bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation and optimization of vehicle pedal comfort based on biomechanics
Authors: Chen Liqing , Li Wanjun , Yang Yang , Miao Wei
Published: September 2019

Existing research on the manipulation comfort of the cab pedal generally focuses on the completion of the pedal movement when a vehicle is at rest, with certain data collected for analysis. This paper, by taking passenger vehicles in China as the study object and in view of the actual road conditions in China and the Chinese body size, attempts to solve the problem of muscle redundancy through the maximum/minimum optimization model of muscle activation. The road test was carried out on a typical pavement in a Chinese city. The parameters of pedal stroke, pedal force, and typical Electromyography signal (EMG) signal of drivers’ lower limbs during driving were obtained, from which muscle activation degree was calculated. The obtained experimental data were used as external driving one to simulate and analyze the pedal comfort under the layout of different human percentile and different pedal parameters in an aim to obtain the optimal value. The results indicate that the difference in pedal strokes, pedal preload, pedal resistance coefficients, seat heights, and H-point distances can have a noticeable effect on muscle activation. Taking a 95th-percentile accelerator pedal as an example, with the optimal values of each parameter selected (pedal preload: 8.2 N, pedal resistance coefficient: 2.55, seat height: 0.45 m and H-point distance: 0.86 m), as the pedal strokes increase, muscle activation shows a trend of increase after initial decrease. In the common stroke of a pedal after optimization, the degree of muscle activation is significantly lower than that before optimization, indicating a decrease in muscle fatigue.
The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons
Authors: Ghalehkhani Nima , Farhoudi Behnam , Gouya Mohammad Mehdi , Sharifi Hamid , SeyedAlinaghi SeyedAhmad , Kamali Kianoush , Fahimfar Noushin , Rajabpour Zahra , Doosti-Irani Amin , Sedaghat Abbas , Mirzazadeh Ali
Published: September 2019

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.
User preference for HIV self-testing or self-sampling within a free online sexual health service: a service evaluation
Authors: Baraitser Paula , Black Adam , Amos-Gibbs Stuart , Holdsworth Gillian , Ardines Elena , Courtenay Mollie , Howroyd Chris , Brady Michael
Published: September 2019

The objective of this study was to evaluate a service improvement project offering HIV testing through either self-testing or self-sampling in an online sexual health service by measuring type of test chosen and the reason for this choice. We created a web-page offering choice of online self-sampling or self-testing with information on the advantages and disadvantages of both methods. Anyone aged over 18 years resident in England, Scotland or Wales could order either type of test. We describe the characteristics of users, the tests chosen and the reasons for the choice. A total of 1502 HIV testing orders were placed and 1466 (97.6%) testing kits were dispatched after exclusion of multiple orders by the same user. Sixty-seven per cent of users chose self-testing (n = 984) and the rest chose self-sampling (n = 482, 32.9%). The most frequent reasons for choosing self-testing were: immediate results (n = 264, 46.9%), ability to complete the test themselves (n = 168, 29.8%), less blood required (n = 67, 11.9%) and the privacy of testing at home (n = 55, 9.8%). Public sector provision of self-testing as an adjunct to clinic-based HIV testing services is likely to be highly acceptable to UK populations. However, a proportion will prefer self-sampling, and maintaining choice of testing modality is important.
Secondary syphilis mimicking tuberculoid leprosy in an HIV-positive individual: a case report
Authors: Fernandez-Nieto D , Ortega-Quijano D , Jimenez-Cauhe J , Fernandez-Gonzalez P , Moreno-Moreno E , Bea-Ardebol S
Published: September 2019

Secondary syphilis is a polymorphic condition resulting from the hematogenous and lymphatic dissemination of Treponema pallidum. Human immunodeficiency virus-positive patients are in greater risk of atypical and severe forms of the disease. The most common manifestation is a generalized papulosquamous eruption with variable mucosal involvement. However, annular plaques, split commissural papules, crusted necrotic or ulcerated lesions are also frequent. Granulomatous lesions, both clinically and histologically, are less common and present a diagnostic challenge. We describe a case of secondary syphilis presenting as a granulomatous rash with both clinical and histological features of tuberculoid leprosy. Complementary tests and clinical suspicion are essential to ensure a correct diagnosis and avoid subsequent complications.
Autoimmune haemolytic anaemia and thrombocytopaenia in a single-centre cohort of patients with systemic lupus erythematosus from Turkey: clinical associations and effect on disease damage and survival
Authors: Artım-Esen B , Çene E , Şahinkaya Y , Erdugan M , Oğuz E , Gül A , Öcal L , İnanç M
Published: September 2019

Introduction

Thrombocytopaenia and autoimmune haemolytic anaemia (AIHA) have considerable impact on prognosis in systemic lupus erythematosus (SLE). We investigated the frequencies of these haemocytopaenias, along with their associations and effect on outcome in a single-centre cohort of patients with SLE.

