bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of male social environment on sperm phenotype and genome integrity
Authors: Silva Willian T. A. F. , Sáez‐Espinosa Paula , Torijo‐Boix Stéphanie , Romero Alejandro , Devaux Caroline , Durieux Mathilde , Gómez‐Torres María José , Immler Simone
Published: February 2019

Sperm function and quality are primary determinants of male reproductive performance and hence fitness. The presence of rival males has been shown to affect ejaculate and sperm traits in a wide range of taxa. However, male physiological conditions may not only affect sperm phenotypic traits but also their genetic and epigenetic signatures, affecting the fitness of the resulting offspring. We investigated the effects of male‐male competition on sperm quality using TUNEL assays and geometric morphometrics in the zebrafish, Danio rerio. We found that the sperm produced by males exposed to high male–male competition had smaller heads but larger midpiece and flagellum than sperm produced by males under low competition. Head and flagella also appeared less sensitive to the osmotic stress induced by activation with water. In addition, more sperm showed signals of DNA damage in ejaculates of males under high competition. These findings suggest that the presence of a rival male may have positive effects on sperm phenotypic traits but negative effects on sperm DNA integrity. Overall, males facing the presence of rival males may produce faster swimming and more competitive sperm but this may come at a cost for the next generation.
Improving the flavor of microbone meal with Flavourzyme by response surface method
Authors: Zhang Yin , Zhang Longyi , Venkitasamy Chandrasekar , Guo Siya , Pan Zhongli , Ke Huan , Tang Huan , Huang Weiming , Zhao Liming
Published: February 2019

To improve the flavor of microbone meal, Flavourzyme was adopted to hydrolyze the meal and the hydrolysis conditions were optimized with the response surface method. The ANOVA results showed that the degree of hydrolysis (DH) of the microbone meal was significantly (p < 0.05) influenced by the amount of enzyme and hydrolysis time. In addition, the bitter and umami tastes of the microbone meal were significantly (p < 0.05) influenced by hydrolysis time and amount of enzyme, respectively. The optimization results showed that the optimal hydrolysis conditions were a Flavourzyme amount of 10.36%, hydrolysis temperature of 59.60°C, hydrolysis time of 5.84 hr, and pH of 7.75. The corresponding DH, bitter, and umami taste of the hydrolysate were 4.11%, 0.80 cent, and 1.90 cent, respectively. Characteristic volatile flavor compounds of the hydrolysate indicated that the Flavourzyme hydrolysis increased the meaty flavor of the microbone meal.

Practical applications

The obvious fishy smell and less meaty taste limited the microbone meal being mainly used in feeds. To broaden the applications of microbone meal in other fields, the Flavourzyme was adopted to improve its flavor. The Flavourzyme hydrolysis conditions were optimized with response surface method. The obtained hydrolysis conditions will benefit not only future investigations of animal bone by‐products applications, but also bone meal related product development. We believe that our findings could be of interest to meat related research units and enterprises by virtue of providing an alternative flavor improvement processing for bone meal application.
Incidence of Lower‐Extremity Fractures in US Nursing Homes
Authors: Sine Kathryn , Lee Yoojin , Zullo Andrew R. , Daiello Lori A. , Zhang Tingting , Berry Sarah D.
Published: February 2019

BACKGROUND/OBJECTIVES

Limited studies suggest lower‐extremity (LE) fractures are morbid events for nursing home (NH) residents. Our objective was to conduct a nationwide study comparing the incidence and resident characteristics associated with hip (proximal femur) vs nonhip LE (femoral shaft and tibia‐fibula) fractures in the NH.

DESIGN

Retrospective cohort study.

SETTING

US NHs.

PARTICIPANTS

We included all long‐stay residents, aged 65 years or older, enrolled in Medicare from January 1, 2008, to December 31, 2009 (N = 1 257 279). Residents were followed from long‐stay qualification until the first event of LE fracture, death, or end of follow‐up (2 years).

MEASUREMENTS

Fractures were classified using Medicare diagnostic and procedural codes. Function, cognition, and medical status were obtained from the Minimum Data Set prior to long‐stay qualification. Incidence rates (IRs) were calculated as the total number of fractures divided by person‐years.

RESULTS

During 42 800 person‐years of follow‐up, 52 177 residents had an LE fracture (43 695 hip, 6001 femoral shaft, 2481 tibia‐fibula). The unadjusted IRs of LE fractures were 1.32/1000 person‐years (95% confidence interval [CI] = 1.27‐1.38) for tibia‐fibula, 3.20/1000 person‐years (95% CI = 3.12‐3.29) for femoral shaft, and 23.32/1000 person‐years (95% CI = 23.11‐23.54) for hip. As compared with hip fracture residents, non‐hip LE fracture residents were more likely to be immobile (58.1% vs 18.4%), to be dependent in all activities of daily living (31.6% vs 10.8%), to be transferred mechanically (20.5% vs 4.4%), to be overweight (mean body mass index = 26.6 vs 24.0 kg/m2), and to have diabetes (34.8% vs 25.7%).

