar Typhimurium-specific serum bactericidal activity (SBA) and whole-blood bactericidal activity (WBBA), complement C3 deposition, and neutrophil respiratory burst activity (NRBA) were measured. Levels of SBA with respect to
S
. Typhimurium were reduced in febrile
P. falciparum
-infected children (median, −0.20 log10 [interquartile range {IQR}, −1.85, 0.32]) compared to nonfebrile malaria-negative children (median, −1.42 log10 [IQR, −2.0, −0.47],
P
= 0.052). In relation to SBA, C3 deposition on
S
. Typhimurium was significantly reduced in febrile
P. falciparum
-infected children (median, 7.5% [IQR, 4.1, 15.0]) compared to nonfebrile malaria-negative children (median, 29% [IQR, 11.8, 48.0],
P
= 0.048). WBBA with respect to
S
. Typhimurium was significantly reduced in febrile
P. falciparum
-infected children (median, 0.25 log10 [IQR, −0.73, 1.13],
P
= 0.0001) compared to nonfebrile malaria-negative children (median, −1.0 log10 [IQR, −1.68, −0.16]). In relation to WBBA,
S
. Typhimurium-specific NRBA was reduced in febrile
P. falciparum
-infected children (median, 8.8% [IQR, 3.7, 20],
P
= 0.0001) compared to nonfebrile malaria-negative children (median, 40.5% [IQR, 33, 65.8]).
P. falciparum
infection impairs humoral and cellular immunity to
S
. Typhimurium in children during malaria episodes, which may explain the increased risk of iNTS observed in children from settings of malaria endemicity. The mechanisms underlying humoral immunity impairment are incompletely understood and should be explored further.
Not All Antigens Are Created Equally: Progress, Challenges, and Lessons Associated with Developing a Vaccine for Leishmaniasis
Authors: Duthie Malcolm S. , Reed Steven G.
Published: May 2017

From experimental models and the analyses of patients, it is well documented that antigen-specific T cells are critical for protection againstLeishmaniainfection. Effective vaccines require both targeting to the pathogen and an immune stimulant to induce maturation of appropriate immune responses. While a great number of antigens have been examined as vaccine candidates against variousLeishmaniaspecies, few have advanced to human or canine clinical trials. With emphasis on antigen expression, in this minireview we discuss some of the vaccine platforms that are currently being explored for the development ofLeishmaniavaccines. It is clear that the vaccine platform of choice can have a significant impact upon the level of protection induced by particular antigens, and we provide and highlight some examples for which the vaccine system used has impacted the protective efficacy imparted.
Rapid Identification of Five Classes of Carbapenem Resistance Genes Directly from Rectal Swabs by Use of the Xpert Carba-R Assay
Authors: Moore Nicholas M. , Cantón Rafael , Carretto Edoardo , Peterson Lance R. , Sautter Robert L. , Traczewski Maria M.
Published: May 2017

Carbapenemase-producing organisms (CPO) have been identified by global health leaders as an urgent threat. Detection of patients with gastrointestinal carriage of CPO is necessary to interrupt their spread within health care facilities. In this multisite study, we assessed the performance of the Xpert Carba-R test, a rapid real-time quantitative PCR (qPCR) assay that detects five families of carbapenemase genes (
bla
IMP
,
bla
KPC
,
bla
NDM
,
bla
OXA-48
, and
bla
VIM
) directly from rectal swab specimens. Using dual swabs, specimens from 755 patients were collected and tested prospectively. An additional 432 contrived specimens were prepared by seeding well-characterized carbapenem-susceptible and -nonsusceptible strains into a rectal swab matrix and inoculating them onto swabs prior to testing. Antimicrobial susceptibility testing, broth enriched culture, and DNA sequencing were performed by a central laboratory blind to the Xpert Carba-R results. The Xpert Carba-R assay demonstrated a positive percentage of agreement (PPA) between 60 and 100% for four targets (
bla
KPC
,
bla
NDM
,
bla
VIM
, and
bla
OXA-48
) and a negative percentage of agreement (NPA) ranging between 98.9 and 99.9% relative to the reference method (culture and sequencing of any carbapenem-nonsusceptible isolate). There were no prospective
bla
IMP
-positive samples. Contrived specimens demonstrated a PPA between 95 and 100% and an NPA of 100% for all targets. Testing of rectal swabs directly using the Xpert Carba-R assay is effective for rapid detection and identification of CPO from hospitalized patients.
Analytical and Clinical Evaluation of the PathoNostics AsperGenius Assay for Detection of Invasive Aspergillosis and Resistance to Azole Antifungal Drugs Directly from Plasma Samples
Authors: White P. Lewis , Posso Raquel B. , Barnes Rosemary A.
Published: May 2017

