bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Satisfaction and Clinical Complications after Endoscopic or Surgical Saphenous Vein Harvesting
Authors: Filip Tomas , Schröther Filip , Haase Robert , Rudolph Nicol , Claus Thomas , Albes Johannes M.
Published: April 2019

Background Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been developed to reduce leg wound problems. This study was undertaken to evaluate postoperative complications and patient's subjective satisfaction comparing EVH and surgical vein harvesting (SVH).

Methods From January to December 2017, patients undergoing elective cardiac surgery (CABG, CABG + Valve repair or replacement) underwent saphenous vein graft harvesting either by EVH (n = 136) or SVH (n = 104). Clinical follow-up was scheduled for day 7 and > 45 days after surgery. Primary end points were divided into two subgroups. The first one included postoperative extent of subjective pain and satisfaction with the cosmetic results described by the patients themselves, while the second subgroup included objective postoperative complications including wound healing disturbances, hematoma, and neuropathy. Secondary end point was length of hospital stay.

Results At 7 days follow-up, EVH patients were more satisfied with the cosmetic results than those of the SVH group (p < 0.001) and expressed a significant tendency toward lower subjective pain compared with the SVH patients (p < 0.001), exhibited significantly lower cellulitis (p-0.002), neuropathy (p-0.005), and superficial wound healing disturbance (p-0.007). During further follow-up at > 45 days, patients with EVH were still more satisfied with the cosmetic results (p < 0.001) and expressed lower subjective pain (p < 0.001), while the other objective wound parameters did not show significant differences between both groups. Mean length of hospital stay of EVH patients was 0.7 days less compared with SVH patients.

Conclusions Our findings demonstrate the noninferiority of EVH in the short term and in the early medium term.
Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Cardiac Surgery
Authors: Salem Mohamed , Mohammad Baland , Huenges Katharina , Friedrich Christine , Panholzer Bernd , Cremer Jochen , Hanyea Assad
Published: April 2019

Background Incidentally discovered severe calcified ascending aorta (CAA) is a major challenge faced by surgeons during cardiac surgery. The aim of this study was to evaluate the outcome in patients undergoing cardiac surgery in this condition with the additional replacement of the CAA.

Methods A retrospective study on a cohort of 74 patients (28.4% females; mean age: 73 ± 7 years) underwent cardiac surgery and initial replacement of an incidentally discovered CAA using moderate hypothermic circulatory arrest. A control group was matched according to age, gender, and procedure.

Results No significant differences were noted with regard to preoperative risk factors. Due to the additional replacement of CAA, the extracorporeal circulation and cross-clamping time were significantly longer in the study group (p < 0.001). Postoperatively, no significant differences in complications were observed between the groups. There was no significant difference in regard to incidence of neurologic adverse events (5.4 vs. 2.7%; p = 0.68) or 30-day mortality (6.7 vs. 4.1%; p = 0.72).

Conclusion Our study showed that the initial replacement of incidental CAA in patients undergoing cardiac surgery was not associated with increased risks for neurologic adverse events and mortality.
Cluster perturbation theory. III. Perturbation series for coupled cluster singles and doubles excitation energies
Authors: Baudin Pablo , Pawłowski Filip , Bykov Dmytro , Liakh Dmitry , Kristensen Kasper , Olsen Jeppe , Jørgensen Poul
Published: April 2019

The cluster perturbation series, CPS(D), for coupled cluster singles and doubles excitation energies is considered. It is demonstrated that the second-order model CPS(D-2) is identical to the configuration interaction singles with perturbative doubles, CIS(D) model. The third-order model, CPS(D-3), provides excitation energies of coupled cluster singles and doubles (CCSD) quality in the sense that the difference between CPS(D-3) and CCSD excitation energies is of the same size or smaller than the effect of adding triples corrections to CCSD excitation energies. We further show that the third-order corrections can be efficiently implemented, in particular, when the resolution of the identity approximation is used for integrals. We also show that the CPS(D-3) excitation energies can be determined for system sizes that are far beyond what can be considered in conventional CCSD excitation energy calculations.
Extensive analysis of photovoltaic battery self-consumption: Evaluation through an innovative district case-study
Authors: Millet L. , Berrueta A. , Bruch M. , Reiners N. , Vetter M.
Published: April 2019

Energy storage is one of the key elements within the actual stage of the energy transition, as it is probably one of the most important factors to allow high penetration of fluctuating renewable energies, such as wind or solar, in the existing power systems. Intensive research is being conducted to assess the economic aspects and technical performance of renewable energy-based systems supported by batteries by evaluating different services that batteries can provide to the electric grid or to the end-consumers. In Germany, where the majority of the currently installed 43 GW of PV capacity corresponds to small residential, commercial, or industrial facilities, an interesting market for batteries to enhance local self-consumption and autarky is already booming, with more than 80 000 storage system installations in 2017. In this context, this study presents a comprehensive analysis of the photovoltaic battery model by analyzing the technical and economic consequences that variations on the most relevant system parameters induce. The presented results are based on high resolution data obtained from a representative residential district with an autarky of above 95%. The employed battery model is based on the results obtained through an extensive test campaign and includes electrical and thermal sub-models. The analysis predicts that grid parity of residential PV battery systems can be reached in the upcoming years, with especially great potential of the retrofitting market for those PV installations which run out of the feed-in tariff policy.
A compact laser system for a portable atom interferometry gravimeter
Authors: Luo Qin , Zhang Heng , Zhang Ke , Duan Xiao-Chun , Hu Zhong-Kun , Chen Le-Le , Zhou Min-Kang
Published: April 2019

