bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of the First Gene Transfer Agent (GTA) Small Terminase in
Rhodobacter capsulatus
and Its Role in GTA Production and Packaging of DNA
Authors: Sherlock D. , Leong J. X. , Fogg P. C. M.
Published: September 2019

Random transfer of any and all genes between bacteria could be influential in the spread of virulence or antimicrobial resistance genes. Discovery of the true prevalence of GTAs in sequenced genomes is hampered by their apparent similarity to bacteriophages. Our data allowed the prediction of small terminases in diverse GTA producer species, and defining the characteristics of a “GTA-type” terminase could be an important step toward novel GTA identification. Importantly, the GTA small terminase shares many features with its phage counterpart. We propose that the GTA terminase complex could become a streamlined model system to answer fundamental questions about double-stranded DNA (dsDNA) packaging by viruses that have not been forthcoming to date.
Antibody-Dependent Dengue Virus Entry Modulates Cell Intrinsic Responses for Enhanced Infection
Authors: Chan Candice Y. Y. , Low John Zhong Heng , Gan Esther Shuyi , Ong Eugenia Ziying , Zhang Summer Li-Xin , Tan Hwee Cheng , Chai Xiaoran , Ghosh Sujoy , Ooi Eng Eong , Chan Kuan Rong
Published: September 2019

Dengue virus is the most prevalent mosquito-borne viral infection globally, resulting in variable manifestations ranging from asymptomatic viremia to life-threatening shock and multiorgan failure. Previous studies have indicated that the risk of severe dengue in humans can be increased by a specific range of preexisting anti-dengue virus antibody titers, a phenomenon termed antibody-dependent enhancement. There is hence a need to understand how antibodies augment dengue virus infection compared to the alternative canonical receptor-mediated viral entry route. Herein, we show that, besides facilitating viral uptake, antibody-mediated entry increases the expression of early host dependency factors to promote viral infection; these factors include RNA splicing, mitochondrial respiratory chain complexes, vesicle trafficking, and ribosomal genes. These findings will enhance our understanding of how differences in entry pathways can affect host responses and offer opportunities to design therapeutics that can specifically inhibit antibody-dependent enhancement of dengue virus infection.
Late Quaternary sea-level history of Saipan, Commonwealth of the Northern Mariana Islands, USA: A test of tectonic uplift and glacial isostatic adjustment models
Authors: Muhs Daniel R. , Schweig Eugene S. , Simmons Kathleen R.
Published: September 2019

In 1979, S. Uyeda and H. Kanamori proposed a tectonic model with two end members of a subduction-boundary continuum: the “Chilean” type (shallow dip of the subducting plate, great thrust events, compression, and uplift of the overriding plate) and a “Mariana” type (steep dip of the subducting plate, no great thrust events, tension, and no uplift). This concept has been used to explain variable rates of Quaternary uplift around the Pacific Rim, yet no uplift rates have been determined for the Mariana Islands themselves, one of the end members in this model. We studied the late Quaternary Tanapag Limestone, which rims much of the eastern and southern coasts of Saipan, Northern Mariana Islands, with elevations of ∼13 m to ∼30 m. Samples from 12 well-preserved corals (Acropora, Porites, and Goniastrea) yielded U-series ages ranging from ca. 134 ka to ca. 126 ka. These ages correlate the emergent reef of the Tanapag Limestone with the last interglacial period, when sea level was several meters above present. Ages and measured reef elevations from the Tanapag Limestone, along with paleo–sea-level data, yield relatively low late Quaternary uplift rates of 0.002–0.19 m/k.y., consistent with the Uyeda-Kanamori model. A review of data from other localities near subduction zones around the Pacific Basin, however, indicates that many coastlines do not fit the model. Uplift rates along the Chilean coast are predicted to be relatively high, but field studies indicate they are low. On some coastlines, relatively high uplift rates are better explained by subduction of seamounts or submarine ridges rather than subduction zone geometry. Despite the low long-term uplift rate on Saipan, the island also hosts an emergent, low-elevation (+3.9–4.0 m) reef with corals in growth position below a notch (+4.2 m). The corals are dated to 3.9–3.1 ka. The occurrence of this young, emergent reef is likely not due to tectonic uplift; instead, it is interpreted to be the result of glacial isostatic adjustment processes after the end of the last glacial period. Our findings are consistent with similar observations on tectonically stable or slowly uplifting islands elsewhere in the equatorial Pacific Ocean and agree with numerical models of a higher-than-present Holocene sea level in this region due to glacial isostatic adjustment processes.
Autoimmune encephalitis: the clinical evolution as a key to the diagnosis
Authors: Teixeira Sara , Caldeira Santos Joana , Vila Real Marta , Santos Fátima
Published: September 2019

