bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful kidney transplantation in a small child with end‐stage renal disease due to angiotensin receptor blocker fetopathy and atretic inferior vena cava
Authors: Geha John A. , Geha Joseph D. , Goss Matthew , Kueht Michael L. , Cotton Ronald T. , Rana Abbas , Goss John A. , Bhakta Kirti , Swartz Sarah J. , O'Mahony Christine A. , Brewer Eileen D. , Galvan Nhu T. N.
Published: June 2019

Kidney transplantation is the treatment of choice in pediatric patients with end‐stage renal disease. This population presents technical challenges particularly in those less than 20 kg due to anomalous anatomy, vascular access issues prior to transplantation, and a generally small size for age. Standard allograft outflow is usually achieved utilizing the iliac veins or IVC. When use of the iliocaval system is not feasible, alternative anastomosis must be considered. Herein, we report a case of a pediatric kidney transplantation where successful allograft outflow was achieved using the SMV when he was found to have an atretic IVC intraoperatively. In this setting, use of the portal system was required to achieve adequate allograft outflow. We created a donor iliac graft for added length to anastomose the renal vein with the SMV. In the setting of IVC occlusion with poor drainage, we utilized a patent vessel with larger caliber for outflow to reduce the risk of high venous pressures, allograft failure, venous rotation, and thrombosis. We conclude that the SMV may serve as an alternative outflow tract in the small pediatric patient and provides the vessel caliber needed to reduce the risks of complications.
20‐ to 25‐year patient and graft survival following a single pediatric liver transplant—Analysis of the United Network of Organ Sharing database: Where to go from here
Authors: Ekong Udeme D. , Gupta Nitika A. , Urban Read , Andrews Walter S.
Published: June 2019

To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age (P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age (P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age (P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection.
The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients
Authors: Fernandez Hilda E. , Amaral Sandra , Shaw Pamela A. , Doyle Alden M. , Bloom Roy D. , Palmer Jo Ann , Baluarte Hobart J. , Furth Susan L.
Published: June 2019

Adolescent age at time of transplant has been recognized as a risk factor for renal allograft loss. Increased risk for graft failure may persist from adolescence to young adulthood. Transfer of care is hypothesized as a risk factor for non‐adherence and graft loss. We explored whether kidney allograft function declined at an accelerated rate after transfer of care to adult transplant centers and whether coefficient of variation of tacrolimus (CV TAC) trough levels predicted allograft loss. Single‐center, retrospective chart review was performed for pediatric kidney transplant recipients who received transplants between 1999 and 2011. Change in eGFR pre‐ and post‐transfer was performed via a linear mixed‐effects model. CV TAC was calculated in transplant recipients with TAC data pre‐ and post‐transfer. t test was performed to determine the difference between means of CV TAC in subjects with and without allograft loss following transfer of care. Of the 138 subjects who transferred to adult care, 47 subjects with data pre‐ and post‐transfer demonstrated a decrease in the rate of eGFR decline post‐transfer from 8.0 mL/min/1.73 m2 per year to 2.1 mL/min/1.73 m2 per year, an ~80% decrease in eGFR decline post‐transfer (P = 0.01). Twenty‐four subjects had CV TAC data pre‐ and post‐transfer of care. Pretransfer CV TAC for subjects with allograft loss post‐transfer was significantly higher than in subjects without allograft loss (49% vs 26%, P < 0.05). Transfer of care was not independently associated with acceleration in eGFR decline. CV TAC may aid in identifying patients at risk for allograft loss post‐transfer.
Does Forecast‐Accuracy‐Based Allocation Induce Customers to Share Truthful Order Forecasts?
Authors: Pekgün Pelin , Park Minseok , Keskinocak Pınar , Janakiram Mani
Published: June 2019

Through a behavioral study, we investigate buyers’ strategic order forecasting behavior in a multi‐period setting under a forecast accuracy‐based allocation policy, where the supplier allocates (proportionally) more inventory to the buyer with the better order forecast accuracy in case of scarce supply. We developed an interactive game that simulates a supply chain in which one supplier sells a key component to two buyers, who in turn sell to consumers. In each period, buyers share forecasts of future orders with their supplier. The participants in the game play the role of a buyer, while the supplier is automated. Our experimental findings suggest that rewarding forecast accuracy in allocating inventory can significantly improve the order forecast accuracy of the buyers and reduce their forecast inflation behavior. Interestingly, even without communication of the policy, buyers learn over time that more accurate forecasts lead to better service from their supplier and improve their order forecast accuracy.
The importance of long‐term social‐ecological research for the future of restoration ecology
Authors: Wells Henry B. M. , Dougill Andrew J. , Stringer Lindsay C.
Published: June 2019

