bluuebunny/crossref_metadata_2025 huggingface dataset:
Mathematical modelling of the agglomeration in a reactive porous medium with variable permeability
Authors: Donskoy I G
Published: July 2020

When processing low-grade fuels, such as waste and biomass, the problems associated with bed agglomeration often arise. In this work, one of the variants of the agglomeration model is proposed, in which local permeability decreases as a result of the physicochemical process caused by heating, and the agglomeration centers (particles of the melting material) are randomly distributed in a two-dimensional porous medium. A relatively simple model allows the study of the development of thermohydrodynamic inhomogeneities in the fixed granular bed and evaluation of its hydraulic resistance at different fractions of melting material.
Experimental study of Partially Premixed-Diffusion Turbulent Flame with Circular Plate Bluff Body
Authors: Handawy M Koraiem , Hegazy A A , Koura N S , Dahab O M
Published: July 2020

This Study presents a parametric study on flame stabilization of partially premixed-diffusion turbulent flame behind the circular bluff body. The effects of the premixing and equivalence fuel ratios on flame temperature distribution and emission variation along the flame axis are investigated. The results indicate that as the premixing ratio increases the residence time and the recirculation zone length increase while the flame length decreases. The axial temperature distribution enhancements at the recirculation zone, and then a decrease towards the flame tip. As the premixed ratio increases the flame average temperature increase while emission measurements indicate a decrease in CO concentration with a slight increase in NOX production along the flame axis.
Biocompatible exosomes nanodrug cargo for cancer cell bioimaging and drug delivery
Authors: Qambrani Aqsa , Rehman Fawad Ur , Tanziela Tanziela , Shaikh Sana , Semcheddine Farouk , Du Tianyu , Liu Weiwei , Jiang Hui , Wang Xuemei
Published: July 2020

Therapy against cancer remains a daunting issue for human health, despite remarkable innovations in many areas of pathology.In situbiosynthesized nanoclusters bestow a novel remedy for carcinogenic cell imaging. Exosomes have received special attention as an efficient tool for the diagnosis of various diseases, including cancers. All types of cells (healthy or diseased) generate exosomes, making them significantly unique for relevant disease diagnosis and treatment. In this contribution, we exploit the possibility of utilizing the exosomes to facilitate chemotherapeutics, viz. the combination of doxorubicin (Dox) and biosynthesized silver nanoclusters in cancer cells. Our study showed a new facile way for bioimaging of cancer cells using biosynthesized silver-DNA nanoclusters, and thus further targeting cancer cells using the relevant cancer exosomes as drug delivery cargo. After isolating exosomes from neoplastic cells, i.e. HeLa, loaded with the drug, and treating other neoplastic cells with cargo-loaded isolated exosomes, we found that cargo-loaded isolated exosomes can readily enter into the targeted cancer cells and efficiently kill these neoplastic cells. This raises the possibility of acting as a novel facile modality for target cancer theranostics with high efficiency and biocompability.
A new perspective on the spatial, temporal, and vertical distribution of biomass burning: quantifying a significant increase in CO emissions
Authors: Lin Chuyong , Cohen Jason Blake , Wang Shuo , Lan Ruoyu , Deng Weizhi
Published: July 2020

A variance-maximization approach based on 19 years of weekly measurements of pollution in the troposphere carbon monoxide (CO) measurements quantifies the spatial-temporal distribution of global biomass burning. Seven regions consistent with existing datasets are discovered and shown to burn for longer, over a more widespread area. Each region has a unique and recurring burning season, with three dominated by inter- and intra-annual variation. The CO is primarily lofted to the free troposphere from where it spreads downwind at 800 to 700 mb with three exceptions: The Maritime Continent and South America where there is spread at 300 mb consistent with deep- and pyro-convection; and Southern Africa which reaches to 600 mb. The total mass of CO lofted into the free troposphere ranges from 46% over Central Africa to 92% over Australia. The global, annual emissions made using two different techniques lead to an increase of biomass burning CO emissions of 47TgCO/year and 99TgCO/year respectively. The larger increase is mainly due to two factors: first, a large amount of the emissions is lofted rapidly upwards over the biomass burning region and subsequently transported downwind, therefore not appearing near the biomass source in space and time and second, an increase in inter-annual variability. Consistently, there is an increase in variability year-to-year and during peak events, from which 35% to more than 80% of the total emissions is lofted into the free troposphere. The results demonstrate a significantly higher CO emission from biomass burning, a larger impact on the global atmospheric composition, and likely impacts on atmospheric chemistry and climate change.
Preliminary Research of Synthesizing Battery Grade Nickel Sulphate from Dissolution of Nickel Matte in Dilute Sulphuric Acid
Authors: Andayani Sih Wuri , Qizwini Alfiz Muhammad , Wibowo Harry Setyo , Arsyansyah Muhamad
Published: July 2020