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a devastating disease, that despite being increasingly diagnosed, there are no consensus guidelines for the optimal management. A previously healthy 3-year-old-boy brought to the emergency department due to seizures. Neurological examination was normal, and electroencephalogram (EEG) suggested focal epilepsy. Anticonvulsive medication was initiated. He progressively lost age-appropriate language skills, presented behavioural changes and psychiatric symptoms. Neurological examination at that time revealed symmetric gross motor weakness of the lower limbs. Brain and spinal cord MRI and cerebrospinal fluid were normal. Repeated EEG showed global lentification. Steroid therapy was initiated for the suspicion of autoimmune encephalitis, later confirmed as NMDAR encephalitis. He became clinically improved after 10 days of treatment but only returned to his baseline after 3 months of disease onset. The authors emphasised the variable course of the disease and possible late response to treatment.
Split thickness skin graft in active psoriasis in patient with clear cell variant squamous cell carcinoma
Authors: Scupham Lisa , Ingle Atul
Published: September 2019

The case report discusses split thickness skin grafting in a patient with active psoriasis. This also reports a case of a rare variant of squamous cell carcinoma.
Chronic thrombotic microangiopathy secondary to antiphospholipid syndrome, presenting with severe hypertension and chronic renal impairment
Authors: Yee Yucai , Angkodjojo Stanley , Tan Puay Hoon
Published: September 2019

A 42-year-old woman was referred from a primary care centre for severe hypertension, stage 3A chronic kidney disease and proteinuria. This was associated with a significant obstetric history of pre-eclampsia during her previous two pregnancies. Secondary hypertension was suspected and autoimmune workup was positive for anticardiolipin IgG and lupus anticoagulant. A renal biopsy showed evidence of chronic thrombotic microangiopathy, with electron microscopy features suggestive of fibrillar glomerulonephritis. The diagnosis of antiphospholipid syndrome with antiphospholipid-associated nephropathy was made. She was started on anticoagulation with warfarin, and her hypertension was controlled with lisinopril and amlodipine with subsequent improvement in proteinuria. She remains on regular follow-up to monitor for possible development of malignancy or connective tissue disease.
Low-cost, smartphone-based frequency doubling technology visual field testing using a head-mounted display
Authors: Alawa Karam AlRahman , Nolan Ryan P , Han Elaine , Arboleda Alejandro , Durkee Heather , Sayed Mohamed S , Aguilar Mariela C , Lee Richard K
Published: September 2019

Background

Current visual field screening machines are bulky and expensive, limiting their accessibility, affordability and use. We report the design and evaluation of a novel, portable, cost-effective system for glaucoma screening using smartphone-based visual field screening using frequency doubling technology (FDT) and a head-mounted display.

Methods

Nineteen eyes of 10 subjects with new-onset or chronic primary open angle glaucoma were tested and compared with the Humphrey Zeiss FDT and the newly developed Mobile Virtual Perimetry (MVP) FDT with the C-20 testing pattern. Mann-Whitney, Bland-Altman and linear regression analyses were performed to assess statistical difference, agreement and correlation, respectively, between the two devices.

Results

The average age of the participants was 58±15 years. No statistically significant difference was found between the MVP FDT and the Humphrey Zeiss FDT (p>0.05). Bland-Altman and linear regression analyses demonstrated good agreement and correlation between the two devices.

Conclusion

The MVP FDT is a low-cost, portable visual field screening device that produces comparable results to the Humphrey Zeiss FDT and may be used as an easily accessible screening tool for glaucoma.
Can clinical audits be enhanced by pathway simulation and machine learning? An example from the acute stroke pathway
Authors: Allen Michael , Pearn Kerry , Monks Thomas , Bray Benjamin D , Everson Richard , Salmon Andrew , James Martin , Stein Ken
Published: September 2019

Objective

To evaluate the application of clinical pathway simulation in machine learning, using clinical audit data, in order to identify key drivers for improving use and speed of thrombolysis at individual hospitals.

Design

Computer simulation modelling and machine learning.

Setting

Seven acute stroke units.

Participants

Anonymised clinical audit data for 7864 patients.

Results

Three factors were pivotal in governing thrombolysis use: (1) the proportion of patients with a known stroke onset time (range 44%–73%), (2) pathway speed (for patients arriving within 4 hours of onset: per-hospital median arrival-to-scan ranged from 11 to 56 min; median scan-to-thrombolysis ranged from 21 to 44 min) and (3) predisposition to use thrombolysis (thrombolysis use ranged from 31% to 52% for patients with stroke scanned with 30 min left to administer thrombolysis). A pathway simulation model could predict the potential benefit of improving individual stages of the clinical pathway speed, whereas a machine learning model could predict the benefit of ‘exporting’ clinical decision making from one hospital to another, while allowing for differences in patient population between hospitals. By applying pathway simulation and machine learning together, we found a realistic ceiling of 15%–25% use of thrombolysis across different hospitals and, in the seven hospitals studied, a realistic opportunity to double the number of patients with no significant disability that may be attributed to thrombolysis.