In the face of rapid environmental and cultural change, long‐term ecological research (LTER) and social‐ecological research (LTSER) are more important than ever. LTER contributes disproportionately to ecology and policy, evidenced by the greater proportion of LTER in higher impact journals and the disproportionate representation of LTER in reports informing policymaking. Historical evidence has played a significant role in restoration projects and it will continue to guide restoration into the future, but its use is often hampered by lack of information, leading to considerable uncertainties. By facilitating the storage and retrieval of historical information, LTSER will prove valuable for future restoration.
Inter‐American Court of Human Rights Advisory Opinion OC‐23/17: Jurisdictional, procedural and substantive implications of human rights duties in the context of environmental protection
Authors: Abello‐Galvis Ricardo , Arevalo‐Ramirez Walter
Published: June 2019

This case note analyses the jurisdictional, procedural and substantive implications of human rights duties in the context of environmental protection as devised by the Inter‐American Court of Human Rights in its Advisory Opinion OC‐23/17 of 15 November 2017 concerning State obligations on the environment, in the context of the rights to life and to personal integrity.
PD‐L1 detection in histology specimens and matched pleural fluid cell blocks of patients with NSCLC
Authors: Grosu Horiana B. , Arriola Aileen , Stewart John , Ma Junsheng , Bassett Roland , Hernandez Mike , Ost David , Roy‐Chowdhuri Sinchita
Published: June 2019

Background and objective

Analysis of programmed death ligand‐1 (PD‐L1) in tumour samples is necessary to identify candidates for anti‐PD‐L1/PD‐L1 therapy. Because PD‐L1 is evaluated by immunohistochemistry (IHC), an adequate amount of tumour tissue is a prerequisite for PD‐L1 testing. To examine whether pleural fluid might be an alternative to biopsy/resection specimens for IHC evaluation of PD‐L1 in patients with non‐small cell lung carcinoma (NSCLC), we compared PD‐L1 by IHC between histological specimens and matched pleural fluid.

Methods

A retrospective cohort study of patients with NSCLC who underwent core biopsy of a lung mass/surgical resection with PD‐L1 IHC and had a pleural fluid cell block (CB) available for PD‐L1 staining was conducted. PD‐L1 was categorized as negative (PD‐L1 in <1% of tumour cells), moderately positive (PD‐L1 in ≥1% to <50%), strongly positive (PD‐L1 ≥ 50) or inadequate for PD‐L1 testing (<100 tumour cells in the CB). Weighted Cohen's kappa was calculated to evaluate the agreement between PD‐L1 on biopsy/resection specimen and pleural fluid for variables with more than two categories.

Results

Of the 115 patients included in this study, 82 (71.3%) had at least 100 tumour cells and were included in the analysis. Of these, 80 (97.6%) had adenocarcinoma. For PD‐L1 of histological specimens versus pleural fluid categorized as negative, moderately positive or strongly positive, the weighted kappa statistic was 0.76 (95% CI: 0.64–0.88), and the concordance was 0.78 (95% CI: 0.68–0.86).

Conclusion

Correlation and concordance are high between PD‐L1 in histological specimens and matched pleural fluid. Evaluation of PD‐L1 in pleural fluid should be considered in patients unable to undergo histological biopsies.
Barriers to finding and maintaining open employment for people with intellectual disability in Australia
Authors: Meltzer Ariella , Robinson Sally , Fisher Karen R.
Published: June 2019

Everyone has the right to employment. Work is important for health, well‐being, and social, economic, and financial inclusion. However, it is often difficult for people with intellectual disability to find and maintain work, especially in the open labour market. Policy challenges remain about who can access open employment (also sometimes called competitive or supported employment) and how often people with intellectual disability do so. Greater understanding about the barriers that people with intellectual disability encounter when they try to find and keep work in open employment is needed.

Drawing on research with 51 people with intellectual disability in Australia, this paper examines the systemic barriers they report to finding and maintaining work in open employment. The findings highlight that the barriers they experience stem from narrow, dismissive, and discouraging attitudes to their work in open employment and from a spectrum of experiences of stigma and discrimination in open workplaces. The paper thus provides new knowledge about reasons that people with intellectual disability may either reject or not continue in open employment and take up less inclusive work options. The paper discusses the implications of the findings, including the need for policy development for attitudinal change, designing more varied roles for employees with intellectual disability, ensuring access to industrial relations protections, and increasing and better regulating and funding requirements on support to people with intellectual disability who are seeking work in open employment.
Triassic stretching directions in Iberia and North Africa inferred from magnetic fabrics
Authors: Soto Ruth , Casas‐Sainz Antonio M. , Oliva‐Urcia Belén , García‐Lasanta Cristina , Izquierdo‐Llavall Esther , Moussaid Bennacer , Kullberg José Carlos , Román‐Berdiel Teresa , Sánchez‐Moya Yolanda , Sopeña Alfonso , Torres‐López Sara , Villalaín Juan José , El‐Ouardi Hamidou , Gil‐Peña Inmaculada , Hirt Ann M.
Published: June 2019