With the proposal to include
Aspergillus
PCR in the revised European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions for fungal disease, commercially manufactured assays may be required to provide standardization and accessibility. The PathoNostics AsperGenius assay represents one such test that has the ability to detect a range of
Aspergillus
species as well as azole resistance in
Aspergillus fumigatus
. Its performance has been validated on bronchoalveolar lavage (BAL) fluid and serum specimens, but recent evidence suggests that testing of plasma may have enhanced sensitivity over that with serum. We decided to evaluate the analytical and clinical performances of the PathoNostics AsperGenius assay for testing of plasma. For the analytical evaluations, plasma was spiked with various concentrations of
Aspergillus
genomic DNA before extraction following international recommendations, using two automated platforms. For the clinical study, 211 samples from 10 proven/probable invasive aspergillosis (IA) and 2 possible IA cases and 27 controls were tested. The limits of detection for testing of DNA extracted using the bioMérieux EasyMag and Qiagen EZ1 extractors were 5 and 10 genomes/0.5-ml sample, respectively. In the clinical study, true positivity was significantly greater than false positivity (
P
< 0.0001). The sensitivity and specificity obtained using a single positive result as significant were 80% and 77.8%, respectively. If multiple samples were required to be positive, specificity was increased to 100%, albeit sensitivity was reduced to 50%. The AsperGenius assay provided good clinical performance, but the predicted improvement of testing with plasma was not seen, possibly as a result of target degradation attributed to sample storage. Prospective testing is required to determine the clinical utility of this assay, particularly for the diagnosis of azole-resistant disease.
Cell Cycle-Dependent Expression of Adeno-Associated Virus 2 (AAV2) Rep in Coinfections with Herpes Simplex Virus 1 (HSV-1) Gives Rise to a Mosaic of Cells Replicating either AAV2 or HSV-1
Authors: Franzoso Francesca D. , Seyffert Michael , Vogel Rebecca , Yakimovich Artur , de Andrade Pereira Bruna , Meier Anita F. , Sutter Sereina O. , Tobler Kurt , Vogt Bernd , Greber Urs F. , Büning Hildegard , Ackermann Mathias , Fraefel Cornel
Published: May 2017

Adeno-associated virus 2 (AAV2) depends on the simultaneous presence of a helper virus such as herpes simplex virus 1 (HSV-1) for productive replication. At the same time, AAV2 efficiently blocks the replication of HSV-1, which would eventually limit its own replication by diminishing the helper virus reservoir. This discrepancy begs the question of how AAV2 and HSV-1 can coexist in a cell population. Here we show that in coinfected cultures, AAV2 DNA replication takes place almost exclusively in S/G
2
-phase cells, while HSV-1 DNA replication is restricted to G
1
phase. Live microscopy revealed that not only wild-type AAV2 (wtAAV2) replication but also reporter gene expression from both single-stranded and double-stranded (self-complementary) recombinant AAV2 vectors preferentially occurs in S/G
2
-phase cells, suggesting that the preference for S/G
2
phase is independent of the nature of the viral genome. Interestingly, however, a substantial proportion of S/G
2
-phase cells transduced by the double-stranded but not the single-stranded recombinant AAV2 vectors progressed through mitosis in the absence of the helper virus. We conclude that cell cycle-dependent AAV2
rep
expression facilitates cell cycle-dependent AAV2 DNA replication and inhibits HSV-1 DNA replication. This may limit competition for cellular and viral helper factors and, hence, creates a biological niche for either virus to replicate.

IMPORTANCE
Adeno-associated virus 2 (AAV2) differs from most other viruses, as it requires not only a host cell for replication but also a helper virus such as an adenovirus or a herpesvirus. This situation inevitably leads to competition for cellular resources. AAV2 has been shown to efficiently inhibit the replication of helper viruses. Here we present a new facet of the interaction between AAV2 and one of its helper viruses, herpes simplex virus 1 (HSV-1). We observed that AAV2
rep
gene expression is cell cycle dependent and gives rise to distinct time-controlled windows for HSV-1 replication. High Rep protein levels in S/G
2
phase support AAV2 replication and inhibit HSV-1 replication. Conversely, low Rep protein levels in G
1
phase permit HSV-1 replication but are insufficient for AAV2 replication. This allows both viruses to productively replicate in distinct sets of dividing cells.
A Glycosylphosphatidylinositol-Anchored Carbonic Anhydrase-Related Protein of Toxoplasma gondii Is Important for Rhoptry Biogenesis and Virulence
Authors: Chasen Nathan M. , Asady Beejan , Lemgruber Leandro , Vommaro Rossiane C. , Kissinger Jessica C. , Coppens Isabelle , Moreno Silvia N. J.
Published: May 2017

