bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure analysis of an aluminum extrusion aircraft wing component
Authors: Stamoulis Konstantinos , Panagiotopoulos Dimitrios , Pantazopoulos George , Papaefthymiou Spyros
Published: October 2016

Purpose

The purpose of this paper is to deal with the failure analysis of a fractured spar stiffener, extruded from 7075-T6 aluminum alloy, which was found in the central wing, trailing edge structure of a military transport aircraft. The previous loading history and the dominant environmental factors (corrosive and humid atmosphere, water entrapment, etc.) suggest corrosion and fatigue as the principal failure modes, synergistically acting on the wing component.

Design/methodology/approach

This study presents the failure analysis concentrated on finding evidence of failure mechanisms and plausible root-cause(s) of the fractured spar stiffener. Chemical analysis, stereo and scanning electron microscopy, as well as finite element analysis employed as the main analytical tools for material characterization and failure investigation.

Findings

The overall evaluation of the findings suggest that the failure caused by a synergy of two mechanisms; a crack initiated in the longitudinal, extrusion direction by an environmentally assisted corrosion attack, then propagated by the superimposed transverse stress field, branched/deflected due to a low crack driving force and extended in a transverse path through a high cycle fatigue process. Finally, the complete fracture occurred as fast fracture, resulted by a ductile overload.

Originality/value

This paper deals with an industrial damage case study, providing analysis and modeling from structural engineering standpoint. The aforementioned findings concerning the fractured aircraft component allow gaining a deeper knowledge about the mechanisms of crack initiation and propagation which, in turn, can produce a valuable feedback to design, inspection and maintenance procedures. This includes a modified heat treatment from T6 to T73 temper for the redesigned component.
Rape as a Weapon of War(riors): The Militarisation of Sexual Violence in the United States, 1990–2000
Authors: Cerretti Josh
Published: October 2016

This article uses a transnational feminist lens to examine how accusations of sexual violence were mobilised by the United States (US) government to justify military intervention at the same time that the US military failed to address sexual violence perpetrated by and against its own service members. Drawing upon an archive of civilian representations ranging from the New York Times to G.I. Jane, the author explores US interventions in the Persian Gulf, Haiti and the former Yugoslavia alongside sexual assaults committed by servicemen at the Tailhook Convention, on Okinawa and at the Aberdeen Proving Grounds. This article draws connections between feminism and neo‐imperialism, between Cold War and War on Terror ideologies, and between rape as a weapon of war and rape during times of ‘peace’ in order to better understand the relationships between sexual politics and geopolitics at the end of the twentieth century.
Taxonomy of Sterictiphora Billberg (Hymenoptera: Argidae: Sterictiphorinae) in South Korea with descriptions of two new species
Authors: Wei Meicai , Lee Su‐Bin , Choi Jin‐Kyung , Lee Jong‐Wook
Published: October 2016

Sterictiphora Billberg (Hymenoptera: Argidae: Sterictiphorinae) in South Korea is reviewed. Sterictiphora koreana Lee J‐W & Wei sp. nov. and S. rugosa Lee J‐W & Wei sp. nov. are described and illustrated. The redescriptions of S. notensis Togashi, and S. tanoi Togashi, are provided. The female of S. tanoi is first reported. A key to the species and descriptions of Sterictiphora from South Korea are provided.
Associations of lifestyle factors (smoking, alcohol consumption, diet and physical activity) with type 2 diabetes among American adults from National Health and Nutrition Examination Survey (NHANES) 2005–2014
Authors: Liu Ying , Wang Kesheng , Maisonet Mildred , Wang Liang , Zheng Shimin
Published: October 2016

Background

Over the long term, unhealthy lifestyles can lead to many health problems, especially type 2 diabetes (T2D). The aim of the present study was to determine associations between lifestyle factors (smoking, alcohol consumption, physical activity, and diet) and T2D in American adults (aged ≥20 years) in a nationally representative sample.

Methods

Data for 12 987 American adults participating in the National Health and Nutrition Examination Survey 2005–2014 were evaluated. Weighted multiple logistic regression models were used to examine associations between the four lifestyle factors and T2D after adjusting for demographics and socioeconomic status (SES). Prevalence trends for T2D were examined using Cochran–Armitage tests.

Results

There was a significant increasing prevalence trend for T2D among American adults. Smokers and individuals consuming >12 alcoholic drinks in the past year were less likely to report having T2D than non‐smokers (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.35–0.48) and those consuming <12 alcoholic drinks (OR 0.46; 95% CI 0.39–0.55). Participants with light physical activity have a greater likelihood of having T2D than those engaging in vigorous physical activity (OR 5.72; 95% CI 4.30–7.60). Individuals consuming a poor diet were more likely to report having T2D than those eating an excellent diet (OR 1.18; 95% CI 1.02–1.41). All these relationships remained significant after adjustment for demographics and SES.