A compact laser system for a portable 87Rb atom interferometry gravimeter has been demonstrated in this work. This laser system is based on frequency doubling of a single seed laser at the wavelength of 1560 nm. The frequency of the seed laser is controlled by a digital unit with an analog feedback circuit. By using this frequency control method, the frequency of the laser system can be shifted over 1 GHz. Based on this method, the Raman frequency can be locked on the F = 3 → F′ = 4 transition of 85Rb atoms. Moreover, the Raman sideband and the repumping laser are generated by a phase modulator, and it can generate different laser frequencies to meet the requirements of a typical atom interferometer. Additional sidebands in the Raman beam produced from the phase modulator are optimized and reduced, allowing us to observe atom interference with a free evolution time of 320 ms. The control unit including the laser system has been integrated into a box with a volume of 1.5 m × 0.6 m × 0.6 m, and the weight of which is only 150 kg. Using this compact optical scheme, our atomic gravimeter has achieved a sensitivity of 53 μGal/Hz1/2 and a resolution of better than 1 μGal (1 μGal = 1 × 10−8 m/s2) in an integration time of 3000 s.
High-speed side-shooter using Leidenfrost phenomena
Authors: Sugioka Hideyuki , Segawa Satoru , Kubota Mako
Published: April 2019

Liquid delivery systems are important in microfluidic applications. In this paper, we report a high-speed side-shooter using a simple plate-like hot protrusion placed on the lower edge of a hot slope. In particular, we experimentally show that the side-shooter launches a droplet with a high speed (∼15cm/s). We propose a simple model to explain the side-shooting phenomenon; i.e., the hot protrusion causes an increase in the surface energy due to the formation of a new folded surface, which results from a new Leidenfrost phenomenon coupled with the protrusion, and therefore, the droplet can be launched at a high speed on the hot slope with a low friction due to the ordinary Leidenfrost phenomenon. A comparison of the theoretical results with the experimental results shows that they are in good agreement with each other. We believe that our side-shooter will play an important role in microfluidics in the future.
Reactions at noble metal contacts with methylammonium lead triiodide perovskites: Role of underpotential deposition and electrochemistry
Authors: Kerner Ross A. , Schulz Philip , Christians Jeffrey A. , Dunfield Sean P. , Dou Benjia , Zhao Lianfeng , Teeter Glenn , Berry Joseph J. , Rand Barry P.
Published: April 2019

Chemical reactivity of halide perovskites coupled with a low energy of formation makes it a challenge to characterize material properties and achieve long-term device stability. In this study, we elucidate electrochemical reactions occurring at the methylammonium lead triiodide (MAPbI3)/Au interface. X-ray photoemission spectroscopy is used to identify a type of reduction/oxidation reaction termed underpotential deposition (UPD) involving lead, iodine, and hydrogen occurring at interfaces with noble metals. Changes in surface compositions and oxidation states suggest that UPD derived adsorbates at MAPbI3/Au interfaces lower the energy barrier for release of volatile HI and/or I2 catalyzing degradation at exposed contacts. Additionally, comparison to PbI2/Au interfaces demonstrates that the presence of methylammonium/methylamine accelerates the formation of a Pb0 adlayer on the Au. Reactions involving UPD Pb0 can transform the typically anodic (hole collecting) Au to a cathode in a photovoltaic measurement. Cyclic voltammetry reveals electrochemical reaction peaks in indium tin oxide (ITO)/MAPbI3/Au devices occurring within voltage ranges commonly used for perovskite characterization. The electrochemical stability window of this device architecture is measured to be between −0.5 V and 0.9 V. Voltage induced interfacial reactions contribute to reversible electrochemical peaks, hysteresis, switchable perovskite diode polarity, and permanent degradation at larger voltages. These types of surface reactions alter the interface/interphase composition beyond ion accumulation, provide a source for the diffusion of defects, and contribute to electrode material dependent current-voltage hysteresis. Moreover, the results imply fundamental limitations to achieving high device stability with noble metals and/or methylammonium containing perovskites.
Symmetries and local conservation laws of variational schemes for the surface plasmon polaritons
Authors: Chen Qiang , Hao Xiaojun , Wang Chuanchuan , Wang Xiaoyang , Chen Xiang , Geng Lifei
Published: April 2019

