bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of the Integrated Behavioral Model to oral self‐care behavior of community‐dwelling middle‐aged and older people in Taiwan
Authors: Ho Mu‐Hsing , (Rita) Chang Hui‐Chen , Lin Yen‐Kuang , Traynor Victoria , Tsai Hung‐Huey , Buckwalter Kathleen , Liu Megan F. , Chang Chia‐Chi
Published: July 2019

Objectives

This study evaluated the Integrated Behavioral Model and examined oral self‐care behavior of community‐dwelling middle‐aged and older people.

Design

A cross‐sectional design was used.

Sample

Purposive sampling was employed to recruit middle and older age community‐dwelling individuals, with research locations in public health centers in northern Taiwan.

Measurements

Structured questionnaires comprised: participant demographics, oral health literacy, oral self‐care attitude, self‐efficacy, intention, and behavior, and significant others' perceptions and beliefs as well as environmental constraints. The Model verification was evaluated by path analysis.

Results

Two hundred and sixty‐three participants (N = 263) completed the questionnaire survey. Results identified significant direct effects of the independent variables of oral health care literacy, intention of oral self‐care, and perception of environmental constraints on the dependent variable of oral self‐care behavior; and significant indirect effects on attitude of oral self‐care, perception of significant other beliefs, self‐efficacy of oral self‐care.

Conclusion

Public health nurses work with the whole community and can potentially improve the oral self‐care behavior of middle‐aged and older adults by enhancing their oral health knowledge, maintaining their positive attitudes, assisting acceptance of recognition and support from others, increasing their ability to perform oral self‐care, reducing environmental constraints, and thereby enhancing their oral self‐care awareness.
Respecting the Game: Blame and Practice Failure
Authors: Dorsey Dale
Published: July 2019

Typically, we think that blameworthiness is tied to normative failure. To be susceptible to blame for an act, attitude, or trait it must be that this target of blame entailed some sort of mistake: bad, wrong, or unjustified action on the part of the agent. In this paper, I challenge this common presumption. Instead, I suggest that blameworthiness needn’t be a result of normative failure or a failure to maintain normative justification, but can also be a result of failures to conform to the standards that govern particular practices in which one is engaged, whether or not engagement in that practice, or indeed the norms that structure it, help to determine how one ought to live.
Foreign Aid, Instability, and Governance in Africa
Authors: Asongu Simplice A. , Nnanna Joseph
Published: July 2019

This article contributes to the attendant literature by bundling governance dynamics and focusing on foreign aid instability instead of foreign aid. We assess the role of foreign aid instability on governance dynamics in 53 African countries for the period 1996‐2010. An autoregressive endogeneity‐robust generalized method of moments is employed. Instabilities are measured in terms of variance of the errors and standard deviations. Three main aid indicators are used, namely: total aid, aid from multilateral donors, and bilateral aid. Principal component analysis is used to bundle governance indicators, namely: political governance (voice and accountability and political stability/no violence), economic governance (regulation quality and government effectiveness), institutional governance (rule of law and corruption control), and general governance (political, economic, and institutional governance). Our findings show that foreign aid instability increases governance standards, especially political and general governance. Policy implications are discussed.

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Fails, Matthew D. 2014. “Leader Turnover, Volatility, and Political Risk.” Politics & Policy 42 (3): 369‐399. https://doi.org/10.1111/polp.12078

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Quantitative expression of mRNA encoding BMP/SMAD signalling genes in the ovaries of Booroola carrier and non‐carrier GMM sheep
Authors: Bahire Sangharatna V. , Rajput Pradeep K. , Kumar Vijay , Kumar Davendra , Kataria Meena , Kumar Satish
Published: July 2019

The GMM sheep is a carrier of Booroola fecundity (FecB) gene, which produces the twins and triplets in one lambing. The homozygous carrier GMM (FecBBB), non‐carrier GMM and Malpura (FecB++) ewes were synchronized by progesterone sponges, and the plasma progesterone concentration was measured by RIA. The results showed that the progesterone concentration did not differ significantly (p > .05) in homozygous carrier GMM (5.74 ± 1.2 ng/ml), non‐carrier GMM (5.42 ± 1.4 ng/ml) and non‐carrier Malpura ewes (5.67 ± 1.5 ng/ml). Further, quantitative expression of BMP factors/receptors and SMAD signalling genes were analysed in the ovaries of sheep by qRT‐PCR. The study showed that the expression of BMP2 was slightly higher (p > .05) in carrier GMM than that of non‐carrier GMM, but it was almost similar to Malpura ewes. Expression of BMP4 and BMP7 was significantly higher (p < .001; p < .05) in carrier GMM than that of non‐carrier GMM and Malpura ewes. Although BMP6 expression was higher (p > .05) in carrier GMM than that of non‐carrier GMM, but lower (p > .05) than the Malpura ewes. Expression of BMP15 (p < .05), GDF5 (p < .01) and GDF9 (p < .05) was significantly higher in carrier GMM than non‐carrier GMM ewes. Surprisingly, BMPR1B expression was significantly higher (p < .001) in non‐carrier GMM and Malpura than the carrier GMM ewes, while TGFβRI did not differ significantly (p > .05) among both GMM genotypes. On the other hand, expression of BMPR1A (p > .05) and BMPRII (p < .05) was higher in carrier GMM than the non‐carrier GMM, but significantly lower (p < .001) than the Malpura ewes. It was interesting to note that the expression of SMAD1 (p > .05), SMAD2 (p < .001), SMAD3 (p < .05), SMAD4 (p < .001), SMAD5 (p < .001) and SMAD8 (p < .001) was lower in the carrier GMM than that of non‐carrier GMM ewes. It is concluded that the FecB mutation alters the expression of BMPR1B and SMAD signalling genes in the ovaries of homozygous carrier GMM ewes.
The Elasticity of Taxable Income: The Case of South Africa
Authors: Kemp Johannes Hermanus
Published: July 2019

