bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH
Authors: Williamson Anna , Skinner Adam , Falster Kathleen , Clapham Kathleen , Eades Sandra J , Banks Emily
Published: November 2018

Objectives

The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.

Setting

Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.

Participants

1476 Aboriginal children aged 0–17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.

Primary outcome measures

ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.

Results

Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).

Conclusions

Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.
Exploring variation in how ambulance services address non-conveyance: a qualitative interview study
Authors: Knowles Emma , Bishop-Edwards Lindsey , O’Cathain Alicia
Published: November 2018

Objectives

There is considerable variation in non-conveyance rates between ambulance services in England. The aim was to explore variation in how each ambulance service addressed non-conveyance for calls ending in telephone advice and discharge at scene.

Design

A qualitative interview study.

Setting

Ten large regional ambulance services covering 99% of the population in England.

Participants

Between four and seven interviewees from each ambulance service including managers, paramedics and healthcare commissioners, totalling 49 interviews.

Methods

Telephone semistructured interviews.

Results

The way interviewees in each ambulance service discussed non-conveyance within their organisation varied for three broad themes. First, ambulance service senior management appeared to set the culture around non-conveyance within an organisation, viewing it either as an opportunity or as a risky endeavour. Although motivation levels to undertake non-conveyance did not appear to be directly affected by the stability of an ambulance service in terms of continuity of leadership and externally assessed quality, this stability could affect the ability of the organisation to innovate to increase non-conveyance rates. Second, descriptions of workforce configuration differed between ambulance services, as well as how this workforce was used, trained and valued. Third, interviewees in each ambulance service described health and social care in the wider emergency and urgent care system differently in terms of availability of services that could facilitate non-conveyance, the amount of collaborative working between health and social care services and the ambulance service and complexity related to the numbers of services and healthcare commissioners with whom they had to work.

Conclusions

This study suggests that factors within and outside the control of ambulance services may contribute to variation in non-conveyance rates. These findings can be tested in a quantitative analysis of factors affecting variation in non-conveyance rates between ambulance services in England.
Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014–2016
Authors: Sharapova Saida , Reyes-Guzman Carolyn , Singh Tushar , Phillips Elyse , Marynak Kristy L , Agaku Israel
Published: November 2018

Introduction

Tobacco use mostly begins in adolescence and young adulthood. Earlier age of initiation of cigarette smoking is associated with greater nicotine dependence and sustained tobacco use. However, data are limited on the age of initiation of non-cigarette tobacco products, and the association between using these products and nicotine dependence and progression to established use.

Methods

Combined 2014–2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6–12 yielded 19 580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco and hookah. Analyses assessed age of reported first use of each product among ever-users, overall and by sex and race/ethnicity. Current daily use, past 30-day use, feelings of craving tobacco and time to first tobacco use after waking were assessed by age of first use.

Results

Among ever-users, weighted median age for first use was 12.6 years for cigarettes, 13.8 years for cigars, 13.4 years for smokeless tobacco, 14.1 years for hookah and 14.1 years for e-cigarettes. First trying these tobacco products at age ≤13 years was associated with greater current use of the respective product and nicotine dependence compared with initiating use at age >13 years.

Conclusions

First tobacco use at age ≤13 years is associated with current daily and past 30-day use of non-cigarette tobacco products, and with the development of nicotine dependence among youth ever-users. Proven tobacco prevention interventions that reach early adolescents are important to reduce overall youth tobacco use.
Determination of efficient sampling locations in geotechnical site characterization using information entropy and Bayesian compressive sampling
Authors: Zhao Tengyuan , Wang Yu
Published: November 2018

Site characterization is indispensable in geotechnical engineering practice, and measurements on soil properties are performed through in situ tests, laboratory tests or other methods. However, due to time or budget limit, technical or access constraints, etc., the measurements are usually taken at a limited number of locations. This leads to a question of how to select the efficient locations for measurements or sampling such that as much information as possible on the spatial variability of soil properties can be obtained from a given number of measurements. In addition, geotechnical site characterization is a multi-stage process, and additional measurements might be required at a later stage of site characterization. In such a case, how the additional sampling locations can be selected efficiently such that the pre-existing measurements obtained from the preliminary stages of site characterization can be best used and how can as much information as possible on soil properties be further obtained are problems engineers face. This paper aims to address these two problems using information entropy and Bayesian compressive sampling. Real cone penetration test data along both vertical and horizontal directions are used to illustrate and validate the proposed methods. Results show that the proposed methods are very effective and robust in selecting efficient sampling locations for geotechnical site characterization.
Climate-driven biophysical changes in feeding and breeding environments explain the decline of southernmost European Atlantic salmon populations
Authors: Almodóvar Ana , Ayllón Daniel , Nicola Graciela G. , Jonsson Bror , Elvira Benigno
Published: November 2018