The relation between symmetries and local conservation laws, known as Noether's theorem, plays an important role in modern theoretical physics. As a discrete analog of the differentiable physical system, a good numerical scheme should admit the discrete local conservation laws and inherent mathematical structures. A class of variational schemes constructed for the hydrodynamic-electrodynamic model of lossless free-electron gas in a quasi-neutral background shows good properties in secular simulations of surface plasmon polaritons [Q. Chen et al., Phys. Rev. E 99, 023313 (2019)]. We show the discrete local conservation laws admitted by these schemes. Based on the gauge symmetry of the discrete action functional, a discrete charge conservation law is realized locally, which is consistent with the discrete Euler-Lagrange equations obtained from the variational schemes. Based on the discrete Euler-Lagrange equations, discrete local momentum and energy conservation laws are derived directly, which are rigorous in theory. The preservation of the discrete local conservation laws and Lagrangian symplectic structure ensure that the numerical scheme is correct in physics.
Researches on preconditioned wire array Z pinches in Xi’an Jiaotong University
Authors: Wu Jian , Lu Yihan , Sun Fengju , Jiang Xiaofeng , Wang Zhiguo , Zhang Daoyuan , Li Xingwen , Qiu Aici
Published: April 2019

The dynamics of wire array Z pinches are greatly affected by the initial state of the wires, which can be preconditioned by a prepulse current. Recent advances in experimental research on preconditioned wire array Z pinches at Xi’an Jiaotong University are presented in this paper. Single-wire explosion experiments were carried out to check the state of the preconditioning and to obtain the current parameters needed for wire gasification. Double-wire explosion experiments were conducted to investigate the temporal evolution of the density distribution of the two gasified wires. Based on the results of these experiments, a double-pulse Z-pinch facility, Qin-1, in which a 10 kA prepulse current was coupled with the 0.8 MA main current was designed and constructed. Wire arrays of different wire materials, including silver and tungsten, can be preconditioned by the prepulse current to a gaseous state. Implosion of the two preconditioned aluminum wires exhibited no ablation and little trailing mass.
A universal density matrix functional from molecular orbital-based machine learning: Transferability across organic molecules
Authors: Cheng Lixue , Welborn Matthew , Christensen Anders S. , Miller Thomas F.
Published: April 2019

We address the degree to which machine learning (ML) can be used to accurately and transferably predict post-Hartree-Fock correlation energies. Refined strategies for feature design and selection are presented, and the molecular-orbital-based machine learning (MOB-ML) method is applied to several test systems. Strikingly, for the second-order Møller-Plessett perturbation theory, coupled cluster with singles and doubles (CCSD), and CCSD with perturbative triples levels of theory, it is shown that the thermally accessible (350 K) potential energy surface for a single water molecule can be described to within 1 mhartree using a model that is trained from only a single reference calculation at a randomized geometry. To explore the breadth of chemical diversity that can be described, MOB-ML is also applied to a new dataset of thermalized (350 K) geometries of 7211 organic models with up to seven heavy atoms. In comparison with the previously reported Δ-ML method, MOB-ML is shown to reach chemical accuracy with threefold fewer training geometries. Finally, a transferability test in which models trained for seven-heavy-atom systems are used to predict energies for thirteen-heavy-atom systems reveals that MOB-ML reaches chemical accuracy with 36-fold fewer training calculations than Δ-ML (140 vs 5000 training calculations).
Spatial and temporal pre-alignment of an X-ray split-and-delay unit by laser light interferometry
Authors: Roseker W. , Lee S. , Walther M. , Rysov R. , Sprung M. , Grübel G.
Published: April 2019

We present a novel experimental setup for performing a precise pre-alignment of a hard X-ray split-and-delay unit based on low coherence light interferometry and high-precision penta-prisms. A split-and-delay unit is a sophisticated perfect crystal-optics device that splits an incoming X-ray pulse into two sub-pulses and generates a controlled time-delay between them. While the availability of a split-and-delay system will make ultrafast time-correlation and X-ray pump-probe experiments possible at free-electron lasers, its alignment process can be very tedious and time-consuming due to its complex construction. By implementing our experimental setup at beamline P10 of PETRA III, we were able to reduce the time of alignment to less than 3 h. We also propose an alternate method for finding the zero-time delay crossing without the use of X-rays or pulsed laser sources. The successful demonstration of this method brings prospect for operating the split-and-delay systems under alignment-time-critical environments such as X-ray free electron laser facilities.
High-resolution angle sensor using multiple peak positions of a double slit interference pattern
Authors: Kim Jong-Ahn , Kim Jae Wan , Lee Jae Yong , Kang Chu-Shik , Jin Jonghan
Published: April 2019

A high-resolution angle sensor which uses a double slit (DS) is proposed. By analyzing the positions of intensity peaks in the DS interference pattern, the incident angle of a collimated beam entering the DS is measured. The DS was designed to generate the multiple-order interference pattern with almost even modulation amplitude so that not only the central peak but also multiple side peaks could be used for the measurement. By averaging the incident angle values obtained from each peak position, the angle sensor achieved higher resolution and a smaller periodic nonlinearity error. The performance of the DS angle sensor was tested by comparison with a commercial autocollimator. The Allan deviation of the readout of the angle sensor was 0.0002 in. with the averaging time of 4 s, and the periodic nonlinearity error was evaluated to be less than 0.01 in.
Scalable and efficient Sb2S3 thin-film solar cells fabricated by close space sublimation
Authors: Guo Liping , Zhang Baiyu , Li Shan , Zhang Qian , Buettner Michael , Li Lin , Qian Xiaofeng , Yan Feng
Published: April 2019