A key tax policy parameter that has received much attention in the international literature, but about which there is substantial uncertainty, is the overall elasticity of taxable income. The size of this parameter is central to the formulation of tax and transfer policy, as well as for the study of the welfare implications of tax decisions. This paper uses a panel of individual tax returns for the period 2009–2013 and the phenomenon of “bracket creep” to construct instrumental variable estimates of the sensitivity of income to changes in tax rates. Estimates suggest that the overall elasticity of taxable income is approximately 0.3, while that of broad income is significantly lower. The overall response is primarily driven by the elastic response of taxable income for high‐income earners, who have an elasticity of closer to 0.4. Using the elasticity estimates within an optimal tax framework, it is determined that the optimal marginal tax rate for the top 10% of income earners is broadly in line with the current income tax schedule. However, results also suggest that there is little scope for raising marginal rates on high‐income earners further without inducing a negative revenue response.
Perception of managers’ influence depending on status, power, and company performance
Authors: Agut Sonia , Hernández Blasi Carlos , Lozano Nomdedeu Francisco A.
Published: July 2019

This research examines others’ perception of the influence of managers working in successful or unsuccessful companies who possess or lack status (to be respected by others) and power (control of valued resources). Study 1 shows that high‐status managers were judged as more influential in the firm than their low‐status peers, regardless of the company's situation. Study 2 finds that in a context of economic uncertainty, a manager with high status and power is perceived to be more capable of affecting the firm. The effect of power seems to be secondary since when a manager has low status, having high power does not significantly benefit the influence attributed to him or her. Furthermore, dominance (assertive behavior), not warmth, mediated the relationship between status and the attributed influence. Overall, these findings confirm that status is a very potent source of social influence, status and power are distinct constructs with different effects, and dominance rather than warmth is a key personal dimension linked to successful leadership.
Identification of MHC‐DMA and ‐DMB alleles in Tibetan macaques (Macaca thibetana)
Authors: Min Shaokun , Yang Fan , Zhou Liang , Zhang Xinshang , Chen Hui
Published: July 2019

Fifteen Math‐DMA and 16 Math‐DMB novel alleles of Tibetan macaques were identified.
Optimized immunocytochemistry using leukocyte and tissue markers on Romanowsky‐stained slides from dogs and cats
Authors: Raskin Rose E. , Vickers Julie , Ward Jennifer G. , Toland Angus , Torrance Andrew G.
Published: July 2019

Background

Romanowsky staining is often the initial method used to stain hematologic and cytologic materials. While immunocytochemistry (ICC) is a well‐established method on air‐dried smears, there are rare veterinary reports of ICC involving Romanowsky‐stained slides.

Objectives

This study aimed to compare immunoreactivity of unstained vs Romanowsky‐stained specimens, evaluate reactions over time, and assess ICC associations with confirmatory tests of 50 lymphoma cases. Another goal aimed to optimize manual ICC protocols with cellular and tissue immunomarkers to detect CD3ε, CD20, Pax5, MHCII, lysozyme, MUM1, vimentin, cytokeratin, and Melan‐A antigens on Romanowsky‐stained specimens.

Materials and methods

Cytologic specimens from cases of lymphoid and nonlymphoid neoplasms were stained with a methanolic Romanowsky method. Additional unstained slides from these cases were used for comparison with the stained materials. Antigen retrieval involved a citrate buffer pH6 or Tris/EDTA pH9 at 95°C for 25 minutes in a decloaking chamber. Immunocytochemistry used known positive and secondary antibody‐only negative cytologic controls. Immunoreactivity of unstained and prestained lymphoma slides was graded by the intensity and percent of stained cells. Signal grading was monitored over time for diagnostic differences.

Results

Unstained and Romanowsky‐stained slides had similar membrane/cytoplasm graded reactions, but unstained slides produced stronger signals. Romanowsky‐stained blood films from B‐cell and T‐cell leukemias showed minimal loss of signal when monitored over 20 weeks. Signal differences did not change the diagnosis. There was a significant association between ICC and confirmatory tests. Optimization involved antibody dilution and antigen retrieval methodology for each antibody tested.

