bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractional wave packet systems in L2(R)
Authors: Shah Firdous A. , Ahmad O. , Jorgensen P. E.
Published: July 2018

Wave packet systems have been used as a potential tool for solving dynamic systems and have recently been studied using various Fourier-type transforms. In this article, we introduce wave packet systems of fractional order in L2(R) and investigate their orthogonal properties by means of two basic equations in the frequency domain. We also provide a sufficient condition for such a system to be orthonormal in L2(R). Finally, we establish the necessary and sufficient conditions for fractional wave packet frames in L2(R), which include the corresponding results of wave packet, wavelet analysis, and Gabor theory as the special cases.
A new implementation of LSMR algorithm for the quaternionic least squares problem
Authors: Ling Si-Tao , Wang Ming-Hui , Cheng Xue-Han
Published: July 2018

This paper is endeavored to present a new version of the LSMR algorithm for solving the linear least squares problem in quaternion field, by means of direct quaternion arithmetics rather than the usually used real or complex representation methods. The present new algorithm is based on the classical Golub-Kahan bidiagonalization process, but is instead of using two QR factorizations. It has several advantages as follows: (i) does not make the scale of the problem dilate exponentially, compared to the conventional complex representation or real representation methods, (ii) has monotonic and smooth convergence behavior, compared to the Q-LSQR algorithm, and (iii) the new algorithm is more straightforward, and there is no expensive matrix inversion or decomposition. It may reduce the number of iterations in some cases. The performances of the algorithm are illustrated by some numerical experiments.
Functionalized Ionic Liquids Sputter Decorated with Pd Nanoparticles
Authors: Qadir Muhammad I. , Kauling Alan , Ebeling Günter , Fartmann Michael , Grehl Thomas , Dupont Jairton
Published: July 2018

The fabrication of surface clean palladium nanoparticles of 3–4nm was accomplished in imidazolium-based functionalized ionic liquids (ILs) having methoxy, cyano, and thio groups by magnetron sputtering deposition. The size of the NPs was strongly dependent on the surface composition and/or organisation of the ILs. The NP growth apparently occurred preferentially in the bulk of the fluids, whereas nucleation apparently occurred preferentially at the IL surface. Smaller NPs were detected close to the methoxy containing IL surface and were covered by at least one layer of IL ion pairs, as revealed by high-sensitivity low-energy ion scattering (HS-LEIS) measurements.
Are Aminomethyl Thioesters Viable Intermediates in Native Chemical Ligation Type Amide Bond Forming Reactions?
Authors: Charron Carlie L. , Cottam Jones Jade M. , Hutton Craig A.
Published: July 2018

The condensation of N-mercaptomethyl amines and thioesters is a potential route to amides, via aminomethyl thioester intermediates, in a native chemical ligation type process followed by self-cleavage of the ‘mercaptomethyl’ auxiliary. This paper describes investigations towards the preparation of aminomethyl thioesters, and subsequent conversion into amides, from a three-component coupling of formaldehyde, a thioacid, and an amine. Our studies suggest that while such intermediates may be formed en route to amides, no advantages are offered over the direct reaction of the amine and thioacid precursors.
Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial
Authors: Nazarpour Soheila , Simbar Masoumeh , Majd Hamid Alavi , Tehrani Fahimeh Ramezani
Published: July 2018

Background
The adverse effects of menopause on sexual function could be mitigated by pelvic floor muscle (PFM) training. This study aimed to investigate the effects of PFM exercises on sexual function in postmenopausal women. Methods: A randomised clinical trial was conducted among 97 Iranian postmenopausal women, aged 40 to 60 years. The participants’ baseline sexual functions were assessed using the Female Sexual Function Index (FSFI) questionnaire. They were then randomly designated to two groups: (1) the intervention group, which received specific instructions on PFM exercises and was followed up on a weekly basis; and (2) the control group, which received general information on menopause. After 12 weeks, the sexual functions of the participants were reassessed. Results: No significant difference was initially observed between the two groups in terms of demographic and socioeconomic characteristics and total scores of FSFI. After the intervention, however, the scores of arousal, orgasm and satisfaction were significantly higher in the intervention group (3.10, 4.36, and 4.84 vs 2.75, 3.89, and 4.36 respectively; P < 0.05). Conclusion: PFM exercises have the potential to improve the sexual function of postmenopausal women and are thus suggested to be included in healthcare packages designed for postmenopausal women.
Corrigendum to: Livestock depredation by large carnivores in the South Gobi, Mongolia
Authors: Mijiddorj Tserennadmid Nadia , Alexander Justine Shanti , Samelius Gustaf , Badola Ruchi , Rawat G. S. , Dutta Sutirtha
Published: July 2018

Context
Livestock depredation is a major conservation challenge around the world, causing considerable economical losses to pastoral communities and often result in retaliatory killing. In Mongolia, livestock depredation rates are thought to be increasing due to changes in pastoral practices and the transformation of wild habitats into pasture lands. Few studies have examined the interactions between humans and carnivores and even fewer have considered how recent changes in pastoral practices may affect depredation rates.

Aim
This study aimed to assess the influence of herding practices on self-reported livestock losses to snow leopards and wolves in two communities in South Gobi, Mongolia.