Antimony sulfide as a cost-effective, low-toxic, and earth-abundant solar cell absorber with the desired bandgap was successfully deposited using a scalable close space sublimation technique. The deposition process can separately control the substrate and source temperature with better engineering of the absorber quality. The device performance can reach 3.8% with the configuration of glass/FTO/CdS/Sb2S3/graphite back contact. The defect formation energy and the corresponding transition levels were investigated in detail using theoretical calculations. Our results suggest that Sb2S3 exhibits intrinsic p-type owing to S-on-Sb antisites (SSb) and the device performance is limited by the S vacancies. The localized conduction characterization at nanoscale shows that the non-cubic Sb2S3 has conductive grains and benign grain boundaries. The study of the defects, microstructure, and nanoscale conduction behavior suggests that Sb2S3 could be a promising photovoltaic candidate for scalable manufacturing.
Enhanced charge separation by oriented growth of Ta3N5-Cu2O n-p array heterojunction
Authors: Wang Hongxu , Shi Zhan , Yan Shicheng , Zou Zhigang
Published: April 2019

Tantalum nitride (Ta3N5) is one of the most promising photoresponsive semiconductor materials for efficient solar energy conversion, but its fast carrier recombination has hindered research progress severely. Fabricating a heterojunction structure is an effective strategy to promote the charge separation efficiency and thus enhance solar conversion efficiency. Herein, we designed a p-n heterojunction photoanode consisting of n-type Ta3N5 nanorod arrays (NRAs) that grew along the a-axis (light electron effective mass) and p-type Cu2O nanoparticles. This NRA heterojunction shortens the hole diffusion distance, transfers electrons along the a-axis effectively, and enlarges the space charge region. The heterojunction improves the charge separation efficiency of Ta3N5 NRAs significantly, and Ta3N5-Cu2O exhibits a photocurrent density of 9.19 mA cm−2 at 1.6 V vs normal hydrogen electrode (VNHE, pH = 0), an onset potential of 0.326 VNHE, and a maximum incident photon to current efficiency of 60% at 380 nm. Our results demonstrated a potential crystal oriented growth strategy of nanostructured heterojunctions for overcoming the short carrier diffusion distance and fast carrier recombination.
Design, fabrication and testing of CVD diamond detectors with high performance
Authors: Liu Jiawei , Chang Jiafeng , Zhang Jizong , Zhong Guoqiang , Liu Xionghui , Pang Xiankai , Jia Junji
Published: April 2019

A single crystal diamond (SCD) detector and a polycrystalline diamond (PCD) detector have been designed and fabricated using electronic grade CVD diamond. The fabricated detectors were tested for their dark current and X-ray photocurrent. It was found that the SCD and PCD detectors have superb signal to noise ratios (SNR) under X-ray irradiation from an Ag target with 10kV and 40kV accelerating voltage, 2000 and 7000 respectively for the SCD detector and 550 and 2000 for the PCD detector. The performance of these detectors using an 241Am α source was tested under different bias voltages and the results were benchmarked against a commercial SCD detector. The typical rise time of an α event in both of the fabricated detectors are about 1.2ns. The fabricated SCD detector has a 3.7% net energy resolution while that of the commercial detector is about 3.9%. The pulse height spectra are integrated and fitted to obtain the charge collection efficiency. For the fabricated SCD detector, this value is above 97% at bias 200V or beyond, which is 1-2% higher than that of the commercial detector at the same voltage. Finally, the fabricated PCD detector can also detect the presence of α particle although it only has a continuous and decreasing energy spectrum under α radiation. These results fully reveal that the fabricated SCD detector has good performance as a multifunctional detector for both X-ray and α radiation, and show great potential as neutron spectrometer as well.
The eudemonic and hedonic role of happiness in a population with high levels of life satisfaction / El rol eudemónico y hedónico de la felicidad en una población con altos niveles de satisfacción con la vida
Authors: Rodríguez-Hernández Gabriela
Published: April 2019

The hedonic perspective of happiness focuses on studying positive emotions and life satisfaction, while the eudemonic perspective prioritizes a meaningful life which leads to high functioning and the development of individual talents. It was hypothesized that well-being will be positively related to the domains associated with family and affective satisfaction and negatively associated with issues related to economic and physical security, and that the structure of happiness would primarily be comprised of elements of hedonic happiness. Measurements from a national survey (BIARE, 2014) were used, and the sample size was 39,274 men and women between the ages of 18 and 85. Via confirmatory factor analysis techniques, a model was confirmed with two factors which correlated negatively, one of which consolidates eudemonic elements while the other refers to negative affect. The findings contribute to explaining why the population of Mexico, the subject of this study, shows high levels of happiness even though it ranks below the average on almost all the quality-of-life indicators.
TeraPCA: a fast and scalable software package to study genetic variation in tera-scale genotypes
Authors: Bose Aritra , Kalantzis Vassilis , Kontopoulou Eugenia-Maria , Elkady Mai , Paschou Peristera , Drineas Petros
Published: April 2019

Motivation

Principal Component Analysis is a key tool in the study of population structure in human genetics. As modern datasets become increasingly larger in size, traditional approaches based on loading the entire dataset in the system memory (Random Access Memory) become impractical and out-of-core implementations are the only viable alternative.