The consistency of the global declining trend of Atlantic salmon (Salmo salar) populations suggests that climate-driven reduced survival and growth at sea are the main driving factors. The southernmost populations have experienced the greatest declines, consistent with harsher conditions in natal fresh waters. We analyzed temporal trends in Spanish Atlantic salmon, important food organisms at sea, and climatic variables in the breeding (fresh water) and feeding (marine) salmon areas from 1950 onwards to elucidate drivers of declining patterns. Salmon abundance dropped abruptly in 1970–1971, plausibly linked to widespread overfishing coincident with incipient changes in the marine food webs and freshwater hydrology. A major regime shift in biophysical conditions throughout the North Atlantic salmon feeding grounds occurred in 1986–1987, driven by the concurrence of an abrupt acceleration in the anthropogenic warming trend and the warm phase of the Atlantic Multidecadal Oscillation. This regime shift may be the proximate cause of the collapse of Spanish salmon observed in 1988–1989, which kept declining in parallel to trends of ever-increasing ocean and freshwater temperatures, decreasing river flows, and poorer marine trophic conditions.
Spin thermoelectric transport in a four-quantum-dot ring: Influence of quantum dots magnetization
Authors: Liang Feng , Zhang Dong , Gao Ben-Ling , Wang Yan-Zong , Gu Yu
Published: November 2018

Non-equilibrium Green’s function method is applied to study the spin thermoelectric effects in a four-quantum-dot ring with two of the quantum dots magnetized. The influence of magnetic configuration on the spin thermoelectric transport through the system is investigated. In some magnetic configurations, a significant spin Seebeck coefficient [Formula: see text] can be generated with the variation of the quantum dot (QD) energy level. Appropriately tuning the QD energy level can let the present device work as a pure spin-up (spin-down) or a pure-spin-current thermal generator. The combined effect of the magnetization and magnetic flux (or Rashba spin-orbit coupling) is also investigated. Finally, the charge figure of merit [Formula: see text] and spin figure of merit [Formula: see text] are evaluated, it is found that the magnitude of the spin figure of merit can be comparable to that of the charge counterpart.
Pore size fractal dimension for characterizing Au/TiO2 catalyst
Authors: Mahmood Asif
Published: November 2018

The quality and assessment of a catalyst can be documented in detail by the application of pore size. This research aims to calculate fractal dimension from the relationship among pore size, maximum pore size and wetting phase saturation and to confirm it by the fractal dimension derived from the relationship among the ratio between surface area per unit pore volume, entry surface area per unit pore volume and wetting phase saturation. In this research, pore size was measured on Au/TiO2 using Brunauer–Emmett–Teller (BET) surface area. Two equations for calculating the fractal dimensions have been employed. The first one describes the functional relationship between wetting phase saturation, pore size, maximum pore size and fractal dimension. The second equation implies to the wetting phase saturation as a function of surface area per unit pore volume, entry surface area per unit pore volume and the fractal dimension. Two procedures for obtaining the fractal dimension have been utilized. The first procedure was done by plotting the logarithm of the ratio between pore size and maximum pore size versus logarithm wetting phase saturation. The positive slope of the first procedure = 3 − Df (fractal dimension). The second procedure for obtaining the fractal dimension was determined by plotting the logarithm of the ratio between surface area per unit pore volume, entry surface area per unit pore volume versus the logarithm of wetting phase saturation. The negative slope of the second procedure = Df − 3. It was found that the plasma + thermally treated Au/TiO2 has the highest fractal dimension value owing to possibility of having holes and channels. The results also show similarity between pore size fractal dimension and surface area per unit pore volume fractal dimension. In our case, as conclusions, the higher the fractal dimension, the better the catalytic activity.
Metatox - Web application for generation of metabolic pathways and toxicity estimation
Authors: Rudik Anastasiya , Bezhentsev Vladislav , Dmitriev Alexander , Lagunin Alexey , Filimonov Dmitry , Poroikov Vladimir
Published: November 2018

Xenobiotics biotransformation in humans is a process of the chemical modifications, which may lead to the formation of toxic metabolites. The prediction of such metabolites is very important for drug development and ecotoxicology studies. We created the web-application MetaTox ( http://way2drug.com/mg ) for the generation of xenobiotics metabolic pathways in the human organism. For each generated metabolite, the estimations of the acute toxicity (based on GUSAR software prediction), organ-specific carcinogenicity and adverse effects (based on PASS software prediction) are performed. Generation of metabolites by MetaTox is based on the fragments datasets, which describe transformations of substrates structures to a metabolites structure. We added three new classes of biotransformation reactions: Dehydrogenation, Glutathionation, and Hydrolysis, and now metabolite generation for 15 most frequent classes of xenobiotic’s biotransformation reactions are available. MetaTox calculates the probability of formation of generated metabolite — it is the integrated assessment of the biotransformation reactions probabilities and their sites using the algorithm of PASS ( http://way2drug.com/passonline ). The prediction accuracy estimated by the leave-one-out cross-validation (LOO-CV) procedure calculated separately for the probabilities of biotransformation reactions and their sites is about 0.9 on the average for all reactions.
Gone with the wind: dune provenance and sediment recycling in the northern Rub’ al-Khali, United Arab Emirates
Authors: Farrant Andrew R. , Mounteney Ian , Burton Amy , Thomas Robert J. , Roberts Nick M. W. , Knox Robert W. O. , Bide Thomas
Published: November 2018

