bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic prediction of mandibular third molar eruption and mandibular canal involvement based on angulation
Authors: Vranckx Myrthel , Ockerman Anna , Coucke Wim , Claerhout Elke , Grommen Bieke , Miclotte Annelie , Van Vlierberghe Martine , Politis Constantinus , Jacobs Reinhilde
Published: February 2019

Structured Abstract

Objectives

The aim of our study was to identify and predict patients at risk of impeded mandibular third molar eruption and potential relation between the third molar roots and the mandibular canal, based on molar angulations in an early development stage.

Setting and Sample Population

A total of 1011 adolescent orthodontic patients were included in this longitudinal study.

Materials and Methods

We analysed pre‐eruptive rotational changes and root development of mandibular third molars on 2022 panoramic radiographs (two time‐points). Five variables were evaluated: third molar eruption level, development stage, risk of relation between the third molar and the mandibular canal, the molar angulations and orthodontic treatment. The relation between early third molar angulation and mean annual angulation change was assessed using a linear mixed model. Logistic regression was applied to investigate a potential correlation of the radiographic variables with the eruption potential and risk of developing a relation between the third molar and the mandibular canal.

Results

Mandibular third molar follicles with an initial angulation exceeding 27.0° relative to the second molar tend to progressively increase their angulation during further development. A significant correlation was found between the hemimandibular molar angulations and the probability of eruption (P < 0.0001). The second to first molar angulation was predictive for potential development of a relation with the mandibular canal (P = 0.005).

Conclusion

From the present data, it appears that severely angulated mandibular third molars (>27.0°) have a minimal chance of future eruption and a maximal risk of developing a relation with the mandibular canal.
MicroRNA‐181a and microRNA‐155 are involved in the regulation of the differentiation and function of regulatory T cells in allergic rhinitis children
Authors: Zeng Qingxiang , Liu Wenlong , Luo Renzhong , Lu Gen
Published: February 2019

Background

Regulatory T cells (Tregs) play central roles in limiting airway allergic inflammation and preventing inappropriate Th2 responses to environmental allergens. This study aims to evaluate the role of miR‐181a and miR‐155 in the regulation of the differentiation and function of Tregs through both in vivo and in vitro studies.

Methods

The CD4+ T cells and Tregs were purified from peripheral blood mononuclear cells (PBMCs) in allergic rhinitis (AR) children, respectively. The miR‐155/181a mimics and inhibitors were transfected into CD4+ T cells and Tregs. The differentiation and function of Tregs were evaluated by flow cytometry and enzyme‐linked immunosorbent assay. AR mice models were established, and miR‐155/181a mimics or inhibitors were injected through tail vein. The Treg percentage and function from mice were compared among different groups.

Results

The miR‐181a up‐regulated the release of interleukin (IL)‐10 and TGF‐β, whereas the miR‐155 promoted Treg differentiation in CD4+ T cells. Similarly, we also found that miR‐155 promoted Treg proliferation directly through suppressor of cytokine signaling 1 (SOCS1) and sirtuin1 (SIRT1) signaling pathway, whereas miR‐181a up‐regulated mRNA expression of IL‐10 and TGF‐β through phosphatidylinositol 3‐OH kinase (PI3K)/Akt pathway. We also found that miR‐155/181a affect Treg percentage and function in mice model.

Conclusion

Our findings suggest that miR‐181a and miR‐155 were closely correlated with the proliferation and function of Tregs in AR, providing new potential treatment target.
The dependence of leaf senescence on the balance between 1‐aminocyclopropane‐1‐carboxylate acid synthase 1 (ACS1)‐catalysed ACC generation and nitric oxide‐associated 1 (NOS1)‐dependent NO accumulation in Arabidopsis
Authors: Lv S.‐F. , Jia M.‐Z. , Zhang S.‐S. , Han S. , Jiang J.
Published: February 2019

Ethylene and nitric oxide (NO) act as endogenous regulators during leaf senescence. Levels of ethylene or its precursor 1‐aminocyclopropane‐1‐carboxylate acid (ACC) depend on the activity of ACC synthases (ACS), and NO production is controlled by NO‐associated 1 (NOA1). However, the integration mechanisms of ACS and NOA1 activity still need to be explored during leaf senescence.

Here, using experimental techniques, such as physiological and molecular detection, liquid chromatography‐tandem mass spectrometry and fluorescence measurement, we investigated the relevant mechanisms.

Our observations showed that the loss‐of‐function acs1‐1 mutant ameliorated age‐ or dark‐induced leaf senescence syndrome, such as yellowing and loss of chlorophyll, that acs1‐1 reduced ACC accumulation mainly in mature leaves and that acs1‐1‐promoted NOA1 expression and NO accumulation mainly in juvenile leaves, when compared with the wild type (WT). But the leaf senescence promoted by the NO‐deficient noa1 mutant was not involved in ACS1 expression. There was a similar sharp reduction of ACS1 and NOA1 expression with the increase in WT leaf age, and this inflection point appeared in mature leaves and coincided with the onset of leaf senescence.