Methods

Demographic characteristics, clinical features, autoantibody profiles, damage and mortality data were compared between patients with and without each haematological abnormality. Variables displaying significant differences between the groups were entered into logistic regression.

Results

Ninety-three patients had AIHA and 215 had thrombocytopaenia. Both were associated with neuropsychiatric (NP) involvement, with each other, leucopaenia, antiphospholipid syndrome (APS) and antiphospholipid antibodies. More patients in both groups had organ damage, and their damage scores were higher. Association to NP damage was discernible. In addition, cardiovascular and renal damage and diabetes were more pronounced in patients with thrombocytopaenia. At logistic regression analysis, younger age, anticardiolipin antibody IgM positivity, leucopaenia and thrombocytopaenia were associated with AIHA whilst lupus anticoagulant activity, AIHA, leucopaenia, APS and NP involvement were associated with thrombocytopaenia. Among damage items, peripheral vascular damage, diabetes, NP damage, renal and ocular damage displayed significant associations with thrombocytopaenia, whereas none of the items did with AIHA. Patients with AIHA had significantly reduced survival rates at 10 and 20 years.

Conclusions

We observed that AIHA and thrombocytopaenia were associated with severe lupus, affecting major organs and causing end organ damage. Thus, they may be considered as prognostic markers. Furthermore, AIHA and especially thrombocytopaenia may also be a marker for a subgroup of lupus patients who have or may develop APS.
An omnibus approach to assess covariate balance in observational studies using the distance covariance
Authors: Andrei Adin-Cristian , McCarthy Patrick M
Published: September 2019

Adequate baseline covariate balance among groups is critical in observational studies designed to estimate causal effects. Propensity score-based methods are popular ways to achieve covariate balance among groups. Existing methods are not easily generalizable to situations in which covariates of mixed type are collected nor do they provide a convenient way to compare the overall covariate vector distributions. Instead, covariate balance is assessed at the individual covariate level, thus the potential for increased overall type I error. We propose the use of the distance covariance, developed by Székely and colleagues, as an omnibus test of independence between covariate vectors and study group. We illustrate the advantages of this methodology in simulated data and in a cardiac surgery study designed to assess the impact of preoperative statin therapy on outcomes.
Effects of electrodes and protective layers on the electromechanical characteristics of piezoelectric stack actuators
Authors: Wang Jianjun , Li Weijie , Qin Lei , Zhang Jing , Wei Peijun
Published: September 2019

Piezoelectric stack actuators are a type of excellent smart devices that can activate large power and displacement outputs due to their unique stack configuration and have been widely used in linear vibrators for various engineering applications. For the fabricated piezoelectric stack actuator, it usually consists of multiple thin piezoelectric wafers, multiple electrodes, and two protective layers. All the piezoelectric wafers are connected electrically in parallel through the electrodes and are protected by two protective layers at the two ends. However, in most of the theoretical models, the active piezoelectric portion is mainly considered, while the electrodes and protective layers are usually neglected to simplify the complicated problem, which results in an inaccurate prediction of the electromechanical characteristics. In our previously published work, the exact theoretical models of the piezoelectric stack energy harvester and sensor with the electrodes and the protective layers included have been established successfully to evaluate the electromechanical performance of these two types of devices, and their validity has verified by the experimental results. However, the exact theoretical model of the piezoelectric stack actuators has not been established, and the effects of the electrodes and the protective layers on the electromechanical characteristics of the actuator are not fully understood. In this article, the exact theoretical model of piezoelectric stack actuator was derived based on our previous work, and the effects of these two factors on the electromechanical characteristics were investigated. Comparisons with the results in the earlier literatures and the experimental results were presented to validate the model. Furthermore, two kinds of typical working states, including clamped–free (C-F) and free–free (F-F), were discussed. The results showed that neglecting the electrodes and the protective layers will greatly affect the accuracy of the prediction model, thus providing some valuable guidelines in designing the piezoelectric stack actuators.
Reinhard Hoeppli (1893–1973): The life and curious afterlife of a distinguished parasitologist
Authors: Morley NJ
Published: September 2019

Reinhard Hoeepli was a Swiss-German physician with a distinguished career as a researcher and historian of medical parasitology. He spent the majority of his career at the Peking Union Medical College in Beijing, China, where he undertook research on host responses to parasitic infections, in particular describing the ‘Splendore-Hoeppli phenomenon’, between 1929 and 1952. During the Second World War, he acted as the Swiss honorary Consul in Japanese-occupied Beijing. After leaving China following the militarization of the College in the wake of the Korean War, he subsequently worked in Singapore and Liberia before retiring to Switzerland. Hoeppli is most widely known for his association with Sir Edmund Backhouse, a controversial and enigmatic Chinese scholar, who was his war-time patient towards the end of his life. With Hoeppli's encouragement, Backhouse wrote two scandalous and unpublishable memoirs which remained in Hoeppli's safe-keeping until his own death in 1973. However, the revelations by the historian Hugh Trevor-Roper in 1976 that Backhouse was a fraudster and fantasist has had a detrimental effect on Hoeppli's posthumous reputation that has overshadowed his many lifetime achievements. Alongside a biography of his life, an examination of the controversies of the Backhouse revelations on Hoeppli's repute is presented.
What’s in a name? From minimum wages to living wages in Europe
Authors: Schulten Thorsten , Müller Torsten
Published: September 2019

