bluuebunny/crossref_metadata_2025 huggingface dataset:
Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation
Authors: McRorie Johnson W. , Fahey George C. , Gibb Roger D. , Chey William D.
Published: November 2019

Background:

Treatment guidelines for chronic idiopathic constipation (CIC) recommend an “increase in fiber intake” as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating.

Objectives:

The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines.

Data sources:

A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968–2018; latest date included, December 31, 2018).

Conclusions:

In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect.

Implications for practice:

It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to “increase fiber intake” is akin to a recommendation to “increase pill intake” without regard to therapeutic or adverse effects.
The anticoagulants rivaroxaban and low molecular weight heparin prevent PICC-related upper extremity venous thrombosis in cancer patients
Authors: Lv Shoutian , Liu Yongmei , Wei Gang , Shi Xueyan , Chen Shaoping , Zhang Xuehui
Published: November 2019

Peripherally inserted central catheter (PICC) is often applied in chemotherapy patients and commonly causes upper extremity venous thrombosis (UEVT), which should be prevented.

To assess the preventive effects of the anticoagulants rivaroxaban and low molecular weight heparin (LMWH) on UEVT in patients receiving chemotherapy through PICCs.

A total of 423 chemotherapy patients with continuous PICC use between January 2014 and June 2015 at the Oncology Department of Dongying People's Hospital were divided into 3 groups: rivaroxaban (10 mg/day, orally), LMWH (Enoxaparine, 4000 anti-Xa IU/day, subcutaneous injection), and control (no anticoagulant). UEVT incidence and other complications during PICC use were observed and recorded.

The rivaroxaban, LMWH, and control groups included 138 (79 males; 54.9 ± 11.0 years), 144 (76 males; 56.0 ± 10.9 years), and 141 (71 males; 53.3 ± 10.9 years) patients, (P = .402 and P = .623 for age and sex respectively). There were no differences in cancer location (P = .628), PICC implantation site (P > .05), body mass index (BMI) (P = .434), blood pressure (all P > .05), blood lipids (5 laboratory parameters included, all P > .5), smoking (P = .138), history of lower limb venous thrombosis (P = .082), and 10 other associated comorbidities (all P > .5). Twenty-nine patients withdrew from the study (5 from the rivaroxaban, 12 from the LMWH, and 12 from the control groups, respectively), and 394 patients were analyzed. There were significant differences in the rivaroxaban group and the LMWH group compared to the control group (P = .010 and P = .009, respectively), but no significant difference was observed between the rivaroxaban group and the LMWH group (P = .743).

Anticoagulants such as rivaroxaban and LMWH may reduce the incidence of PICC-related UEVT in patients receiving chemotherapy.
Usefulness of contrast-enhanced ultrasonography for diagnosis of renal cell carcinoma in dialysis patients
Authors: Hashimoto Masahiro , Ohkuma Kiyoshi , Akita Hirotaka , Yamada Yoshitake , Nakatsuka Seishi , Mizuno Ryuichi , Oya Mototsugu , Jinzaki Masahiro
Published: November 2019

Aims:

To investigate the usefulness of contrast-enhanced ultrasonography for diagnosing renal cell carcinoma (RCC) in dialysis patients.

Material and methods:

Of 1301 dialysis patients who underwent abdominal computed tomography (CT) between January 2012 and March 2017, 19 were suspected to have solid renal lesions; of these patients, 18 gave consent for and underwent contrast-enhanced ultrasonography with perflubutane in addition to CT; 13 underwent dynamic contrast-enhanced CT, and 5, who could not be administered iodinated contrast media, underwent unenhanced CT. The final diagnoses were based on histopathological findings or the presence/absence of enlargement of the lesion during follow-up.

Results:

Of the 19 lesions in 18 patients, 14 were diagnosed as RCC and 5 as benign cysts. CT facilitated accurate diagnosis in 10/19 lesions (52.6%) with obvious enhancement (≥20 Hounsfield units [HU]), while definitive diagnosis by CT was difficult in 9 lesions: 2 lesions showed ambiguous enhancement (10–20 HU), 1 lesion was an inflammatory cyst with obvious enhancement, and 6 lesions were assessed by unenhanced CT. Compared with CT, contrast-enhanced ultrasonography allowed more accurate diagnosis (McNemar test, P = .02) in 17/19 lesions (89.5%, 14 RCC and 3 cysts; including all lesions assessed by unenhanced CT and 2 with ambiguous enhancement on CT), with 1 false-positive (inflammatory cyst with hyper-enhancement) and 1 false-negative result due to deep location of the lesion.

Conclusions:

Contrast-enhanced ultrasonography was useful for the diagnosis of RCC in dialysis patients with suspected solid renal lesions especially when contrast enhancement was not obvious on CT or contrast-enhanced CT could not be performed.
Biosimilars and Novel Insulins
Authors: Ampudia-Blasco Francisco Javier
Published: November 2019

Background:

Insulin therapy is the mainstay of treatment for type 1 diabetes and may be necessary in type 2 diabetes. Current insulin analogues present a more physiological profile, are effective, and with less risk of hypoglycemia, but they are expensive. Biosimilar insulins should offer the advantages of insulin analogues at reduced costs. In addition, current rapid-acting insulin analogues are not fast enough to control excessive postprandial glucose excursions in many patients.