The Rub’ al-Khali dune field in southern Arabia is the largest sand sea in the world. Deciphering the palaeoenvironmental history of the Rub’ al-Khali is critical to understanding its role as a barrier to human migration, dispersal and settlement. To determine sediment provenance and transport pathways, we combined data from a geological mapping project with traditional heavy mineral optical point-counting methods, heavy mineral geochemical fingerprinting and detrital zircon U–Pb geochronology of Miocene and Quaternary sediments in the United Arab Emirates (UAE). Detrital zircon U–Pb age spectra demonstrate that most Neogene and Quaternary sediments in the UAE are ultimately sourced from the Precambrian Arabian Shield. Heavy mineral and geochemical signatures indicate that the dune sands are locally recycled from the deflation of Miocene sandstones and Quaternary siliciclastic palaeodunes exposed along the Arabian Gulf coast, whereas carbonate palaeodunes along the Gulf coast are derived from the deflation of sediments deposited by the Tigris–Euphrates River system in the Gulf during Pleistocene lowstands. In the eastern Emirates, Miocene and Quaternary alluvial fan deposits emanating from the Hajar Mountains have an ophiolitic heavy mineral signature. The data reveal new insights into the origin and development of the Rub’ al-Khali dune field.

Supplementary material:
A map, details of the geochronology methods and a full dataset are available at
https://doi.org/10.6084/m9.figshare.c.4290350
CapVis
Authors: Liang Haoran , Jiang Ming , Liang Ronghua , Zhao Qi
Published: November 2018

When looking at an image, humans shift their attention toward interesting regions, making sequences of eye fixations. When describing an image, they also come up with simple sentences that highlight the key elements in the scene. What is the correlation between where people look and what they describe in an image? To investigate this problem intuitively, we develop a visual analytics system, CapVis, to look into visual attention and image captioning, two types of subjective annotations that are relatively task-free and natural. Using these annotations, we propose a word-weighting scheme to extract visual and verbal saliency ranks to compare against each other. In our approach, a number of low-level and semantic-level features relevant to visual-verbal saliency consistency are proposed and visualized for a better understanding of image content. Our method also shows the different ways that a human and a computational model look at and describe images, which provides reliable information for a captioning model. Experiment also shows that the visualized feature can be integrated into a computational model to effectively predict the consistency between the two modalities on an image dataset with both types of annotations.
ResumeVis
Authors: Zhang Chen , Wang Hao
Published: November 2018

Massive public resume data emerging on the internet indicates individual-related characteristics in terms of profile and career experiences. Resume Analysis (RA) provides opportunities for many applications, such as recruitment trend predict, talent seeking and evaluation. Existing RA studies either largely rely on the knowledge of domain experts, or leverage classic statistical or data mining models to identify and filter explicit attributes based on pre-defined rules. However, they fail to discover the latent semantic information from semi-structured resume text, i.e., individual career progress trajectory and social-relations, which are otherwise vital to comprehensive understanding of people’s career evolving patterns. Besides, when dealing with large numbers of resumes, how to properly visualize such semantic information to reduce the information load and to support better human cognition is also challenging.

To tackle these issues, we propose a visual analytics system called
ResumeVis
to mine and visualize resume data. First, a text mining-based approach is presented to extract semantic information. Then, a set of visualizations are devised to represent the semantic information in multiple perspectives. Through interactive exploration on
ResumeVis
performed by domain experts, the following tasks can be accomplished: to trace individual career evolving trajectory; to mine latent social-relations among individuals; and to hold the full picture of massive resumes’ collective mobility. Case studies with over 2,500 government officer resumes demonstrate the effectiveness of our system.
Adaptive Fixed-Time Stability Control and Parameters Identification for Chaotic Oscillation in Second Order Power System
Authors: Ma Caoyuan , Wu Wenbei , Li Zhijie , Cheng Yuzhou , Wang Faxin
Published: November 2018

In this paper, the novel adaptive fixed-time stability control for chaotic oscillation in second order power system is proposed. The settling time of fixed-time control can be adjusted to the desired value without knowing the initial condition, while the finite time control depends on that. Then, we develop a parameter identification method of fixed-time depending on synchronous observer with adaptive law of parameters, which can guarantee these uncertain parameters to be identified effectively. Finally, some numerical results demonstrate the effectiveness and practicability of the scheme.
A Dynamic Model of Rescuer Parameters for Optimizing Blood Gas Delivery during Cardiopulmonary Resuscitation
Authors: Jalali Ali , Simpao Allan F. , Gálvez Jorge A. , Berg Robert A. , Nadkarni Vinay M. , Nataraj Chandrasekhar
Published: November 2018