Toxoplasma gondii
is an intracellular pathogen that infects humans and animals. The pathogenesis of
T. gondii
is linked to its lytic cycle, which starts when tachyzoites invade host cells and secrete proteins from specialized organelles. Once inside the host cell, the parasite creates a parasitophorous vacuole (PV) where it divides. Rhoptries are specialized secretory organelles that contain proteins, many of which are secreted during invasion. These proteins have important roles not only during the initial interaction between parasite and host but also in the formation of the PV and in the modification of the host cell. We report here the identification of a new
T. gondii
carbonic anhydrase-related protein (TgCA_RP), which localizes to rhoptries of mature tachyzoites. TgCA_RP is important for the morphology of rhoptries and for invasion and growth of parasites. TgCA_RP is also critical for parasite virulence. We propose that TgCA_RP plays a role in the biogenesis of rhoptries.
Design and Implementation of a Trauma Care Bundle at a Community Hospital
Authors: Andres Ryan , Hahn Elan , de Kok Steffen , Setrak Rafi , Doyle Jeffrey , Brown Allison
Published: May 2017

The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS. In other settings healthcare checklists and bundles have proven effective in streamlining processes to ensure effective, efficient and timely patient care.

Quality Improvement (QI) tools and methods were used to design, implement, and evaluate a trauma care bundle at one of the NHS's community hospitals. We assessed outcome and process measures through a chart audit of all trauma care patients in the NHS from July 2015 - November 2015. A Safety Attitudes Questionnaire (SAQ) was administered to health system staff who were involved in the pilot to assess balancing measures. Between July-November 2015, 39 patients were treated at the St. Catharines Hospital that were identified as either Canadian Triage and Acuity Scale (CTAS) I or CTAS II trauma patients. Of those 39 major trauma patients, 15 received care using the trauma care bundle, representing a 38% uptake. Patients who received care with the trauma bundle had an average Emergency Department (ED) length of stay (LOS) of 1.7 hours, compared with those patients in whom the bundle was not used, whose average ED LOS was 3.4 hours. The SAQ administered to ED physicians who used the bundle (n=10) highlighted the impact on ED patient safety. These early findings suggest that the bundle provides a substantial improvement to the current trauma care process within the Niagara Health System.
Prevalence of externalizing disorders and Autism Spectrum Disorders among children with Fetal Alcohol Spectrum Disorder: systematic review and meta-analysis
Authors: Lange Shannon , Rehm Jürgen , Anagnostou Evdokia , Popova Svetlana
Published: May 2017

Owing to their central nervous system impairments, children with Fetal Alcohol Spectrum Disorder (FASD) commonly exhibit externalizing behaviours such as hyperactivity, impulsivity, and (or) delinquency. The purpose of this study was to estimate the prevalence of neurodevelopmental disorders with prominent externalizing behaviours, namely Attention-Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), as well as Autism Spectrum Disorders (ASD) among children with FASD. A comprehensive systematic literature search was performed, followed by disorder-specific random-effects meta-analyses. Of the disorders investigated, ADHD was found to be the most common co-morbid disorder among children with FASD (52.9%), followed by ODD (12.9%), CD (7.0%), and ASD (2.6%). When compared with the general population of the USA, these rates are notably higher: 15 times higher for ADHD, 2 times higher for ASD, 3 times higher for CD, and 5 times higher for ODD. The results call attention to the need for identifying a distinct neurodevelopmental profile to aid in the accurate identification of children with FASD and the discrimination of FASD from certain idiopathic neurodevelopmental disorders.
Vectorlike deformations of relativistic quantum phase-space and relativistic kinematics
Authors: Loret Niccoló , Meljanac Stjepan , Mercati Flavio , Pikutić Danijel
Published: May 2017

We study a family of noncommutative spacetimes constructed by one four-vector. The large set of coordinate commutation relations described in this way includes many cases that are widely studied in the literature. The Hopf-algebra symmetries of these noncommutative spacetimes, as well as the structures of star product and twist are introduced and considered at first order in the deformation, described by four parameters. We also study the deformations to relativistic kinematics implied by this framework, and calculate the most general expression for the momentum dependence of the Lorentz transformations on momenta, which is an effect that is required by consistency. At the end of the paper we analyse the phenomenological consequences of this large family of vectorlike deformations on particles propagation in spacetime. This leads to a set of characteristic phenomenological effects.
Fast parallel multi-point evaluation of sparse polynomials
Authors: Monagan Michael , Wong Alan
Published: May 2017