CONCLUSIONS

Our findings that non‐hip LE fractures often occur in severely functionally impaired residents suggest these fractures may have a different mechanism of injury than hip fractures. The resident differences in our study highlight the need for distinct prevention strategies for hip and non‐hip LE fractures.
A pilot evaluation of an advocacy programme on knowledge, empowerment, family–school partnership and parent well‐being
Authors: Burke M. M. , Lee C. E. , Rios K.
Published: February 2019

Background

Internationally, it has been recognised that parents need to advocate for their children with disabilities to receive services. However, many parents find advocacy difficult because of systemic and logistical barriers. As such, parents of children with disabilities may seek a special education advocate to help them understand their child's rights and secure services. Yet little research has been conducted about programmes to develop special education advocates.

Methods

In this study, we conducted a comparison study to determine the association of an advocacy programme (i.e. the Volunteer Advocacy Project) on a primary outcome (i.e. special education knowledge) and other outcomes (i.e. family–school partnership, empowerment and parent well‐being). Specifically, in 2017, 34 participants, all mothers of children with disabilities, were recruited from disability organisations in the USA. Seventeen mothers participated in the intervention group (i.e. the advocacy training), while 17 mothers participated in the wait list control group. The Volunteer Advocacy Project is a 36 hr advocacy training for individuals to gain instrumental and affective knowledge to advocate for their own children with disabilities and for other families. All participants completed a pre‐survey and post‐survey; only intervention group participants completed a 6‐month follow‐up survey.

Results

Compared with 17 wait list control group participants, the 17 intervention group participants demonstrated improvements in special education knowledge, P = 0.002, η2 = 0.32, and self‐mastery, P = 0.04, η2 = 0.15, and decreases in the quality of family–school partnerships, P = 0.002, η2 = 0.32. At the follow‐up survey, intervention group participants demonstrated increases in empowerment, P = 0.04, η2 = 0.29, and special education knowledge, P = 0.02, η2 = 0.38.

Conclusions

Implications for research including the need for a randomised controlled trial are discussed; also, practitioners need to evaluate advocacy training programmes regarding their effectiveness.
Electoral Reform and Parliamentary Debates
Authors: Høyland Bjørn , Søyland Martin G.
Published: February 2019

The early twentieth century saw many democracies adopt proportional representative systems. The textbook explanation, pioneered by Rokkan, emphasize between‐party electoral competition; the rise of the Socialist vote share made Bourgeois parties prefer PR systems to maximize their seat share. While appealing, this account is not entirely compelling. Consequently, scholars are investigating within‐party explanations of support for such reforms. Particularly, Cox, Fiva, and Smith show how list PR enable party leaders to discipline members and build cohesive parties. Relying on roll‐call votes across the Norwegian 1919 electoral reform from two‐round single‐member plurality to closed‐list PR, they show that the internal party cohesion increased following the reform. We investigate how the Norwegian electoral reform changed the content of parliamentary speeches. Comparing speeches from MPs present both before and after the reform, we show how parties become more cohesive in parliamentary debates under list PR than they were under the single‐member‐district system.
Entanglements in Health and Well‐being: Working with Model Organisms in Biomedicine and Bioscience
Authors: Friese Carrie , Latimer Joanna
Published: February 2019

Drawing on collaborative ethnographic fieldwork, this article explores how human health becomes entangled with that of model organisms in day‐to‐day biomedical science. Social science scholarship on modeling has exploredeitherhow specific models impact and shape our knowledge of human diseaseorhow animal technicians and scientists affect laboratory animals. This article extends this relational approach by asking how embodied and institutional care practices for model organisms affect the health and well‐being of animal technicians and scientists. We focus on two interspecies bodily experiences: pathogenic exchange and stress. We then explore enrichment as a strategy for producing health and well‐being across species. We suggest that relations of care form a crucial part of biomedical knowledge production. Not only does care figure in the shaping of model organisms; care for technicians and scientists also plays a role in bioscientific knowledge production. We conclude by proposing an interspecies approach to occupational health.
Encoder–decoder network for pixel‐level road crack detection in black‐box images
Authors: Bang Seongdeok , Park Somin , Kim Hongjo , Kim Hyoungkwan
Published: February 2019