Nickel matte is a smelter product of Indonesia mining, and it was produced from laterit ores by pyrometallurgy. The nickel matte composition is about 77% Ni, 1% Co and 0.3% Fe. This study is involving with synthesizing nickel sulphate by dissolution of nickel matte in sulphuric acid. The dissolution condition was varied by sulphuric acid grade, temperature and time of process. The dissolution process will be more effective in higher temperature and longer process time, with additional mangan oxide as catalyst. The efficiency process was observed from the filtrate, residue and nickel sulphate. The filtrate was evaluated by using Atomic Absorption Spectrometer, and residue/nickel sulphate were analysed by XRD. The more efficient process of nickel dissolution was observed at 95 °C for 3 hours, with the conversion rate about 55% - 60%. There was no difference result between sulphuric acid technical grade and pure analytic grade. After dissolution process, the synthesizing was using co-precipitation method in varied pH and alcohol/oxalic acid. The characterization of nickel suphate has been carried out by X-ray Diffraction. The most effective of synthesizing of nickel sulphate is adjusting the pH above 5. The product of nickel sulphate will be used a precursor material for lithium battery cathode materials.
The Influence of the Pitch to Diameter Ratio (P/D) on a Novel Tidal Turbine Performance
Authors: Rosli Roslynna , Norman Rosemary , Atlar Mehmet
Published: July 2020

Computational Fluid Dynamics (CFD) offers numerical modeling investigating the performance that can be used other than or in tandem with experimental investigation. In order to offer meaningful results, the grid sensitivity test or Grid Convergence Index are usually carried out to ensure the solutions converging. This paper presents both grid sensitivity test results and the GCI calculation of a same numerical model exercised to investigate the performance of a tidal turbine, the Hydro-Spinna, with different P/D ratio. The CGI calculation presented the fine grid relative error to be 2.34% for the power coefficient and 2.28% for the thrust coefficient at their optimal TSR respectively. It was found that turbine with lowest P/D ratio has the highest power and thrust coefficient as well as TSR operational range. The turbine with P/D = 0.43 gives a power coefficient of 0.32 at the optimal TSR of 2.25.
Fe-doped Co-N/C as effective electrocatalyst for oxygen reaction
Authors: Lin Qin , Shang Chaoqun , Chen Zhihong , Akinoglu Eser Metin , Wang Xin , Zhou Guofu
Published: July 2020

The development of cost-effective bifunctional electrocatalysts for metal-air batteries with high electrocatalytic activity and stability is crucial for the conversion of clean and renewable energy. In this work, Fe doped nitrogen-enriched porous carbon derived from ZIF-67 was synthesized via a simple ligand exchange reaction with subsequent calcination and acid leaching treatment. The catalysts pyrolysis at 700 °C (CoFe@NC-700) exhibited high electrocatalytic activity and superior stability toward oxygen reaction. Larger surface area and abundant mesopores structure are advantageous for charge transportation and exposure of active sites. More importantly, the synergistic effect of Co–N and Fe–N active sites and the increased number of active sites by modulating the local electronic structure further enhance the electrocatalytic performance of the as-prepared CoFe@NC-700.
PAG1 directs SRC-family kinase intracellular localization to mediate receptor tyrosine kinase-induced differentiation
Authors: Foltz Lauren , Palacios-Moreno Juan , Mayfield Makenzie , Kinch Shelby , Dillon Jordan , Syrenne Jed , Levy Tyler , Grimes Mark
Published: July 2020

Different receptor tyrosine kinases employ shared downstream cell signaling pathways to induce differentiation or proliferation. The scaffold protein, PAG1 controls SRC-family kinase (SFK) activity in lipid rafts, and new data show that PAG1 also influences SFK sequestration in multivesicular bodies and is required for neuronal differentiation.
Spanish subsistence wages and the Little Divergence in Europe, 1500–1800
Authors: Losa Ernesto López , Zarauz Santiago Piquero
Published: July 2020

This paper suggests an alternative view of Europe’s Little Divergence in real wages. It presents a new dataset of prices and wages for Spain and proposes a new way of measuring the cost of bare-bones subsistence. The substitution of brown-bread prices for grain prices in the baskets transforms the scale and chronology of the divergence between North-western Europe and Spain. The results show that it began later and that unskilled subsistence wages in London and Amsterdam were significantly lower than those calculated by the canonical model, which would nuance the “high-wage” hypothesis.
Dirty float or clean intervention? The Bank of England in the foreign exchange market
Authors: Naef Alain
Published: July 2020

The effectiveness of central bank intervention is debated and despite literature showing mixed results, central banks regularly intervene in the foreign exchange market, both in developing and developed economies. Does foreign exchange intervention work? Using over 60,000 new daily observations on intervention and exchange rates, this paper is the first to study the Bank of England's foreign exchange intervention between 1952 and 1972. The main finding is that the Bank was unsuccessful in managing a credible exchange rate over that period. Running an event study, I demonstrate that betting systematically against the Bank of England would have been a profitable trading strategy. Pressures increased in the 1960s and the Bank eventually manipulated the publication of its reserve figures to avoid a run on sterling.
Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial
Authors: Budoff Matthew J , Bhatt Deepak L , Kinninger April , Lakshmanan Suvasini , Muhlestein Joseph B , Le Viet T , May Heidi T , Shaikh Kashif , Shekar Chandana , Roy Sion K , Tayek John , Nelson John R
Published: July 2020

Aims

Despite the effects of statins in reducing cardiovascular events and slowing progression of coronary atherosclerosis, significant cardiovascular (CV) risk remains. Icosapent ethyl (IPE), a highly purified eicosapentaenoic acid ethyl ester, added to a statin was shown to reduce initial CV events by 25% and total CV events by 32% in the REDUCE-IT trial, with the mechanisms of benefit not yet fully explained. The EVAPORATE trial sought to determine whether IPE 4 g/day, as an adjunct to diet and statin therapy, would result in a greater change from baseline in plaque volume, measured by serial multidetector computed tomography (MDCT), than placebo in statin-treated patients.