Conclusions

Immunocytochemistry of Romanowsky‐stained material can be successfully performed using antibodies against CD3ε, CD20, cytokeratin, lysozyme, Melan‐A, MHCII, MUM1, Pax5, and vimentin.
Inflation Targeting Monetary Policy and Macroeconomic Performance: The Case of Middle Income Countries
Authors: Takyi Paul Owusu , Fosu Richard
Published: July 2019

The number of studies investigating the effects of inflation targeting (IT) on inflation and macroeconomic variables has increased with the rising number of countries adopting IT. The empirical evidence has, however, failed to converge. In line with the need for more such studies, this paper uses a difference-in-differences (DID) model with dynamic panel fixed effect and instrumental variable (IV) techniques to estimate the effect of IT on inflation and economic growth for a sample of 40 middle-income countries. Generally, we find that the effects of IT on inflation is quantitatively large but statistically insignificant. We, however, find strong evidence that IT leads to higher growth in middle-income countries.
Lq‐valued Burkholder–Rosenthal inequalities and sharp estimates for stochastic integrals
Authors: Dirksen Sjoerd , Yaroslavtsev Ivan
Published: July 2019

We prove sharp maximal inequalities for ‐valued stochastic integrals with respect to any Hilbert space‐valued local martingale. Our proof relies on new Burkholder–Rosenthal type inequalities for martingales taking values in an ‐space.
Maintenance of the latent reservoir by pyroptosis and superinfection in a fractional order HIV transmission model
Authors: Carvalho Ana R , Pinto Carla M , Tavares João N
Published: July 2019

We focus on the importance of pyroptosis and superinfection on the maintenance of thehuman immunodeficiency virus (HIV) latent reservoir on infected patients. The latent reservoir hasbeen found to be crucial to the persistence of low levels of viral loads found in HIV-infected patients,after many years of successfully suppressive anti-retroviral therapy (ART). This reservoir seems to actas an archive for strains of HIV no longer dominant in the blood, such as wild-type virus. When apatient decides to quit therapy there is a rapid turnover and the wild-type virus re-emerges. Thus, itis extremely important to understand the mechanisms behind the maintenance of this reservoir. Forthat, we propose a fractional order model for the dynamics of HIV, where pyroptosis and superinfectionare considered. The model is simulated for biological meaningful parameters and interesting patternsare found. Our results are interpreted for clinical appreciation.
Optimal Selection of Basis Functions for Minimum-Effort Tracking Control of Nonminimum Phase Systems Using Filtered Basis Functions
Authors: Ramani Keval S. , Duan Molong , Okwudire Chinedum E. , Ulsoy A. Galip
Published: July 2019

Accurate tracking of nonminimum phase (NMP) systems is well known to require large amounts of control effort. It is, therefore, of practical value to minimize the effort needed to achieve a desired level of tracking accuracy for NMP systems. There is growing interest in the use of the filtered basis functions (FBF) approach for tracking the control of linear NMP systems because of distinct performance advantages it has over other methods. The FBF approach expresses the control input as a linear combination of user-defined basis functions. The basis functions are forward filtered through the dynamics of the plant, and the coefficients are selected such that the tracking error is minimized. There is a wide variety of basis functions that can be used with the FBF approach, but there has been no work to date on how to select the best set of basis functions. Toward selecting the best basis functions, the Frobenius norm of the lifted system representation (LSR) of dynamics is proposed as an excellent metric for evaluating the performance of linear time varying (LTV) discrete-time tracking controllers, like FBF, independent of the desired trajectory to be tracked. Using the metric, an optimal set of basis functions that minimize the control effort without sacrificing tracking accuracy is proposed. The optimal set of basis functions is shown in simulations and experiments to significantly reduce control effort while maintaining or improving tracking accuracy compared to popular basis functions, like B-splines.
Packaging for Laser-Based White Lighting: Status and Perspectives
Authors: Ma Yupu , Luo Xiaobing
Published: July 2019

Light-emitting diodes (LEDs) have gained wide adoption in general illumination applications in the last decade. However, the efficiency drop of LEDs with increasing current density limits the luminous flux per wafer area. In contrast, laser diodes (LDs) can achieve higher efficiency at high current density. Likewise, the etendue of LDs is very low due to the small emitting area and divergent angle, facilitating the high-luminance. Hence, LDs may outperform LEDs in future high-luminance solid-state lighting (SSL). However, the rapid development of high-luminance white laser diode (WLD) is still facing some challenges. First, the heat flux of LD chip is extremely high, leading to a higher junction temperature. Second, the laser beam exhibits an elliptical and astigmatic pattern with Gaussian intensity distribution, which may deteriorate the lighting performances. Third, to achieve high-luminance lighting, the laser beam is usually focused onto the phosphor layer, which may easily increase the phosphor temperature to the thermal quenching region. A comprehensive understanding of these problems enables the advancements of packaging designs for WLDs. In this review, we summarized the recent progress in the packaging of WLDs. First, the advantages and applications of LDs were presented. Then, the state-of-the-art methods of generating white light using LDs were reviewed, in terms of packaging structures and performances. Finally, the challenges and corresponding progresses for the packaging of WLDs were overviewed. This review intends to contribute to the development of next-generation high-luminance laser-based white lighting.
Current Status and Future Challenges for Small Horizontal Axis Wind Turbines
Authors: Van Treuren Kenneth W.
Published: July 2019