These findings suggest that NOA1‐dependent NO accumulation blocked the ACS1‐induced onset of leaf senescence, and that ACS1 activity corresponds to the onset of leaf senescence in Arabidopsis.
Concurrent antipsychotic use in older adults treated with antidepressants in Asia
Authors: Dong Min , Zeng Liang‐Nan , Zhang Qinge , Ungvari Gabor S. , Ng Chee H. , Chiu Helen F. K. , Si Tian‐Mei , Sim Kang , Avasthi Ajit , Grover Sandeep , Chong Mian‐Yoon , Chee Kok‐Yoon , Kanba Shigenobu , Lee Min‐Soo , Yang Shu‐Yu , Udomratn Pichet , Kallivayalil Roy A. , Tanra Andi J. , Maramis Margarita M. , Shen Winston W. , Sartorius Norman , Mahendran Rathi , Tan Chay‐Hoon , Shinfuku Naotaka , Xiang Yu‐Tao
Published: February 2019

Aim

Depressive disorders are common in old age. Antipsychotics (APs) are often used as an adjunctive treatment with antidepressants (ADs) in this population but its patterns of use in Asia are not known. This study explored the rate of combination of APs and ADs in older adult psychiatric patients in Asia.

Methods

This is a secondary analysis of the database of a multicentre study which recorded participants’ basic demographical and clinical data in standardised format in 10 Asian countries and territories. The data were analysed using univariate and multivariate logistic regression analyses.

Results

A total of 955 older adult psychiatric in‐ and outpatients were included in this study. The proportion of concurrent AP and AD use was 32.0%, ranging from 23.3% in Korea to 44.0% in Taiwan. Multivariate logistic regression analysis found that younger age, inpatient status and diagnosis of schizophrenia, anxiety and other mental disorders were significantly related to a higher proportion of concurrent use of APs and ADs.

Conclusion

Around a third of older adult psychiatric patients had concurrent AP and AD use in the Asian countries/regions surveyed. Considering the uncertain effectiveness and questionable safety of the AP and AD combination in this patient population, such should be cautiously used.
Conceptualisations on home care for pressure ulcers in Spain: perspectives of patients and their caregivers
Authors: García‐Sánchez Francisco José , Martínez‐Vizcaíno Vicente , Rodríguez‐Martín Beatriz
Published: February 2019

Background

Pressure ulcers represent an important worldwide public health problem, which substantially decrease the quality of life of those affected. Yet, few studies to date have analysed the perceptions regarding home care for pressure ulcers.

Aims

To explore the conceptualisations regarding home care of pressure ulcers from the perspective of affected patients and their caregivers.

Methods

A qualitative study design based on Grounded Theory. In‐depth interviews were conducted on a theoretical sample of 10 people currently suffering from a pressure ulcer, or who had experienced one in the past, and 15 caregivers of patients who had suffered from this pathology, all of whom came from the four health districts of Puertollano (Ciudad Real, Spain).

Findings

Two categories emerged to explain the conceptualisations regarding pressure ulcers: (a) Cause of the pressure ulcer with three subcategories (unavoidable injuries, caregiver's lack of knowledge and painful wounds) and (b) Preferences regarding caring for pressure ulcers with two subcategories (home care as the best approach to treatment and noninstitutionalisation).

Conclusions

This research provides a novel perspective on the specific problems surrounding home care for pressure ulcers, including the perceptions of both patients and their caregivers. It is important to give a voice to patients and their caregivers as this will help understand their needs and improve the care provided. Further studies are required to improve current treatment protocols and clinical practice guidelines for the prevention and treatment of this pathology.
Politics as Unusual? Exploring Issues and the 2016 Presidential Vote*
Authors: Gibson Nadine S. , Shaw Daron R.
Published: February 2019

Objective

In this article, we examine the correlation between voters' opinions on relevant issues and vote choice, as well as where they located Donald Trump and Hillary Clinton in the competitive issue space. We are particularly interested in the extent to which anti‐politics attitudes, nativist attitudes, and social issue attitudes structured the way voters perceived the candidates.

Methods

Using principal components analysis of feeling thermometer ratings of presidential candidates in the 2016 general election, we are able to identify two major dimensions structuring voters’ perceptions of political figures.

Results

Data from national surveys suggest that anti‐politics attitudes were prevalent in 2016, but that the major party candidates were only marginally effective at tapping into this sentiment.

