bluuebunny/crossref_metadata_2025 huggingface dataset:
High risk of silent stroke in older bipolar patients with typical‐onset age
Authors: Lee Hsin‐Chien , Hsu Jung‐Lung , Chen Pao‐Huan , Chung Kuo‐Hsuan , Huang Yu‐Jui , Tsai Shang‐Ying
Published: February 2019

Aim

Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical‐onset age.

Methods

Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole‐brain magnetic resonance imaging was conducted, the patients were divided into stroke and non‐stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members.

Results

We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non‐stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12–10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases.

Conclusions

High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical‐onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients.
Influence of cognitive load on the dynamics of neurophysiological adjustments during fatiguing exercise
Authors: Chatain Cyril , Radel Rémi , Vercruyssen Fabrice , Rabahi Tahar , Vallier Jean‐Marc , Bernard Thierry , Gruet Mathieu
Published: February 2019

We aimed to determine the neurophysiological mechanisms associated with reduced endurance performance during cognitive‐motor dual task at different levels of cognitive load, compared to a motor task alone. Eighteen healthy men performed isometric quadriceps contractions at 15% of maximal voluntary contraction (blocks of 170 s interspaced by neuromuscular evaluations) until exhaustion. This task was performed on three separate days: (a) in the absence of concomitant cognitive task, (b) with concomitant 1‐back task, and (c) with concomitant 2‐back task. Autonomic nervous system activity, perceived exertion, and cognitive performance were continuously monitored. Peripheral and central determinants of neuromuscular function were assessed at rest, between each block, and at task failure using femoral nerve stimulation. Endurance time was shorter during 2‐back (982 ± 545 s) and 1‐back (1,128 ± 592 s) conditions, compared with control (1,306 ± 836 s). Voluntary activation level was lower in 2‐back (87.1%; p < 0.001) and 1‐back (88.6%; p = 0.04) conditions compared to control (91.2%) at isotime (100% of the shortest test duration). Sympathetic activity showed a greater increase in 2‐back condition compared to control. Perceived muscular exertion was higher during 2‐back than during control. Cognitive performance decreased similarly with time during both cognitive‐motor dual task but was always lower during 2‐back condition. Motor performance is reduced when adding a concomitant demanding memory task to a prolonged isometric exercise. This can be explained by the interaction of various psychological and neurophysiological factors including higher perceived exertion, greater perturbations of autonomic nervous system activity, and cerebral impairments leading to earlier onset of central fatigue.
Fostering environmental democracy in Latin America and the Caribbean: An analysis of the Regional Agreement on Environmental Access Rights
Authors: Olmos Giupponi Belén
Published: February 2019

Principle 10 of the 1992 Rio Declaration laid the groundwork for the implementation of access to environmental information, public participation and access to environmental justice, which constitute the three pillars of environmental democracy. The 2012 United Nations Conference on Sustainable Development marked a turning point in this evolution as Latin American and Caribbean (LAC) countries launched the negotiations for a treaty embodying these environmental rights. This process resulted in the adoption of the Regional Agreement on Environmental Access Rights (RAEAR) in March 2018. This presents a unique opportunity to reflect not only on the RAEAR but, more broadly, on the implementation of environmental rights in international environmental law. The article first addresses the question of the delayed implementation of environmental democracy rights in LAC. It then critically analyses the RAEAR provisions and the lessons to be learned from the negotiations. Finally, the article underlines outstanding challenges in the implementation.
The core components of Community Paramedicine – integrated care in primary care setting: a scoping review
Authors: Rasku Tuija , Kaunonen Marja , Thyer Elizabeth , Paavilainen Eija , Joronen Katja
Published: February 2019

Background

Since the beginning of 2000, the primary healthcare services around the globe are challenged between demands of home care and number of staff delivering it. The delivery of healthcare needs new models to reduce the costs, patient's readmission and increase their possibilities to stay at home. Several paramedicine programmes have been developed to deliver home care as an integral part of the local healthcare system. The programmes varied in nature and the concept of Community Paramedicine (CP) has not been established, demanding clarity. The aim of this review was to identify and describe the core components of CP, and identify research gaps for the further study.

Method

A scoping review was performed using five electronic databases: Medline; CINAHL; Academic Search Premier; PubMed and the Cochrane Library for the period 2005 – June 2018. The references of articles were checked, and papers were assessed against inclusion criteria and appraised for quality.

Results

From 803 initial articles, 21 met the criteria and were included. Inductive content analysis was carried out. The four core components of Community Paramedicine emerged (a) Community engagement, (b) Multi‐agency collaboration, (c) Patient‐centred prevention and (d) Outcomes of programme: cost‐effectiveness and patients’ experiences.