Conclusions

National clinical audit may be enhanced by a combination of pathway simulation and machine learning, which best allows for an understanding of key levers for improvement in hyperacute stroke pathways, allowing for differences between local patient populations. These models, based on standard clinical audit data, may be applied at scale while providing results at individual hospital level. The models facilitate understanding of variation and levers for improvement in stroke pathways, and help set realistic targets tailored to local populations.
Monthly variance in UK renal transplantation activity: a national retrospective cohort study
Authors: Lowe Marcus , Maidstone Robert , Poulton Kay , Worthington Judith , Durrington Hannah J , Ray David W , van Dellen David , Asderakis Argiris , Blaikley John , Augustine Titus
Published: September 2019

Objective

To identify whether renal transplant activity varies in a reproducible manner across the year.

Design

Retrospective cohort study using NHS Blood and Transplant data.

Setting

All renal transplant centres in the UK.

Participants

A total of 24 270 patients who underwent renal transplantation between 2005 and 2014.

Primary outcome

Monthly transplant activity was analysed to see if transplant activity showed variation during the year.

Secondary outcome

The number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates.

Results

Analysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity.

Conclusion

UK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system.
Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study
Authors: Mooney John F , Croal Bernard L , Cassidy Sean , Lee Vincent W , Chow Clara K , Cuthbertson Brian H , Hillis Graham S
Published: September 2019

Objective

Renal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients.

Design

A prospective cohort study.

Setting

Regional cardiothoracic centre in Northeast Scotland.

Participants

1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded.

Primary outcome measure

All-cause mortality, established from the National Records of Scotland.

Results

The median duration of follow-up after surgery was 9.7 years (IQR 8.9–10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR.

Conclusions

Cystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest.
Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol
Authors: Wangdahl Josefin M , Dahlberg Karuna , Jaensson Maria , Nilsson Ulrica
Published: September 2019

Introduction

Equity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual’s knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.

The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers’ Health literacy and eHealth literacy levels in Sweden.

Methods and analysis

This is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.

This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ2and Fisher’s exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.

Ethics and dissemination

The project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.
Mortality and cause of death in South Korean patients with Parkinson’s disease: a longitudinal follow-up study using a national sample cohort
Authors: Choi Hyo Geun , Lim Jae-Sung , Lee Young Kyung , Sim Songyong , Kim Miyoung
Published: September 2019

Objective

The incidence rate of Parkinson’s disease (PD) is growing rapidly owing to the ageing population. We investigated the mortality rates and causes of death in South Korean patients with PD.

Design

We investigated a national cohort using the nationwide insurance database.

Setting

Korean Health Insurance Review and Assessment Service—National Sample Cohort database.

Participants

We included 3510 participants ≥60 years of age who were diagnosed with PD between 2002 and 2013, as well as 14 040 matched controls.

Interventions

None

Primary and secondary outcome measures

A stratified Cox proportional hazards model was used to evaluate patients with PD who were matched 1:4 with non-PD control subjects adjusted for age, sex, income and region of residence. The causes of death were grouped into 12 classifications.

Results

The adjusted HR for mortality in the PD group was 2.09 (95% CI 1.94 to 2.24, p<0.001). Subgroup analysis according to age (<70 years, 70–79 years, and ≥80 years) and sex revealed that patients with PD showed higher adjusted HRs for mortality across all subgroups. Mortalities caused by metabolic, mental, neurologic, circulatory, respiratory, and genitourinary diseases, as well as trauma, were more common in the PD group than in the control group, with the highest OR observed in patients with neurologic disease.

Conclusions

We demonstrated that PD in South Korean patients ≥60 years of age was associated with increased mortality in both sexes regardless of age.
A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation
Authors: Mai Linlin , Wu Yu , Luo Jianjing , Liu Xinyue , Zhu Hailan , Zheng Haoxiao , Liang Guoquan , Zhang Yan , Huang Yuli
Published: September 2019

Objective

To examine the real-world patterns of oral anticoagulant (OAC) therapy in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) in Southern China undergoing percutaneous coronary intervention (PCI) and determine the clinical characteristics associated with OAC prescription.

Design

A retrospective cohort study.

Setting

This study was conducted in the Shunde Hospital, Southern Medical University and the second hospital of Zhaoqing, China, from January 2013 to 31 December 2018.