Results

We present TeraPCA, a C++ implementation of the Randomized Subspace Iteration method to perform Principal Component Analysis of large-scale datasets. TeraPCA can be applied both in-core and out-of-core and is able to successfully operate even on commodity hardware with a system memory of just a few gigabytes. Moreover, TeraPCA has minimal dependencies on external libraries and only requires a working installation of the BLAS and LAPACK libraries. When applied to a dataset containing a million individuals genotyped on a million markers, TeraPCA requires <5 h (in multi-threaded mode) to accurately compute the 10 leading principal components. An extensive experimental analysis shows that TeraPCA is both fast and accurate and is competitive with current state-of-the-art software for the same task.

Availability and implementation

Source code and documentation are both available at https://github.com/aritra90/TeraPCA.

Supplementary information

Supplementary data are available at Bioinformatics online.
Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes
Authors: Minejima Emi , Mai Nikki , Bui Nancy , Mert Melissa , Mack Wendy J , She Rosemary C , Nieberg Paul , Spellberg Brad , Wong-Beringer Annie
Published: April 2019

Background

Persistent Staphylococcus aureus bacteremia (SAB) is defined based on varying duration in literature. The primary objective was to determine the risk of poor outcomes in relation to bacteremia duration.

Methods

Multicenter, prospective, observational study of adult hospitalized patients with SAB. Medical records were reviewed for pertinent data. Patients were grouped by bacteremia duration: short (1–2 days), intermediate (3–6 days), and prolonged (≥7 days) and compared for risk factors and outcomes.

Results

Of 884 patients, 63% had short, 28% intermediate, and 9% prolonged bacteremia. Overall mean age was 57 years, and 70% were male. The prolonged group had the highest proportion of methicillin-resistant SAB (P < .0001). Choice of antibiotic therapy did not significantly affect bacteremia duration; however, time to source-control procedure was delayed in the prolonged and intermediate groups compared with the short group (3.5 vs 3 vs 1 day, P < .0001). Metastatic complications, length of stay, and 30-day mortality were progressively worse as bacteremia duration increased (P < .0001). Every continued day of bacteremia was associated with a relative risk of death of 1.16 (95% confidence interval, 1.10–1.22; P < .0001), with a significant increase in risk starting at 3 days as determined by receiver operating characteristic analysis.

Conclusions

Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of antistaphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes.
Antiretroviral Drugs Associated With Subclinical Coronary Artery Disease in the Swiss Human Immunodeficiency Virus Cohort Study
Authors: Kovari Helen , Calmy Alexandra , Doco-Lecompte Thanh , Nkoulou René , Marzel Alex , Weber Rainer , Kaufmann Philipp A , Buechel Ronny R , Ledergerber Bruno , Tarr Philip E ,   Swiss Human Immunodeficiency Virus Cohort Study, Aubert V , Battegay M , Bernasconi E , Böni J , Braun D L , Bucher H C , Burton-Jeangros C , Calmy A , Cavassini M , Dollenmaier G , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , Fux C A , Gorgievski M , Günthard H , Haerry D , Hasse B , Hirsch H H , Hoffmann M , Hösli I , Kahlert C , Kaiser L , Keiser O , Klimkait T , Kouyos R , Kovari H , Ledergerber B , Martinetti G , Martinez de Tejada B , Marzolini C , Metzner K , Müller N , Nadal D , Nicca D , Pantaleo G , Rauch A , Rudin C , Schöni-Affolter F , Schmid P , Speck R , Stöckle M , Tarr P , Trkola A , Vernazza P , Weber R , Yerly S
Published: April 2019

Background

Coronary artery disease (CAD) events have been associated with certain antiretroviral therapy (ART) agents. In contrast, the influence of ART on subclinical atherosclerosis is not clear. The study objective was to assess the association between individual ART agents and the prevalence and extent of subclinical CAD.

Methods

Coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) were performed in ≥45-year-old Swiss Human Immunodeficiency Virus Cohort Study participants. The following subclinical CAD endpoints were analyzed separately: CAC score >0, any plaque, calcified plaque, noncalcified/mixed plaque, segment involvement score (SIS), and segment severity score (SSS). Logistic regression models calculated by inverse probability of treatment weights (IPTW) were used to explore associations between subclinical CAD and cumulative exposure to the 10 most frequently used drugs.