The development of a European minimum wage policy is back on the political agenda. While in the past the debate about a European minimum wage policy was largely detached from developments at national level, more recently the debate has been based on various national-level initiatives to ensure a living wage that enables workers and their families to enjoy a decent standard of living. Based on an introduction to the living wage concept, this article analyses how recent living wage initiatives in several EU Member States and the development of a European minimum wage policy could mutually reinforce each other and eventually result in a European living wage policy. In view of the significant heterogeneity of minimum wage regimes and welfare state traditions across Europe, the article calls for a pragmatic approach that adopts a common European target of 60 per cent of the national median wage as the benchmark for an adequate minimum wage.
Advocacy Outcomes Are Not Self-Evident: The Quest for Outcome Identification
Authors: Arensman Bodille
Published: September 2019

Advocacy outcomes are not self-evident. Identifying advocacy outcomes is extremely difficult because they are often intangible, arising from (personal) interactions, and they are not always traceable. This challenges conventional evaluation methods, which is recognized in the advocacy evaluation literature. However, current evaluation methods claim to do justice to these complexities while in reality, these methods assume outcomes are identified logically following from actions. Based on empirical findings from a multisited ethnographic study of an advocacy evaluation, this article questions these underlying assumptions and empirically demonstrates how advocacy outcomes are socially and politically constructed, leaving room for interpretation.
Tribological performance of AlCrN–MoS2/PTFE hard-lubricant composite coatings
Authors: Lu Yang , Deng Jianxin , Song Wenlong , Li Xuemu , Zhang Liangliang , Sun Jie
Published: September 2019

In order to improve the tribological performance of the physical vapor-deposited AlCrN coatings, molybdenum disulfide (MoS2)/poly tetra fluoroethylene (PTFE) coatings were fabricated on the AlCrN coatings surface through the thermal spraying method. The microstructure, adhesive strength, hardness, and tribological properties were investigated. Reciprocating sliding tests against SiC ball were executed with a ball-on-plate tribometer. Results showed that the adhesive strength between the AlCrN–MoS2/PTFE composite coatings and substrate was increased by about 15% compared with single AlCrN coatings. Compared with the single MoS2/PTFE coatings, the hardness of the AlCrN–MoS2/PTFE composite coatings surface was increased by about 15%. The MoS2/PTFE layer can availably reduce the friction coefficient of single AlCrN layer, and the AlCrN–MoS2/PTFE composite coatings exhibited the lowest and the most stable friction coefficient. In addition, the MoS2/PTFE layer existed on the wear track and accumulated on both the sides, which was the main reason that the friction coefficient was still lower compared with the samples without MoS2/PTFE coatings.
Numerical analysis on effects of blade number on hydrodynamic performance of low-pitch marine cycloidal propeller
Authors: Bakhtiari Mohammad , Ghassemi Hassan
Published: September 2019

Marine cycloidal propeller, as a special type of marine propulsion system, is used for ships that require high maneuverability, such as tugs and ferries. In a marine cycloidal propeller, the thrust force is generated by rotation of a circular disk with a number of lifting blades fitted on the periphery of the disk, so that the propeller axis of rotation is perpendicular to the direction of thrust force. Each blade pitches about its own axis, and the thrust magnitude and direction can be adjusted by controlling the pitching angle of the blades. Therefore, the propulsion and maneuvering units are combined together and no separate rudder is needed to maneuver the ship. Two configurations of marine cycloidal propeller have been studied and developed based on propeller pitch: low-pitch propeller (designed for advance coefficient less than one, means λ < 1) and high-pitch propeller (designed for λ > 1). Low-pitch marine cycloidal propellers are used in applications with low-speed maneuvering requirements, such as tugboats and minesweepers. In this study, the effects of blade number on hydrodynamic performance of low-pitch marine cycloidal propeller with pure cycloidal motion of the blades are investigated. The turbulent flow around marine cycloidal propeller is solved using a 2.5D numerical method based on unsteady Reynolds-averaged Navier–Stokes equations with shear-stress transport k–ω turbulent model. The presented numerical method was validated against experimental data and showed good agreement. The results showed that the thrust coefficient of marine cycloidal propeller generally decreases by increasing the blade number, whereas the torque coefficient increases. Consequently, the hydrodynamic efficiency of marine cycloidal propeller drops as the blade number increases.
One Seizure Please, Hold the Sprouts: The Role of Hippocampal Mossy Fiber Sprouting in Epilepsy
Authors: Beenhakker Mark , Ritger Matthew
Published: September 2019