Methods
In total, 144 herder households were interviewed and an information-theoretic approach was used to analyse the factors influencing self-reported livestock losses to snow leopards and wolves.

Key results
The majority of self-reported losses to both snow leopards and wolves occurred when herds were left unattended in the pastures. The economic loss associated with livestock losses to snow leopards and wolves amounted to an average loss of US$825 per herder and year. The number of livestock owned by a household and the frequency of shifting campsite had the strongest influence on livestock losses to snow leopards and wolves. Other determinants of livestock losses included frequency of visiting the soum (county) centre.

Implications
On the basis of the findings, we make recommendations for mitigating the conflict with large carnivores, with focus on guiding future herding practices.
Fish community indices of ecosystem health: How does Toronto Harbour compare to other Lake Ontario nearshore areas?
Authors: Hoyle James A. , Boston Christine M. , Chu Cindy , Yuille Michael J. , Portiss Rick , Randall Robert G.
Published: July 2018

We assessed fish community status for 16 nearshore areas in Lake Ontario and the upper St. Lawrence River, from 2006 to 2016, using complementary fish sampling gear types and protocols, boat electrofishing and trap nets, and the published aquatic ecosystem health indicators associated with them. Factors influencing Indices of Biotic Integrity scores included degree of exposure to the open-waters of Lake Ontario, effective fetch, and land cover and use in surrounding watersheds. Focusing on Toronto Harbour, we determined that Indices of Biotic Integrity scores were lower (45.1 and 45.6 for electrofishing and trap net gear types, respectively) than predicted (55.5 and 59.6) based on other Lake Ontario nearshore areas with similar physical/environmental conditions but seemed reasonable given the significant influence of Canada’s largest urban area, the City of Toronto. The proportion of fish community biomass comprised of piscivores (0.21 and 0.18 for electrofishing and trap nets, respectively) approached target levels (0.20) set for the Toronto Harbour fish community, and indicated a balanced trophic structure. On-going aquatic habitat remediation and creation projects on the Leslie Street Spit (including Tommy Thompson Park) and the Toronto Islands, should ensure maintenance or improvement in Indices of Biotic Integrity scores and aquatic ecosystem health generally.
On the role of transient depolarization-activated K+ current in microvillar photoreceptors
Authors: Frolov Roman V.
Published: July 2018

Photoreceptors in the compound eyes of most insect species express two functional types of depolarization-activated potassium currents: a transient A-type current (IA) and a sustained delayed rectifier current (IDR). The role of Shaker-dependent IA in Drosophila melanogaster photoreceptors was previously investigated by comparing intracellular recordings from Shaker and wild-type photoreceptors. Shaker channels were proposed to be involved in low-frequency signal amplification in dim light and reduction of the metabolic cost of information transfer. Here, I study the function of IA in photoreceptors of the cockroach Panchlora nivea using the patch-clamp method. Responses to Gaussian white-noise stimuli reveal that blockade of IA with 4-aminopyridine has no discernible effect on voltage responses or information processing. However, because open-channel blockers are often ineffective at low membrane potentials, no conclusion on the role of IA could be made on the basis of negative results of pharmacological tests. Using a relatively large set of control data, a physiological variability analysis was performed to discern the role of IA. Amplitudes of the IA window current and half-activation potentials correlate strongly with membrane corner frequencies, especially in dim light, indicating that IA facilitates transmission of higher frequencies. Consistent with voltage-dependent inactivation of IA, these correlations decrease with depolarization in brighter backgrounds. In contrast, correlations involving IDR are comparatively weak. Upon reexamining photoreceptor conductance in wild-type and Shaker strains of D. melanogaster, I find a biphasic voltage dependence near the resting potential in a minority of photoreceptors from both strains, indicating that Shaker channels are not crucial for early amplification of voltage signals in D. melanogaster photoreceptors. Leak current in Shaker photoreceptors at the level of the soma is not elevated. These results suggest a novel role for IA in facilitating transmission of high-frequency signals in microvillar photoreceptors.
Attitude motion of space debris during its removal by ion beam taking into account atmospheric disturbance
Authors: Ledkov A S , Aslanov V S
Published: July 2018

The paper is devoted to the issue of active large space debris removal. The contactless method of influencing space debris through the ion flow is considered. The main advantage of this method is absence of a dangerous and complex stage of space debris capturing or docking. In this study, the project “Ion Beam Shepherd” was taken as a basis. The aim of this paper is to study the effect of the atmosphere in LEO on the space debris behaviour during its removal. The equations of plane motion of space debris under the action of the ion beam, gravitational and aerodynamic forces and torques were obtained using Lagrange formalism. For calculation ion beam force and torque the self-similar model of ion engine plume exploration and fully diffused reflection model of ions interaction with the surface were used. Simulation of deorbiting the spent upper stage of the Cosmos 3M rocket was carried out. Phase portraits of the rocket stage attitude motion for various heights were constructed and analysed. It was shown that the motion of the stage around its centre of mass has a noticeable effect on the average ion beam force and descent time.
5. Labour markets
Authors: Jefferson Philip N.
Published: July 2018