Conclusion

Relative to other Republican presidential candidates, Trump was more effective in tapping into anti‐political feelings prior to the Republican Convention. By the general election, issue perceptions of Trump were similar to those we see for most Republican presidential candidates. Feelings toward third‐party candidates, however, were more strongly structured by an anti‐politics dimension.
Learning, Memory, and Syntactic Bootstrapping: A Meditation
Authors: Lidz Jeffrey
Published: February 2019

Lila Gleitman's body of work on word learning raises an apparent paradox. Whereas work on syntactic bootstrapping depends on learners retaining information about the set of distributional contexts that a word occurs in, work on identifying a word's referent suggests that learners do not retain information about the set of extralinguistic contexts that a word occurs in. I argue that this asymmetry derives from the architecture of the language faculty. Learners expect words with similar meanings to have similar distributions, and so learning depends on a memory for syntactic environments. The referential context in which a word is used is less constrained and hence contributes less to the memories that drive word learning.
Treatment of wastewater in sewer by Spirogyra sp. green algae: effects of light and carbon sources
Authors: Amiri Roonak , Ahmadi Mojtaba
Published: February 2019

The aim of this study is to evaluate the use of Spirogyra sp. green algae for wastewater treatment process in sewer. The effects of light and carbon sources were investigated on growth of the algae Spirogyra sp, removal of nitrate, nitrite, phosphate, chemical oxygen demand (COD) and pH changes. Samples 1 & 4 were grown in autotroph form, while samples 2 & 5 and 3 & 6 were grown in media containing 100 and 200 mg/L of glucose, respectively. Samples 1 up to 3 were grown in cycling light but samples 4 up to 6 were grown in continuous light. Results indicated that algal growth, levels of nitrites and pH and removal of nitrate and phosphate were increased in continuous illumination and carbon sources availability (100 and 200 mg/L of glucose). It can be recommended to apply Spirogyra sp. for wastewater treatment process in sewer collection system.
The importance of reduced light intensity on the growth and development of six weed species
Authors: Yasin M , Rosenqvist E , Jensen S M , Andreasen C
Published: February 2019

Crops limit light for photosynthesis and growth of weeds. We studied the effect of reduced light on performance of six weed species [one invasive species (Amsinckia micrantha), three common species (Veronica persica, Capsella bursa‐pastoris, Viola arvensis) and two less common weeds (Anagallis arvensis and Scleranthus annuus)]. In two glasshouse experiments, six light levels were achieved aiming at 0%, 20%, 50%, 80%, 90% and 95% reduction of light and corresponding with daily light integrals (DLI) of 12.4, 9.63, 7.13, 2.74, 0.95 and 0.69 mol m−2 day−1 in experiment 1 and 21.2, 18.0, 10.7, 3.71, 1.64 and 1.20 mol m−2 day−1 in experiment 2. The number of leaves was strictly controlled by DLI. Chlorophyll content index, maximum photochemical efficiency of photosystem II (Fv/Fm), stomatal conductance, flowering and dry matter were strongly reduced when DLI was reduced to 0.69–3.71 mol m−2 day−1 for all species. Threshold DLI for flowering was ca. 3.71 mol m−2 day−1 for S. annuus, V. arvensis, A. arvensis and V. persica, while C. bursa‐pastoris deviated by flowering at DLI of 0.95 mol m−2 day−1. This may explain why C. bursa‐pastoris is common in the seedbank of Danish arable soils in spite of intensive farming with well‐fertilised and dense crops.
Promising potentials of Tibetan macaques in xenotransplantation
Authors: Zheng Hanrui , Liu Ting , Lei Tiantian , Girani Lea , Wang Yi , Deng Shaoping
Published: February 2019

Organ transplantation is a crucial medical procedure, as it is often the only treatment for patients suffering from end‐stage organ failure. Unfortunately, the shortage of donor organs limits the number of patients whose lives can be saved. Carrying out research on xenotransplantation with the aim of eventually replacing human organ transplants with those of animals is very promising, as it could effectively bridge the shortfall in donor organs. Thanks to the success of cloned pigs and to the emergence of gene‐editing techniques, genetically modified pigs have come to be considered ideal animal donors for human xenotransplantation and have been widely used in basic research. Such research focuses on pig‐to‐nonhuman primates transplantation, as the recipients are suitable for preclinical studies because both their genes and organ sizes are similar to those of humans. Chinese transplantation scientists have carried out several experiments on Tibetan macaques, including successful preclinical transplants of material from genetically modified pigs, as well as research on such topics as intraocular pressure, Parkinson's disease, advanced cancer, islet transplantation, and liver transplantation. This article reviews basic and applied research on Tibetan macaques in xenotransplantation, as well as the issues of immune rejection and ethical concerns. We aim to demonstrate the various advantages of Tibetan macaques as transplant recipients compared to other nonhuman primate species and to provide a perspective for the future establishment of Tibetan macaques as principal recipients in preclinical studies of xenotransplantation.
Observations on the Role of Auto-Ignition in Flame Stabilization in Turbulent Non-Premixed Jet Flames in Vitiated Coflow
Authors: Ramachandran Aravind , Narayanaswamy Venkateswaran , Lyons Kevin M.
Published: February 2019