Areas of Uncertainty:

Biosimilar insulins demonstrated that are safe and effective, but interchangeability and automatic substitution remain an issue. Ultrafast-acting insulins should reduce postprandial hyperglycemia and improve flexibility in insulin dosing.

Data sources:

This systematic review was conducted following widely recommended methods. We searched for each topic in Medline, Embase, the Cochrane Library, and SCISEARCH for relevant citations for the appropriate period.

Therapeutic Advances:

LY2963016 and MK-1293 are biosimilar insulins of insulin glargine, and SAR342434 is a biosimilar of insulin lispro. The abbreviated developed program demonstrated comparable efficacy and safety and supports their use for treatment of people with diabetes but no interchangeability. Faster-acting insulin aspart is a new formulation of insulin aspart with accelerated subcutaneous absorption. Faster aspart demonstrated noninferiority in reducing HbA1c as compared to insulin aspart with superiority in controlling postprandial hyperglycemia without increasing hypoglycemia, and flexible insulin dosing.

Conclusions:

Biosimilar insulins have comparable PK-PD profiles and equivalent efficacy and safety to original insulins at a lower price, making them available for more people with diabetes. Faster aspart is the first ultrafast-acting insulin. New upcoming clinical trials and more clinical experience with faster aspart will show the real potential of this new insulin.
Effect of High-dose Vitamin A Supplementation in Children With Sickle Cell Disease: A Randomized, Double-blind, Dose-finding Pilot Study
Authors: Brownell Jefferson N. , Schall Joan I. , Mcanlis Carolyn R. , Smith-Whitley Kim , Norris Cynthia F. , Stallings Virginia A.
Published: November 2019

Suboptimal vitamin A status (serum retinol <30 µg/dL) is associated with poor clinical outcomes in children with the hemoglobin-SS disease (HbSS), and supplementation with the recommended daily allowance of retinol is ineffective in improving vitamin A status. In a single-center randomized blinded dose-finding pilot study, we compared vitamin A and nutritional status in children with HbSS to healthy children and explored the impact of high-dose supplementation on the primary outcome serum vitamin A status. Exploratory outcomes included hematologic, nutritional, immunologic, and muscle function status in children with HbSS. A mixed-effects linear regression model evaluated associations between vitamin A dose, serum retinol, and exploratory outcomes. Twenty healthy children participated, and 22 subjects with HbSS were randomized to oral 3000 or 6000 IU/d retinol for 8 weeks; 21 subjects completed all evaluations. Serum retinol, growth, and nutritional status were all suboptimal in HbSS subjects at baseline, and supplementation did not change vitamin A status. Fetal hemoglobin (Δ=2.5, 95% confidence interval [CI], 0.5-4.3), mean corpuscular volume (Δ=2.7, 95% CI, 0.7-4.7), mean corpuscular hemoglobin (Δ=1.4, 95% CI, 0.5-2.3), and mean corpuscular hemoglobin concentration (Δ=0.5, 95% CI, 0.1-0.9) all improved with supplementation. Mild improvements in erythrocyte indices, growth status, and muscle function occurred independent of hydroxyurea use.
Look at the cognitive deficits in patients with myotonic dystrophy type 1: an exploratory research on the effects of virtual reality
Authors: Maresca Giuseppa , Portaro Simona , Naro Antonino , Scarcella Ileana , Bramanti Placido , Militi David , Accorinti Maria , De Luca Rosaria , Calabrò Rocco Salvatore
Published: November 2019

Myotonic dystrophy type 1 is a neuromuscular disease, characterized by a progressive loss of strength, muscle stiffness, and difficulty in relaxation. Myotonic dystrophy type 1 patients can present several neuropsychological deficits, as well as anxiety and mood disorders. Aim of this study is to evaluate the feasibility and the effect of virtual reality in the cognitive and behavioral recovery of myotonic dystrophy type 1 patients. Eleven patients (8 female and 3 male) underwent a specific cognitive rehabilitation program including a conventional neuropsychological treatment followed by a virtual reality neurorehabilitation training using the Virtual Reality Rehabilitation System (Khymeia, Italy). Virtual reality improved many cognitive domains, including executive function, attention, verbal and visuo-spatial abilities, as well as mood and coping strategies. Due to the high prevalence of neuropsychological symptoms in patients with myotonic dystrophy type 1, cognitive rehabilitation should enter into the framework of these patients to potentially boost cognitive and behavioral function and improve quality of life.
Enhanced Recovery After Surgery
Authors: Wainwright Thomas W. , Immins Tikki , Antonis Johannes H. A. , Hartley Richard , Middleton Robert G.
Published: November 2019

BACKGROUND:

Enhanced Recovery After Surgery (ERAS) focuses on optimizing each element on a treatment pathway and encouraging the patient to actively engage in his or her recovery and rehabilitation. It requires collaboration across a multidisciplinary team and has been successful in improving patient outcomes, length of stay (LOS), and costs for a wide range of surgical procedures, including musculoskeletal surgeries such as total hip and total knee replacement.