For most people, their performance in the labour market determines their station in life. What determines who earns what in the labour market? Are there systemic impediments that inhibit the ability of particular groups to prosper in the labour market? What is the role of education, skills, race, and gender? Are there ways to make the financial return on work greater regardless of skill level? If skills are lacking, are there policies that directly help to close skill gaps? ‘Labour markets’ considers these questions and concludes that a goal of labour market policy is to create pathways out of poverty. Well-functioning labour markets facilitate the economic mobility of people over the course of their lifetimes and across generations.
8. Whither poverty?
Authors: Jefferson Philip N.
Published: July 2018

A world without extreme poverty is still some way off, but there have been moments where some actual poverty reduction occurred. ‘Whither poverty?’ considers three of the post-1960 attempts to place poverty reduction on the public agenda: President Lyndon B. Johnson’s 1964 War on Poverty, the United Nations’ Millennium Development Goals set out in 2000, and their Sustainable Development Goals outlined in 2015. It concludes that the goal of action against poverty is the creation of a world where every individual’s opportunity to thrive (not just survive) can be independent of the circumstances of their birth, if they choose. Poverty matters because it is an obstacle to our progress, properly defined.
3. The later medieval empire
Authors: Whaley Joachim
Published: July 2018

After the post-Hohenstaufen era, two decades of weak kings were followed by several dynasties competing for the German crown before the Habsburgs emerged dominant in the 15th century. During this period, the German kingdom evolved constitutional structures that institutionalized the elective monarchy. The most important was the establishment of a formal group of royal electors. ‘The later medieval empire: the emergence of the Habsburgs’ describes this key period, including the reigns of the first Habsburg king, Rudolf; Charles IV of Bavaria (r. 1347–78) and his important law the Golden Bull of 1356; Sigismund (r. 1410–37) and the reform of the church and empire; and the long reign of Frederick III (r. 1440–93)
5. The early modern empire (2)
Authors: Whaley Joachim
Published: July 2018

The Thirty Years War was a disaster for much of the empire, yet the post-war era provided new opportunities and developments, which all contributed to the extraordinary cultural vitality of the German lands, manifest especially in the literary, musical, and philosophical achievements of the 18th and early 19th centuries. ‘The early modern empire (2): from the Peace of Westphalia to 1806’ outlines the empire’s revival after 1648 and the external threats that helped maintain its solidarity—the Ottoman wars, hostilities with France, and conflicts with Sweden in the north. It concludes with the French Revolution and Napoleon, whose insistence on the abdication of Francis II resulted in the dissolution of the empire in 1806.
Epilogue
Authors: Whaley Joachim
Published: July 2018

‘The legacy of the Holy Roman Empire’ describes the region’s history after 1806. The empire’s dissolution in 1806 effectively partitioned its territory into four zones. Would ‘Germany’ ever be united again? Napoleon’s defeat by the Austrians is discussed along with the creation of the German Confederation, the failure of the Frankfurt Parliament, the 1866 Austro-Prussian war, the creation of the German Empire in 1871, the aftermath of World War I, and the rise of the Third Reich. Is the empire relevant as a model for the present? There is no doubt that its traditions of law and of rights contributed, alongside the traditions that evolved in other European countries, to the development of modern Europe.
Stoicism: A Very Short Introduction
Authors: Inwood Brad
Published: July 2018

Stoicism: A Very Short Introduction introduces Stoic philosophy, and explains how ancient Stoicism survived and evolved into the movement we see today. Exploring the roots of the school in the philosophy of 4th century bce Greece, it examines its basic history and doctrines and its relationship to the thought of Plato, Aristotle and his successors, and the Epicureans. Sketching the history of the school’s reception in the western tradition, it argues that, despite the differences between ancient and contemporary Stoics, there is a common core of philosophical insight that unites the modern version not just to Seneca, Epictetus, and Marcus Aurelius, but also to the school’s original founders, Zeno, Cleanthes, and Chrysippus.
1. Biology: from analysis to synthesis
Authors: Davies Jamie A.
Published: July 2018

Synthetic biology—the creation of new living systems by design—is a rapidly growing area of science and technology that is attracting attention well beyond the laboratory and is provoking vigorous public debate. ‘Biology: from analysis to synthesis’ explains that the most general definition of synthetic biology works by dividing biology as a whole into analytic and synthetic branches. Synthetic biology is a broad subject partly because of the way it is defined, and partly because it has two distinct and independent historical roots: one intellectually driven and running deep into 19th-century natural philosophy, and the other more practically orientated and emerging from late 20th-century biotechnology.
3. Synthetic biology and the environment
Authors: Davies Jamie A.
Published: July 2018

The world faces a number of pressing environmental challenges: limited resources; limited space; loss of biodiversity; pollution of land, water, and air; and the impact of climate change thought to be driven by air pollution and by altered land use. Synthetic biology is being seen by many as a potentially powerful tool to be used in solving some of these problems in combination with other technical, social, and legislative advances. ‘Synthetic biology and the environment’ considers examples of synthetic biology approaches to environmental protection including reduction of greenhouse gas production, more efficient agricultural land use, detection of pollution, and bio-remediation of polluted environments, and discusses the barriers to commercial application.
7. Creating life
Authors: Davies Jamie A.
Published: July 2018