Turbulent combustion of non-premixed jets issuing into a vitiated coflow is studied at coflow temperatures that do not significantly exceed the fuel auto-ignition temperatures, with the objective of observing the global features of lifted flames in this operating temperature regime and the role played by auto-ignition in flame stabilization. Three distinct modes of flame base motions are identified, which include a fluctuating lifted flame base (mode A), avalanche downstream motion of the flame base (mode B), and the formation and propagation of auto-ignition kernels (mode C). Reducing the confinement length of the hot coflow serves to highlight the role of auto-ignition in flame stabilization when the flame is subjected to destabilization by ambient air entrainment. The influence of auto-ignition is further assessed by computing ignition delay times for homogeneous CH4/air mixtures using chemical kinetic simulations and comparing them against the flow transit time corresponding to mean flame liftoff height of the bulk flame base. It is inferred from these studies that while auto-ignition is an active flame stabilization mechanism in this regime, the effect of turbulence may be crucial in determining the importance of auto-ignition toward stabilizing the flame at the conditions studied. An experimental investigation of auto-ignition characteristics at various jet Reynolds numbers reveals that turbulence appears to have a suppressing effect on the active role of auto-ignition in flame stabilization.
Morphological characteristics of male and female hypopharynx: A magnetic resonance imaging-based study
Authors: Zhang Ju , Honda Kiyoshi , Wei Jianguo , Kitamura Tatsuya
Published: February 2019

Studies with three-dimensional (3D) vocal tract visualization using magnetic resonance imaging (MRI) have suggested that hypopharyngeal cavities, i.e., laryngeal cavity and bilateral piriform fossa, may be the acoustic loci to express speaker characteristics in male speech sounds. Previous studies mainly investigated the hypopharynx in males but few for females. This study explored the hypopharynx morphological characteristics for the subjects in both genders by MRI. 3D numerical vocal tracts at vowels were reconstructed from the MRI datasets of three male and four female Chinese subjects. Geometrical measurements were conducted for the hypopharyngeal cavities. Morphological observations and statistical analyses revealed both commonalities and differences between the male and female subjects. The laryngeal cavity shapes in females were found similar to males resembling a Helmholtz resonator rather than a simple straight closed tube, and the bilateral piriform fossa cavities showed an asymmetry: the right is longer and wider than the left in both genders. As for the cavity size across vowels, for both the male and female subjects the laryngeal cavity and piriform fossa in /i/ were observed larger than those in /a/. To summarize gender characteristics, the female subjects were characterized by the smaller laryngeal cavity and piriform fossa compared with males.
Slowing blood flow to fight viral infection
Authors: Hickman Heather D.
Published: February 2019

T cells produce acetylcholine to dilate blood vessels and migrate into infected tissues
Transcending boundaries
Authors: Hamburg Margaret
Published: February 2019

Next week in Washington, DC, the Annual Meeting of the American Association for the Advancement of Science (AAAS, the publisher of
Science
) will celebrate science and explore many daunting global challenges. The meeting's theme—Science Transcending Boundaries—considers how science can bring together people, ideas, and solutions from across real and artificial borders, disciplines, sectors, ideologies, and traditions. Today's rapidly changing social and scientific terrain demands thinking and acting in new ways. The scientific community must evolve to meet new realities if it is to continue its path of growth and progress and address the world's most pressing problems.
The Basic-Region Helix-Loop-Helix Transcription Factor DevR Significantly Affects Polysaccharide Metabolism in Aspergillus oryzae
Authors: Zhuang Miao , Zhang Zhi-Min , Jin Long , Wang Bao-Teng , Koyama Yasuji , Jin Feng-Jie
Published: February 2019

Aspergillus oryzae
is an industrially important filamentous fungus; therefore, a clear understanding of its polysaccharide metabolism and utilization is very important for its industrial utilization. In this study, we revealed that the basic-region helix-loop-helix (bHLH) transcription factor AoDevR is importantly involved in chitin and starch metabolism in
A. oryzae
. The overexpression of Ao
devR
strongly suppressed the expression of amylase-related genes. The results of a yeast one-hybrid assay suggested that the DevR protein potentially interacts with the promoter of
amyR
, which encodes a transcription factor involved in amylase production and starch utilization. This study provides new insight for further revealing the regulation mechanism of amylase production in
A. oryzae
.
Artificial Fusion of mCherry Enhances Trehalose Transferase Solubility and Stability
Authors: Mestrom Luuk , Marsden Stefan R. , Dieters Marit , Achterberg Puck , Stolk Lysanne , Bento Isabel , Hanefeld Ulf , Hagedoorn Peter-Leon
Published: February 2019

The heterologous expression of proteins in
Escherichia coli
is of great relevance for their functional and structural characterization and applications. However, the formation of insoluble inclusion bodies is observed in approximately 70% of all cases, and the subsequent effects can range from reduced soluble protein yields to a complete failure of the expression system. Here, we present an efficient methodology for the production and analysis of a thermostable, aggregation-prone trehalose transferase (TreT) from
Pyrobaculum yellowstonensis
via its fusion with mCherry as a thermostable fluorescent protein tag. This fusion strategy allowed for increased enzyme stability and solubility and could be applied to other (thermostable) proteins, allowing rapid visualization and quantification of the mCherry-fused protein of interest. Finally, we have demonstrated that the enzymatic synthesis of trehalose from glucose and a nucleotide sugar is reversible by approaching the thermodynamic equilibrium in both the synthesis and hydrolysis directions. Our results show that uridine establishes an equilibrium constant which is more in favor of the product trehalose than when adenosine is employed as the nucleotide under identical conditions. The influence of different nucleotides on the reaction can be generalized for all LeLoir glycosyltransferases under thermodynamic control as the position of the equilibrium depends solely on the reaction conditions and is not affected by the nature of the catalyst.
Fifteen-minute consultation: Recognising primary immune deficiencies in children
Authors: Wekell Per , Hertting Olof , Holmgren Daniel , Fasth Anders
Published: February 2019