Participants

Patients were aged ≥18 years, hospitalised for ACS and received PCI treatment.

Outcome measures

AF was diagnosed based on an ECG recording or a Holter monitor. Prescription of OACs and antiplatelets were determined from the discharge medication list.

Results

A total of 3612 patients with ACS were included: 286 (7.9%) were diagnosed with AF, including 45 (1.2%) with paroxysmal AF, 227 (6.3%) with persistent/permanent AF and 14 (0.4%) with unclassified AF. Although 95.5% of patients with AF were at high risk (CHA2DS2-VASc score ≥2) of stroke, only 21.7% of them were discharged on OACs (10.5% received warfarin and 11.2% received non-vitamin K antagonist OACs). Patients with pre-admission use of OAC, a HAS-BLED score <3, with persistent/permanent AF were more likely to receive OAC treatment at discharge.

Conclusion

We found that approximately 8% of patients who underwent PCI during ACS hospitalisation also demonstrated AF. Anticoagulant therapy was greatly underused. Patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment. Further efforts should be made to increase the adherence to guideline recommendations for OACs.
Antibiotics for COPD exacerbations: does drug or duration matter? A primary care database analysis
Authors: Stolbrink Marie , Bonnett Laura J , Blakey John D
Published: September 2019

Introduction

Antibiotics are routinely given to people with chronic obstructive pulmonary disease (COPD) presenting with lower respiratory tract infection (LRTI) symptoms in primary care. Population prescribing habits and their consequences have not been well-described.

Methods

We conducted a retrospective analysis of antibiotic prescriptions for non-pneumonic exacerbations of COPD from 2010 to 2015 using the UK primary care Optimum Patient Care Research Database. As a proxy of initial treatment failure, second antibiotic prescriptions for LRTI or all indications within 14 days were the primary and secondary outcomes, respectively. We derived a model for repeat courses using univariable and multivariable logistic regression analysis.

Results

A total of 8.4% of the 9042 incident events received further antibiotics for LRTI, 15.5% further courses for any indication. Amoxicillin and doxycycline were the most common index and second-line drugs, respectively (58.7% and 28.7%), mostly given for 7 days. Index drugs other than amoxicillin, cardiovascular disease, pneumococcal vaccination and more primary care consultations were statistically significantly associated with repeat prescriptions for LRTI (p<0.05). The ORs and 95% CIs were: OR 1.28, 95% CI 1.10 to 1.49; OR 1.37, 95% CI 1.13 to 1.66; OR 1.33, 95% CI 1.14 to 1.55 and OR 1.05, 95% CI 1.02 to 1.07, respectively. Index duration, inhaled steroid use and exacerbation frequency were not statistically significant. The derived model had an area under the curve of 0.61, 95% CI 0.59 to 0.63.

Discussion

The prescription of multiple antibiotic courses for COPD exacerbations was relatively common—one in twelve patients receiving antibiotics for LRTI had a further course within 2 weeks. The findings support the current preference for amoxicillin as index drug within the limitations of this observational study. Further clinical trials to determine best practice in this common clinical situation appear required.
Alternative to the finger in the dike: use of the vascular closure button to control postdialysis bleeding in a haemodialysis access conduit
Authors: Sacchetti Alfred , Hennessey Adam , Shannon Brian
Published: September 2019

Objective

The purpose of this case series is to describe the application of a vascular closure button (VCB) for the repair of haemodialysis access bleeding. The VCB’s main function is not to assist in bleeding control, but instead to provide easy access for removal of tightly placed sutures in the repair.

Methods

A retrospective review of patients undergoing ED repair of persistent bleeding from puncture sites in haemodialysis access conduits (HACs) using a VCB was conducted. Study patients were collected from ED visits to Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, between May 2013 and August 2017. Patients were followed until the time of definitive repair of the underlying pathology or until the end of the study period.

Results

Seventeen VCBs were used to control persistent bleeding from HACs in the ED. Sixteen bleeds were the result of recent haemodialysis punctures, while one was from a bleeding site ulcer. All repairs were successful at controlling the bleeding with preserved HAC function in the ED and no delayed thrombosis. Follow-up time ranged from 1 day to 778 days.

Conclusion

Vascular control buttons provide an effective means to control HAC postdialysis bleeding and allow for ease of suture removal without disruption of a repair with no long-term complications.
Endovascular management of acute postprocedural flow diverting stent thrombosis
Authors: Townsend Robert Kyle , Wolfe Stacey Q , Anadani Mohammad , Spiotta Alejandro , De Leacy Reade , Mocco J , Garner Rebecca M , Albuquerque Felipe C , Ducruet Andrew F , Kan Peter , Fargen Kyle M
Published: September 2019

Introduction

Postprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported.

Methods

A multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure.