Synthetic biology has ‘two souls’, one focused on engineering new features into existing life, the other aiming to create life de novo. The goal of creating life is arguably far more significant in terms of long-term scientific and philosophical impact. ‘Creating life’ considers the approach to creating life from the bottom up, starting with simple chemicals and taking only inspirations from existing living things. So far, self-reproducing catalytic cycles have been generated that produce molecules of modest complexity from simple precursors. Those working on containment have made self-reproducing membrane vesicles, albeit ones requiring somewhat complex starting molecules. What seems not yet to have been done is to join these concepts.
Geology: A Very Short Introduction
Authors: Zalasiewicz Jan
Published: July 2018

Geology: A Very Short Introduction provides a concise introduction to the fascinating field of geology. Describing how the science began, it looks at the key discoveries that have transformed it, before delving into the modern science and its various subfields, such as sedimentology, tectonics, and stratigraphy. Analysing the geological foundations of the Earth, this VSI explains the interlocking studies of tectonics, geophysics, igneous and metamorphic petrology, and geochemistry and describes the geology of both the deep interior and surface of the Earth. Considering the role and importance of geology in the finding and exploitation of resources, it also discusses its place in environmental issues and in tackling problems associated with climate change.
5. Earth surface geology
Authors: Zalasiewicz Jan
Published: July 2018

‘Earth surface geology’ considers the particular conditions created by the water cycle governing the distinctive surface geology of Earth. It looks at the efficiency of the rock cycle: the breakdown of ‘primary’ igneous rocks into sediments, which are buried and lithified to produce sedimentary rock, which in turn becomes metamorphosed as heat and pressure increase, finally ending in melting and magma production. It also looks at the ways that geological time has been subdivided using biostratigraphy (the tracking of species’ evolution through fossils) and tracing chemical changes in the rocks. Earth’s evolution has included regular and gradual influences, with episodes of sudden massive change from more or less random events.
8. Geology for society and the environment
Authors: Zalasiewicz Jan
Published: July 2018

Geology is involved, somehow or another, in most of the resources that sustain us. Equally, it is a significant factor in many of the hazards that threaten us, and geology is often involved in devising means of avoiding, or counteracting, or simply of living with, these hazards as sensibly as possible. ‘Geology for society and the environment’ considers both Earth-generated hazards, such as volcanoes, earthquakes, and tsunamis, and human-made geological hazards, including the rise in carbon release fuelling climate change and the ever-increasing volume of waste materials and pollutants. It looks at how geology is used to help devise the best means for society to deal with these hazards.
Process evaluation of the effects of patient safety auditing in hospital care (part 2)
Authors: Hanskamp-Sebregts Mirelle , Zegers Marieke , Boeijen Wilma , Wollersheim Hub , van Gurp Petra J , Westert Gert P
Published: July 2018

Objective

To identify factors that explain the observed effects of internal auditing on improving patient safety.

Design setting and participants

A process evaluation study within eight departments of a university medical centre in the Netherlands.

Intervention(s)

Internal auditing and feedback for improving patient safety in hospital care.

Main outcome measure(s)

Experiences with patient safety auditing, percentage implemented improvement actions tailored to the audit results and perceived factors that hindered or facilitated the implementation of improvement actions.

Results

The respondents had positive audit experiences, with the exception of the amount of preparatory work by departments. Fifteen months after the audit visit, 21% of the intended improvement actions based on the audit results were completely implemented. Factors that hindered implementation were short implementation time: 9 months (range 5–11 months) instead of the 15 months’ planned implementation time; time-consuming and labour-intensive implementation of improvement actions; and limited organizational support for quality improvement (e.g. insufficient staff capacity and time, no available quality improvement data and information and communication technological (ICT) support).

Conclusions

A well-constructed analysis and feedback of patient safety problems is insufficient to reduce the occurrence of poor patient safety outcomes. Without focus and support in the implementation of audit-based improvement actions, quality improvement by patient safety auditing will remain limited.
Ineffectiveness of Insecticide Bendiocarb Against a Cimex lectularius (Hemiptera: Cimicidae) Population in Paris, France
Authors: Candy Kerdalidec , Akhoundi Mohammad , Bruel Christiane , Izri Arezki
Published: July 2018

Bed bugs, nocturnal ectoparasites adapted to feed on humans, have demonstrated a global resurgence since 1990s, presumably due to increased international travel and insecticide resistance. Resistance to insecticides has restricted the ability to manage bed bug populations. We evaluated the susceptibility of Cimex lectularius L. (Hemiptera: Cimicidae) collected from five districts in Paris against bendiocarb, a carbamate insecticide. The susceptible strain of C. lectularius from London included in our experiments as a control. Mortality of adult bed bugs was assessed after exposure to a fixed concentration of bendiocarb (80%) at intervals ranging from 15 min to 72 h. Mortality in samples ranged from 14% in Bobigny to 0% in Paris 15th arrondissement and Drancy. Bioassays with bendiocarb insecticide on C. lectularius revealed high levels of resistance in Paris.
Skeletal Muscle Fibrosis in Pancreatic Cancer Patients with Respect to Survival
Authors: Judge Sarah M , Nosacka Rachel L , Delitto Daniel , Gerber Michael H , Cameron Miles E , Trevino Jose G , Judge Andrew R
Published: July 2018

Background

Cancer cachexia is a catabolic condition characterized by skeletal muscle wasting, consequent to tumor burden, which negatively impacts tolerance to cancer therapies and contributes to increased mortality. Partly because of the limited knowledge of the underlying mechanisms of cancer cachexia derived from human studies, however, the ability to therapeutically intervene remains elusive. The purpose of the current study was therefore to better define the phenotype of skeletal muscle obtained from patients with pancreatic ductal adenocarcinoma (PDAC), which has one of the highest rates of cachexia.