Timely monitoring of pavement cracks is essential for successful maintenance of road infrastructure. Accurate information concerning crack location and severity enables proactive management of the infrastructure. Black‐box cameras, which are becoming increasingly widespread at an affordable price, can be used as efficient road‐image collectors over a wide area. However, the cracks in these images are difficult to detect, because the images containing them often include objects other than roads. Thus, we propose a pixel‐level detection method for identifying road cracks in black‐box images using a deep convolutional encoder–decoder network. The encoder consists of convolutional layers of the residual network for extracting crack features, and the decoder consists of deconvolutional layers for localizing the cracks in an input image. The proposed network was trained on 427 out of 527 images extracted from black‐box videos and tested on the remaining 100 images. Compared with VGG‐16, ResNet‐50, ResNet‐101, ResNet‐200 with transfer learning, and ResNet‐152 without transfer learning, ResNet‐152 with transfer learning exhibited the best performance, achieving recall, precision, and intersection of union of 71.98%, 77.68%, and 59.65%, respectively. The experimental results prove that the proposed method is optimal for detecting cracks in black‐box images at the pixel level.
Negotiation Contexts: How and Why They Shape Women's and Men's Decision to Negotiate
Authors: Reif Julia A. M. , Kunz Fiona A. , Kugler Katharina G. , Brodbeck Felix C.
Published: February 2019

In the substantial body of research on gender differences in the initiation of negotiation, the findings consistently favor men (Kugler et al., 2018). We propose that this research itself is gendered because negotiation research has traditionally focused on masculine negotiation contexts. In the current study, we replicate the gender effect in initiating negotiations (favoring men) and provide an empirically based selection of “masculine,” “feminine,” and “neutral” negotiation contexts, which can be used for future negotiation research. We show that the negotiation context shapes gender differences such that in specific social contexts, women tend to have even higher initiation intentions compared to men. Negotiation contexts generally seem to differ regarding their affordance to negotiate. We offer a possible explanation for gender effects on initiation intentions by uncovering the mediating role of expectancy considerations across all negotiation contexts, especially in masculine contexts, and instrumentality considerations in specific masculine and feminine contexts.
Genetic diversity in Dactylorhiza majalis subsp. majalis populations (Orchidaceae) of northern Poland
Authors: Naczk Aleksandra M. , Ziętara Marek S.
Published: February 2019

We analysed 16 populations of Dactylorhiza majalis subsp. majalis from northern Poland, simultaneously utilizing both morphological and molecular data. Genetic differentiation was examined using five microsatellite loci, and morphological variation was assessed for 23 characters. At the species level, our results showed a moderate level of genetic diversity (A = 6.00; Ae = 1.86; Ho = 0.387; FIS = 0.139) which varied between the studied populations (A = 2.60–4.20; Ae = 1.68–2.39; Ho = 0.270–0.523; FIS = −0.064–0.355). A significant excess of homozygotes was detected in five population, while excess of heterozygotes was observed in four populations, but the latter values were statistically insignificant. Moderate, but clear between population genetic differentiation was found (FST = 0.101; p < 0.001). Considering pairwise‐FST and number of migrants among populations, we recognized three population groups (I, II, III), where the first could be further divided into two subgroups (Ia, Ib). These three groups differed with respect to gene flow values (Nm = 0.39–1.12). The highest number of migrants per generation was noticed among populations of subgroup Ia (8.58), indicative of a central panmictic population with free gene flow surrounded by peripatric local populations (Ib) with more limited gene flow. Geographic isolation, habitat fragmentation and limited seed dispersal are inferred to have caused limitations to gene flow among the three indicated population groups. There was a significant correlation between the morphological and genetic distance matrices. A weak but significant pattern of isolation by distance was also observed (r = 0.351; p < 0.05).
Rapid plant diversification in the Andes does not require flowers
Authors: Lagomarsino Laura P.
Published: February 2019

This article is a Commentary on Testo et al., 222: 604–613.
Exploitation of the gall: adaption of Agrobacterium to the host metabolome
Authors: Woodcock Stuart Daniel , Malone Jacob George
Published: February 2019

This article is a Commentary on Gonzalez‐Mula et al., 222: 455–467.
The bZIP73 transcription factor controls rice cold tolerance at the reproductive stage
Authors: Liu Citao , Schläppi Michael R. , Mao Bigang , Wang Wei , Wang Aiju , Chu Chengcai
Published: February 2019