Methods and results

A total of 80 patients were enrolled in this randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis as documented by MDCT (one or more angiographic stenoses with ≥20% narrowing), be on statin therapy, and have persistently elevated triglyceride (TG) levels. Patients underwent an interim scan at 9 months and a final scan at 18 months with coronary computed tomographic angiography. The pre-specified primary endpoint was change in low-attenuation plaque (LAP) volume at 18 months between IPE and placebo groups. Baseline demographics, vitals, and laboratory results were not significantly different between the IPE and placebo groups; the median TG level was 259.1 ± 78.1 mg/dL. There was a significant reduction in the primary endpoint as IPE reduced LAP plaque volume by 17%, while in the placebo group LAP plaque volume more than doubled (+109%) (P = 0.0061). There were significant differences in rates of progression between IPE and placebo at study end involving other plaque volumes including fibrous, and fibrofatty (FF) plaque volumes which regressed in the IPE group and progressed in the placebo group (P < 0.01 for all). When further adjusted for age, sex, diabetes status, hypertension, and baseline TG, plaque volume changes between groups remained significantly different, P < 0.01. Only dense calcium did not show a significant difference between groups in multivariable modelling (P = 0.053).

Conclusions

Icosapent ethyl demonstrated significant regression of LAP volume on MDCT compared with placebo over 18 months. EVAPORATE provides important mechanistic data on plaque characteristics that may have relevance to the REDUCE-IT results and clinical use of IPE.
Advance in yellowing mechanism and the regulation technology of post-harvested broccoli
Authors: Luo Feng , Fang Huixin , Wei Baodong , Cheng shunchang , Zhou Qian , Zhou Xin , Zhang Xuan , Zhao Yingbo , Ji Shujuan
Published: July 2020

Yellowing is one of the main problems of quality deterioration in the storage, transportation, and sales of post-harvested broccoli, which seriously affects the commodity value of broccoli. Therefore, it is of significance to understand the mechanism of the process and develop effective regulation technology. In this review, we expounded the changes in the appearance of the flower ball, bud morphology, and calyx cell structure, as well as endogenous pigment metabolism, accompanying the yellowing process of broccoli. In addition, recent research on the molecular mechanism of yellowing was summarized from the aspects of transcriptome analysis and transcription regulation. Finally, the progress on the control technology of broccoli yellowing was reviewed.
Concurrent Liability in Contract and Intellectual Property Law: Licensing Agreements in Light of Case C-666/18 IT Development SAS
Authors: Schovsbo Jens , Riis Thomas
Published: July 2020

It is the starting point in some jurisdictions that if a licensing agreement has been breached, the licensor may choose to establish their claims against the licensee on the basis of either contract or intellectual property law. This article argues that such a starting point should not be upheld. Not least because of developments in EU law, the intellectual property rights (IPR) system contains special remedies and procedures, which systematically and unilaterally benefit one of the parties to a contract, viz. the rightholder (licensor). The ability to have recourse against a contractual party via IPR instead of contract law ought to be limited as far as possible, i.e. restricted to those instances where this is prescribed by law. In the recent judgment of the CJEU, C-666/18 IT Development SAS, the Court held that a copyright holder/licensor must be able to rely on the remedies and procedures of the Enforcement Directive (IPRED). Consequently, freedom of choice between contract and IPR law is guaranteed in this respect. It is notable that this judgment deals exclusively with IPRED and does not have any broader effect in relation to the basic question of choice between contract and IPR law outside of the scope of the IPRED. Therefore, freedom of choice could still be limited, and licensees shielded against the special remedies and procedures which are at rightholders’ disposal outside of the IPRED.***
Bifunctional Role of the Sternohyoideus Muscle During Suction Feeding in Striped Surfperch,Embiotoca lateralis
Authors: Lomax J J , Martinson T F , Jimenez Y E , Brainerd E L
Published: July 2020