Methods

Morphological analyses were performed on rectus abdominis muscle biopsies obtained from resectable PDAC patients undergoing tumor resection surgery (N = 20) and from weight-stable non-cancer control subjects undergoing benign abdominal surgery (N = 16). PDAC patients with a body weight loss of greater than 5% during the previous 6 months were considered cachectic (N = 15). Statistical tests were two sided.

Results

Skeletal muscle from cachectic PDAC patients had increased collagen content compared with non-cancer control subjects (1.43% vs 9.66%, P = .0004, Dunn test). Across all PDAC patients, collagen content positively correlated with body weight loss (P = .0016, r = 0.672), was increased in patients with lymph node metastasis (P = .007, Mann-Whitney U test), and was associated with survival on univariate (HR = 1.08, 95% confidence interval [CI] = 1.02 to 1.04, P = .008) and multivariable analyses (HR = 1.08, 95% CI = 1.00 to 1.17, P = .038). Cachectic PDAC patients also displayed increased lipid deposition (2.63% vs 5.72%, P = .042), infiltration of CD68+ macrophages (63.6 cells/mm2 vs 233.8 cells/mm2, P = .0238), calcium deposition (0.21% vs 2.51%, P = .030), and evidence of deficient cellular quality control mechanisms (Mann-Whitney U test). Transcriptional profiling of all patients supported these findings by identifying gene clusters related to wounding, inflammation, and cellular response to TGF-β upregulated in cachectic PDAC patients compared with non-cancer control subjects.

Conclusions

To our knowledge, this work is the first to demonstrate increased collagen content in cachectic PDAC patients that is associated with poor survival.
Tidal stripping as a possible origin of the ultra diffuse galaxy lacking dark matter
Authors: Ogiya Go
Published: July 2018

Recent observations revealed a mysterious ultra diffuse galaxy, NGC 1052-DF2, in the group of a large elliptical galaxy, NGC 1052. Compared to expectations from abundance matching models, the dark matter mass contained in NGC 1052-DF2 is smaller by a factor of ∼400. We utilize controlled N-body simulations of the tidal interaction between NGC 1052 and a smaller satellite galaxy that we suppose as the progenitor of NGC 1052-DF2, to test if tidal stripping can explain dark-matter deficiency at such levels. We find that when assuming a tightly bound and quite radial orbit and cored density structure for the dark halo of the satellite, our simulations reproduce well both the mass profile and the effective radius inferred from the observations of NGC 1052-DF2. Orbital parameters are in the tail, but still consistent with measurements of their distributions from cosmological simulations. Such strongly dark-matter deficient galaxies, in our scenario, are thus expected to be relatively rare in groups and clusters, and not present in the field.
Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20–50 years: a study by the ERA–EDTA Registry
Authors: Pippias Maria , Jager Kitty J , Åsberg Anders , Berger Stefan P , Finne Patrik , Heaf James G , Kerschbaum Julia , Lempinen Marko , Magaz Ángela , Massy Ziad A , Stel Vianda S
Published: July 2018

Background

Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.

Methods

We examined outcomes in 6448 European kidney allografts donated from younger (≥20–<50 years) and older (≥50–<70 years) deceased donors when transplanted into very young (≥20–<35 years) or young (≥35–<50 years) adult recipients. Outcomes of first kidney transplantations during 2000–13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.

Results

The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1–24.9]} and young [15.3% (95% CI 13.7–16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9–41.5)] and young [29.2% (95% CI 25.1–33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44–0.68)] and 40% [young aHR 0.60 (95% CI 0.53–0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00–1.04)] or 1% [young aHR 1.01 (95% CI 1.00–1.01)] increase in the 10-year risk of death.

Conclusions

Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20–50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.
Flavor Capsule Variants’ Performance in a “Dark Market”: Implications for Standardized Packaging
Authors: Haggart Kerri , Hoek Janet , Blank Mei-Ling
Published: July 2018

Background

By increasing excise taxes, eliminating tobacco marketing, and requiring standardized (plain) packaging of tobacco products, governments internationally have reduced smoking’s allure. Yet product innovations, such as flavor capsule variants (FCVs), remain unregulated and may appeal to non-smokers. We examined the growth of FCVs in a country with a progressive policy environment.

Methods

Each year, New Zealand tobacco companies must provide details of the number of cigarette sticks released for each brand and variant to the Ministry of Health. We used this information to analyze FCVs’ performance for British American Tobacco (BAT) and Philip Morris International (PMI), which account for a large proportion of New Zealand tobacco sales. We report the quantity released of each variant and share of parent brand portfolio, and examine growth patterns within the premium, everyday, and value market subsections.