Introduction. The quality of cardiopulmonary resuscitation (CPR) has been shown to impact patient outcomes. However, post-CPR morbidity and mortality remain high, and CPR optimization is an area of active research. One approach to optimizing CPR involves establishing reliable CPR performance measures and then modifying CPR parameters, such as compressions and ventilator breaths, to enhance these measures. We aimed to define a reliable CPR performance measure, optimize the CPR performance based on the defined measure and design a dynamically optimized scheme that varies CPR parameters to optimize CPR performance. Materials and Methods. We selected total blood gas delivery (systemic oxygen delivery and carbon dioxide delivery to the lungs) as an objective function for maximization. CPR parameters were divided into three categories: rescuer dependent, patient dependent, and constant parameters. Two optimization schemes were developed using simulated annealing method: a global optimization scheme and a sequential optimization scheme. Results and Discussion. Variations of CPR parameters over CPR sequences (cycles) were analyzed. Across all patient groups, the sequential optimization scheme resulted in significant enhancement in the effectiveness of the CPR procedure when compared to the global optimization scheme. Conclusions. Our study illustrates the potential benefit of considering dynamic changes in rescuer-dependent parameters during CPR in order to improve performance. The advantage of the sequential optimization technique stemmed from its dynamically adapting effect. Our CPR optimization findings suggest that as CPR progresses, the compression to ventilation ratio should decrease, and the sequential optimization technique can potentially improve CPR performance. Validation in vivo is needed before implementing these changes in actual practice.
Experimental Study on Medium Viscosity Oil Displacement Using Viscoelastic Polymer
Authors: Zhong Huiying , Zang Qiuyuan , Yin Hongjun , Xia Huifen
Published: November 2018

With the growing demand for oil energy and a decrease in the recoverable reserves of conventional oil, the development of viscous oil, bitumen, and shale oil is playing an important role in the oil industry. Bohai Bay in China is an offshore oilfield that was developed through polymer flooding process. This study investigated the pore-scale displacement of medium viscosity oil by hydrophobically associating water-soluble polymers and purely viscous glycerin solutions. The role and contribution of elasticity on medium oil recovery were revealed and determined. Comparing the residual oil distribution after polymer flooding with that after glycerin flooding at a dead end, the results showed that the residual oil interface exhibited an asymmetrical “U” shape owing to the elasticity behavior of the polymer. This phenomenon revealed the key of elasticity enhancing oil recovery. Comparing the results of polymer flooding with that of glycerin flooding at different water flooding sweep efficiency levels, it was shown that the ratio of elastic contribution on the oil displacement efficiency increased as the water flooding sweep efficiency decreased. Additionally, the experiments on polymers, glycerin solutions, and brines displacement medium viscosity oil based on a constant pressure gradient at the core scale were carried out. The results indicated that the elasticity of the polymer can further reduce the saturation of medium viscosity oil with the same number of capillaries. In this study, the elasticity effect on the medium viscosity oil interface and the elasticity contribution on the medium viscosity oil were specified and clarified. The results of this study are promising with regard to the design and optimum polymers applied in an oilfield and to an improvement in the recovery of medium viscosity oil.
Acute Agitation as an Initial Manifestation of Neuro-Behçet’s Disease
Authors: Otsuka Yuki , Yumoto Tetsuya , Ihoriya Hiromi , Matsumoto Namiko , Sato Kota , Abe Koji , Naito Hiromichi , Nakao Atsunori
Published: November 2018

Managing acutely agitated or violent patients in the emergency department (ED) represents a significant challenge. Acute agitation as an initial manifestation of neuro-Behcet’s disease (NBD) is an extremely rare clinical entity. A 44-year-old male, who had been complaining about a severe headache and fever for several days, was admitted to our ED due to acutely presented incontinence and agitation. On admission, physical restraint and sedation with sevoflurane and propofol were required for his combative and violent behavior. Cerebrospinal fluid examination revealed increased cell count. Fluid attenuated inversion recovery magnetic resonance imaging showed a high intensity signal in the left parietal lobe and bilateral occipital lobe. As infectious meningoencephalitis was suspected, empirical therapy was immediately started. He recovered uneventfully without neurological defect in seven days. Based on positive human leukocyte antigen B-51 and clinical manifestations, the diagnosis of NBD was made and remitted by steroid therapy. Although acute NBD commonly presents with focal neurological symptoms, psychiatric symptoms could be considered the first manifestation. A focused and thorough examination coupled with appropriate management strategies can assist emergency clinicians safely and effectively manage these patients.
Effect of Contact Conditions of Torsional Wave Elastographic Probe on Human Cervix
Authors: Rus G. , Riveiro M. , Molina F. S.
Published: November 2018

