bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Element point‐of‐care blood gas analyzer for use in horses
Authors: Krueger Clarisa R. , Hackett Eileen S. , Hess Ann M. , Mama Khursheed R.
Published: March 2020

Objective

To compare the Element point‐of‐care (POC) portable blood gas analyzer with a laboratory‐based bench‐top reference analyzer using whole blood samples obtained from horses presenting to a referral center with various disorders in order to determine agreement between these analyzers.

Design

Prospective clinical study.

Setting

The study was conducted at a university teaching hospital at moderate altitude.

Animals

One hundred paired samples from 80 horses >1 year of age were collected after obtaining informed client consent. Fifty paired samples were from patients admitted for elective procedures and considered to be healthy, and 50 paired samples were emergency admissions and considered to be critically ill.

Measurements and Main Results

Paired whole blood samples were evaluated on both the Element POC and Radiometer ABL 800 FLEX analyzers simultaneously, and results were compared. Pearson correlation coefficients between analyzers were calculated. To assess agreement, scatter and Bland–Altman plots were evaluated, and mean difference and 95% limits of agreement were calculated for each analyte. Correlation was either good (0.8–0.92) or excellent (>0.93) for the majority of analytes. All analytes apart from hemoglobin had acceptable agreement, with ≥80% of individual results within agreement targets. Precision targets were acceptable for most analytes, with partial pressure of carbon dioxide (pCO2) and calcium (Ca2+) exceeding precision targets.

Conclusions

The portable Element POC system had acceptable agreement with the ABL 800 FLEX bench‐top analyzer currently in use at the study center when evaluating the majority of analytes from equine whole blood samples.
The Impact of Education on Fluid Intelligence
Authors: Sanginabadi Bahram
Published: March 2020

Fluid intelligence, which refers to the ability of a person to solve novel problems independent of previously acquired knowledge, is a highly crucial factor in learning and has a big impact on educational and professional success. However, the impacts of formal education on fluid intelligence has been neglected in the literature. In this paper, we apply an exogenous variation in years of schooling to explore the impacts of education on fluid intelligence. From 1971 to the end of 1973, the global price of crude oil increased over 400%. Such an increase in oil price improved the revenue of the Indonesian government from oil production. Indonesia invested most of the new income on central government’s construction projects famous as “Presidential Instructions” (INPRES), which aimed to improve regional equity in the country. The largest INPRES program, known as Sekolah Dasar INPRES, also remains the largest school construction project in history. The government built over 60 thousand elementary schools all over the country from 1973 to 1978. Duflo (2001) studies the impacts of the program on years of education. We have received INPRES data from Duflo and combined it with the Indonesian Family Life Survey (IFLS), which contains individual cognitive ability tests. This dataset represents 83% of the population of 13 out of 26 Indonesian provinces. The results show positive and statistically significant impacts of years of schooling on the fluid intelligence of both females and males.
Increased oxygenation in the non‐contracting forearm muscle during contralateral skilful hand movement
Authors: Asahara Ryota , Ishii Kei , Okamoto Izumi , Sunami Yuki , Hamada Hironobu , Kataoka Tsuyoshi , Ohshita Wakana , Watanabe Tae , Matsukawa Kanji
Published: March 2020

New Findings

What is the central question of this study?

When performing skilful hand movement, motor command descends especially towards distal arm muscles. Does central command evoke a vascular response selectively in the distal arm muscles during skilful hand movement?

What is the main finding and its importance?

We found, using near‐infrared spectroscopy, that unilateral skilful hand movement evoked a greater increase in oxygenation of the contralateral forearm muscle compared with that of the upper arm muscles. Mental imagery of the hand movement also increased oxygenation of the forearm muscle. These findings suggest that central command might contribute to the vasodilator response in the non‐contracting forearm muscle during contralateral skilful hand movement.

The human hand is a special organ to perform skilful movement in daily life. To meet metabolic demands of the working distal arm muscles, central command might evoke neurogenic vasodilatation in the muscles. Based on our previous demonstration that a centrally generated vasodilator signal is transmitted bilaterally to skeletal muscles during exercise, centrally induced vasodilatation might occur in the non‐contracting distal arm muscles during contralateral skilful hand movement. To examine this possibility, we used near‐infrared spectroscopy to measure the relative concentrations of oxygenated haemoglobin (Oxy‐Hb; as an index of regional blood flow) in the non‐contracting arm muscles during skilful hand movement (two‐ball rotation) in 22 subjects. Two‐ball rotation increased Oxy‐Hb of both forearm and upper arm muscles, with little changes in perfusion pressure and cardiac output. The increased Oxy‐Hb was greater in the forearm muscle than in the upper arm muscles. The increased Oxy‐Hb of the forearm muscle during two‐ball rotation was greater than that during one‐armed cranking performed with no load. Mental imagery of two‐ball rotation increased Oxy‐Hb of the forearm and biceps muscles. The increases in Oxy‐Hb of both forearm and upper arm muscles during two‐ball rotation were reduced by decreasing the level of task difficulty. Intravenous administration of atropine attenuated the increases in Oxy‐Hb of the arm muscles during two‐ball rotation. It is likely that contralateral skilful hand movement evokes a selective increase in Oxy‐Hb of the non‐contracting forearm muscle via a sympathetic cholinergic mechanism and that the increase in oxygenation might be mediated, at least in part, by central command.
sMF-BO-2CoGP: A Sequential Multi-Fidelity Constrained Bayesian Optimization Framework for Design Applications
Authors: Tran Anh , Wildey Tim , McCann Scott
Published: March 2020