Cold temperature during the reproductive stage often causes great yield loss of grain crops in subtropical and temperate regions. Previously we showed that the rice transcription factor bZIP73Jap plays an important role in cold adaptation at the seedling stage. Here we further demonstrate that bZIP73Jap also confers cold stress tolerance at the reproductive stage. bZIP73Jap was up‐regulated under cold treatment and predominately expressed in panicles at the early binucleate and flowering stages. bZIP73Jap forms heterodimers with bZIP71, and co‐expression of bZIP73Jap and bZIP71 transgenic lines significantly increased seed‐setting rate and grain yield under natural cold stress conditions. bZIP73Jap:bZIP71 not only repressed ABA level in anthers, but also enhanced soluble sugar transport from anthers to pollens and improved pollen grain fertility, seed‐setting rate, and grain yield. Interestingly, bZIP73Jap:bZIP71 also regulated the expression of qLTG3‐1Nip, and qLTG3‐1Nip overexpression lines greatly improved rice tolerance to cold stress during the reproductive stage. Therefore, our work establishes a framework for rice cold stress tolerance through the bZIP71‐bZIP73Jap‐qLTG3‐1Nip‐sugar transport pathway. Together with our previous work, our results provide a powerful tool for improving rice cold stress tolerance at both the seedling and the reproductive stages.
Dermoscopic findings of umbilical granuloma
Authors: Ancer‐Arellano Jesus , Argenziano Giuseppe , Villarreal‐Martinez Alejandra , Cardenas‐de la Garza Jesus A. , Villarreal‐Villarreal Cesar D. , Ocampo‐Candiani Jorge
Published: February 2019

Dermoscopic findings in umbilical granuloma are vascular polymorphism comprised of linear irregular and arborizing vessels with structureless areas distributed over a milky‐red background. The increase of angiogenesis and neovascularization is represented by the linear irregular and arborizing vessels. Structureless areas over an irregularly milky‐red background are originated by the proliferation of vascular endothelial cells and fibroblasts, with capillary and granulation tissue formation.
Targeted next generation sequencing of pancreatic solid pseudopapillary neoplasms show mutations in Wnt signaling pathway genes
Authors: Wang Jayson , Gerrard Gareth , Poskitt Ben , Dawson Kay , Trivedi Pritesh , Foroni Letizia , El‐Bahrawy Mona
Published: February 2019

Solid pseudopapillary neoplasms of the pancreas are rare neoplasms that have been shown to harbor recurrent somatic pathogenic variants in the beta‐catenin gene, CTNNB1. Here, we used targeted next generation sequencing to analyze these tumors for other associated mutations. Six cases of solid pseudopapillary neoplasms were studied. DNA extracted from formalin‐fixed paraffin embedded tissue blocks was analyzed using the Ion Torrent platform, with the 50‐gene Ampliseq Cancer Hotspot Panel v2 (CHPv2), with further variant validation performed by Sanger sequencing. Four tumors (67%) were confirmed to harbor mutations within CTNNB1, two with c.109T > G p.(Ser37Ala) and two with c.94G > A p.(Asp32Asn). One case showed a frameshift deletion in the Adenomatous Polyposis Coli gene, APC c.3964delG p.(Glu1322Lysfs*93) with a variant allele frequency of 42.6%. Sanger sequencing on non‐tumoral tissue confirmed the variant was somatic. The patient with the APC mutation developed metastasis and died. In addition to the four cases harboring CTNNB1 variants, we found a case characterized by poor outcome, showing a rare frameshift deletion in the APC gene. Since the APC product interacts with beta‐catenin, APC variants may, in addition to CTNNB1, contribute to the pathogenesis of solid pseudopapillary neoplasms via the Wnt signaling pathway.
Innovation by Heterogeneous Leaders*
Authors: Iwaisako Tatsuro , Ohki Kazuyoshi
Published: February 2019

We develop a Schumpeterian growth model in which leaders and followers conduct research and development (R&D) activities and in which leaders have different‐sized quality leads over their followers, and thus have different profit flows. We show that leaders with larger quality leads make smaller R&D investments; this result is consistent with the actual behaviors of some previous leader firms, such as Sony and Eastman–Kodak. Moreover, we show that subsidizing the R&D of followers can promote the aggregate R&D of leaders, because promotion of followers' R&D decreases (increases) the number of leaders with larger (smaller) quality leads and smaller (larger) R&D investments.
Novel heterocyclic chitosan‐based Schiff base: evaluation as adsorbent for removal of methyl orange from aqueous solution
Authors: Manchaiah A.S. , Badalamoole V.
Published: February 2019

A Schiff base has been made by reacting chitosan with 2‐hydroxy quinoline‐3‐carbaldehyde in the presence of acetic acid. The synthesized compound was characterized by FTIR, TGA, XRD and SEM techniques. The Schiff base was evaluated for removal of anionic dye from aqueous solution using methyl orange as model dye. Influences of initial dye concentration, pH and contact time on the extent of adsorption were investigated. The adsorption data fits best with Freundlich isotherm model and the maximum adsorption capacity was found to be 55.55 mg/g. The kinetic study indicated second‐order adsorption. The thermodynamic parameters showed the adsorption to be endothermic and non‐spontaneous. Desorption studies indicated the reusability of the compound as adsorbent material.
Modeling Multiphase Effects in CO2 Compressors at Subcritical Inlet Conditions
Authors: Hosangadi Ashvin , Liu Zisen , Weathers Timothy , Ahuja Vineet , Busby Judy
Published: February 2019