PURPOSE:

To examine the application of ERAS concepts to total shoulder replacement (TSR) surgery.

METHODS:

Hospital Episode Statistics (HES) in England on LOS for TSR surgery were examined, and a review of literature on the use of ERAS concepts in TSR was undertaken.

RESULTS:

Analysis of HES data suggested scope for improvement in reducing LOS. A review of the literature found some evidence of the use of ERAS concepts, particularly in multimodal pain management.

CONCLUSIONS:

Future research is now required for ERAS procedure-specific components for TSR surgery.
Expansion of PD1-positive T Cells in Nodal Marginal Zone Lymphoma
Authors: Egan Caoimhe , Laurent Camille , Alejo Julie C. , Pileri Stefano , Campo Elias , Swerdlow Steven H. , Piris Miguel , Chan Wing C. , Warnke Roger , Gascoyne Randy D. , Xi Liqiang , Raffeld Mark , Pittaluga Stefania , Jaffe Elaine S.
Published: November 2019

The diagnosis of nodal marginal zone lymphoma (NMZL) can be challenging, with the differential diagnosis including other low-grade B-cell lymphomas, reactive hyperplasia, and even some cases of peripheral T-cell lymphoma (PTCL). PTCL may have a perifollicular growth pattern mimicking NMZL. We and others have noted an atypical distribution of T-follicular helper (TFH) cells in some cases of NMZL. This study was prompted by the diagnosis of NMZL in several cases in which a marked increase of TFHcells, as determined by staining for programmed death-1 (PD1), had prompted suspicion for a diagnosis of PTCL. We analyzed PD1 staining in 48 cases of NMZL to characterize the extent and pattern of the PD1-positive infiltrate. Three main patterns of PD1 staining were identified: follicular pattern (peripheral, n=16; central, n=9; mixed, n=3), diffuse pattern (n=4), and a reduced or normal staining pattern in residual follicles (n=16). A comprehensive analysis of other TFHmarkers was undertaken in 14 cases with a high content of PD1-positive cells that were confirmed as B-cell lymphoma by clonality analysis. We describe in detail 5 of these cases in which PTCL was an initial consideration. This study illuminates the diverse immunohistochemical patterns encountered in NMZL and highlights a diagnostic pitfall important for diagnostic accuracy.
The Shifting Paradigm in Chronic Lymphocytic Leukemia
Authors: Jain Nitin , O'Brien Susan
Published: November 2019

Chemoimmunotherapy (CIT) was the standard treatment for patients with chronic lymphocytic leukemia for the last 2 decades. Recently, with the introduction of targeted therapies, the role of CIT has declined significantly. In the first-line setting, the role of CIT is limited to young fit patients with mutated immunoglobulin heavy chain variable region and without del(17p)/TP53 mutation. There is a limited role for CIT in relapsed chronic lymphocytic leukemia.
Contemporary Approaches to Postoperative Pain Management
Authors: Murphy Amanda M. , Haykal Siba , Lalonde Donald H. , Zhong Toni
Published: November 2019

Learning Objectives:

After reading this article, the participant should be able to: 1. Describe the fundamental concepts of multimodal analgesia techniques and how they target pain pathophysiology. 2. Effectively educate patients on postoperative pain and safe opioid use. 3. Develop and implement a multimodal postoperative analgesia regimen.

For many years, opioids were the cornerstone of postoperative pain control, contributing to what has become a significant public health concern. This article discusses contemporary approaches to multimodal, opioid-sparing postoperative pain management in the plastic surgical patient.
Histologic Analysis of Sensory and Motor Axons in Branches of the Human Brachial Plexus
Authors: Mioton Lauren M. , Dumanian Gregory A. , De la Garza Mauricio , Ko Jason H.
Published: November 2019

Background:

The topographic distribution through histologic analysis of motor and sensory axons within peripheral nerves at the brachial plexus level is not clearly defined, as there has previously been little need to appreciate this microanatomy. A desire to better understand the topography of fascicle groups developed with the introduction of targeted muscle reinnervation.

Methods:

Fourteen bilateral brachial plexus specimens from seven fresh human cadavers were harvested at the time of organ donation, and immunofluorescent staining of motor and sensory nerves with choline acetyltransferase and Neurofilament 200 was performed to determine whether a consistent somatotopic orientation exists at the brachial plexus level.

Results:

There was significant variability in the number of fascicles at the level of the brachial plexus. Qualitative analysis of choline acetyltransferase staining demonstrated that although motor axons tended to be grouped in clusters, there were high degrees of variability in somatotopic orientation across specimens. The radial nerve demonstrated the highest number of total myelinated axons, whereas the median nerve exhibited the greatest number of motor axons. The ulnar nerve contained only 13 percent motor axons, which was significantly lower than the median, radial, and musculocutaneous nerves.