Results

There were 403 patients who underwent CCTA. A CAC score >0 was recorded in 188 (47%), any plaque in 214 (53%), calcified plaque in 151 (38%), and noncalcified/mixed plaque in 150 (37%) participants. A CAC score >0 was negatively associated with efavirenz (IPTW adjusted odds ratio per 5 years 0.73, 95% confidence interval [CI] 0.56–0.96), tenofovir disoproxil fumarate (0.68, 95% CI 0.49–0.95), and lopinavir (0.64, 95% CI 0.43–0.96). Any plaque was negatively associated with tenofovir disoproxil fumarate (0.71, 95% CI 0.51–0.99). Calcified plaque was negatively associated with efavirenz (0.7, 95% CI 0.57–0.97). Noncalcified/mixed plaque was positively associated with abacavir (1.46, 95% CI 1.08–1.98) and negatively associated with emtricitabine (0.67, 95% CI 0.46–0.99). For SSS and SIS, we found no association with any drug.

Conclusions

An increased risk of noncalcified/mixed plaque was only found in patients exposed to abacavir. Emtricitabine was negatively associated with noncalcified/mixed plaque, while tenofovir disoproxil fumarate and efavirenz were negatively associated with any plaque and calcified plaque, respectively.
A Retrospective Cohort Study to Assess the Impact of an Inpatient Infectious Disease Telemedicine Consultation Service on Hospital and Patient Outcomes
Authors: Monkowski Daniel , Rhodes Luther V , Templer Suzanne , Kromer Sharon , Hartner Jessica , Pianucci Kimberly , Kincaid Hope
Published: April 2019

Background

Here, we review our experience of providing inpatient infectious disease (ID) consultations using real-time interactive telemedicine assessments. We sought to obtain a baseline and document trends regarding the use of telemedicine ID (teleID) consults as an adjunct to the standard of care through the time period in which teleID consultations were introduced.

Methods

Data were pulled via manual, retrospective chart reviews of the electronic medical record. Primary outcomes included lengths of stay (LOS), antibiotic usage, and relapse incidences.

Results

There were a total of 244 patients at 1 remote hospital site who were provided with ID consultations, either in person, via teleID, or both. Before the availability of teleID (pre-teleID), there were 73 patients transferred for ID consults, while 171 patients were seen via teleID once available. While all 73 patients in the pre-teleID group were transferred from the remote hospital to the hub hospital, only 14 (8.2%) of all remote hospital patients assessed by teleID were transferred. Patient LOS across both facilities decreased when patients were seen via teleID, compared to pre-teleID (P = .0001). The median number of days that patients received antibiotics decreased in the teleID group (median 15, interquartile range [IQR] 9–25), compared to the pre-teleID group (median 19, IQR 11–28), but this decrease was not statistically significant (P = .0770). There was no statistically significant difference in relapse rates, although data were lacking because of patients being lost to follow-up.

Conclusions

ID telemedicine practice directed at inpatients appears to be a promising route of care.
Celiprolol but not losartan improves the biomechanical integrity of the aorta in a mouse model of vascular Ehlers–Danlos syndrome
Authors: Dubacher Nicolo , Münger Justyna , Gorosabel Maria C , Crabb Jessica , Ksiazek Agnieszka A , Caspar Sylvan M , Bakker Erik N T P , van Bavel Ed , Ziegler Urs , Carrel Thierry , Steinmann Beat , Zeisberger Steffen , Meienberg Janine , Matyas Gabor
Published: April 2019

Aims

Antihypertensive drugs are included in the medical therapy of vascular Ehlers–Danlos syndrome (vEDS). The β-blocker celiprolol has been suggested to prevent arterial damage in vEDS, but the underlying mechanism remains unclear. It is also unknown whether the widely used angiotensin II receptor type 1 antagonist losartan has a therapeutic effect in vEDS. Here, we evaluated the impact of celiprolol and losartan on the biomechanical integrity of the vEDS thoracic aorta.

Methods and results

We established a new approach to measure the maximum tensile force at rupture of uniaxially stretched murine thoracic aortic rings. In a vEDS model, which we (re-)characterized here at molecular level, heterozygous mice showed a significant reduction in the rupture force compared to wild-type mice, reflecting the increased mortality due to aortic rupture. For the assessment of treatment effects, heterozygous mice at 4 weeks of age underwent a 4-week treatment with celiprolol, losartan, and, as a proof-of-concept drug, the matrix metalloproteinase inhibitor doxycycline. Compared to age- and sex-matched untreated heterozygous mice, treatment with doxycycline or celiprolol resulted in a significant increase of rupture force, whereas no significant change was detected upon losartan treatment.

Conclusions

In a vEDS model, celiprolol or doxycycline, but not losartan, can improve the biomechanical integrity of the aortic wall, thereby potentially reducing the risk of dissection and rupture. As doxycycline is a broad-spectrum antibiotic with considerable side effects, celiprolol may be more suitable for a long-term therapy and thus rather indicated for the medication of patients with vEDS.
Prevalence of type III arch configuration in patients with type B aortic dissection
Authors: Marrocco-Trischitta Massimiliano M , Rylski Bartosz , Schofer Florian , Secchi Francesco , Piffaretti Gabriele , de Beaufort Hector , Belvroy Viony , Bismuth Jean , Czerny Martin , Trimarchi Santi
Published: April 2019

OBJECTIVES

Type III aortic arch configuration consistently presents anatomical and biomechanical characteristics which have been associated with an increased risk of type B aortic dissection (TBD). Our aim was to investigate the prevalence of type III arch in patients with TBD and type B intramural haematoma (IMH-B).