During the Triassic, Iberia and western North Africa displayed a unique situation in relation with the Central and North Atlantic opening and westward expansion of the Tethys. Unravelling the stretching direction in Triassic deposits of the studied area can help in our understanding of this scenario. The tectonic setting is characterized by localized basins with strong thickness variations greatly influenced by previous post‐Variscan mechanical discontinuities. In this work, we revise and compile magnetic fabric data from eight Triassic depocentres in terms of defining the stretching direction (i.e. magnetic lineation), resulting from extensional deformation of this period. Data show the importance of the opening of the Atlantic rift as the leading process during the Triassic. Dextral transtension can explain the deflection of the extensional direction observed in most studied depocentres that is caused by the activity of previous major oblique faults.
Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients
Authors: Kallon Delordson , Navarrete Cristina V. , Sage Deborah A. , Stanworth Simon , Mufti Ghulam J. , Marsh Judith C. W. , Brown Colin J.
Published: June 2019

Aims/Objectives

To explore the impact of Human Leucocyte Antigen (HLA)‐A and B epitope‐matched platelets on the outcome of platelet transfusions in alloimmunised patients with aplastic anaemia (AA). The relevance of HLA‐C epitope mismatches was also investigated.

Background

Patients who become immunologically refractory (IR) to random platelet transfusions can experience an adequate rise in platelet count through the provision of HLA‐compatible platelets using an antigen‐matching algorithm. This approach has been shown to be effective in patients with a low calculated reaction frequency, but it is not always successful in highly sensitised patients. The use of HLA epitopes‐selected platelets has been suggested as an alternative to the antigen matching approach.

Methods

The effect of HLA epitope matching (both Eplets and Triplets) on the outcome of platelet transfusion was analysed in 37 highly immunised AA patients previously transfused with HLA‐A and B antigen‐matched platelets. Epitope matching was determined using the HLAMatchmaker programme. The outcome of the transfusions was assessed by the platelet count increments (PCIs) obtained 1 and 24 hours post‐transfusions.

Results

HLA‐A and B epitope matching was equivalent to HLA antigen matching in raising platelet counts. There was no significant difference in PCI when HLA‐C epitope mismatches were considered. In addition, transfusions with fewer than two antigen mismatches resulted in significantly higher PCIs compared to transfusions with more than two antigen mismatches.

Conclusions

HLA epitope‐matched platelet provision may represent a clinically effective transfusion strategy for patients IR to random platelet transfusions. Further prospective studies are required.
Migration and servicification: Do immigrant employees spur firm exports of services?
Authors: Hatzigeorgiou Andreas , Lodefalk Magnus
Published: June 2019

Services play an increasingly important role in production, employment and international trade but are subject to substantially higher trade costs relative to manufactured goods. Knowledge of how these trade costs can be mitigated is important for facilitating trade of services. In this paper, we analyse the role of immigrant employees as facilitators of firm exports of services, a role that remains largely unexamined. We bridge the gap in existing research by drawing on new data for nearly 30,000 Swedish firms during the period 1998–2007 within a heterogeneous firm framework. The results have important policy implications. As the multilateral approach to facilitating trade is challenged and more countries are imposing measures to restrict the cross‐country mobility of people, policymakers may need to find new ways to promote exports of services. Our results indicate that immigrant employees spur firms' export of services activities: hiring one additional foreign‐born worker can increase services exports by approximately 2.5 per cent, on average, with a stronger effect found for skilled and newly arrived immigrants. Therefore, policymakers could leverage the findings of this study to implement initiatives that utilise high‐skilled immigrants to promote services exports.
Mucoid Pseudomonas aeruginosa infection in a cat with severe chronic rhinosinusitis
Authors: Sharma Diya , Pakravan Natasha , Pritchard Jessica C. , Hartmann Faye A. , Young Karen M.
Published: June 2019

A 6‐year‐old male neutered Bengal cat was presented to the University of Wisconsin Veterinary Care Hospital with a history of severe chronic rhinitis that was unresolved from kittenhood. In weeks prior to presentation, the cat's upper respiratory signs had significantly worsened and a left‐sided facial swelling overlying the left frontal sinus was noted. Skull computed tomography, rhinoscopy, bilateral nasal biopsies, bacterial and fungal cultures of fluid from the left frontal sinus, and cryptococcal fungal antigen testing were performed. The cat was diagnosed with severe chronic rhinosinusitis and determined to have an infection with a mucoid variant of Pseudomonas aeruginosa (P aeruginosa). This case highlights an atypical cytomorphologic appearance of the well‐known bacterial pathogen, P aeruginosa, an appearance that could be confused cytologically with other microorganisms, such as septate fungi. Mucoid variants of P aeruginosa are often associated with progressive lung or airway disease in people with cystic fibrosis and have not been previously documented in feline respiratory tract disease. This report also presents a brief review of chronic rhinosinusitis (CRS) in cats and describes a novel interventional treatment approach to feline CRS via sinusotomy and sinus flushing for severely affected cats.
Design and Analysis of a Sixteen-Legged Vehicle With Reconfigurable Close-Chain Leg Mechanisms
Authors: Wu Jianxu , Yao Yan-an , Li Yibin , Wang Sen , Ruan Qiang
Published: June 2019