Synopsis

In ray-finned fishes, the sternohyoideus (SH) is among the largest muscles in the head region and, based on its size, can potentially contribute to the overall power required for suction feeding. However, the function of the SH varies interspecifically. In largemouth bass (Micropterus salmoides) and several clariid catfishes, the SH functions similarly to a stiff ligament. In these species, the SH remains isometric and transmitts power from the hypaxial musculature to the hyoid apparatus during suction feeding. Alternatively, the SH can shorten and contribute muscle power during suction feeding, a condition observed in the bluegill sunfish (Lepomis macrochirus) and one clariid catfish. An emerging hypothesis centers on SH muscle size as a predictor of function: in fishes with a large SH, the SH shortens during suction feeding, whereas in fish with a smaller SH, the muscle may remain isometric. Here, we studied striped surfperch (Embiotoca lateralis), a species in which the SH is relatively large at 8.8% of axial muscle mass compared with 4.0% for L. macrochirus and 1.7% for M. salmoides, to determine whether the SH shortens during suction feeding and is, therefore, bifunctional—both transmitting and generating power—or remains isometric and only transmits power. We measured skeletal kinematics of the neurocranium, urohyal, and cleithrum with Video Reconstruction of Moving Morphology, along with muscle strain and shortening velocity in the SH and epaxial muscles, using a new method of 3D external marker tracking. We found mean SH shortening during suction feeding strikes (n = 22 strikes from four individual E. lateralis) was 7.2 ± 0.55% (±SEM) of initial muscle length. Mean peak speed of shortening was 4.9 ± 0.65 lengths s−1, and maximum shortening speed occurred right around peak gape when peak power is generated in suction feeding. The cleithrum of E. lateralis retracts and depresses but the urohyal retracts and depresses even more, a strong indicator of a bifunctional SH capable of not only generating its own power but also transmitting hypaxial power to the hyoid. While power production in E. lateralis is still likely dominated by the axial musculature, since even the relatively large SH of E. lateralis is only 8.8% of axial muscle mass, the SH may contribute a meaningful amount of power given its continual shortening just prior to peak gape across all strikes. These results support the finding from other groups of fishes that a large SH muscle, relative to axial muscle mass, is likely to both generate and transmit power during suction feeding.
Inverse Gaussian beam stacking method for imaging both primary reflections and free-surface multiples in 2D VSP
Authors: Yang Feilong , Huang Dezhi , Yang Jidong , Yu Dai , Luo Hao , Zhao Chi , Zhao Chong
Published: July 2020

In vertical seismic profiling (VSP) exploration, it is difficult to produce an accurate image for large-offset reflections only using reflection waves and the image resolution is low in traditional VSP-CDP stacking as is the number of folds of reflection points. To mitigate these problems, we present an inverse Gaussian beam stacking method for imaging both primary reflections and free-surface multiples. We first compute the stacking weighted functions at each trace location by Gaussian beam forward modeling, and then apply an inverse projection for VSP data to produce common shot gathers (CRP). Since inverse Gaussian beam stacking maps the common-shot data along finite-frequency wave-paths instead of single rays as the traditional ray-based stacking method does, it enlarges the reflection-point coverage, increases stacking fold and reduces the requirement for large bin sizes. We incorporate free-surface multiples into the proposed inverse Gaussian beam stacking, which enables us to expand the horizontal imaging aperture and mitigate the low-fold problem of primary reflections in the shallow large-offset regions for VSP surveys. Numerical examples for synthetic and field data demonstrate the feasibility and adaptability of the proposed inverse Gaussian beam stacking method for VSP data.
IPANEMAP: integrative probing analysis of nucleic acids empowered by multiple accessibility profiles
Authors: Saaidi Afaf , Allouche Delphine , Regnier Mireille , Sargueil Bruno , Ponty Yann
Published: July 2020

The manual production of reliable RNA structure models from chemical probing experiments benefits from the integration of information derived from multiple protocols and reagents. However, the interpretation of multiple probing profiles remains a complex task, hindering the quality and reproducibility of modeling efforts. We introduce IPANEMAP, the first automated method for the modeling of RNA structure from multiple probing reactivity profiles. Input profiles can result from experiments based on diverse protocols, reagents, or collection of variants, and are jointly analyzed to predict the dominant conformations of an RNA. IPANEMAP combines sampling, clustering and multi-optimization, to produce secondary structure models that are both stable and well-supported by experimental evidences. The analysis of multiple reactivity profiles, both publicly available and produced in our study, demonstrates the good performances of IPANEMAP, even in a mono probing setting. It confirms the potential of integrating multiple sources of probing data, informing the design of informative probing assays.
Insights into the global effect on Staphylococcus aureus growth arrest by induction of the endoribonuclease MazF toxin
Authors: Sierra Roberto , Prados Julien , Panasenko Olesya O , Andrey Diego O , Fleuchot Betty , Redder Peter , Kelley William L , Viollier Patrick H , Renzoni Adriana
Published: July 2020

A crucial bacterial strategy to avoid killing by antibiotics is to enter a growth arrested state, yet the molecular mechanisms behind this process remain elusive. The conditional overexpression of mazF, the endoribonuclease toxin of the MazEF toxin–antitoxin system in Staphylococcus aureus, is one approach to induce bacterial growth arrest, but its targets remain largely unknown. We used overexpression of mazF and high-throughput sequence analysis following the exact mapping of non-phosphorylated transcriptome ends (nEMOTE) technique to reveal in vivo toxin cleavage sites on a global scale. We obtained a catalogue of MazF cleavage sites and unearthed an extended MazF cleavage specificity that goes beyond the previously reported one. We correlated transcript cleavage and abundance in a global transcriptomic profiling during mazF overexpression. We observed that MazF affects RNA molecules involved in ribosome biogenesis, cell wall synthesis, cell division and RNA turnover and thus deliver a plausible explanation for how mazF overexpression induces stasis. We hypothesize that autoregulation of MazF occurs by directly modulating the MazEF operon, such as the rsbUVW genes that regulate the sigma factor SigB, including an observed cleavage site on the MazF mRNA that would ultimately play a role in entry and exit from bacterial stasis.
Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature
Authors: Nussbaum Eric S , Touchette Jillienne C , Madison Michael T , Goddard James K , Lassig Jeffrey P , Nussbaum Leslie A
Published: July 2020

BACKGROUND

With advances in endovascular techniques, the relative roles of microsurgery and endovascular therapy in the management of intracranial aneurysms have become less clear, and data regarding treatment-specific outcomes are increasingly important.