Conclusions:

There was no consistent somatotopic organization of motor and sensory axons of the mixed major nerves of the arm just distal to the brachial plexus, but clustering of motor axons may facilitate the splitting of nerves into primarily “motor” and “sensory” fascicles.
Use of the dapivirine vaginal ring and effect on cervical cytology abnormalities
Authors: Reddy Krishnaveni , Kelly Cliff , Brown Elizabeth R. , Jeenarain Nitesha , Naidoo Logashvari , Siva Samantha , Bekker Linda-Gail , Nair Gonasagrie , Makanani Bonus , Chinula Lameck , Mgodi Nyaradzo , Chirenje Zvavahera , Kiweewa Flavia Matovu , Marrazzo Jeanne , Bunge Katherine , Soto-Torres Lydia , Piper Jeanna , Baeten Jared M. , Palanee-Phillips Thesla
Published: November 2019

Objective:

We aimed to determine if the dapivirine vaginal ring and the ring device alone (flexible silicone matrix polymer) was associated with the development of cervical cytology abnormalities.

Design:

Secondary analysis comparing cervical cytology results between two randomized controlled microbicide trials (MTN-020/ASPIRE and MTN-003/VOICE).

Methods:

Data from ASPIRE, a phase III, placebo-controlled trial of the dapivirine vaginal ring, were used in this analysis. Cervical cytology smears were evaluated at baseline and at the final visit with product use. We compared cytology results between women randomized to dapivirine versus placebo vaginal ring. We further assessed for the effect of the vaginal ring device on cervical cytology by comparing results with data from the oral placebo arm of VOICE, a prior HIV-1 prevention trial conducted in a similar population.

Results:

Cervical cytology results for 2394 women from ASPIRE (1197 per study arm) were used in this analysis; median time between baseline and final visit with product use was 22.1 months. Cytology smear findings were comparable between dapivirine and placebo vaginal ring arms: at final visit, normal: 90.6 versus 91.5%, ASC-US//LSIL: 7.8 versus 7.4%, ASC-H/HSIL/AGC/AGC-favor neoplastic: 1.7 versus 1.1%, P = 0.44. Cytology data from VOICE had findings (normal: 87.8%, ASC-US/LSIL: 9.8%, ASC-H/HSIL/AGC/AGC-favor neoplastic: 2.4%) comparable with that of both dapivirine (P = 0.93) and placebo vaginal ring arms (P = 0.24).

Conclusion:

These findings indicate that neither use of the dapivirine vaginal ring nor the vaginal ring device alone, over a period of 2 years, is associated with development of cervical cytology abnormalities that could lead to precancerous or cancerous lesions.
Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review
Authors: Roberts D. Allen , Tan Nicholas , Limaye Nishaant , Irungu Elizabeth , Barnabas Ruanne V.
Published: November 2019

Background:

Efficient and scalable models for HIV treatment are needed to maximize health outcomes with available resources. By adapting services to client needs, differentiated antiretroviral therapy (DART) has the potential to use resources more efficiently. We conducted a systematic review assessing the cost of DART in sub-Saharan Africa compared with the standard of care.

Methods:

We searched PubMed, Embase, Global Health, EconLit, and the grey literature for studies published between 2005 and 2019 that assessed the cost of DART. Models were classified as facility-vs. community-based and individual- vs group-based. We extracted the annual per-patient service delivery cost and incremental cost of DART compared with standard of care in 2018 USD.

Results:

We identified 12 articles that reported costs for 16 DART models in 7 countries. The majority of models were facility-based (n = 12) and located in Uganda (n = 7). The annual cost per patient within DART models (excluding drugs) ranged from $27 to $889 (2018 USD). Of the 11 models reporting incremental costs, 7 found DART to be cost saving. The median incremental saving per patient per year among cost-saving models was $67. Personnel was the most common driver of reduced costs, but savings were sometimes offset by higher overheads or utilization.

Conclusions:

DART models can save personnel costs by task shifting and reducing visit frequency. Additional economic evidence from community-based and group models is needed to better understand the scalability of DART. To decrease costs, programs will need to match DART models to client needs without incurring substantial overheads.
Getting to Zero San Francisco: A Collective Impact Approach
Authors: Buchbinder Susan P. , Havlir Diane V.
Published: November 2019

Background:

Building on several decades of innovative HIV prevention and treatment programming in San Francisco, in 2014, a small group of academic, civic, and community leaders launched Getting to Zero San Francisco, a city-wide consortium focused on getting to zero HIV infections, zero HIV-related deaths, and zero HIV stigma and discrimination.

Setting:

San Francisco city and county.

Methods:

The consortium operates under the principles of collective impact composed of 5 components: a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and organization backbone. Two flagship initiatives are described: citywide scale-up of pre-exposure prophylaxis and rapid antiretroviral therapy upon diagnosis.

Results:

The number of new HIV diagnoses declined by over 50% from 399 to 197 from 2013 to 2018; the time from diagnosis to viral suppression decreased from 134 to 62 days during that period. However, continued racial/ethnic disparities in new HIV diagnoses and viral suppression rates point to the need for the Getting to Zero San Francisco committees to focus on racial/ethnic equity as a primary focus. Cisgender and transgender women, people who inject drugs, and people who are homeless also have lower viral suppression rates; ongoing initiatives are attempting to address these disparities.