An advanced numerical framework to model CO2 compressors over a wide range of subcritical conditions is presented in this paper. Thermodynamic and transport properties are obtained through a table look-up procedure with specialized features for subcritical conditions. Phase change is triggered by the difference between the local values of pressure and saturation pressure, and both vaporization and condensation can be modeled. Rigorous validation of the framework is presented for condensation in high pressure CO2 using test data in a De Laval nozzle. The comparisons between computations and test data include: condensation onset locations, Wilson line, and nozzle pressure profiles as a function of inlet pressures. The framework is applied to the Sandia compressor that has been modeled over broad range of conditions spanning the saturation dome including: near critical inlet conditions (305.4 K, and 7.843 MPa), pure liquid inlet conditions (at 295 K), pure vapor inlet conditions (at 302 K), and two-phase inlet conditions (at 290 K). Multiphase effects ranging from cavitation at the liquid line to condensation at the vapor line have been simulated. The role of real fluid effects in enhancing multiphase effects at elevated temperatures closer to the critical point has been identified. The performance of the compressor has been compared with test data; the computational fluid dynamics (CFD) results also show that the head-flow coefficient curve collapses with relatively minor scatter, similar to the test data, when the flow coefficient is defined on the impeller exit meridional velocity.
Studies on solid state reactions of atomic layer deposited thin films of lithium carbonate with hafnia and zirconia
Authors: Mäntymäki Miia , Atosuo Elisa , Heikkilä Mikko J. , Vehkamäki Marko , Mattinen Miika , Mizohata Kenichiro , Räisänen Jyrki , Ritala Mikko , Leskelä Markku
Published: February 2019

In this paper, results on the solid state reactions of atomic layer deposited Li2CO3 with HfO2 and ZrO2 are reported. An Li2CO3 film was deposited on top of hafnia and zirconia, and the stacks were annealed at various temperatures in air to remove the carbonate and facilitate lithium diffusion into the oxides. It was found that Li+ ions are mobile in hafnia and zirconia at high temperatures, diffusing to the film–substrate interface and forming silicates with the Si substrate during heating. Based on grazing incidence x-ray diffraction experiments, no changes in the oxide phases take place during this process. Field emission scanning electron microscopy images reveal that some surface defects are formed on the transition metal oxide surfaces during lithium diffusion. The authors also show that lithium can diffuse through hafnia and react with a potential lithium-ion battery electrode material TiO2 residing below the HfO2 layer, forming Li2TiO3.
Evaluating hospital soundscapes to improve patient experience
Authors: Bliefnick Jay M. , Ryherd Erica E. , Jackson Rebecca
Published: February 2019

Hospital soundscapes can be difficult environments to assess acoustically due to alarms, medical equipment, and the continuous activity within units. Routinely, patients perceive these soundscapes to be poor when rating their hospital experience on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys administered after discharge. In this study, five hospital units of widely varying HCAHPS “quietness” performance were analyzed. Sound pressure levels were measured in 15 patient rooms and 5 nursing stations over 24-h periods. HCAHPS “quietness of the hospital environment” patient survey data were correlated with measured acoustical data at a room-level, revealing acoustical metrics linked to patient perceptions of hospital soundscape conditions. Metrics found to be statistically correlated (p < 0.05) included the absolute LAMIN levels in patient rooms, which found significantly higher HCAHPS quietness scores in units with average LAMIN levels below 35 dBA, in addition to specific low frequency octave bands and occurrence rates. Many other standard acoustical metrics (such as LAEQ, LAMAX, LCPEAK, and LA90) were not found to be statistically correlated between measured acoustical data and HCAHPS quietness patient responses. Taken as a whole, this study provides insights into the potential relationships between hospital noise and patient satisfaction.
Immune checkpoint inhibitor-induced rheumatoid arthritis: insights into an increasingly common aetiology of polyarthritis
Authors: Kwok Timothy Shun Him , Bell Mary Jane
Published: February 2019

Nivolumab is an immune checkpoint inhibitor that is used in the treatment of a variety of cancers in the adjuvant or metastatic setting. Adverse effects include non-specific activation of T cells, leading to immune-related adverse events in downstream organs. We present a case of a 36-year-old man with unresectable oropharyngeal squamous cell carcinoma who developed nivolumab-induced rheumatoid arthritis. As immune checkpoint inhibitor use is becoming widespread in the medical oncology domain, the purpose of this case report is to increase awareness of an increasingly common cause of rheumatic disease and to alert clinicians to consider immunotherapy in their differential diagnosis of polyarthritis. This case also highlights the importance of working in an interdisciplinary manner to enhance cancer care for the patient as well as to increase awareness of the potential adverse effects of immunotherapy in patients with cancer.
Uveal melanoma incidence trends in Canada: a national comprehensive population-based study
Authors: Ghazawi Feras M , Darwich Rami , Le Michelle , Rahme Elham , Zubarev Andrei , Moreau Linda , Burnier Julia Valdemarin , Sasseville Denis , Burnier Miguel N , Litvinov Ivan V
Published: February 2019

Background

In the developed countries, uveal melanoma is the most common primary intraocular malignancy in adults. Little is known about the epidemiological and geographical distribution of uveal melanoma in Canada.