Conclusion

All four lifestyle factors were significantly associated with T2D among American adults. The findings of the present study provide useful information for healthcare providers that may help them promote specific lifestyle modifications.
Artefact on CT brain images caused by the presence of air bubbles in the cooling oil of the X‐ray tube
Authors: Trieu Nelson , Xia Ryan , Loneragan Robert , Ridley Lloyd , Trieu Joseph
Published: October 2016

Introduction

We report a series of patients who had computed tomography (CT) of their brains which showed an uncommon artefact caused by excess air bubbles in the cooling oil around the X‐ray tube.

Methods

In November and December 2015, it was recognised that artefacts appearing on CT brain images acquired at our department were caused by a scanner fault. The test images were reviewed and the service engineer for the CT scanner was questioned about the artefact cause. A retrospective audit was then performed of images acquired on the CT scanner from December 2015 back to the date that the CT scanner was last serviced in September 2015 to identify any other scans affected by the artefact.

Results

Seven patients were identified whose CT brain scans showed the artefact. The artefact manifested in the form of an ill‐defined low density area in varying locations. The artefact also appeared on CT phantom test images. It was discovered to be caused by the presence of excess air bubbles within the cooling oil of the X‐ray tube. The fault was then rectified.

Conclusions

The artefact described may not be easily recognised and could lead to misinterpretation and unnecessary investigation. We aim to promote awareness of this artefact and to reinforce the importance of frequent quality control testing of CT systems.
Occupational burnout among radiographers, sonographers and radiologists in Australia and New Zealand: Findings from a national survey
Authors: Singh Nabita , Knight Kellie , Wright Caroline , Baird Marilyn , Akroyd Duane , Adams Robert D , Schneider Michal E
Published: October 2016

Introduction

Evidence demonstrates that health care professionals are more prone to burnout than other professionals due to the emotionally taxing interactions they have with their patients on a daily basis. The aims of this study were to measure occupational burnout levels among sonographers, radiographers and radiologists and to examine predictors of burnout according to demographic characteristics.

Methods

A cross‐sectional online survey was administered in 2010 to radiographers, sonographers and radiologists who were members of the following professional bodies: Australian Institute of Radiography, Australian Sonographers Association and The Royal Australian and New Zealand College of Radiologists. The Maslach Burnout Inventory was used to measure burnout levels for each profession. Data were analysed using SPSS Ver 20 (IBM, Chicago, IL, USA) statistical software.

Results

A total of 613 radiographers, 121 sonographers and 35 radiologists participated in the survey. Radiographers, sonographers and radiologists had a high mean (±SD) burnout score for emotional exhaustion (39.9 ± 8.5, 42.2 ± 8.5 and 44.9 ± 7.1 respectively) and depersonalization (18.9 ± 5.5, 20.3 ± 5.8 and 20.6 ± 5.6) compared to MBI norms. Radiographers also had low personal achievement (30.8 ± 5.5) compared to MBI norms. Radiographers and sonographers who were male, worked >10 hours overtime and spent <10% of their time training students per week had significantly higher depersonalization scores (p < 0.05).

Conclusion

Burnout levels among radiographers, sonographers and radiologists are high and likely to vary according to some demographic and work‐related factors. Further research is needed to examine ways to alleviate burnout in these professions so that loss of experienced staff due to burnout can be minimized and quality of patient care can be maintained.
swinger: a user‐friendly computer program to establish captive breeding groups that minimize relatedness without pedigree information
Authors: Sandoval‐Castillo Jonathan , Attard Catherine R. M. , Marri Shashikanth , Brauer Chris J. , Möller Luciana M. , Beheregaray Luciano B.
Published: October 2016

Captive breeding programmes are often a necessity for the continued persistence of a population or species. They typically have the goal of maintaining genetic diversity and minimizing inbreeding. However, most captive breeding programmes have been based on the assumption that the founding breeders are unrelated and outbred, even though in situ anthropogenic impacts often mean these founders may have high relatedness and substantial inbreeding. In addition, polygamous group‐breeding species in captivity often have uncertain pedigrees, making it difficult to select the group composition for subsequent breeding. Molecular‐based estimates of relatedness and inbreeding may instead be used to select breeding groups (≥two individuals) that minimize relatedness and filter out inbred individuals. swinger constructs breeding groups based on molecular estimates of relatedness and inbreeding. The number of possible combinations of breeding groups quickly becomes intractable by hand. swinger was designed to overcome this major issue in ex situ conservation biology. The user can specify parameters within swinger to reach breeding solutions that suit the mating system of the target species and available resources. We provide evidence of the efficiency of the software with an empirical example and using simulations. The only data required are a typical molecular marker data set, such as a microsatellite or SNP data set, from which estimates of inbreeding and pairwise relatedness may be obtained. Such molecular data sets are becoming easier to gather from non‐model organisms with next‐generation sequencing technology. swinger is an open‐source software with a user‐friendly interface and is available at http://www.molecularecology.flinders.edu.au/molecular-ecology-lab/software/swinger/swinger/ and https://github.com/Yuma248/Swinger.
Improving equity premium forecasts by incorporating structural break uncertainty
Authors: Tian Jing , Zhou Qing
Published: October 2016