Conclusion

The Community Paramedicine programmes are perceived to be promising. However, Community Paramedicine research data are lacking. Further research is required to understand whether this novel model of healthcare is reducing costs, improving health and enhancing people's experiences.
The impact of an individualised neonatal parent support programme on parental stress: a quasi‐experimental study
Authors: Månsson Catrin , Sivberg Bengt , Selander Bo , Lundqvist Pia
Published: February 2019

Aim

To evaluate the impact on parental stress of an individualised neonatal parent support programme.

Method

A quasi‐experimental design. Parents of preterm infants, at a level II NICU, were consecutively assigned to a control group (n = 130) and to an intervention group (n = 101). The programme focused on person‐centred communication and consisted of four individual nurse–parent dialogues during the infants’ hospitalisation. The Swedish version of the Parental Stressor Scale: Neonatal Intensive Care Unit was used to assess parental stress.

Result

The total stress scores did not vary significantly between the control and intervention groups either for mothers or for fathers. However, on item‐level, some items were significantly more distressed for mothers in the control group compared to the intervention group; other sick babies being cared for in the room (p = 0.016); my baby's unusual or abnormal breathing patterns (p = 0.025); not being able to hold my baby (p = 0.014); sometimes forgetting what my baby looks like (p = 0.042); being afraid of touching or holding my baby (p = 0.030); feeling the staff is closer to my baby than I am (p = 0.006). Comparing stress between mothers and fathers in the control group demonstrated a significant higher overall stress level for mothers compared to fathers (p < 0.005). The same result was found in the subscales Infant's behaviour and appearance (p = 0.016) as well as Parental role alteration (p = 0.001). No significant differences revealed between parents in the intervention group except for one item not being able to feed the babies themselves. It was significantly more distressed for mothers (p < 0.001).

Conclusion

In this study, there was a decreased stress experience on item level in different subscales amongst mothers, but the study did not demonstrate any impact of the intervention on total stress experience either for mothers or for fathers.
“I wanted to hurt her”: Children’s and adolescents’ experiences of desiring and seeking revenge in their own peer conflicts
Authors: Recchia Holly E. , Wainryb Cecilia , Pasupathi Monisha
Published: February 2019

This study examined children's and adolescents’ descriptions of wanting and seeking revenge in peer conflicts. A total of 100 youth divided into three age groups (7‐, 11‐, and 16‐year‐olds) were interviewed about experiences in which they wanted to get back at a peer who harmed them. Most youth recalled experiencing retaliatory desires, but typically indicated that such desires were not acted out; 7‐year olds were less likely than older youth to describe carrying out their retaliatory desires. Youths’ reasons for seeking revenge versus containing their retaliatory desires revealed age effects in their thinking about their own retaliation. Younger children's reasoning focused on the undesirability of harming others and potential punishments that could ensue, but they generally did not coordinate these concerns with the fact that they themselves had just been harmed. In contrast, older youth described their own retaliatory actions as driven by goals stemming from being deeply hurt, but such goals were balanced against their self‐protective motives, sensitivity to the particularities of transgressions, and self‐reflective moral commitments. Findings underscore that desires for revenge can be considered to be a part of children's experiences of conflict, but also crucially, that youth recognize their own capacities to contain and redirect these desires.
Where Will the British Go? And Why?*
Authors: Duch Raymond M. , Laroze Denise , Reinprecht Constantin , Robinson Thomas S.
Published: February 2019

Objective

Immigration is a highly salient political issue. We examine the migration preferences of potential emigrants from the United Kingdom to determine whether the migration calculus is primarily economic or political.

Methods

A conjoint survey experiment was conducted with U.K. subjects drawn from the CESS, Nuffield College, Oxford University, student subject pool to identify causal drivers of emigration preferences.

Results

Logit estimation of emigration preferences indicates that economics and politics matters. Anti‐immigrant rhetoric, “Trumpian policies,” and the United States deter high‐skilled U.K. potential emigrants; economic growth, education, and social benefits attract them. Politics and social benefits are more important for those on the political left, while economics and education weigh more heavily for those on the right.