Methods

To determine the incidence patterns and geographical distribution of uveal melanoma cases in Canada, we conducted the first comprehensive, population-based national study of this malignancy across all Canadian provinces and territories during 1992–2010 years. We examined two independent population-based registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer using corresponding International Classification of Diseases for Oncology-3rd edition codes for all histological subtypes of uveal melanoma.

Results

We report that 2215 patients were diagnosed with uveal melanoma, of which 52.1% were males. The average -annual incidence rate of uveal melanoma in Canada was 3.75 cases per million individuals per year (95% CI 3.60 to 3.91). Overall, we report a steady increase in uveal melanoma incidence with an annual increase of 0.074 cases per million individuals per year. Significant differences in the incidence rates of uveal melanoma between Canadian provinces and territories were noted, where the highest crude incidence was in British Columbia and Saskatchewan with rates of 6.38 and 5.47 cases per million individuals per year, respectively.

Conclusions

This work, for the first time, defines the disease burden of uveal melanoma in Canada and highlights important longitudinal, geographical and spatial differences in the distribution of uveal melanoma in Canada.
Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects
Authors: Garrity Sean T , Jung Joo Yeon , Zambrowski Olivia , Pichi Francesco , Su Daniel , Arya Malvika , Waheed Nadia K , Duker Jay S , Chetrit Yaïr , Miserocchi Elisabetta , Giuffrè Chiara , Kaden Talia R , Querques Giuseppe , Souied Eric H , Freund K Bailey , Sarraf David
Published: February 2019

Background/Aims

Hydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.

Methods

Data from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.

Results

Seventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.

Conclusion

Patients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.
Darkroom prone provocative testing in primary angle closure suspects and those with open angles
Authors: Friedman David S , Chang Dolly Shuo-Teh , Jiang Yuzhen , Huang Shengsong , Kong Xiangbin , Munoz Beatriz , Aung Tin , Foster Paul J , He Mingguang
Published: February 2019

Purpose

To describe the results of darkroom prone provocative testing (DRPPT) in primary angle closure suspects (PACS) and to compare the findings to controls with open angles.

Methods

889 subjects with PACS in the Zhongshan Angle Closure Prevention Trial (a randomised controlled trial to compare prophylactic laser iridotomy to no treatment in PACS) and 89 with open angles in the 5-year follow-up of Liwan Eye Study were placed in a darkroom face down for 15 min. Intraocular pressure (IOP) was measured immediately before and after DRPPT.

Results

PACS participants were of similar age than controls (59.3 vs 60.5), more often female (82.9% vs 58.4%) and had lower IOP (14.3 vs 15.2 mm Hg). The average IOP increases after DRPPT was 4.3±3 mm Hg in PACS and 5.2±2.8 in controls (p<0.05). 20.5% of controls and 13.9 % of those with PACS developed an IOP spike ≥8 mm Hg after DRPPT (p<0.05). Among PACS, 15.8 % of those with all four quadrants closed had an IOP elevation of ≥ 8 mm Hg as opposed to 10.0%–12.4 % with two or three closed quadrants (p<0.05). DRPPT failed to predict who would reach a clinical trial endpoint over 6-year follow-up of those with PACS.

Conclusions

A modified DRPPT failed to separate PACS from those with open angle. Although the test resulted in greater IOP elevation among those PACS participants with all four quadrants closed than in those with two or three closed quadrants, it did not offer any insight into the risk of developing acute or chronic angle closure disease over 6-year follow-up.
Prospective randomised clinical trial of intravitreal bevacizumab versus triamcinolone in eyes with diabetic macular oedema undergoing cataract surgery: 6-month results
Authors: Kandasamy Rathika , Constantinou Marios , Rogers Sophie L , Sandhu Sukhpal Singh , Wickremasinghe Sanjeewa , Al-Qureshi Salmaan , Lim Lyndell L
Published: February 2019

Aim

To report the 6-month results of a clinical trial that compared intravitreous bevacizumab (BVB) 1.25 mg versus triamcinolone acetonide (TA) 4 mg when administered as an adjunct during cataract surgery to patients with diabetic macular oedema (DMO).

Methods

Prospective, double-masked, single-centre (Royal Victorian Eye and Ear Hospital, Melbourne) clinical trial. Patients with visually significant cataract and centre-involving DMO (either current or prior) were randomised (1: 1) to receive either intravitreous BVB 1.25 mg or TA 4 mg at the time of cataract surgery and if required at review. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to the 6-month time point of this 12-month study.