This article compares five alternative methods for directly dealing with structural break uncertainty in forecasting the U.S. equity premium using 30 widely used bivariate and multivariate predictive regressions. We find that two recently developed methods – Robust Optimal Weights on Observations and Forecast Combination across Estimation Windows – outperform the conventional rolling window and postbreak estimation methods. This result indicates that very early historical information is beneficial for U.S. equity premium forecasting but should be discounted to incorporate structural break uncertainty.
Fashion or future: does creating shared value pay?
Authors: Jones Stewart , Wright Christopher
Published: October 2016

Porter and Kramer's () concept of ‘creating shared value’ (CSV) has attracted considerable attention from business and academics. According to Porter and Kramer, CSV is about creating economic value in a way that also generates value for society by addressing its basic needs and challenges. One of the key assumptions of the CSV concept is that companies will benefit economically through engaging in CSV activity. We test this empirically by developing a proxy measure of CSV based on 26 sustainability performance indicators drawn from a customised database. Based on a sample of ASX 300 companies taken over a 5‐year period (2008–2012), we find a strong statistical association between the CSV proxies and a range of financial performance indicators. These companies also tend to be larger and have higher growth opportunities. However, statistical tests of causality indicate that superior financial performance leads to greater CSV activity, rather than CSV activity driving financial outcomes. This finding suggests that successful companies may well be adopting CSV‐type practices more as an outcome of management fashion than because of their tangible contribution to the financial performance of the firm.
International codes and agreements to restrict the promotion of harmful products can hold lessons for the control of alcohol marketing
Authors: Landon Jane , Lobstein Tim , Godfrey Fiona , Johns Paula , Brookes Chris , Jernigan David
Published: October 2016

Background and aims The 2011 UN Summit on Non‐Communicable Disease failed to call for global action on alcohol marketing despite calls in the World Health Organization (WHO) Global Action Plan on Non‐Communicable Diseases 2013–20 to restrict or ban alcohol advertising. In this paper we ask what it might take to match the global approach to tobacco enshrined in the Framework Convention on Tobacco Control (FCTC), and suggest that public health advocates can learn from the development of the FCTC and the Code of Marketing on infant formula milks and the recent recommendations on restricting food marketing to children. Methods Narrative review of qualitative accounts of the processes that created and monitor existing codes and treaties to restrict the marketing of consumer products, specifically breast milk substitutes, unhealthy foods and tobacco. Findings The development of treaties and codes for market restrictions include: (i) evidence of a public health crisis; (ii) the cost of inaction; (iii) civil society advocacy; (iv) the building of capacity; (v) the management of conflicting interests in policy development; and (vi) the need to consider monitoring and accountability to ensure compliance. Conclusion International public health treaties and codes provide an umbrella under which national governments can strengthen their own legislation, assisted by technical support from international agencies and non‐governmental organizations. Three examples of international agreements, those for breast milk substitutes, unhealthy foods and tobacco, can provide lessons for the public health community to make progress on alcohol controls. Lessons include stronger alliances of advocates and health professionals and better tools and capacity to monitor and report current marketing practices and trends.
Up‐regulation of miR‐203 expression induces endothelial inflammatory response: Potential role in preeclampsia
Authors: Wang Yuping , Dong Qin , Gu Yang , Groome Lynn J.
Published: October 2016

Problem

To determine whether miR‐203 mediates endothelial inflammatory response in preeclampsia.

Method of study

Maternal vessel miR‐203 expression was assessed by in situ hybridization. Suppressor of cytokine signaling‐3 (SOCS‐3) and ICAM expression was determined by immunostaining. Subcutaneous fat tissue sections from normal and preeclamptic pregnant women were used. miR‐203‐induced inflammatory response was evaluated by the measurements of IL‐6, IL‐8, ICAM, and VCAM expression and production and neutrophil adhesion in the endothelial cells (EC) transfected with miR‐203 precursor, pre‐miR‐203. SOCS3 expression was also determined.

Results

Up‐regulation of miR‐203 and ICAM expression and down‐regulation of SOCS‐3 expression were demonstrated in maternal vessel endothelium in preeclampsia. Overexpression of miR‐203 resulted in down‐regulation of SOCS‐3 expression and increases in the production of IL‐6, IL‐8, ICAM, and VCAM and neutrophil adhesion in ECs.

Conclusion

As miR‐203 is an inflammatory microRNA, increased miR‐203 production/expression in ECs could diminish an anti‐inflammatory activity and increase the endothelial inflammatory response in preeclampsia.
Forsythia suspensa extract attenuates lipopolysaccharide‐induced inflammatory liver injury in rats via promoting antioxidant defense mechanisms
Authors: Zhao Panfeng , Piao Xiangshu , Pan Long , Zeng Zhikai , Li Qingyun , Xu Xiao , Wang Hongliang
Published: October 2016