Conclusion

What will attract the highly skilled migrants from a post‐Brexit United Kingdom? Economics matters of course but for many of these potential emigrants politics is important—they are particularly sensitive to anti‐immigrant rhetoric.
Detection of HLA‐C*08:147, an HLA‐C*08 variant, in a Taiwanese hematopoietic stem cell donor
Authors: Yang Kuo‐Liang , Lin Py‐Yu
Published: February 2019

Nucleotide replacements at residues 766 and 855 of HLA‐C*08:01:01:01 result in a novel allele, HLA‐C*08:147.
Description of four new HLA alleles: HLA‐A*01:288, ‐A*02:06:23, ‐A*32:121 and ‐DRB1*07:100
Authors: Loginova Maria , Pavlov Alexandr , Zaytseva Maria , Simakova Tamara , Paramonov Igor
Published: February 2019

Four novel alleles were identified by sequence based typing and next generation sequencing technology.
Ex vivo haemostatic capacity of plasma upon thawing and beyond: a comparison between fresh frozen plasma (FFP) and frozen plasma prepared from whole blood stored at room temperature up to 24 hours postcollection (RTFP24)
Authors: Ang Ai Leen , Wong Wan Hui , Tan Jeslyn , Ng Heng Joo , Tan Chuen Wen , Kuperan Ponnudurai , Lam Sally , Tan Hwee Huang , Chua Sze Sze
Published: February 2019

Background/objectives

We compared the ex vivo haemostatic capacity of RTFP24 with FFP upon thawing and >24 h post‐thaw. We included thrombin generation (TG) as few studies had compared global haemostatic function, and most did not directly compare RTFP24 with FFP >24 h post‐thaw.

Materials/methods

Twenty units each of RTFP24 and FFP were measured for coagulation factors and thrombin generation upon thawing (D0) and 4 days post‐thaw (D4). Labile factors were also measured from D1 to D3. 10 single cryoprecipitate units were each prepared from FFP and RTFP24, and measured for FXIII, FVIII and fibrinogen at D0.

Results

At D0, RTFP24 was comparable to FFP except for lower FV, protein S, endogenous thrombin potential (ETP) and higher FXIII. These differences were likely clinically insignificant since 95% and 80% of RTFP24 met our laboratory's reference ranges for FV/protein S and ETP, respectively. There were no differences between RTFP24‐ and FFP‐derived cryoprecipitate.

At D4, RTFP24 was comparable to FFP except for lower FV, ETP, and higher FXI and FXIII. More RTFP24 than FFP had ETP lower than our laboratory's reference range (45% vs 15%). Multiple coagulation factors and all TG parameters declined from their respective baselines. The percentage declines were comparable or less in RTFP24, except for protein C, fibrinogen and time to peak.

Conclusion

RTFP24 and FFP, and their derived cryoprecipitate have comparable haemostatic capacity upon thawing. RTFP24 has poorer TG potential than FFP >24 h post‐thaw, not supporting universal extension of RTFP24's shelf life except to facilitate urgent transfusions for massive haemorrhage.
Provider trends in paediatric and adult transfusion reaction reporting
Authors: Vossoughi Sarah , Parker‐Jones Sylvia , Schwartz Joseph , Stotler Brie
Published: February 2019

Background and Objectives

Passive transfusion reaction reporting systems fail to capture a significant number of reactions, and no data exist on provider reporting trends. The aim of this study was to describe transfusion reaction reporting patterns by adult and paediatric providers.

Materials and Methods

This is a multihospital study on transfusion reaction reporting over a 7‐year period. Reports were categorized according to transfusion location and assigned to either a transfusion reaction or nonreaction group according to Centers for Disease Control imputability guidelines. Included in the reaction group (RXN) were definite, probable or possible reaction categories; with the remainder assigned as nonreactions (NORXN). Rates were calculated per 100,000 components transfused using chi‐square comparison.

Results

There were 1092 reports generated from 363 437 transfusions; 230 reports from 69 311 paediatric and 862 reports from 294 126 adult treatment areas. The reporting rate per 100 000 components transfused was 332 for paediatric and 293 for adult (P = 0·09). The per 100 000 components transfused rates were as follows: 237 for paediatric and 169 for adult (P < 0·01) in the RXN group; with 95 paediatric and 124 adult rates in the NORXN group (P = 0·04).

Conclusion

The total number of reports generated by paediatric and adult providers was not significantly different, suggesting that both provider groups engage the passive reporting system equally. However, paediatric providers reported more true reactions compared to adult providers. Robust hemovigilance systems will further the understanding of these trends and may aid in the development of targeted provider education programmes.
Thermal and Mechanical Behavior in Laser Trepan Drilling of Yttria-Stabilized Zirconia
Authors: Shen Hong , Feng Decai
Published: February 2019

Cracking control is very important for laser drilling of yttria-stabilized zirconia (YSZ). In this paper, a thermomechanical model is presented to investigate what will be happened in the trepan drilling of YSZ by a picosecond pulsed laser. The thermal model is developed for describing the interaction between laser and YSZ material to obtain the transient temperature. The mechanical model is developed to calculate the stress distribution caused by the phase transformation based on the temperature results. The goal of the present study is to explore the intrinsic mechanism of cracking around the drilled hole from the aspect of the phase transformation in laser drilling of YSZ.
Characterization of Impingement Heat/Mass Transfer to the Synthetic Jet Generated by a Biomimetic Actuator
Authors: Trávníček Zdeněk , Broučková Zuzana
Published: February 2019