Bayesian optimization (BO) is an efiective surrogate-based method that has been widely used to optimize simulation-based applications. While the traditional Bayesian optimization approach only applies to single-fidelity models, many realistic applications provide multiple levels of fidelity with various computational complexity and predictive capability. In this work, we propose a multi-fidelity Bayesian optimization method for design applications with both known and unknown constraints. The proposed framework, called sMF-BO-2CoGP, is built on a multi-level CoKriging method to predict the objective function. An external binary classifier, which we approximate using a separate CoKriging model, is used to distinguish between feasible and infeasible regions. The sMF-BO-2CoGP method is demonstrated using a series of analytical examples, and a fiip-chip application for design optimization to minimize the deformation due to warping under thermal loading conditions.
Measurement of Convective Heat Transfer Coefficients With Supercritical CO2 Using the Wilson-Plot Technique
Authors: Black Jim , Straub Doug , Robey Ed , Yip Joe , Ramesh Sridharan , Roy Arnab , Searle Matthew
Published: March 2020

This paper describes the measurement of convective heat transfer coefficients and friction factors for sCO2 flowing in a smooth tube and compares the results with published correlations for validation. The paper also describes the Heat Exchange and Experimental Testing (HEET) rig recently designed and built at the U.S. Department of Energy’s (DoE’s) National Energy Technology Laboratory (NETL) in Morgantown, WV. The Wilson-plot technique used for measuring the heat transfer coefficients is described along with the data reduction process. The Wilson-plot technique was chosen as the basis for the design of NETL’s HEET rig. Advantages of the Wilson-plot technique include the (1) ability to measure high convective heat transfer coefficients accurately, (2) ability to measure average heat transfer coefficient for complicated heat exchange geometries like those produced using additive manufacturing, (3) ability to measure heat transfer coefficients on both sides of a heat exchanger independently, and (4) simplicity of experimental setup. Capabilities of the HEET rig include pressure to 24 MPa (3500 psig), temperature to 538 °C (1000 °F), mass flow rate to 1.5 kg/s (3 lb/s), and Re to 500,000. The rig is designed to operate with pure CO2 or a mixture of CO2 and up to 10% N2 by volume to study the impact of gas mixtures typical of direct-fired sCO2 power cycles on the convective heat transfer and pressure drop. Preliminary tests in the HEET rig were performed with smooth stainless-steel tube and pure CO2, and the results were compared with published correlations for Nusselt number (Nu) and friction factor. Over a Reynolds number (Re) range from 58,000 to 228,000, measured Nu was compared to predictions using the Dittus and Boelter equation (Kreith and Bohn, 1993, “Principles of Heat Transfer, West Publishing Company”) within 5% and measured friction factors were compared to predictions using the McAdams correlation (“McAdams, 1954, “Heat Transmission,” 3rd ed., McGraw Hill, New York)” for smooth tube to be within 5%.
A Novel Model for Well Production Performance Estimate in Low-Permeability and Tight Reservoirs Considering Stress Sensitivity
Authors: Dong Mingda , Shi Xuedong , bai Jie , Yang Zhilong , Qi Zhilin
Published: March 2020

Stress sensitivity phenomenon is an important property in low-permeability and tight reservoirs and has a large impact on the productivity of production wells, which is defined as the effect of effective stress on the reservoir parameters such as permeability, threshold pressure gradient, and rock compressibility change accordingly. Most of the previous works are focused on the effect of effective stress on permeability and threshold pressure gradient, while rock compressibility is critical of stress sensitivity but rarely noticed. A series of rock compressibility measurement experiments have been conducted, and the quantitative relationship between effective stress and rock compressibility is accurately described in this paper. In the experiment, the defects in previous experiments were eliminated by using a new-type core holder. The results show that as the effective stress increases, the rock compressibility becomes lower. Then, a stress sensitivity model that considers the effect of effective stress on rock compressibility is established due to the experimental results. The well performance of a vertical well estimated by this model shows when considering the effect of effective stress on the rock compressibility, the production rate and recovery factor are larger than those without considering it. Moreover, the effect of porosity and confining pressure on the productivity of a vertical well is also studied and discussed in this paper. The results show that the productivity of a vertical well decreases with the increase in overburden pressure, and increases with the increase in the porosity.
Susceptibility and development of resistance of the mite Tetranychus urticae to aerial conidia and blastospores of the entomopathogenic fungus Beauveria bassiana