Children with primary immunodeficiency syndromes present with broad variation of clinical features and the consequences are often severe if not promptly recognised. Here, support is provided for the general paediatrician to recognise primary immunodeficiencies among the many children they meet in their clinical practice.
Exploring the human factors of prescribing errors in paediatric intensive care units
Authors: Sutherland Adam , Ashcroft Darren M , Phipps Denham L
Published: February 2019

Objective

To explore the factors contributing to prescribing error in paediatric intensive care units (PICUs) using a human factors approach based on Reason’s theory of error causation to support planning of interventions to mitigate slips and lapses, rules-based mistakes and knowledge-based mistakes.

Methods

A hierarchical task analysis (HTA) of prescribing was conducted using documentary analysis. Eleven semistructured interviews with prescribers were conducted using vignettes and were analysed using template analysis. Contributory factors were identified through the interviews and were related to tasks in the HTA by an expert panel involving a PICU clinician, nurse and pharmacist.

Results

Prescribing in PICU is composed of 30 subtasks. Our findings indicate that cognitive burden was the main contributory factor of prescribing error. This manifested in two ways: physical, associated with fatigue, distraction and interruption, and poor information transfer; and psychological, related to inexperience, changing workload and insufficient decision support information. Physical burden was associated with errors of omission or selection; psychological burden was linked to errors related to a lack of knowledge and/or awareness. Social control through nursing staff was the only identified control step. This control was dysfunctional at times as nurses were part of an informal mechanism to support decision making, was ineffective.

Conclusions

Cognitive burden on prescribers is the principal latent factor contributing to prescribing error. This research suggests that interventions relating to skill mix, and communication and presentation of information may be effective at mitigating rule and knowledge-based mistakes. Mitigating fatigue and standardising procedures may minimise slips and lapses.
One month of nitrous oxide abuse causing acute vitamin B12deficiency with severe neuropsychiatric symptoms
Authors: Lundin Michael S , Cherian John , Andrew Michael Nyika , Tikaria Richa
Published: February 2019

A 21-year-old university student studying abroad in the USA presented to the emergency department with double vision, lower extremity weakness with difficulty ambulating and other neuropsychiatric symptoms. MRI of the brain and spinal cord were normal. Vitamin B12was 78 pg/mL (58 pmol/L, reference 211–911 pg/mL). The patient had been using nitrous oxide capsules used for whipped cream recharging, which she obtained from other students, a few times daily for a month for the purpose of anxiety relief. The patient was not a vegan or vegetarian. The patient was treated with intramuscular vitamin B12repletion with partial resolution of neurologic symptoms and discharged on vitamin B12supplementation.
Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus
Authors: Tanaka Thaís Shiota , Hood Christopher Thomas , Kriegel Matthias Frank , Niziol Leslie , Soong H Kaz
Published: February 2019

Background/Aim

To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).

Methods

We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center.

Results

The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2–4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241).

Conclusions

Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.
Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial
Authors: Palmer Antony J R , Ayyar Gupta Vandana , Fernquest Scott , Rombach Ines , Dutton Susan J , Mansour Ramy , Wood Simon , Khanduja Vikas , Pollard Tom C B , McCaskie Andrew W , Barker Karen L , Andrade Tony J M D , Carr Andrew J , Beard David J , Glyn-Jones Sion
Published: February 2019

Objective

To compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic femoroacetabular impingement (FAI).

Design

Two group parallel, assessor blinded, pragmatic randomised controlled trial.

Setting

Secondary and tertiary care centres across seven NHS England sites.

Participants

222 participants aged 18 to 60 years with symptomatic FAI confirmed clinically and with imaging (radiography or magnetic resonance imaging) were randomised (1:1) to receive arthroscopic hip surgery (n=112) or a programme of physiotherapy and activity modification (n=110). Exclusion criteria included previous surgery, completion of a physiotherapy programme targeting FAI within the preceding 12 months, established osteoarthritis (Kellgren-Lawrence grade ≥2), and hip dysplasia (centre-edge angle <20 degrees).

Interventions

Participants in the physiotherapy group received a goal based programme tailored to individual patient needs, with emphasis on improving core stability and movement control. A maximum of eight physiotherapy sessions were delivered over five months. Participants in the arthroscopic surgery group received surgery to excise the bone that impinged during hip movements, followed by routine postoperative care.

Main outcome measures

The primary outcome measure was the hip outcome score activities of daily living subscale (HOS ADL) at eight months post-randomisation, with a minimum clinically important difference between groups of 9 points. Secondary outcome measures included additional patient reported outcome measures and clinical assessment.