In order to exert the advantages of simplified control and integral rigidity, a novel 16-legged walking vehicle is proposed as a carrying platform based on closed-chain mechanisms. Considering the demand for mobility of one degree-of-freedom leg mechanism, we adopt the reconfigurable approach for trajectory flexibility. Serving as a walking module, the whole close-chain leg mechanism is designed to construct the walking vehicle. On the basis of kinematic analysis and sensitivity analysis, the reconfigurable leg with “gluteus maximus” is presented for increasing the obstacle-surmounting ability. In terms of the whole vehicle, the reconfiguration assignments and strategies are analyzed to satisfy the different climbing requirements. The obstacle-climbing capabilities of the legged units are evaluated through the probability analysis. In slope-climbing process, the supporting and the propelling regions for reconfiguration are discussed and obtained with two decision conditions. A series of dynamic simulations and experiments are performed to testify the walking stability, the walking speed, the steering performance, the terrain adaptability, and the obstacle-surmounting capability.
Improving student understanding of a system of identical particles with a fixed total energy
Authors: Keebaugh Christof , Marshman Emily , Singh Chandralekha
Published: June 2019

We discuss an investigation of student difficulties with whether a given total energy is possible for the system under given constraints, the possible outcomes of an energy measurement, and the probability of obtaining a particular energy if we randomly measured the energy of one particle and concepts involved in determining the number of distinct many-particle states in a system of noninteracting identical particles with a fixed total energy. The investigation was carried out in advanced quantum mechanics courses by administering free-response and multiple-choice questions and conducting individual interviews with students. We also discuss how the research was used as a guide to develop, validate, and evaluate a Quantum Interactive Learning Tutorial (QuILT), which strives to help students develop a functional understanding of the relevant concepts for a system of non-interacting identical particles with a fixed total energy. We discuss the development and validation of the identical particles QuILT and its evaluation in the undergraduate and graduate courses that focused on these issues.
Going through a phase: Infrared cameras in a teaching sequence on evaporation and condensation
Authors: Samuelsson Christopher Robin , Elmgren Maja , Xie Charles , Haglund Jesper
Published: June 2019

Phase transitions are everyday occurring phenomena, but students often find them difficult to comprehend, not least in terms of the principles of thermal physics. To be able to explain phase transitions in primary school, teachers need to understand various concepts and phenomena, such as condensation, evaporation, energy, and temperature. As energy is absorbed or released during phase transitions, changes in temperature can occur. Infrared (IR) cameras can thus be utilized to visually observe and explore surface phenomena such as condensation and evaporation. In line with the resources framework, we have designed a teaching sequence which involves both everyday experiences and observations through IR cameras, and which is designed to encourage students to leverage common resources associated with evaporation and condensation. In testing our teaching sequence, we presented three thermal phenomena to a group of pre-service teacher students. Two of these phenomena, namely, walking out of a shower and sitting in a sauna, were anchored in embodied experiences to hopefully activate the students' resources and to make the students pay attention to the thermally relevant aspects. The third phenomenon was less familiar, involving the condensation of water on a piece of paper. The result shows that the students managed to carry out the sequence with the three phenomena and applied an explanatory model across all three to consistently explain evaporation. However, the lack of a more general model of chemical bonding and an overreliance on the second law of thermodynamics seem to have acted as barriers for the students' forming of a coherent understanding of both evaporation and condensation.
An example of computer modeling to teach energy conservation concepts
Authors: Acioli Paulo H.
Published: June 2019

Energy is a concept widely used in all areas of science but its meaning is not completely understood. It is a subtle concept and a straightforward definition is not available. There have been many studies on its meaning and on the different metaphors used to describe it. The present work uses a pragmatic approach to mechanical energy and its conservation by using computer simulations inspired on the work of Chabay and Sherwood. We report the results of modifying the calculus based University Physics sequence at Northeastern Illinois University. The modifications include a revision of the laboratory activities adding computer based activities to the more traditional hands on measurements. A more substantial change was the inclusion of mini-research projects that were part of the National Science Foundation—Improving Undergraduate STEM Education (NSF-IUSE) funded project Peer Enhanced Experiential Research in STEM (PEERS). In this manuscript, we discuss a student project that helps us understand energy, energy exchanges, and energy conservation. We discuss how the chosen student project helps in the understanding on how conserving potentials can lead to apparent non-energy conservation.
Where does energy go when it's “Gone”? Promoting understanding of energy dissipation
Authors: Tobin Roger G. , Lacy Sara J. , Crissman Sally , Haddad Nick , Wentink Orlala , Seeley Lane
Published: June 2019