Authors: Khoury Charbel Al , Guillot Jacques , Nemer Nabil
Published: March 2020

The virulence of aerial conidia of the entomopathogenic fungi Beauveria bassiana (Balsamo-Crivelli) Vuillemin (Hypocreales: Cordycipitaceae) has been documented on a very broad range of arthropods; however, the activity of blastospores against the two-spotted spider mite has been seldomly reported. Moreover, studies investigating the activity of blastospores under greenhouse conditions were not found in the literature. In this study, we tested the efficacy of blastospores and aerial conidia of two B. bassiana strains, against all life stages of Tetranychus urticae Koch (Acari: Tetranychidae). The concentration of 109 blastospores/ml of the Lebanese strain was the most efficient in laboratory experiments, and the recorded mortalities were 52, 67.9 and 95.3% in treated eggs, motile juveniles and adults, respectively. In greenhouse experiments, higher T. urticae mortalities were recorded among strawberry plants (Fragaria x ananassa) sprayed with blastospores of B. bassiana. Furthermore, the latter plants also recorded a higher yield (454.92 ± 5 g/plant) compared to infested control plants (144.42 ± 5 g/plant) during the growing season. In addition, this study also investigated for the first time the resistance development of T. urticae to different types of infective propagules of B. bassiana. Under selective pressure for 40 generations, the laboratory yielded aerial conidia (AC-TSM) and blastospores (BS-TSM) resistant strains of the mite recorded 28.8- and 8.4- fold change in LC50 values respectively when compared to the field strain; however, this resistance ratio was minimal when compared to those of chemical acaricides.
Practical guide for x-ray photoelectron spectroscopy: Applications to the study of catalysts
Authors: Davies Philip R. , Morgan David J.
Published: March 2020

X-ray photoelectron spectroscopy (XPS) has become a standard tool for the study of catalytic materials over the last two decades, and with the increasing popularity of turnkey XPS systems, the analysis of these types of materials is open to an even wider audience. However, increased accessibility leads to an increase in the number of new or inexperienced practitioners, leading to erroneous data collection and interpretation. Over many years of working on a wide range of catalytic materials, the authors have developed procedures for the planning and execution of XPS analysis and subsequent data analysis, and this guide has been produced to help users of all levels of expertise to question their approach toward analysis and get the most out of the technique and avoiding some common pitfalls.
Schottky conjecture and beyond
Authors: Biswas Debabrata
Published: March 2020

The “Schottky conjecture” deals with the electrostatic field enhancement at the tip of compound structures such as a hemiellipsoid on top of a hemisphere. For such a 2-primitive compound structure, the apex field enhancement factor γa(C) is conjectured to be multiplicative (γa(C)=γa(1)γa(2)), provided the structure at the base (labeled 1, e.g., the hemisphere) is much larger than the structure on top (referred to as crown and labeled 2, e.g., the hemiellipsoid). The author first demonstrates numerically that, for generic smooth structures, the conjecture holds in the limiting sense when the apex radius of curvature of the primitive-base Ra(1) is much larger than the height of the crown h2 (i.e., h2/Ra(1)→0). If the condition is somewhat relaxed, the author shows that it is the electric field above the primitive-base (i.e., in the absence of the crown), averaged over the height of the crown, that gets magnified instead of the field at the apex of the primitive-base. This observation leads to the corrected Schottky conjecture (CSC), which, for 2-primitive structures, reads as γa(C)≃⟨γa(1)⟩γa(2), where ⟨⋅⟩ denotes the average value over the height of the crown. For small protrusions (h2/h1 typically less than 0.2), ⟨γa(1)⟩ can be approximately determined using the line charge model so that γa(C)≃γa(1)γa(2)(2Ra(1)/h2)ln⁡(1+h2/2Ra(1)). The error is found to be within 1% for h2/Ra(1)<0.05, increasing to about 3% (or less) for h2/Ra(1)=0.1 and bounded below 5% for h2/Ra(1) as large as 0.5. The CSC is also found to give good results for 3-primitive compound structures. The relevance of the CSC for field emission is discussed.
Species-specific molecular responses of wild coral reef fishes during a marine heatwave
Authors: Bernal Moisés A. , Schunter Celia , Lehmann Robert , Lightfoot Damien J. , Allan Bridie J. M. , Veilleux Heather D. , Rummer Jodie L. , Munday Philip L. , Ravasi Timothy
Published: March 2020

Molecular responses of fishes to a heatwave are species specific and do not concur with measures of oxygen uptake in captivity.
Past warming trend constrains future warming in CMIP6 models
Authors: Tokarska Katarzyna B. , Stolpe Martin B. , Sippel Sebastian , Fischer Erich M. , Smith Christopher J. , Lehner Flavio , Knutti Reto
Published: March 2020

Strong future warming in some new climate models is less likely as their recent warming is inconsistent with observed trends.
Priorities for developing respiratory syncytial virus vaccines in different target populations
Authors: Drysdale Simon B. , Barr Rachael S. , Rollier Christine S. , Green Christopher A. , Pollard Andrew J. , Sande Charles J.
Published: March 2020

About 38 candidate vaccines and monoclonal antibodies are in clinical development for treating respiratory syncytial virus in different populations.
The Streptococcal Protease SpeB Antagonizes the Biofilms of the Human PathogenStaphylococcus aureusUSA300 through Cleavage of the Staphylococcal SdrC Protein
Authors: Carothers Katelyn E. , Liang Zhong , Mayfield Jeffrey , Donahue Deborah L. , Lee Mijoon , Boggess Bill , Ploplis Victoria A. , Castellino Francis J. , Lee Shaun W.
Published: March 2020