Results

61 eyes of 58 patients were enrolled. At baseline, both groups were similar in terms of BCVA and CMT (p>0.2). At 6 months, there was no significant difference in vision between the groups, with mean letter gain of +21.4 (95% CI +14.5 to +28.4) in the TA group and +17.3 (95% CI +12.1 to +22.6) in the BVB group (p=0.35). The TA group had a significant sustained anatomical improvement at 6 months, with a reduction in CMT (−51.4 µm; 95% CI −98.2 to -4.7) compared with thickening in the BVB group (+15.6 µm; 95% CI −26.4 to +57.7, p=0.04).

Conclusions

When given as an adjunct to cataract surgery, both TA and BVB improved visual outcomes at 6 months postoperatively. However, only TA resulted in sustained improvement in CMT, with the majority not requiring any further treatment postoperatively.
Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
Authors: Mavropoulou Eirini , Ternes Kristin , Mechie Nicolae-Catalin , Bremer Sebastian Christopher Benjamin , Kunsch Steffen , Ellenrieder Volker , Neesse Albrecht , Amanzada Ahmad
Published: February 2019

Background

Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.

Methods

A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.

Results

The sensitivity of quantitative PCR (qPCR) with a cut-off value of >250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and >2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and >2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.

Conclusions

In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.
Novel mainstream capnometer system is safe and feasible even under CO2insufflation during ERCP-related procedure: a pilot study
Authors: Takimoto Yoichi , Iwasaki Eisuke , Masaoka Tatsuhiro , Fukuhara Seiichiro , Kawasaki Shintaro , Seino Takashi , Katayama Tadashi , Minami Kazuhiro , Tamagawa Hiroki , Machida Yujiro , Ogata Haruhiko , Kanai Takanori
Published: February 2019

Background and aims

There is a need to safely achieve conscious sedation during endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the safety and feasibility of a mainstream capnometer system to monitor apnoea during ERCP under CO2insufflation.

Methods

Non-intubated adult patients undergoing ERCP-related procedures with intravenous sedation were enrolled. End-tidal CO2(EtCO2) was continuously monitored during the procedure under CO2insufflation using a mainstream capnometer system, comprising a capnometer and a specially designed bite block for upper gastrointestinal endoscopy and ERCP. Oxygen saturation (SpO2) was also monitored continuously during the procedure. In this study, we evaluated the safety and feasibility of the capnometer system.

Results

Eleven patients were enrolled. Measurement of EtCO2concentration was possible from the beginning to the end of the procedure in all 11 cases. There was no measurement failure, dislocation of the bite block, or adverse event related to the bite block. Apnoea linked to hypoxaemia occurred five times (mean duration, 174.4 s).

Conclusion

This study confirmed that apnoea was detected earlier than when using a percutaneous oxygen monitor. Measurement of EtCO2concentration using the newly developed mainstream capnometer system was feasible and safe even under CO2insufflation.
GPs’ views and experiences of managing patients with personality disorder: a qualitative interview study
Authors: French Lydia , Moran Paul , Wiles Nicola , Kessler David , Turner Katrina M
Published: February 2019

Objective

The aim of this study was to explore GPs’ views and experiences of managing patients with personality disorder (PD), and their views on the role of the Improving Access to Psychological Therapies (IAPT) programme as a support service.

Design

In-depth interviews, analysed thematically.

Participants

Fifteen GPs (7 women and 8 men) of varying age and clinical experience, working in practices that differed in terms of the socio-demographic characteristics of their patient populations.

Setting

Twelve general practices based in the West of England, UK.

Results

GPs described patients with PD as being challenging to work with and that this work required dedicated time and care. They described experiencing particular difficulty with monitoring their patient’s mental health, as well as having little knowledge about the efficacy or availability of treatments for their attenders with PD. They were aware that this patient population often experienced poor mental health and reported a propensity for them to fall into the gap between primary and secondary mental health services, leaving GPs with little choice but to improvise their own management plans, which occasionally involved funding third-sector treatment options. In terms of IAPT services’ role in managing these patients, GPs wanted shorter waiting times, better inter-agency communication, more highly trained therapists and more treatment options for patients with PD. They also wanted the service to be able to ‘hold’ patients with PD in treatment over a longer period than currently offered.