There is a challenge in characterizing the soft tissue mechanical functionality in cylindrical geometries by current elastography techniques applied to small organs. Torsional waves are a type of shear elastic waves that propagate through soft tissue radially and in depth in a curled geometry, ideally suited to explore structures such as the cervix. Here, a sensor based on a novel arrangement of concentric sandwiches of piezo- and electromechanical elements is prototyped and tested to quantitatively assess stiffness in human cervix. The purpose is to determine the robustness of a torsional wave elastography (TWE) sensor prototype to quantify cervical stiffness, as a first step to validate a reliable measurement protocol using TWE. An array of tests designed to validate a set of hypothesis about the contact conditions were performed on up to 3 different nonpregnant voluntary women. The mechanical properties were reconstructed from the recorded TWE signals, and the outcomes were statistically analyzed to validate the contact condition hypothesis. The results suggest that, although future tests need to be performed to fully assess the repeatability and quality of the measurements, some characteristics of the measurement protocol become clear; in particular: (1) the use of speculum is recommended since it not only stabilizes the measurements, but also corrects and stabilizes the orientation of the cervical neck, and allows to visually verify the positioning and alignment of the probe, while not significantly increasing discomfort to women during this test; (2) the use of lubricant gel has no significant effect on the measurement quality; (3) 1cm off-centering from external cervical os is not acceptable; (4) a range of applied force between 500-2000 N does not significantly vary measurement signal quality, but the reconstructed value of the shear modulus does vary, probably due to its constitutive nonlinearity; (5) breathing movements affects measurements, but short duration of TWE pulse (0.3 s) allows to take measurements in apnea.
Microbial Assessment of Tomatoes (Lycopersicon esculentum) Sold at Some Central Markets in Ghana
Authors: Obeng Forson Akua , Gyasi Pokuaa Belinda , Olu-Taiwo Michael , Ayeh-kumi F. Patrick
Published: November 2018

Background. Tomato (Lycopersicon esculentum) has a high water content which predisposes it to spoilage by pathogenic bacteria that can pose significant health threats to consumers. Aim. The study aimed to determine the various pathogenic bacteria associated with tomatoes sold in some central markets in the Accra Metropolis. Method. A total of 120 tomatoes were sampled, out of which 60 fresh, firm, undamaged tomatoes and 60 spoilt tomatoes were analysed. Cut portions of the fresh and spoilt tomatoes were swabbed with sterile swabs and cultured on Blood agar, Nutrient agar, and MacConkey agar. The antibiogram of bacterial isolates was determined by Kirby-Bauer disc-diffusion method. Results. Out of the 120 tomatoes analysed, a total of 66 bacterial isolates were recovered, 68.2% were associated with spoilt tomatoes, and 31.8% were from fresh tomatoes. Klebsiella sp. (34.8%), Enterobacter sp. (24.2%), and Citrobacter sp. (7.6%) were the predominant bacteria isolated. Agbogbloshie market (36.4%) had both fresh (18.2%) and spoilt (18.2%) tomatoes contaminated, whilst Makola market (31.8%) had a higher spoilt (30.3%) tomatoes contaminated. Although none of the isolates expressed resistance to ciprofloxacin, resistance was found for ampicillin (63.1%), tetracycline (60.1%), and cefuroxime (59.1%). Conclusion. Varying levels of antibiotic resistance bacteria amongst tomatoes sold at various markets were found. Contamination might have been caused by poor sanitation, improper handling or transportation from the farms to the markets. The presence of antibiotic resistance bacteria amongst tomatoes raises concern on public health risks associated with the consumption of fresh tomatoes.
Black Esophagus: A Rare Case of Acute Esophageal Necrosis Induced by Diabetic Ketoacidosis in a Young Adult Female
Authors: Field Zachary , Kropf Jacqueline , Lytle Meghan , Castaneira Giselle , Madruga Mario , Carlan S. J.
Published: November 2018

Background. Acute esophageal necrosis is an uncommon clinical disorder diagnosed on endoscopy as a black esophagus. It has a multifactorial etiology that probably represents a combination of poor nutritional status, gastric outlet obstruction, and ischemia secondary to hypoperfusion of the distal esophagus. It typically occurs in older males with comorbidities. Case. A 37-year-old woman presented with diabetic ketoacidosis and hematemesis. At esophagogastroduodenoscopy acute esophageal necrosis was diagnosed. The treatment included fluid and electrolyte management, insulin, and a proton pump inhibitor. She improved and left the hospital on day 3. Conclusion. Diabetic ketoacidosis can result in a profound osmotic diuresis, fluid loss, and hypoperfusion of the distal esophagus. This condition can then lead to ischemic injury and acute esophageal necrosis. Awareness of the possibility of its presence in young women with hematemesis and poorly controlled diabetes is important since early identification with esophagogastroduodenoscopy is necessary to prevent serious postnecrotic complications.
The Influence of Clinically Diagnosed Neuropathy on Respiratory Muscle Strength in Type 2 Diabetes Mellitus
Authors: Van Eetvelde Birgit L. M. , Cambier Dirk , Vanden Wyngaert Karsten , Celie Bert , Calders Patrick
Published: November 2018