Results

BAT introduced FCVs in 2012 and by 2014 offered FCVs in all market subsections; PMI introduced a Marlboro FCV in 2014. FCVs grew rapidly relative to unflavored variants and, by 2017, represented nearly 10% of BAT’s product portfolio and more than 3% of PMI’s product portfolio. By 2017, FCVs accounted for more than a third of the Dunhill sticks released, 14% of Holiday, and 17% of Pall Mall.

Conclusions

FCVs’ rapid growth may have reduced declines in the numbers of sticks released. Policy makers should disallow FCV innovations, which offer no health benefits to smokers and may instead attract non-smokers to smoking. Where timely, these regulations could be incorporated into standardized packaging policies.

Implications

FCVs have grown quickly in countries with comprehensive tobacco marketing restrictions, which suggests tobacco companies are now focusing on novel product designs to attract new smokers. Standardized packaging regulations could address both external packaging and stick design innovations, such as FCVs; alternatively, specific regulations prohibiting FCVs may be required.
Phenotypes, endotypes and biomarkers in anaphylaxis: current insights
Authors: Sala-Cunill Anna , Guilarte Mar , Cardona Victoria
Published: July 2018

Purpose of review

The aim of the review is to describe the different clinical pictures of anaphylaxis (phenotypes), in relation to the underlying mechanisms and potential biomarkers, to describe anaphylaxis endotypes. This may aid in achieving a better understanding, management and outcomes of such severe reactions.

Recent findings

Different anaphylaxis phenotypes have been outlined, ranging from the classical type-I-like to those suggestive of cytokine-storm-like or complement-mediated reactions. Underlying mechanisms differ and biomarkers of cells and systems involved are being identified (tryptase, IL-6, bradykinin etc.)

Identifying specific phenotypes/endotypes will allow the application of precision medicine in patients with anaphylaxis, providing insights to the most appropriate approach in each case.
Perioperative considerations in spinal deformity surgery
Authors: Sun Li , Cheung Zoe B. , Cho Samuel K.
Published: July 2018

Spinal deformity correction remains one of the most challenging surgical procedures in spine surgery. Historically, it has been associated with high complication rates. Despite advances in surgical approaches, modern instrumentation, and innovative technology, surgical correction of adult spinal deformity (ASD) continues to present a challenge in the preoperative, intraoperative, and postoperative period for spine surgeons. While the technical aspects of ASD surgery are often the primary focus during residency and fellowship training, perioperative considerations are sometimes not emphasized. Multimodal planning to address perioperative concerns in ASD surgery is critical to not only optimize clinical outcomes, but also to minimize perioperative complications and associated costs. In this review, we present articles published within the past 2 years to highlight the importance of five considerations in perioperative planning for ASD surgery: preoperative risk stratification, blood loss management, intraoperative safety, infection risk, and cost effectiveness. Preoperative risk stratification can be performed using assessment tools such as the American Society of Anesthesiologists (ASA) classification and the Modified Frailty Index. Blood loss management strategies include intraoperative blood salvage as well as the use of antifibrinolytic agents. Intraoperative safety encompasses intraoperative neuromonitoring and radiation exposure. Risk stratification can help identify patients at high risk for infection, and strategies to reduce surgical site infections include the use of vancomycin powder. Last, the cost effectiveness of ASD surgery remains a topic of interest for future studies as comprehensive cost-benefit analyses are still lacking in the current literature.
Blood conservation techniques in scoliosis surgery
Authors: Chevinsky Jonathan , Yoshihara Hiroyuki
Published: July 2018

Blood conservation techniques have largely been implemented to improve outcomes of scoliosis surgery, though there still remains some debate as to which particular techniques should be implemented and how efficacious they are in avoiding allogeneic blood transfusion. The most common domains of blood conservation include autologous blood donation, cell salvage, normovolemic hemodilution, and intraoperative antifibrinolytic use. While autologous blood donation has been a staple of care among such techniques, recent research has suggested that it may not decrease the risk of allogeneic blood transplant, and may, in fact, increase the risk. Thus, it has largely been phased out in scoliosis surgery. Cell saving techniques are widely used and have largely demonstrated decreased transfusion necessity, thus warranting its continued use. Normovolemic hemodilution has limited data regarding its efficacy in scoliosis surgery, though some of the available data support its efficacy. Further research is required before any definitive recommendation can be made. Finally, antifibrinolytics clearly have a role in limiting blood loss in scoliosis surgery, with tranexamic acid serving as the most studied example. In conclusion, there is still no definitive answer to the question of how blood can be best conserved in the setting of scoliosis surgery, and effective treatment regimens should involve multiple strategies.
ACUTE RETINAL NECROSIS ASSOCIATED WITH HERPES ZOSTER VACCINATION
Authors: Menghini Moreno , Raja Vignesh , Raiter Jeremy , Balaratnasingam Chandrakumar , Constable Ian J.
Published: July 2018

Purpose:

To report a case of Zostavax-associated acute retinal necrosis in a patient with chronic lymphocytic leukemia.

Methods:

Case report.

Patients:

A 76-year-old white man.