Two biomimetic synthetic jet (SJ) actuators were designed, manufactured, and tested under conditions of a jet impingement onto a wall. Nozzles of the actuators were formed by a flexible diaphragm rim, the working fluid was air, and the operating frequencies were chosen near the resonance at 65 Hz and 69 Hz. Four experimental methods were used: phase-locked visualization of the oscillating nozzle lips, jet momentum flux measurement using a precision scale, hot-wire anemometry, and mass transfer measurement using the naphthalene sublimation technique. The results demonstrated possibilities of the proposed actuators to cause a desired heat/mass transfer distribution on the exposed wall. It was concluded that the heat/mass transfer rate was commensurable with a conventional continuous impinging jets (IJs) at the same Reynolds numbers.
Value-Based Care: A Review of Key Challenges and Opportunities Relevant to Medical Technology Innovators
Authors: Peiffer Véronique , Yock Cynthia A. , Yock Paul G. , Pietzsch Jan B.
Published: February 2019

Developed countries struggle with high healthcare spending, and cost is often cited as a barrier to the introduction of new patient care technologies. The core objective of this review article is to help familiarize medical technology innovators with trends in the health economic environment and the implications for the adoption of new technologies. We review and discuss this topic in language accessible to medical technology innovators. We assess macrolevel developments in healthcare spending and highlight measures already taken to control spending. We discuss practical implications for anyone involved in healthcare innovation. Two observations are central to this discussion: (1) the U.S. spends significantly more on healthcare per capita than any other developed country; (2) across developed countries, healthcare spending has risen steadily over the past two decades. Nevertheless, higher spending has not always led to improvements in health. As a result, innovators need to be prepared to navigate an outcomes-oriented and value-based environment that is being defined by the emerging requirements of various healthcare stakeholders. Practically, new products should aim to improve health outcomes at a cost deemed “good value” and/or reduce cost for one or multiple stakeholders. Opportunities also exist for tools that enable cost/outcomes tracking, which will help demonstrate value to providers, insurers, and patients.
Analytical Modeling of Self-Loosening of Bolted Joints Subjected to Transverse Loading
Authors: Fort Valentin , Bouzid Abdel-Hakim , Gratton Michel
Published: February 2019

Self-loosening of bolted joints is a common issue in structural connections and machine design. This phenomenon can not only cause the industry a lot of losses due to maintenance but can result in catastrophic incidents leading to environment and health issues. This paper presents a new analytical model with an improved criterion that could be used to predict self-loosening of bolted joints. A complete study involving analytical, numerical, and experimental work has been conducted to give an insight of the mechanism leading to self-loosening of bolted joints and support the developed model. Particular focus is put on the effect of the clamping plate thickness on the self-loosening of the joint. A fully instrumented experimental setup, in conjunction with an M12-1.75 bolt, is deployed to track the bolt tension decrease with the application of an imposed cyclic transverse displacement. In addition to the measurement of the transverse relative displacement between the two clamping parts, the clamping and transverse loads are also recorded. Finally, the relative rotation between the bolt and the nut is measured by means of a rotation sensor directly installed on the nut. The results show that there is a good agreement between the analytical, numerical and experimental results. The new model is compared with finite element method (FEM) and experimentation for different plate thickness configurations.
Structural Design of Land Grid Array Loading Mechanisms for Intel Central Processor Unit Stack Retention
Authors: Geng Phil
Published: February 2019

For more than a decade, land grid array (LGA) has been one of the main central processor unit (CPU) packages developed at Intel and AMD, and widely used in different computer systems. LGA loading mechanism has become more critical to achieve mechanical, thermal, and electrical functions with the increasing retention force requirement. During the development of the loading mechanisms for LGA packages and sockets, socket pin contact to LGA pad under retention load, solder joint reliability under shock load, socket pin fretting under vibration, and load degradation are some of the key structural risks. This paper reviews the structural designs of different loading mechanism solutions systematically and summarizes the key structural concerns and advantages. While the finite element analysis (FEA) was used to guide the design options in early platform architectural definition, this review discusses the evolution of Xeon LGA loading mechanisms developed at the Intel Data Center Group.
Experimental SAC305 Shear Stress–Strain Hysteresis Loop Construction Using Hall's One-Dimensional Model Based on Strain Gages Measurements
Authors: Libot J.-B. , Alexis J. , Dalverny O. , Arnaud L. , Milesi P. , Dulondel F.
Published: February 2019