METHODS

A multicentre retrospective analysis was performed on patients with TBD and IMH-B observed between 2002 and 2017. The computed tomographic images were reviewed to identify the type of aortic arch. Exclusion criteria included previous arch surgery, presence of aortic dissection or aneurysm proximal to the left subclavian artery and bovine arches. An ad hoc systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to assess the prevalence of type III arch in non-TBD and non-aneurysmal patients.

RESULTS

Two hundred and sixty-one patients with TBD/IMH-B were found to be suitable for the study and were stratified according to aortic arch classification. The ad hoc literature search provided 10 relevant articles, from which a total of 7983 control cases were retrieved. TBD/IMH-B patients were significantly younger than controls [64.3, standard error: 0.74 (62.84–65.76) vs mean pooled age 70.5, standard error: 0.40 (69.71–71.28)]. Patients with TBD/IMH-B presented with a significantly higher prevalence of type III arch [41.0% (107/261) (35.2–47.1)] than controls [16% (1241/7983) (10–22)].

CONCLUSIONS

Our data indicate an association between type III arch configuration and the occurrence of TBD/IMH-B. These findings warrant further studies to disclose the potential role of type III arch configuration as an anatomical risk factor for TBD/IMH-B.
In situ skeletonized bilateral thoracic artery for left coronary circulation: a 20-year experience
Authors: Bonacchi Massimo , Prifti Edvin , Bugetti Marco , Cabrucci Francesco , Cresci Michael , Lucá Fabiana , Parise Orlando , Matteucci Francesco , Sani Guido , Johnson Daniel M , Gelsomino Sandro
Published: April 2019

OBJECTIVES

Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes.

METHODS

Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61–189 months) and ranged from 1 to 245 months.

RESULTS

A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.6 ± 9.3%, 62.5 ± 6.3% and 53.9 ± 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction ≤35%, chronic obstructive pulmonary disease, peripheral vascular disease (P < 0.001), chronic kidney disease and age ≥80 years (P = 0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P < 0.001) predicted repeat revascularization. Finally, age ≥80 years, peripheral vascular disease, left ventricular ejection fraction ≤35%, off-pump coronary artery bypass and chronic pulmonary obstructive disease were independent predictors of major adverse cardiac events during the long-term follow-up period (all, P < 0.001).

CONCLUSIONS

Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.
Does volunteer community health work empower women? Evidence from Ethiopia’s Women’s Development Army
Authors: Closser Svea , Napier Harriet , Maes Kenneth , Abesha Roza , Gebremariam Hana , Backe Grace , Fossett Sarah , Tesfaye Yihenew
Published: April 2019

Of the millions of Community Health Workers (CHWs) serving their communities across the world, there are approximately twice as many female CHWs as there are male. Hiring women has in many cases become an ethical expectation, in part because working as a CHW is often seen as empowering the CHW herself to enact positive change in her community. This article draws on interviews, participant observation, document review and a survey carried out in rural Amhara, Ethiopia from 2013 to 2016 to explore discourses and experiences of empowerment among unpaid female CHWs in Ethiopia’s Women’s Development Army (WDA). This programme was designed to encourage women to leave the house and gain decision-making power vis-à-vis their husbands—and to use this power to achieve specific, state-mandated, domestically centred goals. Some women discovered new opportunities for mobility and self-actualization through this work, and some made positive contributions to the health system. At the same time, by design, women in the WDA had limited ability to exercise political power or gain authority within the structures that employed them, and they were taken away from tending to their individual work demands without compensation. The official rhetoric of the WDA—that women’s empowerment can happen by rearranging village-level social relations, without offering poor women opportunities like paid employment, job advancement or the ability to shape government policy—allowed the Ethiopian government and its donors to pursue ‘empowerment’ without investments in pay for lower-level health workers, or fundamental freedoms introduced into state-society relations.
Genome-wide analysis revealed sex-specific gene expression in asthmatics
Authors: Gautam Yadu , Afanador Yashira , Abebe Tilahun , López Javier E , Mersha Tesfaye B
Published: April 2019

Global gene-expression analysis has shown remarkable difference between males and females in response to exposure to many diseases. Nevertheless, gene expression studies in asthmatics have so far focused on sex-combined analysis, ignoring inherent variabilities between the sexes, which potentially drive disparities in asthma prevalence. The objectives of this study were to identify (1) sex-specific differentially expressed genes (DEGs), (2) genes that show sex-interaction effects and (3) sex-specific pathways and networks enriched in asthma risk. We analyzed 711 males and 689 females and more than 2.8 million transcripts covering 20 000 genes leveraged from five different tissues and cell types (i.e. epithelial, blood, induced sputum, T cells and lymphoblastoids). Using tissue-specific meta-analysis, we identified 439 male- and 297 female-specific DEGs in all cell types, with 32 genes in common. By linking DEGs to the genome-wide association study (GWAS) catalog and the lung and blood eQTL annotation data from GTEx, we identified four male-specific genes (FBXL7, ITPR3 and RAD51B from epithelial tissue and ALOX15 from blood) and one female-specific gene (HLA-DQA1 from epithelial tissue) that are disregulated during asthma. The hypoxia-inducible factor 1 signaling pathway was enriched only in males, and IL-17 and chemokine signaling pathways were enriched in females. The cytokine–cytokine signaling pathway was enriched in both sexes. The presence of sex-specific genes and pathways demonstrates that sex-combined analysis does not identify genes preferentially expressed in each sex in response to diseases. Linking DEG and molecular eQTLs to GWAS catalog represents an important avenue for identifying biologically and clinically relevant genes.
Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle
Authors: Nielsen Niels Erik , Baranowska Julia , Bramlage Peter , Baranowski Jacek
Published: April 2019