Results:

Unilateral acute retinal necrosis with obliterative angiopathy developed in close proximity of a Zostavax vaccine. Treatment with valacyclovir hydrochloride (1 g orally three times a day) and intravitreal ganciclovir (4 mg/0.1 mL) was initiated on presentation. Because of continuous increase of the retinal necrosis, patient was switched to intravenous acyclovir (7.5 mg/kg body weight, adapted to reduced glomerular filtration rate) and given intravitreal foscarnet (2.4 mg/0.1 mL). Despite being on maximal antiviral therapy, the patient suffered a central retinal artery occlusion.

Discussion:

Acute retinal necrosis is a severe complication and potentially blinding disease of herpes zoster, and can occur in association with herpes zoster immunization, in particular, in immune suppressed patients.
Vision-Specific Quality of Life: Laser-Assisted in situ Keratomileusis Versus Overnight Contact Lens Wear
Authors: González-Pérez Javier , Sánchez García Ángel , Villa-Collar César
Published: July 2018

Objectives:

To compare the visual-related quality of life in myopic subjects with different refractive treatments such as continuous wear of silicone-hydrogel contact lenses (CL), corneal refractive therapy (CRT), and laser-assisted in situ keratomileusis (LASIK).

Methods:

The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) questionnaire was administered to 96 subjects with a mean age of 30.0±7.9 years. There were 72 myopic subjects with a mean spherical equivalent of −2.74±0.98 D (−5.50 to −1.25 D). Subjects were corrected with LASIK (n=24), Paragon CRT orthokeratology lenses (n=24), and lotrafilcon A silicone-hydrogel CL under continuous wear (n=24). The NEI RQL-42 survey was used to compare differences between groups as well as with an emmetropic group (n=24).

Results:

After 1 year of treatment, significant differences were found among all groups in the subscales glare (P=0.017), symptoms (P=0.016), dependence on correction (P<0.001), and worry (P<0.001). The mean difference compared with emmetropes were −5.5% (P=0.063) for LASIK patients, −2.0% (P=0.212) for orthokeratology subjects, and +1.6% (P=0.934) for the silicone-hydrogel CL group.

Conclusions:

Myopic subjects analyzed in this study reported better vision-related quality of life when they were corrected with continuous wear silicone-hydrogel lenses. The average score reached by CRT was similar to emmetropes, which showed the main disadvantage in worry subscale. The patients who underwent LASIK had the lowest valuation, highlighting the decreases in scores of diurnal fluctuations, glare, and especially in expectations and worry subscales, due to the first and second subscales, but especially to the false expectations created about treatment.
Epstein-Barr Virus–Associated Genital Ulcers
Authors: Dylewski Joe
Published: July 2018

Acute Epstein-Barr virus (EBV) infection is most often associated with a clinical presentation of pharyngitis, fever, lymphadenopathy, and fatigue. There has been a recent recognition of the association of EBV with genital ulcers, predominately in females. Over 100 years ago, Lipschütz (Arch Dermatol Syph (Berlin). 1913;114:363–395) described a series of females with severe genital ulcers, which had 3 suspected causes: herpes simplex virus infection, Behçet syndrome, and what he termed ulcus vulvae acutum (UVA). I wish to present the case of a young female who presented with UVA in the context of an acute EBV infection. The possible pathogenic role of EBV in UVA will be reviewed.
Optimizing the Approach to Patients With Pleural Effusion and Radiologic Findings Suspect for Cancer
Authors: Alzghoul Bashar , Innabi Ayoub , Subramany Swathi , Boye Bradley , Chatterjee Kshitij , Koppurapu Vikas S. , Bartter Thaddeus , Meena Nikhil K.
Published: July 2018

Background:

When patients present with pleural effusion and structural abnormalities consistent with malignancy on imaging, the traditional approach has been to perform a thoracentesis and await the results before proceeding to more invasive diagnostic procedures. The objective of this study was to evaluate whether concurrent thoracentesis and tissue biopsy is superior to sequential sampling.

Methods:

Retrospective chart review was performed for patients who had a pleural cytology from May 2014 until January 2017. Patients without parenchymal, pleural, or mediastinal abnormalities and those with a prior primary thoracic malignancy were excluded. Patients with an effusion and additional suspect findings were grouped based upon whether initial approach was concurrent versus sequential. The following outcomes were documented: lag time to diagnosis from thoracentesis, lag time to hematology/oncology (HONC) service consult, time to molecular study results, lag time to therapy, and time to death.

Results:

Of 565 cases, 45 met criteria, 28 (62%) having undergone concurrent and 17 (38%) sequential sampling. The median lag time to biopsy for the concurrent group, 3 days, was significantly shorter than the 9-day lag time for the sequential group (P=0.006). Five patients in the sequential group and one in the concurrent group were lost to follow-up. Patients in the concurrent group had earlier diagnosis and oncology visits (2 d, 7 d) than those in the sequential group (6.5 d, 16 d) (P<0.001 and <0.039, respectively). Time from diagnosis to death did not differ for the 2 groups.

Conclusion:

For patients presenting with pleural effusion accompanied by additional suspect findings, concurrent tissue sampling, and thoracentesis may both reduce loss to follow up and accelerate care.
Improvement of clinical management and outcome in hepatocellular carcinoma nowadays compared with historical cohorts
Authors: Schellhaas Barbara , Strobel Deike , Stumpf Miriam , Ganslmayer Marion , Pfeifer Lukas , Goertz Ruediger S. , Neurath Markus F. , Zopf Steffen
Published: July 2018

Objectives

Therapeutic approaches in the treatment of hepatocellular carcinoma (HCC) depend on tumour stage, liver function and patient comorbidities. The aim of this study was to investigate the influence of tumour stage and therapeutic approach on overall survival in HCC.