Temperature-induced solder joint fatigue is a main reliability concern for aerospace and military industries whose electronic equipment used in the field is required to remain functional under harsh loadings. Due to the RoHS directive, which eventually will prevent lead from being utilized in electronic systems, there is a need for a better understanding of lead-free thermomechanical behavior when subjected to temperature variations. Characterizing solder joints properties remains a challenge as viscoplastic behavior during thermal cycling is complex, and their small dimensions prevent direct measurements from being performed. This paper reports the experimentation based on strain gage measurements, allowing the construction of the shear stress–strain hysteresis loop corresponding to Sn3.0Ag0.5Cu (SAC305) solder joints behavior during thermomechanical loading. This methodology, initially developed in 1984 by Hall for Sn60Pb40 interconnects, allows the measurement of the strain energy density dissipated during temperature cycles. Custom daisy-chained 76 I/O ceramic ball grid array (CBGA76) components were designed and assembled on flame retardant (FR-4) multilayered printed circuit boards (PCB). Four strain gages were specifically placed at the center of the assembly on top and bottom faces of both PCB and CBGA76 component. The assembly was subjected to temperature cycles and the SAC305 solder joints shear stress–strain hysteresis loop was plotted. The correlation between the measured strain energy density and measured lifetime corresponds to one point of the energy based fatigue curve for SAC305 solder joints. The hysteresis loop also provides the necessary data to derive SAC305 solder joints constitutive laws.
On the Effective Thermal Conductivity of Nanofluids With Fractal Aggregation
Authors: Subramaniam C. G.
Published: February 2019

A generalized effective medium theory (EMT) is proposed to account for the fractal structure of the dispersed phase in a dispersing medium under the dilute limit. The thermal conductivity of nanofluids with fractal aggregates is studied using the proposed model. Fractal aggregates are considered as functionally graded spherical inclusions and its effective thermal conductivity is derived as a function of its fractal dimension. The results are studied for self-consistency and accuracy within the limitations of the analytical approximations used.
Pills give patients a shot inside the stomach
Authors: Service Robert F.
Published: February 2019

Capsules that internally inject insulin and other medicines could do away with daily jabs.
The new potato
Authors: Stokstad Erik
Published: February 2019

Breeders seek a breakthrough to help farmers facing an uncertain future.
Government data, commercial cloud: Will public access suffer?
Authors: Borowitz Mariel
Published: February 2019

New data handling models may affect use for research
An ingestible self-orienting system for oral delivery of macromolecules
Authors: Abramson Alex , Caffarel-Salvador Ester , Khang Minsoo , Dellal David , Silverstein David , Gao Yuan , Frederiksen Morten Revsgaard , Vegge Andreas , Hubálek František , Water Jorrit J. , Friderichsen Anders V. , Fels Johannes , Kirk Rikke Kaae , Cleveland Cody , Collins Joy , Tamang Siddartha , Hayward Alison , Landh Tomas , Buckley Stephen T. , Roxhed Niclas , Rahbek Ulrik , Langer Robert , Traverso Giovanni
Published: February 2019

Delivering fragile drugs to the gut

Oral delivery is the simplest and least invasive way to deliver many pharmaceuticals, but many drugs and medications, including insulin, cannot survive passage through the stomach or the gastrointestinal tract. Abramson
et al.
developed an ingestible delivery vehicle that could self-reorient from any starting position so as to attach to the gastric wall. Encapsulation of a spring in a sugar casing allowed for triggered actuation for the delivery of biomolecules. The approach successfully provided active insulin delivery in pigs.

Science
, this issue p.
611
Life history responses of meerkats to seasonal changes in extreme environments
Authors: Paniw Maria , Maag Nino , Cozzi Gabriele , Clutton-Brock Tim , Ozgul Arpat
Published: February 2019

Timing matters

How a species responds to rapid climate change is complicated. Paniw
et al.
used long-term data on the Kalahari meerkat, an arid specialist, to explore how predicted changes might affect population persistence over time. Warming and rainfall changes in one part of the year had a negative impact on survival and persistence, whereas similar changes during another part of the year had the opposite effect. Understanding such variability will be essential as we attempt to understand the broader influence of climate change.

Science
, this issue p.
631
Response to Comment on “Friction at the bed does not control fast glacier flow”
Authors: Stearns Leigh A. , van der Veen Cornelis
Published: February 2019

Minchew
et al
. take issue with our main conclusion that friction at the glacier bed does not control fast glacier flow. In this response, we further justify our methodology. We also point out that numerical studies referred to by Minchew
et al
. rely on inversions that are based on a sliding relation in which sliding speed is proportional to basal drag. Furthermore, observational studies referred to by Minchew
et al
. apply to glaciological settings that do not correspond to the terminal regions of Greenland outlet glaciers that we studied.
Structural basis for blue-green light harvesting and energy dissipation in diatoms
Authors: Wang Wenda , Yu Long-Jiang , Xu Caizhe , Tomizaki Takashi , Zhao Songhao , Umena Yasufumi , Chen Xiaobo , Qin Xiaochun , Xin Yueyong , Suga Michihiro , Han Guangye , Kuang Tingyun , Shen Jian-Ren
Published: February 2019