Results

A total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0–83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0–2) at 3 months were achieved in 88% of patients.

Conclusion

Acute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1–2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.
Legal authorized representative experience with smartphone-based electronic informed consent in an acute stroke trial
Authors: Haussen Diogo C , Craft Leah , Doppelheuer Shannon , Rodrigues Gabriel Martins , Al-Bayati Alhamza R , Ravindran Krishnan , Schultz Meagan , Sutherly Loretta , Schindler Kiva M , Frankel Michael R , Nogueira Raul G
Published: September 2019

Background

The pilot use of a smartphone platform for electronic informed consent (e-Consent) in large vessel occlusion acute stroke (LVOS) trials has recently been reported. The degree of satisfaction from Legal Authorized Representatives (LARs) with regard to this process remains to be established.

Methods

A single-center study evaluating the experience of LARs with the use of e-Consent in a LVOS randomized trial of an investigational drug administered within 12 hours of last known normal was carried out. A structured survey was used to evaluate the experience of the LARs with the e-consenting process.

Results

From February to November 2018, 60 consecutive patients were e-Consented. Of these, 53 LARs completed the survey. The median (IQR) age of the patients was 63 (53–70) years, baseline/discharge National Institutes of Health Stroke Scale score was 17 (12–20)/3(1–12), and 45% were independent at discharge. The survey was applied in person in 43% of cases and via telephone in 57%. Median LAR age was 48 (39–59) years, 64% were female, and a multi-ethnic composition was observed. Forty percent of LARs had less than tertiary level of education (high-school or less). Regarding the e-Consent, 98% of LARs reported to be ‘clear’ and 83% felt ‘very comfortable’ in signing. The overall experience was ‘excellent/good’ in 91%. Despite the positive general impression regarding the use of e-Consent, 12 LARs (22%) would have preferred paper consent. Multivariable regression indicated that lower educational status (tertiary education or less: OR 5.09, 95% CI 1.02 to 25.48; p=0.04) and lower baseline ASPECTS score (OR 0.63, 95% CI 0.41 to 0.96; p=0.03) were independently associated with preference for paper consent.

Conclusions

e-Consent was overall very well perceived by LARs in a randomized clinical trial of LVOS. A minority of proxies, who were more commonly less formally educated, would have preferred paper consenting.
Paratuberculosis in dairy goat flocks from southern Spain: risk factors associated with seroprevalence
Authors: Barrero‐Domínguez Belén , Luque Inmaculada , Huerta Belen , Gomez‐Laguna Jaime , Galán‐Relaño Ángela , Gómez‐Gascón Lidia , Sánchez Manuel , Astorga Rafael Jesus
Published: September 2019

Background

Paratuberculosis (PTB) is a chronic, enteric wasting disease of ruminants caused by Mycobacterium avium subspecies paratuberculosis (MAP), with a worldwide distribution. Andalusia, located in southern Spain, is one of the European regions with the highest goat census and the highest milk production; however, current data on the prevalence of MAP in this species are not available.

Methods

A cross‐sectional study was performed to determine the seroprevalence and risk factors associated with PTB in dairy goat flocks from southern Spain. A total of 3312 serum samples were collected from 48 flocks located in three different geographical areas. Health and productive parameters were surveyed during the visit to the herds.

Results

A total of 511 goats were seropositive, with overall true seroprevalence of 22.54 per cent (95 per cent confidence interval (CI95) 21.12–23.97). Of the goat herds, 87.50 per cent (CI9578.14–96.98) were seropositive. The intraherd seroprevalence was 25.43±31.71, distributed as follows: 22 flocks with a seroprevalence under 10 per cent; 18 flocks between 10 per cent and 50 per cent; and eight flocks with a frequency over 50 per cent. Multivariate logistic regression showed significant association between PTB seropositivity and the following variables: intensive production system, lack of management by batches, inappropriate ventilation and seropositivity to c aprine a rthritis e ncephalitis v irus ( CAEV ).

Conclusions

The results indicate a widespread PTB infection in goat herds in southern Spain. Thus, control programmes must include management and sanitary measures to reduce the prevalence. Further experimental studies are necessary to determine the influence of CAEV‐PTB coinfection on immune status.
Influence of sex gap on muscle strength and functional mobility in patients with cystic fibrosis
Authors: Martínez-García María del M. , Rodríguez-Juan Juan J. , Ruiz-Cárdenas Juan D.
Published: September 2019