Conclusion:

A collective impact implementation strategy that operates by unifying municipal organizations toward a common goal was associated with citywide gains in reducing new HIV diagnosis and time to viral suppression in San Francisco. Formal evaluation of this strategy will help elucidate under which conditions this approach is most likely to succeed.
Implementation of HIV Interventions Into Faith-Based Organizations: Models and Methodological Considerations
Authors: Stewart Jennifer , Salas-Brooks Jessica , Kelly Brittany
Published: November 2019

Background:

Implementation of evidence-based interventions aimed at reducing and treating HIV can have a wider spread if funneled through faith-based organizations. However, there is a paucity of frameworks or process models aimed at providing the best practices to implement HIV interventions into faith-based community organizations.

Setting:

Implementation framework and process model for African American faith settings.

Results:

Presented here is a systems multilevel implementation framework and implementation process model for integrating HIV interventions into faith-based organizations. We conclude with presentation of key methodological considerations and recommendations and discuss strategies for moving implementation science forward in faith-based organizations.

Conclusion:

Because of their key role in the African American community, faith-based settings must be engaged in implementing evidence-based HIV interventions. Through use of a multilevel systems framework and process model, the methods and approaches of implementation science can be leveraged to encourage the spread of HIV interventions in the African American community.
Security Hi-Tech Individual Extra-Light Device Mask 3.0: A Continuous Evolution
Authors: Vellone Valentino , Ramieri Valerio , Cascone Piero
Published: November 2019

In 2008, the authors presented their Security Hi-tech Individual Extra-Light Device Mask (SHIELD), a customizable protective shield based on the (soccer) player's face cast.

In 2017, the authors presented an update in the realization process, based on computer-aided design/computer-aided manufacturing technology, and called it SHIELD 2.0.

Now, the authors present a further update in the realization process.
Impact of Canthal Height on Horizontal Upper Eyelid Peak Position: A Guide for Blepharoptosis Surgery
Authors: Kitaguchi Yoshiyuki , Takahashi Yasuhiro , Kakizaki Hirohiko , Gomi Fumi , Nishida Kohji
Published: November 2019

This study was aimed at examining the relationship between the horizontal upper eyelid peak position (Δpeak-pupil) and the difference between the medial and lateral canthal heights (Δcanthi) in Japanese individuals. Images of the left eyelid of 71 participants without eyelid disease were acquired with a camera with a slit-lamp microscope. Multivariate linear regression analysis was performed to determine the influence of age, sex, distance from the pupil center to the upper eyelid margin (margin reflex distance-1), Δcanthi, and palpebral fissure width on Δpeak-pupil. In addition, Δpeak-pupil distribution in participants with Δcanthi <3 (Group A), 3 to 6 (Group B), and >6 mm (Group C) was calculated as the average±2x the standard deviation. The mean Δpeak-pupil was 1.12 ± 1.29 mm (range: −1.44 to 6.12) and the mean Δcanthi was 4.50 ± 1.71 mm (1.02–7.96). Δcanthi was a significant determinant factor of Δpeak-pupil (P < 0.0001), whereas age (P = 0.62), sex (P = 0.88), margin reflex distance-1 (P = 0.29), and the horizontal palpebral fissure width (P = 0.65) were not related to Δpeak-pupil. The normal Δpeak-pupil ranges were −1.47 to 1.52, −0.95 to 3.22, and −0.84 to 4.73 mm in Groups A, B, and C, respectively. There was a statistically significant difference between the Group A and B ranges and between the Group A and C ranges (Kruskal–Wallis test, P < 0.01). It was concluded that the normal eyelid peak position differs according to medial-to-lateral canthal positional difference. This finding may help intraoperative determination of the upper eyelid peak position in blepharoptosis surgery.
The Reproducibility of the Point of Care Microcirculation (POEM) Score When Used to Assess Critically Ill Patients: A Multicenter Prospective Observational Study
Authors: Watchorn James C. , Fargaly Hithem , Gilani Muhammad , Assadi Jordan , Deitchman Andrew R. , Naumann David N. , Wollborn Jakob , Goebel Ulrich , McCurdy Michael T. , Hutchings Sam D.
Published: November 2019

Background:

The current standard of analyzing microcirculatory video microscopy is time-consuming and occurs away from the patient, limiting its clinical utility. Point-of-care assessment with incident dark field (IDF) microscopy, however, may offer greater clinical applicability. We aimed to determine the reproducibility of the Point of Care Microcirculation (POEM) tool when used at the bedside in critically ill patients.

Methods:

A multinational, multicenter, prospective observational study of adult intubated patients was undertaken during a 9-month period in Germany, the United Kingdom, and the United States. A user recorded a batch of four standardized video clips from each patient, calculated a POEM score and recorded the time for image acquisition. A second user blinded to the first repeated this process. Patients with video clips of poor quality were excluded. At a later date, the two users again blinded themselves to reassess both their own clips and those of the other user. Basic demographic information was recorded. Intrauser reliability (an individual user rescoring the same batch of videos after blinding), interuser reliability (a second user rescoring the other user's video batch after blinding), and test–retest reliability (two users individually capturing videos and recording POEM scores) were assessed using a linearly weighted kappa statistic for ordinal data.