Reactive oxygen species (ROS) have been shown to have a role in inflammation. We investigated whether Forsythia suspensa extract (FSE) could exert its antioxidant potential against lipopolysaccharide (LPS)‐induced inflammatory liver injury in rats. Rats were orally fed FSE once daily for 7 consecutive days prior to LPS (Escherichia coli, serotype O55:B5) injection. LPS treatment caused liver dysfunction as evidenced by massive histopathological changes and increased serum alanine aminotransferase and aspartate aminotransferase activities which were ameliorated by FSE pretreatment. FSE attenuated LPS‐induced depletion of cytosolic nuclear factor‐erythroid 2‐related factor 2 (Nrf2) and suppression of Nrf2 nuclear translocation in liver, and the generation of ROS and malondialdehyde in serum and liver. FSE increased the Nrf2‐mediated induction of heme oxygenase‐1 in liver, as well as superoxide dismutase and glutathione peroxidase activities in serum and liver. Importantly, FSE attenuated LPS‐induced nuclear factor‐кB (NF‐кB) nuclear translocation in liver, and subsequently decreased tumor necrosis factor‐α, interleukin (IL)‐1β and IL‐6 levels in serum and liver, which were associated with FSE‐induced activation of Nrf2 in liver. These results indicate that the protective mechanisms of FSE may be involved in the attenuation of oxidative stress and the inhibition of the NF‐кB‐mediated inflammatory response by modulating the Nrf2‐mediated antioxidant response against LPS‐induced inflammatory liver injury.
Quality‐of‐life outcomes from the Prostate Adenocarcinoma: TransCutaneous Hormones (PATCH) trial evaluating luteinising hormone‐releasing hormone agonists versus transdermal oestradiol for androgen suppression in advanced prostate cancer
Authors: Gilbert Duncan C. , Duong Trinh , Kynaston Howard G. , Alhasso Abdulla A. , Cafferty Fay H. , Rosen Stuart D. , Kanaga‐Sundaram Subramanian , Dixit Sanjay , Laniado Marc , Madaan Sanjeev , Collins Gerald , Pope Alvan , Welland Andrew , Nankivell Matthew , Wassersug Richard , Parmar Mahesh K. B. , Langley Ruth E. , Abel Paul D.
Published: October 2016

Objectives

To compare quality‐of‐life (QoL) outcomes at 6 months between men with advanced prostate cancer receiving either transdermal oestradiol (tE2) or luteinising hormone‐releasing hormone agonists (LHRHa) for androgen‐deprivation therapy (ADT).

Patients and methods

Men with locally advanced or metastatic prostate cancer participating in an ongoing randomised, multicentre UK trial comparing tE2 versus LHRHa for ADT were enrolled into a QoL sub‐study. tE2 was delivered via three or four transcutaneous patches containing oestradiol 100 μg/24 h. LHRHa was administered as per local practice. Patients completed questionnaires based on the European Organisation for Research and Treatment of Cancer quality of life questionnaire 30‐item core (EORTC QLQ‐C30) with prostate‐specific module QLQ PR25. The primary outcome measure was global QoL score at 6 months, compared between randomised arms.

Results

In all, 727 men were enrolled between August 2007 and October 2015 (412 tE2, 315 LHRHa) with QoL questionnaires completed at both baseline and 6 months. Baseline clinical characteristics were similar between arms: median (interquartile range) age of 74 (68–79) years and PSA level of 44 (19–119) ng/mL, and 40% (294/727) had metastatic disease. At 6 months, patients on tE2 reported higher global QoL than those on LHRHa (mean difference +4.2, 95% confidence interval 1.2–7.1; P = 0.006), less fatigue, and improved physical function. Men in the tE2 arm were less likely to experience hot flushes (8% vs 46%), and report a lack of sexual interest (59% vs 74%) and sexual activity, but had higher rates of significant gynaecomastia (37% vs 5%). The higher incidence of hot flushes among LHRHa patients appear to account for both the reduced global QoL and increased fatigue in the LHRHa arm compared to the tE2 arm.

Conclusion

Patients receiving tE2 for ADT had better 6‐month self‐reported QoL outcomes compared to those on LHRHa, but increased likelihood of gynaecomastia. The ongoing trial will evaluate clinical efficacy and longer term QoL. These findings are also potentially relevant for short‐term neoadjuvant ADT.
Analogue modelling of inverted domino‐style basement fault systems
Authors: Jagger Lydia J. , McClay Ken R.
Published: October 2016

Inversion of pre‐existing extensional fault systems is common in rift systems, back‐arc basins and passive margins. It can significantly influence the development of structural traps in hydrocarbon basins. The analogue models of domino‐style basement fault systems shown in this paper produced, on extension, characteristic hangingwall growth stratal wedges that, when contracted and inverted, formed classic inversion harpoon geometries and asymmetric hangingwall contractional fault‐propagation folds. Segmented footwall shortcut faults formed as the basement faults were progressively back‐rotated and steepened. The pre‐existing extensional fault architectures, basement fault geometries and the relative hangingwall and footwall block rotations exerted fundamental controls on the inversion styles. Digital image correlation (DIC) strain monitoring illustrated complex vertical fault segmentation and linkage during inversion as the major faults were reactivated and strain was progressively transferred onto footwall shortcut faults. Hangingwall deformation during inversion was dominated by significant back‐rotation as the inversion progressed. The mechanical stratigraphy of the cover sequences strongly influenced the fold and fault evolution of the reactivated fault systems. The implications of the experimental results for the interpretation and analysis of inversion structures are discussed and are compared with natural examples of inverted basement‐involved extensional faults observed in seismic datasets.
Steering Dynamics in Complex Education Systems. An Agenda for Empirical Research
Authors: Theisens Henno , Hooge Edith , Waslander Sietske
Published: October 2016