Results

At eight months post-randomisation, data were available for 100 patients in the arthroscopic hip surgery group (89%) and 88 patients in the physiotherapy programme group (80%). Mean HOS ADL was 78.4 (95% confidence interval 74.4 to 82.3) for patients randomised to arthroscopic hip surgery and 69.2 (65.2 to 73.3) for patients randomised to the physiotherapy programme. After adjusting for baseline HOS ADL, age, sex, and study site, the mean HOS ADL was 10.0 points higher (6.4 to 13.6) in the arthroscopic hip surgery group compared with the physiotherapy programme group (P<0.001)). No serious adverse events were reported in either group.

Conclusions

Patients with symptomatic FAI referred to secondary or tertiary care achieve superior outcomes with arthroscopic hip surgery than with physiotherapy and activity modification.

Trial registration

ClinicalTrials.gov
NCT01893034
.
Selenium supplementation and insulin resistance in a randomized, clinical trial
Authors: Jacobs Elizabeth Theresa , Lance Peter , Mandarino Lawrence J , Ellis Nathan A , Chow H-H Sherry , Foote Janet , Martinez Jessica A , Hsu Chiu-Hsieh Paul , Batai Ken , Saboda Kathylynn , Thompson Patricia A
Published: February 2019

Objective

While controversial, observational and randomized clinical trial data implicate the micronutrient selenium (Se) in the development of type 2 diabetes (T2D). The aim of this study was to test the hypothesis that Se supplementation adversely affects pancreatic β-cell function and insulin sensitivity.

Research design and methods

In a subset of 400 individuals participating in a randomized, placebo-controlled trial of Se at 200 µg/day for colorectal adenomatous polyps, fasting plasma glucose and insulin were measured before randomization and within 6 months of completing intervention. Change in the homeostasis model assessment-β cell function (HOMA2-%β) and insulin sensitivity (HOMA2-%S) were compared between arms. A subgroup of 175 (79 Se and 96 placebo) participants underwent a modified oral glucose tolerance test (mOGTT) at the end of intervention and change in glucose values was assessed.

Results

No statistically significant differences were observed for changes in HOMA2-%β or HOMA2-%S between those who received Se compared with placebo. After a mean of 2.9 years on study, mean HOMA2-%β values were 3.1±24.0 and 3.1±29.8 for the Se and placebo groups, respectively (p=0.99). For HOMA2-%S, the values were −0.5±223.2 and 80.9±1530.9 for the Se and placebo groups, respectively (p=1.00). Stratification by sex or age did not reveal any statistically significant effects on insulin sensitivity by treatment group. For mOGTT, mean baseline fasting blood glucose concentrations were significantly higher among participants in the placebo group compared with the Se group (96.6±14.6 and 92.3±12.0, respectively; p=0.04), a trend which remained through the 20 min assessment.

Conclusions

These findings do not support a significant adverse effect of daily Se supplementation with 200 µg/day of selenized yeast on β-cell function or insulin sensitivity as an explanation for previously reported associations between Se and T2D. Further clarification of longer term effects of Se is needed.

Clinical trial registry

NIH Clinical Trials.gov numberNCT00078897.
Successful use of TNFα blockade in a severe case of idiopathic non-granulomatous ulcerative jejunoileitis associated with thrombotic thrombocytopenic purpura
Authors: Braun Fabian , Suarez Victor , Dinter Johanna , Haneder Stefan , Quaas Alexander , Benzing Thomas , Nierhoff Dirk , Müller Roman-Ulrich
Published: February 2019

We describe the case of 50-year-old female patient who presented with severe gastrointestinal symptoms and progressive weight loss of unknown origin. Shortly after admission, she developed an acute flare of thrombotic thrombocytopaenic purpura (TTP) that had to be treated by plasma exchange therapy and rituximab administration. While the signs of TTP subsided, the gastrointestinal symptoms worsened with abdominal cramps, massive gastric retention, malnourishment and a stenosis due to extensive inflammation and wall thickening of the small bowel. Extensive diagnostic efforts yielded no specific cause, so the patient—based on the histopathological findings—was diagnosed with idiopathic non-granulomatous ulcerative jejunoileitis. Following a highly complicated clinical course over several months, successful remission of the inflammatory activity and recovery of the patient could be obtained by TNF-alpha blockade.
Is the current surge in political and financial attention to One Health solidifying or splintering the movement?
Authors: Spencer Julia , McRobie Ellen , Dar Osman , Rahman-Shepherd Afifah , Hasan Nadeem , Hanefeld Johanna , Khan Mishal
Published: February 2019

Introduction

The global health field has witnessed the rise, short-term persistence and fall of several movements. One Health, which addresses links between human, animal and environmental health, is currently experiencing a surge in political and financial attention, but there are well-documented barriers to collaboration between stakeholders from different sectors. We examined how stakeholder dynamics and approaches to operationalising One Health have evolved further to recent political and financial support for One Health.

Methods

We conducted a mixed methods study, first by qualitatively investigating views of 25 major policymakers and funders of One Health programmes about factors supporting or impeding systemic changes to strengthen the One Health movement. We then triangulated these findings with a quantitative analysis of the current operations of 100 global One Health Networks.