Streptococcus pyogenes, or group AStreptococcus(GAS), is both a pathogen and an asymptomatic colonizer of human hosts and produces a large number of surface-expressed and secreted factors that contribute to a variety of infection outcomes. The GAS-secreted cysteine protease SpeB has been well studied for its effects on the human host; however, despite its broad proteolytic activity, studies on how this factor is utilized in polymicrobial environments are lacking. Here, we utilized various forms of SpeB protease to evaluate its antimicrobial and antibiofilm properties against the clinically important human colonizerStaphylococcus aureus, which occupies niches similar to those of GAS. For our investigation, we used a skin-tropic GAS strain, AP53CovS+, and its isogenic ΔspeBmutant to compare the production and activity of native SpeB protease. We also generated active and inactive forms of recombinant purified SpeB for functional studies. We demonstrate that SpeB exhibits potent biofilm disruption activity at multiple stages ofS. aureusbiofilm formation. We hypothesized that the surface-expressed adhesin SdrC inS. aureuswas cleaved by SpeB, which contributed to the observed biofilm disruption. Indeed, we found that SpeB cleaved recombinant SdrCin vitroand in the context of the fullS. aureusbiofilm. Our results suggest an understudied role for the broadly proteolytic SpeB as an important factor for GAS colonization and competition with other microorganisms in its niche.

IMPORTANCEStreptococcus pyogenes(GAS) causes a range of diseases in humans, ranging from mild to severe, and produces many virulence factors in order to be a successful pathogen. One factor produced by many GAS strains is the protease SpeB, which has been studied for its ability to cleave and degrade human proteins, an important factor in GAS pathogenesis. An understudied aspect of SpeB is the manner in which its broad proteolytic activity affects other microorganisms that co-occupy niches similar to that of GAS. The significance of the research reported herein is the demonstration that SpeB can degrade the biofilms of the human pathogenStaphylococcus aureus, which has important implications for how SpeB may be utilized by GAS to successfully compete in a polymicrobial environment.
Maternal Zika Virus (ZIKV) Infection following Vaginal Inoculation with ZIKV-Infected Semen in Timed-Pregnant Olive Baboons
Authors: Gurung Sunam , Nadeau Hugh , Maxted Marta , Peregrine Jamie , Reuter Darlene , Norris Abby , Edwards Rodney , Hyatt Kimberly , Singleton Krista , Papin James F. , Myers Dean A.
Published: March 2020

Zika virus remains a worldwide health threat, with outbreaks still occurring in the Americas. While mosquitos are the primary vector for the spread of the virus, sexual transmission of Zika virus is also a significant means of infection, especially in terms of passage from an infected to an uninfected partner. While sexual transmission has been documented in humans, and male-to-female transmission has been reported in mice, ours is the first study in nonhuman primates to demonstrate infection via vaginal deposition of Zika virus-infected semen. The latter is important since a recent publication indicated that human semen inhibited, in a laboratory setting, Zika virus infection of reproductive tissues. We also found that compared to the French Polynesian isolate, the Puerto Rican Zika virus isolate led to greater spread throughout the body, particularly in reproductive tissues. The American isolates of Zika virus appear to have acquired mutations that increase their efficacy.
Rhesus Monkey Rhadinovirus Isolated from Hemangioma Tissue
Authors: Ensser Armin , Yasuda Koji , Lauer William , Desrosiers Ronald C. , Hahn Alexander S.
Published: March 2020

We isolated a rhesus monkey rhadinovirus, isolate RRVmmu 209-07, from hemangioma tissue. The virion DNA was sequenced by Illumina-based sequencing. Isolate RRVmmu 209-07 is highly similar overall to RRV 26-95, but considerable differences exist in the 3′ region of the genome.
Complete Genome Sequences of 28 Lactococcal Bacteriophages Isolated from Failed Dairy Fermentation Processes
Authors: Marcelli Barbara , de Jong Anne , Janzen Thomas , Serrano Mariela , Kok Jan , Kuipers Oscar P.
Published: March 2020

Lactococcus lactis
is a Gram-positive lactic acid bacterium commonly used in the dairy industry for the production of fermented foods such as buttermilk and a wide variety of cheeses. Here, we report the complete genome sequences of 28 bacteriophages infecting different
L. lactis
industrial starter strains isolated from dairy plants throughout the world.
Early Devonian (415–400 Ma) A-type granitoids and diabases in the Wuyishan, eastern Cathaysia: A signal of crustal extension coeval with the separation of South China from Gondwana
Authors: Xin Yujia , Li Jianhua , Ratschbacher Lothar , Zhao Guochun , Zhang Yueqiao , Dong Shuwen , Xia Xiao-Ping , Yu Yingqi
Published: March 2020

The evolution of the South China continental crust and its linkage to the assembly and rifting of eastern Gondwana are key issues in the understanding of the early Paleozoic evolution of eastern Asia. We report U-Pb zircon ages and geochemical and Lu-Hf isotopic data for the South Fufang and Yingshang granitoids and the Mayuan diabases from the Wuyishan of eastern South China. The zircons yielded U-Pb ages of ca. 414–404 and ca. 409–401 Ma for the granitoids and diabases, respectively. Petrographic and geochemical features indicate that the granitoids are peraluminous A-type granites, expressed by high Ga/Al ratios and high Zr, Nb, Ce, Y, and rare earth element contents. They show negative zircon εHf(t) values (–15.4 to –5.8), consistent with the derivation from a crustal source. The granitoids likely originated from partial melting of dry granulite residues in the lower crust. The diabases show depletion in Ti, and negative correlations between FeOt and Mg#, and SiO2 and TiO2/FeOt, reflecting clinopyroxene, olivine, and Fe-Ti oxide fractionation. Their negative zircon εHf(t) values (–4.5 to –0.4) indicate an ancient enriched-mantle origin. The diabases likely originated from partial melting of a sub-continental lithospheric mantle. We interpret these A-type granitoids and diabases as post-orogenic, formed during extensional collapse of thickened crust. Their generation indicates that South China experienced crustal extension during the Early Devonian. The extension occurred coevally with global rifting that led to the separation of the continental blocks of eastern Asia from eastern Gondwana, which was associated with the Early Devonian opening of the paleo–Tethys Ocean.
The effect of cooling during deformation on recrystallized grain-size piezometry
Authors: Soleymani Hamid , Kidder Steven , Hirth Greg , Garapić Gordana
Published: March 2020