Conclusions

Findings suggest that, overall, GPs did not consider National Health Service mental health services to offer an effective treatment for patients with PD. While they considered the IAPT programme to be a valuable service for patients with less complex mental health needs, such as depression and anxiety; they felt that the current service provision struggled to meet the needs of patients with more complex mental health needs, as exemplified by people with PD.
Cardiovascular risk factors and disease among non-European immigrants living in Catalonia
Authors: Cainzos-Achirica Miguel , Vela Emili , Cleries Montse , Bilal Usama , Mauri Josepa , Pueyo Maria Jesus , Rosas Alba , Enjuanes Cristina , Blaha Michael J , Kanaya Alka M , Comin-Colet Josep
Published: February 2019

Objective

To describe the prevalence and incidence of cardiovascular risk factors, established cardiovascular disease (CVD) and cardiovascular medication use, among immigrant individuals of diverse national origins living in Catalonia (Spain), a region receiving large groups of immigrants from all around the world, and with universal access to healthcare.

Methods

We conducted a population-based analysis including >6 million adult individuals living in Catalonia, using the local administrative healthcare databases. Immigrants were classified in 6 World Bank geographic areas: Latin America/Caribbean, North Africa/Middle East, sub-Saharan Africa, East Asia and South Asia. Prevalence calculations were set as of 31 December 2017.

Results

Immigrant groups were younger than the local population; despite this, the prevalence of CVD risk factors and of established CVD was very high in some immigrant subgroups compared with local individuals. South Asians had the highest prevalence of diabetes, and of hyperlipidemia among adults aged <55 years; hypertension was highly prevalent among sub-Saharan Africans, and obesity was most common among women of African and South Asian ancestry. In this context, South Asians had the highest prevalence of coronary heart disease across all groups, and of heart failure among women. Heart failure was also highly prevalent in African women.

Conclusions

The high prevalence of risk factors and established CVD among South Asians and sub-Saharan Africans stresses the need for tailored, aggressive health promotion interventions. These are likely to be beneficial in Catalonia, and in countries receiving similar migratory fluxes, as well as in their countries of origin.
Making sure you’re compliant with tax legislation when locuming
Authors: Sweeney Ben
Published: February 2019

If you’re a vet or vet nurse who is locuming, it is important to do your research and make sure that you are compliant with IR35 tax legislation. Here, we look at what IR35 is and why it is important to all of us, both as services providers and for the practices we work for.
Blocked cats and limited finances: an ethical obstruction?
Authors: Williams David
Published: February 2019

This series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Blocked cats and limited finances: an ethical obstruction?’, was submitted and is discussed by David Williams. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.

The series is being coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings
Authors: Miller Bradley S , Spencer Sandra P , Geffner Mitchell E , Gourgari Evgenia , Lahoti Amit , Kamboj Manmohan K , Stanley Takara L , Uli Naveen K , Wicklow Brandy A , Sarafoglou Kyriakie
Published: February 2019

Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient's HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient's home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.
Chance to cut: defining a negative exploration rate in patients with suspected necrotizing soft tissue infection
Authors: Howell Erin C , Keeley Jessica A , Kaji Amy H , Deane Molly R , Kim Dennis Y , Putnam Brant , Lee Steven L , Woods Alexis L , Neville Angela L
Published: February 2019

Background

Necrotizing soft tissue infections (NSTI) are aggressive infections associated with significant morbidity and mortality. Despite multiple predictive models for the identification of NSTI, a subset of patients will not have an NSTI at the time of surgical exploration. We hypothesized there is a subset of patients without NSTI who are clinically indistinguishable from those with NSTI. We aimed to characterize the differences between NSTI and non-NSTI patients and describe a negative exploration rate for this disease process.

Methods

We conducted a retrospective review of adult patients undergoing surgical exploration for suspected NSTI at our county-funded, academic-affiliated medical center between 2008 and 2015. Patients were identified as having NSTI or not (non-NSTI) based on surgical findings at the initial operation. Pathology reports were reviewed to confirm diagnosis. The NSTI and non-NSTI patients were compared using χ2test, Fisher’s exact test, and Wilcoxon rank-sum test as appropriate. A p value <0.05 was considered significant.

Results

Of 295 patients undergoing operation for suspected NSTI, 232 (79%) were diagnosed with NSTI at the initial operation and 63 (21%) were not. Of these 63 patients, 5 (7.9%) had an abscess and 58 (92%) had cellulitis resulting in a total of 237 patients (80%) with a surgical disease process. Patients with NSTI had higher white cell counts (18.5 vs. 14.9 k/mm3, p=0.02) and glucose levels (244 vs. 114 mg/dL, p<0.0001), but lower sodium values (130 vs. 134 mmol/L, p≤0.0001) and less violaceous skin changes (9.2% vs. 23.8%, p=0.004). Eight patients (14%) initially diagnosed with cellulitis had an NSTI diagnosed on return to the operating room for failure to improve.

Conclusions

Clinical differences between NSTI and non-NSTI patients are subtle. We found a 20% negative exploration rate for suspected NSTI. Close postoperative attention to this cohort is warranted as a small subset may progress.

Level of evidence

Retrospective cohort study, level III.