All the hues, even the blues

Photosynthetic organisms must balance maximizing productive light absorption and protecting themselves from too much light, which causes damage. Both tasks require pigments—chlorophylls and carotenoids—which absorb light energy and either transfer it to photosystems or disperse it as heat. Wang
et al.
determined the structure of a fucoxanthin chlorophyll a/c–binding protein (FCP) from a diatom. The structure reveals the arrangement of the specialized photosynthetic pigments in this light-harvesting protein. Fucoxanthin and chlorophyll c absorb the blue-green light that penetrates to deeper water and is not absorbed well by chlorophylls a or b. FCPs are related to the light-harvesting complexes of plants but have more binding sites for carotenoids and fewer for chlorophylls, which may help transfer and disperse light energy.

Science
, this issue p.
eaav0365
Schema cells in the macaque hippocampus
Authors: Baraduc P. , Duhamel J.-R. , Wirth S.
Published: February 2019

Abstract concepts in the primate brain

Do primates have neurons that encode the conceptual similarity between spaces that differ by their appearance but correspond to the same mental schema? Baraduc
et al.
recorded from monkey hippocampal neurons while the animals explored both a familiar environment and a novel virtual environment that shared the same general structure as the familiar environment but displayed never-before-seen landmarks. About one-third of hippocampal cells showed significantly correlated firing for both familiar and novel landscapes. These correlations hinged on space or task elements, rather than on immediate visual information. The functional features of these cells are analogous to human concept cells, which represent the meaning of a specific stimulus rather than its apparent visual properties.

Science
, this issue p.
635
A sweeter approach to vaccine design
Authors: Wilson John T.
Published: February 2019

Glycoengineering may improve next-generation vaccines and immunotherapies
Structural basis of cooling agent and lipid sensing by the cold-activated TRPM8 channel
Authors: Yin Ying , Le Son C. , Hsu Allen L. , Borgnia Mario J. , Yang Huanghe , Lee Seok-Yong
Published: February 2019

Cool mechanism for sensing cool

In humans, cold is primarily sensed by transient receptor potential melastatin member 8 (TRPM8), a calcium channel. Yin
et al.
present cryo–electron microscopy structures of TRPM8 with cooling agents, membrane lipid phosphatidylinositol-4,5-bisphosphate (PIP2), and calcium. Structural and functional analyses showed that the PIP2 binding site in TRPM8 is completely different from PIP2 sites in other TRP channels. The binding of PIP2 and cooling agents allosterically enhance each other and activate the channel opening. Thus, the activation mechanism of TRPM8 is distinct from that used by other TRP channels.

Science
, this issue p.
eaav9334
Single-mode lasing by selective mode pairing
Authors: Kottos Tsampikos
Published: February 2019

High-order laser modes are suppressed by pairing them with lossy “superpartners”
Phosphorothioated DNA Is Shielded from Oxidative Damage
Authors: Pu Tianning , Liang Jingdan , Mei Zhiling , Yang Yan , Wang Jialiang , Zhang Wei , Liang Wei-Jun , Zhou Xiufen , Deng Zixin , Wang Zhijun
Published: February 2019

DNA phosphorothioation has been reported in many bacteria. These PT-hosting bacteria live in very different environments, such as the human body, soil, or hot springs. The physiological function of DNA PT modification is still elusive. A remarkable property of PT modification is that purified genomic PT DNA is susceptible to oxidative cleavage. Among the oxidants, hypochlorous acid and H
2
O
2
are of physiological relevance for human pathogens since they are generated during the human inflammation response to bacterial infection. However, expression of PT genes in the catalase-deficient
E. coli
Hpx
−
strain restores H
2
O
2
resistance. Here, we seek to solve this obvious paradox. We demonstrate that DndCDE-FeS is a short-lived catalase that binds tightly to PT DNA. It is thus possible that by docking to PT sites the catalase activity protects the bacterial genome against H
2
O
2
damage.
Historical Nitrogen Deposition and Straw Addition Facilitate the Resistance of Soil Multifunctionality to Drying-Wetting Cycles
Authors: Luo Gongwen , Wang Tingting , Li Kaisong , Li Ling , Zhang Junwei , Guo Shiwei , Ling Ning , Shen Qirong
Published: February 2019