This paper examines the category of small wind turbines. Numerous definitions are found in the literature. However, this paper's focus is on fixed pitch, small horizontal axis wind turbines, with a direct drive DC generator in the 1–10 kW class. Small wind turbine growth world-wide is analyzed for trends and predicted development. It is necessary to discuss design tools available for design, including computational fluid dynamic models and experimentally testing both open rotors and wind tunnel models. Wind turbines must be optimized for peak performance to include startup/cut-in speeds and other modifications. These wind turbines will rely on new and purposely designed airfoils; however, for low-Reynolds number conditions, computational tools do not accurately predict separation. An analysis of noise generation as well as design techniques for reducing noise is necessary for future designs. Discussions on the technologies particular to small wind turbines should include the topics of aerodynamics and structures/materials. Small wind turbines are contributing to the concept of distributed generation. Urban applications are leading to studies of flow fields in and around buildings. Interest in hybrid systems, which combine wind with other energy generation systems such as solar, internal combustion engines, and diesel engines, is growing. These systems are advantageous for the homeowner, small business, cell phone towers, remote locations, and backup emergency power systems (to include lighting). Finally, the concept of energy storage must be addressed in the context of small wind turbines, especially those turbines used in an isolated application.
Formation mechanisms of etched feature profiles during Si etching in Cl2/O2 plasmas
Authors: Mori Masahito , Osano Yugo , Irie Shoki , Eriguchi Koji , Ono Kouichi
Published: July 2019

Feature profiles of poly-Si etched in Cl2/O2 plasmas have been analyzed through a mechanistic comparison between experiments and simulations. The emphasis was placed on a comprehensive understanding of the formation mechanisms for profile anomalies of tapering, microtrenching, and footing (or corner rounding near the feature bottom). Experiments were conducted in a commercial etching reactor with ultra-high-frequency plasmas by varying O2 percentage, wafer stage temperature, rf bias power, and feed gas pressure. Simulations of the feature profile evolution were done by using a semiempirical, atomic-scale cellular model based on the Monte Carlo method that we have developed. The experiments indicated that sidewall profiles become more tapered with increasing O2 addition to Cl2 plasmas, while microtrenching and footing are pronounced in pure Cl2 plasma, being suppressed with increasing O2. A comparison with the simulations indicated that the tapered profiles are caused by the deposition of etch products/by-products on feature sidewalls from the plasma, being enhanced with increasing oxygen flux (due to synergistic effects between deposition of products/by-products and surface oxidation) and being reduced with increasing ion energy and neutral reactant flux. On the other hand, the footing is attributed to the redeposition of etch products on sidewalls from the feature bottom being etched, being reduced with increasing oxygen flux, ion energy, and neutral reactant flux. Microtrenching is caused by the ion reflection from feature sidewalls on incidence, being reduced with increasing oxygen flux (partly due to surface oxidation of the feature bottom) and being enhanced and then reduced with increasing ion energy and neutral reactant flux. The tapering, footing, and microtrenching were found to be closely related to each other: the footing near the feature bottom fades away under conditions of increased tapering of sidewalls, and the microtrenching is affected significantly by the degree of footing as well as the taper angle of the sidewalls.
Design of an acoustic illusion device based on a shifting medium and multi-folded transformation
Authors: Yang Chengfu , Huang Ming , Yang Jingjing , Yang Meixia , Mao Fuchun , Hu Baojing
Published: July 2019

An acoustic illusion device that can act as an invisible cloak or a shifting medium depending on the value of shift distance, which is about twice the circum-radius of the outer polygon, is proposed and designed based on linear coordinate transformation. A multi-folded transformation approach is used to design an illusion device with a circular opening window that allows for information interaction with the outside world. The results show that the proposed device can hide objects with arbitrary shapes or positions. Furthermore, in order to remove the material anisotropy of the proposed illusion device, a layered structure composed of homogenous and isotropic material is used based on the effective medium theory. The combination of the layered structure and the circular opening provide a flexible and feasible approach to achieve the partial implementation of the illusion device. It is hoped that these results may open an avenue for designing and implementing invisibility cloaks or illusion devices, and speed up potential applications for noise shielding, target camouflage, or target protection from active sonar signals.
Single molecule–mediated assembly of polyoxometalate single-cluster rings and their three-dimensional superstructures
Authors: Liu Qingda , He Peilei , Yu Hongde , Gu Lin , Ni Bing , Wang Dong , Wang Xun
Published: July 2019

A series of single-cluster nanostructures in different configurations can be achieved with up to 15 kinds of POM clusters.
Rotavirus Species B Encodes a Functional Fusion-Associated Small Transmembrane Protein
Authors: Diller Julia R. , Parrington Helen M. , Patton John T. , Ogden Kristen M.
Published: July 2019