Many policy systems and education systems have grown more complex in the last three decades. Power has moved away from central governments in different directions: upwards towards international organisations, sideways towards private institutions and non‐governmental organisations and downwards towards local governments and public enterprises such as schools. Where once we had central government, we now have governance, which can be defined as the processes of establishing priorities, formulating and implementing policies, and being accountable in complex networks with many different actors. Steering in such complex education systems emerges from the activities, tasks and responsibilities of state and non‐state actors, operating at different levels and from different positions and often has un‐deliberate, un‐intentional and un‐foreseen consequences. There are many conceptual models that encapsulate this complexity, but this article suggests that there is a real need for empirical research. Without empirical research it remains unknown whether and how steering in complex networks works out in practice, what are its effects and for whom. Moreover, it is only through empirical research that we can find out whether central government has become less dominant, or rather whether its appearance has changed and it has become less visible, but not necessarily less influential. Foucault's governmentality perspective is a useful notion on which to build such a framework for empirical research which allows for a careful study of the interactions that signify steering. Inspired by Foucault, this article develops a trilogy of assumed conditions for steering to take effect in modern societies. Following this reasoning, ‘something' first needs to be made thinkable, calculable and practicable by different actors for steering to occur. This trilogy is a promising starting point for empirical research into very specific phenomena which can help us to understand how steering in complex education systems works.
Clinical evaluation of a hemochromatosis next‐generation sequencing gene panel
Authors: Lanktree Matthew B. , Sadikovic Bekim , Waye John S. , Levstik Alexander , Lanktree Bruce B. , Yudin Jovana , Crowther Mark A. , Pare Guillaume , Adams Paul C.
Published: October 2016

Background

Next‐generation sequencing of an iron metabolism gene panel could identify pathogenic mutations, improving on standard hemochromatosis genetic testing and providing a molecular diagnosis in patients with suspected iron overload.

Methods

A next‐generation sequencing panel of 15 genes with known roles in iron metabolism was constructed. A total of 190 patients were sequenced: 94 from a tertiary hemochromatosis clinic and 96 submitted for HFE testing with biochemical evidence of iron overload [elevated ferritin (>450 μg/L) or transferrin saturation (>55%)] obtained from a chart review.

Results

From the hemochromatosis clinic cohort, six patients were diagnosed with non‐HFE hemochromatosis due to homozygous hemojuvelin (HFE2) mutations. Ten additional heterozygous pathogenic mutations were observed. From the chart review cohort, a C‐terminus ferritin light chain (FTL) frameshift mutation was observed consistent with neuroferritinopathy. Heterozygous deletion of HFE2 and four additional rare pathogenic or likely pathogenic heterozygous mutations were identified in seven patients.

Conclusions

An iron metabolism gene panel provided a molecular diagnosis in six patients with non‐HFE iron overload and is suitable for diagnostic purposes in exceptional cases in specialized clinics. Further research will be required to assess the modifier effect of rare heterozygous mutations in iron metabolism genes.
Long‐term results of splenectomy in adult chronic immune thrombocytopenia
Authors: Guan Yue , Wang Shixuan , Xue Feng , Liu Xiaofan , Zhang Lei , Li Huiyuan , Yang Renchi
Published: October 2016

Objectives

We performed this study in adult patients with chronic primary immune thrombocytopenia to explore the long‐term efficacy and safety of splenectomy.

Methods

Data of 174 patients who underwent splenectomy in our hospital from 1994 to 2014 were analyzed.

Results

After splenectomy, 126 (72.4%) patients achieved a complete response (CR) and 28 (16.1%) achieved a response (R). Thirty‐two (20.8%) responders relapsed with a median time of 24 months. Compared with non‐responders and recurrent patients, the stable responders were younger and had higher preoperation and postoperation peak platelet count, later peak platelet count emergence time, and more megakaryocytes. Corticosteroid‐dependent patients were more likely to response to splenectomy than those refractory to corticosteroid. We performed a relapse‐free survival analysis among the 154 responders. In univariate analyses, corticosteroid dependent and time from diagnosis to splenectomy ≤24 months showed predictive value to persistent response. But only corticosteroid dependent was a significant predictor in multivariate analysis. The 30‐d complication rate after the surgery was 25.9%. There were five (2.9%) patients experienced thrombosis and three (1.7%) refractory patients died during follow‐up.

Conclusions

Splenectomy was a safe treatment with a cure rate of 58.0%. Corticosteroid dependent showed predictive value to persistent response.
Transient ischaemic attack and subsequent cognitive impairment
Authors: Kawada T.
Published: October 2016

Click here to view the accompanying paper in this issue.
Structural explanation of poor prognosis of amyotrophic lateral sclerosis in the non‐demented state
Authors: Kim H.‐J. , Oh S.‐I. , de Leon M. , Wang X. , Oh K.‐W. , Park J.‐S. , Deshpande A. , Buj M. , Kim S. H.
Published: October 2016

Background and purpose

Amyotrophic lateral sclerosis (ALS), a motor neuron disease, is associated with various cortical symptoms including mild cognitive decline with behavior changes, suggesting the involvement of extra‐motor areas in ALS. Our aim was to investigate the specific patterns of brain atrophy in sporadic, impaired ALS patients without commonly known genetic mutations using voxel‐based morphometry.