The principle of energy conservation cannot be fully accepted or applied in most real-world contexts without an understanding and acceptance of the idea of dissipation: when the perceptible changes in the system have stopped, the energy that was present in the beginning is still present in the system and its environment, even if it is no longer detectable. This idea is challenging for learners of all ages and presents a serious obstacle to understanding. Results from Focus on Energy, an innovative elementary-school energy curriculum, show that fourth- and fifth-grade students can engage productively with the idea of dissipation, leading to a model of energy that includes dissipation. The curriculum does not explicitly include dissipation as a learning target, but it includes early and frequent exposure to dissipative phenomena, a meaningful conceptual framework, and appropriate representational tools. These resources offer opportunities to reason about dissipation and incorporate it into the students' developing energy model. In an open-response assessment, 23% of Focus on Energy students spontaneously included dissipation in their tracking of energy in a wind-up toy, compared to 3% for students who received standard energy instruction. Adult teachers experience similar difficulties with the concept of dissipation, and results from professional development workshops show that the same curricular approach is effective with these adult learners. We suggest that if young children and adult teachers can begin to reconcile energy conservation and energy dissipation, then similar instructional approaches could enable high school and college students to engage productively with dissipation ideas.
Flow dynamics of concentrated starlike micelles: A superposition rheometry investigation into relaxation mechanisms
Authors: Jacob Alan R. , Poulos Andreas S. , Semenov Alexander N. , Vermant Jan , Petekidis George
Published: June 2019

The steady state flow of a concentrated dispersion of starlike micelles above the colloidal glass transition concentration is interrogated by superimposing a small amplitude straining motion orthogonal to the main flow direction. Strain amplitude sweeps reveal that the linear response region of the orthogonal perturbation increases with increasing flow rate, consistent with a fluidization of the materials. Orthogonal dynamic frequency sweeps (ODFSs) are obtained for a wide range of shear rates probing the full flow curve. The shear-induced fluidization of the initially glassy suspension is more clearly evidenced by the appearance of a crossover frequency ωc in ODFS, which steadily increases, reflecting a faster structural relaxation under shear. The dependence of ωc on the shear rate is sublinear and follows a power law with an exponent of 0.8. We show that the shape of the orthogonal viscoelastic spectrum changes at a critical shear rate γ˙cr, indicative of a structural relaxation modulus that changes from exponential at lower shear rates to multistep with alternating exponential and power law response at higher shear rates. We finally provide a theoretical framework which explains the observed sublinear power law dependence of the crossover frequency and relates it with the shear rate dependence of the viscosity measured by the flow curve.
Efflux-Mediated Resistance to New Oxazolidinones and Pleuromutilin Derivatives in Escherichia coli with Class Specificities in the Resistance-Nodulation-Cell Division-Type Drug Transport Pathways
Authors: Schuster Sabine , Vavra Martina , Kern Winfried V.
Published: June 2019

A major contribution of the resistance-nodulation-cell division (RND)-transporter AcrB to resistance to oxazolidinones and pleuromutilin derivatives in
Escherichia coli
was confirmed. However, we discovered significant differences in efflux inhibitor activities, specificities of the homologous pump YhiV (MdtF), and the impact of AcrB pathway mutations.
Comparison of Respiratory Specimen Collection Methods for Detection of Influenza Virus Infection by Reverse Transcription-PCR: a Literature Review
Authors: Spencer Sarah , Thompson Mark G. , Flannery Brendan , Fry Alicia
Published: June 2019

The detection of influenza virus in respiratory specimens from ill individuals is the most commonly used method to identify influenza virus infection. A number of respiratory specimen types may be used, including swabs, brush, aspirate, and wash, and specimens may be collected from numerous sites, including the anterior and posterior nasopharynx, oropharynx, and nares.
Clinical Utility of Advanced Microbiology Testing Tools
Authors: Miller Melissa B. , Atrzadeh Faranak , Burnham Carey-Ann D. , Cavalieri Stephen , Dunn James , Jones Stephen , Mathews Charles , McNult Peggy , Meduri John , Newhouse Chris , Newton Duane , Oberholzer Michael , Osiecki John , Pedersen David , Sweeney Nicole , Whitfield Natalie , Campos Joe
Published: June 2019

Advanced microbiology technologies are rapidly changing our ability to diagnose infections, improve patient care, and enhance clinical workflow. These tools are increasing the breadth, depth, and speed of diagnostic data generated per patient, and testing is being moved closer to the patient through rapid diagnostic technologies, including point-of-care (POC) technologies.
The
Aspergillus fumigatus
Mucin MsbA Regulates the Cell Wall Integrity Pathway and Controls Recognition of the Fungus by the Immune System
Authors: Gurgel Isabella Luísa da Silva , Jorge Karina Talita de Oliveira Santana , Malacco Nathália Luísa Sousa de Oliveira , Souza Jéssica Amanda Marques , Rocha Marina Campos , Fernandes Marina Faria , Martins Flávia Rayssa Braga , Malavazi Iran , Teixeira Mauro Martins , Soriani Frederico Marianetti
Published: June 2019