[Box: see text]
Cognitive Systems Engineering Applied to Decision Support in Space Situational Awareness
Authors: Jaunzemis Andris D. , Feigh Karen M. , Holzinger Marcus J. , Minotra Dev , Chan Moses W.
Published: September 2019

Existing approaches for sensor network tasking in space situational awareness (SSA) rely on techniques from the 1950s and limited application areas while also requiring significant human-in-the-loop involvement. Increasing numbers of space objects, sensors, and decision-making needs create a demand for improved methods of gathering and fusing disparate information to resolve hypotheses about the space object environment. This work focuses on the cognitive work in SSA sensor tasking approaches. The application of a cognitive work analysis for the SSA domain highlights capabilities and constraints inherent to the domain that can drive SSA operations toward decision-maker goals. A control task analysis is also conducted to derive requirements for cognitive work and information relationships that support the information fusion and sensor allocation tasks of SSA. A prototype decision-support system is developed using a subset of the derived requirements. This prototype is evaluated in a human-in-the-loop experiment using both a hypothesis-based and covariance-based scheduling approaches. Results from this preliminary evaluation show operator ability to address SSA decision-maker hypotheses using the prototype decision-support system (DSS) using both scheduling approaches.
Cutaneous metastasis as a primary presentation of a pulmonary enteric adenocarcinoma
Authors: Todisco Annalisa , Internò Valeria , Stucci Luigia Stefania , Ostuni Carmela , Lovero Domenica , D’Oronzo Stella , Mele Fabio , Duda Loren , Palmirotta Raffaele , Silvestris Franco
Published: September 2019

Background:

Primary pulmonary enteric adenocarcinoma (PEAC) is a rare non-small cell lung cancer subtype sharing morphologic and immunohistochemical features with colorectal adenocarcinoma. Given the frequency of lung metastases in colorectal cancer, the differential diagnosis of PEAC according to routine morphological and immunohistochemical findings may be difficult. Genome sequence by next-generation sequencing has recently introduced new perspectives to better define the diagnosis and tumor sensitivity to treatments, while the rarity of this subtype of cancer still limits the current knowledge of its molecular features and provides no information to address patients to tailored therapies.

Methods:

We diagnosed a rare case of subcutaneous metastasis as a first symptom of a PEAC. Formalin-fixed paraffin-embedded samples of the primary tumor and subcutaneous metastases were examined by immunohistochemistry, and subsequently by targeted next-generation sequencing analysis.

Results:

Morphological and immunohistochemical findings suggested a rare case of metastatic pulmonary adenocarcinoma with enteric aspects. Next-generation sequencing analysis performed on both the primary tumor sample and the cutaneous lesion identified two pathogenic variants on CDKN2A and KRAS in both of them. However, the metastasis showed two additional pathogenic mutations located in SMAD4 and FLT3 genes.

Conclusions:

We describe for the first time an extensive molecular analysis on a rare case of PEAC with an unusual cutaneous metastasis. Our observation suggests that a specific pattern of mutations is harbored in this neoplasm, and that additional molecular studies may provide further information to identify prognostic and hopefully predictive genes of response to treatment.
Incorporating neuro-fuzzy with extended Kalman filter for simultaneous localization and mapping
Authors: Do Cong Hung , Lin Huei-Yung
Published: September 2019

Extended Kalman filter is well-known as a popular solution to the simultaneous localization and mapping problem for mobile robot platforms or vehicles. In this article, the development of a neuro-fuzzy-based adaptive extended Kalman filter technique is presented. The objective is to estimate the proper values of the R matrix at each step. We design an adaptive neuro-fuzzy extended Kalman filter to minimize the difference between the actual and theoretical covariance matrices of the innovation consequence. The parameters of the adaptive neuro-fuzzy extended Kalman filter is then trained offline using a particle swarm optimization technique. With this approach, the advantages of high-dimensional search space can be exploited and more effective training can be achieved. In the experiments, the mobile robot navigation with a number of landmarks under two benchmark situations is evaluated. The results have demonstrated that the proposed adaptive neuro-fuzzy extended Kalman filter technique provides the improvement in both performance efficiency and computational cost.
Coping resources and strategies of Canadian ice-hockey players: An empirical National Hockey League career model
Authors: Battochio Randy C , Stambulova Natalia
Published: September 2019