Materials and methods

Forty‐seven patients with sporadic ALS and 28 age‐matched healthy controls were recruited. ALS participants were divided into three groups according to comprehensive neuropsychological testing: pure (ALS‐pure), cognitive impairment (ALSci) and behavioral impairment (ALSbi). Quantitative comparison of brain atrophy patterns was performed amongst these three groups using voxel‐based analysis. All analyses were adjusted for total intracranial volume, age, sex, disease duration and functional disability score.

Results

The ALSci group exhibited decreased volume in the left cerebellum, fusiform gyrus, optic radiations and corticospinal tracts compared to healthy controls. ALSci patient imaging showed decreased brain volume in the bilateral cerebellum, right putamen gray matter and bilateral superior longitudinal fasciculi white matter compared to pure ALS patients (P < 0.001 uncorrected, corrected for the entire volume). Compared to healthy controls, ALS‐pure and ALSbi groups did not show any significant volume changes in gray and white matter.

Conclusions

These findings also support the hypothesis that ALS pathogenesis has a dual focality of onset (cortex and anterior horn) with contiguous spread outwards. Additionally, neuropsychological features may be an important predictor of progression and survival rates in ALS.
Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis?
Authors: Bonenfant J. , Bajeux E. , Deburghgraeve V. , Le Page E. , Edan G. , Kerbrat A.
Published: October 2016

Background and purpose

The benefits of immunomodulatory treatments in secondary progressive multiple sclerosis (SPMS) are unclear, calling into question their continuation. In the present observational study, we investigated the effect of treatment withdrawal on the clinical course of SPMS.

Methods

We included 100 consecutive patients with SPMS who regularly attended our multiple sclerosis clinic. Inclusion criteria were (i) secondary progressive phenotype for at least 2 years, (ii) immunomodulatory treatment for at least 6 months and (iii) treatment stopped with no plans to switch to another. Clinical and magnetic resonance imaging (MRI) data before and after treatment discontinuation were assessed. Factors associated with relapses and/or MRI activity were identified.

Results

Mean treatment duration was 60.4 ± 39.3 months, and mean follow‐up duration after treatment withdrawal was 62.4 ± 38.4 months. The annualized relapse rate remained stable at 1 and 3 years after treatment withdrawal [0.09, 95% confidence interval (CI), 0.05–0.17 and 0.07, 95% CI, 0.05–0.11, respectively], relative to the 3 years prior to treatment withdrawal (0.12, 95% CI, 0.09–0.16). Sixteen patients experienced a relapse and 19 had a gadolinium‐positive MRI scan without relapse during follow‐up. A gadolinium‐positive MRI scan within the previous 3 years before treatment withdrawal and Expanded Disability Status Scale score of <6 were positively associated with relapse and/or MRI activity after discontinuation (P = 0.0004 and P = 0.03, respectively).

Conclusion

In this retrospective study, including a limited number of patients with SPMS, the annualized relapse rate remained stable after treatment withdrawal, relative to before treatment withdrawal. Further prospective studies are needed to confirm this result and provide evidence‐based guidelines for daily practice.
Assessment of transient elastography in Japanese patients with non‐alcoholic fatty liver disease
Authors: Seki Kojiro , Shima Toshihide , Oya Hirohisa , Mitsumoto Yasuhide , Mizuno Masayuki , Okanoue Takeshi
Published: October 2016

Aim

Transient elastography (TE) is a non‐invasive method for predicting liver fibrosis. However, there are limited data regarding the performance of TE in Japanese patients with non‐alcoholic fatty liver disease (NAFLD). We aimed to evaluate the association between liver stiffness measurement (LSM) by TE and liver fibrosis stage, and define a cut‐off value for predicting liver fibrosis.

Methods

A total of 171 Japanese patients with biopsy‐proven NAFLD underwent LSM using TE with FibroScan. The area under the receiver operating characteristic curve of LSM and other non‐invasive markers of liver fibrosis were compared to determine the most accurate method of predicting liver fibrosis.

Results

Liver stiffness measurement significantly correlated with fibrosis stage (P < 0.001). The areas under the receiver operating characteristic curve of LSM for fibrosis stage ≥1 and ≥3 was 0.85 and 0.91, respectively and were higher than those of the aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, fibrosis‐4 index, and NAFLD fibrosis score. The best cut‐off values of LSM fibrosis stage ≥1 and ≥3 were 7.2 kPa (sensitivity 78.5%, specificity 78.3%) and 10.0 kPa (sensitivity 89.5%, specificity 87.6%), respectively. The combination of LSM (≥10 kPa) and type IV collagen 7 s (≥6.0 ng/mL) had a specificity of 97.6% for advanced fibrosis. The LSM in patients with high alanine aminotransferase levels or high body mass index was associated with false positive results regarding advanced fibrosis.