Aspergillus fumigatus
is an opportunistic fungus with great medical importance. During infection,
Aspergillus
grows, forming hyphae that colonize the lung tissue and invade and spread over the mammal host, resulting in high mortality rates. The knowledge of the mechanisms responsible for regulation of fungal growth and virulence comprises an important point to better understand fungal physiology and host-pathogen interactions. Msb2 is a mucin that acts as a sensor and an upstream regulator of the MAPK pathway responsible for fungal development in
Candida albicans
and
Aspergillus nidulans
. Here, we show the role of the signaling mucin MsbA in the pathogen
A. fumigatus
, as a core sensor for cell wall morphogenesis, fungal growth, and virulence. Moreover, we show that cell wall composition, controlled by MsbA, is detrimental for fungal recognition and clearance by immune cells. Our findings are important for the understanding of how fungal sensors modulate cell physiology.
Paleomagnetism of the Chuar Group and evaluation of the late Tonian Laurentian apparent polar wander path with implications for the makeup and breakup of Rodinia
Authors: Eyster Athena , Weiss Benjamin P. , Karlstrom Karl , Macdonald Francis A.
Published: June 2019

Paleogeographic models commonly assume that the supercontinent Rodinia was long-lived, with a static geometry involving Mesoproterozoic links that developed during assembly and persisted until Neoproterozoic rifting. However, Rodinian paleogeography and dynamics of continental separation around its centerpiece, Laurentia, remain poorly constrained. On the western Laurentian margin, geological and geochronological data suggest that breakup did not occur until after 720 Ma. Thus, late Tonian (ca. 780–720 Ma) paleomagnetic data are critical for reconstructing paleogeography prior to dispersal and assessing the proposed stasis of Rodinia. Here, we report new paleomagnetic data from the late Tonian Chuar Group in the Grand Canyon, Arizona. We combined this new data set with reanalyzed existing data to obtain a new paleopole preserved in hematite, the reliability of which is supported by six of the seven (Q1–Q6) Van der Voo reliability quality criteria. In addition, we identified pervasive mid- to high-temperature overprints. This new paleomagnetic pole was incorporated with recent high-precision geochronological data and existing paleomagnetic data to present a new late Tonian Laurentian apparent polar wander path (APWP). Having examined the paleomagnetic data of other cratons, global reconstructions for 775 Ma, 751 Ma, and 716 Ma are presented. These reconstructions are consistent with Australia located near the present southern margin of Laurentia. However, a stringent analysis of the global data set does not support a good match between any major craton and the rifted conjugate margin to western Laurentia. Breakup on the western Laurentian margin may have involved rifting of a continental fragment or a craton with uncertainties in its late Tonian geochronologic and paleomagnetic constraints. Our revised Laurentian APWP will allow for more robust tests of paleogeography and evaluation of the proposed supercontinent Rodinia.
Challenges in a unique presentation of congenital dengue with congenital heart disease
Authors: Swaminathan Aravind , Kirupanandhan Suresh , Rathnavelu Ezhilarasan
Published: June 2019

Vertical transmission of dengue has been documented and is associated with diverse presentations in newborns. Care of such babies requires meticulous support to maintain homeostasis until the baby recovers. We present a neonate diagnosed with congenital dengue, born to a mother diagnosed with dengue on the second day after delivery. Baby was diagnosed by serological tests, underwent appropriate management in neonatal intensive care but was noted to have had coexistent persistent ductus arteriosus and pulmonary hypertension complicating pneumonia and seizures. Management of the baby was complicated by persistent haematological derangements caused by dengue and haemodynamic alterations caused by the heart disease.
Development of a predictive risk model for school readiness at age 3 years using the UK Millennium Cohort Study
Authors: Camacho Christine , Straatmann Viviane S , Day Jennie C , Taylor-Robinson David
Published: June 2019

Objectives

The aim of this study is to develop a predictive risk model (PRM) for school readiness measured at age 3 years using perinatal and early infancy data.

Design and participants

This paper describes the development of a PRM. Predictors were identified from the UK Millennium Cohort Study wave 1 data, collected when participants were 9 months old. The outcome was school readiness at age 3 years, measured by the Bracken School Readiness Assessment. Stepwise selection and dominance analysis were used to specify two models. The models were compared by the area under the receiver operating characteristic curve (AUROC) and integrated discrimination improvement (IDI).

Results

Data were available for 9487 complete cases. At age 3, 11.7% (95% CI 11.0% to 12.3%) of children were not school ready. The variables identified were: parents’ Socio-Economic Classification, child’s ethnicity, maternal education, income band, sex, household number of children, mother’s age, low birth weight, mother’s mental health, infant developmental milestones, breastfeeding, parents’ employment, housing type. A parsimonious model included the first six listed variables (model 2). The AUROC for model 1 was 0.80 (95% CI 0.78 to 0.81) and 0.78 (95% CI 0.77 to 0.79) for model 2. Model 1 resulted in a small improvement in discrimination (IDI=1.3%, p<0.001).

