bluuebunny/crossref_metadata_2025 huggingface dataset:
Which is better, high‐dose metformin monotherapy or low‐dose metformin/linagliptin combination therapy, in improving glycemic variability in type 2 diabetes patients with insufficient glycemic control despite low‐dose metformin monotherapy? A randomized, cross‐over, continuous glucose monitoring‐based pilot study
Authors: Takahashi Hiroshi , Nishimura Rimei , Tsujino Daisuke , Utsunomiya Kazunori
Published: September 2018

Aims/Introduction

The present study investigated the effect of high‐dose metformin or low‐dose metformin/linagliptin combination therapy on glycemic variability (GV) in type 2 diabetes patients with insufficient glycemic control despite low‐dose metformin monotherapy in a cross‐over study using continuous glucose monitoring.

Materials and Methods

The present study was carried out with 11 type 2 diabetes outpatients (7% < glycated hemoglobin < 10%) receiving low‐dose metformin monotherapy (500–1,000 mg). All patients were assigned to either metformin 1,500 mg monotherapy (HMET) or combination therapy of low‐dose (750 mg) metformin and linagliptin 5 mg (LMET + dipeptidyl peptidase‐4 [DPP4]). GV was evaluated by continuous glucose monitoring after >4 weeks of the initial treatment and again after cross‐over to the other treatment. GV metrics were compared between the treatments using the Wilcoxon signed‐rank test.

Results

Of the continuous glucose monitoring‐derived GV metrics for the HMET versus LMET + DPP4, mean glucose levels, standard deviations and mean amplitude of glucose excursions were not significantly different. Although the pre‐breakfast glucose levels were not significantly different among the treatments (P = 0.248), the 3‐h postprandial glucose area under the curve (>160 mg/dL) after breakfast was significantly larger with HMET versus LMET + DPP4 (9,550 [2,075–11,395] vs 4,065 [1,950–8,895]; P = 0.041).

Conclusions

A comparison of GV with HMET versus LMET + DPP4 suggested that LMET + DPP4 might reduce post‐breakfast GV to a greater degree than HMET in type 2 diabetes patients receiving low‐dose metformin monotherapy.
Plant lncRNAs are enriched in and move systemically through the phloem in response to phosphate deficiency
Authors: Zhang Zhaoliang , Zheng Yi , Ham Byung‐Kook , Zhang Shupei , Fei Zhangjun , Lucas William J.
Published: September 2018

In response to phosphate (Pi) deficiency, it has been shown that micro‐RNAs (miRNAs) and mRNAs are transported through the phloem for delivery to sink tissues. Growing evidence also indicates that long non‐coding RNAs (lncRNAs) are critical regulators of Pi homeostasis in plants. However, whether lncRNAs are present in and move through the phloem, in response to Pi deficiency, remains to be established. Here, using cucumber as a model plant, we show that lncRNAs are enriched in the phloem translocation stream and respond, systemically, to an imposed Pi‐stress. A well‐known lncRNA, IPS1, the target mimic (TM) of miRNA399, accumulates to a high level in the phloem, but is not responsive to early Pi deficiency. An additional 24 miRNA TMs were also detected in the phloem translocation stream; among them miRNA171 TMs and miR166 TMs were induced in response to an imposed Pi stress. Grafting studies identified 22 lncRNAs which move systemically into developing leaves and root tips. A CU‐rich PTB motif was further identified in these mobile lncRNAs. Our findings revealed that lncRNAs respond to Pi deficiency, non‐cell‐autonomously, and may act as systemic signaling agents to coordinate early Pi deficiency signaling, at the whole‐plant level.
Novel ethosomal gel of clove oil for the treatment of cutaneous candidiasis
Authors: Shetty Shweta , Jose Jobin , Kumar Lalit , Charyulu R Narayana
Published: September 2018

Background

Dual‐release mechanism of ethosomal gels (ie, ethosomes and gel) makes them as versatile drug delivery systems for topical applications. Clove oil is obtained from the clove buds exhibited broad antifungal and antibacterial activity. Cutaneous candidiasis is the infection caused by Candida albicans or other Candida species.

Aim

The aim of the present study was to prepare ethosomal gel of clove oil and evaluate its effectiveness in the treatment of cutaneous candidiasis.

Methods

Ethosomes of clove oil was formulated by using varying concentrations of soyaphosphotidyl choline and ethanol, and later, it was incorporated into carbapol 974 base gels to form ethosomal gel. The prepared ethosomal gels were also evaluated for spreadability, drug release studies, ex vivo permeation study, and antifungal activity.

Results

The optimized formulation did not cause any irritation to the skin since the pH of formulation was in the pH range of skin. The ethosomal gel showed satisfactory antifungal activity against the fungus C. albicans compared to pure clove oil.