Results

We found that recent attention to One Health at high-level political fora has increased power struggles between dominant human and animal health stakeholders, in a context where investment in collaboration building skills is lacking. The injection of funding to support One Health initiatives has been accompanied by a rise in organisations conducting diverse activities under the One Health umbrella, with stakeholders shifting operationalisation in directions most aligned with their own interests, thereby splintering and weakening the movement. While international attention to antimicrobial resistance was identified as a unique opportunity to strengthen the One Health movement, there is a risk that this will further drive a siloed, disease-specific approach and that structural changes required for wider collaboration will be neglected.

Conclusion

Our analysis indicated several opportunities to capitalise on the current growth in One Health initiatives and funding. In particular, evidence from better monitoring and evaluation of ongoing activities could support the case for future funding and allow development of more precise guidelines on best practices.
How socioeconomic status moderates the stunting-age relationship in low-income and middle-income countries
Authors: Bommer Christian , Vollmer Sebastian , Subramanian S V
Published: February 2019

Introduction

Reducing stunting is an important part of the global health agenda. Despite likely changes in risk factors as children age, determinants of stunting are typically analysed without taking into account age-related heterogeneity. We aim to fill this gap by providing an in-depth analysis of the role of socioeconomic status (SES) as a moderator for the stunting-age pattern.

Methods

Epidemiological and socioeconomic data from 72 Demographic and Health Surveys (DHS) were used to calculate stunting-age patterns by SES quartiles, derived from an index of household assets. We further investigated how differences in age-specific stunting rates between children from rich and poor households are explained by determinants that could be modified by nutrition-specific versus nutrition-sensitive interventions.

Results

While stunting prevalence in the pooled sample of 72 DHS is low in children up to the age of 5 months (maximum prevalence of 17.8% (95% CI 16.4;19.3)), stunting rates in older children tend to exceed those of younger ones in the age bracket of 6–20 months. This pattern is more pronounced in the poorest than in the richest quartile, with large differences in stunting prevalence at 20 months (stunting rates: 40.7% (95% CI 39.5 to 41.8) in the full sample, 50.3% (95% CI 48.2 to 52.4) in the poorest quartile and 29.2% (95% CI 26.8 to 31.5) in the richest quartile). When adjusting for determinants related to nutrition-specific interventions only, SES-related differences decrease by up to 30.1%. Much stronger effects (up to 59.2%) occur when determinants related to nutrition-sensitive interventions are additionally included.

Conclusion

While differences between children from rich and poor households are small during the first 5 months of life, SES is an important moderator for age-specific stunting rates in older children. Determinants related to nutrition-specific interventions are not sufficient to explain these SES-related differences, which could imply that a multifactorial approach is needed to reduce age-specific stunting rates in the poorest children.
Detailed injury epidemiology in contemporary dance: a 1-year prospective study of 134 students
Authors: van Winden Diana P A M , Van Rijn Rogier M , Richardson Angelo , Savelsbergh Geert J P , Oudejans Raôul R D , Stubbe Janine H
Published: February 2019

Aim

We investigated the extent and characteristics of injuries in contemporary dance students.

Methods

During one academic year, 134 students of Bachelor dance and Bachelor dance teacher from Codarts University of the Arts (Rotterdam, the Netherlands) were prospectively monitored monthly, using the Performing Artist and Athlete Health Monitor which includes the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

Results

130 students were included in the analyses. The response rate of monthly completed questionnaires was 80%. During the academic year, 97% of students reported at least one injury, mental complaint or other health problem. The 1-year injury incidence proportion was 81%. Of these injured students, 58% were substantially injured (ie, problems leading to moderate or severe reductions in training volume or performance or complete inability to participate in activities). The monthly injury proportion (all injuries) ranged from 23% to 43% and for substantial injuries from 6% to 17%. The injury incidence rate per 1000 hours dance exposure was 1.9 (95% CI 1.7 to 2.2). Ankle/foot (30%), lower back (17%) and knee (15%) were the most common sites of injury.

Conclusion

Contemporary dance students are at high risk for injuries. Injury prevention programmes among contemporary dance students should focus on the ankle/foot, lower back and knee.
Leadership sharing in maternity emergency teams: a retrospective cohort study in simulation
Authors: Janssens Sarah , Simon Robert , Barwick Stephanie , Beckmann Michael , Marshall Stuart
Published: February 2019

Background

Shared leadership is associated with improved team performance in many domains, but little is understood about how leadership is shared spontaneously in maternity emergency teams, and if it is associated with improved team performance.

Methods

A video analysis study of multidisciplinary teams attending a maternity emergency management course was performed at a simulation centre colocated with a tertiary maternity hospital. Sixteen teams responding to a simulated postpartum haemorrhage were analysed between November 2016 and November 2017. Videos were transcribed, and utterances coded for leadership type using a coding system developeda priori. Distribution of leadership utterances between team members was calculated using the Gini coefficient. Teamwork was assessed using validated tools and clinical performance was assessed by time to perform a critical intervention and a checklist of required tasks.