The objectives of this study were to determine whether there were differences in handgrip strength and functional mobility between patients with cystic fibrosis (CF) and healthy controls with regard to sex and to ascertain whether these differences were related to lung function. Thirty-eight patients with CF (21 women) and 38 healthy controls aged 18–65 years were included. Muscle weakness and functional mobility were assessed through handgrip strength; walking speed; and time, velocity, and power derived from a single sit-to-stand (STS) test. Patients with CF showed differences for STS variables and walking speed but not for handgrip strength, compared with healthy controls. Considering sex differences, female patients showed differences for all variables analyzed while males with CF only exhibited differences for STS variables, compared with healthy controls. Females with CF showed moderate relationship between muscle weakness, functional mobility, and lung function (|r| = 0.45–0.49; p ≤ 0.05) whereas no relationships were observed for males with CF. The influence of chronic infection with Pseudomonas aeruginosa and pancreatic insufficiency on muscle weakness and functional mobility was similar in both sexes. Differences in muscle strength and functional mobility were predominantly observed in females with CF. These results suggest an important effect of sex gap on muscle weakness and functional mobility in patients with CF.

Novelty The influence of sex gap on muscle weakness in CF has been shown. Muscle weakness was predominantly observed in females with CF.
Study of horseradish peroxidase and hydrogen peroxide bi-analyte sensor with boronate affinity-based molecularly imprinted film
Authors: Yang Shaoming , Bai Chaopeng , Teng Yu , Zhang Jian , Peng Jiaxi , Fang Zhili , Xu Wenyuan
Published: September 2019

A novel electrochemical horseradish peroxidase (HRP) sensor was developed based on boronate affinity-based electropolymerized polythionine (PTh) molecularly imprinted polymer (MIP) as specific recognition element for HRP on gold nanoparticles (AuNPs) modified glassy carbon electrode, in which PTh acted as the electrochemical probe for the sensor. The sensor was characterized by scanning electron microscopy and electron dispersive spectroscopy. Electrochemical impedance spectroscopy, cyclic voltammetry, and differential pulse voltammetry were exploited for the study of the properties of the MIP sensor. The MIP sensor exhibited excellent linear response over the range of 2.0 × 10−10 mg/mL ∼ 1.0 × 10−7 mg/mL for HRP. In addition, with MIP film as HRP immobilized matrices, the sensor for the detection of H2O2 was developed with the MIP sensor based on the reduction of H2O2 catalyzed by HRP in the presence of electron mediator PTh. The sensor showed linear relationships between the current response and H2O2 concentration from 6.0 × 10−7 to 2.0 × 10−5 mol/L. HRP and H2O2 bi-analyte sensor based on MIP film was successfully developed in this work. The developed method can also be applicable for enzyme and its enzymatic substrate bi-analyte sensor.
High power RF operations studies at TARLA facility
Authors: Karsli Ozlem , Aksoy Avni , Kaya Caglar , Koc Burak , Dogan Mustafa , Elcim O. Faruk , Bozdogan Mehmet
Published: September 2019

Turkish Accelerator and Radiation Laboratory (TARLA) is a facility capable of accelerating an electron beam up to 40 MeV. Two beamlines were proposed to generate free-electron laser radiation and bremsstrahlung. The accelerator employs two normal conducting cavities, so-called buncher cavities: subharmonic buncher (SHB) and fundamental buncher (FB), and two cryomodules that house two TESLA cavities each. SHB operates in 260 MHz and FB in 1.3 GHz, and is powered by 1.5 kW and 500 W radio frequency (RF) amplifiers, respectively. Each TESLA cavity is driven by 18 kW saturated high-power solid-state amplifiers (SSA). In addition, a L band pulse compressor system is designed and implemented at the facility to actively promote high-power RF research. Currently, setup of a resonant ring test bench is approved to test the RF components under high power RF conditions. This paper describes the TARLA high power RF, RF controller, and network structures. High power tests and measurements of the RF components of the TARLA beamline are given. Outcomes from the operation of the L band pulse compressor are explained, and the resonant ring test stand is stated as a summary.
A FRACTAL PERMEABILITY MODEL FOR POROUS–FRACTURE MEDIA WITH THE TRANSFER OF FLUIDS FROM POROUS MATRIX TO FRACTURE
Authors: MIAO TONGJUN , CHEN AIMIN , XU YAN , CHENG SUJUN , YU BOMING
Published: September 2019

The transfer of fluids from porous matrix to fracture is a key issue to accurately predict the fluid flow behavior in porous–fracture media. In this work, to take into account the transfer of fluids, the analytical model of dimensionless permeability is proposed based on the fractal geometry theory for porous media. The proposed model is expressed as a function of microstructural parameters of the porous matrix and fracture, such as the pore area fractal dimension [Formula: see text], fractal dimension [Formula: see text] for tortuosity of tortuous capillaries, the ratio [Formula: see text] of the maximum pore size in porous matrix to fracture aperture, as well as the ratio [Formula: see text] of the pressure difference along the fracture to that along the porous matrix layers. The model reveals that the ratios [Formula: see text] and [Formula: see text] have significant influences on the permeability contribution from the porous matrix to the seepage behavior of the fracture. While the contribution of porosity of leak-wall porous surface of the fracture to the permeability is less than 10%. The present results may provide an important theoretical foundation for exploration of petroleum, gas and geothermal energy extraction systems.
Mining Changes in Temporal Patterns in Latest Time Window for Knowledge Discovery
Authors: Shalini Sheel , Lal Kanhaiya
Published: September 2019