Objectives. This cross-sectional study investigated the influence of clinically diagnosed neuropathy (cdNP) on respiratory muscle strength in patients with type 2 diabetes mellitus (T2DM).Methods. 110 T2DM patients and 35 nondiabetic healthy controls (≥60 years) were allocated to one of three groups depending on the presence of cdNP: T2DM without cdNP (D−;n=28), T2DM with cdNP (D+;n=82), and controls without cdNP (C;n=35). Clinical neurological diagnostic examination consisted of Vibration Perception Threshold and Diabetic Neuropathy Symptom score. Respiratory muscle strength was registered by maximal Inspiratory and Expiratory Pressures (PImaxand PEmax), and respiratory function by Peak Expiratory Flow (PEF). Isometric Handgrip Strength and Short Physical Performance Battery were used to evaluate peripheral skeletal muscle strength and physical performance. Univariate analysis of covariance was used with age, level of physical activity, and body mass index as covariates.Results. PImax, PEmax, and PEF were higher in C compared to D− and D+. Exploring more in detail, PImax, PEmax, and PEF were significantly lower in D+ compared to C. PEmaxand PEF were also significantly lower in D− versus C. Measures of peripheral muscle strength and physical performance showed less associations with cdNP and T2DM.Conclusions. The presence of cdNP affects respiratory muscle strength in T2DM patients compared to healthy controls. Both cdNP and diabetes in themselves showed a distinctive impact on respiratory muscle strength and function; however, an accumulating effect could not be ascertained in this study. As commonly used measures of peripheral muscle strength and physical performance seemed to be less affected at the given time, the integration of PImax, PEmax, and PEF measurements in the assessment of respiratory muscle weakness could be of added value in the (early) screening for neuropathy in patients with T2DM.
Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?
Authors: Gadi Sneha R. , Ruth Benjamin K. , Johnson Alan , Mazimba Sula , Kwon Younghoon
Published: November 2018

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.
The Relationship between Acculturation and Experimental Pain Sensitivity in Asian Americans with Knee Osteoarthritis
Authors: Ahn Hyochol , Sorkpor Setor K. , Kim Miyong , Miao Hongyu , Zhong Chengxue , Wang Jing , Lyon Debra , Fillingim Roger B.
Published: November 2018

Multiple studies in healthy populations and clinical samples have shown that ethnic minorities have greater pain sensitivity than their majority counterparts. Acculturation is speculated to be one of the sociocultural factors contributing to pain sensitivity since cultural beliefs and practices can influence the way patients perceive and respond to pain. However, the relationship of acculturation to pain sensitivity in minority populations remains poorly understood. Therefore, in this cross-sectional study, we examined the relationship between acculturation and experimental pain sensitivity in 50 Asian Americans residing in North Central Florida with knee osteoarthritis pain. The Suinn-Lew Asian Self Identity Acculturation Scale was used to assess acculturation, and multimodal quantitative sensory testing was performed to measure experimental sensitivity, including heat pain tolerance, pressure pain threshold, and punctate mechanical pain. Descriptive and regression analyses were performed. Participants’ mean age was 55.7 years, and about half of this sample were Korean American (56%). The participants had lived in the United States for 21 years on average. Regression analyses indicated that lower acculturation to American culture may contribute to greater experimental pain sensitivity. Asian Americans who were more acculturated to the American culture had higher heat pain tolerance (beta = 0.61, P=0.01), higher pressure pain threshold (beta = 0.59, P=0.02), and lower ratings of punctate mechanical pain (beta = −0.70, P<0.01). These findings add to the literature regarding sociocultural factors associated with pain in Asian Americans; additional research with a larger and more diverse sample of Asian Americans is warranted for cross-validation.
TLR Signaling Is Activated in Lymph Node–Resident CLL Cells and Is Only Partially Inhibited by Ibrutinib
Authors: Dadashian Eman L. , McAuley Erin M. , Liu Delong , Shaffer Arthur L. , Young Ryan M. , Iyer Jessica R. , Kruhlak Michael J. , Staudt Louis M. , Wiestner Adrian , Herman Sarah E. M.
Published: November 2018

Chronic lymphocytic leukemia (CLL) is a malignancy of mature B cells driven by B-cell receptor (BCR) signaling and activated primarily in the lymph node. The Bruton's tyrosine kinase (BTK) inhibitor ibrutinib effectively inhibits BCR-dependent proliferation and survival signals and has emerged as a breakthrough therapy for CLL. However, complete remissions are uncommon and are achieved only after years of continuous therapy. We hypothesized that other signaling pathways that sustain CLL cell survival are only partially inhibited by ibrutinib. In normal B cells, Toll-like receptor (TLR) signaling cooperates with BCR signaling to activate prosurvival NF-κB. Here, we show that an experimentally validated gene signature of TLR activation is overexpressed in lymph node–resident CLL cells compared with cells in the blood. Consistent with TLR activation, we detected phosphorylation of NF-κB, STAT1, and STAT3 in lymph node–resident CLL cells and in cells stimulated with CpG oligonucleotides in vitro. CpG promoted IRAK1 degradation, secretion of IL10, and extended survival of CLL cells in culture. CpG-induced TLR signaling was significantly inhibited by both an IRAK1/4 inhibitor and ibrutinib. Although inhibition of TLR signaling was incomplete with either drug, the combination achieved superior results, including more effective inhibition of TLR-mediated survival signaling. Our data suggest an important role for TLR signaling in CLL pathogenesis and in sustaining the viability of CLL cells during ibrutinib therapy. The combination of ibrutinib with a TLR pathway inhibitor could provide superior antitumor activity and should be investigated in clinical studies.