Sport psychology researchers have studied careers of Canadian ice hockey players in the National Hockey League (NHL) and devised an empirical NHL career model. The model was comprised of career stages, statuses, demands and barriers to career progression without any indication of coping. The intent in the present article is to feature coping resources and strategies utilized by players during each status and career stage within the empirical model. Five rookies, 5 veterans, and 13 retirees participated in conversational interviews and the data underwent a deductive thematic analysis. Prospects seeking to gain entry into the NHL set controllable expectations rather than playing to impress coaches and staff. Most prospects played in the minor leagues where they adjusted their expectations to accept roles that they were likely to have during an NHL call-up. The career stage of developing as an NHL player was about rookies producing immediately in their role while holding off internal competition for their roster spot. In the same stage, sophomores were in their second full NHL season and they studied their opponents to avoid the sophomore slump. The stage of reaching the NHL elite involved constant pressure for point production and winning playoff games. The final stage was about seasoned veterans maintaining NHL play involvement by preserving their physique despite being worn down from long careers in a contact sport. The authors will discuss the significance of the model for sport psychology researchers and practitioners, and NHL stakeholders.
Effect of orlistat on liver fat content in patients with nonalcoholic fatty liver disease with obesity: assessment using magnetic resonance imaging-derived proton density fat fraction
Authors: Ye Junzhao , Wu Yanqin , Li Fuxi , Wu Tingfeng , Shao Congxiang , Lin Yansong , Wang Wei , Feng Shiting , Zhong Bihui
Published: September 2019

Background:

The liver effect of orlistat as a weight control treatment in patients with nonalcoholic fatty liver disease (NAFLD) with obesity remains undetermined. This study quantified liver fat improvement by orlistat in a Chinese cohort with NAFLD accompanied by obesity, diagnosed by a lower body mass index threshold than that for White patients.

Materials and methods:

We conducted a parallel-group, open-label, 24-week, randomized clinical trial registered at the Chinese Clinical Trial Registry (ChiCTR-IPR-17012258). Obese participants with NAFLD were randomized 1:1.5 to the intervention group with orlistat or conventional care. Liver fat quantification was assessed by magnetic resonance imaging-based proton density fat fraction with Dixon sequence.

Results:

Overall, 170 ( n = 68, orlistat 120 mg three times/day and n = 102, conventional therapy) and 130 patients with NAFLD ( n = 56, orlistat and n = 74, conventional therapy) were included for intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. Orlistat reduced liver fat content to a greater degree than conventional care [−5.45% versus −1.96%, p < 0.001 (ITT analysis) and −6.66% versus −2.68%, p < 0.001 (PP analysis)]. The 6-month rate of decrease in steatosis grades was higher in the orlistat group [45.6% versus 22.5% (ITT analysis), 57.4% versus 30.3% (PP analysis), both p < 0.001]. Multivariate logistic regression analysis identified orlistat treatment [odds ratio (OR) = 2.4; 95% confidence interval (CI) 1.1–5.6, p = 0.036] as an independent predictor of steatosis improvement. Among patients with orlistat therapy, weight loss (OR = 1.2, 95% CI 1.1–1.4, p = 0.040) and severe steatosis (OR = 6.7, 95% CI: 1.1–40.3, p = 0.03) remained predictive of steatosis improvement.

Conclusions:

Orlistat can effectively promote steatosis improvement and may serve as a treatment option for controlling NAFLD.

Chinese Clinical Trial Registry identifier:

ChiCTR-IPR-17012258
Age-related schwannomatosis with potential exosome-mediated contribution to prostate hyperplasia: a case report and mini-review
Authors: Chignon-Sicard Bérengère , Hofman Véronique , Chevallier Daniel , Cucchi Jean-Michel , Ilié Marius , Dadone-Montaudié Bérengère , Paul Florence , Carpentier Xavier , Quintens Hervé , Bence-Gauchiez Coraline , Caselles Didier , Rossant Jacqueline , Durand Matthieu , Bertolotti Roger
Published: September 2019

A 72-year-old Caucasian man incurring a prostate hypertrophy presented with a right forearm nodule, the growth of which appeared to parallel the rise in his blood prostate-specific antigen (PSA) level. Echographic examination was consistent with a median-nerve schwannoma, and was confirmed upon magnetic resonance imaging (MRI). Excision of the nodule was readily performed without significant neural damage, and its schwannoma nature was confirmed upon immunohistochemistry analysis. Importantly, blood PSA dropped abruptly from ≈13 to ≈5 ng/ml within 2 months postschwannoma resection, a swift drastic reduction unachievable with oral dutasteride alone. However, 6 weeks later, a new nodule became apparent on the back of the left knee and was identified as a second schwannoma, thereby suggesting that its growth could have been stimulated by the resection of the first schwannoma, as previously described for vestibular schwannomas. The second schwannoma was in fact two: the bigger one was in the common fibular nerve and the smaller one in the tibial nerve. Both echography and MRI results were confirmed upon surgical resection of the bigger knee schwannoma. Although the third schwannoma has not yet been resected and formally characterized, we face a schwannomatosis case with an unexpected potential exosome-mediated stimulating effect on PSA secretion (PSA immunohistochemistry was negative on both schwannomas). On the other hand, preliminary genomic analysis showed a deficient balance for chromosome 22, the very chromosome carrying the three main genes involved in schwannomatosis. This age-related schwannomatosis case is thus discussed in light of the following: age-related DNA repair deficiency culminating in loss of chromosome/heterozygosity; CpG methylation/demethylation-based epigenetic aging; age-related functional decline of the immune system responsible for inefficient elimination of abnormal cells and subsequent tumorigenic cell turn-over; exosome-mediated pathologic intercellular communications; and prostate-invading brain neural progenitors as pathologic peripheral nervous system (PNS) cells.
Allergic Rhinitis Is Associated With Loss of Energy and Concentration Difficulty: A Cross-sectional Study
Authors: Robles-Figueroa Martín , Bedolla-Barajas Martín , Morales-Romero Jaime , Pulido-Guillén Norma A. , Bustos-Gutiérrez Luis R. Manuel
Published: September 2019

Objective

To assess whether loss of energy and concentration difficulty are related to allergic rhinitis.