Current climate trends indicate an increasing frequency of drying-wetting cycles. Such cycles are severe environmental perturbations and have received an enormous amount of attention. Prediction of ecosystem’s stability and adaptability requires a better mechanistic understanding of the responses of microbially mediated C and nutrient cycling processes to external disturbance. Assessment of this stability and adaptability further need to disentangle the relationships between functional capacity of soil microbial communities and the resistance of multifunctionality. Study of the physiological responses and community reorganization of soil microbes in response to stresses requires large investments of resources that vary with the management history of the system. Our study provides evidence that nutrient managements on agroecosystems can be expected to buffer the impacts of progressive climate change on ecosystem functioning by enhancing the functional capacity of soil microbial communities, which can serve as a basis for field studies.
Fifteen-minute consultation: A general paediatrician’s guide to oncological abdominal masses
Authors: Uzunova Lena , Bailie Helen , Murray Matthew J
Published: February 2019

The identification of an abdominal mass in a child, either coincidental or symptomatic, may be due to a tumour. An abdominal tumour may present with life-threatening symptoms, requiring prompt assessment and management. Although the discovery of such a finding usually warrants inpatient transfer or outpatient referral to the tertiary oncology centre, the initial evaluation, management and communication with the family by the general paediatrician is crucial. A thorough history and examination, which includes an organised, structured approach to abdominal masses, is paramount. The anatomical location of the mass, age of the patient and the presence of any associated symptoms or signs must be considered together in order to formulate a list of potential differential diagnoses and guide the next appropriate investigations. This article aims to guide general paediatricians through the assessment and initial management of a child presenting with an abdominal mass suspected to be a tumour.
Paraduodenal inflammatory pseudotumor masquerading as malignancy
Authors: Peng June S , Lu Haiyan , Cruise Michael W , Chalikonda Sricharan
Published: February 2019

A 30-year-old woman presented with severe abdominal pain and abdominal distension. CT demonstrated two intra-abdominal masses, one involving the left lateral segment of the liver and the other adjacent to the duodenum. Initial biopsies were consistent with focal nodular hyperplasia of the liver and non-specific lymphocytic infiltrate in the paraduodenal mass. Due to persistent symptoms, the patient underwent laparoscopic resection of the paraduodenal mass. Final pathology was consistent with an inflammatory pseudotumour and the patient’s symptoms subsequently resolved.
Complete recovery in Wernicke’s encephalopathy complicating hyperemesis gravidarum
Authors: Aneja Tripti , Chaturvedula Latha , Nair Pradeep Pankajakshan , Barathi Deepak , Keepanasseril Anish
Published: February 2019

Wernicke’s encephalopathy (WE) is an uncommon neurological complication in pregnancies complicated with hyperemesis due to thiamine deficiency. In women with hyperemesis, inadvertent glucose administration prior to thiamine supplementation triggers the development of neurological manifestations. Delay in the diagnosis can lead to maternal morbidity, and in one-third of cases may lead to persistence of some neurological deficit. With early recognition and thiamine supplementation, complete recovery is reported. We report a case of WE complicating a case of triplet pregnancy with hyperemesis gravidarum, which highlights the importance of early recognition and treatment, resulting in complete recovery as in the index case.
Review and Classification Update: Unilateral condylar hyperplasia
Authors: Arora Karandeep Singh , Bansal Rahul , Mohapatra Shreeyam , Pareek Shubhangi
Published: February 2019

Unilateral condylar hyperplasia is characterised by slow progressive growth of the different parts of mandible, the aetiology of which is still unclear. It is a self-limiting condition mostly seen between the age of 11–30 years causing facial asymmetry and its progression ceases after a certain time. In literature until now very few cases have been reported and every case that is being reported adds to its features or the aetiology. Previously, it has been classified into two types that is, hemimandibular hyperplasia and hemimandibular elongation. Here, we report a similar case with a few features distinct from those reported earlier.
Using lean thinking to improve hypertension in a community health centre: a quality improvement report
Authors: Lee Patrick , Pham Linhchi , Oakley Stephen , Eng Kimberly , Freydin Elena , Rose Tayla , Ruiz Alyssa , Reen Joyce , Suleyman Deborah , Altman Vanna , Keating Bench Kara , Lee Alice , Mahaniah Kiame
Published: February 2019

Background

Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.

Objective

To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control.

Setting

Lynn Community Health Center, the third largest FQHC in Massachusetts, USA.

Participants

4762 adult patients with a diagnosis of hypertension.

Intervention

First, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation.

Measurements

The primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention.

Results

Hypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%.

Limitations

Durability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented.

Conclusions

Success factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.
Interprofessional simulation training’s impact on process and outcome team efficacy beliefs over time
Authors: Kerry Matthew James , Ander Douglas S , Davis Beth P
Published: February 2019

Introduction

Recent findings suggest that process and outcome-based efficacy beliefs are factorially distinct with differential effects for team performance. This study extends this work by examining process and outcome efficacy (TPE, TOE) of interprofessional (IP) care teams over time.