Conclusions

In NAFLD patients, TE has excellent utility for the assessment of liver fibrosis, particularly for advanced stage cases. The cut‐off value of LSM by TE for predicting liver fibrosis stage ≥3 is 10.0 kPa in Japanese NAFLD patients.
Hatching order and sex ratio in Southern Grey Shrike Lanius meridionalis in relation to clutch size
Authors: Moreno‐Rueda Gregorio , Campos Francisco , Gutiérrez‐Corchero Francisco , Hernández María Ángeles
Published: October 2016

Despite major advances in sex ratio theory, how offspring sex should vary with hatching order remains unclear. We examine nestling sex ratio in the Southern Grey Shrike Lanius meridionalis according to hatching order and clutch size. Southern Grey Shrike nestlings present a different sex ratio with body‐mass rank order depending on clutch size. When the clutch size was five eggs (with a very low risk of brood reduction; 13%) the less costly sex (male) was found at the end of the body mass hierarchy. However, when clutch size was six eggs (with a high risk of brood reduction; 42%) the larger sex (female) was found at intermediate positions in the hatching order, possibly to decrease competitive asymmetries.
Electron microscopic investigation and elemental analysis of titanium dioxide in sun lotion
Authors: Sysoltseva M. , Winterhalter R. , Wochnik A. S. , Scheu C. , Fromme H.
Published: October 2016

Objective

The objective of this research was to determine the size, shape and aggregation of titanium dioxide (TiO2) particles which are used in sun lotion as UV‐blocker.

Methods

Overall, six sunscreens from various suppliers and two reference substances were analysed by electron microscopy (EM) techniques in combination with energy dispersive X‐ray spectroscopy (EDS). Because of a high fat content in sun lotion, it was impossible to visualize the TiO2 particles without previous EM sample preparation. Different defatting methods for TiO2 from sun screens were tested. A novel sample preparation method was developed which allowed the characterization of TiO2 particles with the help of EM and EDS.

Results

Aggregates of titanium dioxide with the size of primary particles varying between 15 and 40 nm were observed only in five products. In the sun lotion with the highest SPF, only few small aggregates were found. In the sun screen with the lowest SPF, the largest aggregates of TiO2 particles were detected with sizes up to 1.6 μm. In one of the sun lotions, neither TiO2 nor ZnO was found in spite of the labelling. Instead, approx. 500 nm large diamond‐shaped particles were observed. These particles are composed of an organic material as only carbon was detected by EDS.

Conclusion

A novel defatting method for sample preparation of titanium dioxide nanoparticles used in sun cosmetics was developed. This method was applied to six different sun lotions with SPF between 30 and 50+. TiO2 particles were found in only five sunscreens. The sizes of the primary particles were below 100 nm and, according to the EU Cosmetic Regulation, have to be listed on the package with the term ‘nano’.
Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes
Authors: Amadoru S. , Lim K. , Tacey M. , Aboltins C.
Published: October 2016

Background

Clinical features of infection can become more atypical as we age. Spinal infections can be insidious, and timely diagnosis and treatment are essential to prevent adverse outcomes.

Aims

To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections.

Methods

Clinical, microbiological and radiological information was collected for patients with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis and spinal epidural abscess) at a single metropolitan hospital between January 2008 and January 2015. Patients were excluded if they were under 18 years of age or if clinical and imaging findings were inconsistent with the diagnosis. Presenting features, investigations and outcomes were compared for patients ≥65 (older) or <65 (younger) years old.

Results

Of 53 identified patients, 34 (64%) were classified as older, with more males in both older (65%) and younger (79%) groups. Older patients presented later (median symptom duration 13 vs 4 days, P = 0.016). Back pain was nearly ubiquitous. Older patients presented less commonly with fevers (38 vs 63%) and rigors (24 vs 42%) but more commonly with hypotension (18 vs 5%), delirium (24 vs 11%), higher median inflammatory marker levels and variable microbiological findings, although these differences were not statistically significant. They had longer median lengths of stay (24 vs 14 days) and a higher likelihood of death or failure of medical treatment (HR 9.34, P = 0.031). Radicular pain was associated with poor outcome (HR 3.29, P = 0.046).

Conclusion

Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.
Formalising multidisciplinary peer review: developing a haematological malignancy‐specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence‐based clinical practice
Authors: Trotman Judith , Trinh Jimmy , Kwan Yiu Lam , Estell Jane A. , Fletcher Julie , Archer Kate , Lee Kenneth , Foo Kerwin , Curnow Jennifer , Bianchi Alessandra , Wignall Lynda , Verner Emma , Gasiorowski Robin , Siedlecka Elizabeth , Cunningham Ilona
Published: October 2016

Background

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings.

Aims

To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician.

Methods

A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient‐specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception.

Results

Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT.

Conclusion

Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care.
Host genetics role in the pathogenesis of periodontal disease and caries
Authors: Nibali Luigi , Di Iorio Anna , Tu Yu‐Kang , Vieira Alexandre R.
Published: October 2016

Background

This study aimed to produce the latest summary of the evidence for association of host genetic variants contributing to both periodontal diseases and caries.