Design

A cross-sectional study.

Setting

Secondary care allergy outpatients.

Participants

A total of 100 patients with allergic rhinitis and 96 healthy subjects. Main Outcome Measure: Loss of energy and concentration difficulty were assessed through a survey using the Beck Depression Inventory-II (BDI-II).

Results

The average BDI-II score was higher in the allergic rhinitis population than in the healthy controls (12.8 points vs 1.8 points, P < .0001), and the frequencies of loss of energy (69.0% vs 32.3%) and concentration difficulty (65.0% vs 34.4%) were higher in patients with allergic rhinitis ( P < .0001). The prevalence of depression was 0% in the control group and 38% in the case group ( P < .0001). Allergic rhinitis and depression were independently associated with loss of energy, odds ratio (OR) = 2.55, P = .005, and OR = 9.61, P = .001, respectively, and concentration difficulty (OR = 2.04, P = .033; OR = 6.19, P = .001, respectively).

Conclusions

This study is one of the first studies in Latin America to report an independent association of allergic rhinitis with loss of energy and concentration difficulty.
An Evolutionary Ecological Framework for Understanding Human Behavioral Syndromes: Commentary on Lukaszewski et al. 2017
Authors: Međedović Janko
Published: September 2019

In their recent paper, Lukaszewski et al. proposed a socioecological hypothesis for analyzing the covariations between the Big Five personality traits. The hypothesis states that the shared variance between the personality traits is higher in less complex societies marked by lower economic development, urbanization, and niche diversity. We welcome this hypothesis and add an additional framework for understanding the covariation between the traits—behavioral syndromes. We state that behavioral syndromes and their effects on fitness should be the primary target for the evolutionary ecological analysis of the relations between human personality traits on a population level. Behavioral syndromes are extensively studied in animal behavioral ecology which provides an opportunity for the comparative study of personality. We point to the behavioral syndromes in Lukaszewski et al. data, especially to the agreeableness–conscientiousness correlation, which roughly corresponds to the aggressiveness–impulsiveness behavioral syndrome in animals. We point to other potentially problematic issues and provide recommendations for future research.
Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol
Authors: Correa-Pérez Andrea , Delgado-Silveira Eva , Martín-Aragón Sagrario , Cruz-Jentoft Alfonso J.
Published: September 2019

Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. However, no information is available about the association between FRIDS and injurious falls after hospital discharge due to hip fracture in a very old population. We aim to assess the association between the use of FRIDS at discharge and injurious falls in patients older than 80 years hospitalized due to a hip fracture. A retrospective cohort study using routinely collected health data will be conducted at the Orthogeriatric Unit of a teaching hospital. Patients will be included at hospital discharge (2014), with a 2-year follow-up. Fall-risk increasing drugs will be recorded at hospital discharge, and exposure to drugs will be estimated from usage records during the 2-year follow-up. Injurious falls are defined as falls that lead to any kind of health care (primary or specialized care, including emergency department visits and hospital admissions). A sample size of 193 participants was calculated, assuming that 40% of patients who receive any FRID at discharge, and 20% who do not, will experience an injurious fall during follow up. This protocol explains the study methods and the planned analysis. We expect to find a relevant association between FRIDS at hospital discharge and the incidence of injurious falls in this very old, high risk population. If confirmed, this would support the need for a careful pharmacotherapeutic review in patients discharged after a hip fracture. However, results should be carefully interpreted due to the risk of bias inherent to the study design.
A new treatment for severe pulmonary arterial hypertension based on an old idea: inhibition of 5‐lipoxygenase
Authors: Voelkel Norbert F. , Peters‐Golden Marc
Published: September 2019

It has been generally accepted that severe forms of pulmonary arterial hypertension are associated with inflammation. Plasma levels in patients with severe pulmonary arterial hypertension show elevated levels of interleukins and mediators of inflammation and histologically the diseased small pulmonary arterioles show infiltrates of inflammatory and immune cells. Here, we review the literature that connects pulmonary hypertension with the arachidonic acid/5‐lipoxygenase‐derived leukotriens. This mostly preclinical background data together with the availability of 5‐lipoxygenase inhibitors and leukotriene receptor blockers provide the rationale for testing the hypothesis that 5‐lipoxygenase products contribute to the pathobiology of severe pulmonary arterial hypertension in a subgroup of patients.
Relationship between physical activity and long-term outcomes in patients with stable coronary artery disease
Authors: Biscaglia Simone , Campo Gianluca , Sorbets Emmanuel , Ford Ian , Fox Kim M , Greenlaw Nicola , Parkhomenko Alexander , Tardif Jean-Claude , Tavazzi Luigi , Tendera Michal , Wetherall Kirsty , Ferrari Roberto , Steg Ph. Gabriel ,   on behalf of the CLARIFY investigators
Published: September 2019

Aims

The aims of this study were to ascertain the relationship between level of physical activity and outcomes and to discriminate the determinants of physical activity performance or avoidance.