Most exposed middle- and lower-crustal shear zones experienced deformation while cooling. We investigated the effect of the strengthening associated with such cooling on differential stress estimates based on recrystallized grain size. Typical geologic ratios of temperature change per strain unit were applied in Griggs Rig (high pressure-temperature deformation apparatus) general shear experiments on quartzite with cooling rates of 2–10 °C/h from 900 °C to 800 °C, and a shear strain rate of ∼2 × 10−5 s−1. Comparisons between these “cooling-ramp” experiments and control experiments at constant temperatures of 800 °C and 900 °C indicated that recrystallized grain size did not keep pace with evolving stress. Mean recrystallized grain sizes of the cooling-ramp experiments were twice as large as expected from the final stresses of the experiments. The traditional approach to piezometry involves a routine assumption of a steady-state microstructure, and this would underestimate the final stress during the cooling-ramp experiments by ∼40%. Recrystallized grain size in the cooling-ramp experiments is a better indicator of the average stress of the experiments (shear strains ≥3). Due to the temperature sensitivity of recrystallization processes and rock strength, the results may underrepresent the effect of cooling in natural samples. Cooling-ramp experiments produced wider and more skewed grain-size distributions than control experiments, suggesting that analyses of grain-size distributions might be used to quantify the degree to which grain size departs from steady-state values due to cooling, and thereby provide more accurate constraints on final stress.
Large-scale stable isotope characterization of a Late Cretaceous dinosaur-dominated ecosystem
Authors: Cullen T.M. , Longstaffe F.J. , Wortmann U.G. , Huang L. , Fanti F. , Goodwin M.B. , Ryan M.J. , Evans D.C.
Published: March 2020

In the Cretaceous of North America, environmental sensitivity and habitat specialization have been hypothesized to explain the surprisingly restricted geographic ranges of many large-bodied dinosaurs. Understanding the drivers behind this are key to determining broader trends of dinosaur species and community response to climate change under greenhouse conditions. However, previous studies of this question have commonly examined only small components of the paleo-ecosystem or operated without comparison to similar modern systems from which to constrain interpretations. Here we perform a high-resolution multi-taxic δ13C and δ18O study of a Cretaceous coastal floodplain ecosystem, focusing on species interactions and paleotemperature estimation, and compare with similar data from extant systems. Bioapatite δ13C preserves predator-prey offsets between tyrannosaurs and ornithischians (large herbivorous dinosaurs), and between aquatic reptiles and fish. Large ornithischians had broadly overlapping stable isotope ranges, contrary to hypothesized niche partitioning driven by specialization on coastal or inland subhabitat use. Comparisons to a modern analogue coastal floodplain show similar patterns of ecological guild structure and aquatic-terrestrial resource interchange. Multi-taxic oxygen isotope temperature estimations yield results for the Campanian of Alberta (Canada) consistent with the few other paleotemperature proxies available, and are validated when applied for extant species from a modern coastal floodplain, suggesting that this approach is a simple and effective avenue for paleoenvironmental reconstruction. Together, these new data suggest that dinosaur niche partitioning was more complex than previously hypothesized, and provide a framework for future research on dinosaur-dominated Mesozoic floodplain communities.
No lesion? No problem: case of oesophageal lichen planus in a patient without any cutaneous lesions
Authors: Arshad Tamoore , Fleckenstein Katarina , Sardana Nitin , Scudera Peter L
Published: March 2020

Oesophageal lichen planus (ELP) is an uncommon presentation of mucocutaneous lichen planus. Due to its rare nature, it can often be misdiagnosed. As such, there can be a significant delay between symptom onset and diagnosis. ELP drastically reduces quality of life secondary to the severe dysphagia and odynophagia that typically accompany this pathogenesis. Additionally, it is important to diagnose ELP in a timely manner as ELP increases the risk of squamous cell carcinoma, with reported cases of malignant transformation. More research is needed on ELP with regard to diagnostic criteria and evidence-based therapeutic recommendations.
Hyperglycaemic chorea-ballism or unmasking of Huntington’s chorea in a patient with diabetes
Authors: Yelam Anudeep , Nagarajan Elanagan , Digala Lakshmi Prasanna , Bollu Pradeep C
Published: March 2020

Chorea-ballism is a neurological syndrome characterised by violent involuntary movements of one or both extremities. In the last decades, several patients with these involuntary movements were reported in association with hyperglycaemia. Here, we present a unique case of possible Huntington’s disease, which could have been unmasked by the hyperglycaemic insult to the basal ganglia in a 64-year-old man who presented with chorea-ballism.
Unusual case of antiphospholipid syndrome presenting as adrenal insufficiency
Authors: Warriach Sanval Ahmed , Mustafa Mohamad , O'Keeffe Denis , Watts Michael
Published: March 2020