Temporal Association Rule mining uncovers time integrated associations in a transactional database. However, in an environment where database is regularly updated, maintenance of rules is a challenging process. Earlier algorithms suggested for maintaining frequent patterns either suffered from the problem of repeated scanning or the problem of larger storage space. Therefore, this paper proposes an algorithm “Probabilistic Incremental Temporal Association Rule Mining (PITARM)” that uncovers the changed behaviour in an updated database to maintain the rules efficiently. The proposed algorithm defines two support measures to identify itemsets expected to be frequent in the successive segment in advance. It reduces unnecessary scanning of itemsets in the entire database through three-fold verification and avoids generating redundant supersets and power sets from infrequent itemsets. Implementation of pruning technique in incremental mining is a novel approach that makes it better than earlier incremental mining algorithms and consequently reduces search space to a great extent. It scans the entire database only once, thus reducing execution time. Experimental results confirm that it is an enhancement over earlier algorithms.
Negative Tone in Lobbying the International Accounting Standards Board
Authors: Shields Karin , Clacher Iain , Zhang Qi
Published: September 2019

With the aid of computerized sentiment analysis, this paper analyzes the role of constituents’ comment letters in the process of setting international financial reporting standards for financial instruments. Whilst explicit agreement in comment letters is associated with the board’s decision to proceed with its proposed course of action, we find no consistent evidence that explicitly stated disagreement has an impact on the resulting accounting standard. Using context-specific dictionaries, we find that increased levels of negative tone in comment letters increase the probability of the board subsequently abandoning a proposed course of action. Capturing dissent through negative tone facilitates large-scale analysis, and we show that the financial industry has been less successful than other constituents in its lobbying efforts through comment letters.
Heritage stones in India
Authors: Sharma Vinod K.
Published: September 2019

India has a great variety of natural stones that have been extensively used as dimension, ornamental and sculptural stone for numerous temples and monuments over many centuries. These temples and monuments, now heritage sites, have a major role in showcasing India's natural stone resources that occur in diverse geological formations of different geological systems across the Indian subcontinent. The formations contain a variety of stone, with colours and textures produced by varied geological processes thus providing a storehouse of diverse stone resources. This paper outlines four potential Global Heritage Stone Provinces where natural stones have been used in heritage monuments: the North and Northwestern Province, the Central and Western Peninsular Province, the Southern Peninsular Province and the Eastern and Northeastern Province. The geotechnical and aesthetic characteristics of the stones, and their response to weathering are discussed.
The Biochemical Markers Associated with the Occurrence of Coronary Spasm
Authors: Li Liang , Jin Yong-Ping , Xia Shu-Dong , Feng Chao
Published: September 2019

Coronary artery spasm (CAS) is one of the mechanisms of angina pectoris. Unlike the diagnosis of acute myocardial infarction which is based on the elevation of cardiac markers, the diagnosis of CAS is difficult and sometimes requires sophisticated and risky provocative test which is not widely accepted in China. There is no well-established biomarker for the diagnosis or prediction of CAS. However, there are some biomarkers proven to be associated with the occurrence of CAS. For example, inflammatory factors including C-reactive protein and cytokines, lipoprotein (a), and cystatin-C might be precipitating factor for CAS. Rho-kinase as a mediator involved in multiple mechanisms of CAS, serotonin, and endothelin-1 as powerful vasoconstrictors leading to vasospasm were all observed being elevated in patients with CAS. Thioredoxin and nitrotyrosine reflected the oxidative status and could be observed to be elevated after the occurrence of CAS. In some cases doubted to be CAS without the evidence of provocative test, the blood test for the biomarkers mentioned above could be useful for the diagnosis of CAS.
Short-Term High-NaCl Dietary Intake Changes Leukocyte Expression of VLA-4, LFA-1, and Mac-1 Integrins in Both Healthy Humans and Sprague-Dawley Rats: A Comparative Study
Authors: Mihalj Martina , Matić Anita , Mihaljević Zrinka , Barić Lidija , Stupin Ana , Drenjančević Ines
Published: September 2019