Methods

CLARIFY is an international prospective registry of 32,370 consecutive outpatients with stable coronary artery disease who were followed for up to five years. Patients were grouped according to the level and frequency of physical activity: i) sedentary ( n = 5223; 16.1%); ii) only light physical activity most weeks (light; n = 16,634; 51.4%); iii) vigorous physical activity once or twice per week (vigorous ≤ 2×; n = 5427; 16.8%); iv) vigorous physical activity three or more times per week (vigorous >2×; n = 5086; 15.7%). The primary outcome was the composite of cardiovascular death, myocardial infarction and stroke.

Results

Patients performing vigorous physical activity ≤2 × had the lowest risk of the primary outcome (hazard ratio, 0.82; 95% confidence interval, 0.71–0.93; p = 0.0031) taking the light group as reference. Engaging in more frequent exercise did not result in further outcome benefit. All-cause death, cardiovascular death, and stroke occurred less frequently in patients performing vigorous physical activity ≤2×. However, the rate of myocardial infarction was comparable between the four physical activity groups. Female sex, peripheral artery disease, diabetes, previous myocardial infarction or stroke, pulmonary disease and body mass index all emerged as independent predictors of lower physical activity.

Conclusion

Vigorous physical activity once or twice per week was associated with superior cardiac outcomes compared with patients performing no or a low level of physical activity in outpatients with stable coronary artery disease.
Systematic investment in the delivery of guideline-coherent therapy reduces mortality and overall costs in patients with ST-elevation myocardial infarction: Results from the Stent for Life economic model for Romania, Portugal, Basque Country and Kemerovo region
Authors: Wein Bastian , Bashkireva Anna , Au-Yeung Alex , Yoculan Adam , Vinereanu Dragos , Deleanu Dan , Pereira Helder , Pereira Ernesto , de Mello Sofia , Rumoroso Jose R , Ganyukov Vladimir , Wijns William , Naber Christoph K
Published: September 2019

Aims:

The Stent for Life initiative aims at the reduction of mortality in patients with ST-elevation myocardial infarction by enhancing timely access to primary percutaneous coronary intervention. To assess the associated health and socioeconomic impact, the Stent for Life economic project was launched and applied to four model regions: Romania, Portugal, the Basque Country in Spain, and the Kemerovo region in the Russian Federation.

Methods and results:

The Stent for Life economic model is based on a decision tree that incorporates primary percutaneous coronary intervention rates and mortality. Healthcare costs and indirect costs caused by loss of productivity were estimated. A baseline scenario simulating the status quo was compared to the Stent for Life scenario which integrated changes initiated by the Stent for Life programme. In the four model regions, primary percutaneous coronary intervention numbers rose substantially between 29–303%, while ST-elevation myocardial infarction mortality was reduced between 3–10%. Healthcare costs increased by 8% to 70%. Indirect cost savings ranged from 2–7%. Net societal costs were reduced in all model regions by 2–4%.

Conclusion:

The joint effort of the Stent for Life initiative and their local partners successfully saves lives. Moreover, the increase in healthcare costs was outweighed by indirect cost savings, leading to a net cost reduction in all four model regions. These findings demonstrate that systematic investments to improve the access of ST-elevation myocardial infarction patients to guideline-coherent therapy is beneficial, not only for the individual, but also for the society at large.
Acute effect of high-intensity interval training on metabolic and inflammatory markers in obese and overweight adolescents: Pilot study
Authors: Monteiro Paula Alves , Freitas Junior Ismael Forte , Zagatto Alessandro Moura , Ribeiro José Procópio Jabur , Cabral-Santos Carolina , Inoue Daniela Sayuri , Gerosa-Neto José , Lira Fábio Santos
Published: September 2019