Results:

Sixty-five patients were included in the final analysis. Observer agreement was substantial for all tests. Intrauser agreement was 0.73 (0.95 CI 0.64–0.81), interuser agreement 0.71 (0.95 CI 0.63–0.79), and test–retest agreement 0.75 (0.95 CI 0.65–0.86). Average time to record videos and assess POEM scores 7:34 ± 3:37 minutes.

Conclusions:

Point-of-care assessment of the microcirculation using IDF video microscopy and POEM scoring appears to be both a feasible and reproducible approach to microcirculatory assessment. Testing of the score in critically ill patients showed substantial agreement within and between investigators, but further studies should validate its utility as a tool to guide shock resuscitation.
Peptidylarginine Deiminase 2 Knockout Improves Survival in hemorrhagic shock
Authors: Zhou Jing , Biesterveld Ben E. , Li Yongqing , Wu Zhenyu , Tian Yuzi , Williams Aaron M. , Tian Shuo , Gao Wenbin , Bhatti Umar F. , Duan Xiuzhen , Wang Tianbing , Zhang Justin , Jiang Baoguo , Wang Zhong , Alam Hasan B.
Published: November 2019

Background:

The peptidylarginine deiminase (PAD) family converts arginine into citrulline through protein citrullination. PAD2 and PAD4 inhibitors can improve survival in hemorrhagic shock (HS). However, the impact of isoform-specific PAD inhibition in improving survival has not been studied. In this study, we utilize selective Pad2−/− knockout mice to elucidate loss of function of PAD2 leads to pro-survival effect in HS.

Methods:

HS: Pad2
−/− and wild-type (WT) mice (n = 5/group) were subjected to lethal HS (55% volume hemorrhage). Survival was monitored over 7 days. Myocardial infarction (MI): Pad2
−/− and WT mice (n = 9/group) were subjected to MI by permanent LAD ligation to examine the effect of ischemia on the heart. After 24 h cardiac function and infarct size were measured.

Results:

HS: Pad2
−/− mice demonstrated 100% survival compared with 0% for WT mice (P = 0.002). In a sub-lethal HS model, cardiac β-catenin levels were higher in Pad2
−/− compared with WT after 24 h. MI: WT mice demonstrated larger MI (75%) compared with Pad2
−/− (60%) (P < 0.05). Pad2
−/− had significantly higher ejection fraction and fractional shortening compared with WT (P < 0.05).

Conclusions:

Pad2
−/− improves survival in lethal HS. Possible mechanisms by which loss of PAD2 function improves survival include the activation of cell survival pathways, improved tolerance of cardiac ischemia, and improved cardiac function during ischemia. PAD2 is promising as a future therapeutic target for the treatment of HS and cardiac ischemia.
In Vivo Analysis of Human Immune Responses in Immunodeficient Rats
Authors: Ménoret Séverine , Ouisse Laure-Hélène , Tesson Laurent , Remy Séverine , Usal Claire , Guiffes Aude , Chenouard Vanessa , Royer Pierre-Joseph , Evanno Gwenaelle , Vanhove Bernard , Piaggio Eliane , Anegon Ignacio
Published: November 2019

Background.

Humanized immune system immunodeficient mice have been extremely useful for the in vivo analyses of immune responses in a variety of models, including organ transplantation and graft versus host disease (GVHD) but they have limitations. Rat models are interesting complementary alternatives presenting advantages over mice, such as their size and their active complement compartment. Immunodeficient rats have been generated but human immune responses have not yet been described.

Methods.

We generated immunodeficient Rat Rag−/− Gamma chain−/− human signal regulatory protein alpha-positive (RRGS) rats combining Rag1 and Il2rg deficiency with the expression of human signal regulatory protein alpha, a negative regulator of macrophage phagocytosis allowing repression of rat macrophages by human CD47-positive cells. We then immune humanized RRGS animals with human peripheral blood mononuclear cells (hPBMCs) to set up a human acute GVHD model. Treatment of GVHD was done with a new porcine antihuman lymphocyte serum active through complement-dependent cytotoxicity. We also established a tumor xenograft rejection model in these hPBMCs immune system RRGS animals by subcutaneous implantation of a human tumor cell line.

Results.

RRGS animals receiving hPBMCs showed robust and reproducible reconstitution, mainly by T and B cells. A dose-dependent acute GVHD process was observed with progressive weight loss, tissue damage, and death censoring. Antihuman lymphocyte serum (L1S1) antibody completely prevented acute GVHD. In the human tumor xenograft model, detectable tumors were rejected upon hPBMCs injection.