A 64-year-old man presented to the emergency department with generalised fatigue and dizzy spells. His background history includes a previous admission with right leg deep vein thrombosis, provoked by pneumonia. Laboratory results showed evidence of hyponatremia and hyperkalaemia. A synacthen test was performed that indicated hypoadrenalism. CT of his abdomen revealed enlarged adrenal glands bilaterally. Adrenal antibodies and positron emission tomography (PET) scan were performed to assess the cause of enlarged adrenals. PET scan showed no evidence of increased uptake. Adrenal antibodies were found to be negative. Tuberculous (TB) adrenalitis was the principle differential diagnosis. TB QuantiFERON was strongly positive. Following 9 months of TB treatment, surveillance CT scan indicated a significant reduction in adrenal gland size. However, subsequent events culminated in a retrospective review of CT scans questioning the initial clinical diagnosis and suggesting that the observed adrenal gland enlargement was secondary to bilateral adrenal infarction and haemorrhage. Equally, the subsequently observed marked reduction in adrenal gland size was not secondary to an assumed response to TB therapy, but rather the sequela of infracted atrophied adrenal glands, as a manifestation of the underlying antiphospholipid syndrome (APS). The case highlights the importance of recognising adrenal insufficiency in patients with a history of APS. It also illustrates the role of multidisciplinary meetings in the management of such complex cases.
HHV-6: an unusual cause of cerebellar ataxia
Authors: Abu Sitta Emad , Khazan Ana , Luttmann Kelly , Hanrahan Jennifer
Published: March 2020

Human herpesvirus 6 (HHV-6) infection is the cause of roseola infantum in children. The reactivation of HHV-6 is associated with multiple clinical syndromes including encephalitis and myelitis, especially in haematopoietic stem cell transplant recipients. However, the virus can cause encephalitis in other immunosuppressed as well as immunocompetent individuals. We report a case of a 70-year-old woman who was immunocompromised secondary to treatment of rheumatoid arthritis with leflunomide and methotrexate. The patient presented with acute ataxia, diplopia and dysarthria. MRI brain showed an enhancing lesion in the midbrain. The diagnosis of HHV-6 encephalitis was made after HHV-6 A DNA was detected in both serum and cerebrospinal fluid. Treatment consisted of a 3-week course of intravenous ganciclovir along with physiotherapy. At a 3-month follow-up, repeat MRI brain showed a decrease in size and oedema of the lesion and the patient’s neurological function was improved.
Reduced stereoacuity as a predictor for clinically significant convergence insufficiency
Authors: Leshno Ari , Stolovitch Chaim , Zloto Ofira , Blum Meirovitch Sharon , Mezad-Koursh Daphna
Published: March 2020

Background

Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work.

Objective

To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort.

Methods

Retrospective chart review included patients aged 6–17 years; excluded patients with amblyopia, manifest strabismus or visual acuity <20/30 in either eye. Stereoacuity, measured by Randot test was defined as normal (≤40arcsec), subnormal (50–400arcsec) and poor (>400 arcsec). CA, measured using base out prism bar was defined by fusion break point (BP) and recovery point (RP), as none (BP=0), poor (BP <20 prism diopter (PD)), borderline (BP <30 PD or RP <20 PD), good (BP ≥30 PD and RP ≥20 PD) and excellent (does not break at 40PD).

Results

In 2200 subjects included, we found an increased prevalence of normal stereoacuity as convergence ability improves (χ2 test, p<0.001) with a negative correlation between stereoacuity and BP (Pearson correlation −0.13, p<0.001).

CI was significantly associated with below normal stereopsis OR 1.86 (95% CI 1.3 to 2.7, p<0.001). Conversely, prevalence of CI was similar, whether or not CI-symptoms were reported. Follow-up data of at least 2.5 years from presentation was available for a small subgroup of 21 patients treated for CI. Convergence improved in 14 (66%), rate of normal stereoacuity increased from 29% at baseline to 76% at last follow-up (p=0.006).

Conclusions

CA affects stereoacuity function in children. Evaluation of CA is required in all cases with poor stereoacuity, especially when other etiologies are amiss. The role of convergence improvement exercise on stereoacuity warrants further investigation.
Prevalence of myopic macular degeneration worldwide: a systematic review and meta-analysis
Authors: Zou Minjie , Wang Shibin , Chen Aiming , Liu Zhenzhen , Young Charlotte Aimee , Zhang Yichi , Jin Guangming , Zheng Danying
Published: March 2020

Purpose

To investigate the prevalence of myopic macular degeneration (MMD) in the global population.

Methods

All published literature of population-based studies on MMD prevalence worldwide were searched and only those with clear definitions to diagnose and classify MMD lesions by standardised grading methods were selected. Meta-analysis methods were used to calculate the pooled prevalence of MMD and its 95% CI in a random-effects model. The prevalence of MMD lesions would also be reported, together with the subgroup analysis of age, region and gender. Correlation between MMD prevalence and spherical equivalent levels and axial length were also evaluated.

Results

12 studies with 58 558 subjects were included in this meta-analysis. The pooled prevalence of MMD in the world population was 2.1% (95% CI: 1.3% to 3.3%). In the subgroup analysis, people with the following characteristics were at higher risk of developing MMD: female, urban life, living in Asia, older age, longer axial length and severer myopia.