Significance:

CLL relies on the concomitant cooperation of B-cell receptor and Toll-like receptor signaling; inhibition of both pathways is superior to inhibition of either pathway alone.
Expression of PD-1 by T Cells in Malignant Glioma Patients Reflects Exhaustion and Activation
Authors: Davidson Tom B. , Lee Alexander , Hsu Melody , Sedighim Shaina , Orpilla Joey , Treger Janet , Mastall Max , Roesch Saskia , Rapp Carmen , Galvez Mildred , Mochizuki Aaron , Antonios Joseph , Garcia Alejandro , Kotecha Nikesh , Bayless Nicholas , Nathanson David , Wang Anthony , Everson Richard , Yong William H. , Cloughesy Timothy F. , Liau Linda M. , Herold-Mende Christel , Prins Robert M.
Published: November 2018

Purpose:

Glioblastoma (GBM) is the most common primary malignant tumor in the central nervous system. Our recent preclinical work has suggested that PD-1/PD-L1 plays an important immunoregulatory role to limit effective antitumor T-cell responses induced by active immunotherapy. However, little is known about the functional role that PD-1 plays on human T lymphocytes in patients with malignant glioma.

Experimental Design: In this study, we examined the immune landscape and function of PD-1 expression by T cells from tumor and peripheral blood in patients with malignant glioma.

Results:

We found several differences between PD-1+ tumor-infiltrating lymphocytes (TIL) and patient-matched PD-1+ peripheral blood T lymphocytes. Phenotypically, PD-1+ TILs exhibited higher expression of markers of activation and exhaustion than peripheral blood PD-1+ T cells, which instead had increased markers of memory. A comparison of the T-cell receptor variable chain populations revealed decreased diversity in T cells that expressed PD-1, regardless of the location obtained. Functionally, peripheral blood PD-1+ T cells had a significantly increased proliferative capacity upon activation compared with PD-1− T cells.

Conclusions:

Our evidence suggests that PD-1 expression in patients with glioma reflects chronically activated effector T cells that display hallmarks of memory and exhaustion depending on its anatomic location. The decreased diversity in PD-1+ T cells suggests that the PD-1–expressing population has a narrower range of cognate antigen targets compared with the PD-1 nonexpression population. This information can be used to inform how we interpret immune responses to PD-1–blocking therapies or other immunotherapies.
Safety and Efficacy of Tolvaptan for the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Heart Failure and Chronic Kidney Disease
Authors: Yamashita Kennosuke , Igawa Wataru , Ono Morio , Kido Takehiko , Okabe Toshitaka , Yamamoto Myong Hwa , Amemiya Kisaki , Isomura Naoei , Araki Hiroshi , Ochiai Masahiko
Published: November 2018

Background: Tolvaptan is a promising drug for the prevention of contrast-induced acute kidney injury (CI-AKI) because it induces aquaresis without adversely affecting renal hemodynamics. CI-AKI is a major cause of acute renal failure associated with increased morbidity and mortality. Objective: To investigate the effectiveness of different doses of tolvaptan for the prevention of CI-AKI. Method: Ninety-one consecutive patients with congestive heart failure (CHF) and chronic kidney disease (CKD) were prospectively enrolled as the tolvaptan group in this study (T-group; 7.5-mg: n = 42, 15-mg: n = 49). In addition, 91 consecutive patients with CHF and CKD were collected retrospectively as a control group (C-group, n = 91). All patients received continuous intravenous infusion of isotonic saline, and tolvaptan was administered to the T-group. Results: One patient developed CI-AKI in the T-group versus 3 in the C-group (1.1 vs. 3.3%, p = 0.61). On the other hand, the change of serum creatinine in the T-group was lower than that in the C-group. Additionally, in the 7.5-mg group, serum creatinine was unchanged up to 72 h after contrast administration, showing a significant difference from the 15-mg group (–0.00 ± 0.09 vs. 0.05 ± 0.12 mg/dL, p = 0.009). Similarly, the change of eGFR was significantly smaller in the 7.5-mg group than that in the 15-mg group (0.7 ± 5.4 vs. –2.8 ± 5.1 mL/min/1.73 m2, p = 0.002). No patient required hemodialysis and there was no prolongation of hospitalization due to exacerbation of heart failure. Conclusions: Compared to hydration alone, tolvaptan combined with hydration could be a safer method for preventing CI-AKI while avoiding exacerbation of heart failure, and a dosage of 7.5-mg might be safer than 15-mg.
Co-Occurrence of Myeloid Sarcoma of the Lymph Node and Acute Monocytic Myeloid Leukemia: A Case Report and Literature Review
Authors: Khaja Misbahuddin , Omesh Toolsie , Niazi Masooma , Shaikh Danial , Mudunuru Sitarama Arvind , Reyes Olga Alexandra , Malik Sandeep
Published: November 2018