Conclusions.

hPBMC can be implanted in RRGS animals and elicit acute GVHD or rejection of human tumor cells and these are useful models to test new immunotherapies.
Thiamethoxam exposure deregulates short ORF gene expression in the honey bee and compromises immune response to bacteria
Authors: Decio Pâmela , Ustaoglu Pinar , Derecka Kamila , Hardy Ian C. W. , Roat Thaisa C. , Malaspina Osmar , Mongan Nigel , Stöger Reinhard , Soller Matthias
Published: November 2019

Maximizing crop yields relies on the use of agrochemicals to control insect pests. One of the most widely used classes of insecticides are neonicotinoids that interfere with signalling of the neurotransmitter acetylcholine, but these can also disrupt crop-pollination services provided by bees. Here, we analysed whether chronic low dose long-term exposure to the neonicotinoid thiamethoxam alters gene expression and alternative splicing in brains of Africanized honey bees,Apis mellifera, as adaptation to altered neuronal signalling. We find differentially regulated genes that show concentration-dependent responses to thiamethoxam, but no changes in alternative splicing. Most differentially expressed genes have no annotated function but encode short Open Reading Frames (sORFs), a characteristic feature of anti-microbial peptides. As this suggested that immune responses may be compromised by thiamethoxam exposure, we tested the impact of thiamethoxam on bee immunity by injecting bacteria. We show that intrinsically sub-lethal thiamethoxam exposure makes bees more vulnerable to normally non-pathogenic bacteria. Our findings imply a synergistic mechanism for the observed bee population declines that concern agriculturists, conservation ecologists and the public.
Loading effects on the performance of needle free jet injections in different skin models
Authors: Rohilla Pankaj , Lawal Idera , Le Blanc Andrew , O’Brien Veronica , Weeks Cormak , Tran Whitney , Rane Yatish , Khusnatdinov Emil , Marston Jeremy
Published: November 2019

Intradermal delivery of vaccines with jet injection is one of the leading alternatives to conventional delivery with hypodermic needles via the Mantoux technique. However, for a given fluid, the effects of various parameters related to injector design, as well as skin properties are still not well understood. Whilst the key design parameters are orifice diameter, jet speed, ampoule volume, and standoff distances, we must also consider applied load of the device on the skin, and axial skin tension. These parameters are all studied herein using different ex-vivo models (guinea pig, pig and human skin) and different fluid viscosities. We find that the applied load can have a significant effect on the amount of drug delivered through the skin, as well as the fluid dispersion pattern in the intradermal tissues. Regardless of skin type or fluid viscosity, we show that minimal standoff and applied loads of approximately 1 kg should be used to maximize injection efficiency when targeting intradermal tissue.
The head direction circuit of two insect species
Authors: Pisokas Ioannis , Heinze Stanley , Webb Barbara
Published: November 2019

Recent studies of the Central Complex in the brain of the fruit fly have identified neurons with activity that tracks the animal’s heading direction. These neurons are part of a neuronal circuit with dynamics resembling those of a ring attractor. Other insects have a homologous circuit sharing a generally similar topographic structure but with significant structural and connectivity differences. We model the connectivity patterns in two insect species to investigate the effect of the differences on the dynamics of the circuit. We illustrate that the circuit found in locusts can also operate as a ring attractor and identify differences that enable the fruit fly circuit to respond faster to heading changes while they render the locust circuit more tolerant to noise. Our findings demonstrate that subtle differences in neuronal projection patterns can have a significant effect on the circuit performance and emphasise the need for a comparative approach in neuroscience.
Gives you wings or not? Exploring the impact of viewers’ responsibility attribution and surprise on their attitude, identification and trust
Authors: Seiffert-Brockmann Jens , Ruppel Christopher , Einwiller Sabine
Published: November 2019

Purpose

The purpose of this paper is to explore the impact of critical, journalistic documentaries on viewers. More precisely, it investigates the effects of responsibility attribution and surprise on stakeholder attitude, trust and identification.

Design/methodology/approach

In a quasi-experimental pre-post setting, 127 participants viewed a documentary about Austrian beverage and marketing company Red Bull. The film inquired into the deaths of six extreme athletes sponsored by the company. As a critical, investigative piece, the documentary was designed to give viewers the impression that Red Bull was, at least partially, responsible for the athletes’ deaths.

Findings

Results show that responsibility attribution, the feeling of being surprised and being in a state of negative affect, had a significant impact on viewers’ attitude and trust toward, and identification with Red Bull.

Originality/value

The study adds insights on surprise as a factor in viewers’ assessment of responsibility. The study is original in terms of methodology by using real-time rating to ascertain which sequences trigger changes in responsibility attribution among viewers. Furthermore, implications of the study’s findings with regard to inoculation theory are discussed.
Overall equipment effectiveness (OEE) evaluation for an automated ice cream production line
Authors: Tsarouhas Panagiotis H.
Published: November 2019

Purpose

As overall equipment effectiveness (OEE) is a metric to estimate equipment effectiveness of production systems, the purpose of this paper is to identify strategic management tools and techniques based on OEE assessment of the ice cream production line.

Design/methodology/approach

This paper presents the collection and the analysis of data for ice cream production under real working conditions. The data cover a period of eight months. A framework process to improve the OEE of an automated production system was proposed. Six major stoppage losses, i.e. equipment failure, setup and adjustment, idling and minor stoppage, reduced speed, defects in the process, and reduced yield, were examined with the help of Pareto analysis. In addition, the actual availability (A), performance efficiency (PΕ) and quality rate (QR) measures, together with the complete OEE for each working day, week and month of the production line were shown.

Findings

The main goal of the study is to identify major stoppage losses, in order to examine and improve the overall equipment efficiency (OEE) of the ice cream production line through the application of an adequate management, i.e. TPM approach. Based on the obtained results, maintenance management strategy and production planning have been suggested to improve their maintenance procedures and the productivity as well.