Conclusions

MMD is a serious public health concern worldwide, particularly in subjects who are women, subjects living in urban areas, subjects living in Asia, and subjects with longer axial lengths and severer myopia. Further studies from other continents/ethnicities are needed for comprehensive estimates of the prevalence of MMD globally.
Indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal disease in India
Authors: Das Anthony Vipin , Basu Sayan
Published: March 2020

Purpose

To describe the indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal diseases in India.

Methods

This hospital-based cross-sectional study included 1 057 215 new patients presenting to a multitier ophthalmology network from 2016 to 2018. All patients with a central corneal pathology and best corrected visual acuity of less than 20/200 in the affected eye(s) were identified as cases and grouped according to laterality. The main outcome measure was the prognosis for keratoplasty, based on the surgical indication.

Results

A total of 28 824 (2.73%) patients were identified with severe visual impairment or blindness due to corneal diseases; of which, 22 582 (78.3%) had unilateral and 6242 (21.7%) had bilateral affliction. Overall, 85% of the corneal pathologies were due to avoidable causes, which accounted for 97% and 63% of the unilateral and bilateral cases, respectively (p<0.0001). The most common aetiologies were microbial keratitis (27.2%) and corneal opacification (25.5%) in unilateral cases; and corneal opacification (38.2%) and ectasias (14.5%) in bilateral cases. Overall, 60.1% of affected eyes carried a fair to poor prognosis for keratoplasty. However, while in unilateral cases only 29.9% of eyes carried good to excellent prognosis for keratoplasty, in bilateral cases, 58% of eyes carried good to excellent prognosis for keratoplasty (p<0.0001).

Conclusions

The indications and prognosis for keratoplasty varied greatly based on whether the affliction was unilateral or bilateral. Most of the eyes affected by corneal visual impairment or blindness, however, carried an unfavourable prognosis for keratoplasty.
Prevalence and genetic–phenotypic characteristics of patients with USH2A mutations in a large cohort of Chinese patients with inherited retinal disease
Authors: Gao Feng-Juan , Wang Dan-Dan , Chen Fang , Sun Hao-Xiang , Hu Fang-Yuan , Xu Ping , Li Jiankang , Liu Wei , Qi Yu-He , Li Wei , Wang Ming , Zhang Shenghai , Xu Ge-Zhi , Chang Qing , Wu Ji-Hong
Published: March 2020

Aims

To investigate the frequency of USH2A mutation and the clinical and genetic differences between Usher syndrome type II (USH2) and retinitis pigmentosa (RP) in a large cohort of Chinese patients.

Methods

A total of 1381 patients with inherited retinal disease (IRD) were recruited. The phenotypic and genotypic information of patients with USH2A mutations was evaluated.

Results

The prevalence of patients with USH2A mutations was 15.75%, which was the most frequently detected gene in this cohort of patients. Hotspot of USH2A mutations was c.8559-2A >G and c.2802T >G. Patients with USH2 had an earlier and more serious decline of visual function and damage to retina structure than did patients with RP in the first 10 years (p<0.05), but there was no difference in the visual prognosis between the two groups when the course of disease exceeded 10 years (p>0.05). Missense variants had less severe consequences and were found more commonly in RP, whereas more deleterious genotypes were associated with an earlier onset of disease and were found more commonly in USH2.

Conclusions

This study provides detailed clinical–genetic assessment of patients with USH2A mutations of Chinese origin, enabling precise genetic diagnoses, better management of these patients and putative therapeutic approaches.
Prevalence and clinical features of systemic diseases in Chinese patients with uveitis
Authors: Yang Peizeng , Zhong Zhenyu , Du Liping , Li Fuzhen , Chen Zhijun , Zhu Ying , Zhang Wanyun , Huang Fanfan , Ye Xingsheng , Su Guannan , Kijlstra Aize
Published: March 2020

Purpose

Systemic diseases are frequently associated with uveitis but are often not recognised by clinicians. An estimate of the prevalence in a large-scale uveitis population is essential for understanding the epidemiological profile and may be helpful for clinical practice.

Design

A nationwide survey.

Methods

Data were obtained from a national database which included the registration of uveitis cases from 23 provinces, 5 autonomous regions and 4 municipalities across mainland China. The primary outcome was identification of a systemic disease associated with uveitis.

Results

From April 2008 through August 2018, 15 373 uveitis patients were included in the study. Males accounted for 52.9%, and the mean (SD) age of uveitis onset was 35.4 (15.9) years. After standardisation for age, the prevalence of systemic disease among patients with uveitis was 30.8% (95% CI, 30.1% to 31.6%). Vogt-Koyanagi-Harada disease (VKH; age-standardised prevalence, 12.7%; 95% CI, 12.1% to 13.2%), Behçet’s disease (BD; 8.7%; 95% CI, 8.3% to 9.2%), ankylosing spondylitis (AS; 5.0%; 95% CI, 4.6% to 5.3%) and juvenile idiopathic arthritis (JIA; 1.2%; 95% CI, 1.0% to 1.3%) were the most common entities among 36 different forms of systemic diseases identified. The prevalence was significantly higher in males (37.0%; 95% CI, 36.0% to 38.1%) than in females (23.6%; 95% CI, 22.6% to 24.6%), and also higher in bilateral uveitis patients (41.2%; 95% CI, 40.2% to 42.2%) compared with unilateral cases (14.3%; 95% CI, 13.4% to 15.2%), and was highest in panuveitis (59.5%; 95% CI, 58.2% to 60.8%).