Materials and Methods

Two systematic searches of the literature were conducted in Ovid Medline, Embase, LILACS and Cochrane Library for large candidate gene studies (CGS), systematic reviews and genome‐wide association studies reporting data on host genetic variants and presence of periodontal disease and caries.

Results

A total of 124 studies were included in the review (59 for the periodontitis outcome and 65 for the caries outcome), from an initial search of 15,487 titles. Gene variants associated with periodontitis were categorized based on strength of evidence and then compared with gene variants associated with caries. Several gene variants showed moderate to strong evidence of association with periodontitis, although none of them had also been associated with the caries trait.

Conclusions

Despite some potential aetiopathogenic similarities between periodontitis and caries, no genetic variants to date have clearly been associated with both diseases. Further studies or comparisons across studies with large sample size and clear phenotype definition could shed light into possible shared genetic risk factors for caries and periodontitis.
Diagnosis of Elder Abuse in U.S. Emergency Departments
Authors: Evans Christopher S. , Hunold Katherine M. , Rosen Tony , Platts‐Mills Timothy F.
Published: October 2016

Objectives

To estimate the proportion of visits to U.S. emergency departments (EDs) in which a diagnosis of elder abuse is reached using two nationally representative datasets.

Design

Retrospective cross‐sectional analysis.

Setting

U.S. ED visits recorded in the 2012 Nationwide Emergency Department Sample (NEDS) or the 2011 National Hospital Ambulatory Medical Care Survey (NHAMCS).

Participants

All ED visits of individuals aged 60 and older.

Measurements

The primary outcome was elder abuse defined according to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The proportion of visits with elder abuse was estimated using survey weights. Odds ratios (ORs) were calculated to identify demographic characteristics and common ED diagnoses associated with elder abuse.

Results

In 2012, NEDS contained information on 6,723,667 ED visits of older adults, representing an estimated 29,056,673 ED visits. Elder abuse was diagnosed in an estimated 3,846 visits, corresponding to a weighted diagnosis period prevalence of elder abuse in U.S. EDs of 0.013% (95% confidence interval (CI) = 0.012–0.015%). Neglect and physical abuse were the most common types diagnosed, accounting for 32.9% and 32.2% of cases, respectively. Multivariable analysis showed greater weighted odds of elder abuse diagnosis in women (odds ratio (OR) = 1.95, 95% CI = 1.68–2.26) and individuals with contusions (OR = 2.91, 95% CI = 2.36–3.57), urinary tract infection (OR = 2.21, 95% CI = 1.84–2.65), and septicemia (OR = 1.92, 95% CI = 1.44–2.55). In the 2011 NHAMCS dataset, no cases of elder abuse were recorded for the 5,965 older adult ED visits.

Conclusion

The proportion of U.S. ED visits by older adults receiving a diagnosis of elder abuse is at least two orders of magnitude lower than the estimated prevalence in the population. Efforts to improve the identification of elder abuse in EDs may be warranted.
High‐grade metamorphism and partial melting in Archean composite grey gneiss complexes
Authors: White R. W. , Palin R. M. , Green E. C. R.
Published: October 2016

Much of the exposed Archean crust is composed of composite gneiss which includes a large proportion of intermediate to tonalitic material. These gneiss terranes were typically metamorphosed to amphibolite to granulite facies conditions, with evidence for substantial partial melting at higher grade. Recently published activity–composition (a−x) models for partial melting of metabasic to intermediate compositions allows calculation of the stable metamorphic minerals, melt production and melt composition in such rocks for the first time. CalculatedP−Tpseudosections are presented for six bulk rock compositions taken from the literature, comprising two metabasic compositions, two intermediate/dioritic compositions and two tonalitic compositions. This range of bulk compositions captures much of the diversity of rock types found in Archean banded gneiss terranes, enabling us to present an overview of metamorphism and partial melting in such terranes. If such rocks are fluid saturated at the solidus, they first begin to melt in the upper amphibolite facies. However, at such conditions, very little (< 5%) melt is produced and this melt is granitic in composition for all rocks. The production of greater proportions of melt requires temperatures ∼800–850 °C and is associated with the first appearance of orthopyroxene at pressures below 8–9 kbar or with the appearance and growth of garnet at higher pressures. The temperature at which orthopyroxene appears varies little with composition providing a robust estimate of the amphibolite–granulite facies boundary. Across this boundary, melt production is coincident with the breakdown of hornblende and/or biotite. Melts produced at granulite facies range from tonalite–trondhjemite–granodiorite for the metabasic protoliths, granodiorite to granite for the intermediate protoliths and granite for the tonalitic protoliths. Under fluid‐absent conditions the melt fertility of the different protoliths is largely controlled by the relative proportions of hornblende and quartz at high grade, with the intermediate compositions being the most fertile. The least fertile rocks are the most leucocratic tonalites due to their relatively small proportions of hydrous mafic phases such as hornblende or biotite. In the metabasic rocks, melt production becomes limited by the complete consumption of quartz to higher temperatures. The use of phase equilibrium forward‐modelling provides a thermodynamic framework for understanding melt production, melt loss and intracrustal differentiation during the Archean.