Originality/value

The proposed method can be applied to each automated production system. The main benefits of this method are the improvement of productivity, quality enhancement of products, the reduction of sudden breakdowns and the cost of maintenance. Moreover, the analysis provides a useful perspective and helps managers/engineers make better decisions on the operations management of the line, and suggestions for improvement were proposed and will be implemented accordingly.
Designing a practical lab-based assessment: a case study
Authors: Amida Ademola , Chang Isaac , Yearwood David
Published: November 2019

Purpose

This paper aims to present the finding of a practical lab assessment used to evaluate students’ mastery of Ohm’s law. The researchers used an approach combining different instruction types and lab formats to examine whether this combination produced a unique effect on students’ performance. This multifaceted approach provided evidence about how assessment design could affect students’ lab performance. The study also discussed various strategies that could guide instructors and curriculum designers about how to incorporate lab tasks into their curriculum to facilitate students’ mastery of subject content.

Design/methodology/approach

This study was a quantitative experiment that used a factorial repeated measures design. The design allowed the researchers to measure participants’ task scores and time across different treatment conditions, hence enabling the effects of lab format and instructional type to be observed. All participants were recruited through the convenience sampling strategy.

Findings

The results suggested that there was a statistically significant difference in the time taken to complete the task. However, no statistically significant difference was recorded in the participants’ task scores. Overall, it appeared that participants performed better in the simulation-based labs with expository instructions.

Originality/value

The current study contributes to the body of knowledge on the effect of lab format and instructional type on students’ performance in lab-based assessments. The results presented here may also help instructors to determine the most appropriate form of lab formats and instruction types to be used in an electronics course.
Geographies of Algorithmic Violence: Redlining the Smart City
Authors: Safransky Sara
Published: November 2019

City governments are embracing data‐driven and algorithmic planning to tackle urban problems. Data‐driven analytics have an unprecedented capacity to call urban futures into being. At the same time, they can depoliticize planning decisions. I argue that this shift calls urban studies scholars to investigate geographies of algorithmic violence—a repetitive and standardized form of violence that contributes to the racialization of space and spatialization of poverty. This article examines this broader phenomenon through the case of a proprietary market value assessment that is being used to guide development in cities across the United States. The assessment employs an algorithm that helps city officials make critical decisions about which neighborhoods to target for investment, disinvestment and public service upgrades or disconnections. I argue that the racial, infrastructural, and epistemological violence associated with this evaluation can potentially lead to a new kind of municipal redlining. The article brings insights from critical race theory into conversation with critical scholarship on algorithms by analyzing how algorithmic violence works through data‐driven planning technologies to depoliticize and leverage power while further entrenching racism and inequality.
Does foreign direct investment impede forest area in Sub‐Saharan Africa?
Authors: Lokonon Boris OK , Mounirou Ichaou
Published: November 2019

Foreign direct investment is an engine of economic growth. However, it may affect environmental quality (improve or deteriorate it), depending on the context. Under a multivariate framework, this paper aims to investigate the relationship between foreign direct investment and deforestation for Sub‐Sahara African countries with economic growth, trade openness and urbanization as additional determinants of deforestation. The analyses reveal that all variables are non‐stationary and cointegrated based on recent panel data techniques. On applying dynamic ordinary least squares, the long‐run results suggest the validity of the pollution haven hypothesis for some countries, and that of the pollution halo hypothesis for other countries. The findings are also mixed across Sub‐Sahara African countries for trade openness and urbanization. The results from this study suggest that Sub‐Sahara African countries should continue attracting foreign direct investment, while a certain number of them should put more emphasis on controlling deforestation associated with foreign direct investment inflows to limit greenhouse gas concentrations in the atmosphere.
Fitness costs of reflex bleeding in the ladybird beetle Harmonia axyridis: the role of parental effects
Authors: Bayoumy Mohamed H. , Osawa Naoya , Hatt Séverin
Published: November 2019

Reflex bleeding is an important antipredator defense mechanism in Coccinellidae. We examined the costs of reflex bleeding in larval and adult stages of the ladybird beetle Harmonia axyridis on offspring fitness and reproductive performance through the comparisons between bled and control larvae, reciprocal crosses of bled/control beetles, and early and late clutch phenotypes. Beetles bled during their larval stage spent a longer time in development and weighed less than controls. Egg fertility was reduced for crosses where either one or both parents had been bled during the larval or adult stage. Offspring crosses that included a parent bled during the larval stage suffered fitness costs in development and female body mass, while those bled during the adult stage suffered no transgenerational costs. Males that suffered bleeding during their larval stage accelerated progeny development of nonbled females in early clutches, suggesting a positive transgenerational effect of larval bleeding, while males that did not suffer bleeding accelerated progeny development of bled females in later clutches. As the underlying effects of bleeding on females’ offspring in the early clutches were diminished in the late ones, suggesting another transgenerational effect. The strengths of maternal and paternal effects on progeny development of parents bled at the larval stage were higher in earlier clutches. This study suggests that H. axyridis adults are less affected than larvae by the frequent use of the defensive secretions in their stressful habitats.