Conclusion

Approximately one third of uveitis patients in this nationwide survey have an associated systemic disease, whereby VKH, BD, AS and JIA are the most frequent entities seen in China.
Efficacy and effectiveness studies of depression are not well-differentiated in the literature: a systematic review
Authors: Schmaling Karen , Kaplan Robert M , Porzsolt Franz
Published: March 2020

Background

In the literature on the treatment of depression, efficacy and effectiveness research have different purposes and should apply different research methodologies.

Objective

The purpose of the study was to review characteristics of depression treatment studies identified using efficacy or effectiveness search terms. We considered subject inclusion and exclusion criteria; numbers of subjects enrolled and the proportion in the primary analyses; inclusion of a Consolidated Standards of Reporting Trials (CONSORT) flow diagram; use of random assignment; use of placebo control conditions; lengths of treatment and follow-up; primary outcome variable; trial registration; journal impact factor.

Study selection

Studies indexed as efficacy AND ‘real-world’ AND depression or effectiveness AND ‘real-world’ AND depression in PubMed up to 18 May 2019.

Findings

27 studies met the inclusion criteria: 13 effectiveness studies, 6 efficacy studies and 8 studies indexed as both effectiveness and efficacy. Studies identified as effectiveness, efficacy, or both differed on three outcome measures: the inclusion criteria were lengthier for efficacy than for effectiveness studies; efficacy studies were more likely to have a placebo control condition than effectiveness studies; and the journal impact factor was lower for effectiveness studies than for studies from the efficacy search or studies identified by both searches.

Conclusions

Efficacy and effectiveness research hypothetically use different methodologies, but the efficacy and effectiveness literatures in the treatment of depression were comparable for most of the coded characteristics. The lack of distinguishable characteristics suggests that variably applied terminology may hinder efforts to narrow the gap between research and practice.

PROSPERO registration number

#CRD42019136840.
Strategies to reduce the impact of demand for concurrent endovascular thrombectomy
Authors: Dalsania Ankur K , Kansagra Akash P
Published: March 2020

Background

The rise in demand for endovascular thrombectomy (EVT) has increased the possibility that multiple patients with acute ischemic stroke may present concurrently and exceed local capacity to provide timely treatment. In this work, we quantitatively compared the efficacy of various strategies to mitigate demand in excess of capacity (DEC).

Methods

Strategies evaluated included a backup neurointerventional team for 3 hours, 8 hours, or 24 hours per day; a separate pre-intervention imaging team; and a 30% decrease in procedure duration. For each strategy, empirical distributions were used to probabilistically generate arrival time and case duration for 16 000 independent trials repeated across a range of annual case volumes. DEC was calculated from time series representing the number of concurrent cases at each minute of the year for each trial at each case volume.

Results

All strategies decreased DEC compared with baseline. At a representative volume of 250 cases per year, availability of a backup team for 3 hours, 8 hours, and 24 hours per day reduced DEC by 27.0%, 60.3%, and 97.2%, respectively, compared with baseline. Similarly, availability of a pre-intervention imaging team and a 30% decrease in procedure duration reduced DEC by 26.6% and 17.7%, respectively, compared with baseline.

Conclusions

A backup neurointerventional team, even if available only part time, was an effective strategy for decreasing DEC for EVT. Understanding the actual quantitative benefit of each strategy can facilitate rational cost–benefit analyses underlying the development of efficient and sustainable models of care.
Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: an analysis from the Global Burden of Disease Study 2017
Authors: Shi Peng , Xing Xiaoyue , Xi Shuhua , Jing Hongmei , Yuan Jiamei , Fu Zhushan , Zhao Hanqing
Published: March 2020

Objectives

Pneumoconiosis remains a major global occupational health hazard and illness. Accurate data on the incidence of pneumoconiosis are critical for health resource planning and development of health policy.

Methods

We collected data for the period between 1990 and 2017 on the annual incident cases and the age-standardised incidence rates (ASIR) of pneumoconiosis aetiology from the Global Burden of Disease Study 2017. We calculated the average annual percentage changes of ASIR by sex, region and aetiology in order to determine the trends of pneumoconiosis.

Results

Globally, the number of pneumoconiosis cases increased by a measure of 66.0%, from 36 186 in 1990 to 60 055 in 2017. The overall ASIR decreased by an average of 0.6% per year in the same period. The number of pneumoconiosis cases increased across the five sociodemographic index regions, and there was a decrease in the ASIR from 1990 to 2017. The ASIR of silicosis, coal workers’ pneumoconiosis and other pneumoconiosis decreased. In contrast, measures of the ASIR of asbestosis displayed an increasing trend. Patterns of the incidence of pneumoconiosis caused by different aetiologies were found to have been heterogeneous for analyses across regions and among countries.

Conclusion

Incidence patterns of pneumoconiosis which were caused by different aetiologies varied considerably across regions and countries of the world. The patterns of incidence and temporal trends should facilitate the establishment of more effective and increasingly targeted methods for prevention of pneumoconiosis and reduce associated disease burden.