OBJECTIVE

To describe our experience with microsurgery in a large series of unruptured anterior communicating artery aneurysms (ACOMMAAs) and detail our treatment decision-making process based on individual aneurysm morphology.

METHODS

We retrospectively reviewed unruptured ACOMMAAs treated microsurgically at our center between 1997 and 2018, recording aneurysm size, surgical approach, occlusion rates, neurological outcomes, and complications.

RESULTS

We treated 300 unruptured ACOMMAAs in 300 patients, mean age 49 yr, 180 (60.0%) female, including 245 (81.7%) small, 50 (16.7%) large, and 5 (1.7%) giant aneurysms. Most underwent a pterional approach (253, 84.3%), with orbitozygomatic or anterior interhemispheric approaches in 35 (11.7%) and 12 (4%), respectively. Greater than 95% occlusion was achieved in 284 (94.7%), 90% to 95% occlusion in 13 (4.3%), and 3 (1.0%) underwent wrapping. Serious complications occurred in 3 patients (1.0%) resulting in 2 deaths (0.7%), and minor complications in 12 (4.0%). At final follow-up, good neurological outcome was observed in 297 (99.0%) patients.

CONCLUSION

Given clinical equipoise regarding optimal treatment of unruptured ACOMMAAs, this work provides a benchmark for achievable microsurgical outcomes. Future surgical/endovascular studies should separate results of ruptured and unruptured lesions and describe aneurysm morphology to allow for better comparison of outcomes between treatments. We suggest that open microsurgery represents an important option for select, morphologically complex ACOMMAAs, and that a multidisciplinary approach offers optimal patient outcomes.
Nonlinear Effects of Linearly Increasing Perceptual Load on ERPs to Emotional Pictures
Authors: Schindler Sebastian , Gutewort Laura , Bruchmann Maximilian , Moeck Robert , Straube Thomas
Published: July 2020

The prioritized processing of emotional as compared to neutral stimuli is reflected in enlarged event-related potentials (ERPs). However, perceptual load theory proposes that under conditions of high perceptual load, information processing is attenuated or abolished. The parametrical effects of load on ERPs to emotional pictures are unknown. To shed light on this question, the current preregistered ERP study (N = 30) systematically investigated the effects of load on ERPs to task-irrelevant negative, neutral, and positive pictures. Crucially, while perceptual input was held constant, perceptual load was systematically manipulated so that it increased linearly across 4 load levels, which was evident in behavioral data. In contrast, load effects on ERP differences between emotional and neutral stimuli did not follow a linear function. For the N1, early posterior negativity and late positive potential, a nonlinear function with reversed emotion effects at the third load level provided the best fit. These findings do not only show that perceptual load attenuates emotional picture processing but also suggest that active processes are initiated to reduce distraction by emotional information. Moreover, these effects of perceptual load on emotional ERP components appear to deviate from theoretically expected functions.
Identification of Risk Factors for Testing of Hepatitis C in Non-Birth Cohort Patients: Is Universal Screening Necessary?
Authors: Smart Amanda , Geboy Alexander , Basch Peter , Nichols Whitney , Zeymo Alexander , Perez Idene , Hafeez Maria , Fleisher Ilan , Fernandez Stephen , Fishbein Dawn
Published: July 2020

Objectives:

CDC reported that 45% of Hepatitis C (HCV) infected people denied known risk factors. Electronic health record RF-based, non-Birth Cohort (born outside of years 1945–1965) screening is challenging as risk factors are often input as nonsearchable data. Testing non-Birth Cohort patients solely based on risk factors has the potential to miss a substantial number of HCV infected patients. The aim was to determine the HCV antibody positive prevalence who would have been missed had providers only followed risk factor based screening recommendations.

Methods:

A 1:3 case-control retrospective nested chart review was conducted. HCV risk factors and opioid prescriptions were manually abstracted from the Electronic Health Record; other variables were collected using Explorys. In July 2015 HCV screening data was collected on non-Birth Cohort patients who were HCV tested across MedStar Health, as a presumptive marker for high risk. Univariate and multivariate logistic regression models were utilized to determine HCV antibody positive predictors.

Results:

Eighteen (23%) HCV antibody positive and 123 (49%) HCV antibody negative had no identified risk factors; 6 (33%) HCV antibody positive reported risk factors only after a positive test result. There was a significant interaction between age over 40 and opioid prescription use; these groups were 11× more likely to be HCV antibody positive (CI95 1.6–74.8).

Conclusions:

HCV testing solely based on presence of risk factors in non-Birth Cohort patients has the potential to miss a significant number of HCV antibody positive patients. Given patient- and provider-level barriers in elucidating risk factors, universal HCV antibody screening may be warranted.
Patterns of Prescription Opioid Use Prior to Self-reported Heroin Initiation
Authors: Hartung Daniel M. , Geddes Jonah , Johnston Kirbee A. , Leichtling Gillian , Hallvik Sara , Hildebran Christi , Korthuis P. Todd
Published: July 2020

Objectives:

To determine the association between self-reported heroin initiation and patterns of prescription opioid use.