Conclusions

The results showed that developed formulation could be promising one in the topical delivery of clove oil for the treatment of cutaneous candidiasis.
Drivers and Pathways of NPD Success in the Marketing–External Design Relationship
Authors: Hemonnet‐Goujot Aurélie , Manceau Delphine , Abecassis‐Moedas Céline
Published: September 2018

Marketing often cooperates with external design in the new product development (NPD) process. While this relationship is crucial for NPD success and is a typical case of interorganizational collaboration between a business‐oriented function (marketing) and a creative partner (external design), a comprehensive understanding of this relationship remains lacking. As the NPD field evolves to open systems that have changed concepts like functional integration into interorganizational integration, this study contributes to NPD literature by developing an integrated conceptual framework leading to a model of drivers and pathways of NPD success in the marketing–external design relationship. Building on the literature on NPD, design management and relationship marketing, and on nine dyadic case studies from the luxury fragrance and cosmetics industry, a content analysis was conducted, enriched by a crisp‐set qualitative comparative analysis (QCA). This research confirms several NPD success drivers suggested in the literature and reveals three new drivers: source of design expertise, designer brand commitment, and number of NPD stages involving designer. The first new driver (source of design expertise) impacts the relationship process, which then impacts NPD success, while the other two drivers (designer brand commitment, and number of NPD stages involving designer) directly influence NPD success. The paper also identifies the pathways of NPD success, showing that contact authority and designer brand commitment are necessary conditions for NPD success, especially when combined with a high number of NPD stages involving designer or a previous relationship. The results also indicate that pathways of NPD success may differ according to the source of design expertise. From a managerial perspective, this study provides recommendations to managers to select the right design partner and choose from a range of drivers and pathways to devise more effective ways to work with external designers, thereby leading to NPD success.
Transient genetic transformation of Mougeotia scalaris (Zygnematophyceae) mediated by the endogenous α‐tubulin1 promoter
Authors: Regensdorff Merle , Deckena Marek , Stein Maike , Borchers Agnes , Scherer Gwydion , Lammers Maike , Hänsch Robert , Zachgo Sabine , Buschmann Henrik
Published: September 2018

Mougeotia scalaris is a filamentous streptophyte alga renowned for light‐inducible plastid rotation and microtubule‐dependent polarity establishment. As a first step toward transgenic approaches we determined the 5,825 base pair genomic sequence encoding the α‐tubulin1 gene (MsTUA1) of M. scalaris (strain SAG 164.80). The subcloned MsTUA1 promoter facilitated strong transgene expression in M. scalaris and tobacco leaf cells, as shown by particle bombardment and the subsequent visualization of expressed fluorescent protein markers. Our results provide a route for the genetic transformation of the filamentous streptophyte alga M. scalaris based on the endogenous TUA1 promoter.
Identification and quantification of domestic feline cytochrome P450 transcriptome across multiple tissues
Authors: Visser Marike , Weber Kristina L. , Lyons Leslie A. , Rincon Gonzalo , Boothe Dawn M. , Merritt Dawn A.
Published: September 2018

Understanding of cytochrome P450 (CYP) isoform distribution and function in the domestic feline is limited. Only a few studies have defined individual CYP isoforms across metabolically relevant tissues, hampering the ability to predict drug metabolism and potential drug–drug interactions. Using RNA sequencing (RNA‐seq), transcriptomes from the 99 Lives Cat Genome Sequencing Initiative databank combined with experimentally acquired whole transcriptome sequencing of healthy, adult male (n = 2) and female (n = 2) domestic felines, expression of 42 CYP isoforms were identified in 20 different tissues. Thirty‐seven of these isoforms had not been previously reported in cats. Depending on the tissue, three to twenty‐nine CYP isoform transcripts were expressed. The feline genome annotations did not differentiate CYP2E1 and 2E2 genes, demonstrating poor annotation for this gene using the reference genome. As the majority of the sequences are based on automated pipelines, complete cDNA sequences for translation into CYP protein sequences could not be determined. This study is the first to identify and characterize 37 additional CYP isoforms in feline tissues, increasing the number of identified CYP from the previously reported seven isoforms to 42 across 20 tissues.
Phytophthora infestans small phospholipase D‐like proteins elicit plant cell death and promote virulence
Authors: Meijer Harold J. G. , Schoina Charikleia , Wang Shutong , Bouwmeester Klaas , Hua Chenlei , Govers Francine
Published: September 2018