It is still unclear whether a high-intensity interval exercise (HIIE) protocol is effective for promoting anti-inflammatory and anti-atherogenic responses. The objective of this study was to analyze the acute effects of HIIE on inflammatory and metabolic responses in obese and overweight girls and boys. Initially, the body composition of 19 sedentary volunteers was evaluated. The participants completed an interval experimental run on a treadmill (2:1 min at 95% maximum velocity, totaling ~3 km) and blood samples were collected at rest and immediately after the exercise protocol. Serum was analyzed for interleukins 6 and 10 (IL-6 and IL-10), tumor necrosis factor-α (TNF-α), cortisol, glucose, triacylglycerol (TG), non-esterified fatty acid (NEFA), plasminogen activator inhibitor-1 (PAI-1), and the lipoprotein profile. Under baseline conditions, the groups of boys and girls exhibited differences in the anthropometry measures for fat-free mass ( p = 0.011), gynoid fat ( p = 0.002), visceral fat ( p = 0.004), and glucose ( p = 0.031). After the exercise session, cholesterol, glucose, NEFA, PAI-1, IL-10, and TNF-α did not demonstrate effects for time, group, or interaction under the different conditions. Cortisol (F = 9.018; p = 0.008; partial η2 = 0.347), TG (F = 25.189; p < 0.0001; partial η2 = 0.597), and IL-6 levels (F = 6.543; p = 0.020; partial η2 = 0.278) showed an effect for time. In conclusion, our results demonstrated that HIIE promoted an immune-endocrine response, increasing cortisol and IL-6 levels immediately after the exercise protocol in overweight and obese girls.
Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults
Authors: Gagné Marie-Ève , McFadyen Bradford J , Cossette Isabelle , Fait Philippe , Gagnon Isabelle , Sirois Katia , Blanchet Sophie , Le Sage Natalie , Ouellet Marie-Christine
Published: September 2019

Objectives

To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries.

Methods

Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated.

Results

Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking.

Conclusion

Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.
Effect of Integrated Supportive Supervision on the Quality of Health-Care Service Delivery in Katsina State, Northwest Nigeria
Authors: Nass Shafique Sani , Isah Murtala Bindawa , Sani Aminu
Published: September 2019

Background:

Katsina State Government in Northern Nigeria introduced integrated supportive supervision (ISS) in primary health centers. The study was guided by the Primary Health Care Performance Initiative Conceptual Framework. The goal of the study was to measure the impact of ISS on the quality of primary health-care delivery. The outcome variables measured include infrastructure, basic equipment, human resources for health, essential drugs, the number of pregnant women screened for HIV, and the number of children receiving immunization.

Methods:

The study was a cross-sectional survey of 34 health facilities. Kruskal-Wallis nonparametric test followed by Dunn post hoc test and analysis of variance followed by Tukey post hoc test were both employed to compare the mean values of various indicators obtained over 6 visits of the ISS program from July 2018 to December 2018.

Findings:

The study shows the positive effect of the ISS on infrastructure, human resources for health, essential drugs, and the number of pregnant women screened for HIV ( P < .05). Human resources for health and the number of children receiving immunization were both not affected by ISS ( P > .05).

Conclusion:

Integrated supportive supervision need to be embedded into the 3 levels (primary, secondary, and tertiary) of health-care service delivery.

Implications:

Integrated supportive supervision will strengthen the Katsina State health system, ensure efficient use of the health facility assets and resources utilization, and improve patient/client satisfaction.
Back to the Basics: Resting State Functional Connectivity of the Reticular Activation System in PTSD and its Dissociative Subtype
Authors: Thome Janine , Densmore Maria , Koppe Georgia , Terpou Braeden , Théberge Jean , McKinnon Margaret C. , Lanius Ruth A.
Published: September 2019

Background

Brainstem and midbrain neuronal circuits that control innate, reflexive responses and arousal are increasingly recognized as central to the neurobiological framework of post-traumatic stress disorder (PTSD). The reticular activation system represents a fundamental neuronal circuit that plays a critical role not only in generating arousal but also in coordinating innate, reflexive responding. Accordingly, the present investigation aims to characterize the resting state functional connectivity of the reticular activation system in PTSD and its dissociative subtype.

Methods

We investigated patterns of resting state functional connectivity of a central node of the reticular activation system, namely, the pedunculopontine nuclei, among individuals with PTSD (n = 77), its dissociative subtype (PTSD+DS; n = 48), and healthy controls (n = 51).

Results

Participants with PTSD and PTSD+DS were characterized by within-group pedunculopontine nuclei resting state functional connectivity to brain regions involved in innate threat processing and arousal modulation (i.e., midbrain, amygdala, ventromedial prefrontal cortex). Critically, this pattern was most pronounced in individuals with PTSD+DS, as compared to both control and PTSD groups. As compared to participants with PTSD and controls, individuals with PTSD+DS showed enhanced pedunculopontine nuclei resting state functional connectivity to the amygdala and the parahippocampal gyrus as well as to the anterior cingulate and the ventromedial prefrontal cortex. No group differences emerged between PTSD and control groups. In individuals with PTSD+DS, state derealization/depersonalization was associated with reduced resting state functional connectivity between the left pedunculopontine nuclei and the anterior nucleus of the thalamus. Altered connectivity in these regions may restrict the thalamo-cortical transmission necessary to integrate internal and external signals at a cortical level and underlie, in part, experiences of depersonalization and derealization.

Conclusions

The present findings extend the current neurobiological model of PTSD and provide emerging evidence for the need to incorporate brainstem structures, including the reticular activation system, into current conceptualizations of PTSD and its dissociative subtype.