In [3] the following polynomial evaluation problem arises. Let
A
be a sparse polynomial with
s
terms in

Z
p

[

x
0
,x
1
,...,x
n

]. Suppose we seek evaluations of
A
into
t
bivariate images in

Z
p

[

x
0
,x
1

], for some
t
≪
s
. We do not know
a priori
the exact number of images
t
needed. This will be determined by using a trial value
T
for
t
, and increasing
T
as required.
Seeking better algorithms for approximate GCD
Authors: Nagasaka Kosaku
Published: May 2017

We are interested in seeking better algorithms by just slightly updating and combining the well-known algorithms for the following well-known problem in Symbolic-Numeric Computations.
An algorithm for symbolic-numeric sparse interpolation of multivariate polynomials whose degree bounds are unknown
Authors: Numahata Dai , Sekigawa Hiroshi
Published: May 2017

We consider the problem of sparse interpolation of a multivariate black-box polynomial in floatingpoint arithmetic. More specifically, we assume that we are given a black-box polynomial
f
(
x
1
,...
x
n
) = Σ

t

j
=1

c

j

x
1

d

j
, 1

...
x

n

d

j
, n

∈ C[
x
1
,...,
x

n

] (

c
j

≠ 0)and the number of terms
t
, and that we can evaluate the value of
f
(

x
1
,...,x
n
)

at any point in C

n

in floating-point arithmetic. The problem is to find the coefficients

c
1

, ...,

c
t

and the exponents

d
1,1,
..., d
t,n

. We propose an efficient algorithm to solve the problem.
An upper bound for the order of a differential algebraic variety
Authors: Sánchez Omar León
Published: May 2017

we present an upper bound for the order of each irreducible component of
finite order
of a differential algebraic variety
V
in the context of partial differential fields of characteristic zero. This bound is constructed recursively in terms of explicit data obtained from
V
.
Antiquantization of deformed Heun class equations as a tool for symbolic generation of Painlevé equations
Authors: Slavyanov S. Yu. , Stesik O. L.
Published: May 2017

We have used antiquantization of deformed Heun class equations for programming the generation of Painlevé equations with the CAS Maple.
Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects
Authors: Madry Henning , Gao Liang , Eichler Hermann , Orth Patrick , Cucchiarini Magali
Published: May 2017

Mesenchymal stem cells (MSCs) from bone marrow play a critical role in osteochondral repair. A bone marrow clot forms within the cartilage defect either as a result of marrow stimulation or during the course of the spontaneous repair of osteochondral defects. Mobilized pluripotent MSCs from the subchondral bone migrate into the defect filled with the clot, differentiate into chondrocytes and osteoblasts, and form a repair tissue over time. The additional application of a bone marrow aspirate (BMA) to the procedure of marrow stimulation is thought to enhance cartilage repair as it may provide both an additional cell population capable of chondrogenesis and a source of growth factors stimulating cartilage repair. Moreover, the BMA clot provides a three-dimensional environment, possibly further supporting chondrogenesis and protecting the subchondral bone from structural alterations. The purpose of this review is to bridge the gap in our understanding between the basic science knowledge on MSCs and BMA and the clinical and technical aspects of marrow stimulation-based cartilage repair by examining available data on the role and mechanisms of MSCs and BMA in osteochondral repair. Implications of findings from both translational and clinical studies using BMA concentrate-enhanced marrow stimulation are discussed.
Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture
Authors: Giordano Vincenzo , Parilha Coutinho Bruno , Miyahira Mateus Kenji , de Souza Felipe Serrão Mendes , do Amaral Ney Pecegueiro
Published: May 2017

We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training.
Evaluation of Shear Strength of Concrete Flat Plates Reinforced with GFRP Plates
Authors: Kim Min Sook , Lee Young Hak
Published: May 2017

The shear performance of concrete flat plates with glass fiber-reinforced polymer (GFRP) plate shear reinforcement was investigated through punching shear tests. Each GFRP plate was embedded in the concrete and included openings to permit the flow of concrete during fabrication. Punching shear tests were conducted on a total of 8 specimens, and the resulting crack and fracture formations, strains, and load-displacement curves were analyzed and compared. The experimental variables considered were the types of shear reinforcement, including steel stirrups or GFRP plates, and the shear reinforcement spacing. The experimental results show that the GFRP shear reinforcement effectively increased the shear strengths of flat plates. Furthermore, the applicability of two formulas was investigated: a modified version of a shear strength formula from ACI 318-14 and the ACI 318-14 fracture prediction formula.