The successful invasion of host tissue by (hemi‐)biotrophic plant pathogens is dependent on modifications of the host plasma membrane to facilitate the two‐way transfer of proteins and other compounds. Haustorium formation and the establishment of extrahaustorial membranes are probably dependent on a variety of enzymes that modify membranes in a coordinated fashion. Phospholipases, enzymes that hydrolyse phospholipids, have been implicated as virulence factors in several pathogens. The oomycete Phytophthora infestans is a hemibiotrophic pathogen that causes potato late blight. It possesses different classes of phospholipase D (PLD) proteins, including small PLD‐like proteins with and without signal peptide (sPLD‐likes and PLD‐likes, respectively). Here, we studied the role of sPLD‐like‐1, sPLD‐like‐12 and PLD‐like‐1 in the infection process. They are expressed in expanding lesions on potato leaves and during in vitro growth, with the highest transcript levels in germinating cysts. When expressed in planta in the presence of the silencing suppressor P19, all three elicited a local cell death response that was visible at the microscopic level as autofluorescence and strongly boosted in the presence of calcium. Moreover, inoculation of leaves expressing the small PLD‐like genes resulted in increased lesion growth and greater numbers of sporangia, but this was abolished when mutated PLD‐like genes were expressed with non‐functional PLD catalytic motifs. These results show that the three small PLD‐likes are catalytically active and suggest that their enzymatic activity is required for the promotion of virulence, possibly by executing membrane modifications to support the growth of P. infestans in the host.
Onset of estrus and preovulatory LH surge and ovulatory efficiency in sheep after short‐term treatments with progestagen‐sponges and progesterone‐CIDRs
Authors: Martinez‐Ros Paula , Astiz Susana , Garcia‐Rosello Empar , Rios‐Abellan Alejandro , Gonzalez‐Bulnes Antonio
Published: September 2018

Contents

The present study supports that short‐term (7‐days) protocols based on progestagen‐impregnated sponges and progesterone‐loaded CIDRs are equally effective to induce ovulatory response in sheep. There were no significant differences in the onset of estrus behavior (32.0 ± 6.0 and 33.8 ± 4.0 hr after device withdrawal for sponges and CIDRs, respectively; p > 0.05) and preovulatory LH discharge (5.1 ± 2.1 and 5.8 ± 3.3 hr after onset of estrus behavior for sponges and CIDRs, respectively; p > 0.05). These features are similar to previously described for classical long‐term (12–14 days) treatments. Hence, short‐term CIDR‐based protocols may be implemented using the same time‐intervals for insemination than sponge‐based and long‐term protocols.
Acute kidney injury caused by systemic Neisseria gonorrhoeae infection after successful kidney transplantation
Authors: Harada Hiroshi , Mitsuke Akihiko , Fukuzawa Nobuyuki , Kodama Fumihiro , Hirose Takayuki , Tanaka Toshiaki , Imamoto Teppei , Tanaka Hiroshi
Published: September 2018

Neisseria gonorrhoeae is one of the microbes that can causes male urethritis. This microbe is most likely to be transmitted via sexual intercourse. In men, the representative infection sites are the urethra, and oral mucosa but gonococcemia is rere. We present a case of gonococcemia in a 47‐year‐old male successful kidney recipient. He temporarily lost his graft function due to acute kidney injury followed by sepsis; however, short‐course intermittent hemodialysis and long‐term intensive ceftriaxone inoculation saved his life and his graft function.
Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data
Authors: Davis Stephanie M , Hines Jonas Z , Habel Melissa , Grund Jonathan M , Ridzon Renee , Baack Brittney , Davitte Jonathan , Thomas Anne , Kiggundu Valerian , Bock Naomi , Pordell Paran , Cooney Caroline , Zaidi Irum , Toledo Carlos
Published: September 2018

Objective

This article provides an overview and interpretation of the performance of the US President’s Emergency Plan for AIDS Relief’s (PEPFAR’s) male circumcision programme which has supported the majority of voluntary medical male circumcisions (VMMCs) performed for HIV prevention, from its 2007 inception to 2017, and client characteristics in 2017.

Design

Longitudinal collection of routine programme data and disaggregations.

Setting

14 countries in sub-Saharan Africa with low baseline male circumcision coverage, high HIV prevalence and PEPFAR-supported VMMC programmes.

Participants

Clients of PEPFAR-supported VMMC programmes directed at males aged 10 years and above.

Main outcome measures

Numbers of circumcisions performed and disaggregations by age band, result of HIV test offer, procedure technique and follow-up visit attendance.

Results

PEPFAR supported a total of 15 269 720 circumcisions in 14 countries in Southern and Eastern Africa. In 2017, 45% of clients were under 15 years of age, 8% had unknown HIV status, 1% of those tested were HIV+ and 84% returned for a follow-up visit within 14 days of circumcision.

Conclusions

Over 15 million VMMCs have been supported by PEPFAR since 2007. VMMC continues to attract primarily young clients. The non-trivial proportion of clients not testing for HIV is expected, and may be reassuring that testing is not being presented as mandatory for access to circumcision, or in some cases reflect test kit stockouts or recent testing elsewhere. While VMMC is extremely safe, achieving the highest possible follow-up rates for early diagnosis and intervention on complications is crucial, and programmes continue to work to raise follow-up rates. The VMMC programme has achieved rapid scale-up but continues to face challenges, and new approaches may be needed to achieve the new Joint United Nations Programme on HIV/AIDS goal of 27 million additional circumcisions through 2020.
Convergent parallel mixed-methods study to understand information exchange in paediatric critical care and inform the development of safety-enhancing interventions: a protocol study
Authors: Tomasi Jessica , Warren Carly , Kolodzey Lauren , Pinkney Sonia , Guerguerian Anne-Marie , Kirsch Roxanne , Hubbert Jackie , Sperling Christina , Sutton Patricia , Laussen Peter , Trbovich Patricia
Published: September 2018