Conclusions

Perinatal and infant risk factors predicted school readiness at age three with good discrimination. Social determinants were strong predictors of school readiness. This study demonstrates that school readiness can be predicted by six attributes collected around the time of birth.
Asthma and risk of glioma: a population-based case–control study
Authors: Kaur Harsheen , Lachance Daniel H , Ryan Conor S , Sheen Youn Ho , Seol Hee Yun , Wi Chung-Il , Sohn Sunghwan , King Katherine S , Ryu Euijung , Juhn Young
Published: June 2019

Objectives

Literature suggests an inconsistent, but largely inverse, association between asthma and risk of glioma, which is primarily due to methodological inconsistency in sampling frame and ascertainment of asthma. The objective of the study was to clarify the association between asthma and risk of glioma by minimising methodological biases (eg, recall and detection bias).

Design

A population-based case–control study.

Setting

General population in Olmsted County, Minnesota, USA.

Participants

All eligible biopsy-proven incident glioma cases (1995–2014) and two sets of controls among residents matched to age and sex (first set: community controls without glioma; second set: MRI-negative controls from the same community).

Methods

The predetermined asthma criteria via medical record review were applied to ascertain asthma status of cases and controls. History of asthma prior to index date was compared between glioma cases and their matched controls using conditional logistic regression models. Propensity score for asthma status was adjusted for multivariate analysis.

Results

We enrolled 135 glioma cases (median age at index date: 53 years) and 270 controls. Of the cases, 21 had a history of asthma (16%), compared with 36 of MRI controls (27%) (OR (95% CI) 0.48 (0.26 to 0.91), p=0.03). With MRI controls, an inverse association between asthma and risk of glioma persisted after adjusting for the propensity score for asthma status, but did not reach statistical significance probably due to the lack of statistical power (OR (95% CI) 0.48 (0.21 to 1.09); p=0.08). Based on comparison of characteristics of controls and cases, community controls seem to be more susceptible to a detection bias.

Conclusions

While differential detection might account for the association between asthma and risk of glioma, asthma may potentially pose a protective effect on risk of glioma. Our study results need to be replicated by a larger study.
Assessment of patients’ expectations: development and validation of the Expectation for Treatment Scale (ETS)
Authors: Barth Jürgen , Kern Alexandra , Lüthi Sebastian , Witt Claudia M
Published: June 2019

Objective

To develop a short self-report instrument for the assessment of expectations (Expectation for Treatment Scale(ETS)) using acupuncture as a case example.

Design

A cross-sectional assessment with retest after 1 week.

Setting

A web-based survey with patients suffering from pain.

Methods

In a three-step approach, we reduced the initially collected number of items from 17 to 9 and to 5, including expectations about coping ability, vitality, physical health and reduction of patient complaints. Items were selected according to internal consistency (Cronbach’s alpha); convergent and divergent validities with related constructs (optimism, pessimism, resilience, perceived sensitivity to medicines, depression and others); 1-week retest reliability (intraclass correlation coefficient (ICC)); and exploratory and confirmatory factor analysis (CFA).

Results

A total of 102 patients suffering from pain were included, and 54 of these patients completed the retest assessment. The final version of the ETS consisted of five items and had an excellent Cronbach’s alpha (0.90), with 72.33% variance on one single factor. Depression, pessimism and perceived sensitivity to medicines showed positive correlations with our expectation measure (r=0.23, r=0.20 and r=0.34, respectively); the correlation between the ETS and optimism was low (r=−0.07) and no correlation between the ETS and resilience was found (r=−0.07). Convergent validity was confirmed with a high correlation (r>0.90) between ETS and a treatment-specific measure of expectations. The retest ICC was 0.86, which showed high stability over 1 week. A CFA (n=439) with data from patients with low back pain confirmed the single-factor structure of the instrument.

Conclusion

The ETS showed strong psychometric properties and covered a distinct construct. As the next step, the ETS might be implemented in different clinical conditions and settings to investigate psychometrics and its predictive power for treatment outcomes.
Mixed methods evaluation of a hospital group model using an embedded research approach: study protocol
Authors: Vindrola-Padros Cecilia , Capelas Barbosa Estela , Ramsay Angus I G , Turner Simon , Morris Stephen , Agble Ronald , Caldwell-Nichols Amy , Fulop Naomi J
Published: June 2019

Introduction

Hospital group models represent an organisational form that aims to bring together multiple provider organisations with a central headquarters and unified leadership responsible for locally managed operating units, standardised systems and a value-set shared across the group. These models seek to improve outcomes by reducing unwarranted variations in care provision and reducing costs through economies of scale. There is limited evidence on the impact and processes of implementing these models, so this study aims to evaluate one case study of a hospital group model.

Methods and analysis

We will conduct a formative, mixed-methods evaluation using an embedded research approach to analyse the implementation of the model and its impact on outcomes and costs. We will carry out a multisited ethnography to analyse the programme theory for model design and implementation, the barriers and facilitators in the implementation; and wider contextual issues that influence implementation using semi-structured interviews (n=80), non-participant observations (n=80 hours), ‘shadowing’ (n=20 hours) and documentary analysis. We will also carry out an economic evaluation composed of a cost-consequence analysis and a return on investment analysis to evaluate the costs of creating and running the model and balance these against the potential cost-savings.