Methods:

Using linked Oregon Medicaid, prescription drug monitoring program, and Treatment Episodes Data Set data, we conducted a case-control study of individuals reporting heroin initiation between 2015 and 2017 during treatment intake. Prescription drug monitoring program data provided prescription opioid use patterns, including long-term prescription opioid therapy, in the year before self-reported heroin initiation. Four controls were matched to each case on aggregate prescription opioid use and demographics.

Results:

About half (49%) of individuals who reported heroin initiation filled an opioid in the year before initiation. Individuals who initiated heroin (n = 306) were more likely to receive prescriptions from multiple prescribers (24% vs 18%, P = 0.007) and pharmacies (12% vs 5%, P < 0.001) compared with matched controls (n = 1224). Long-term opioid therapy (13% vs 14%, P = 0.74) was uncommon and did not differ between groups.

Conclusions:

Although prescription opioid use commonly preceded self-reported heroin initiation, long-term opioid therapy was not common. Although this study did not find an association between opioid discontinuation and heroin initiation, sample size and follow-up limitations preclude definitive conclusions. Efforts to limit prescription opioids should continue to evaluate for unintended harms.
A survey on the frequency of COVID-19-like symptoms on students and staff of the University of Milan
Authors: Negri Eva , La Vecchia Carlo
Published: July 2020

A survey was conducted through a web link on the students and staff of the Università degli Studi di Milano, Italy in the period 14–30 April 2020. It was anonymous at the source and included history of COVID-19-related questions (fever, headache, cold, cough, anosmia, gastrointestinal complaints and separately fever over 38.5°C) in the previous three weeks, and similar information on cohabitants. A total of 14 374 subjects were included. Overall, from 24 March to 30 April, 3138 subjects (21.8%) reported COVID-19-like symptoms, and 219 (1.5%) fever above 38.5°C; 217 subjects performed at least one swab. Of these, 46 were positive (21.3% of those performed, 0.3% of the total). The frequency of any symptom was similar in women and men, but fever above 38.5°C was lower in women (multivariate odds ratio (OR) = 0.65, 95% confidence interval, CI, 0.49–0.85). There was a strong association between symptoms in the respondent and in cohabitants: 64% of subjects with symptoms reported at least one cohabitant with symptoms, compared to 14% of asymptomatic subjects (OR = 11.4, 95% CI, 10.4–12.6). The lower risk of serious symptoms in women, and the strong intra-nucleus of cohabitation contagiousness are an indication that at least part of the symptoms was caused by a new pathogen – SARS-CoV-2. These data, therefore, suggest that the number of persons affected by COVID-19 was much greater in northern Italy than the number of recorded cases. This has implications for the prevention, management and mortality of other serious diseases, including cancer.
Health Professionals' Engagement With Email—Enabler or Disrupter?
Authors: Dennis Sally , Waterworth Susan
Published: July 2020

The use of email is an internationally recognized and accepted method to communicate information in an asynchronous manner. Yet, despite its ubiquitous use, there is evidence that there are differences in the degree of engagement with and perceived value of email as legitimate work within the healthcare setting. A lack of engagement with email could have consequences on the care of patients if email communication is not read or responded to by the intended recipient. The purpose of this study was to understand the email practices of health professionals within a hospital setting, including their interactions, experiences, and thoughts and ideas for sharing information in the future. Four focus groups (total number of participants, 30) were conducted in 2015 and 2016 using an Appreciative Inquiry model to focus on the use of email. Data were thematically analyzed, with three overarching themes identified: professional practice, workforce self-care, and shaping the future using technology. Overall, email was perceived as a less important function within a health professional's everyday clinical practice; however, this differed depending on their role. The health professionals' use of email ranged from very little engagement to what could be judged as over-engagement, all of which have implications for healthcare organizations who view email as a legitimate work task and a key way to communicate.
Role of Optic Nerve Sheath Fenestration in Inflammatory Pachymeningitis Causing Visual Impairment
Authors: Bae Sol , Dunn Hamish , Leahy Kate , Tan Kimberley , O’Donnell Brett , Brazier David , Soh Hwei-Choo
Published: July 2020

Eye disease due to pachymeningitis caused by immunoglobulin G4–related disease (IgG4-RD) is a rare occurrence. Here, the authors report a unique case of a patient presenting with visual loss from raised intracerebral pressure from pachymeningitis most likely related to IgG4-RD. The patient was treated with acetazolamide and steroids, and an optic nerve sheath fenestration was performed to successfully save the patients vision.
Investigation of the Efficacy of an Intervention on Vancomycin Use in a Country With High Rate of Vancomycin Prescription
Authors: Mohseni Maryam , Sheybani Fereshte , Eslami Saeid , Taherzadeh Zhila , Naderi HamidReza , YaddolahiFar Mohaddeseh , Khosravi Nasrin , Tayefi Maryam
Published: July 2020

Objective

The aim of the study was to investigate the efficacy of a reminder for the prescriber at the second key time of antimicrobial prescription on vancomycin use.