Introduction

The effective exchange of clinical information is essential to high-quality patient care, especially in the critical care unit (CCU) where communication failures can have profoundly negative impacts on critically ill patients with limited physiological capacity to tolerate errors. A comprehensive systematic characterisation of information exchange within a CCU is needed to inform the development and implementation of effective, contextually appropriate interventions. The objective of this study is to characterise when, where and how healthcare providers exchange clinical information in the Department of Critical Care Medicine at The Hospital for Sick Children and explore the factors that currently facilitate or counter established best rounding practices therein.

Methods and analysis

A convergent parallel mixed-methods study design will be used to collect, analyse and interpret quantitative and qualitative data. Naturalistic observations of rounds and relevant peripheral information exchange activities will be conducted to collect time-stamped event data on workflow and communication patterns (time–motion data) and field notes. To complement observational data, the subjective perspectives of healthcare providers and patient families will be gathered through surveys and interviews. Departmental metrics will be collected to further contextualise the environment. Time–motion data will be analysed quantitatively; patterns in field note, survey and interview results will be examined based on themes identified deductively from literature and/or inductively based on the data collected (thematic analysis). The proactive triangulation of these systemic, procedural and contextual data will inform the design and implementation of efficacious interventions in future work.

Ethics and dissemination

Institutional research ethics approval has been acquired (REB #1000059173). Results will be published in peer-reviewed journals and presented at relevant conferences. Findings will be presented to stakeholders including interdisciplinary staff, departmental management and leadership and families to highlight the strengths and weaknesses of the exchange of clinical information in its current state and develop user-centred recommendations for improvement.
The role of osteopathy in the Swiss primary health care system: a practice review
Authors: Vaucher Paul , Macdonald Mia , Carnes Dawn
Published: September 2018

Objectives

The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system.

Design

A questionnaire survey that included a patient record-based retrospective clinical audit.

Setting/population

Osteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association.

Questionnaire

The survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016.

Results

The response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider.

Conclusions

In Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system.
Prevalence of long-term health conditions in adults with autism: observational study of a whole country population
Authors: Rydzewska Ewelina , Hughes-McCormack Laura Anne , Gillberg Christopher , Henderson Angela , MacIntyre Cecilia , Rintoul Julie , Cooper Sally-Ann
Published: September 2018

Objectives

To investigate the prevalence of comorbid mental health conditions and physical disabilities in a whole country population of adults aged 25+ with and without reported autism.

Design

Secondary analysis of Scotland’s Census, 2011 data. Cross-sectional study.

Setting

General population.

Participants

94% of Scotland’s population, including 6649/3 746 584 adults aged 25+ reported to have autism.

Main outcome measures

Prevalence of six comorbidities: deafness or partial hearing loss, blindness or partial sight loss, intellectual disabilities, mental health conditions, physical disability and other condition; ORs (95% CI) of autism predicting these comorbidities, adjusted for age and gender; and OR for age and gender in predicting comorbidities within the population with reported autism.

Results

Comorbidities were common: deafness/hearing loss—17.5%; blindness/sight loss—12.1%; intellectual disabilities—29.4%; mental health conditions—33.0%; physical disability—30.7%; other condition—34.1%. Autism statistically predicted all of the conditions: OR 3.3 (95% CI 3.1 to 3.6) for deafness or partial hearing loss, OR 8.5 (95% CI 7.9 to 9.2) for blindness or partial sight loss, OR 94.6 (95% CI 89.4 to 100.0) for intellectual disabilities, OR 8.6 (95% CI 8.2 to 9.0) for mental health conditions, OR 6.2 (95% CI 5.8 to 6.6) for physical disability and OR 2.6 (95% CI 2.5 to 2.8) for other condition. Contrary to findings within the general population, female gender predicted all conditions within the population with reported autism, including intellectual disabilities (OR=1.4).

Conclusions

Clinicians need heightened awareness of comorbidities in adults with autism to improve detection and suitable care, especially given the added complexity of assessment in this population and the fact that hearing and visual impairments may cause additional difficulties with reciprocal communication which are also a feature of autism; hence posing further challenges in assessment.
The Genealogy of the “Leader of the People”: Images of Leaders and the Political Language of the Russian Revolution of 1917
Authors: Ivanovich Kolonitskii Boris
Published: September 2018