This study is aimed at assessing the effects of a short-term high-salt (HS) diet on the peripheral blood leukocyte (PBL) activation status in healthy rats and young human individuals. Distribution of PBL subpopulations and surface expression of integrins were determined using flow cytometry in 36 men and women on a 7-day low-salt diet (<3.2 g salt/day) immediately followed by a 7-day HS diet (~14 g salt/day) or in Sprague-Dawley (SD) rats (n=24) on a 0.4% NaCl diet (aLS group) or a 4% NaCl diet (aHS group) for 7 days. The aHS group presented with an increased frequency of granulocytes, while the frequency of lymphocytes was reduced. Although in humans HS diet reduced the expression of CD11b(act) integrin on lymphocytes, the frequency of CD11b(act)-bearing cells among all PBL subsets was increased. The aHS group of rats exhibited increased expression of total CD11b/c in granulocytes and CD3 lymphocytes. The expression of CD11a was significantly reduced in all PBL subsets from human subjects and increased in the aHS group. CD49d expression on all PBL subsets was significantly decreased in both humans and rats. In human subjects, we found reduced frequencies of intermediate monocytes accompanied by a reciprocal increase in classical monocytes. Present results suggest that a short-term HS diet can alter leukocytes’ activation status and promote vascular low-grade inflammation.
Diverse Effects of Lysophosphatidic Acid Receptors on Ovarian Cancer Signaling Pathways
Authors: Onallah Hadil , Davidson Ben , Reich Reuven
Published: September 2019

Lysophosphatidic acid (LPA) is a bioactive phospholipid with mitogenic and growth factor-like activities affecting cell invasion, cancer progression, and resistance. It is produced mainly by autotaxin and acts on six G-protein-coupled receptors, LPAR1-6. LPA has recently been implicated as a growth factor present in ascites of ovarian cancer patients. However, mitogenic pathways stimulated by LPA via its receptors may involve any novel, thus far uncharacterized, signaling pathway(s). Here we show that three LPA receptors are involved in tumor progression by activation of both the AKT and ERK signaling pathways. CRISPR-edited LPAR2 and LPAR3 knockouts have opposing effects on ERK activation, whereas LPAR6 is involved in the activation of AKT, affecting cell migration and invasion. Our study identifies specific molecular machinery triggered by LPA and its receptors that modulates tumor cells and can serve as therapeutic target in this malignancy.
Changes in Estimated Glomerular Filtration after Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
Authors: Darocha Szymon , Banaszkiewicz Marta , Pietrasik Arkadiusz , Siennicka Anna , Piorunek Mateusz , Grochowska Emilia , Piłka Michał , Dobosiewicz Anna , Florczyk Michał , Pietura Radosław , Torbicki Adam , Kurzyna Marcin
Published: September 2019

Background: Balloon pulmonary angioplasty (BPA) is a novel treatment option for inoperable or persistent chronic thromboembolic pulmonary hypertension (CTEPH). Little is known about renal function in CTEPH patients undergoing BPA. Objectives: The aim of this study was to assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with CTEPH undergoing BPA and to evaluate the relationship between hemodynamic and renal function. Methods: A total of 41 CTEPH patients were included and 250 consecutive BPA sessions were analyzed for frequency of CI-AKI. The serum creatinine (SC) concentration was measured and the glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease equation before and 72 h after each BPA procedure. CI-AKI was defined as an increase of 25% or 0.5 mg/dL in SC from the baseline value within 48–72 h of contrast administration. SC and GFR were assessed before and after 3–6 months of completing the BPA treatment and correlated with hemodynamic parameters. Results: The SC concentration and GFR did not change significantly within 72 h after BPA (+1%, p = 0.921, and +4%, p = 0.112, respectively). CI-AKI was noted in 2 cases (0.8%). Significant improvement was noted in GFR (75.4 ± 21.2 vs. 80.9 ± 22.4 mL/min/1.73 m2; p = 0.012) in addition to improvement in right atrial pressure (RAP; 9.1 ± 4.1 to 5.0 ± 2.2 mm Hg; p < 0.001), mean pulmonary artery pressure (49.1 ± 10.7 to 29.8 ± 8.3 mm Hg; p < 0.001), cardiac index (CI; 2.42 ± 0.6 to 2.70 ± 0.6 L/min/m2; p = 0.004), and pulmonary vascular resistance (9.42 ± 3.6 to 4.4 ± 2.3 Wood units; p < 0.001). In a subpopulation of 12 patients with impaired renal function at baseline, the relative increase in GFR was significantly correlated with relative improvement in CI (r = 0.060; p = 0.037), RAP (r = –0.587; p = 0.044), and mixed venous saturation (r = 0.069; p = 0.012). Conclusions: Hemodynamically effective BPA procedures improve renal function in patients with CTEPH with a minimal risk of CI-AKI in the course of treatment.