Methods and Materials

This study was conducted in a teaching hospital affiliated to Mashhad University of Medical Sciences, Iran, during a 6-month period. All hospitalized adult patients who received more than 48 hours of vancomycin were included and divided into an intervention and a non-intervention group. The intervention was a reminder to the prescriber in the form of a warning letter attached to the patient medical record at the second key time of the antibiotic prescription, emphasizing the microbiological test results. The primary outcome measure was the number of vancomycin days per patient.

Results

A total of 24,597 hospitalized adult patients were assessed for eligibility, of whom 1006 met the inclusion criteria. Overall, the rate of vancomycin prescription in preintervention period was 152.3 per 1000 hospitalized adult patients. In the post intervention period, the overall number of vancomycin days decreased significantly, with a reduction from 4342 to 1012 days in the intervention group that was equal to a decline of the mean of vancomycin days per patient from 10.9 to 8.9 days (P = 0.001).

Conclusions

Our study showed the effectiveness of an intervention in the form of a reminder at the second key time of antibiotic prescription in decreasing the overall number of vancomycin days and a mean of vancomycin days per patient. Despite this, there was still a high rate of overuse of vancomycin in the intervention group in postintervention period; a finding that emphasizes the importance and needs of root cause analysis of the factors associated with antibiotic prescription behaviors despite implementation of interventions in the future studies.
Strongyloides stercoralis in Immunocompromised Patients
Authors: Hirani Fizza , Oladunjoye Olubunmi , Oladunjoye Adeolu , Patel Nitin
Published: July 2020

Strongyloides hyperinfection diagnosis has been associated with high mortality. We present a case series of 3 immunocompromised patients who had severe infection of Strongyloides including 1 fatal case. The first patient was on chronic steroids and cyclophosphamide for acquired hemophilia. She was admitted for sepsis with bacteremia and multifocal pneumonia, acute respiratory distress syndrome, and sputum positive for Strongyloides. The second patient was on chronic steroids and infliximab and developed septic shock secondary to multifocal pneumonia, enterococcal bacteremia, and disseminated strongyloidiasis with hyperinfection. The third patient on chronic steroids and immunosuppressive therapy presented with worsening dyspnea and cough and was found to have strongyloidiasis in bronchoalveolar lavage fluid. Early identification and treatment of at-risk population particularly the immunocompromised could potentially reduce the risk of mortality.
Efficacy of the DEET, IR3535, and Picaridin Topical Use Against Aedes Aegypti
Authors: Feuser Zoé Paulina , Colonetti Tamy , Grande Antonio José , Rodrigues Uggioni Maria Laura , Roever Leonardo , da Rosa Maria Inês
Published: July 2020

Objective

This systematic review aims to determine the efficacy of the insect repellent for topical use against the Aedes aegypti.

Methods

A systematic search was conducted until June 2018 using the following terms: “Aedes aegypti,” “topical repellents,” “picaridin,” “DEET,” and “IR3535.” The quality of the study was assessed using the Downs and Black checklist.

Results

The most effective asset was 80% DEET with 420-minute protection time but used at a very high concentration, with risks of adverse effects, followed by 20% picaridin with protection time of 410.4 minutes, 20% DEET with protection time greater than 380 minutes, 15% IR3535 with protection time of 362 minutes, 10% IR3535 with 356-minute protection time, and 10% picaridin with protection time of 351.5 minutes.

Conclusions

Because of the results found here, it is recommended to carry out new studies to compare the performance of repellent with reliability.
Maternal and Microorganism Characteristics Cannot Predict Adverse Outcome in Pregnancies Complicated With Urinary Tract Infection
Authors: Orgul Gokcen , Uyanik Esra , Sancak Banu , Beksac M. Sinan
Published: July 2020

Background

Previous studies revealed different results on the impact of urinary tract infection on pregnancy outcomes. Inconsistent data on adverse outcomes such as preterm delivery, low birth weight, and intrauterine growth restriction (IUGR) are reported in several studies.

Methods

Microorganisms were classified into 4 groups; Enterobacteriaceae, gram-positive cocci, fungi and others. Adverse pregnancy outcome was defined in the presence of IUGR, preterm delivery, low birth weight, and low appearance, pulse, grimace, activity, and respiration score. Adverse and no adverse outcome groups were compared.

Results

The total number of women with a positive urinary culture was 186. The most common isolated microorganism was Escherichia coli (n = 111, 59.7%). Among E. coli isolates, resistance was most common to ampicillin and trimethoprim sulfamethoxazole. The mean gestational week was 23.3 ± 1.12 for the urinary tract infection onset time and recurrence rate was 11.8% (n = 22). Oral antibiotics were prescribed to 164 outpatient women and hospitalization was required in 22 cases (11.8%). The rates of IUGR, low birth weight, low appearance, pulse, grimace, activity, and respiration, and preterm delivery were 11.8%, 11.3%, 6.9%, and 17.7%, respectively. There were 137 women (73.7%) in no adverse outcome group, whereas 49 women (26.3%) were in adverse outcome group. There was no significant difference in terms of bacteria group and maternal characteristics between 2 groups (P < 0.05 for all).