Boris Kolonitskii continues his studies of the cult of Alexander Kerensky in 1917 and the larger issues of the vocabulary used to describe leaders and the nature of cults and their relationship to authoritarianism in Russian and Soviet history. He reviews the linguistic fields surrounding such revolutionary figures as Miliukov, Rodzianko, Chernov, Plekhanov and Lenin and shows how politicians may become hostages of their own rhetoric. Hero image terminology can sanctify the leader. But even negative publicity or criticism can lead to the strengthening of the cult image. The construction of cults is subject to reversals and shifting creativity. Cults have pre- histories and are vital to our understanding of 20th century politics.
Reducing Unmet Demand and Spoilage in Cut Rose Logistics: Modeling and Control of Fast Moving Perishable Goods
Authors: Lin Xiao , Negenborn Rudy R. , Duinkerken Mark B. , Lodewijks Gabriel
Published: September 2018

Fresh cut flower supply chains are aware of the need for reducing spoilage and increasing customer satisfaction. This paper focuses on a part of the cut rose supply chain, from auction house to several end customers. A new business mode is considered that would allow end customers to subscribe to florists and have a continuous supply of bouquets of roses. To make this business mode feasible, we propose to benefit from real-time information on roses’ remaining vase life. First, a quality-aware modeling technique is applied to describe supply chain events and quality change of cut roses among several supply chain players. Then, a distributed model predictive control strategy is used to make up-to-date decisions for supply chain players according to the latest logistics and quality information. This approach provides a tool for multiple stakeholders to collaboratively plan the logistics activities in a typical cut rose supply chain based on roses’ estimated vase life in real time. The proposed approach is compared with a currently used business mode in simulation experiments. Results illustrate that the new business mode and the planning approach could reduce unmet demand and spoilage in a cut rose supply chain.
New Connection Detail to Connect Precast Column to Cap Beam using Ultra-High-Performance Concrete in Accelerated Bridge Construction Applications
Authors: Shafieifar Mohamadreza , Farzad Mahsa , Azizinamini Atorod
Published: September 2018

Accelerated bridge construction (ABC) is a paradigm change in delivery of bridges. ABC minimizes the traffic interruption, enhances safety to public and workers by significantly reducing on-site construction activities, and results in longer-lasting bridges. The use of precast elements is gaining attention owing to inherent benefits of accelerated construction. Designing an economical connection is one of the main concerns for these structures. New improved materials such as ultra-high-performance concrete (UHPC) with superior characteristics can provide solutions for joining precast concrete elements. In this paper two types of column to cap beam connection using UHPC are proposed for seismic and non-seismic regions. Among the merits of the proposed details, large tolerances in construction and simplicity of the connection can be highlighted which facilitates and accelerates the on-site construction time. The experimental program was carried out to evaluate the performance and structural behavior of the proposed connections. Four specimens were subjected to constant axial compressive loads and cyclic lateral loading. Results of the experiment showed that the displacement ductility of the specimens, incorporating suggested details, demonstrated adequate levels of displacement ductility. More importantly, the proposed connections prevented the damage into capacity protected element—in this case the cap beam. Analytical and nonlinear finite element analysis on the specimens was carried out to better comprehend the behavior of the proposed connections.
Assessing Transportation Assets for Vulnerability to Extreme Weather and Other Natural Hazards
Authors: Blandford Benjamin , Schurman Scott , Wallace Candice
Published: September 2018

The Kentucky Transportation Cabinet (KYTC) and Kentucky Transportation Center (KTC) at the University of Kentucky developed and performed an assessment of the vulnerability of the state’s national highway system (NHS) to extreme weather events and natural hazards. The assessment was designed as a hybrid process that 1) gathered and analyzed existing and available quantitative data on natural hazards, including meteorological hazards and geological hazards; 2) executed a series of workshops at KYTC districts throughout the state to elicit local expert knowledge on transportation system vulnerabilities; and 3) incorporated all data into a single vulnerability assessment. The workshops involved several facilitated exercises, including map-based discussions and keypad exercises to identify vulnerabilities along highway segments. Data from the mapping and keypad exercises were gathered in a geographic information system (GIS) and combined with the other hazard data to identify vulnerabilities for each highway segment. FHWA’s Vulnerability Assessment Scoring Tool (VAST) was used to process all the data into a single and ultimate assessment. Results from this analysis include a district-level prioritized ranking of NHS segments based on their vulnerability to extreme weather and natural hazard events. Additionally, a district vulnerability assessment report for each district highlighted the most vulnerable assets in the district and discussed their vulnerabilities in detail. This research is intended to aid KYTC in identifying at-risk infrastructure and direct the implementation of preparedness and resilience measures, thus helping to protect the integrity of the transportation system and the sound investment of taxpayer dollars.
Evaluating the Impact of Rumble Strips on Fatal and Injury Freeway Crashes
Authors: Dadashova Bahar , Wu Lingtao , Dixon Karen
Published: September 2018