While species A rotavirus is commonly associated with diarrheal disease in young children, species B rotavirus has caused sporadic outbreaks of adult diarrheal disease. A major genetic difference between species A and B rotaviruses is the NSP1 gene, which encodes two proteins for species B rotavirus. We demonstrate that the smaller of these proteins, NSP1-1, can mediate fusion of cultured human cells. Comparison with viral proteins of similar function provides insight into NSP1-1 domain organization and fusion mechanism. These comparisons suggest that there is a fatty acid modification at the amino terminus of the protein, and our results show that an intact amino terminus is required for NSP1-1-mediated fusion. NSP1-1 from a human virus mediates fusion of human cells, but not hamster cells, and enhances species A rotavirus replication in culture. These findings suggest potential, but currently untested, roles for NSP1-1 in RVB host species tropism, immune evasion, and pathogenesis.
Glycine 29 Is Critical for Conformational Changes of the Spike Glycoprotein of Mouse Hepatitis Virus A59 Triggered by either Receptor Binding or High pH
Authors: Mi Dan , Ou Xiuyuan , Li Pei , Peng Guiqing , Liu Yan , Guo Ruixuan , Mu Zhixia , Li Fang , Holmes Kathryn , Qian Zhaohui
Published: July 2019

Binding of the MHV S protein to the receptor mCEACAM1a triggers conformational changes of S proteins, leading to the formation of a six-helix bundle and viral and cellular membrane fusion. However, the mechanism by which the conformational change of the S protein is initiated after receptor binding has not been determined. In this study, we showed that while replacement of G29, a residue at the edge of the receptor binding interface and the center of the structural turn after the β1-sheet of the S protein, with D or T triggered spontaneous conformational changes of the S protein and pH-independent RIS, the G29P mutation significantly impeded the conformational changes of S proteins triggered by either receptor binding or pH 8.0. We reason that this structural turn might be critical for conformational changes of the S protein and that altering this structural turn could initiate conformational changes of the S protein, leading to membrane fusion.
Antibody Responses Elicited by Immunization with BG505 Trimer Immune Complexes
Authors: Gach Johannes S. , Mara Kane J. V. , LaBranche Celia C. , van Gils Marit J. , McCoy Laura E. , Klasse P. J. , Montefiori David C. , Sanders Rogier W. , Moore John P. , Forthal Donald N.
Published: July 2019

Immunodominant epitopes may suppress immune responses to more desirable determinants, such as those that elicit potentially protective neutralizing antibody responses. To overcome this problem, we attempted to mask immunodominant glycan holes by immunizing rabbits with ICs consisting of the BG505 SOSIP.664 gp140 trimer and MAbs that targeted the glycan holes. We found that IC vaccination likely diverted antibody responses, to some extent, away from the glycan holes and toward other regions of the trimer. IC vaccination resulted in slower decay of HIV-1-specific antibodies than did immunization with uncomplexed trimer. We did not observe a widening of the breadth or an increase in the potency of neutralizing antibody responses compared to uncomplexed trimers. Our results suggest that selective epitope dampening of BG505 trimers by ICs is rather ineffective. However, IC vaccination may represent a novel means of increasing the duration of vaccine-induced antibody responses.
Численное моделирование возвратного течения при разделении движущихся со сверхзвуковыми скоростями тел
Authors: Афендиков Андрей Леонидович , Afendikov Andrei Leonidovich , Луцкий Александр Евгеньевич , Lutsky Alexander Evgenjevich , Меньшов Игорь Станиславович , Menshov Igor Stanislavovich , Никитин Вячеслав Сергеевич , Nikitin Vyacheslav Sergeevich , Ханхасаева Яна Владиславовна , Khankhasaeva Yana Vladislavovna
Published: July 2019

Исследуются особенности течения, образующегося при сверхзвуковом вылете тела малых размеров из канала сферически затупленного цилиндра в сверхзвуковом потоке. Диаметр цилиндра в 35 раз превышает диаметр выстреливаемого тела. Расчет проводится на многоуровневых декартовых сетках с локальной адаптацией на основе вейвлетного анализа. Движение тел моделируется с помощью метода свободной границы. Исследуется динамика взаимодействия движущегося тела с головной ударной волной обтекаемого цилиндра, формирование области возвратного течения между телами, ее эволюция, исчезновение и последующий выход на стационарный режим. Результаты показывают максимальное снижение сопротивления главного тела до уровня 0.2 от начальной величины.
Occlusion of the central retinal artery inPlasmodium falciparummalaria
Authors: Choudhury Himadri , Panchal Bhavik , Doshi Shreyansh , Pathengay Avinash
Published: July 2019

A 40-year-old woman presented with sudden painless diminution of vision in left eye. The best corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. The vision loss occurred 3 days after the onset of fever with chills and rigour. Rapid diagnostic test and peripheral blood smear examination revealedPlasmodium falciparummalaria. The left eye fundus showed a pale disc with marked attenuation of arterioles. A detailed systemic evaluation including cardiovascular, haematological and angiographic assessments was performed which did not reveal any abnormality. A diagnosis of central retinal artery occlusion (CRAO) associated with uncomplicatedP. falciparummalaria was made. In this communication, we report that acute loss of vision in a patient withP. falciparummalaria, CRAO needs to be ruled out.
Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research
Authors: Mowafi Hani , Ngaruiya Christine , O'Reilly Gerard , Kobusingye Olive , Kapil Vikas , Rubiano Andres M , Ong Marcus , Puyana Juan Carlos , Rahman AKM Fazlur , Jooma Rashid , Beecroft Blythe , Razzak Junaid
Published: July 2019