Background: Acute myeloid leukemia (AML) is the most common leukemia in adults. According to the French-American-British (FAB) system, monocytic leukemia is classified as M5. Myeloid sarcoma further occurs in 3–5% of AML. This is defined as an extramedullary tumor of myeloid cells in the lymph nodes, soft tissues, periosteum, bone, central nervous system (CNS), spinal cord, intestine, mediastinum, prostate, uterus, or ovaries. Case Presentation: Here, we describe the case of a 29-year-old female who presented with fever, swelling of gums, neck pain, and weakness, which had persisted for 1 week. The patient had a white blood cell (WBC) count of 53.5 K/μL, and a peripheral smear revealed a myeloid blast cell (blast) percentage of 8%. Computed tomography (CT) of the neck indicated lymphadenopathy. Fine needle aspiration of the cervical lymph node showed groups of atypical immature myeloid cells, mixed with occasional megakaryocytes, and infiltration of eosinophilic myeloid cells into the lymph node, consistent with myeloid sarcoma. Flow cytometry analysis revealed intermediate to large circulating blasts, with irregular nuclei, fine chromatin, and distinct nucleoli, indicative of AML, with monocytic differentiation. The patient responded well to chemotherapy with fludarabine, cytarabine, granulocyte colony stimulating factor (G-CSF), and idarubicin; WBC counts returned to normal and patient was discharged to home. Conclusion: Myeloid sarcoma of the lymph node is a rare co-occurrence with AML. Results of our study are consistent with the conclusion that early diagnosis and appropriate treatment improve survival.
Habitat segregation patterns of reptiles in Northern Dinaric Mountains (Slovenia)
Authors: Žagar Anamarija , Žagar Anamarija , Kos Ivan , Žagar Anamarija , Kos Ivan , Vrezec Al
Published: November 2018

We have surveyed sympatric reptiles in a diverse and preserved montane environment in the Northern Dinaric region (Southern Slovenia) to determine the assemblage structure and assess the patterns of habitat segregation. Altitude and habitat type contributed the most to segregations between the most abundant species. The most similar were species pairs of L. viridis/bilineata and P. muralis, and I. horvathi and V. ammodytes. In snakes, significant segregation patterns have been observed between all species. Among lizards, we have found strong altitudinal segregation between two morphologically and ecologically most similar species; P. muralis was most abundant at low and I. horvathi at higher elevations. This result indicated a potential competitive interaction between these species.
Niche segregation of sand lizard (Lacerta agilis) and green lizard (Lacerta viridis) in an urban semi-natural habitat
Authors: Heltai Botond , Sály Péter , Kovács Dániel , Kiss István
Published: November 2018

Different types of semi natural habitats has important role in long-term survival and maintenance of reptile species in urban environments. Heterogeneous urban green islands can provide conditions that enable competing species to live together in relatively small areas. However, the key mechanism of coexistence could vary from types of habitats and taxa. We investigated the population structure, the fine scale habitat segregation and diel activity pattern of two lizard species (Lacerta viridis and L. agilis) coexisting populations in a town cemetery. We hypothesized, that fine scale habitat segregation is a more important factor in coexistence than differences in diel activity pattern, because of the environmental dependent thermoregulation constrain. During the study, 178 L. agilis and 79 L. viridis occurrences were recorded. The daily activity patterns of both species were very similar, with peaks found in the forenoon and afternoon. Lizards were found to be the most active at 31-32°C. The probability of occurrence of the species was influenced more by the differences in the random selection of parcels rather than the random differences in the survey days. Around the proximate observation point the bush covered areas was significantly higher than average in the parcels. Our results showed that niche segregation based on fine scale habitat patches had a fundamental role in the coexistence of the two lizard species. L. agilis preferred the more open spaces, whereas L. viridis preferred areas with more bushes, but there was no difference in the daily activity pattern of the two species.
Iridescent (angle-dependent reflectance) properties of dorsal coloration in Podarcis muralis (Laurenti, 1768)
Authors: Pérez i de Lanuza Guillem , Font Enrique
Published: November 2018

Iridescence is a visual property of those surfaces that change in colour with viewing angle. Iridescence has been rarely reported in reptiles, but some snakes and lizards show this type of coloration. Here we study the effect of different angles of light incidence and observation on the spectrophotometrically assessed reflectance of dorsal coloration in the lizard Podarcis muralis. The results demonstrate clear angle dependence of several colour parameters. In particular, different angles of light incidence and observation result in changes in hue of more than 30 nm. This suggests that lizard dorsal coloration may be perceived, depending on viewing geometry, as being of different colours by a wide range of potential observers. Functional implications of iridescence in dorsal coloration are discussed.