Conclusions

Maternal and microorganism characteristics are similar in pregnancies complicated with urinary infections in terms of adverse outcome. It is not possible to predict the ongoing pregnancy course by identifying maternal and microbiological features.
Coexistence of Crohn’s disease and systemic lupus erythematosus: a case report and literature review
Authors: Jin Xiaorong , Wang Gui , Xu Xiaohua , Bai Yunjing , An Ran , Jiang Dexun
Published: July 2020

Lupus enteritis and Crohn’s disease are two common immune diseases involving the gastrointestinal tract. There are many similar clinical manifestations, therefore it is very difficult to distinguish between them. The digestive system is involved anywhere from 8 to 40% of patients with systemic lupus erythematosus (SLE) and up to 53% of these go on to develop lupus enteritis. In patients with Crohn’s disease, 6–40% were presented with oral mucosa ulceration, nodular erythema of skin, arthritis, eye disease and other extraintestinal manifestations. The concomitant of Crohn’s disease and SLE is extremely rare; however, here we described a case of concomitant Crohn’s disease and SLE characterized by recurrent intestinal obstruction. A systematic literature review of lupus concomitant with Crohn’s disease was then conducted.
Gastrointestinal manifestations of angioedema: a potential area of misdiagnosis
Authors: Mormile Ilaria , Cocchiaro Antonio , Bova Maria , Loffredo Stefania , de Paulis Amato , Spadaro Giuseppe , Petraroli Angelica
Published: July 2020

Abdominal pain is one of the most common conditions leading people to the emergency department. An uncommon but well described cause of abdominal pain is angioedema of the gastrointestinal tract due to recurrent angioedema without wheals. Abdominal involvement is very common in hereditary angioedema (HAE), but it is also described in acquired angioedema and allergic forms. In patients with HAE, the involvement of gastrointestinal tract with resultant abdominal pain occurs in 43–93% of cases. Attacks can involve the entire gastrointestinal tract, such as the oropharynx, small intestine, colon, liver, or pancreas. Pain is the most common gastrointestinal symptom, and it may occur for many years even without cutaneous or respiratory symptoms. The case report we included in this article emphasizes the importance of accurate evaluation of personal and family history in patients with a long history of acute, severe, and unexplained abdominal pain, and it gives an example of how diagnostic delay may be longer if gastroenterological symptoms are the predominant clinical presentation. Furthermore, sometimes the simultaneous presence of concomitant gastrointestinal disorders and HAE may cause difficulties in differential diagnosis. Gastroenterologists and other physicians should add HAE to their list of potential causes of unexplained abdominal pain. The initiation of appropriate prophylaxis and treatment will prevent needless suffering and useless surgical and medical procedures.
Micronutrient deficits in patients with chronic pancreatitis: prevalence, risk factors and pitfalls
Authors: Jøker-Jensen Henriette , Mathiasen Anne Sofie , Køhler Marianne , Rasmussen Henrik Højgaard , Drewes Asbjørn Mohr , Olesen Søren Schou
Published: July 2020

Objective

We investigated the prevalence of micronutrient deficiencies and associated patient and disease-related risk factors in patients with chronic pancreatitis (CP).

Methods

We enrolled 115 consecutive CP outpatients. Micro-nutritional assessments included plasma levels of fat-soluble vitamins (A, D and E) and trace elements (magnesium and zinc). Bioelectrical impedance and muscle function tests were used to characterize the macro-nutritional status (sarcopenia and phase angle). Prevalence of micro-nutritional deficiencies was estimated and associated with a number of patient and disease characteristics including presence of exocrine pancreatic insufficiency (EPI) and diabetes mellitus. In an additional analysis, we explored the association between micronutrient levels and macro-nutritional status.

Results

The mean age of patients was 57.9 ± 13.0 years, 71% were men and 50% had an alcoholic aetiology. Vitamin D deficiency (22%) was the most common micronutrient deficit followed by zinc deficiency (20%) and magnesium deficiency (17%). Vitamin A deficiency (10%) and vitamin E deficiency (7%) were only seen in patients with EPI (P ≤ 0.03), while the presence of trace element deficits was associated with plasma albumin levels (P ≤ 0.006). Plasma zinc levels were decreased in sarcopenic patients (P < 0.001) and positively correlated to phase angle (coefficient 0.28; P < 0.001).

Conclusion

Various micronutrient deficits were observed in CP outpatients, and associated risk factors were diverse and distinct for the individual nutrients. Taken together, our findings highlight the complexity of micronutrient assessment in patients with CP and emphasise the importance of simultaneous evaluation of plasma protein levels, inflammatory activity and macro-nutritional status.
Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia
Authors: Hamina Aleksi , Tanskanen Antti , Tiihonen Jari , Taipale Heidi
Published: July 2020

Background:

Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization.

Objective:

The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in Finland.

Research Design:

Interrupted time series analysis.

Subjects:

All persons with schizophrenia in Finland who were alive at the beginning of 2015 (N=41,017).

Measures:

We measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers.

Results:

During 2016, the proportion of antipsychotic purchasers decreased by −0.26 percentage points per month [95% confidence interval (CI): −0.47 to −0.05] compared with 2015. The trend of other psychotropic purchasers decreased to −0.13 percentage points per month in 2016 (95% CI: −0.22 to −0.04) compared with 2015 and cardiometabolic drug purchases to −0.17 percentage points per month (95% CI: −0.29 to −0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization.

Conclusions:

In our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on January 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.