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.
Effect of Baduanjin exercise on patients with chronic heart failure: protocol for a systematic review and meta-analysis
Authors: Li Jieying , Yu Feng , Huang Na , Lu Jianhui , Xu Weixian , Liu Nan
Published: July 2019

Introduction

Chronic heart failure (CHF) is defined when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs, and it is caused by various cardiopulmonary diseases. CHF is a common, lifelong and costly condition. Baduanjin exercise (BDJE), a form of traditional Chinese regimen, has been integrated into China’s clinical practice in recent years and has shown promise in cardiac rehabilitation of CHF patients. However, the efficacy of BDJE on CHF patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of BDJE for CHF patients.

Methods and analysis

A systematic literature search for articles up to October 2018 will be conducted in the following databases: Web of Science, Pubmed, Embase, Cochrane Library, Chinese Science and Technology Periodicals Database, Chinese National Knowledge Infrastructure and Wanfang Database. We will also search other resources. Randomised controlled trials that examined treatment of CHF patients with BDJE will be selected. Results will be analysed by assessing the quality of life of patients using the Minnesota living with heart failure questionnaire, and measurement of distance walked over a span of 6 min in the 6 min walk test. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilised to assess the quality of evidence.

Ethics and dissemination

This systematic review will be submitted to a peer-reviewed journal.

PROSPEROregistration number

CRD42018114672.
Factors associated with long-term prescription of benzodiazepine: a retrospective cohort study using a health insurance database in Japan
Authors: Takano Ayumi , Ono Sachiko , Yamana Hayato , Matsui Hiroki , Matsumoto Toshihiko , Yasunaga Hideo , Kawakami Norito
Published: July 2019

Objectives

Current clinical guidelines discourage long-term prescription of benzodiazepines and Z-drugs (BZD); however, the practice continues to exist. The aim of this study was to investigate the proportion of long-term BZD prescriptions and its risk factors.

Design

Retrospective cohort study using a health insurance database.

Setting

Japan.

Participants

A total of 86 909 patients were identified as outpatients aged 18 to 65 years who started BZD between 1 October 2012 and 1 April 2015. After excluding patients who underwent surgery on the day of first BZD prescription (n=762) and patients without 8 months follow-up (n=12 103), 74 044 outpatients were analysed.

Main outcome measures

We investigated the proportion of long-term prescriptions for ≥8 months among new BZD users. We assessed patient demographics, diagnoses, characteristics of the initial BZD prescription and prescribers as potential predictors of the long-term BZD prescription. Multivariable logistic regression was performed to assess the association between long-term prescription and potential predictors.

Results

Of the new BZD users, 6687 (9.0%) were consecutively prescribed BZD for ≥8 months. The long-term prescription was significantly associated with mood and neurotic disorder, cancer, prescription by psychiatrists, multiple prescriptions, hypnotics and medium half-life BZD in the initial prescription.

Conclusion

Despite the recent clinical guidelines, 9% of new BZD users were given prescriptions for more than 8 months. Physicians should be aware of risk factors when prescribing BZDs for the first time.
016 One disease or three: is frontotemporal dementia – motor neuron disease a distinct entity?
Authors: Long Zhe (Jill) , Irish Muireann , Foxe David , Hodges John , Piguet Olivier , Burrell James
Published: July 2019

Introduction

Frontotemporal dementia-motor neuron disease (FTD-MND) is diagnosed when patients meet criteria for the diagnosis of both FTD and MND, but the mode presentation of this disorder is currently unknown. This study aimed to compare the mode of presentation, and profiles of behavioural and language disturbances, of FTD-MND with that of other FTD phenotypes using a data-driven approach.

Methods

31 FTD-MND, 119 bvFTD, 47 PNFA, 42 SD patients and 127 controls underwent comprehensive clinical, neuropsychological and neuroimaging assessments. Z-transformed scores were used to compare the severity of behavioural and language domains in each disease group. Two-step cluster analysis profiled patient subgroups. Voxel-based morphometry investigated differential patterns of cortical atrophy between groups.

Results

Overall, FTD-MND patients presented with behavioural or language disturbances less frequently than FTD phenotypes, but mixed behavioural-language presentations were more common. FTD-MND patients demonstrated less severe disinhibition, apathy and semantic deficits relative to bvFTD and SD respectively.Behavioural and language deficits were of comparable severity in FTD-MND, unlike other FTD phenotypes where behaviour was worse than language (bvFTD) or language worse than behaviour (PNFA, SD).In cluster analysis, FTD-MND patients were evenly distributed across three subgroups designated as ‘mild mixed’, ‘language dominant’ and ‘behavioural dominant’. Relative to the ‘mild mixed’ group, ‘language dominant’ patients demonstarted more atrophy of the anterior temporal lobe and peri-insular regions, while ‘behavioural dominant’ patients displayed more prefrontal atrophy.