Rumble strips are known to be one of the most cost-effective treatments for preventing roadway departure crashes. However, in recent years some studies have found controversial results indicating that rumble strips may in fact increase the number of more severe crashes. Although these effects are estimated to be very small, highway safety agencies deploy these treatments with an expectation that they will reduce all crash types. In this paper, the authors have conducted a statistical evaluation to determine the impact of rumble strip presence on fatal and injury crashes at freeway locations. For this purpose, the authors acquired an existing database used for one of the aforementioned studies and evaluated the variables using alternative assessment methods. The results of the current study suggest that rumble strips do in fact improve the safety outcomes in rural freeways. These findings are observed to also apply to urban freeways, but the effects are not statistically significant for the study database.
Urban Metro Rail Demand: Evidence from Dynamic Generalized Method of Moments Estimates using Panel Data
Authors: Canavan Shane , Graham Daniel J. , Anderson Richard J. , Barron Alexander
Published: September 2018

This paper estimates elasticities of demand for metro services with respect to fares, income, quality of service, population and network length. Data for 32 world metro systems covering the period from 1996 to 2015 are analyzed within a dynamic panel data specification. Three key contributions are made. First, we collate a database for estimation that is more extensive than that used in previous studies. Second, the quality of the data we have available allows us to more accurately represent quality of service than has been possible previously. Lastly, we estimate and compare two different measures of demand. Our analysis finds a statistically significant negative fare elasticity of −0.25 in the long run for a passenger km specified model and −0.4 in the long run for a passenger journey specified model, and a positive long run income elasticity of 0.17 and 0.18 for the passenger km and passenger journey models respectively. Regarding quality of service, we find positive long run elasticities of 0.56 and 0.47 for the passenger km and passenger journey models respectively. Income levels, population, and the size of the network are also found to be statistically significant and positive in nature. The results suggest passenger km and passenger journeys will increase more in response to changes in service (here represented by increased capacity) than to changes in fares, with the difference in elasticities of service and fares being more pronounced for passenger km.
A closed-form model for estimating the effective thermal conductivities of carbon nanotube–polymer nanocomposites
Authors: Moheimani Reza , Hasansade M
Published: September 2018

This paper describes a closed-form unit cell micromechanical model for estimating the effective thermal conductivities of unidirectional carbon nanotube reinforced polymer nanocomposites. The model incorporates the typically observed misalignment and curvature of carbon nanotubes into the polymer nanocomposites. Also, the interfacial thermal resistance between the carbon nanotube and the polymer matrix is considered in the nanocomposite simulation. The micromechanics model is seen to produce reasonable agreement with available experimental data for the effective thermal conductivities of polymer nanocomposites reinforced with different carbon nanotube volume fractions. The results indicate that the thermal conductivities are strongly dependent on the waviness wherein, even a slight change in the carbon nanotube curvature can induce a prominent change in the polymer nanocomposite thermal conducting behavior. In general, the carbon nanotube curvature improves the nanocomposite thermal conductivity in the transverse direction. However, using the straight carbon nanotubes leads to maximum levels of axial thermal conductivities. With the increase in carbon nanotube diameter, an enhancement in nanocomposite transverse thermal conductivity is observed. Also, the results of micromechanical simulation show that it is necessary to form a perfectly bonded interface if the full potential of carbon nanotube reinforcement is to be realized.
Chronic vulvovaginitis caused by Candida dubliniensis in an immunologically competent adult female
Authors: Kolekar Ketan , Tambe Swagata , Aderao Rashmi , Nayak Chitra
Published: September 2018

Candida, a commensal dimorphic fungus, is the most common microorganism that causes opportunistic fungal infections worldwide. It can cause diseases ranging from superficial mucosal infections to disseminated, systemic life-threatening infections. Among Candida species, Candida albicans is the most common infectious agent. Nowadays, non- albicans Candida species are also emerging as significant pathogens. Candida dubliniensis has been implicated as a causative agent of oral candidiasis in HIV-infected individuals but has also been recovered from HIV non-infected individuals with oral candidiasis and rarely from the genital tract of women with vaginitis. Such cases have been under-reported due to phenotypic resemblance to C. albicans. The majority of C. dubliniensis clinical isolates tested to date have been susceptible to fluconazole, but they tend to develop resistance rapidly. Here, we report a case of chronic vulvovaginitis due to C. dubliniensis not responding to standard doses of fluconazole.
Is urethral microscopy useful in symptomatic male patients without urethral discharge?
Authors: Borg S , Daniel J , Forsyth S
Published: September 2018

National guidelines recommend that male patients presenting with symptoms of urethritis or epididymo-orchitis undergo a urethral swab for microscopy. However, this is resource intensive. The aim of this audit was to determine the proportion of symptomatic patients without urethral discharge who have positive findings on urethral swab microscopy and explore associations between presenting symptoms and microscopy findings. We conducted a retrospective audit of symptomatic male patients who underwent microscopy. There was a significant difference between the percentage of symptomatic patients with positive findings on microscopy in those with and without urethral discharge (67% vs 33%, p < 0.001). In a patient presenting with symptoms other than urethral discharge, the likelihood that positive findings on microscopy would occur in a patient with dysuria was 4.73 times more likely than if they did not have dysuria, when controlling for age, testicular pain or discomfort, and urethral discomfort or penile irritation (p < 0.01). In situations where there are limited resources, patients without urethral discharge presenting with dysuria could be prioritised. However, further research is required to identify and stratify which patients require microscopy.
The role of social support in the association between childhood trauma and depression among HIV-infected and HIV-uninfected individuals
Authors: Rodriguez Violeta J , Butts Stefani A , Mandell Lissa N , Weiss Stephen M , Kumar Mahendra , Jones Deborah L
Published: September 2018