OBJECTIVES

The presence of a stiff guidewire in the apex of the left ventricle (LV) is a known risk factor for LV perforation. Our goal was to minimize the risk of LV rupture during transcatheter aortic valve implantation (TAVI) by omitting the interaction between the stiff guidewire and the LV apex using a modified procedure.

METHODS

A TAVI protocol designed to allow minimal interaction between a stiff guidewire and the LV was developed in Linköping University Hospital in Sweden. A total of 316 patients were treated exclusively by this approach between March 2014 and May 2018.

RESULTS

All procedures were completed successfully. There were no cases (0%) of ventricular perforation. Only 1 patient (0.3%) had a pericardial effusion, and it was due to annulus rupture. There was 1 case of acute kidney injury (0.3%). Five patients (1.6%) required a new permanent pacemaker. Stroke occurred in 3 patients (0.9%). No patient had valve embolization. Vascular complications were experienced by 6 patients (1.9%). A mild paravalvular leak occurred in 27 (8.5%) patients. At 30 days post-TAVI, 6 patients (2%) had died. The mortality rate at 1 year was 8.6% (n = 20/232).

CONCLUSIONS

Our series shows that TAVI without the prolonged use of a stiff guidewire in the LV apex is feasible. The risk of LV perforation is eliminated by this approach, and other procedural complications are limited.
The Presidential Pardon of Fujimori: Political Struggles in Peru and the Subsidiary Role of the Inter-American Court of Human Rights
Authors: Cornejo Chavez Leiry , Pérez-León-Acevedo Juan-Pablo , García-Godos Jemima
Published: April 2019

Abstract∞

In 2017, former Peruvian president Alberto Fujimori was pardoned after serving less than half of a 25-year sentence for human rights violations. The measure was taken amidst political turmoil and an impeachment process led by the Fujimorista party against former president Pedro Pablo Kuczynski. Fujimori’s victims in the Barrios Altos and La Cantuta cases requested the Inter-American Court of Human Rights (IACtHR) to annul the pardon due to its incompatibility with Peru’s human rights obligations. The IACtHR decided that it was for the Peruvian courts to exercise jurisdictional control over the pardon, thus affirming its subsidiary role. Through an examination of the political situation, the underlying principles of the IACtHR’s jurisprudence on amnesties, and rule of law and international standards, this article argues that the IACtHR had sufficient grounds to overturn the pardon. The court’s resolution to refer the matter to the Peruvian jurisdiction may be explained by an increasing awareness of its subsidiary role, particularly regarding sensitive political issues.
Inviolability Not Immunity
Authors: Weatherall Thomas
Published: April 2019

Recent proceedings involving former Sudanese President Omar Al-Bashir have highlighted a novel intersection of international and domestic law: the domestic execution of international arrest warrants for an incumbent high state official. While the overwhelming trend over the past decade has been for international and domestic courts to analyse this issue from the perspective of immunity, that approach is not sufficient. The domestic execution of an international arrest warrant presents a question of inviolability, not immunity. Although the immunity and inviolability enjoyed by incumbent high state officials under customary international law often apply coextensively, the two doctrines are distinct in function and scope. While immunity precludes the exercise of jurisdiction by a foreign court, it is inviolability that operates as a privilege from physical interference by domestic authorities. The arrest and surrender of incumbent high state officials is likely to persist as both an objective and a challenge for international courts. If they are to succeed in this regard, international courts must account for why the privilege of inviolability does not bar the execution of international arrest warrants.
Executive Influence on State Supreme Court Justices: Strategic Deference in Reappointment States
Authors: Gray Thomas R
Published: April 2019

State supreme court justices are often the final arbiters of cases in their jurisdictions. Yet, in states that grant governors the power to selectively reappoint supreme court justices, justices’ independence is limited. These governors are able to monitor justices’ decisions and are empowered to remove justices whose jurisprudence conflicts with the governor’s preferences. This power gives governors substantial influence over judicial decision-making by justices eligible for another term on the bench. I test this proposition on an exhaustive set of state supreme court criminal appeals from 1995 to 2010, and show that votes by justices who need to be reappointed covary with executive preferences, and more than votes by justices ineligible for reappointment. These effects are stable across time within a justice’s term so long as the serving governor may one day be their reappointer. I also show that these shifting individual votes lead to changes in outcomes for defendants.