Conclusion

FTD-MND does not present as a uniform syndrome. Rather, there may be at least three subgroups that demonstrate distinctive cognitive, behavioural, and neuroanatomical characteristics.
048 Harding’s disease: an important MS mimic
Authors: Joshi Stuti , Kermode Allan
Published: July 2019

Introduction

Leber’s hereditary optic neuropathy is a mitochondrially-inherited disorder characterized by bilateral, painless visual loss, which leads to severe optic atrophy.1 LHON can be associated with an MS-like illness referred to as Harding’s disease.2

We report two siblings, who both harbour the 11778 mtDNA mutation, but manifest markedly different clinical phenotypes; a male with classical LHON and a female with Harding’s disease.

Methods and Results

A 61-year-old female, who was diagnosed with MS 22 years ago was referred to our service for a second opinion. She developed unilateral painless visual loss in her 20’s, was diagnosed with optic neuritis and treated with corticosteroids with some recovery. A second episode of more severe visual loss at age 39 left her with visual impairment to less than finger counting. 4 years later, she had an episode of dysarthria and gait ataxia. MRI showed multifocal white matter lesions involving the juxta-cortical and periventricular regions, cerebellar peduncle and cervical cord. Targeted views of the optic pathways showed hyperintensity of the left optic nerve, with involvement extending into the optic canal.

The patient has one brother who was diagnosed with LHON at age 37 after presenting with severe painless bilateral sequential visual loss. Genetic testing of the index patient confirmed the presence of the same mutation identified in her brother.

Conclusion

LHON and Harding’s disease demonstrate a great degree of variability in clinical phenotype and penetrance between males and females as well as individuals within the same family.3 While there is no evidence for screening MS cohorts for the LHON, consider genetic testing in patients with severe and persistent bilateral visual loss or with a suggestive family history.4

References

Harding AE, Sweeney MG, Miller DH, Mumford CJ, Kellar-Wood H, Menard D,McDonald WI, Compston DA. Occurrence of a multiple sclerosis-like illness in women who have a Leber’s hereditary optic neuropathy mitochondrial DNA mutation. Brain. 1992 August;115 ( Pt 4):979–89.

Palace J. Multiple sclerosis associated with Leber’s Hereditary Optic Neuropathy. J Neurol Sci. 2009 November 15;286(1–2):24–7. Review.

Pfeffer G, Burke A, Yu-Wai-Man P, Compston DAS, Chinnery PF. Clinical features of MS associated with Leber hereditary optic neuropathy mtDNA mutations. Neurology. 2013;81(24):2073–2081.

Yu-Wai-Man P, Chinnery PF. Leber hereditary optic neuropathy. In: Pagon RA MP, Adam Ardinger HH eds. GeneReviews. Seattle, WA: University of Washington, Seattle; 2013. Accessed May 7, 2018.
049 Real world evidence (RWE) on impact of age on long-term persistence to disease modifying therapies (DMTS) in relapsing-remitting multiple sclerosis (RRMS) in australia
Authors: Kornberg Andrew , Spelman Tim , Schulz Mark , Arora Birendra , Chung Eric , Juneja Prabjot , Walker Robert , Walt Anneke van der , Butzkueven Helmut
Published: July 2019

Background

Age has been independently associated with higher rates of treatment discontinuation in multiple sclerosis.

Objective

The current study examines the impact of age on persistence for all reimbursed DMTs for RRMS in Australia.

Methods

The Pharmaceutical Benefits Scheme (PBS) 10% sample supplied by the Department of Human Services was used in this study. Eligible patients must have received a script for a reimbursed DMT for RRMS between September 2011 and February 2016. Patients were classified into five age-groups (ages 18–30; 31–40; 41–50; 51–60; 61+) and defined as persistent if their DMT script was filled within 4 months. Persistence was derived using the Kaplan-Meier method and hazard ratios (HR) to represent the relative rate of drop-off of different age groups.

Results

Patients aged 18–30 (n=250) had a 44% increased risk of discontinuation (HR 1.44 (95%CI: 1.22–1.72) compared to the ‘all ages’ cohort (n=1,866); no significant difference was observed for any other age group (HRs between 1.08 and 0.92). Patients in this 18–30 age-group had a significantly higher risk of discontinuation on injectable therapy (glatiramer acetate, interferon beta-1a, interferon beta-1b) compared to those on non-injectable therapy (dimethyl fumarate, fingolimod, natalizumab, teriflunomide) (HR 2.42 (95% CI: 1.63–3.61).

Conclusions

Patients aged 18–30 were the least persistent age group in this study. Patients aged 18–30 were less persistent on injectable than non-injectable DMTs.
062 Alcohol associated toxic myelopathy with normal hepatic function
Authors: Vijayan Srimathy , Davies Scott , Leong Wai
Published: July 2019

Introduction

Alcohol related neurological dysfunction affects the central and peripheral nervous system. We present a rare consequence of excessive alcohol consumption. A 42-year-old female consuming 2 bottles of wine daily for the preceding 5 years presented with 12 months of progressive gait disturbance. Examination revealed a spastic paraparesis with prominent dorsal column signs. Extensive work up found no alternate cause for her presentation. The final diagnosis was direct alcohol mediated toxic myelopathy. We reviewed the current literature on this rare condition.