Childhood trauma (CT) – emotional, physical or sexual abuse, or emotional or physical neglect – has been associated with HIV infection and can lead to poor health outcomes and depression in adulthood. Though the impact of CT on depression may be decreased by social support, this may not be true of individuals living with HIV, due to the additive traumatic effects of both CT and acquisition of HIV. This study examined social support, depression, and CT among HIV-infected (n = 134) and HIV-uninfected (n = 306) men and women. Participants (N = 440) were assessed regarding sociodemographic characteristics, CT, depression, and social support. Participants were racially and ethnically diverse, 36 ± 9 years of age on average, and 44% had an income of less than USD$500 a month. Among HIV-uninfected individuals, social support explained the association between depression in persons with CT ( b = 0.082, bCI [0.044, 0.130]). Among HIV-infected individuals, after accounting for sociodemographic characteristics, social support did not explain the association between depression and CT due to lower levels of social support among HIV-infected individuals [95% CI: −0.006, 0.265]. The quality of social support may differ among HIV-infected persons due to decreased social support and smaller social networks among those living with HIV. Depressive symptoms among those living with HIV appear to be less influenced by social support, likely due to the additive effects of HIV infection combined with CT.
Consecutive hypoglycemia attacks induced by co-trimoxazole followed by pentamidine in a patient with acquired immunodeficiency syndrome
Authors: Okazaki Moemi , Okazaki Masafumi , Nakamura Miho , Asagiri Tadashi , Takeuchi Seisho
Published: September 2018

Both co-trimoxazole and pentamidine are used for the treatment of pneumocystis pneumonia (PCP) and are known to cause hypoglycemia as an adverse drug reaction. Here, we describe a rare case of a late-diagnosed female patient with acquired immunodeficiency syndrome (AIDS) who developed the first hypoglycemic attack as an adverse effect of co-trimoxazole, followed by a second hypoglycemic attack as an adverse effect of pentamidine. Physicians caring for patients with AIDS and PCP should be aware of possible hypoglycemia in patients with many risk factors.
Roots to Grow: Family Firms and Local Embeddedness in Rural and Urban Contexts
Authors: Baù Massimo , Chirico Francesco , Pittino Daniel , Backman Mikaela , Klaesson Johan
Published: September 2018

The present study analyzes the nexus among business growth, ownership structure, and local embeddedness—that is, the involvement of economic actors in a geographically bound social structure—in rural and urban contexts. This work combines regional economics with studies on family business and firm growth and uses a coarsened matched sample of privately held Swedish firms. The findings indicate that family firms benefit more than nonfamily firms from local embeddedness and as such they achieve higher levels of growth and that this effect is more pronounced in rural areas. Research implications are shared in the Conclusion section.
Effect of Fixation Type and Bone Graft on Tarsometatarsal Fusion
Authors: Buda Matteo , Hagemeijer Noortje Catharina , Kink Shaun , Johnson Anne Holly , Guss Daniel , DiGiovanni Christopher William
Published: September 2018

Background:

End-stage tarsometatarsal (TMT) arthritis is commonly treated with arthrodesis of involved joints. Fixation hardware can consist of varying combinations of screws, plates, and staples with or without supplemental bone graft. There are limited data to demonstrate either superiority of a given fixation method or the impact of bone graft on fusion rates. The purpose of this study, therefore, was to determine whether nonunion rates after TMT arthrodesis were influenced by either the use of screw vs plate fixation or the addition of bone graft vs no bone graft.

Methods:

All patients older than 18 years undergoing arthrodesis for TMT arthritis between July 1991 and July 2016 were identified retrospectively. Exclusion criteria included less than 12 months follow-up, prior midfoot surgery, any added procedure beyond TMT arthrodesis using plates or screws, and acute foot trauma. All patients with radiographic or clinical nonunion, including those requiring revision surgery, were identified. Demographic data and associated risk factors were recorded via chart and radiographic image review. Eighty-eight patients (88 feet, mean follow-up: 75.1 ± 51.4; range, 12-179), with a total of 189 joints and who met enrollment criteria were treated by 9 different surgeons with arthrodesis.