Ethics and dissemination

The study protocol was reviewed by the local R&D Office and University College London Ethics Committee and classified as a service evaluation, not requiring approval by a research ethics committee. We will follow guidelines for informed consent, confidentiality and information governance, and address issues of critical distance prevalent in embedded research. Findings will be shared at regular time points to inform the implementation of the model. The evaluation will also generate: an evaluation framework to evaluate future changes; recommendations for meaningful baseline data and measuring improvement; identification of implementation costs and potential cost-savings; and lessons for the National Health Service on implementing these models.
Life and bladder cancer: protocol for a longitudinal and cross-sectional patient-reported outcomes study of Yorkshire (UK) patients
Authors: Mason Samantha J , Downing Amy , Wright Penny , Bottomley Sarah E , Winterbottom Andrew , Glaser Adam W , Catto James W F
Published: June 2019

Introduction

Little is known about the impact of bladder cancer (BC) and its treatments on health-related quality of life (HRQL). To date, most work has been small in scale or restricted to subsets of patients. Life and bladder cancer is a cross-sectional and longitudinal study collecting patient-reported outcomes within two distinct cohorts.

Methods and analysis

A longitudinal study will collect patient-reported outcomes at 3-monthly intervals from newly diagnosed patients. Eligible cases will be identified by recruiting hospitals and surveyed at baseline, 6, 9 and 12 months postdiagnosis to explore changes in outcomes over time. A separate cross-sectional cohort of patients diagnosed within the last 10 years across Yorkshire will be identified through cancer registration systems and surveyed once to explore longer-term HRQL in BC survivors. A comprehensive patient-reported outcome measure (PROM) has been developed using generic, cancer-specific and BC-specific instruments. The study will provide evidence about how useful these PROMs are in measuring BC patient HRQL. The outcome data will be linked with administrative health data (eg, treatment information from hospital data).

Ethics and dissemination

The study has received the following approvals: Yorkshire and the Humber—South Yorkshire Research Ethics Committee (17/YH/0095), Health Research Authority Confidentiality Advisory Group (17/CAG/0054). Results will be made available to patients, funders, NHS Trusts, Clinical Commissioning Groups, Strategic Clinical Networks and other researchers.
Improving hospital-based communication and decision-making about scope of treatment using a standard documentation tool
Authors: Kohen Samuel Abuaf , Nair Rajesh
Published: June 2019

Background

The Vancouver Island Health Authority (VIHA) implemented a standard advance care planning (ACP) document called the medical order for scope of treatment (MOST) in February 2016 to improve end of life communication and documentation. This study aims to see if the MOST implementation improves inpatient ACP documentation when compared with the ‘do not resuscitate’ (DNR) order. Improvement is measured by: (1) proportion of inpatients with documented orders for life-sustaining treatment, (2) discordance between patient’s expressed wishes and chart documentation, (3) patient satisfaction and (4) days admitted to an acute care hospital within 90 days of study inclusion.

Methods

We performed a single-centre quality improvement study tracking the effects of MOST implementation. 329 consecutive patients were enrolled at a 215-bed community hospital located in Comox, British Columbia, Canada.

Results

The MOST integrated well into the process of care, significantly improving ACP documentation from 33% preimplementation to 100% over 8 months of implementation. MOST completion was associated with a significant decrease in discordance between patients’ wishes and documented goals of care. Patients with a MOST were significantly older and had a higher charlson comorbidity score than those without a MOST. Despite this, there was no difference in the number of days study patients were admitted to hospital within 90 days of study inclusion.

Conclusions

MOST implementation improves the frequency and quality of inpatient ACP documentation with no effect on acute care utilisation.
Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox
Authors: Sharpe Michael , Greco Monica
Published: June 2019

Contemporary medicine distinguishes between illness and disease. Illness refers to a person’s subjective experience of symptoms; disease refers to objective bodily pathology. For many illnesses, medicine has made great progress in finding and treating associated disease. However, not all illnesses are successfully relieved by treating the disease. In some such cases, the patient’s suffering can only be reduced by treatment that is focused on the illness itself. Chronic disabling fatigue is a common symptom of illness, for which disease-focused treatment is often not effective, but for which illness-focused treatments (psychological or behavioural) often are. In this article, we explore a controversy surrounding illness-focused treatments for fatigue. We do this by contrasting their acceptance by people whose fatigue is associated with a disease (using the example of cancer-related fatigue) with their controversial rejection by some people whose fatigue is not associated with an established disease (chronic fatigue syndrome or CFS, sometimes called ME (myalgic encephalomyelitis)). In order to understand this difference in acceptability we consider the differing moral connotations of illness and disease and then go on to examine the limitations of the concepts of illness and disease themselves. We conclude that a general acceptance of illness-focused treatments by all who might benefit from them will require a major long-term change in thinking about illness, but that improvements to the care of individual patients can be made today.