Methods

We searched PubMED/OVID databases with the terms ‘alcohol AND myelopathy’.

Results

There is a paucity of research on this clinical entity. Sage et al.1 described 5 well-nourished alcoholics presenting with a progressive myelopathy. As with our patient, routine laboratory tests, including nutritional screen, were normal. CT Myelogram revealed no structural cause. CSF was normal. In contrast, a myelopathic syndrome can occur in alcoholic hepatic failure, attributed to portosystemic shunting of blood, with resultant hyper-ammonaemia and demyelination of corticospinal tracts.2–4

Conclusion

Alcohol associated toxic myelopathy is a rare entity, distinct from hepatic myelopathy. It is thought to result from direct toxic effects of ethanol on corticospinal and large myelinated sensory tracts. The sensory involvement is unique for this entity, which distinguishes it from hepatic myelopathy, where corticospinal involvement predominates. It is prudent to look for other potentially treatable secondary causes of myelopathy. Abstinence from alcohol results in modest improvement in symptoms. Minimal literature exists on this clinical entity and further research is required.

References

Sage JI, et al. Alcoholic myelopathy without substantial liver disease. A syndrome of progressive dorsal and lateral column dysfunction. Arch Neurol. 1984 Sep;41(9):999–1001.

Premkumar M, et al. Hepatic Myelopathy in a Patient with Decompensated Alcoholic Cirrhosis and Portal Colopathy. Volume 2012, Article ID 735906, 4 pages.

Koo JE, et al. Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt. Korean J Hepatol. 2008 Mar;14(1):89–96.

Kori P, et al. Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis. BMJ Case Rep. 2013; 2013: bcr2013009078.
094 Towards objective testing in parkinson’s disease: a systematic review of the literature looking at assessment of postural sway
Authors: Ge Wenbo , Apthorp Deborah , Lueck Christian J , Suominen Hanna
Published: July 2019

Introduction

Parkinson’s Disease (PD) is associated with increased mortality and reduced quality of life. There is currently no accurate objective measure for use in diagnosis or assessment of severity. Analysis of postural sway may help in this regard. This systematic review aimed to assess the effectiveness of the various features currently used to analyse postural sway.

Methods

Five databases were searched for articles that examined postural sway in both PD patients and controls. An effect size (ES) was derived for every feature reported in each article. The most effective features and feature-families were determined, along with the influence on these measures of data sampling rate and experimental condition.

Results

441 papers were initially retrieved, of which 31 met the requirements for analysis. The most commonly-used features were not the most effective (e.g. PathLength had an ES of 0.47 while TotalEnergy had an ES of 1.78). Decreased sampling rate was associated with decreased ES (e.g. ES of PathLength lowered from 1.12 at 100 Hz to 0.40 at 10 Hz). Being off medication was associated with a larger ES (e.g. ES of PathLength was 0.21 on medication and 0.83 off medication).

Conclusions

Some measures of postural sway are better able to distinguish PD patients from controls than others. ES is enhanced by using a higher sampling rate and studying patients off medication. These results will inform future studies looking at postural sway in PD and contribute to the aim of finding an objective marker of the disease.
Language and language disorders: neuroscience to clinical practice
Authors: O'Sullivan Michael , Brownsett Sonia , Copland David
Published: July 2019

Language disorders are common in neurological practice but their accurate recognition and description can be challenging. In this review, we summarise the major landmarks in the understanding of language disorders and the organisation of language in the brain. We describe approaches to assessing language disorders at the bedside or in the clinic as well as the treatment and rehabilitation of aphasia. Finally, we describe how the field of neuroscience is providing new computational and neuroscientific approaches to study the mechanisms of recovery and rehabilitation of aphasia.
Modeling the nonlinear elastic behavior of plant epidermis
Authors: Bidhendi Amir J. , Li Hongbo , Geitmann Anja
Published: July 2019

Cell growth and organ development in plants are often correlated with the tensile behavior of the primary cell wall. To understand the mechanical behavior of plant material, various mechanical testing techniques have been employed, such as tensile testing of excised tissue samples. The onion (Allium cepa L.) epidermis has emerged as a model system for plant tissue mechanics. In this study, we performed tensile tests on strips of adaxial onion epidermis. While the tissue appeared stiffer in the direction along the major growth axis compared with the transverse direction, the tensile strength of tissue was not significantly different between the two orientations, indicating a nontrivial link between the cell wall and tissue mechanical anisotropy. Importantly, we observed the stress–strain behavior of the onion epidermis under tension to be highly nonlinear. Several hyperelastic models were fitted to the test data to evaluate their capacity to describe the nonlinear deformation of onion epidermis. The Yeoh hyperelastic model could successfully simulate the uniaxial tensile test data. This study suggests that accounting for nonlinearity in the deformation of the primary tissue may be essential for the accurate interpretation of mechanical test data, and a better understanding of the mechanics of the primary plant cell wall.