Results

There was a significant sharing of leadership functions across the team despite the traditional recommendation for a singular leader, with the dominant leader only accounting for 58% of leadership utterances. There was no significant difference in Auckland Team Assessment Tool scores between high and low leadership sharing teams (5.02 vs 4.96, p=0.574). Time to critical intervention was shorter in low leadership sharing teams (193 s vs 312 s, p=0.018) but checklist completion did not differ significantly. Teams with better clinical performance had fewer leadership utterances beyond the dominant two leaders compared with poorer performing teams.

Conclusions

Leadership is spontaneously shared in maternity emergency teams despite the recommendation for singular leadership. Spontaneous leadership emerging from multiple team members does not appear to be associated with the improvements in team performance seen in other domains.
John Charles Codner
Authors: Lack Alan , Brazil Lindsay
Published: February 2019

A passionate and accomplished farm animal and equine vet, he was also an inspirational teacher. Away from work, he enjoyed sailing and racing and was always viewed as one to beat.
Influence of interior layer properties to moisture dry-out of CLT walls
Authors: Kukk Villu , Külaots Annegrete , Kers Jaan , Kalamees Targo
Published: February 2019

The objective of this study was to determine the maximum allowable initial moisture content (MC) for cross-laminated timber (CLT) walls having both exterior and interior thermal insulation. A laboratory test was conducted, for which four test walls with two different insulation solutions and two different MCs were built. Based on the test results, a simulation model was configured and simulations using the model were completed. The simulation results determined that the maximum allowable initial MC of the CLT panels was 17% for walls insulated additionally from inside with mineral wool and 15% for CLT wall assemblies insulated with polyisocyanurate (PIR). Based on these results, it was concluded that the allowable MC ranges between 8% and 16% for construction timber, and therefore, using a PIR board as interior insulation for CLT walls should be undertaken with caution given the very small margin for error in MC.
Second-Moment-Based Design of Dynamic Systems with Both Uncertain Excitations and Parameters Via Differentiable Meta-Models
Authors: Savage G. J. , Son Young Kap
Published: February 2019

Design using second-moments is readily understood by engineers. The output means (first-moments) and covariances (second-moments) are expressed through the means and covariances of the inputs. Further, various performance indexes can be formulated in terms of the second-moments and used to measure the “goodness” of the system’s performance. This paper addresses the design of nonlinear dynamic systems with uncertainty in both the component parameters and the excitations. In order to reduce the computational effort needed for design iterations on the mechanistic model, meta-models are introduced as computationally efficient surrogates. Herein, a novel, differentiable, meta-model that finds the response of dynamic systems with simultaneous component and excitation uncertainty is presented. Operationally, a family of training excitations and sets of training parameters are chosen and stored in respective matrices. Both types of inputs must have some realistic bounds. The corresponding responses, produced by the mechanistic model, make use of all of the training parameter sets interleafed with the training excitations: the time-sampled results are stored in the response matrix. An application of singular value decomposition on the response matrix reveals a repeating pattern of sub-vectors in the left singular vectors. Each sub-vector (viewed as the output) is replaced by a least-squares meta-model that links in the parameter matrix. The result is a parameter-response matrix with the same number of rows as the excitation matrix. Finally, to complete the meta-model, another application of the least-squares paradigm links the excitation matrix to the columns of the parameter-response matrix. Performance indexes, and approximations of their means and covariances through Taylor series, provide cogent optimization measures. The required derivatives are easily obtained from the explicit form of the meta-model. The efficacy of the meta-model is shown through the design of a nonlinear, quarter automobile, system. The accuracy, increased computation speed and robustness of the methodology provide the impact of the work herein. The sources of errors are identified and ways to mitigate them are discussed.
Complex group algebras of the direct product of non-isomorphic Suzuki groups
Authors: Baniasad Azad Morteza , Khosravi Behrooz
Published: February 2019

In this paper, we prove that the direct product [Formula: see text], where [Formula: see text] are distinct numbers, is uniquely determined by its complex group algebra. Particularly, we show that the direct product [Formula: see text], where [Formula: see text]’s are distinct odd prime numbers, is uniquely determined by its order and three irreducible character degrees.
HEART-RATE BASED SLEEP APNEA DETECTION USING ARDUINO
Authors: PEARSON MICHAEL , FAUST OLIVER
Published: February 2019

The purpose of this study was to investigate the use of a cost-effective heart rate monitor sensor and Arduino Uno configuration to accurately detect simulated sleep apnea, through the use of the inter-beat interval (R-R interval). Three separate 30[Formula: see text]min heart rate recordings were taken, each with six simulated sleep apnea events ranging from 20 to 40[Formula: see text]s. The results were gathered and processed to identify the simulated sleep apnea events. In each of the recordings, the simulated sleep apnea events were visible and the key characteristics, surrounding the events, could be recognized. The heart rate monitor sensor and Arduino Uno configuration successfully detected the simulated sleep apnea events through the analysis and processing of the hearts R-R interval.