Materials and methods

Two hundred and fourteen patients with HCC diagnosed between December 2012 and May 2017 were assessed retrospectively for tumour stage [Barcelona Clinic Liver Cancer (BCLC)], liver function (Child–Pugh score), therapeutic approach and outcome (mean survival time). The results were compared to two historical cohorts from our centre diagnosed between 1999 and 2013 and 1988 and 1999, respectively.

Results

Nowadays, HCC is diagnosed in earlier tumour stages and with better liver function compared with the historical cohorts (P<0.001). Survival times depend on both BCLC stages and liver function for all therapeutic approaches. The 1-year survival rate in the present cohort was 79.4% compared with 58.6% in the historical cohort.

In terms of BCLC stages, therapeutic approaches followed HCC guidelines in 43.9% of cases.

Whereas the percentage of patients receiving resection or ablation did not change between the historical and the present cohort, there was a tendency towards a decrease in transarterial chemoembolization, with a shift towards selective internal radiotherapy, accompanied by an increase in systemic therapy with sorafenib.

Also, the percentage of patients receiving single instead of multiple therapies was significantly higher in the present cohort compared with the historical cohort (P=0.016). In 62/83 patients receiving single therapy (64.7%), tumour remission was maintained during the period of follow-up.

Conclusion

HCC is increasingly being diagnosed in earlier stages, so that single therapy is often sufficient. Besides BCLC stages, therapy in HCC must consider liver function, tumour location, local expertise and patients’ comorbidities and preferences. Further research is needed to evaluate the benefit of early multimodal concepts. Therapeutic approaches in HCC remain individual decisions.
Oral vancomycin induces sustained deep remission in adult patients with ulcerative colitis and primary sclerosing cholangitis
Authors: de Chambrun Guillaume Pineton , Nachury Maria , Funakoshi Natalie , Gerard Romain , Bismuth Michael , Valats Jean-Christophe , Panaro Fabrizio , Navarro Francis , Desreumaux Pierre , Pariente Benjamin , Blanc Pierre
Published: July 2018

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. The treatment of UC is challenging, especially when it is associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the bile ducts that affects around 5% of patients with UC, and leads to an increased risk of cholangiocarcinoma and colorectal cancer. Microbiota is considered to play an important role in the pathogenesis of UC, although the efficacy of antibiotics in this context is only limited and transient. Several studies have investigated the use of antibiotics for the treatment of PSC in adult and pediatric populations, with conflicting results. In this brief report, we describe the effect of oral vancomycin treatment in three patients with UC and PSC refractory to conventional and biologic therapies. All three patients achieved clinical remission and mucosal healing with vancomycin 500 mg twice a day administered orally. Maintenance treatment with oral vancomycin was well tolerated and led to sustained clinical and endoscopic remission in all three patients. Oral vancomycin also improved liver function tests in two patients who did not have pre-existing cirrhosis.
Persistence of Muscle‐bone Deficits Following Anti‐tumour Necrosis Factor Therapy in Adolescents With Crohn Disease
Authors: Altowati Mabrouka M.A. , Shepherd Sheila , McMillan Martin , McGrogan Paraic , Russell Richard , Ahmed S. Faisal , Wong Sze Choong
Published: July 2018

Objectives:

The aim of the study is to assess change in the muscle‐bone unit in adolescents with Crohn disease (CD) on anti‐tumour necrosis factor (anti‐TNFα).

Methods:

Prospective study following anti‐TNFα in 19 adolescents with CD with a median age (range) of 15.1 years (11.2, 17.2). At baseline, 6 and 12 months, subjects had a biochemical assessment of insulin growth factor axis, bone turnover and muscle‐bone health by dual energy absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), and dynamic isometry.

Results:

Significant clinical improvement in disease activity was observed by 2 weeks (P = 0.004 vs baseline) and maintained at 12 months (P = 0.038 vs baseline). Median bone specific alkaline phosphatase standard deviation score (SDS) increased from −1.7 (−3.6 to −1.0) to −1.2 (−3.6 to −0.5) by 6 weeks (P = 0.01). At baseline, DXA total body and lumbar spine bone mineral density (BMD) SDS was −0.9 (−2.3 to 0.5) and −1.1 (−2.9 to 0.4), respectively. At baseline, pQCT trabecular BMD SDS at 4% tibia and muscle cross‐sectional area SDS at 66% radius was −1.6 (−3.2 to 1.1) and −2.4 (−4.3 to −0.3), respectively. At baseline, maximal isometric grip force (MIGF) of the non‐dominant hand adjusted for height was −1.5 (−4.5 to 0.49). All these deficits in muscle‐bone persisted at 6 and 12 months.

Conclusions:

Despite improvement in disease and osteoblast activity, bone and muscle deficits, as assessed by DXA, pQCT, and grip strength in adolescents with CD did not improve following twelve months of anti‐TNFα.