Results:

The overall nonunion rate was 11.4%. Significant independent risk factors associated with nonunion were (1) arthrodesis using plate fixation with all screws through the plate (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.8-21.3; P = .004), (2) smoking during the perioperative period (OR, 7.9; 95% CI, 2.1-30.2; P = .002), and (3) postoperative nonanatomic alignment (OR, 11.2; 95% CI, 2.1-60.8; P = .005). Bone graft utilization was found to significantly lower the rate of nonunion (OR, 0.2; 95% CI, 0.1-0.6; P = .006).

Conclusion:

Isolated plate fixation, smoking, and postoperative nonanatomic alignment appear to significantly increase the rate of nonunion among patients undergoing TMT arthrodesis for midfoot arthritis. Concomitant use of autogenous bone graft significantly decreased this risk.

Level of Evidence:

Level III, retrospective comparative study.
Leflunomide therapy for refractory cytomegalovirus infections in hematopoietic stem cell transplant recipients
Authors: Wang Emily , Jan Anna S , Doan Vi P , Ferguson Jill B , Yeh Jason C
Published: September 2018

Background

Currently, there are no prospective, randomized trials analyzing leflunomide for the treatment of cytomegalovirus infection or disease in allogeneic stem cell transplant patients.

Objective

The primary objective of this case series was to determine the clinical and virological responses of utilizing leflunomide as therapy for refractory cytomegalovirus infections, unresponsive to first-line therapy in allogeneic stem cell transplant patients. Additionally, patient and leflunomide specific characteristics were identified and determined in this descriptive case series.

Methods

This is a single-center, case series of adult allogeneic stem cell transplant patients with refractory cytomegalovirus infections receiving leflunomide between 1 January 2005 and 31 March 2015.

Results

A total of 14 patients with refractory cytomegalovirus infections received leflunomide. All patients received concurrent anti-cytomegalovirus therapy. Nine of 13 patients tested positive for phosphotransferase UL97 and/or viral DNA polymerase UL54 genotype mutations. Nine patients achieved a virological response with undetectable cytomegalovirus titers. Of the 13 patients with teriflunomide serum levels, eight patients maintained levels >40 micrograms/milliliter (mcg/mL). Common adverse effects were pancytopenia (n = 8) and elevated liver function tests (n = 4).

Conclusions

Despite current strategies, refractory or recurrent cytomegalovirus infection and disease remain a clinical challenge to treat in the stem cell transplant patient population. Leflunomide used in combination with other concomitant therapies use for refractory cytomegalovirus infection in clinical practice may be a safe and effective option in the allogeneic stem cell transplant patient population.
Modulating the bitterness of Empeltre olive oil by partitioning polyphenols between oil and water phases: Effect on quality and shelf life
Authors: Abenoza María , Raso Javier , Oria Rosa , Sánchez-Gimeno Ana C
Published: September 2018

Bitterness is a positive sensorial attribute of olive oil that mainly depends on phenol concentration. However, excessive bitterness may be unpleasant for consumers. The aim of this investigation was to evaluate if partitioning polyphenols between oil and water phases could modulate the bitterness of an Empeltre olive oil containing a phenolic concentration higher than the typical content for this olive oil variety. The linear relationship observed between the percentage of oil in the extraction system and the percentage of phenols removed from the oil permitted estimating the olive oil-to-water ratio required to reduce the concentration of phenols for a given value in order to modulate Empeltre olive oil bitterness. Olive oils after liquid–liquid extraction did not develop any negative sensory attributes, and their physicochemical parameters were not substantially affected. Liquid–liquid extraction using water as a solvent is a procedure capable of effectively reducing the total phenol compounds of Empeltre extra virgin olive oil and, as a consequence, of reducing its bitterness intensity without affecting the highest commercial category determined by the parameters legally established by European Community regulations just after extraction and during nine months of storage.
Engagement: Narrative ways of working with men when domestic violence is noticed in couple counselling
Authors: Wendt Sarah , Buchanan Fiona , Dolman Chris , Moss Dan
Published: September 2018

This article reports on a project that explored the complexities of engaging and working with men when domestic violence is noticed in a couple counselling context. There are concerns and controversy surrounding domestic violence and couple counselling; however, it has also been noted that many couples want to remain together and voluntarily approach services for couple counselling. The project reported on in this paper adopted a qualitative methodological design influenced by participatory action research ideas and memory work methods to analyse engagement of men used by nine social work family relationship counsellors.

Findings

Counsellors used narrative therapy ideas to maintain a stance of curiosity when working with couples when domestic violence was noticed. Curiosity was described as a way of opening up conversations to explore power differences and gender relations and as a method to balance safety with engagement. Specific engagement strategies identified included identifying ethics as a conversation point to explore the effects of power, violence and fear perpetrated by the male partners; exploring dynamics of power and control in relationships and exploring other possibilities in relationships.

Applications

Alongside debates about the effectiveness and success in domestic violence men’s perpetration intervention programmes, there is a need to look at engagement of men more broadly. Family relationship counselling can be viewed as an opportunity to engage with men where domestic violence is noticed. Engagement of men is an important piece of practice that can potentially set up effective and successful behaviour change when responding to domestic violence.