Methods

A within-team, repeated measures design with survey methodology was implemented in a sample of prelicensure IP care teams performing over three consecutive clinical simulation scenarios. TPE and TOE were assessed before and after each performance episode.

Results

Initial baseline results replicated the discriminant validity for TPE and TOE separate factors. Further findings from multilevel modelling indicated significant time effects for TPE convergence, but not TOE convergence. However, a cross-level interaction effect of ‘TOE(Start-Mean)×Time’ strengthened TOE convergence over time. A final follow-up analysis of team agreement’s substantive impact was conducted using independent faculty-observer ratings of teams’ final simulation.

Conclusion

Independent sample t-tests of high/low-agreement teams indicated support for agreement’s substantive impact, such that high-agreement teams were rated as significantly better performers than low-agreement teams during the final simulation training. We discuss the substantive merit of methodological within-team agreement as an indicator of team functionality within IP and greater healthcare-simulation trainings at-large.
Changing paradigms in the treatment of systemic lupus erythematosus
Authors: Fanouriakis Antonis , Bertsias George
Published: February 2019

SLE poses formidable therapeutic challenges due to its heterogeneity and treatment decisions often cannot be guided by data of high quality. In this review, we attempt to provide insights regarding the treatment of SLE in everyday clinical practice, based on contemporary evidence and our own personal experience. We focus on common therapeutic issues and dilemmas arising in routine care, including monitoring for retinal toxicity associated with hydroxychloroquine, handling of glucocorticoid regimens in order to minimise their adverse events, choice of immunosuppressive medications based on prevailing disease manifestations and optimal use of available biological agents (belimumab and rituximab). We also provide our view on the position of calcineurin inhibitors in the management of lupus nephritis and conclude with remarks on the future perspectives for this challenging disease.
The people speak: social media on euthanasia/assisted dying
Authors: Jaye Chrystal , Lomax-Sawyers Isabelle , Young Jessica , Egan Richard
Published: February 2019

In New Zealand, aiding and abetting a person to commit suicide or euthanasia even with consent is unlawful. The introduction of a third Bill on assisted dying to the House of Representatives following a high-profile court case afforded an opportunity for examining how assisted dying was discussed in the public sphere. In this article, we report on a discourse analysis of a selection of social media to illustrate the ways in which citizens participate in the voluntary euthanasia debate. The volume of social media posts that made up our data set suggests that the legalisation of assisted dying is a highly topical and deeply salient societal issue. Social media postings represent the voices of ordinary citizens who may not participate in formal public consultation processes. Based on our analysis, the assignment of binary conclusions about public opinion is simplistic and fails to adequately represent the intricacies of public debate. Contributors’ posts reveal deeply held sociocultural values, as well as tensions about the relationship between citizens and the apparatus of government.
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery
Authors: Grant Michael Conrad , Gibbons Melinda M , Ko Clifford Y , Wick Elizabeth C , Cannesson Maxime , Scott Michael J , Wu Christopher L
Published: February 2019

Enhanced recovery after surgery (ERAS) protocols for gynecologic (GYN) surgery are increasingly being reported and may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery, which is a nationwide initiative to disseminate best practices in perioperative care to more than 750 hospitals across five major surgical service lines in a 5-year period. The program is designed to identify evidence-based process measures shown to prevent healthcare-associated conditions and hasten recovery after surgery, integrate those into a comprehensive service line-based pathway, and assist hospitals in program implementation. In conjunction with this effort, we have conducted an evidence review of the various anesthesia components which may influence outcomes and facilitate recovery after GYN surgery. A literature search was performed for each intervention, and the highest levels of available evidence were considered. Anesthesiology-related interventions for preoperative (carbohydrate loading/fasting, multimodal preanesthetic medications), intraoperative (standardized intraoperative pathway, regional anesthesia, protective ventilation strategies, fluid minimization) and postoperative (multimodal analgesia) phases of care are included. We have summarized the best available evidence to recommend the anesthetic components of care for ERAS for GYN surgery.
Increasing adolescent girls’ ability to identify STI-risk characteristics of sexual partners: a pilot study within an alternative disciplinary school
Authors: Richardson Eric , Komro Kelli A , Samarah Esaa , Staras Stephanie A S
Published: February 2019

Objectives

We evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention,Angels in Action,within an alternative disciplinary school for adolescent girls.

Methods

All girls who were 16–18 years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used χ² tests to estimate the intervention effect on participants’ sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3 months after the intervention.

Results

Among the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3 months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3 months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner’s age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3 months after the intervention (p=0.09).

Conclusions

This pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls’ consideration of partner risk characteristics as a means to enhance their STI prevention skills.